Ask a doctor: COVID19 edition

In an effort to bring some topical information to the blog, I interviewed my father who is and MD and chair at a local hospital’s emergency department. While I intend for this interview to be informative, it is by no means intended to treat or diagnose. As always, talk to your own healthcare provider if you begin to experience any symptoms or have additional questions.

Current Questions:

1. What can the average person (non-medical) do to help in addition to staying at home?

While it may be frustrating, social distancing is the best practice to follow. You can also volunteer with your local mutual aid and contribute either time or money (donating money, picking up groceries for others in your community, volunteering to field calls on a hotline), etc.

Some more creative ways to help:

• If you are able to donate cell phone chargers to MGH patients, you can send them directly to Hospital Medicine Unit
c/o Dr. Kathy May Tran ⁣
Massachusetts General Hospital ⁣
55 Fruit St⁣
 Boston, MA 02114⁣ (from a friend who works at MGH. I’m sure this would be applicable to most hospitals).
• sending food delivery to hospital / healthcare facility employees or anyone else still working at this time
• offer to make homemade masks
• if you know someone who has access to PPE and are no longer using it, ask them to donate them to a local hospital or healthcare facility (nursing home, rehab center, etc)
• you can also check out this post for more support ideas

     2. Thoughts on the varying mask guidelines for the general public? (Cloth masks, no masks, etc. Is a homemade mouth covering enough?

Per my father’s recommendation, anything that covers the mouth and nose is enough. Whatever will help you both avoid touching your face, as well as prevent you from coughing on others. He recommends a mask while indoors (any buildings, grocery stores, etc), though reports that it isn’t as necessary when outdoors if the space isn’t saturated with people. If it’s a crowded area, a mask is recommended.

      3. Should I be wearing a mask while on a running trail outdoors?

As stated above, this is personal preference. If the trail is deserted without much human traffic, not as necessary. Though if it’s a running track with many around, you may want to reconsider.

      4. If you’re symptomatic, when do you know if it’s urgent enough to come in?

The most concerning sign is breathlessness at rest. Meaning you have difficulty breathing or shortness of breath while sitting and not moving around. If you have a pulse oximeter at home, an O2 sat <92% would warrant evaluation. Severe signs of dehydration (dizziness, not peeing every 3-4 hours, an infant with dry diapers), would also be reason for further eval. Lastly, he recommends going to the ED with the combination of fever, shaking chills, and vomiting.

      5. If you / your child has an accident, should we go to the ER? Broken bone, laceration?

If you have a deep or dirty laceration, it’s important to seek care within a 6-12 hour time period to decrease the rate of infection. Further, if a bone  / joint is displaced with numbness below the source of injury, also seek care.

6. What’s the first step you should take if you suspect you or a family member has COVID?

• Social distance: remain 6 feet apart, wear a mask, stop sharing cups / utensils, proper cough etiquette (wearing a mask at home), hand washing for >20 seconds
• Isolate if possible
• Immune system support: plenty of fluids and electrolytes, sleep, supplements like vitamin C and melatonin, zinc

      7. What “good” news are we starting to see that maybe the news isn’t highlighting?

We are starting to have a better understanding of the illness based off of other country’s experience with it. For example, non-invasive, non-aerosolizing methods of oxygenation beyond intubation are being more widely utilized. These include (though are not limited to), turning patients, oxymizers, using home CPAP, Venturi masks, 100% non re-breathers, more oxygen in higher amounts.

8. What’s your biggest concern at the moment?

When I spoke to my dad, he reported the wave began that day (4/9/2020). His biggest concern at the moment is the patient capacity on inpatient and ICU units. Other concerns include: vigilance with PPE to prevent staff from falling ill, as well as getting nursing home and rehab facilities the appropriate care and PPE. According to him, PPE supply is adequate at his hospital.

      9. What types of doctors are in high demands at this time?

Inpatient, ICU, and ED are in high demand, though all physicians are still needed and necessary.

      10. Is it true that a lot of EDs are actually low census right now?

At my dad’s hospital at the time of interview , the ED census is down 40%, though there has since been a steady increase in census. He reports 75% are COVID related or rule-out COVID. While the other 25% are accident related (broken bones, lacerations, etc).

Future focused:

      1. Is the light at the end of the tunnel a vaccine or could there be breakthroughs sooner?

Vaccinations for viruses are difficult because the viruses mutate so frequently that the vaccines aren’t often 100% effective. This unfortunately means that if the virus mutates only slightly, we could face another round of it. The flu shot efficacy, for example, ranges from 30-60%. The only virus vaccine success for that matter is polio.

He believes the treatment will be an anti-viral similar to hepatitis C treatment, with a vaccine acting as secondary with yearly administration similar to the flu shot. Both a vaccine and anti-viral take approximately 18 months to create.

2. How do you think this will change the healthcare industry in the future? 

He believes telemedicine will increase in general to avoid leaving work, as well as the use of other technologies at home: pulse ox at home (average $20), iPhone to record EKG rhythm strips, and in general being more prepared for next time with more stockpiles of PPE in advanced.

      3. What are accurate health news sources that you are reading from in regards to COVID?

NPR (Coronavirus daily podcast), Chris Kresser’s episode on Revolution Health Radio, 2 episodes on COVID from Mark Hyman’s the Doctor’s Farmacy

Epidemiology:

      1.Why do some people react so poorly when some people are unaffected? Even younger people?

There are many factors that contribute, none of which are confirmed, but it’s presumed that a combination of our genetics and burden of toxins exposed to and years exposed (ie environmental toxins, pollution, diet, smoking) may contribute to poor outcomes. Smoking especially increases risk: cigarettes, marijuana, vaping, etc.

      2. Will there ever be a time when everyone gets tested for antibodies?

My dad believes there will be, likely at a primary care visit to see how rampant the virus actually is/was. The current COVID tests are ~ 70% accurate, so testing for antibodies may be a more precise way to confirm numbers. Most IGM antibodies appear / increase in about a week and IGG in about 6 weeks. The purpose of this isn’t so much for treatment, but instead for epidemiology and herd immunity, in order to be able to predict mortality rates if the virus resurges.

      3. Any new data on whether there is transmission/danger to baby in utero, or via breastfeeding?

None currently in utero (transplacental). Breastfeeding is still recommended with contact precautions: proper hand hygiene, cough hygiene, etc. The antibodies shared in breastmilk are advantageous (allergies, ear infections, IBD via breastfeeding).

 

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