COVID-19 - News, Tips & Annoucenments
COVID - 19
COVID - 19
HOW IS ADVANCED INTERNAL MEDICINE RESPONDING TO THE PANDEMIC?
HOW IS ADVANCED INTERNAL MEDICINE RESPONDING TO THE PANDEMIC?
At Advanced Internal Medicine, we are doing our best to keep our patients informed of the latest developments and recommendations to protect themselves and their families from this virus. Unfortunately, the information available to the public is often confusing, and we are eager to help our patients stay safe and sane during this difficult time.
In light of the most recent data (discussed below), we do not believe it is safe for our patients or for our staff to have any unnecessary or extended office visits. We are caring for people by phone or video chat the vast majority of the time, limiting the time and quantity of office visits as much as possible. This means we are postponing doing complete physical exams, and providing most routine care by telemedicine. There are times when necessity dictates an in-office visit, and we are accommodating patients in those instances.
WHAT IS COVID-19?
Covid-19 is the infection caused by a novel coronavirus (SARS-COV-2) which was first detected in the Chinese city of Wuhan late in 2019, and spread to the United States early in 2020. This coronavirus has enough unique characteristics compared with other known coronaviruses such that the vast majority of people has no immunity to it whatsoever. Thus, exposure to the virus in sufficient quantity leads inevitably to an infection.
WHAT ARE THE SYMPTOMS OF COVID-19 INFECTION?
Symptoms of Covid-19 vary widely. It is estimated that 40% of infected persons are completely asymptomatic. Others may experience typical cold and flu symptoms. The most common symptoms are fever, cough, fatigue, loss of taste and smell, and shortness of breath. However, sore throat, runny nose, congestion and diarrhea may also be manifestations of infection. Approximately 15% of infected persons will become seriously ill, depleted of oxygen and requiring hospitalization for their illness. The mortality rate of Covid-19 is believed to be approximately 1%, though this is much higher among those more susceptible to severe illness, such as the elderly, the obese, and those with existing heart and lung disease or whose immune system is compromised.
HOW DOES EXPOSURE TO THIS CORONAVIRUS OCCUR?
It appears that most cases of Covid-19 are attributable to respiratory droplets that emanate from an infected person and land on the mucosal surfaces (mouth, nose, eyes) of a susceptible individual. These respiratory droplets are expelled during normal breathing, but the quantity of droplets expelled increases substantially if the infected person is breathing heavily, talking loudly, singing, sneezing or coughing. Respiratory droplets dissipate quickly outdoors but can linger in the air indoors. They can
also linger on the surfaces of counters, doors, and possibly paper products, though the risk of contamination from the latter appears to be small. Touching these surfaces and then touching one’s mouth, nose or eyes can also lead to infection.
HOW CAN I AVOID EXPOSURE TO THE VIRUS?
The best way to avoid exposure is to avoid interacting with people indoors as much as possible. If both persons are wearing a mask, the risk of exposure is dramatically reduced, but does not disappear completely, particularly if the contact is close or the time of exposure is long. Prolonged close exposure to an infected individual indoors is the surest way to contract the virus, and in these cases even wearing a mask is no guarantee of safety. Wearing a mask, keeping a safe distance, and interacting outdoors will substantially reduce the risk. Washing your hands regularly and avoiding surfaces where the virus may linger are also very helpful habits.
WHAT HAPPENS IF I HAVE BEEN EXPOSED OR DEVELOP SYMPTOMS?
We encourage our patients to call for advice in these circumstances, but as a rule of thumb, if you believe you were exposed or you develop symptoms, you are advised to be tested for Covid-19 as soon as possible, and to quarantine yourself from others until the test proves negative. Testing is available at most local pharmacies and at several Urgent Care centers in town.
HOW DO I KNOW IF I HAD THE INFECTION
AND HAVE DEVELOPED AN IMMUNITY?
Unfortunately, we don’t know the answer to this question. There is no standardized antibody test for Covid-19, and we don’t know what a positive antibody test means in terms of future susceptibility to the disease. At this point we recommend that everyone behave as if they are susceptible to infection.
WHEN WILL A VACCINE BE AVAILABLE?
This is the million dollar question, but it appears that we are still many months away from the vaccine being readily available to the public. Once a vaccine has made it through all phases of trials and is deemed to be safe and effective, it will still take several months to produce tens of millions of doses needed to begin widespread vaccination. The usual vaccine trial and approval timeline is several years, so it is perhaps too optimistic to think that can be curtailed to less than one year.
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Dear Patient: There has been a lot of news about the pandemic in recent weeks, and also a lot of confusion. Today’s update is in the FAQ form, in response to many of your concerns. 1) What is the current state of the Covid-19 pandemic? Obviously, it isn’t good, but there may be reason for optimism. The number of cases nationally seems to have plateaued, albeit at a high level, and the number of people vaccinated is steadily growing. Unfortunately, in Ohio, things are likely to get worse before they get better. Case numbers in the state are averaging above 4000 daily, higher than in many months. 2) What can I do to protect myself from infection? The same things we’ve been recommending all along. Wear a mask indoors in public places, keep your distance from those who may not have been vaccinated, and of course, if you haven’t been fully vaccinated, get it done today. 3) I thought the vaccines were effective, why are people talking about boosters? The Pfizer, Moderna and J&J vaccines have all proven to be quite effective at preventing serious Covid infections. However, we are seeing some waning immunity after 6 months, which is leading to a number of “breakthrough” cases. The good news is that the vast majority of these cases are mild or asymptomatic, with no more than a few days of illness. Even 6 or 8 months after completing vaccination, you remain very unlikely to contract a serious Covid infection. 4) What is a booster shot? Should I get it, and if so, when? A booster is just another dose of the vaccine, no different that the ones you already received. It is designed to further enhance the immune system’s ability to combat the Covid virus should it enter your body in some way. The CDC currently recommends a 3rd dose of Pfizer or Moderna in those who meet their strict definition of immune compromise, or (beginning Sept. 20) in those who are 8 months out from their 2nd dose. No recommendation regarding J&J boosters has yet been made. 5) Aren’t there drugs now that can treat Covid? Two drugs have been approved for treatment of SARS-Cov-2 infections. Remdesivir is an antiviral medication that has been shown to reduce mortality and length of stay in hospitalized patients. Regeneron has created a cocktail of monoclonal antibodies (REGEN-COV), which directly attack the virus, and it has been approved for use in Covid-positive patients who are not seriously ill, and in some cases for prophylaxis. Hydroxycholoroquine (an antimalarial drug) and ivermectin (an antiparasitic drug) have not been shown to be of any benefit in fighting Covid, may in fact be dangerous, and should not be used under any circumstances. 6) What do I do if I have been exposed to Covid? A vaccinated person exposed to Covid does not need to quarantine, but should get tested several days after exposure. Vaccinated individuals who are positive do not shed as much virus as unvaccinated individuals, and so are unlikely to transmit the virus to other vaccinated individuals. Nonetheless, those who are unvaccinated or otherwise at high risk for serious Covid infection may be eligible for prophylactic monoclonal antibody treatment. 7) Where can I get treated? If you meet the criteria listed above, you are a candidate for the Regeneron cocktail. Please call the office and we can confirm your eligibility, order the injection, and direct you to a facility where you can receive it. 8) Is this ever going to end? Yes. One-third of Americans have now been infected with Covid, and over 60% of the eligible population has been fully vaccinated. This means that the pool of susceptible individuals is shrinking every day. We will reach a point where there simply aren’t enough susceptible individuals to sustain community outbreaks. The sooner people get their vaccines, the more they wear masks in risky settings, the sooner we will reach that point. Most experts believe that by early next year the virus will no longer be a serious threat in most areas of the country. 9) What can I do to do help? Encourage your friends and family who are reluctant to get vaccinated to get their shots. Keep wearing your mask indoors and practice social distancing. Let us know if you are feeling sick, so we can guide you to the appropriate treatment. And don’t despair! There is a light at the end of the tunnel. Joel D. Weisblat, M.D.
July 6, 2021 Dear Patient, As we attempt to get our lives back to normal after months and months of restrictions, I want to urge everyone to stay cautious. Here are my latest thoughts: 1) The 7-day average of new Covid cases in Ohio has dropped close to 250, and in Cuyahoga County we are seeing only 25 new cases per day. These are easily the lowest numbers we have seen since the earliest days of the pandemic. 2) Unfortunately, the news is not good everywhere. The number of cases nationally is ticking upwards slightly, attributable to the spread of the more contagious Delta variant, most notably in regions where the vaccination rate is low. 3) Studies indicate that being fully vaccinated against Covid, either with the single-dose J&J vaccine or the 2-dose Pfizer and Moderna vaccines, provides strong protection against contracting Covid, and very strong protection against serious Covid infection, even in the face of the Delta variant. 4) I urge everyone who has not yet been vaccinated to do so as soon as possible. If you have concerns about the safety of the vaccine or question whether or not you really need it, please reach out to me. This virus remains a very serious threat for the unvaccinated, and failure to get vaccinated puts you and those around you at much risk. 5) Although the risk of getting sick is quite low for the vaccinated, it is not zero, and I recommend a little more caution at this time than does the CDC. I advise continued mask wearing indoors when around others who may not be vaccinated, particularly in crowded areas or when you anticipate more than a few minutes of potential exposure. 6) There is no need to wear a mask outdoors, except perhaps in very crowded spaces. The risk of outdoor transmission is quite low, particularly if one has been vaccinated. 7) All 3 Covid vaccines available in the U.S. have shown sustained immunity to the virus, so there is unlikely to be a need for boosters before next year at the earliest. The biggest concern is that a new variant will develop which evades vaccine-mediated immunity. Fortunately, there is no indication that this has occurred to date. 8) The best news I can offer for the vaccinated is that it is perfectly safe to interact indoors with others who have been vaccinated. No masking or social distancing is necessary. 9) I hope you were all able to enjoy this holiday weekend without the fear that has plagued us for months. With any luck, our numbers will stay low and life will indeed be close to normal for the foreseeable future. 10) Please give us a call with any questions. We are fully back in the office, and welcome those who have been away to schedule a visit and let us help you stay healthy going forward. Joel D. Weisblat, M.D.