COVID-19 FAQ 3-14-2020

Paul Abramson MD COVID-19, Updates Leave a Comment

Dear Patients,

The situation with COVID-19 continues to evolve world-wide. We have gotten quite a number of inquiries ranging from urgent to unanswerable over the past week. So this post can serve as a “Frequently Asked Questions” document. I will also explain the status of our Home COVID-19 testing service which many have inquired about.

To see my original COVID-19 message to our patients with more general information, see https://homecovidtest.com/covid-19-update-3-12-2020/

Q: “How do I get tested for COVID-19?”

A: “Despite all the talk of expanding testing, the available supply of the correct swabs and viral transport medium is minimal to none . The hospitals/ERs have a limited supply that they’re triaging to people sick enough to need hospital or ICU admission. We do have a limited supply of swabs/media but because we don’t have isolation facilities the samples can only be collected by visiting the patient at their home in full protective gear. Then transport the samples to the lab in a compliant manner. This has a high cost associated with it due to risk and travel time. Contact us if you would like to discuss getting tested in this manner.

Q: “I’m thinking of flying to to..”

  • “See my elderly grandmother in the nursing home.
  • “Go on vacation.
  • “See a long-lost friend”
  • <insert non-critical activity here>

A: “We suggest postponing non-essential travel until we have a better idea of the trajectory of this pandemic. If you’re not sure if it’s essential or not, it’s probably not.”

Q: “Should I avoid going to the movies or a large gathering of people?”
A: “Yes, unless it’s critically important.”

Q: “We are hunkering down at home and never leaving the house. Should we order lots of raw materials to and sterilize and cook it ourselves, or is it safe to order Caviar food delivery? Can SARS-CoV2 be transmitted in prepared food?”
A: “This isn’t really answerable. SARS-CoV2 is probably transmitted by droplets more than airborne aerosol. So it all depends on who’s preparing the food and how careful they are, if they happen to be carrying the virus. Your risk tolerance may vary.”

Q: “We are moving to Texas because the virus doesn’t like warm climates. Will this protect us?”
A: “It’s not known yet whether SARS-CoV2 thrives in warm climates/seasons or not. My guess is that it will be far less seasonal than influenza virus. But time will tell.”

Q: “My cousin had a sore throat yesterday. Should I head to the ER to get tested for COVID-19?”
A: “At the current time (as of 3-14-2020) Emergency Departments at hospitals have a dwindling supply of test kits/media and are triaging the tests to those who are sick enough to need hospital or ICU admission. People who aren’t symptomatic, or are symptomatic but not sick enough to warrant hospital admission, are mostly not being offered the test and are being sent home. ALSO: If you have a low likelihood of having the virus, the risk of a hospital waiting room may exceed any potential benefit of being there.”

Q: “I’ve got a low grade fever and cough. I might be a little short of breath, but I’m not sure if it’s just anxiety. Should I go to the ER?”
A: “This is where having a pulse oximeter and a thermometer would be helpful. We can get you on a video call and with these data points and seeing your on video, often be able to advise whether staying home or going to the hospital is the right move. If you are pretty sure you don’t need hospital-level supportive care, the ER is unlikely to be fruitful. Call your doctor if you’re unsure what to do.”

Q: “I want you to prescribe me a course of to treat myself in the event I think I have COVID-19.”
A: “First of all, self treatment if you’re very ill is the wrong move. You should be in a hospital setting. If you’re not very ill, we have no idea whether any available medication helps to treat COVID-19. Studies are ongoing but none have produced results yet. Self treatment isn’t advisable. Here is more info about some of the medications being tested in clinical trials:”

  • Chloroquine: Has not been available in the US for over 2 years, anyway. Some anecdotal evidence (and in vitro evidence) that it may inhibit SARS-CoV2. But no human data on effectiveness available yet. Significant toxicity (including retinal damage) with longer term use, high dose short term use unknown.
  • Hydroxychloroquine: Similar to chloroquine but more frequent dosing and it is available in the US. However, unproven and similar caveats including possible toxic side effects.
  • HIV meds, such as Kaletra / Aluvia (lopinavir / ritonavir). Under investigation but unproven, expensive and with various potential side effects.
  • Ebola medication remdesivir. Unapproved, still in the pipeline, and unavailable outside of a clinical trial. Plus likely expensive and with various potential side effects.
  • Coenzyme Q10 supplements. Untested, unlikely to have actual benefit.
  • Oseltamivir (Tamiflu). Unlikely to have any benefit in treating coronaviruses.
  • Corticosteroids. Seem to not help, may harm, but data not in yet.

Bottom line: Lots of talk, many news articles, but nothing substantive to suggest there is yet an effective treatment for COVID-19. Self treatment can either delay needed hospital care, have no efficacy, or expose an individual to toxic side effects without adding clear benefit. At this time we recommend against self treatment. If research data comes out that a particular treatment is effective, we will all likely know in the media very shortly therafter.

Q: “Can I have a 3 month supply of my medications?”
A: “Sure, with the following caveats:”

  • If the medication is a controlled substance being monitored as part of a treatment program, we do not provide refills beyond your next scheduled appointment. We will work with you to make sure you can get a supply when you need it.
  • For non-controlled meds, we generally are happy to prescribe a 3 month supply.
  • However, if your insurance company only covers a month at a time, or if the prescription is early, not meeting their refill timing criteria, you may have to pay cash for the extra medication.
  • https://goodrx.com offers coupons that lower the cost of meds when paying out of pocket. Or we can often order medications wholesale for you. Goodrx coupons at a commercial pharmacy are often cheaper, however.

Q: “Should I get the pneumonia vaccine?”
A: “A vaccine for Strep pneumoniaebacteria is alreacy recommended for the following classes of people who should get it (or have already gotten it). If you are not in one of these groups, it likely wouldn’t help you, because you are also not in a high risk group to get very ill from COVID-19 and superimposed bacterial pneumonia is mostly a risk to those in hospital/ICU settings with severe COVID-19. Nonetheless the vaccine is pretty safe so it’s an individual decision. (For childhood vaccine recommendations see the CDC web site, these are for adults)

  • ** Healthy non-smoking adults under 65 do not typically get vaccines against Strep pneumoniae. **
  • Adults 65 and over should get PCV-13 (Prevnar) then PCV-23 (Pneumovax) a year later
  • PCV-23 (Pneumovax) first for adults under 65 with the following medical conditions
    • Smoking cigarettes
    • Asthma, COPD or other chronic lung disease
    • Chronic heart disease (except high blood pressure)
    • Chronic liver disease or cirrhosis
    • Alcohol use disorder (formerly called “alcoholism”)
    • Diabetes mellitus type I or II
  • PCV-13 (Prevnar) first for adults under 65 with the following medical conditions (sometimes followed by Pneumovax later)
    • Immunocompromising conditions, congenital or acquired including HIV.
    • Anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies)
    • Cerebrospinal fluid leak or cochlear implant

Our patients should feel free to ask us questions that aren’t addressed in this FAQ. However, we are having to triage responses due to volume, so please forgive us for any delays. If it’s medically urgent, call us.

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