I hope this finds you well.
I am writing this letter to the members of our concierge medical practice, to keep communication flowing during an uncertain time. If we can help in any way, or if we haven’t seen you for a while and you’d like to re-establish care (which can be done via video depending on the situation), please send us a message here or call us.
We are all reading and hearing a lot about the SARS-CoV2 / COVID-19 situation. I’ve gotten, let’s say “dozens and dozens” (an understatement) of emails and messages from patients asking what to do, asking for prescriptions for meds they read might treat or prevent the new coronavirus, and generally expressing worry about what this all means for them, their families, the economy, and humans in general.
I won’t attempt to regurgitate the basic information that’s available from the CDC and other public health agencies. See https://www.cdc.gov/coronavirus/2019-ncov/index.html. Nonetheless I think the situation in the US is about to evolve into a much more inconvenient scenario and I’d like to communicate a few things.
1. Masks. Most likely useless to protect you from others since you also need the full hat, goggles, mask, gown, gloves and booties, and the skills to don and doff them without cross-contamination. Not practical outside an acute-care medical setting. If you are sick however, a mask may protect others from your droplets. And it might remind you not to touch your face.
2. Diagnosis. People will continue to get regular colds and flus during this COVID-19 scare. All that sneezes is not COVID. But having other infections also doesn’t exclude COVID-19 co-infection. This will be confusing. Available information suggests that COVID-19 symptoms in descending frequency include fever > cough > shortness of breath and that other symptoms are less common (but do happen). Runny nose and sneezing is usually not prominent.
3. Testing. COVID-19 testing is now available at commercial labs. We were hoping to get a bunch of swabs/vials this week, but alas the world seems to be out of the correct viral swabs and vials. Even the ERs are running low and using them only for critically ill patients needing hospital admission. The best sample is a deep nasopharyngeal swab which is hard to self-gather (or at least requires some coaching to do safely). We are actively working to provide a home COVID-19 testing service which would be available to a wider selection of people than are currently being offered testing in health care environments. Please inquire if you’d like more info about this.
4. Treatment. Currently there is no proven or even evidence-based treatment for COVID-19. There is an HIV med being studied, but it’s not commercially available. Chloroquine is being studied, but is unavailable in the US for over 2 years. Hydroxychloroquine works similarly (and has a similar side effect profile) to chloroquine, and we did acquire some just in case, but I’m currently not recommending self treatment since we don’t really understand the risk/benefit equation and I wouldn’t want someone to delay needed supportive care in a hospital trying out uncertain remedies at home. But this situation may evolve.
5. Vaccine. No vaccine will likely be forthcoming for a long time.
6. Natural and preventive strategies. There are strategies from the alternative medicine world that are said to help the immune system work better when fighting external pathogens and viral illnesses. These are not particularly evidence-based, and you should not rely on them, but it’s something to do if you have that bent. I’ve chosen a few that have the following characteristics: a) Make some sense mechanistically or from traditional cultural uses. b) Have very little potential for harm c) Aren’t very expensive. Let us know if you’re interested. [Note: Most of these supplements are on back order now]
7. Medical care. We are likely going to be doing a lot of telemedicine (video/phone) if people are unable to get to the office (or are symptomatic where they shouldn’t expose others) and a house call isn’t feasible. To this end I am suggesting my patients get some equipment that will make video visits much more useful.
- Pulse oximeter (fingertip). Cheap ones are probably OK and widely available (for now) or better ones like Masimo MightySat or a Nonin 9590 device are quicker to read out and a little more accurate. This will allow you to tell me your heart rate and oxygen saturation which are critical datapoints for triage.
- Thermometer. Oral is better than ear/forehead.
- Blood pressure cuff. I like Omron Evolv but any Omron is good.
8. Supply chain issues. If you would like to have a 3-month supply of your essential medications on hand, let us know ASAP – we can either prescribe it to a pharmacy of your choice (www.goodrx.com will let you see which ones have which prices since insurance may not cover an extra supply) — or we can order it wholesale and mail it to you.
9. Labs and imaging. We can currently help arrange blood draws, x-rays, ultrasound and other testing modalities in the home. Our vendors for this are currently up and running, although the situation remains fluid.
10. Contingency planning
- If you have a non-urgent question or update, you can send it via our online patient portal call us, or after hours leave a non-urgent voice mail via the office.
- If you have an URGENT question or are ill (but not too ill), call us and use the option to page if after hours. We can then talk by phone or video in the right time-frame.
- If you are very ill and/or need a hospital. Go to the ER at CPMC Van Ness campus. Second choice CPMC Davies campus. Third choice CPMC Mission Bernal campus. ALSO CALL/PAGE US so we can help coordinate this process and hopefully get you seen more smoothly, and admit you if needed.
Please contact us if we can be of help in any way. We are available 24/7 if you need us. But if after hours please call/page and don’t use the online portal for urgent items.
Paul Abramson MD
And the team at My Doctor Medical Group