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So You Think You Have COVID-19?

April 8, 2020 by Leave a Comment

There is plenty of anxiety. And many patients have made appointments with a request to be tested. But the answers they have been getting are confusing and often frustrating as well. What should you do if you think you have COVID-19 (the disease caused by the novel coronavirus aka SARS-CoV-2)?

The first step is figuring out if you need to go to the emergency department. If you are feeling short of breath and/or having trouble breathing, this is definitely an indication (or a reason) to go to your nearest emergency department for evaluation. Having low oxygen saturation (or hypoxia) may necessitate supplemental oxygen usually being provided by a nasal cannula.

The second step is to call your primary physician and check with your county’s Department of Public Health. These two resources should help you understand the testing capabilities of your locale and unfortunately this will be a big determinant of who can get tested if they are not “sick enough” to require hospitalization.

Many of my visits have involved advising patients about the realities of our situation and lack of adequate testing. I have had to advise patients that have symptoms that they ought to stay at home and assume they have COVID-19 and self quarantine at home. The reasoning for this is that we assume many people who have COVID-19 will be in the spectrum from asymptomatic to mild/moderate disease that does not require admission to the hospital. If people who are well enough NOT to require a hospital admission, then the information obtained from testing will not change the treatment (self quarantining and treating the symptoms).

What symptoms should one look out for? That question is tricky. As we learn more about the disease we are seeing more and more symptoms that can be caused by COVID-19. For example, early on we advised patients to be on the lookout for a new cough, fever, or shortness of breath. However there have been reports of other symptoms including diarrhea, loss of taste/smell, etc. As this is changing, I would recommend the following sources:

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Banned From Work

March 30, 2020 by Leave a Comment

This week has started off oddly. I am at home. I am not on vacation. I wish I were. Instead, I am at home in a sort of self-quarantine.

Last week, as I was getting ready to go to work I noticed that I was coughing. Initially I thought that I was had a tickle in my throat and that I just needed to clear it. But the cough persisted.

At our institution our outpatient faculty clinics had already instituted a strict screening policy. All visitors to the building were funneled to the main entrance. There, two people screen any person entering regardless of whether they are visitor or employee.

The questions each day were the same. Have you had a new fever? Have you had a new cough? Any shortness of breath? Any contact with known COVID19 patient? If all questions were answered with a negative, they would hand you a sticker that said “Cleared” and a face mask.

I knew that I would fail the screening. I also knew we had a shortage of tests. I would not be eligible for testing. And, the institutional policy for returning to work with new symptoms would require me to wait a minimum of 7 days.

So here I am. At home. Avoiding contact not only with patients but with my co-workers. I understand the reason for the policy. With the pandemic we must do everything we can to minimize spread of this COVID-19 disease.

Each day I have checked my temperature. Each day I have not had a fever. My cough has improved each day. And on National Doctor’s Day, while this pandemic rages, and my healthcare colleagues continue the fight, I sit and I wait.

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Rationing Tests?

March 25, 2020 by Leave a Comment

Rationing tests? In the U.S.A.? It may sound strange to hear that in the land of plenty we are rationing tests. But here we are, ill prepared for a global pandemic.

One of the most difficult things to say to patients who are having symptoms of cough and/or fever during this pandemic is that they need to stay home and act as if they had COVID-19. Testing, for the most part, is being reserved for the patients sick enough to require a hospital admission. I don’t think it helps that many people keep seeing things in the news touting how people can get tested without fully explaining the limitations we have. Or maybe my region of the country is the abnormality?

Ideally we could swab anyone who had symptoms. But since we cannot, maybe this will help:

  • With a limited supply of testing supplies, we should only test those in which testing will change the management or treatment.
  • It is accepted that there is a spectrum of presentation of COVID-19. Some patients may have zero symptoms. Some patients may have mild symptoms. Some patients will need extra support that requires treatment in a hospital (like supplemental oxygen, mechanical ventilation, etc.)
  • If patients are stable enough that they are breathing comfortably, they should stay home and act like they have COVID-19. They should treat symptoms and self quarantine to avoid spreading it others who might develop more severe disease.
  • Patients who have symptoms that include shortness of breath or trouble breathing should go to the Emergency Department to be evaluated. They may be hypoxic (have low oxygen saturation) and need additional support. These patients who are sick enough that they require care in a hospital should be tested.

Again, it isn’t a perfect system. We don’t have an infinite number of testing kits/supplies. We don’t even have enough test everyone we suspect of having COVID-19. But this is why testing is being limited.

Needless to say, this post is not intended to be medical advice. If you have questions about your particular case, please contact your primary care physician.

Filed Under: After Residency, My Life Tagged With: , , , ,