IM of CNY COVID-19 Response

Dear Patient,

Many of you have been contacting the office about Coronavirus disease 2019 (COVID-19), a respiratory illness that can spread from person to person. Symptoms can include fever, cough, and shortness of breath. There appear, however, to be certain differences between the presentation of COVID-19 and other viral infections that circulate at this time of year. One of the healthcare workers with a master's degree who worked in Shenzhen Hospital (Guangdong Province, China) highlighted certain differences. We have included these differences along with reports from health care agencies:

Symptoms:

- A runny nose and sputum is more suggestive of the common cold. Coronavirus pneumonia typically presents with dry cough and generally with no runny nose. A runny nose shows up in only 4 percent of individuals, and that may be people who also happen to have a cold or a flu.

- The nasal congestion is particularly severe, and not like the normal kind experienced with viruses. If you experience this, it is important to get tested and seek medical attention through your primary care physician or emergency room.

*It is recommended you call your Primacy Care Office for direction on how to receive medical attention, and to arrange testing if needed.

- The virus will first infect the throat, causing a sore throat lasting 3-4 days.

- It may then enter the trachea and lungs, causing pneumonia. This may take another 5-6 days, and is associated with high fever and difficulty breathing. Any symptoms such as the ones experienced above should alert you to contact your primary care physician for further instructions.

- Overall, 90% of people get a fever, 80 % get a dry cough, and 30 % get shortness of breath and malaise/fatigue. 80 percent of these cases however are “mild” including pneumonia, not requiring hospitalization.

- Highest risk individuals are the elderly (70-75 or older) with underlying medical problems (listed later in this bullet point). The illness seems to be very mild in children, younger people, and young adults. Data from the largest study conducted in China suggests that of coronavirus patients receiving medical attention, 80 percent had mild infections, about 15 percent had severe illnesses, and 5 percent were critical. From the China CDC we understand that the virus is most dangerous to those who are immunocompromised, elderly, and those who have cardiovascular disease, diabetes, hepatitis B, chronic obstructive pulmonary disease, chronic kidney disease, and cancer. China CDC’s analysis of 44,672 patients found that the fatality rate in patients who reported no other health conditions was 0.9%. Additionally, 81% of all diagnosed cases were considered mild or asymptomatic.

Protection:

- There are differences in reports of how far the virus can travel by airborne route. Reports vary between 6 feet and 10 feet before it drops to the ground and is no longer airborne, and if it drops on a metal surface it will live for at least 12 hours, so if you come into contact with any metal surface - wash your hands as soon as you can with soap and water for 20 – 30 seconds. If the virus comes into contact with fabric, it can survive for 6-12 hours. Normal laundry detergent will kill it.

- Wash your hands frequently with soap and water for at least 20 seconds, as the virus can only live on your hands for 5-10 minutes, but a lot can happen during that time - you can rub your eyes, pick your nose unwittingly, touch your mouth, and so on. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

- You can gargle as a prevention. A simple solution of salt in warm water will suffice. Also drink plenty of warm water (not liquids with ice).

- If you are sick and coughing, and you have to be out (for example, going to a doctor’s office) you should wear a mask. A mask at home would be recommended if you are sick and quarantining yourself in your bedroom, so others in the household do not get sick.

- If you will be on an airplane, take some sanitizing wipes with you to wipe the tray table and the hand rests and the areas that you might come into contact with on the plane. In general, extra cleanliness is recommended (bathroom surfaces, computer keyboards, etc.). If you are using a hand sanitizer (vs washing your hands for at least 20 seconds) apply the gel to the palm of one hand and then rub your hands together for 20 seconds.

- When meeting people, consider the Asian custom of putting your hands together and bowing as a sign of respect, instead of shaking hands. You can also place your hands over your own heart and nod to the person you are greeting.

Prevention

The best way to PREVENT infection is to avoid being exposed to the virus that causes COVID-19. There are simple everyday preventive actions to help prevent the spread of respiratory viruses, including:

- Avoid close contact with people who are sick.

- Avoid touching your eyes, nose, and mouth with unwashed hands.

- Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

- Take the recommendations for social distancing VERY SERIOUSLY.

IF YOU ARE SICK, to keep from spreading respiratory illness to others, you should:

- Call ahead before visiting your primary care doctor.

- Wear a facemask.

- Cover your coughs and sneezes in the crook of your arm or in a tissue, not in your hands.

- Avoid sharing personal household items.

- Clean and disinfect frequently touched objects and surfaces.

- Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

- There is no approved antiviral drug for the coronavirus, though several are being tested. The CDC has a site however discussing antiviral medications for the flu: https://www.cdc.gov/flu/treatment/whatyoushould.htm

STAY HOME EXCEPT TO RECEIVE MEDICAL CARE FROM YOUR PRIMARY CARE DOCTOR OR THE EMERGENCY ROOM/URGENT CARE. To be clear, if you are suffering from any flu-like symptoms (fever, cough, chills, fever, body aches, etc.) we ask that you please DO NOT COME INTO THE OFFICE for your in-office appointment. Please contact the office if you are not feeling well with any of these symptoms as we would be happy to convert your appointment to a phone consultation or appointment.

Further Information

The Centers for Disease Control provides updates on the virus and safety information for the public. You can find a fact sheet with what you need to know here:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

The New York State Department of Health provides updates on the disease's spread within our state, and other useful information: https://www.health.ny.gov/diseases/communicable/coronavirus/

The State Department provides a list of travel advisories for those who are planning to fly outside of the United States: https://travel.state.gov/content/travel/en/traveladvisories/ea/novel-coronavirus-hubei-province--china.html

Experts have been working hard to understand this new strain of coronavirus. Because new information is coming out every day, please visit the sites above to stay up to date. The safety of you and your loved ones is of the utmost importance.

General Recommendations from IM of CNY:

To help keep your immune system as resilient as possible, we recommend that you get enough sleep, exercise regularly (including going outside for fresh air and sunshine), eat a healthy diet such as an anti-inflammatory diet that is rich in vegetables (especially yellow and orange ones containing beta-carotene), fruit (particularly citrus/vitamin C rich fruit), fish and meat (unless vegetarian), cooked or sauteed Asian mushrooms (to support the immune system) and use spices liberally (garlic, oregano, ginger, turmeric, and others), and get adequate vitamin d (supplement if necessary). Fermented foods can be helpful for the GI tract (unless you have histamine sensitivity and mast cell disorder). In addition, staying as calm as possible and spending time daily in meditation can support your immune system.

In Good Health,

Dr. Puc and the entire team at IM of CNY