We’re going to address 5 basic things in this Covid-19 update:

• Prevention and stopping the spread of Covid-19 in light of rising cases and the holidays
• Small business owners and Covid-19: tips for safety
• “I have Covid-19, now what?” — home care and what to watch out for
• Updates on hospital care & treatment
• Vaccine news!

 

Prevention and stopping the spread of Covid-19

• Millions of Americans traveled or gathered for Thanksgiving, despite recommendations against it. Dr. Fauci and Dr. Birx recommend that those who traveled for the holiday isolate themselves and get tested for Covid-19, because, “you have to assume you were exposed and became infected.”
  • Learn more about KC-area testing options here. 
• Heading forward, prevention is key!  We don’t have a sure-fire cure or vaccine at this point (see below), so it’s essential to prevent further spread and to take these tips to heart.
• Key ways to slow/stop the spread of Covid-19 haven’t changed. To review:
  • Avoid, if at all possible, prolonged interaction with those outside of your household. As such, we recommend against travel and gatherings — and yes, we also realize this is hard during the holidays.
  • Wear your mask!  Face masks work — especially if they have 2+ layers and fit well without gaps.
  • Wash and/or sanitize hands frequently.  If washing, wash for > 20 seconds with soap on all hand surfaces, or if using sanitizer, find an alcohol-based sanitizer and coat all hand surfaces.
  • If you must interact with people from outside your household, remember the 4 variables:
    • Time: limit the amount of time you’re in close proximity to others.
    • Density & Distance: keep a good distance — ideally farther than 6 feet — when visiting with others, and keep an eye on how densely packed your surroundings are.  If there’s more than one person per 36 square feet (i.e. a 6 foot x 6 foot box), you probably want to avoid the situation. 
    • Ventilation: unless you’re in your home with your immediate housemates, only visit with others in really well ventilated areas; outdoors is great for this!
    • Community Considerations: what’s going on in your community?  Are cases rising? Flat? And when you choose to visit with others — what are their behaviors like?  Are they wearing masks? Practicing frequent hand hygiene? Or did they just attend a party/wedding/funeral/gathering, dramatically increasing their risk? Lastly, think about the fragility of those you want to visit — you may be fairly resilient to a Covid-19 infection, but those w/ underlying illness, advanced age, etc. are at risk.  Think of all these things before you choose to visit with others, and revert back to optimizing the first three variables to lower the risk if you must meet with others.
• Here at the clinic, we’re (still) trying to reduce the risk of transmitting SARS-CoV-2, as the virus is still (frustratingly) present and spreading in our community.  As such, here are a few things we’re still doing:

• We are limiting the number of people in the office; please call ahead before you just stop by to pick up medicines or to get labs!  
• We continue to offer care and appointments via email, phone, or videoconference as a first step for acute visits.
• We are then recommending in-person visits for anyone who needs an in-person procedure or physical exam (and if we can check you out in the safety/distance of your car, we’ll recommend that!).
• Contact us directly to chat about whether or not you or your kids need an annual exam — we are trying to postpone these as COVID-19 cases rise in our community.
• Anyone who comes into the office will be asked to wear a mask + to clean their hands with hand sanitizer.

 

Small business owners and Covid-19: tips for safety

Being a small business owner is hard — and it’s even harder in the context of a global pandemic. We invite those in our community who own and operate small businesses to join us for a half-hour presentation regarding best safety practices during Covid-19.

• What: “Navigating Covid-19 as a Small Business: Safety Suggestions”
• When: Wednesday, December 2, 2020 at 11:00; Q&A to start at 11:30 (Note: if you’re seeing this after, the fact, just check out our YouTube stream.)
• Where: virtually, of course! Register here.
• Who: featuring Dr. Christi Crumpecker, the newest physician at Kansas City Direct Primary Care

 

“I have Covid-19, now what?”

Home care and what to watch out for

• First off, stay isolated from others and isolate yourself.
• Reach out to your contacts and alert them of your illness; while it is technically the job of the various health departments to do this, they are overwhelmed at this point and cannot keep up with this task.
• There are no current treatments to cure Covid-19; additionally, there are no evidence-based treatments for Covid-19 for those who are not in the hospital.
• Do supplements work? While there have been more and more studies trying to look at what might help someone who is Covid-19 positive but who is not in the hospital, there is no current treatment or medicine that has scientific evidence to support using it for those who have Covid-19 but who are not in the hospital. With that caveat, these interventions may — or may not — help, and they’re relatively safe:
  • Vitamin D
  • Zinc
  • Melatonin
• What you can do:
  • Rest! Get up every so often to walk if you can, and advance your activity slowly and as tolerated.
  • Stay hydrated; even if you don’t feel like eating, getting fluids is important!
  • Take acetaminophen (Tylenol) for any fevers, aches, and pains.
    • Early research on ibuprofen suggested we shouldn’t use this, but that hasn’t been consistently demonstrated.  You may use ibuprofen or other NSAIDs if you do not get symptom relief from acetaminophen alone or if you have been taking it regularly as a prescription.
  • Consider spending some time laying on your stomach and/or rotating positions to help keep your lung capacity high.
  • You may try some at-home breathing exercises.
  • Monitor your breathing.
    • If you have a pulse oximeter at home, check it at least once daily; if you get a lower reading, switch fingers and/or hands and verify that it is correct.  We want that number to stay above about 90-92%.
    • If you do not have a pulse oximeter at home, we have a few at the clinic that you may borrow.  They are also available for sale on Amazon.
    • If you find that you are having trouble breathing while doing activities that normally don’t cause breathing trouble, please reach out to us or seek immediate care!  (Examples: having to stop to catch your breath in the middle of sentences; breathing like you’ve been running or climbing a flight of stairs, but you’ve just walked from the kitchen or bathroom; etc.)
  • Keep in close contact with your doctor and update them on any status changes.
• When can you come out of isolation/quarantine?  Right now, the CDC is recommending people who are positive for Covid-19 come out of isolation after:
  • 10 days since symptoms first appeared and
  • 24 hours with no fever without the use of fever-reducing medications and
  • Other symptoms of Covid-19 are improving (though loss of taste/smell may persist for weeks to months and need not delay the end of isolation.)
  • Repeat Covid-19 testing after isolation (in order to get a “Covid negative” result) is NOT currently recommended.  
• When will I feel better?  This is hard to say.  Studies have found that those who are younger and have fewer chronic conditions tend to bounce back faster; those who are older and/or have more chronic conditions can take a little bit longer.  The most common longstanding symptoms are fatigue, shortness of breath, and headache.The sense of smell and taste seem to take quite a long time to recover as well.

 

Updates on hospital-based care & treatment

• Remdesivir: available at most hospitals, this antiviral is given over the course of 5 days via IV.  It has been suggested that it may shorten hospital stays and may improve outcomes for those who are needing oxygen but don’t quite need to be on a ventilator.  That said, the data is weak, and we may see changes on this front in the future that recommend against its frequent use.

• Plasma: unfortunately, convalescent plasma has had several recent studies question whether it actually helps; my gestalt is that this will likely be phased out over time.

• Monoclonal antibodies: we are seeing glimmers of hope that treatments of monoclonal antibodies — like bamlanivimab — can help. The treatment is available at a few hospitals in the region.  Specifically, it was approved for use in the outpatient setting (i.e. someone who is staying at home and is not admitted to the hospital) for those who have specific risk factors: obesity (BMI > 35), chronic kidney disease, diabetes, immunosuppression (either due to disease or current treatment), over the age of 64, and/or those 55 and older who have cardiovascular disease +/- high blood pressure +/- COPD. (Note: there are other monoclonal antibodies aside from bamlanivimab, but the studies on them are either not final or are equivocal, so I will reserve comment at this time.)

• Dexamethasone: this steroid has shown it can help — but only in those people with Covid-19 who are sick enough to need oxygen and be admitted to the hospital.  It actually showed some harm in those who were not admitted to the hospital.

• Hydroxychloroquine: has not been shown to help people and may actually harm people.  We are not using it in any setting for those with Covid-19.

 

Vaccine

Saving the most hopeful topic for last, here :).  

Where are we in the process? 

• There are 5 vaccines currently in phase 3 trials in the US. Of those, two vaccines thus far have shared press releases conveying promising results.  Important to note, however, is that as of November 30, 2020, no vaccine is yet authorized and recommended to prevent Covid-19.  The FDA is working much, much faster than it usually does to move these trials through the bureaucratic approval process, but we still have to have each of the vaccines cleared for them to be given to the public.  

• • Pfizer/Biontech submitted their paperwork to the FDA on November 20, 2020.
  • Moderna will submit its paperwork today, November 30, 2020.
  • (AstraZeneca released positive news via press release but has not applied to the FDA at the time this blog was posted.)

How much longer will this take?

• Million dollar question.  From the FDA/regulatory perspective, you can follow along the process w/ this infographic.
• If the question really is: when can we get back to normal? The answer is probably a little more disappointing than we’d like.  It’s still going to be a while before we get enough people vaccinated to achieve collective immunity.  

How do these vaccines work?

• Both use a new technique using messenger RNA (mRNA) vaccine.  The CDC has a very high-level overview of this technique here.

Are they safe? Isn’t this happening too quickly?

• Most of the “quickness” in the development has come from two factors: 1) the science that guided the vaccine development has actually been around for quite some time and 2) Operation Warp Speed allowed for a very specific focus on preventing bureaucratic and logistic hangups. 
• The vaccine must still demonstrate safety — just like any other vaccine or medicine that has gone through phased trials.  (Read the 24-page FDA document here, if you’d like.)

Who will get the vaccine?

• This will vary on a state-by-state basis.  See the report from Kaiser Family Foundation here.

Will you get the vaccine?

• Yes.

 

 

As always, reach out with any comments or concerns!

 

Allison Edwards, MD