Practice News
COVID 19 Update 4-16-20
Over the next several weeks, you will see movement towards relaxing the social distancing recommendations. For the moment, Governor Ducey’s stay at home order is in effect through April 30, 2020. It is unclear what will happen after that, as the Governor is wisely waiting to see how case numbers progress before making any future decisions. Predictive modeling now suggests we will hit our peak number of cases in early May 2020. However, just this week we have seen a small decrease in the growth rate of new Covid 19 cases in Arizona. New case numbers were increasing by approximately 10% every day, yet this week that rate is down to about 7% each day. Ideally that number would be zero, yet it is an improvement. Unfortunately, we are still identifying over 300 new cases a day. As of April 16, the total number of cases in Arizona is 4234 with 150 deaths. In Pima County, we have identified 760 cases and had 37 people die from the virus.
Clearly, many businesses and individuals have been severely affected by the abrupt changes put into effect since mid-March. The pressure to resume more business and commerce activity is totally understandable, yet the slowing of the rate of new infections is the benefit of social distancing. Unfortunately, if we relax social distancing too soon, we will most likely undo the gains that are being achieved. Even though the daily number of new cases is starting to reduce, we may see a resurgence of cases, especially if the above-mentioned modelling is accurate. That is why the caution.
As I have shared with some people recently, I view COVID19 as a marathon in which we are only in mile 5 of a 26-mile race. We do not anticipate the virus to suddenly disappear, so concerns about new outbreaks and spread will persist for months to come.
Of note though, a lot of what we think is COVID 19 is not. Numbers from Tucson Medical Center (TMC) indicate that approximately 80% of the 900 plus patients with symptoms suggestive of the virus were NEGATIVE for it. However, we have not been able to widely test the population as a whole, so these numbers do not truly reflect the prevalence of the virus in our community since we are not detecting asymptomatic carriers.
One strategy to reduce future risk will center on testing and contact tracing. In brief, we want to evaluate more people with an antibody test to determine if they have been exposed to the virus. Theoretically, someone with antibodies to the virus should have some immunity. Unfortunately, we do not know if this is true with Covid 19. In addition, we remain limited by the lack of a widely available trustworthy antibody test, although several solutions have been announced recently, including one developed here in Tucson at the University of Arizona.
We will use tracing, in combination with PCR testing for the virus itself, to identify any possible contacts of a newly diagnosed individual. The plan is to quickly identify these contacts and then test and/or quarantine them in order to control the spread of this virus.
There are two main ways this tracing may occur: through old fashioned public health surveillance or electronically.
For decades, public health departments have managed communicable diseases by contacting via phone or in person those individuals who were around a contagious person. This process is labor intensive yet does work.
Electronic surveillance of contacts is relatively new and controversial. It is based on the wide usage of cell phones and the ability to monitor an individual’s movements with cell phone data. Democratic countries such as South Korea and Israel have employed these techniques with good success. Dictatorships such as China have also used these types of surveillance for COVID19 control. While effective, there is concern these electronic techniques could have serious civil liberty issues, as they may continue to be used after the major public health threat is eliminated. This topic will get more attention in the coming weeks, and I want you to at least be aware so you may share any opinions you have on it with your elected representatives.
Finally, I want to again emphasize that the vast majority (90+ percent) of people infected with COVID19 recover from it. News coverage focuses on the sad and tragic cases giving a skewed view. Be aware, COVID 19 is a deadly and unpredictable disease, yet for many Americans now, the fear of the disease may be as debilitating. We must be vigilant and observe the public health guidance, yet please also remain hopeful.
Jeff Mayer, MD
COVID 19 Update 4-6-20
Hello this is Dr Jeff Mayer with an update on Coronavirus/Covid 19. Today is Monday April 6, 2020.
The need to STAY HOME has never been greater. Here in Arizona we are seeing the number of COVID cases increase by 10% every day. Currently there are 2269 cases reported as of yesterday. That number will probably be over 2500 today. We are on the steep part of the curve and will continue to see increases over the next several weeks. It is anticipated Arizona cases will peak sometime later this month. Unfortunately, when we hit the peak we will not go down right away, and the numbers will remain elevated for a while.
We hope Arizona will be more like California where the number of cases has been relatively low (only 13,500 out of a population of 39 million) rather than New York (over 100,000 cases). A large part of the reason for this difference is that California aggressively enacted social distancing early. Our leaders here in Arizona have done the same, so there is reason to be optimistic. However, it is going to get much worse before it gets better.
I want to emphasize most patients who get Covid 19 will make a full recovery. This statement includes those in the higher risk categories, specifically those over age 65. The overall death rate from Covid 19 appears to be just under 3% nationwide. In age 65 and up, this death rate approaches 10%. Unfortunately, the data is incomplete, since we have not been able to do widescale testing. While more labs are starting to release test kits, it is going to be a month or more before we can test like we need to.
Testing is now going to be done in 2 ways: First off, we will continue to test with a nasal swab to determine if someone has a current infection. This test is known as a PCR test. PCR stands for polymerase chain reaction, the methodology used to evaluate the specimen. The second type of test which will be done is an antibody test, done either as a fingerstick or a blood draw. This antibody test will tell us if someone was exposed to the virus. It will not allow us to diagnose an active infection, however. There are limitations to both testing methods. For the PCR, we are starting to realize that the virus may not stay in the nasal passages, and therefore may not be detectable there after a few days of infection. Some PCR methods now include saliva or sputum (what you cough up) specimens. Antibody tests have the risk of being positive when someone has antibodies to a different Coronavirus then COVID 19. WE ARE HOPING TO HAVE AN ANTIBODY TEST IN THE OFFICE BY APRIL 15.
I recommend wearing a face mask should you have to go out and be around others, such as at the supermarket or pharmacy. We do not have enough masks to distribute to patients, and I suggest you obtain a cloth mask, as it can be washed and reused.
I do NOT recommend gloves since I believe many people get a false sense of security when wearing them. Once you touch something in a store your hands are contaminated and should be washed before touching a personal item such as your cell phone or purse or even your body. When people wear gloves, they seem to forget this fact. The virus does not appear to be transmitted through the skin, so a 20 second hand wash should eliminate it.
There remains no known treatment for Covid 19. So, the best way to treat yourself is to try to avoid getting it, and the best way to do that is to not be around other people. I realize with the upcoming holidays people may want to spend them with family. We recommend not doing this.
Should you develop respiratory symptoms please do not just go the ER or come to our office. During business hours, the office remains open, and you should call there first. For more urgent attention, or after hours, call my cell phone at 520-403-8529. Naturally, if you have shortness of breath, or other severe symptoms such as lightheadedness, call 911 immediately. We continue to only see urgent appointments in the office to keep people at home.
Thank you and take care.
COVID 19 Brief update
I will be posting brief updates a few times a week regarding COVID 19. I will try to simplify the situation while still staying scientifically up to date.
Today is March 23, 2020.
First off, I want to emphasize that thankfully the vast majority of individuals who contract COVID 19 make a full recovery. With all the attention, this fact is sometimes forgotten. So why all the worry then?
I have been comparing COVID 19 to a wildfire, and while the analogy does not completely describe the situation, I believe it conveys the broad concept in a more understandable fashion. Like a wildfire, COVID 19 will race through a population of people rapidly if there is enough “fuel” for it to burn. The “fuel” in this instance is us, since almost all humans will not have immunity to this virus initially. The idea of keeping people from congregating together is to deny the virus of fuel.
To stay with the wildfire analogy, there are times where a fire will burn remotely, and firefighters will leave it be and just observe. Other times, when the fire burns close to structures or other important areas, there will be an all out effort to stop it, or at the very least contain it. We are at that point with COVID 19. Since we have no way to prevent it or even treat it, we must try to stop its spread. Unfortunately, this approach is not without huge cost, both to our economy and also our psyche.
However, from a public health perspective this is an acceptable trade off, as the alternative is a potential death rate in the tens of thousands or even higher. Arguments made that we have more deaths from other preventable causes such as car accidents and even influenza/flu and do not restrict people’s activities are accurate yet incomplete. For those causes, we have ways to avoid or minimize deaths. We do not have that capability with COVID 19. So in this instance we must err on the side of caution and try to stop this virus from infecting large numbers of people. One of the big fears is that with larger numbers of infected individuals this virus will mutate, and potentially change into a much more deadly variant then we are seeing now. If that were to occur, then we could approach the 25% death rate that occurred in Albert Camus’ classic novel The Plague, a work I recommend reading.
So, once again I urge everyone to stay at home for the next week. In the next update (which I will try to post tomorrow) I will review the various treatment approaches that are being utilized, and hopefully, discuss what has not worked. Take care.
Jeff Mayer, MD
New Shingles Shots
There is a newer Shingles shot called Shingrix. This shot is a replacement for the older shingles shot (Zostavax). The new immunization has two large advantages over the older one: First, it has over 90% effectiveness in preventing a shingles outbreak (as compared to 50% for the Zostavax); Secondly, it is not a live virus so it can be given to more people then the older shot. It is a two shot series, with the second shot being given ideally 2-6 months after the first one. Even if you received the Zostavax vaccine, it is recommended that you get the Shingrix as well. Shingrix is in short supply currently, yet we are getting limited amounts of vaccine each month. Call the office and go on our waiting list if you have not already received your vaccine (you must be a patient to be on our waiting list). (Also see the Vaccine Information Sheet from the CDC below)
New Shingles shot info sheet (VIS)
Almost Summer
With the weather warming up make sure to stay well hydrated and protect your skin from the sun.
New Website Launch
We are very excited to launch our brand new website! It’s been a work in progress for the last few months and it’s finally ready for the limelight. Our goal is to continually provide health related information as well as basic information about how you can contact us and visit our online portal.
Please give us a call if you have any questions at all and we look forward to working with you to see a better and healthier tomorrow!
Great Ways Direct Care Can Impact You
This is a list of great reasons to use Direct Care as a method of providing healthcare to you and your family!
