11/15/2020
COVID-19 review (I had it and missed the month of April)
This is generally what I am saying to my patients, but things change almost daily, and your situation may be different.
I am testing every weekday at my clinic in the parking lot. Every day I am calling and coaching people who test positive. We are in a virus surge, but we will get through this. Be cautious and wise; the vaccine is near; November through February will continue to be rough, but the great majority of us will be fine. Wear masks and be careful with contact with others; if you think you may have it, quarantine until you know. The following are things I'm telling my patients daily.
Testing
* Rapid tests detect the COVID antigen; positive tests are very reliable, negative tests are not as much, and may need follow up with the PCR test to be sure. These are offered at many places, but change from week to week. Call ahead to stand-alone ERs, urgent cares, and pharmacies to know how they do this safely.
* PCR tests are more reliable and accurate, but take 1-4 days for results. State supplied tests and sites are free, but take longer. I am doing PCR tests at my office daily for my patients, and every clinic has a plan for testing; just call your provider to find out that plan.
* For Martindale Family Medicine Clinic (254-262-3188), we do not see anyone with infection symptoms inside our clinic, but each patient with concerns does a telemedicine visit that day with NP Jessica Beverly or me, then I meet them in the parking lot at 4:30 (12:15 on Tue) and test for COVID (and/or strep or flu) and examine them if needed. I am very cautious/patient/gentle but thorough with doing the nasal swab, so it is usually not painful, but I have to go to a place in your nose things don't normally go. I test all ages. I usually get results and call the next day, though occasionally it may take an extra day (especially in this surge). We send tests to CPL for results, and they charge $100 to your insurance or send them for government payment if uninsured. I do not charge for testing, just a copay for the one telemedicine visit that documents why we need to do the test (and that copay is often waived by insurance).
Treatment
* Hospital: Both our local hospitals have several good treatments. All the medicines are IV, and include Remdesivir, Dexamethasone, and convalescent serum (antibodies from someone who had illness and recovered). Bamlanivimab, the newest treatment approved, is on its way soon, but not available locally yet. Also patients are given high flow oxygen, coached on breathing, given supplements and nutrition to help, careful monitoring of vital signs, and intubation/ventilation if necessary. Most do fine in the hospital.
* Home: supplements/breathing/immune support.
Supplements I suggest include Vitamin D (I suggest Vit D3 5000 units daily to promote immune system and healing), Vitamin C (500-1000 mg daily), Zinc (25-50 mg daily to limit virus' ability to make copies of itself), and baby Aspirin (81 mg daily to protect from microclots triggered by virus).
Breathing exercises should include several deep breaths through nose if possible, holding it a few seconds, then breathing out through pursed lips; do this several times a day. In addition, prone breathing means laying on your face/chest and taking deep breaths for a few minutes several times a day.
Work at keeping immune system strong: good nutrition with healthy food, drinking 2-3 liters of water daily (if no heart problems), plenty of sleep/rest, staying active with walking and moving (but not overdoing it), having positive attitudes: listen to positive music, watch positive/courageous media, talk to your friends and family often, and keep your faith strong (sing songs and pray or whatever supports your personal belief system).
When to consider hospital
* Common symptoms are fever, cough, shortness of breath, sore throat, headache, body aches. Less common are loss of smell and taste (but if present, are more likely positive), rash, vomiting and diarrhea. Most of the time anyone can stay home with these.
* If you are having a hard time breathing. If possible, use an O2 pulse oximeter to monitor; if O2 drops below 90%, you might need to consider hospital. Also if you're breathing very fast, wheezing or hands and lips are turning blue.
* If you are having significant chest pressure/pain, especially if you have a lung or heart condition. An evaluation with vital signs, chest x-ray and exam might reassure it's fine to stay home, or confirm you need to be in the hospital to manage your risks.
* If you are getting dehydrated. Some people have persistent vomiting and diarrhea. If you can't get enough liquids and nutrition in you, you may need to be in the hospital.
* Unmanageable fever and pain. If Temp stays over 104, if the body aches are overwhelming, or if the pain/fever make you delirious, you may need to be in the hospital.
If you do go to the ER, someone should call ahead so they can prepare for you and let you know their procedure for coming in.