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  • COVID-19 UPDATE APRIL 20, 2020

COVID-19 UPDATE APRIL 20, 2020

Below is information as of April 20, 2020. Our goal with these updates is to arm you with the best information from multiple credible sources to keep you as current as we are.

Local Impact

Local officials are uncertain as to whether or not we have peaked in our case numbers. (See below for more details).

Angelina County is bound to follow the directives related to business openings and restrictions as prescribed by the Texas State Governor, Greg Abbott. Too, our civic leaders, Mayor Bob Brown, city manager Keith Wright and our City Council are in communication with local healthcare leaders to develop plans that maximize safety while attempting to restore and/or maintain local economies and businesses. Their decisions impact the very lives of thousands of people. We ask for your understanding and support as they formulate plans based on available information to thread a small needle.

As of today, Angelina County has reported 23 cases of COVID-19. No deaths have been recorded yet.

Concerns Regarding Local Testing

For Angelina County, we recommend significant expansion of testing as a critical element in determining the timing of the relaxation of current restrictions.

Of note, several of our patients have reported having specimens obtained inconsistent with recommended guidelines. Below is a brief summary of proper specimen collection from the CDC for COVID-19.

Nasopharyngeal (NP) Swab

nasal-swab.jpg#asset:5857:half

A long flexible swab is introduced clear into the nose as shown by the illustration above. The swab should be rotated during the entire time it is in the nose to maximize absorption of secretions (15 to 20 seconds in each nostril).

Arguably, the greatest question immediately before us is when to begin to consider returning to “normal”. The answer will lie in the data from dramatically expanded testing in all of our population segments, from the very young to the very old. Only by so doing will we be able to piece together the true weighted range of disease expression from little or no symptoms to severe illness and death. The questions like - should we re-open schools, daycare facilities, restaurants, theaters, all businesses - will be better answered with more powerful data. As of today, it remains guesswork.

What To Do Now

  • Remaining at least 6 feet away from people around you while in public must be more widely practiced. As this is our best protection against infection, we recommend strict observance of this singular measure as our greatest weapon against infection.
  • Face masks remain recommended for children five years and older for travel outside of your residence.
  • Routinely clean touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics) with household cleaners that contain at least 60% - 90% alcohol.
  • Wash hands frequently with soap and water. When using waterless hand wash, make sure it contains at least 60% - 90% alcohol.
  • Sneeze or cough into your elbow fold, the back of your forearm or some kind of protective cloth.
  • Shelter in place if you are at high risk (if you have moderate to severe lung disease, kidney disease, diabetes, immunocompromising conditions or are 65 years old and older.)

Reduce Your Risk of Getting Sick with COVID-19

  • Continue your medications and do not change your treatment plan without talking to your doctor.
  • Have at least a 2-week supply of prescription and non-prescription medications. Talk to your healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.
  • Talk to your healthcare provider about whether your vaccinations are up-to-date. People older than 65 years and those with many underlying conditions, such as those who are immunocompromised, have significant heart disease, diabetes, kidney disease or significant liver disease are recommended to receive vaccinations against influenza and pneumococcal disease.
  • Do not delay getting emergency care for your underlying condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care for your underlying condition.
  • Call your healthcare provider if you have any concerns about your underlying medical conditions or if you get sick and think that you may have COVID-19. If you need emergency help, call 911.

If you have moderate-to-severe asthma, follow your Asthma Action Plan.

  1. Keep your asthma under control.
  2. Continue your current medications, including any inhalers with steroids in them.
  3. Know how to use your inhaler.
  4. Avoid your asthma triggers.

If you have type 1, type 2 or gestational diabetes,

  1. Continue taking your diabetes pills and insulin as usual.
  2. Test your blood sugar every four hours and keep track of the results.
  3. Make sure that you have at least two-week supply of your diabetes pills and insulin.
  4. Follow the sick day guidelines.

New Challenges

The American public has feasted on a continuous news cycle for more almost 40 years (CNN began broadcasting June 1, 1980). We have grown accustomed to having questions posed on Mondays and answered by Fridays with all manner of inflammatory, often polarizing, opinions in between. The questions being currently posed regarding every facet of this pandemic will require months, at best, to answer. Unaccustomed to this new cadence we are programmed to look for alternatives that promise answers immediately. To wit, point of care testing for antibodies has a market that is preying on a worried American public. While American and international companies have been unleashed to develop cures and prevent or minimize infection you, our patients, families, employees and indeed the citizens of our county and service areas must understand the more protracted time frame required for reliable solutions to the questions before us.

We are still in the early phase of data collection that then must be analyzed. The analysis will lead to the questions that must be asked. Developing trials and following those to conclusion will be the final step in conquering the challenges that this new infection presents.

As stated in the last update, we will prevail. We are 100% confident of that eventuality. Until then, we invite you, your friends and colleagues to remain informed by visiting our updates which are a synthesis of multiple sources including the CDC, Johns Hopkins University, the National Institute of Health, Harvard School of Public Health, Kaiser Permanente Healthcare System and many others.

Challenges Ahead

The most recent research indicates that we have underestimated the transmissibility of the virus as well as its ability to cause infection. While the question of whether the virus will spread as rapidly in warm, humid conditions remains, (most studies indicate a slowing in progression during warm humid conditions and resurgence when cooler, drier temperatures and conditions return in the fall) Dr. Anthony Fauci reports that his team of scientists believe that this new virus may be here to stay for a few years until effective vaccination protects us. As such, they anticipate a resurgence of infections once colder weather returns in the fall.

Testing for COVID-19

Many point of care tests are being released to the market prior to adequate scientific evaluation. Currently, there are no known reliable point of care tests that provide meaningful information.

Blood tests for COVID-19 are becoming increasingly available. Most are from China and have not undergone any significant reliability evaluations. Testing for antibodies suggest acute infection (IgM) or past exposure (IgG). A positive test may in fact be reacting with one of several common, harmless viruses within or related to the coronavirus family. (High likelihood of false positive). Hence, the reliability of the results are completely unknown. We simply do not know what level of antibody is protective and, if so, for how long. The tests are quite meaningless at this time and may give a dangerous sense of false security. “If you are getting an antibody test and it’s being conducted in your physician’s office, it’s a red flag,” said Kelly Wroblewski, director of the infectious disease programs for the Association of Public Health Laboratories. We agree.

Good News in the Fight Against COVID-19

Time from contracting the virus to developing symptoms has now been somewhat established. Research has now determined that the median incubation period for COVID-19 is just over 5 days and that 97.5% of people who develop symptoms will do so within 11.5 days of infection.

It usually takes about 10 to 15 years to develop a vaccine. The good news: leaps in technology, such as the ability to rapidly sequence virus genomes and to create vaccines out of messenger RNA, are speeding up the process of development. Developing new drug treatments can also take time—about a decade from discovery to getting on the market. But here technology also provides an advantage. New types of antiviral drugs and immunotherapy treatments can treat a wide range of other diseases which means that drugs already in the development pipeline or already treating diseases in patients could be useful to fight COVID-19, shortening the time it will take to make an effective medicine.

Many other drug combinations, 300 in all, are being tested at this time across the globe. It’s just a matter of time before we find the silver bullet.

Treatments

  • Remdesivir is gaining momentum as a leading therapy within the hospital setting. Multiple studies are currently underway and early results are promising.
  • Several monoclonal antibodies are being developed using related technologies and strategies against other known viruses including Ebola virus. Again, early results are bearing fruit.
  • Data regarding hydroxychloroquine/chloroquine and Zithromax are inconclusive at this time. Studies remain ongoing and are having some mixed results although most seem to have some benefit.
  • Ivermectin has been shown to inhibit viral replication in the laboratory setting and has had some success anecdotally. Formal studies are also underway investigating its potential therapeutic benefit.
  • Immunoglobulin therapy: Antibodies from recovered COVID-19 patients could help with free virus and infected cell immune clearance. Further studies are warranted. On March 24, the FDA released guidance for screening donors for COVID-19 convalescent plasma and on emergency investigational new drug applications based on this modality.

Vaccines

Clearly, vaccines represent the “most effective long-term strategy” to prevent future COVID-19 outbreaks, though at least 12-18 months would be required until vaccines can be widely deployed. The company Moderna continues its early testing of the COVID-19 vaccine with the second dose of the immunization administered April 15. Subjects will have blood work performed in approximately 2 to 3 weeks and periodically thereafter to determine immune response. Stay tuned.


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