Coronavirus (COVID-19) Information for our Members

by | Mar 7, 2020 | Staying Healthy | 0 comments

We will be sharing information related to the Coronavirus (COVID-19) in Omaha in this post. When there are particularly timely updates for our members we will also send out an email.

Wednesday, May 6

Overview: We’re seeing an uptick in Nebraska cases. Part of that is more testing, but I think we’re also seeing a higher prevalence. That will likely accelerate somewhat as social restrictions are relaxed, but we’re far from overwhelming the healthcare system. We’re moving to a more Sweden-like approach.

Testing: We can test for both active infection with the nasal swabs and past infection with antibodies in the blood. The cost for the active infection is $85 and if you have insurance you can use your insurance for it. The cost for the antibody test is $50 and you may be able to use your insurance for it. The active infection test goes to UNMC and the antibody test goes to ARUP, a well-respected national reference lab, so these are tests I trust. 

Treatment: Still nothing if you’re not hospitalized other than symptomatic treatment. Further research reassures us that taking ibuprofen and staying on your ACE-inhibitor (like lisinopril) medications is safe. Treatments showing promise for seriously ill people are remdesivir (experimental treatment available here at UNMC) and convalescent serum. Not looking good is chloroquine/hydroxychloroquine and azithromycin. 

Recommendations: Stay safe! Follow the current social distancing rules, enjoy the warmth and sunshine, and get some exercise.

Saturday, April 3

The cases of this continue to rise nationally and locally. The good news is that our hospitalization rate continues to stay below the point where we will overwhelm our medical capacity for hospital beds and ventilators by multiple models. So social distancing is working! Keep it up and hopefully, we won’t have to go to more restrictive policies.

Public Health: the CDC has recommended some kind of nose/mouth covering when out at higher risk areas like the grocery store to limit the spread of the disease from people who don’t realize they have it and are out. 

Treatment: No real change here. The FDA authorized emergency use of hydroxychloroquine for hospitalized patients, but no recommendation for use for people not requiring hospitalization. 

Testing: Again, not much change. Tests are somewhat more available, but we’re still not doing widespread epidemiological testing. Some companies have started to ship antibody testing, which can tell whether you’ve already had the infection. Accuracy of these tests is fairly poor so far, so not sure that it will be all that helpful but it is something to watch. If we get a test that is accurate in terms of not having very many false negatives, then it will be helpful. 

Clinic operations: still default is telehealth visits — we have a new telehealth product that is embedded in the electronic medical records and I’m eager to try it out. We are still seeing patients in the clinic when needed. 

Bottom line: stick to our social distancing rules, get outside for some exercise, and disinfect your hands often, especially after you’ve been out for groceries!

Saturday, March 21

So a slightly less-dramatic week, although still many changes with social distancing. We’ll make this short and sweet by focusing on the core issues:

  • Prevent getting COVID-19 following the CDCs recommendations:
  • Practice social distancing by staying more than 6 feet away from people in public and limiting group sized to less than 10 people
  • Minimize outings for necessities and just send only one person out on errands
  • Wash or use hand sanitizer frequently and anytime you’re out in public after you’ve touched things like grocery carts and other shared surfaces

If you get exposed to someone with known COVID-19 (the Douglas County Health Department website is keeping a running log of exposure sites) or you have traveled somewhere there is active spread quarantine yourself for 14 days. If you don’t get symptoms, you can stop the quarantine.

If you get sick with cough, sore throat, difficulty or pain with breathing, fever:

  • Quarantine yourself in your house and as best you can, even from others in the house
  • Call us so we can do a telehealth assessment
  • Maintain the quarantine for at least 7 days, including at least 3 days with no fever and continual improvement in any other symptoms.
  • NOTE: This is actually a shorter quarantine than if you’ve just been exposed. Once you have the infection, you’re not infectious after about 7 days. This is the most recent CDC recommendation and has also been propagated by the Nebraska Department of Health and Human Services. 
  • Use acetaminophen or ibuprofen/naproxen for fever control and body aches, any over-the-counter cough medicine might help as well.
  • Zinc supplementation I’m not so sure about, but it’s low risk so if you want to do it that’s fine. 
  • If you feel severely ill, especially with breathing complaints, we’ll figure a way to do some evaluation and decide on whether to go to the hospital.

What about testing?  

  • If you have symptoms and/or exposure and we do have some limited capacity for testing.
  • We will check for influenza first and, if negative, discuss further testing including sending a test for SARS-CoV2/COVID-19.
  • I expect the COVID-19 test to cost somewhere between $100-150, but that’s an estimate.
  • I also expect the availability of testing to improve.

A word about testing —

I always think you don’t send a test unless it’s going to change clinical and treatment decision-making and right now, I don’t think a COVID-19 test changes management. You either stay home and try the few things that can make you feel better, or you need to go to the hospital — the test doesn’t determine that your symptoms do.

So absent a public health plan that tests to better understand disease spread (and is paid for with public money) or development of a treatment that targets the virus, I don’t think a test helps. I’m surveying the literature on this daily and although there are reports of a couple of promising drugs, there are no recommendations for people not admitted to the hospital yet.

Saturday, March 14

For all the dramatic news regarding the cancellation of public events this week, little changes from our recommendations from last week.  The number of cases increased this week but remains low from a total number standpoint and still no clear cases of community transmission.  So our advice remains basically the same:

  • Avoid large gatherings (more than 100). 
  • Practice social distancing – keep 6 feet away from others in public (not while hanging out with friends/family) 
  • Wash hands or use alcohol-based sanitizer after touching any objects out in public and try not to touch your face while out doing things in public like grocery shopping

To expand on avoiding large gatherings, we recommend including places like gyms which might not have 100 people present at any one time, but has high turn-over traffic and lots of surfaces on which infected body fluids can land.  The grocery store is the one unavoidable place like this, so just be vigilant in terms of the above measures when you go. And try to minimize trips.  

If you are sick:

The following symptoms should prompt concern: 

  • Fever
  • Cough
  • Shortness of breath or difficulty breathing

If those occur:

  • Self-quarantine yourself and household contacts in your home
  • Call us — we will do a virtual assessment and work to arrange testing when indicated

I have been impressed at the speed with which organizations have adopted social distancing practices, and I think there’s reasonable hope that we can slow the spread so that hospitals don’t get overwhelmed.  Hang in there — catch up on some reading and break out your old “Sorry!” gameboard!

Monday, March 9

Here is a list of quality and reliable sources of information about the Coronavirus (COVID-19). Again, if you are a member and have any questions please contact the clinic. If you are experiencing symptoms please call the clinic prior to coming in.

Local County Health Departments
Douglas County Health Department: Infectious Diseases – 2019 Novel Coronavirus Resources


Sarpy/Cass Health Department – COVID 19

University of Nebraska Medical Center
Daily Coronavirus Update from UNMC

State
Nebraska
http://dhhs.ne.gov/Pages/Coronavirus.aspx

Iowa
https://idph.iowa.gov/Emerging-Health-Issues/Novel-Coronavirus

National
The Center for Disease Control
What you Should Know about COVID-19 from the CDC
Preventing COVID-19 Spread in Communities – CDC

Global
The World Health Organization
Covid-19 FAQs, Advice, Resources – World Health Organization

Fact Sheets in Various Languages
Printable Coronavirus Fact Sheets in English, Spanish, Chinese

Friday, March 6

The new Coronavirus (COVID-19) circulating is worrisome, and now it’s in Omaha.  If you didn’t see the news, a woman who returned here from England has tested positive today at Methodist and is being transferred to the biocontainment unit at UNMC.  She was in Omaha with symptoms for several days before going to the hospital.  

What to do to protect yourself:  

  • Don’t panic.
  • Do check local news for guidance on where the person may have been and whether you have potentially been exposed. They will also issue recommendations on what public gatherings should and shouldn’t go on.
  • Now that it is local, minimize activities with mass gatherings.
  • Keep a 60% alcohol-based hand sanitizer with you and use it anytime you touch an object shared with the public like doorknobs and faucet handles, and don’t touch your face.
  • Masks are highly unlikely to protect you.
  • Don’t use public drinking fountains.
  • Don’t do communal eating or drinking (like communion at church).

What to do if you have a cough, sore throat, or fever, and are concerned you may be infected with the virus:  

  • If you have a fever and cough or difficulty breathing, stay home and give us a call.
  • We will help walk you through whether and how to test for the virus and how to best protect those around you. 
  • Minimize contact with other people.
  • If you have a facemask, wear it as it may prevent you from spreading it further. If you need one, let us know. We don’t have N-95 masks, but we do have simple ones that may help.
  • Most of all, don’t panic! We are here to take care of our members. Call us with your concerns and we will work through them together.

My personal thoughts on this are that it will likely become widespread, most people will get exposed and have mild or no symptoms, but it will remain a significant risk for the elderly and people significant lung, heart, and immune system diseases.

Stay alert to the news and know whether you may have been exposed based on where you’ve been. Don’t hesitate to call us for advice or with questions. We will be watching closely and keeping our members updated on the blog and via e-mail.

John Hallgren, M.D.

John Hallgren, M.D. is the co-founder of Mission Direct Primary Care in Omaha, Nebraska. He graduated from the Uniformed Services University of the Health Sciences medical school in 1995 and has been a board-certified family physician since completing residency in 1998. He is a 26-year veteran of the U.S. Air Force and has been an assistant professor of family medicine for the University of Nebraska Medical Center and Uniformed Services University. He has several publications in such journals as American Family Physician and The Journal of Family Practice.

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