[Coronavirus Update] It’s Not a Question of if, but of when?

“We expect we will see community spread in this country,” said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “It’s not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have a severe illness.”

If you meet the criteria for potential exposure to Coronavirus, that is, lower respiratory illness (fever, cough, difficulty breathing) and have traveled from China, Italy, Iran, or South Korea within the last 14 days, it is recommended you contact your healthcare provider. If you make an emergency appointment at an Emergency Room, Urgent Care, or your Doctor’s office, please contact this facility before showing up, in order to allow the facility to place you in isolation prior to being diagnosed or ruled out for this infection.

The estimated death rate is 2.3% according to China’s Center for Disease Control (http://www.cidrap.umn.edu/news-perspective/2020/02/study-72000-covid-19-patients-finds-23-death-rate). This is approximately 10-fold higher than the yearly influenza strains. A JAMA study found 81% of cases mild, with no pneumonia or mild pneumonia; 14% severe (with difficulty breathing) and 5% critical (respiratory failure, multiple organ dysfunction or failure and/or septic shock) (https://jamanetwork.com/journals/jama/fullarticle/2762130). Of those placed on a ventilator, 81% died (https://jamanetwork.com/journals/jama/fullarticle/2762130).

According to https://www.worldometers.info/coronavirus/, there are currently 97,810 cases, 3,352 deaths, and 54,121 patients that have recovered from Coronavirus. This is a fluid number and many persons who have been infected do not realize this until the virus has already spread to others. At the moment, about 16% of patients identified appear to be serious and require greater support. These numbers may change as we develop immunity and as the virus mutates.

I just spoke with a representative from the Maricopa County Medical Center. She recommended updating yourself via www.maricopa.gov/coronavirus. Their current recommendation is to contact your healthcare provider if you think you may need testing. Maricopa County is currently limiting testing to patients that have traveled in “Level 2” or “Level 3” countries or have had known direct contact with a person known to be infected with Coronavirus or persons in the Intensive Care Unit with a chest X-ray demonstrating pneumonia who have had a negative influenza test and a negative viral panel. In these cases, the Physician or Health Care Provider will contact Maricopa County and they will decide if the patient should be tested on a “case by case” basis due to a limited number of tests available.

For those of you that travel, the “Level 2” and “Level 3” countries are listed on the CDC website at https://wwwnc.cdc.gov/travel/notices. “Watch Level 1” indicates that patients and physicians should “practice usual precautions”. For “Alert Level 2”, practicing enhanced precautions is indicated. “Warning Level 3” recommendations are to avoid nonessential travel. As of today, the Level 3 countries are South Korea, China, Italy and Iran but this is subject to change as the situation evolves.

My advice to my patients is, as always, to keep your asthma or chronic lung disease, under control as being uncontrolled places you at risk for any airway problems and to ensure that your influenza and pneumonia vaccinations are up-to-date. As well, immunodeficient patients should remain compliant with their treatment plan and return to your physician for guidance if you travel. This is a dynamic situation so the advice may change.

If your symptoms are mild, ensure that our office knows ahead of time and if we make an appointment to evaluate you, we will have you contact us from the parking lot, provide your with personal protective equipment (the current recommendation is “droplet precautions” per the Maricopa County Medical Center) and will escort you to a contained room to be evaluated.

See below for the current recommendations from Maricopa County Medical Center:

https://www.maricopa.gov/DocumentCenter/View/57898/COVID-19_FAQ_Current_English

https://www.maricopa.gov/DocumentCenter/View/57897/COVID-19_FAQ_Current_Spanish