COVID-19 Update

Greetings IFC family!

We are reaching out because we know this is a confusing and anxiety provoking time for many of us. We really want to make sure that you know how we plan to serve you as COVID-19 spreads through our community, so we’ve put together the following information to explain what you can expect from us over the next few weeks to months.

As you are likely aware, several Massachusetts residents have tested positive for COVID-19 (the illness caused by the novel Coronavirus). We expect more cases will be identified as testing of suspected cases expands over the coming days. As your physicians, we are committed to staying up to date on developments and changes, so that we can provide you with the most accurate and timely information possible.  We are routinely receiving updates from the Massachusetts Department of Public Health (https://www.mass.gov/orgs/department-of-public-health), the Massachusetts Medical Society, and the CDC (www.CDC.gov). If you have questions or concerns, we strongly urge you to visit and utilize these resources.  

This is not a time to panic, but we do all need to institute some changes in our day to day lives to try to slow the spread of the virus. Yes, it may be inconvenient, but it is necessary. We may not be able to prevent a large portion of the population from getting this infection, and the majority of people who are infected will do just fine. However, it is of UTMOST importance that we slow the spread so that huge numbers of people are not infected at the same time, which would overwhelm our hospitals’ ability to care for the segment of people who need hospital level care due to severe illness. We ask that everyone practice “social distancing” and avoid non-essential large gatherings or travel, wash your hands frequently, avoid touching your face and stay home if you have a fever or cough. This is the best way for us to ensure that there will be adequate health care resources for folks who do get very ill from the virus. The WHO website has accurate advice to the public, which they update regularly, found here: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.

We are fully committed to caring for our patients in the most evidence-based, safe capacity possible. In this vein, we’ve instituted a few policies to protect ourselves and our staff, which — in turn — keeps you all as healthy as possible.

As of March 9, we are asking those who are looking to schedule an appointment to first call or message us on Spruce or Elation. We will reach out to you for more information, as there are many issues that we can help address without a face to face visit. If you are feeling ill and believe you need to be evaluated, we will assess the nature and severity of the situation and help make the best decision as to where you should be evaluated.  

The key points of the triage system are highlighted here:

  • If you have mild, isolated, upper respiratory symptoms (runny nose, nasal congestion, post-nasal drip, sore throat) and no fever or cough, and have not been in close contact with someone diagnosed with COVID-19, nor recently returned from travel to a high transmission country (China, Iran, Italy, South Korea and Japan) or the Northwest US, we will recommend home care and that you not come in for an in-person visit.  You are always welcome to schedule a phone visit with Dr. Cohen or Dr. Cunningham, though, to talk through things and you should notify us if your symptoms change.
  • If you have lower respiratory symptoms (deep cough or shortness of breath) and/or fever, Christine or your physician will recommend a telephone visit to ascertain if an in-person visit is warranted.
    • If we determine that you need an in-person visit, the visit will occur in your vehicle in the parking lot of our clinic so as to prevent potential spread and exposure to others. Seriously. In the parking lot. Though it’s not how we usually do things, it’s the most effective way to prevent the spread in the clinic.
  • If you have severe symptoms, we will likely refer you directly to a hospital. From what we know thus far about COVID-19, symptoms severe enough to require hospitalization occur approximately 9-12 days after symptoms first appear.   
  • Currently we cannot test you for Covid-19, all testing as of today is still being done through the Department of Public Health. We are working with our lab vendor to confirm the exact specifics of when commercial testing will be available (like pricing and where the testing will be available).
    • Until we have clear direction from Quest and/or the CDC that there are enough testing kits for widespread testing, we will not be recommending testing for just anyone with symptoms of respiratory infection; we will be making this decision on a case-by-case basis. 

I cannot be more explicit than this: if we come into contact with someone who is positive for COVID-19, all Infinity Family Care staff & physicians who made contact with that individual will have to quarantine for 14 days. As we’re small, this may lead to a situation where we will have to close for all in-person interactions for up to (and potentially longer than) a 14-day period.  If this were to occur, we would attempt to still offer telephone triage and telemedicine visits. There isn’t any safe way around this.  

Again, we’re putting these guidelines in place to prevent the spread of this illness to the most vulnerable around us.  We so appreciate your understanding, patience, and effort to keep everyone in the IFC family healthy as we all see our routines upended a bit by this virus.

Don’t hesitate to ask questions or reach out.

Wendy Cohen, MD and David Cunningham, MD

Summary: What is Known to Date About COVID-19 and How to Protect Yourself

(used with permission from Dr. Allison Edwards, KCDPC – thanks Allison!)

The novel Coronavirus started in China in late 2019 (the working theory is that it jumped from bats to humans at a wet market in Wuhan, China) and was given the name COVID-19 by the WHO shortly thereafter. The virus eventually spread regionally and in February 2020 we saw cases extend to every continent (except for Antarctica).

Here’s what we know thus far:

  • Every single one of us has had a coronavirus infection in the past — it’s one of the viruses (along with rhinovirus, adenovirus, etc.) that causes the common cold. This novel Coronavirus (COVID-19) is just a variation (or mutation).
  • This new coronavirus can cause anything from nothing to a mild cold to a potentially lethal viral pneumonia.
  • Those who seem to be most affected by COVID-19 thus far are those who are more at risk to begin with: those who are older, those with multiple chronic health conditions, etc.
  • The evidence out of the initial outbreak in Wuhan, China revealed:
    • Median age = 59 years of age
    • 56% male
    • Rare cases in children under 15 years of age and these cases have been mild
    • Estimated basic reproduction number (the number of people an infected person infects) is approximately 2.2
    • The average length of time from the onset of symptoms to hospitalization was 9.5 to 12.1 days
  • There have been new coronaviruses in the past — most notably the SARS (2002, 2003) and MERS (2012 – Present) epidemics; however, the mortality rate of COVID-19 ( 2.0% or below) is notably lower than SARS (9-10%) and MERS (36%).
  • This virus spreads from person to person, though we aren’t exactly sure how.  Our best hypothesis is that it is spread via bodily fluids and droplets from speaking, breathing, coughing, sneezing, etc (and potentially through the GI tract).

Here’s what we don’t know:

  • We don’t know if this virus will peter out as the warmer months kick in; we also don’t know if this is a one-season thing or if it will come back strong again next cold & flu season. 
  • We don’t know when or if we’ll have a successful vaccine to prevent against this new virus.  In a late February 2020 press conference, Dr. Anthony Fauci did a great job describing how a vaccine is created (starts at about 11:00 into the clip) and how far we are away from a successful vaccine.

How to protect yourself & others:

  • Just like any other respiratory virus: stay home if you’re sick!
  • Just like preventing any other respiratory virus: take good care of yourself! Exercise regularly, eat nutritious, balanced meals, practice stress mitigation techniques, and get a solid 7-9 hours of sleep a night, etc.
  • Just like preventing any other respiratory virus: wash your hands! A lot!
  • Just like preventing any other respiratory virus: don’t touch your eyes, mouth, nose, etc., and get into the habit of washing your hands before eating.
  • If you can, avoid contact with those who are sick or are caring for the sick.
  • If you are not actively sick (or caring for someone who is), ear-loop/surgical masks are not likely helpful.  Healthcare workers will wear masks (and often higher-rated ones than the ear-loop masks), as they have a much higher likelihood of caring for someone with the disease and are prioritizing mitigating the spread to others.
  • Those who are exposed to someone with COVID-19 or who are being tested for COVID-19 will likely be asked to self-quarantine (currently not mandatory).  If your job permits, start asking your employer about work-from-home opportunities; if your job doesn’t permit work-from-home, ask your employer what their plan is to keep you safe!  
  • Because of the real possibility of a quarantine, stock a couple week’s worth of non-perishable foods items in a pantry.  Also make sure you have the basics — like medications, OTCs like ibuprofen, acetaminophen, diphenhydramine, and pseudoephedrine, and (a rational amount of) toilet paper, facial tissues, etc.  
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