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Coronavirus 7.0

As of next week there will be expanded screening ability for COVID-19 though not with unlimited capacity. The problem will be if possible but mild cases all flock to get screened they expose all those doing the screening and quickly exhaust testing kits. Most will be negative but what do you do while waiting for results? If someone is positive but well, they will be told to quarantine at home which they should be doing anyway. A better idea would be to have mildly ill people at risk stay home and quarantine there or ideally send teams to them to do the testing, fully prepared to do so. If you think about it, the people we need most if this gets bad are those in health care. Exposing them, their staff and their other patients just to get tested could put not only them and everyone there but their facility out of commission for varying amounts of time.

Our policy for now will be to ask that those at risk (see below) but only mildly ill stay home. We will contact DPH for further guidance on testing and treatment in those cases. Those that are more ill and have a travel history to China, Iran, South Korea, Italy or Japan, those exposed to travelers from those countries and of course anyone exposed to a known case should go to a hospital only if having difficulty breathing or are extremely lethargic. The hospitals can not deal with large numbers of what they call the worried well. Other people outside those categories are not candidates for testing at this point per the State DPH. We will continue to see and evaluate those persons outside the risk categories as we normally do during cold and flu season.

Remember from our last post children tend to be either avoiding this altogether or are being only mildly affected. Thats great news for parents and pediatricians! So far that’s holding up as more data keeps being accumulated.

There are a lot of mixed messages from the media ranging from doomsday to no big deal. Neither approach makes sense until we know more. I think we will see pockets of spread but they will be quickly identified and hopefully mitigated promptly. We are all a lot more informed than ever before and know how to slow or stop transmission.

One thing I keep watching is something the CDC puts out every week. It’s The ILI numbers and stats on hospitalization rates. (ILI stands for Influenza Like Illness). Despite claims this virus is already out of control, the ILI rates have been steadily dropping and the hospitalization rates are not different than in previous years. To me that indicates this has not really taken hold yet in a widespread way and if it starts to spike it will be doing so as the flu season winds down. As a rule all respiratory illness declines in the warmer weather and its not that far off now. All countries are taking steps to contain this virus. China is already seeing steep declines proving it can be slowed down with aggressive measures. Italy is following suit and the US may need to start making those same types of decisions soon.

Finally my firm belief is that the people at highest risk need to be protected by limiting their exposures. If sustained community spread is documented in our area, they should be the first priority. Those would include the elderly and any one with an underlying medical condition. Elderly persons with disease are at the highest risk by a lot. The charts below illustrate the stark differences among the ages and the declining ILI rates. This data set is from the China CDC equivalent and does not take into account underlying illness. The rates would be across the board lower taking that into consideration and drop to less than 1% overall. For young heathy people the risk of severe illness and death becomes extremely rare. Those numbers are reassuring but only if the total case load stays manageable.

We will keep you posted here and on our business hour greeting