2 March 2020 Blog Post: Important Information for Our Patients

Today was an extraordinary day in regards to #COVID-19, the novel coronavirus that continues to spread across the world. Today’s daily situation report from the World Health Organization (WHO) listed 88,948 confirmed cases worldwide (1,804 of them new). The disease is present in 65 countries, including six countries that reported their first cases the previous day (Armenia, Czechia, Dominican Republic, Luxembourg, Iceland, and Indonesia).

In the United States, there are now 105 confirmed cases, 5 deaths and 7 recoveries. The Seattle area and environs has the largest cluster with 4 cases and 1 death in Snohomish County plus 14 cases and 5 deaths in King County. There are 27 Kirkland, WA firefighters and 2 police officers in quarantine after responding and transporting coronavirus patients from the Life Care facility. Statistical modeling has suggested that there could between 350 and 550 as yet undiagnosed cases in Washington State. The CDC will hold a call for physicians and other clinicians on Thursday, March 5, from 2 to 3 p.m. ET, covering what to do to prepare for COVID-19 in the U.S.

This call is too little, too late. Our small Santa Monica clinic was inundated today and, at some points today, we were falling 2 hours behind our scheduled appointment times. Conversations during routine physical examinations stretched on as patients, particularly our older patients with chronic medical conditions, had numerous questions about how to protect themselves and prepare. We had numerous phone conversations which have stretched on late into the night. Given the situation rapidly unfolding in Washington State, it is only reasonable to assume (or at least prepare for) community wide spread in Los Angeles.

To this end, our clinic is physically under-equipped to diagnose and appropriately isolate a suspected coronavirus case. We do not have a negative pressure room nor physical capacity to effectively isolate patients. Current guidelines set forth by the Los Angeles County Health Department suggest patients be brought in by a separate entrance, placed in an dedicated room, attended to by staff in full protective gear, and that after disinfecting the room, to not use it again for 2 hours. So that permits us to see 4 patients a day. During a typical cold and flu season we can have 15-20 patients that need evaluation – and this is anything but typical.

For our patient’s safety as well as to mitigate community wide spread of coronavirus, we have now implemented a virtual office approach for any patient with concerning symptoms.

1. Please call our office should you become ill with symptoms such as fever, cough, or shortness of breath. Our office number is (310) 828-4411
2. Our clinical staff will conduct a telehealth assessment with you. Expect that this will take 15-20 minutes. It will include your current symptoms as well as travel history and any exposure to anybody else who has been ill.
3. Based on clinical algorithms, we will identify those patients who can be managed by telephone and advised to stay home, and which patients will need to be sent for emergency care. We have additional capacity to perform video-based conferencing with you as well.
4. We will follow-up all of our initial assessments with a second call in 24 hours. We may continue regular ‘check ins’ thereafter to assess for any improvement or worsening
5. Should you symptoms worsen, please call us back or activate EMS via ‘911’.
6. We can also help engage local public health, home health services, and community organizations to assist with support services (such as delivery of food, medication and other goods) should you need to be treated at home.
For our patients being seen for routine visits and those without symptoms, we would ask for your patience and good humor in this extraordinary time. Dissemination of routine imaging and laboratory results may not occur in the time frame to which you have become accustomed to from our office. The CDC has further recommended that:
1. We begin to reschedule some non-urgent outpatient visits as necessary. This will begin 3/3/2020.
2. We reach out to patients who may be a higher risk of COVID-19-related complications (e.g., elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women) to confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
3. Lastly, we accelerate the timing of high priority screening and intervention. This has already begun.
We are expecting to manage an influx of COVID-19 patients in the weeks to come. Recent reports suggest that approximately 80% of COVID-19 patients (of all ages) have experienced mild illness. Managing persons at home who are ill with mild disease can reduce the strain on our clinic and the healthcare system in general.
As always, we remain available for questions or concerns at (310) 828-4411.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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