1. Reduce unnecessary healthcare visits.

2. To prevent transmission of respiratory viruses within our clinic, particularly to the most vulnerable of our patient population.

 

To our telemedicine modality, we have also added video-conference capabilities and will begin to roll out that option tomorrow. We have performed 32 remote assessments over the past two days. We appreciate the understanding from those who have had their more routine visits postponed during this extraordinary time.

 

At this writing there are a total of 125 confirmed COVID-19 cases in the United States with 9 total deaths and 8 recoveries. The global case count is now above 90,000 with over 3000 deaths, according to the World Health Organization. Twelve new countries reported their first case in the past day.

 

A study published today in MMWR detailed secondary infection rates among 445 people who had close contact with one of 10 U.S. patients with COVID-19. Over 14 days, 12% of contacts developed new or worsening symptoms and were tested for SARS-CoV-2. Two contacts — household members — tested positive. The overall symptomatic secondary attack rate was estimated to be 0.45% for close contacts and 10.5% for household members.

 

There has been some initial discussion about potential utility of HIV protease inhibitors among more seriously ill COVID-19 patients. In Singapore, 5 patients who required supplemental oxygen also received lopinavir-ritonavir (Kaletra) which is used in the treatment of HIV. Results were mixed with three patients improving and two worsening after beginning medication.

 

Lastly, in a larger sample of 18 patients from Singapore, the median duration of viral shedding in samples from the nose and throat was 12 days. COVID-19 virus was detected in the stool of half the patients tested. These findings would lend additional support to the currently recommended 14 day quarantine from the last date of exposure to the virus.