4 March 2020 Blog Post: COVID-19 Update

This morning Los Angeles County reported it second case of novel coronavirus infection hours after Orange County reported two presumptively positive cases. No further details were available from the LA County incident case except that Kaiser Permanente is involved the patient’s care. In the two Orange County cases, these involve a man in his 60s and a female in her 30s both with recent travel to countries with widespread transmission.

These cases bring the US totals this morning to 128 cases, 9 deaths and recoveries. Given a worldwide estimated mortality rate of 2.3%, the 9 deaths alone would suggest a minimum of 391 cases in the US. Undoubtedly the number is far higher.

The lack of known cases is a direct function of the scarcity of clinical testing. I have highlighted in previous posts how the CDC made critical mistakes by producing and sending out faulty lab tests (for a scathing review see link)

Yesterday Vice President Mike Pence stated that new CDC criteria call for “Americans (to) be tested (for coronavirus), no restrictions, subject to doctors orders.” This statement was followed by an additional misleading statement from Dr. Robin Patel from Mayo Clinic who stated “It’s really good overall that we can now offer this testing for patients. It’s a big advantage because it means people can go in and get tested and find out if they test positive or negative for this virus.”

So reality check before you call my office (and trust me I would be thrilled if I could just order a test as the Vice President suggests I can do or sent you to a lab to get tested as Dr. Patel states

Testing kits are indeed available through The California Department of Public Health. But guess how many tests they are able to administer? The kits contain enough material to kits to test up to 1,200 people. There are almost 40 million people in California. Testing capacity by the end of the week will rise to 75,000 people – across the entire US.

The limited testing capacity stands in stark contrast to other countries dealing with outbreaks; South Korea can test 10,000 people per day (and even created drive-thru testing facilities which I have highlighted on our Twitter account) while the U.K. has done 13,000 tests so far. The U.S. has only tested 3,600 people.

Lastly, CDC today has just this morning recommended that patients with symptoms that could be consistent with #COVID-19 now be evaluated by telemedicine modalities. At our clinic, we have been doing that now for 3 days.

The LA County Health Department now highlights the following preparation procedures:

1. Have provisions that will last a few days (water, food, essential hygiene, etc.)
2. Get immunized against the flu. This will relieve what could be a highly impacted healthcare system
3. Stay home when you’re sick (don’t wait until you are VERY sick)
4. Make sure you are using a robust, regular cleaning schedule for frequently touched surfaces
5. Wash your hands frequently
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Today Santa Monica Primary Care we will add video conferencing to our remote triage and follow-up check in system for patients with worrisome symptoms. We have also begun a process by which a health family member or acquaintance can come pick up a nasal swab to see if your symptoms may be due to another cause such as influenza, bacterial infection or the common cold virus. We will continue to employ these methods to protect our patients, the community and especially those most vulnerable to the effects of novel coronavirus – namely the elderly and those with chronic medical conditions. Specific testing for #COVID-19 is simply not available on a sufficient scale and it may be weeks before independent laboratories can have validated testing available.
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𝗦𝗢𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 π—’π˜‚π—Ώ π—‘π—²π˜„π˜€π—Ήπ—²π˜π˜π—²π—Ώ

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