March 24, 2020in Doctor Resource

Alerting Everyone to Separate and Stop the Pandemic

Centers for Disease Control (CDC) continues to closely monitor the COVID-19 coronavirus outbreak that originated in Asia in December 2019. The first patient in the United States was discovered in January, and the outbreak became a global pandemic by March. Initial detection and prevention measures by the US government were small, leaving doctors now battling to stay ahead of this first wave of coronavirus patients.

COVID-19 coronavirus tests, whether they be nose-swabs, throat-swabs, or blood tests, are still very limited in supply. Only people with specific circumstances (listed below) should get tested at this time. Even if thousands more people could be tested, doing tests will not save the day. What will flatten the wave and stop the rush of new infections is if every person stays in one place for 3-4 weeks and thus stops themselves from catching the coronavirus or giving it to another person or family. That is the key.

Symptoms start appearing about 5 days after catching the virus, plus or minus one day. That means persons sick with cough and fever who call HealthTap doctors on video today are probably people who caught the virus last week. If our entire population stays apart from one another, we should see a dramatic drop in new patients in 5-7 days, not right away. COVID-19 is an infection that travels from person to person, so if we stand at least six feet from each other, we break the chain. That saves the day.

Preventing spread – The World Health Organization (WHO) learned from previous coronavirus outbreaks, the Middle East Respiratory Syndrome and the Severe Acute Respiratory Syndrome, that human-to-human transmission occurs through droplets in the air, direct personal contact, and objects touched by other people.

The WHO recommends during this coronavirus outbreak:

  • Social distancing: avoid close contact with people who are coughing, sneezing, or sniffling
    • In real life, people may be contagious 2 days before they have symptoms, so we should avoid contact with all people, not just the ones showing symptoms
  • Frequent handwashing or using alcohol hand sanitizer: especially after contact with ill people or their environments
  • Avoid touching your eyes, nose, or mouth: to avoid catching the viruses your hands pick up from touching objects and surfaces
  • Practice cough etiquette: maintain a distance from others, cover your coughs and sneezes with disposable tissues or clothing, and wash hands afterwards
  • Stay home if you have any mild symptoms. If you have a fever, cough, or breathing symptoms, call your doctor by video or phone, to ask what to do next. For emergencies, call your local emergency number for an ambulance
    • In order to break the chain of viral transmission, people really have to stay home for 3-4 weeks regardless of whether or not they have symptoms. This is because people may be contagious for 2 days before showing symptoms.
  • Read more about the World Health Organization’s recommendations at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Testing patients – Test kits are still in short supply in the US. China began exporting test kits to help other nations after stamping out its first wave of COVID-19 and ending up with extra test kits and supplies. In most other nations, with a shortage of tests, doctors use their experience and judgment to decide if a patient has signs and symptoms compatible with COVID-19 and whether or not a patient should be tested. Priorities for testing include:

  • Hospitalized patients who have signs and symptoms of COVID-19
    • Patients not sick enough to be hospitalized probably won’t get tested
  • Symptomatic older adults, or persons with chronic medical conditions or an immunocompromised state that may put them at higher risk (examples: diabetes, heart disease, immunosuppressive medications, chronic lung disease, chronic kidney disease)
    • Younger people, and people without symptoms, probably won’t get tested
  • Persons who in the 14 days prior to showing symptoms: had close contact with a confirmed COVID-19 patient or a suspected COVID-19 patient,
  • Persons who within 14 days prior to showing symptoms: had travelled in regions with high COVID-19 activity. See CDC’s risk assessment by country at: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
  • As more tests become available, especially tests in which people can collect their own samples without a nurse or doctor, more people can get tested, even people who might not meet the above criteria
  • Read more about the CDC’s coronavirus testing recommendations at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

Robert Kwok

Robert Kwok

Robert Kwok, MD, Director of Health Informatics at HealthTap, is a board-certified physician who practiced medicine for 27 years. He earned his MD and pediatrics credentials at Baylor College of Medicine. Before HealthTap, he practiced clinical pediatrics in Northern California, most recently with Stanford Medicine.