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Coronavirus Update: 8 July 2020

Dear Patients,

Four months and one day ago, I posted my first COVID-19 update. On March 6, if someone had said “You know, you are going to still be writing these updates 17 weeks later,” I would have crawled back into bed and pulled the covers over my head.

No. I did not see “this” coming. But, here we are and by “we,” I mean the ENTIRE world. I am technically on vacation right now, but like it or not, this damn virus does not believe in R&R... so another update it is.

This week, there is much to share. For you skimmers, to follow are updates on the current state of affairs, “invisible mist”, the PA Travel Quarantine Recommendations, testing criteria, smell screenings (no, really), and highlights from my first trip since last February.

The Current State As you all know, case counts are up in the US and most of the added cases are in states in the West and South. Despite the rising numbers, hospitalizations and death rates have NOT kept up. While this appears to be good news, it is important to remember that there is always a lag between a reported case and a reported death. So, the next few weeks will truly be critical in the analysis of the current case fatality rates.

In PA, we just had our highest daily case count since May, but only ONE death reported — the lowest since March.

More young people are being diagnosed, and they historically have lower death rates.

But, it is important to remind everyone that “death” is not the ONLY thing to fear with this virus. Thousands of people have suffered from long term debilitating consequences like strokes, lung damage, etc., so again, regardless of death rate, this is a virus to be feared.

“Invisible Mist” A group of international scientists has appealed to the WHO to address the concept of the virus lingering in an aerosol, especially in indoor places. This could contribute to a higher rate of infectivity even if the 6-feet-apart rule is respected. So, what to do with this information:

  • Stay home if you are sick.

  • If you're spending time indoors, wear a mask.

  • Avoid indoor crowded places, like bars and restaurants.

Please note: it seems that airplanes are actually safer when it comes to aerosolized viral particles because of the air circulation. However, what is between you and that “safe” plane seat? Chances are, a very long and crowded security line. Here, masks and distancing are critically important.

PA Quarantine Recommendations PA issued guidelines this week recommending that travelers returning to Pennsylvania from any of these 15 states go into a 14-day quarantine. If you can avoid travel to one of these states given this information, please do. For those that must travel to one of the 15, please plan on having your vacation extended by another two weeks at home. These quarantine guidelines are recommendations but difficult to enforce, so it is up to all of us as individuals to bear the responsibility.

PCR Testing (or as I call it, the massive-stick-up-the-nose test) Unfortunately, testing for SARS-CoV-2 is still limited in our area. Testing sites are reserving testing for symptomatic patients. This is NOT ideal – without testing, we cannot trace contacts or get accurate case counts. For now, if you suspect that you have been exposed to SARS-CoV-2 (the virus) but do not have symptoms of COVID-19 (the disease), please stay at home and contact us via virtual visit for further instructions.

It should be noted that we do not perform PCR tests here at our office, and there are screening processes outside of our control in use at medical facilities where they do perform this testing. Patients should expect delays if PCR is performed due to overwhelming increase in testing demand.

Temperature Screening vs. Smell Screening Many places, including our offices, have used temporal thermometers to screen employees and staff for temperatures prior to allowing entry into our offices. These temperature screens are meant to catch patients with above normal temperatures. The idea is that a person may have an elevation in temperature prior to showing any other symptoms of illness. These touchless thermometers are very sensitive. So for the person being temperature-checked, a few minutes spent in a hot car may cause a high reading. Conversely, a few minutes in an air-conditioned vestibule may cause a low reading.

This week, a group of experts proposed that “smell” tests may be more reliable. The truth is that in our limited population, the loss of sense of smell and taste was THE most common symptom of COVID-19 (more than fever even). However, just thinking through the practicality of mountains of chopped garlic, onions, and gallons of mouthwash set out in little dishes makes my head spin.

A good take-away, though, is to pay attention to your smell (sense of, not “when was the last time I washed my hair”). If you notice that a smell or taste you normally would have noticed keenly seems duller, pay attention to it. Schedule a virtual visit with us, and we can discuss the implications further.

... And, A Travel Diary Two weeks ago, Chris and I traveled to the Napa Valley. And because I have received dozens of questions in my multiple live Q&As about the risks, the rewards, and the recommendations for travel during the pandemic, I wanted to share some highlights of the trip.

In a word, it was amazing. We flew Southwest Airlines, and every middle seat was open. Everyone was forced to wear a mask the entire flight. No one on either of our flights complained.

We stayed in a lovely and small B-and-B. Only three of the six rooms were occupied. We spent very little time indoors – all of our wine tastings and restaurant meals were outside. When we did venture into stores, customers were counted and masks were mandatory.

We felt extremely safe. Further, for us, this trip was critical to our mental health and the well-being of our marriage. As is the case for everyone, these past four months have been challenging for our family in innumerable ways – one kid home from college three months early, one “graduating” senior, one distraught tween, two essential businesses, 50+ employees, and two sets of elderly parents.

I am not saying the decision to take a weekend trip would be right for all, but it was CRITICAL for Chris and I.

I would encourage those considering travel to first, look at PA's list of 15 states requiring post-travel quarantine (see above). Our trip to CA happened before those guidelines were released. I would use airlines that are holding seats, and I would select vacation destinations and activities where you will spend the vast majority of your time outside.

Whether you decide to steal a weekend away, or hunker down at home a while longer, or some middle ground in between, please hang in there. I know how hard these times have been. I have weekly “meetings” with my breaking-down-self in the privacy of my toilet stall. It is okay to be frustrated, angry, depressed, despondent. We ALL are at times. But just know that EVERY pandemic ends. As I said in the start of this letter, I NEVER expected us to be having this conversation in July, but the fact is that it. will. end.

And, on the optimistic side, we will have learned so very much. We will respect personal space more, and ridicule chronic mask-wearers and hand-washers less. We will also learn to appreciate the beauty of the outdoors (no, I will never go camping) and the comfort of family. And as I say, as a country, we will have learned to stick together by staying apart.

Stay safe out there,


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