I promised myself at the beginning of this crisis that none
of my patients would succumb to Covid-19 if I could help it. I know that may
sound a little selfish since there are other doctor’s patients who may die but just
as a parent prioritizes their family, charity begins at home.
I still believe that goal is achievable.
The reason I write all these emails is an attempt to realize
that goal. Yes, as I have said ad nauseum prevention is better than cure. This
is an absolute truth. People nod and pay lip service to the notion but then
quickly forget it. This is why I harp on the basics: hand washing, sanitizing
and social distancing.
So why am I boring you with this again? Because I hear
people talking about “the way forward” and “opening up the country” and
“flattening the curve” and other political rhetoric. People are starting to get antsy with cabin
fever. I know you are fed up with being inside and I don’t mean to sound unsympathetic
when I say: you are bored but you are alive! Keep it that way.
Stay the course. Do you want to venture out just to prove
the point? Please don’t!
You heard it here first: If some politician comes up with
the idea that your kid should return to daycare without having the guidance of
sound science, don’t do it. It is not worth it. What is the rush? I understand
you are missing baseball, but it is not going anywhere. You may feel it hasn’t
affected anyone in your neighborhood yet.
That’s a wonderful thing, don’t be the first.
On the same day last
week I was notified of my first two patients who were PUI (person under
investigation). That’s a term that is used when the person is thought to have
Covid-19 but doesn’t yet have a positive test.
As a physician I know I shouldn’t take this to heart.
However, I do because unlike a lot of serious illnesses that I see, like
cancer, this one is 100% preventable. I have been screaming at the top of my
lungs for over a month for folks to get it together.
So I want to tell you what I learned in the last five days
from my two patients.
One was a young lady with no risk factors except she works
in the medical field. She had contact with a co-worker with a fever, who tested
positive. Two days later my patient
started to feel bad. She had body aches and tiredness and lost her sense of
taste and smell. A day later she started to have a horrendous dry barking
cough. We talked via telemed and I was shocked at how forceful the cough was.
My first thought was OK we are going to beat this. I gave
her and her husband a list of things to do and called in three prescriptions. I
told her I wanted her to check in with me daily and of course get tested. She
did not get her results until this morning!
As soon as I saw her face on the screen today I knew she was
feeling better. She was smiling and said her cough was minimal. This news made
my day.
I am not going to share my regimen here because I don’t want
people trying to treat themselves at home unsupervised. Funny enough she feels so good she thought she
could go back to work next week………..uh, no!
What I learned from this case:
·
Start early. You can’t wait for test results and
even when you get them they may be false negative.
·
She must still act like she has Covid and
protect her family for another week.
·
She never got a fever but otherwise was classic
Covid with a known contact.
·
Keep a viral mix and Tylenol at home just in
case.
·
We can handle this!
·
Her test was done at Sinai Hospital and took
five days to get the results, way too late to be useful. Her test was negative
when it finally came.
My second case was a gentleman with a lot of ‘co-morbidities’.
On paper the classic poor outcome. In retrospect he probably should have
stopped his auxillary services work at the hospital two months ago.
His wife called in a panic. He had been sick for 3 days and
wouldn’t go to work (or the hospital for that matter) until she noted he had a
really high fever. His test was positive.
He was admitted to ICU and given oxygen. He has since moved
from the ICU and is doing much better. His wife was notified within 24 hours
that her test was positive too and a day later we were discussing a customized
regimen for her.
Lessons learned:
·
Don’t wait.
With Covid, catch it early and
improve your chance of recovery. Hopefully one day we will all be able to be
tested proactively.
·
It depends where you get the test done how soon
you get the results.
· He is sick and his wife is
not. This case proves again that the test is only a tool not the final say.
·
Always err on the side of caution and act like
your test is positive. Especially for your family’s sake.
·
Last but not least: do not quit when you are
ahead. Don’t ease up on your care and preventive measures for at least 2 weeks.
·
I worry about patients who don’t have their own
primary care physicians! These are confusing times.
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