Dear Patients and Friends,
We are clearly now in the middle of an expanding crisis, which by most experts’ opinions will continue to expand for at least the next 3-4 weeks. We are being updated by all of our local and national medical resources by phone calls, scientific webinars and real-time communications on a daily (sometimes hourly) basis, so that we are continuously abreast of the latest facts and guidelines that inform our clinical care for all of you. Everyone is being flooded with a plethora of reports, facts and advice. I wanted to make everyone aware of several “hot” issues so that you understand the position of the most well-respected clinical researchers and scientists to date:
The pandemic status.
We are now in a logarithmic growth mode of transmission and infection. This novel corona virus has never existed before so we have NO immunity to it. It is more easily transmitted than was previously hoped to be the case and it can be transmitted by people that don’t even know yet that they are infected. We can no longer hope to conquer it. The only strategy now to hopefully stem the tide for this crisis is CONTAINMENT. Since we do not have the supplies, resources or personnel to perform widespread and timely diagnostic testing, social distancing for everyone is the most powerful tool we have for containment.
What’s the latest on testing?
Testing for COVID-19 is currently available at all hospital emergency rooms and at Scripps and UCSD drive up clinics. The drive-up clinic testing requires an appointment which can be made by calling the following numbers:
UCSD: 8am to 5pm daily: 1-800-926-8273
Scripps: M-F 7am to 9pm, Sat and Sun 8am -5pm : 888-261-8431
Unfortunately, due to inadequate testing supplies, all patients requesting testing will be screened and only those meeting strict requirements will be provided appointments. Usually this means contact with a known COVID-19 patient, high fever, cough and travel to/from an endemic area. More available testing has been promised, but is currently not available (unless you’re an NBA athlete).
What can YOU do?
Please comply with the now well-known public health recommendations:
- Frequent hand washing. Wash with soap and warm or cold water which are equally effective.
- Cover all coughs and sneezes with a tissue or an elbow.
- Maintain 6 feet distance between people to avoid inhaling virus droplets. It is now thought that you can be a ‘silent carrier’ of the virus without symptoms or before symptoms appear.
- PLEASE honor lockdown for non-essential service providers.
- If you are an essential service provider, DO NOT go to work if you have any symptoms of fever, chills, shortness of breath or difficulty breathing, sore throat, cough, congestions, unexplained headache, muscle aches or gastrointestinal upset.
Can I come in to the doctor?
If you feel the need to seek help or guidance, please call and we will give you our very best advice. Even if you have any of the above symptoms, please do NOT go to a doctor’s office or emergency room-call first. There is no treatment for this virus that the doctor can give you in the office. If you are unable to control your fever or are experiencing difficulty breathing, then you should go to the emergency room to be fully evaluated, tested and provided with whatever supportive care is needed. One of the biggest risks we have now is having health care providers become infected or health care facilities becoming contaminated. There is a very real risk of quickly running out of available medical providers or facilities which would be catastrophic for us all.
Is Lifewellness Institute open?
YES!! I am in the office as usual. We have reduced our staff in order to comply with social distancing requirements and because most of our care and communications can most safely and effectively be handled by telemedicine. We are all fortunate in that, while telemedicine is relatively new for most providers and medical offices, we’ve been routinely doing this for the last 20 years. And I think we’ve gotten quite good at it. We LOVE to see you in person, but desperate times call for desperate measures and I just will have to give you a hug a bit later. If you have a condition that needs an exam, lab testing or imaging, we will make those decisions on a case-by-case basis and will be happy to have you come in for proper medical care and management – just not if you have any symptoms of a cold. Thank you for understanding that.
What about all the stuff I’m reading about trial medications?
- Here’s what Dr. David Morens, the Senior Scientific Advisor to Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases at NIH, said on a webinar that I participated in this weekend. So this is real-time, latest advice and information from the top Infectious Disease expert at NIH:
- NSAIDS (ibuprofen, naproxen, etc.): There is no scientific proof that these make us more susceptible to COVID-19 infections or make the infections more severe. This data was theoretical and was derived from a very severely sick cohort of patients, not proven, and there actually have been other reports that indicate a possible protective effect from them. Until we know more definite information the best advice is: Use acetaminophen (Tylenol) as first-line treatment and if that doesn’t control your fever, then go ahead and use NSAIDS as the next step, in addition to adequate hydration.
- ACE Inhibitors and ARB medications for Hypertension: There is no valid data that supports the need to stop or change these medications in patients who are taking them to control hypertension. A joint statement from the American Heart Association, American College of Cardiology, and the Heart Failure Society of America on March 17 gave full, unqualified support to maintaining patients on drugs that work this way, specifically the ACE inhibitors and angiotensin-receptor blockers (ARBs), which together form a long-standing cornerstone of treatment for hypertension, heart failure, and ischemic heart disease.
- Chloroquine, hydroxychloroquine and Zithromax: Dr. Morens said that there are over 20 current drugs being studied nationally and more internationally which all have been shown to have potential promise as treatment or prophylactic agents. The reports of positive results have been in such small numbers as to be clinically not significant. He hopes these or others might be shown to be helpful but it’s way too soon to be advising them at this stage. He sees no data that would support the rationale for widespread use of any of these drugs at this time other than in clinical studies or because of intensive care needs. We should know with much more validity in several weeks whether any of these drugs might be indicated. Until then he discourages use of them.
My advice on medications:
These drugs are currently not recommended for prophylactic use. Local pharmacies are essentially out of these medications because of the “toilet paper” mentality and we are being asked to prescribe them only for patients with documented Covid-19 infections who need hospitalization where they can be appropriately tried and also monitored for potential serious side effects. These medications have not been recommended for prophylactic use or for the 80+ percentage of patients who have mild symptoms and are most appropriately cared for at home. It is important to save the necessary medications for those who need it most right now. We are not prescribing them and are leaving that to the hospitalists who will make those decisions on a case by case basis for admissions. Thanks for your understanding and for helping us to maintain critical medical supplies for those with the most need. We are keeping abreast of recommendations from our infectious disease consultants and may modify our decisions based on their updated recommendations.
We are here for you and, as always, want to do offer everything possible to be your trusted partner in health and wellness. Thank you for your respectful cooperation and helpful feedback as we face this unprecedented medical crisis together. As always, it is a privilege to be on your medical team! In closing, we’d like to share these timeless and beautiful thoughts from poet Lynn Unger.
To your health,
Lee and the LWI team