What GPs should know from BMJ, NHS-UK
Consider covid-19 infection in anyone with cough, fever, or breathlessness who has had contact with someone with covid-19, or has returned from a high risk area in the 14 days before the onset of symptoms
- Every effort should be made to avoid in-person assessment of patients with possible covid-19 in primary care
GP surgeries should plan ahead and develop clear protocols for managing possible cases, including isolation procedures, personal protective equipment, seeking specialist advice, and decontamination
One-page Infographic of this article
ASSUMPTION: Transmission will be primarily through exposure to respiratory droplets and direct contact with patients and their contaminated environments.
Universal Early Preparation
☐ Educate staff and patients about changes they can expect to be implemented in the office
during an outbreak or pandemic, and about ways to prepare themselves and their families.COVID-19 Office Prep Checklist
Commonsense information from the US (rare occasion) on 11 March 2020.
Listen to this – takes 12 minutes. Well worth. LINK
The One Stop Shop by CDC, USA that was uploaded yesterday- LINK
Question Beyond good hand hygiene and common sense regarding reducing transmission, what can we tell our patients about COVID-19 both to make them aware of the potential risks but also to hopefully calm them and help with the sense of panic that we’re feeling?
Answer So I think to give them the broad picture without unnecessarily sugar-coating because we’re in a really serious situation here.
But for the individual patient I try to explain that they should not take upon themselves the burden of the broader global health issue. So if you look at the situation of what it means to get infected, in the United States as a country in general the risk of getting infected is clearly very low.
However, the situation is changing, it’s evolving, and the difference of sitting in a place where there are either no cases or two or three easily documented cases. Like a travel case: Someone comes in from Iran to New York, they nail it, they isolate them, it isn’t in the community yet. You have a cluster there.
But for somebody who walks into an ER in an area where there isn’t community spread, the risk of getting infected is low. However, if you do get infected we need to look at the data that we have now and the data predominantly are from China, South Korea, northern Italy, and Japan, and that is about 80 percent of the people who get infected do well. I mean, they’re not asymptomatic, they have a flu-like illness but they recover spontaneously without any specific medical intervention, so to give them a feel.
However if you are an individual who has an underlying condition of which you’re all familiar with — chronic obstructive pulmonary disease, cardiovascular disease, congestive failure, diabetes, anything that could compromise your immune system — if you get infected then you have a much higher chance of having a complication, and then if you look at the serious disease and death it’s totally weighted to that group with the occasional one-off outlier that we even see with flu: A 35-year-old person who’s perfectly well gets the flu and then gets really sick and might die. That can happen, but different from flu, children and young people do really, really well with this.
So you give them the broad picture, that should take like two minutes in the office to tell them that. Then you tell them what do you need to do. Right now in places like Seattle, LA, New York, and Florida there’s clear community spread so what you need to do is start already what we call social distancing which some people don’t understand what that means. It just means separating yourself as best you can. No crowds, don’t get on crowded planes if you’re a senior citizen, particularly with an underlying condition. Don’t get on a cruise ship for sure. Wash your hands as much as you possibly can, and if you have a person in your own home who is immunocompromised or falls into that compromised group, you almost have to act like you yourself are infected.
So if you’re a 35-year-old person who feels healthy and you have someone in your home that’s on cancer chemotherapy, you’ve got to protect them. You’ve got to physically distance yourself from them. Now that’s now in Massachusetts.
If you happen to be in Seattle you’ve got to do more than that. You yourself have to do a lot of social distancing because when you have community spread then you just don’t know the penetration in the community unless you do a massive screening in the community, and that’s where we really need to catch up because what I’d like to see is just flooding the system with testing to see what percentage of people who come into any emergency room actually have COVID-19. If that’s 0.1 percent, okay. If that’s four percent, time out, we really have a problem. Anyway, I was a little bit more long-winded than my usual answer but…
Question I’d like to ask you, Dr Fauci, what do you consider the best sources of information for clinicians and the public who want to keep abreast of that changing information? Is it the CDC site or is it MMWR? What would you recommend?
You know, the CDC has put up a site, the Federal government, it’s an all-of-government site. It’s called Coronavirus.gov. They just put it up. I mean, we said at the press conference yesterday “Just dial coronavirus.gov,” and I did and it wasn’t where I needed it to be. But it should be there today. The other thing is that what we’re putting up on the website is something that we literally put together yesterday and it is what to do at home, what to do at the workplace, what to do in the hospital, what to do here, and really simple talk that not only physicians can benefit from but the general public.
Question What do the clinicians themselves do? What should they be doing given the conflicting ongoing need to be able to continue to screen and treat patients who are potentially affected, but also avoiding getting ill themselves? We know the basics of wearing the masks and the gowns, but what else can we be doing or what should we be doing as a system to protect our clinicians?
Answer Yeah. I mean, obviously that is so critical because if you look at what happened in China, the healthcare providers, I mean, there was like 1700 of them in just in the city of Wuhan who got infected. I would do as strict precautions as you possibly can. I would clearly wear a mask, absolutely. I would wash your hands until it starts getting chaffed. I mean, we do that anyway with universal precautions but I would clearly do that.
The other thing, if you start and you will, guys. You’re going to start seeing cases come in. I mean, it’s inevitable.
Yeah, I would just…when people call in, and I know you’re doing that, you got to tell them and you said you have a system that’s segregated, that if you feel sick don’t just come into the emergency room. Stay at home for now and if you’re going to come in, figure out a way that they don’t come in and essentially infect five other people when they come in. That I think the clinicians need to know.
First instinct is that if this person has it I want to take care of them. You can take care of them but you got to be careful about essentially making the matter worse.
Question Dr Fauci, I wanted to ask you, what is the one thing you hope that people listening to this podcast will do differently in response to COVID-19?
Answer You know, it’s a binary thing. I want them not to panic because panic gets people to do unreasonable things that are even counterproductive to what you’re trying to do from a public health standpoint. You might overwhelm systems when you don’t need to overwhelm systems. But on the other hand without panicking and without making it dominate your life, pay attention to the fact that you have to act differently like you’ve never acted before. You’ve really got to be socially distant.
You know, it’s very interesting that my deputy was one of the two Americans who went to China as part of the WHO umbrella group that visited and in China now, they got hit badly, they had a few missteps in the beginning but they’re getting it right now. I mean, they’re really being super, super careful. They don’t allow anyone to eat at a common table. They have these little tables that are separated from each other in the hospital and other places where people don’t mingle. I mean, we’re all social beings but for the next few months, and I hope it does go down, it might not, but I hope it does the way flu does, we just got to hunker down. It’s part of what we need to do, we need to hunker down.