Good morning,
I hope that you are doing well. I attended a webinar conference hosted by the Collier County Medical Society last night. One of the infectious disease specialists from NCH gave an hour-long summary about the present status of Covid-19 as well as reviewing the up to date studies about its treatment. It was an excellent presentation, and I want to give you a summary:
The new infection numbers have improved- reinforcement was given to use masks, wash hands, and maintain social distancing as they are helping.
Dr. Witherell discussed the difference between rapid antigen testing and the preferred nasal swab PCR testing. Rapid antigen testing is being done in areas where there are large groups of people (i.e. schools, retirement facilities, hospitals, urgent care centers, etc..) and faster results are needed. Unfortunately, they are not as accurate as the nasal PCR testing which take about 3-12 days to return. The recommendation was that if a person does a rapid antigen test and has a positive result, that is to be taken as a positive. If the result is negative but a Covid-19 exposure happened or infection symptoms are present, then a confirmation test needs to be sent out via nasal swab PCR testing. Until the result returns, that person should self-isolate at home.
If someone is found to be positive for Covid-19, they need to self-isolate. Those who have mild to moderate symptoms (=not requiring hospitalization) need to self-isolate for 10 days- they may stop the self-isolation after that time if there has been no fever for over 24 hours and the infection symptoms have improved. If someone was hospitalized for a severe Covid-19 infection, then the self-isolation is a total of 20 days after the 1st symptom. Those that are Covid-19 positive but remain completely asymptomatic need to self-isolate for a total of 10 days. The purpose of self-isolating is to decrease the spread of infection to others.
Outpatient Treatment: There is NO prescription treatment for mild to moderate COVID-19.
Supportive care is advised (fever reduction, hydration, decongestants for cough/congestion, etc..). Self-isolation is essential. Of note, sleeping and lying down in the prone (face-down position) is helpful. There has been NO proven benefit with the use of antiviral therapy in mild to moderate disease.
Treatment of severe Covid-19 infection: hospitalization is advised for those who start to drop their oxygen levels below 90% and require oxygen. Isolation precautions are started as well as placing in a prone position as much as possible. Steroids called dexamethasone are given for 10 days which has been shown to help the lower oxygenation problem that is going on. Antivirals like Remdesivir are offered but interestingly, they help to shorten the duration of the virus but have not been shown to impact the death rate from the infection.
Outpatient vitamin supplements: there was a protocol devised by one center regarding possible helpful vitamins that may be used as prophylaxis and treatment. I had shared this protocol with you at an early Covid-19 time email. These supplements have NOT been shown to help but are not harmful so they are ok to take. Of interest, recent studies have shown that those with vitamin D levels at goal BEFORE getting sick did much better than those with low levels. There seems to be a protective effect of having an adequate vitamin D level before getting sick. Please take the vitamin D supplement advised by me at your routine visits and lab draws. Taking more than needed may raise the level too high and increase your chance of a kidney stone so please avoid this. Studies are ongoing regarding the benefit of vitamin D therapy during an acute infection. Vitamin C is helpful only in IV form in the hospital. Oral over the counter forms of vitamin C have not been shown to help.
Experimental Treatments: Plasma therapy made of antibodies of those that had a Covid-19 infection has been somewhat disappointing. There has been no clear benefit to date in those who have a normal immune system that mounts an antibody response to the infection or if it is late in the infection process. Those with complications early in the disease or who have a compromised immune system (i.e. those on chemotherapy) have been shown to have benefited from this treatment. As no harm has been found from getting the therapy, it is still an active option for those requiring hospitalization.
There is an experimental therapy called Monoclonal Antibody Therapy which is what President Trump apparently received. This may provide antiviral help and a large number of studies are being done for possible prevention and treatment benefits.
Hydroxychloroquine was initially felt to be a good treatment for Covid-19. This is NOT the case and is no longer being used in protocols. Also, the risk of possibly harmful side effects is high.
Mask type: cloth masks need to be frequently washed. Masks with a valve on them are NOT safe. It is the equivalent of not wearing a mask. This type of mask will not be allowed to be worn in the office. N95 and surgical masks cannot be cleaned and need to be replaced frequently. The medical teams are advised to wear a new one daily.
Shields: they may be placed in addition to a mask for eye protection, but are not to be used alone as they do not prevent inhalation of Covid-19 droplets from all of the open spaces. They should be cleaned daily.
Vaccines: Of interest, both the Flu vaccine and MMR vaccines have been shown to have a small protective effect if a Covid-19 exposure occurs after getting the vaccine.
Please make sure that your flu vaccine has been obtained. Please call the office at 239-596-8702 to schedule this.
I found this webinar very helpful in explaining the present update of this terrible infection. Please let me know if you have any questions.
Our "season" has started here in SW Florida. We are scheduling our appointments in a way of decreasing the chance of having multiple patients in the office at the same time. We will continue to follow the guideline of only having patients at the appointments. We will be asking family members and companions to wait in the car. If you have an appointment but have a fever, please let us know by phone as soon as possible. Covid-19 precautions will be ongoing in the office with cleaning protocols, hand washing, hand sanitizer, and having everyone present in masks. If your next follow-up appointment has not yet been set up, please call Debbi at 239-596-8702 to do so.
I look forward to seeing you soon. Have a wonderful rest of the week.
With Kind Regards,
Cristina Sciavolino-Day, MD
