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TRUMP SAYS THAT CHLOROQUINE WORKS!

Thursday, March 19, 2020 // Uncategorized

There you have it.

Actually, the FDA is not anymore sure today than yesterday.

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Is Chloroquine an Effective Treatment for Covid-19?

Wednesday, March 18, 2020 // Uncategorized

The bottom line is we don’t know, but I’ve been asked this question 5( a sixth time while writing this) times today, including from a neurologist who takes it for other reasons. This stems mainly from a jerry-rigged article that came out a week ago.

https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub

It has not been published in a peer-reviewed journal. There are anecdotal reports that chloroquine may shorten hospital stays. In medicine we like to say that data is not the sum of anecdotes. There is no proof that you can take it as a prophylactic.

• Rumors of the drug as a cure popped up in March when a WhatsApp voice message in Nigeria claimed the drug could be a cure for COVID-19, according to AFP.
• The World Health Organization said in a statement back in February that the drug isn’t a confirmed cure for the coronavirus and definitely needs more testing.
• The statement came from Dr.Janet Diaz, the head of clinical care for WHO’s emergency program.
“At this moment in time there is no proven effective treatment for COVID-19 so that is clear at this moment in time. However there are ongoing clinical trials being done in China at this moment as well. The two that we’ve already discussed are testing the priority therapeutics that were prioritized by the WHO R&D blueprints and that includes lopinavir and ritonavir as well as remdesivir. For chloroquine there is no proof that that is an effective treatment at this time. We recommend that therapeutics be tested under ethically approved clinical trials to show efficacy and safety.”

What is the downside of taking Chloroquine? For the most part it is well tolerated by those who take it for autoimmune illnesses. I have taken it years ago when we gave it for malaria prophylaxis, but in that case it was taken once a week and in this paper it is taken daily. Here are the potential side effects from Epocrates:

Adverse Reactions .
Serious Reactions
• anaphylaxis/anaphylactoid rxn
• skin rxn, severe
• photosensitivity
• retinal damage (high dose or long-term use)
• retinopathy (high dose or long-term use)
• macular degeneration (high dose or long-term use)
• auditory toxicity
• neuromuscular impairment, severe
• polyneuritis
• neuropsychiatric disorders
• agranulocytosis
• pancytopenia
• aplastic anemia
• thrombocytopenia
• neutropenia
• QT prolongation
• seizures
• hepatitis
Common Reactions
• nausea/vomiting
• anorexia
• diarrhea
• abdominal pain
• blurred vision
• visual disturbance
• headache
• skin eruptions
• skin pigmentation abnormality
• photosensitivity
• alopecia
• muscle weakness
• tinnitus
• extrapyramidal sx

If 81% of people with this coronavirus have mild symptoms, taking this unproven medication will result in at least an 81% cure rate. That’s pretty darn good for any medication.
That’s what we know. I asked Walgreen’s if they had any and they said it was on back order,
another Covid 19 free day

Here’s to another Covid-19 free day!

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COVID-19 Misinformation

Wednesday, March 18, 2020 // Uncategorized

Not everything that you read on the internet is true, especially these days. Most of this is well meaning, but some of it is not.
Case number one: I was exercising and got a text at 17:58 from a patient who takes ibuprofen and was concerned that he not do this because of the corona virus. He wasn’t sick. He just wanted to know if he should stop it. 15 minutes later, this was mentioned on the NBC Nightly News and was traced to comments by the French Health Minister. There is no evidence that taking Ibuprofen worsens the clinical course of Covid-19, but if you are seriously ill from any cause, non steroidal anti-inflammatory drugs such as Ibuprofen/Motrin/Advil and Naprosyn/ Aleve, may impair kidney function. If one is concerned, Acetaminophen/Tylenol is a safer choice as long as you keep the total daily dose to 3,250 mg or less.
Case number two: There was a letter to the editor in Lancet, a British medical journal, that began to circulate Monday AM that suggested that ACE inhibitors and ARB inhibitors, two classes of blood pressure medicine commonly used especially in diabetics, might make COVID infections worse. While the facts in the letter were true, there is no proof that this is the case. Here is the letter:

Lancet letter 2020

Later in the day, I received and email and a text from patients asking whether they should stop their blood pressure medications. The following day The American Heart Association and The American College of Cardiology weighed in.

AngiotensinCovid 2020

Case Number Three: The Russians are sowing disinformation about Covid-19 to destabilize our country.
https://www.msn.com/en-gb/news/world/russia-feeding-coronavirus-disinformation-to-sow-panic-in-west-eu-document-says/ar-BB11lEtI

Dealing with 1 and 2 are one thing, I don’t know how to deal with number 3, except to advise you to take everything that you read online with a grain of salt. If your read something disturbing, put your phone down and take a deep breath. Wait and see if it corroborated from reliable sites and if it hasn’t been resolved in a day or two, SEND ME AN EMAIL, NOT A CALL OR A TEXT, and I will investigate.

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Update on Covid-19 Testing

Tuesday, March 17, 2020 // Uncategorized

Here is the latest on corona virus testing in SA. We will see how smoothly that goes. Not for the “worried well”. It will require a negative flu screen which we can do. The more elaborate viral panels done in the emergency departments are not practical as they are done once a day in the lab at Main Methodist.

Covid -19 testing 1 2020

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Covid-19 and Exercise

Tuesday, March 17, 2020 // Uncategorized

Exercise and Covid-19
We are exposed to a lot of viruses we don’t catch. Ever wondered why? Our immunity helps to prevent that. What can we do to boost our immunity? Rest, proper diet and exercise. There are a lot of supplements out there that claim to boost your immunity, but no proof that they work. While Linus Pauling touted vitamin C and lived to a ripe old age, there no evidence that vitamin C supplements will reduce the risk or duration of colds. Studies done on medical students show that they are more susceptible to cold viruses around exam time. Stress can reduce our immunity and increase our risk of catching colds. Exercise can certainly help to reduce stress. I just returned from the gym. Patients have asked me if it is safe to go to the gym. I just worked out with my trainer at a small gym. Omar and Andy at New Heights Fitness are clean freaks. I use hand sanitizers before and after training and shower when I get home. This helps to kill both viruses and bacteria like staph that may live on those surfaces. I doubt that I would feel comfortable working out at a big chain gym where there are large numbers of people working out day and night. Remember, it’s a great time of the year to exercise outdoors. A walk in the neighborhood is a great way of getting exercise and relieving stress. I am fond of saying, “I don’t have any drug as good as exercise”.
What about exercising when you are sick? The rule of thumb is that if your symptoms are from the neck up, aerobic activity like walking or running is OK to continue. If your symptoms are in your chest, give your lungs a break. You can focus on doing some light weights and stretching until your cough is better. A young woman called me today and told me that her chest cold was getting worse. She then mentioned that she was still running 3-4 miles a day. When you have a deep cough, let your lungs heal. There is no risk of getting a corona virus is a pool.
One other comment on Covid -19. I don’t know if it’s circulating in the community. Hopefully, increased testing in the near future will let us know. I know, however, that influenza is rampant. If you have headache, a fever and a cough, you will likely be treated for the flu with Tamiflu or Xofluza. If you have Covid instead, taking Tamiflu wouldn’t help (that we know of), but it wouldn’t hurt either. Isolating yourself will help the risk of spreading either. Knowing that you have Covid -19 would require isolating for a longer period of time.

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COVID 19 UPDATE

Monday, March 16, 2020 // Uncategorized

03/16/2020
Dear Patients:
As I know you are all aware, we are preparing as the Coronavirus (COVID-19) pandemic extends its geographic area and number of cases. The most accurate and up to date information can be found on the CDC website. https://www.cdc.gov/coronavirus
This information and recommendations are rapidly evolving and we will try our best to keep you updated on my blog at personalphysicianmd.com.
A few bullet points:
As of today, we have ordered test kits and hopefully will have them later this week.
If you have symptoms suggestive of this disease (fever and cough) you must call the office number (if during office hours) or our cell numbers after office hours to discuss your symptoms and for instructions.
If you are moderately ill we will have you come to the office and will come out to your car to test you (nose swab). We will initially test for the flu which is widespread now. If you need to come into the office and are sick you will need to put on a mask in the lobby. PLEASE DO NOT DROP IN.
We do not want you coming into the office if you might have this illness as that would expose us and other patients.
If you are having severe symptoms we will direct you to the emergency room.

The CDC has outlined specific criteria for testing for COVID 19 and they are as follows:
Fever/cough/sore throat/difficulty breathing AND at least one of the following
You live in a community with confirmed sustained community transmission of COVID 19 (not currently the case in San Antonio)
OR
You have traveled within the last 14 days to an area with confirmed community transmission of COVID 19
OR
You have had contact with someone with known or suspected COVID-19
We need to use the test kits for only those of you who meet testing criteria so we have sufficient quantity for those who truly need to be tested. These criteria may very well change with time and we will update you as they do.
The most difficult hurdle in preventing this illness it that there is a period of asymptomatic carriage which may be up to 2 weeks. The average incubation period is about 5 days during which a person can, without symptoms, transmit it to another person. There appears to be a spectrum of severity
ranging from minimal or mild symptoms (most cases) to severe symptoms including respiratory failure and death .Those patients over 60, especially with chronic lung or heart problems or diabetes care are the most susceptible. The overall mortality rate appears to be greater than that of influenza.
We all need to practice regular hand washing, avoiding contact closer than 6 feet from others, avoiding shaking hands,and avoiding large gatherings. We need to avoid touching our faces as well
There is certainly no need for panic but, rather, for calm and organized preventive measures.
We will get through this together.

Sincerely,

Mark L. Thornton ,M.D.,F.A.C.P.
Jennifer Wallace, M.D.

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The Ides of March

Sunday, March 15, 2020 // Uncategorized

Catchy title, but it has little to do with Covid-19.

There was a photo on the front page of today’s Express-News which showed a mobile testing unit in the Medical Center. That is just for first responders and healthcare personnel who meet certain criteria. So far, drive by testing is not available to the general public. We do not know when or if this will become available.

We hope to have a handful of test kits next week to test for the virus. Initially, we will only have access to a limited number of tests. It’s still unclear when test kits will become widely available, so we will need to be selective about whom we test. We are establishing a protocol for testing and will follow CDC guidance for who should be tested.

We are also going to cancel routine appointments to reduce the possibility of our patients getting sick. We will see patients in the office with urgent medical problems and reschedule routine appointments.

Here is the link to the Center for Disease Control’s advice on preventing infection.https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html

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Thoughts of an Emergency Room Physician

Saturday, March 14, 2020 // Uncategorized

The current recommended protocol which may change is: if the patient has flu like symptoms and exposed to a patient who has tested positive or traveled from endemic country they will likely be asked to go home and self-quarantine x 14days if they do not appear ill since no one has a rapid covid-19 test at this time. That may change when testing is available and has a faster turnaround time than 4 days. FYI when 2-3 potential covid -19 pts enter the ER, the ER becomes completely paralyzed with all personnel in protective suites.
I believe doctors offices, ER‘s and clinics will be the source of propagation of the virus unless patients who present with a concern about having covid19 are asked to turn around go home and self quarantine until drive-through testing is available.
It is probably a good idea to close your office to non-sick patients, but I would have a plan in place for when the patients come in to your office over the next two months and want to be tested because they have the virus.
If they’re walking and talking they should walk back home and stay indoors. If they’re fainting in the waiting room that’s a different story. Hopefully there will be drive-through testing at some point.

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Do The Five

Saturday, March 14, 2020 // Uncategorized

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Covid 19 Update

Saturday, March 14, 2020 // Uncategorized

Here’s the latest on testing.  Governor Greg Abbott announced that San Antonio would have the first drive through testing, but we don’t know when that will happen.  It will still involve having the test sent to a lab.  The results won’t be available immediately.  Hospitals don’t want you to go in for testing unless you are sick enough to be admitted.  Both Quest and LabCorp will do testing, but first we( primary care physicians) have to obtain the proper swabs and containers.  The specimen must be frozen and sent to the lab.  The turn around time is 3-4 days.  Someone would have to be tested, go home and self quarantine while waiting for the results. Not terribly practical.  There are other private labs which are offering testing which I am investigating.  The accuracy of these tests is unknown.  Also, there is the question of cost.  I don’t know if insurance will reimburse for this testing.  One of the prices I have heard quoted is $200.  Another is $2400.  Stay tuned.

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