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Coronavirus Update


You’ve recently traveled to a place where coronavirus cases have been diagnosed. Now, you have developed fever, cough, shortness of breath, and/or diarrhea. From your reading, you know coronavirus is a consideration.

What do you do?

1. Call your local hospital Emergency Department and ask if their lab is equipped to send specimens for COVID-19 testing.

The point of this is your doctor’s office cannot collect and process specimens since there are complex rules for safely packaging and shipping such infectious samples, and they must go at least to the state health dept. lab, or interstate to the Centers for Disease Control in Atlanta, GA. Individual practices are not set up to do this until local labs are able to do the testing; at which point specimens need not be shipped.

2. Tell the ER staff you need evaluation for COVID-19 and ask what is their procedure for seeing you while minimizing risk of exposing others (their staff and other patients) to you.
a. Likely, they will tell you to call on your mobile phone when you arrive outside their facility, so they can meet you with a respiratory mask before you enter.
b. Such a procedure is necessary to not expose unaware medical staff or other patients to COVID-19. And, a facility not handling this with a rigorous, clear procedure might find itself shut-down by public health officials, should a COVID-19 case be diagnosed after-the-fact. Your doctor does not want this, nor does a hospital Emergency Department.

3. Until you are seen by a physician, separate yourself from others-
a. Do not go to public gatherings: shopping areas, schools, church, etc.
b. If you can procure an N-95 respiratory mask (medical supply stores, Home Depot, etc… Google it), do so.
c. Wash your hands frequently, but optimally have no physical contact with anyone.
d. Cough into your bent arm if you haven’t a kerchief.
e. Drive yourself- no passangers.

4. Alternatively, you can call your county or state health department to get directions on where best to go for evaluation and testing. Your primary care doctor will not be able to handle this situation at this time, as testing is not available through his/her routine laboratories.

Finally, realize that influenza is much more likely to account for such illness in the U.S., at least until about the end of April.

Edward R. Rensimer, MD

Director, International Medicine Center

Houston, TX

Copyright, E. Rensimer, MD, 2020, All Rights Reserved


China Origin 1/30/2020

COVID-19 is an apparently “novel” respiratory virus that emerged in Wuhan, China and spread from animals (?bats) recently to cross-over to cause disease in humans for the first time. That is what makes it “novel”, and so more dangerous as there is no broad-based immunity in the human herd from infection in prior years (such as exists with influenza viruses from past vaccines and infections). As such, the conditions exist for rapid spread widely, across large populations. How deadly it might be is not clear as of yet and relates to the COVID-19’s “virulence”, or ability to cause destruction in tissues and to invoke an immune response, which can destroy tissue (see the “Spanish Flu” of 1918). As the virus passes through humans, it can mutate such that virulence and transmissibility can increase or decrease, strengthening or weakening the ability to cause serious disease or death. It is a slot-machine model on which way that goes. If everything lines up, you have a worldwide pandemic. This is why you are seeing urgent public health bulletins from the CDC, the main goal containment to minimize passage through human bodies and so the risk of mutation and evolution to a more ominous disease agent. The news media, on the other hand, hype everything for market share. Realize that paying attention to this is being responsible, without assuming a position of emotional distress or outright panic. Maintain rational balance as information develops to inform your actions.
The other relevant facts are that there has been a COVID-19 case with dramatic inflammatory lung infiltrates in a person who was exposed (and so presumed contagious), but with no symptoms of disease or illness. Additionally, it appears that COVID-19 has an incubation period (virus acquired but the victim not yet showing signs of illness) of several to 14 days. Both situations mean you could be exposed and at risk for illness and not know it.
So, what are reasonable conclusions at this time?

1. Travel: If planning travel to or through areas where there has been widespread COVID-19 illness, it would be prudent to delay such travel.

Public health and political officials often craft propaganda during outbreaks to stabilize social and economic volatility over the specter of widespread, communicable illness. So, you must weigh the information at hand as possibly the tip of the iceberg. Officials tend to bleed bad information out gradually, in small doses, to calm the populace. As such, you could find yourself on a trip and,

2. Your itinerary is totally disrupted because of barriers to transportation and public health prohibitions.
3. Large public gatherings are prohibited (quarantined), such as at tourist spots, restaurants, retail centers, etc.
4. Healthcare resources are overwhelmed (just as you become ill).
5. Airports are shut down or travel directed to chosen airports (out of your way).
6. Quarantines are imposed on travelers attempting to return to the U.S. until a 14-day incubation period has expired without evidence of illness.
7. You become ill and must engage a foreign healthcare system, with all that that implies. Be aware, most people who can afford travel to exotic places are probably over 50, usually over 60. The majority of deaths from COVID-19 have been in those over 65. Not a good set of facts.

What to do if you must go?
1. Take an N-95 respiratory mask.
2. Take hand cleansers (60%, or more, alcohol concentration); soap and water.
3. Avoid close contact with anyone with respiratory symptoms or fever (6 feet or more distance).
4. Avoid spending prolonged periods of time in closed, shared air-spaces with others, especially groups.
5. Take a thermometer and medication for fever, body aches, nausea/vomiting, and diarrhea; possibly a respiratory tract infection antibiotic for bacterial infection secondary to the preceding viral infection.
6. Review your health insurance and obtain a temporary supplement for international travel. Medicare does not cover overseas medical care. Hate to say it, but if you are over 50, consider a medical air-evacuation policy and policy for repatriation of remains (death).

Finally, if you return from a country with COVID-19 activity and develop a fever-associated or respiratory system illness (fever, cough, sore throat, and/or shortness of breath), seek prompt medical evaluation, but wear an N-95 respiratory mask (can obtain at a pharmacy or medical supply store) and warn your doctor, the urgent care center, or emergency department staff that there may be a concern for COVID-19 so they can take measures to protect themselves and their facility (from Public Health closure). Also, put yourself on quarantine from family, friends, and co-workers.

Edward R. Rensimer, MD

Director, International Medicine Center

Houston, TX

Copyright, E. Rensimer, MD, 2020