Coronavirus-like Symptoms

By ROB LAMBERTS, MD

My first possible COVID-19 case came nearly three weeks ago, before there were any cases in our city. He was a healthcare professional who presented with fever, sore throat, and cough. We did the usual strep and influenza testing, both negative, but I thought that he looked different. He had some diarrhea, stomach pain, and a different look to his face that I couldn’t place.

“You might have it,” I said. “You might have coronavirus.”

He looked at me nervously, obviously having thought the same thing. “Is there anything I can do about it? Can you test me?”

No, there were no tests anywhere at that point. Few states had access to any testing, so I knew all we could do was to wait. I sent him home and told him to go to the hospital if he developed shortness of breath, and that we’d get him tested as soon as possible. That seemed to be a short time, as my nurses contacted the national lab we work with and they told us that collection kits for COVID-19 were “on the way” and would get to us in 1-4 days. Perfect.

That was the start of a long odyssey of growing frustration, helplessness, and anger at the testing for this deadly disease. Those kits never showed up. By the time we had local access to testing, the patient had gotten completely better and was asking to go back to work. He works around very vulnerable patients and we told him to let his employer know about my suspicions and to get him tested. We never heard anything.

Of course, since then every cough has been a worry to my patients. Fevers are watched with dread. We have been directing people to contact our local academic hospital to be triaged for COVID-19 testing. A couple of them have been accepted, none has tested positive. Some of them have seemed suspicious to me, but the lack of adequate testing has the triage center restricting tests to the very vulnerable or the obviously sick.

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A Little Context on Coronavirus For At-Risk Patients

By DAN STONE, MD

Joe, a semi-retired 81-year-old, never expected his Italy guys’ trip to thrust him into the front ranks of COVID-19 patients. Joe’s story goes against the grain of news about the coronavirus now gripping the world and providing epidemiologists and public health experts with the challenge of their professional lives.

Joe is a patient of a medical colleague, and he and his wife gave me permission to tell their story. It started with a ski vacation for 14 friends, united by their connections to the real estate industry, who flew from Sweden, San Francisco and Los Angeles to a rendezvous in Munich. From Germany they traveled to Selva di Val Gardena, a ski resort in the Dolomite mountains of northern Italy. Arriving on Feb. 21, they began their usual regimen of morning ski runs and afternoon lounging.

Before long, they could tell something was off. Joe’s friend Peter was the first to develop a cough and general malaise. Some of the others soon noted more shortness of breath than usual on the slopes. In the evening, normally robust appetites faded. By the time the trip ended, Peter was seriously ill with a cough and fever. He was hospitalized in Munich with pneumonia. Although Joe felt unwell, he was able to continue to Los Angeles.

By the time Joe arrived at LAX on March 1, he realized that he might have been exposed to COVID-19. He called Dr. Jonathan Weiner, his primary care doctor, from the airport. Weiner, aware of the public health implications of a potentially infectious patient in a public setting, directed Joe to head home and arranged follow-up care there with the Los Angeles County Department of Public Health.

Joe tested positive for COVID-19 as have all the other trip participants. He has no idea how they could have been exposed, although he thinks back to a crowded tram ride. Since testing positive, Joe has been isolated from all direct interpersonal contact. Confined to a bedroom at home, he communicates with his wife, Barbara, by cellphone, text and Facetime. Barbara is quarantined too. Because test kits and lab time remain limited, and because she exhibits no symptoms, she hasn’t been tested and she won’t be unless she develops a fever or cough.

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COVID-19 Update: Friday the 13th Edition

By ROB LAMBERTS, MD

Hello, and welcome to our new world! Sports has been cancelled, concerts have been cancelled, toilet paper is scarce, and don’t you dare cough in public! The new catch phrase is “social isolation,” which is difficult for many, but easy for some. At last, a crisis that favors the introvert!

Update on Current Situation

To date, there have been over 140,000 documented cases of the virus worldwide, and more than 1800 in the US. More than 5800 people have died, 41 of whom were in the US. Countries have shut down social gatherings, have limited travel, and the president has declared a state of emergency.

To date, there have been no cases in our local area, but I’m fairly certain the infection is everywhere, as it spreads easily from person-to-person and so containment is difficult. We have had suspicion of infection in our patient population, and are moving to get testing supplies so we can confirm or disprove the diagnosis.

The current public health goal is to decrease social contact to slow the spread of the virus. This is why the enormous sports industry has shut down, despite huge financial losses incurred by doing so. This is why conferences, concerts, and even family gatherings are being cancelled. This is why everyone is washing their hands frequently (and hoarding hand sanitizer).

I have no idea why people are hoarding toilet paper.

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