Covid 19 Update for Patients of RPM

Statistics

The current statistics for COVID-19 (SARS-CoV2), as of 4/27/2020, are in the table below. The data assumes that only 20% of sick people have been tested and that 80% of infected people are asymptomatic. These assumptions are based on the good data we now have from studies in NYC and California. You can see below that your chance of dying from COVID-19 in Colorado is only 1 in 8500 (but possibly 20x higher if you have diabetes, lung, heart, or liver disease, are over 80, or are on immunosuppressive drugs). The number of cases in both CO & the US has been the same as flu and the death rate is about the same. In fact, more people have died from flu this season (about 60,000) than have died from Coronavirus. However, COVID-19 appears to be more contagious.

The graph above left shows confirmed new cases of COVID-19 in the USA, and we can see that the curve has finally flattened (but is not yet dropping) as of mid-April. The graph on the right above shows deaths in Colorado which have dropped dramatically since April 9th (and is the reason that Governor Polis has allowed elective surgery and hair/nail salons to open in some counties starting today, April 27th).

Prevention and Masks

Because the disease is deadly for elderly and immunocompromised patients, it is especially important (as things begin to open back up today in Douglas County) that all of us do the following if we are going outside:

1. EVERYONE must wear a mask when going outside. Remember that 80% of people are asymptomatic and we do not know who they are. Here are your options:

• Cloth masks made from 600+ thread cotton folded over twice with a piece of paper towel in-between will block 60% of germs

• We have been able to get 200 surgical masks (these block 75% of virus particles) and can sell them to patients for $2 each (limited to 2/person), plus $1 postage.

• If you will be working with an elderly or immunocompromised person, or in a store or office, we have a very limited number of KN95 masks (these block 95% of virus particles) that we can sell for $10 each, only one per person plus $1 postage.

All the above masks can be sterilized for 30 minutes at the end of each day by buying one of these small UV-C sterilizers from Amazon:

https://amzn.to/3eRa4Hb

https://amzn.to/3eTK6mE

2. Handwashing is imperative every time you touch any surface and after touching your face or the outside of your mask.

3. Stay at least 6 feet away from other people (15 feet from joggers!) if they are not wearing a mask.

4. Get tested, especially if you will be anywhere near other people.

Diagnosis

Most people who have symptoms with COVID-19 have fever greater than 100 degrees (90%, often with chills/shakes), dry cough (80%), severe fatigue (56%), decreased sense of smell (40%), severe body aches (35%). Shortness of breath is usually a later symptom. Only a small number of patients have nausea, diarrhea, headache or sore throat and those symptoms alone should suggest a more common cold, stomach or flu virus. Runny nose is rare in COVID-19 and makes it very likely to be something else.

But remember, as much as 80% of people (especially, younger healthier persons) have NO SYMPTOMS AT ALL. You need to therefore assume that everyone is contagious unless they have been tested.

Testing

We still have rapid fingerstick blood antibody tests that can tell if you:

1. Have active COVID-19 (IgM positive) though this test has a 10% false negative rate, so it is not as accurate as a nasal swab.

2. Have recovered from COVID-19 and have active immunity (IgG positive) and this test is allegedly 98% accurate. We do not know for sure how strong the immunity is or how long it lasts (though early Chinese studies suggest it is fairly good and lasts at least a few months). If you have already had a case of COVID-19 (even if you don’t recall being sick, as 80% of people have no symptoms), then it is safer for you to go outside and go to stores (though we still recommend you wear a mask, just in case).

Right now, we are only testing healthy people (with no disease), but next week we hope to begin testing sick people for only one hour a day in our parking lot or an office next door. This will depend on us getting adequate PPE. Right now, we will refer you to a testing office if you have any fever, cough, sore throat or other symptoms of COVID-19.

If you want to be tested, the cost is $150 cash (we had to pay a lot to get these tests and insurance has not been reimbursing for antibody tests). The tests seem to be accurate and we are finding many people that were surprised to find out they are immune. We are one of only very few practices in Colorado that have these tests. The test is quite easy to do, as it is only a finger stick blood test and you will have results in 30 minutes.

Vaccines

There is still no vaccine for COVID-19 since the virus is so new and vaccine research usually takes years. However, vaccine research is progressing rapidly. CanSino in China is already in Phase 2 Human Trials and may start a Phase III trial in May. If they do, we could possibly have a vaccine from them as soon as November. Cambridge, Massachusetts company Moderna has done a Phase I Human Trial and may possibly have their vaccine ready by December. Almost 70 other companies around the world are working on a vaccine but are further behind and probably will not have a vaccine until 2021 or later.

Treatment

There is still no medication reliably shown to help treat or prevent COVID-19. Plaquenil (Hydroxychloroquine) has not panned out and it has some dangerous side effects. A large study using an HIV drug with moderate side effects showed no benefit. Remdesivir, an antiviral from Israeli company Gilead, has shown extremely limited benefit, but it will be extremely expensive and 60% of patients get side effects. Ivermectin, a cheap, safe anti-parasitic drug looks promising, but it has only been studied (so far) in a petri dish, where it reduced viral replication 5000-fold. An unpublished University of Maryland trial showed improvement in 27 of 31 patients, but one patient got much worse on it and there was no control group.

We are doing a study on a very safe supplement, BrightStar, that is mostly herbal meds, and preliminary data has shown that people get better more quickly on it. It costs $600, but the company will supply it for free if any patient who has tested positive for COVID-19 agrees to take it.

Floyd B. Russak, MD, Clinical Faculty in Medicine (ret.), Harvard, CU, and Rocky Vista Medical Schools

RPM Family Health, 5420 South Quebec, Suite 100, Greenwood Village, CO 303-221-6797