COVID-19

Guidance for COVID-19

OHIO NAACP COVID-19                                                            January 3, 2021

COVID-19 is mostly mild in approximately 80% of individuals or asymptomatic in approximately 25%-40%.  Therefore, most individuals who either experience symptoms and/or are exposed and diagnosed with COVID-19, are usually not tested, but instructed to self-quarantine or isolate at home.

I. How do I get tested?

If you have a fever, cough and/or new shortness of breath, you may have coronavirus. People with COVID-19 have a wide range of symptoms ranging from mild symptoms to severe illness.  The following symptoms may appear 2-14 days (incubation period) after exposure to the virus:

• fever

• cough

• shortness of breath or difficulty breathing

• chills

• repeated shaking with chills

• muscle pain or whole-body aches

• headache

• sore throat

• new loss of taste or smell

• vomiting or diarrhea

If you develop these symptoms, especially if you have been in close contact (within 6 feet), of a person known to have COVD-19, through the use of Telemedicine or distance medicine visits, you should contact your primary care physician (“PCP”) or a healthcare provider that is testing for coronavirus.  Testing copays for COVID-19 testing are waived at most centers at no out of pocket cost to patients during this current crisis. 

II. Emergency Warning Signs.

There are Emergency Warning Signs for COVID-19.  If you develop any of the following symptoms, you should call your nearest ER and inform them you are headed there.

trouble breathing

• persistent pain or pressure in the chest

• new confusion 

• inability to wake or stay awake

• bluish lips or face

* The COVID-19 Hotline for Ohio is (833) 427-5634.  If the COVID-19 Hotline denies one’s request for testing, the patient should contact their PCP to further lobby on their behalf. 

COVID-19 can be indolent and vary in vulnerable individuals early in the course of disease, then it may quickly and significantly relapse even though one was seemingly improving.  The relapse usually occurs within the first 7-10 days.

HOW TO CONDUCT Yourself during the Pandemic

Currently, COVID-19 testing is more widely available and there are published testing sites in our communities, as well as at pharmacies, e.g., CVS, Walgreen’s, and Rite Aid.  Individuals should avoid tests that take over 24-48 hours to return because if you have had symptoms for several days and register to test 4-5 days later, it is unlikely to impact disease transmission if the results return 5 or more days later.  The reason is the infectivity or contagiousness of most mild-moderate coronavirus cases is 7-8 days.  While waiting for a test to return, the entire family and workplace will be unwittingly and repeatedly exposed to this highly contagious virus by the time the results return 10-12 days later from symptom onset.  It will then be too late to isolate and the opportunity to intervene or impact the course of the disease is futile.

Meanwhile, to help alleviate contracting COVID-19, you need to practice the following mitigation strategies:

  • wear a mask when out in public
  • maintain appropriate social distancing a minimum of 6 feet (and more likely 12 feet)
  • wash your hands frequently with hand sanitizer or soap and water
  • avoid touching your face
  • frequently disinfect common touched surfaces such as counter tops, doorknobs, keys, elevator buttons, and handrails in buildings or on mass transit
  • stay at home if you are sick
  • avoid large crowds 
  • if available, use telework and virtual platforms to conduct business or services

If you develop any of these COVID-19 symptom(s), request and seek immediate testing.

Testing COVID-19 Positive

According to the CDC, if you test positive for COVID-19, but remain asymptomatic, isolate yourself, and if 10 -days have passed since the positive test, then you can be with others or return to the workplace.

Formal Release of patients from Isolation who tested positive for COVID

According to the Cuyahoga County Department of Health, it is now the PCP’s responsibility to release patients who tested positive for COVID from isolation.  Earlier, physicians were instructed that the order could only come from the Health Department.  This has changed to:

  • PCP is preferred.
  • 2nd tier is the ordering provider; and
  • If the patient does in home monitoring and does not have a PCP, the home monitoring team will encourage them to establish PCP.  However, if a person declines a PCP, the home monitoring will refer them to ECO for return to work.

According to the CDC, persons who are COVID-19 positive with mild to moderate symptoms can come out of isolation and return to work if:

  • at least 10–days have passed since symptoms first appeared;
  • at least 24 hours have passed since last fever without the use of fever reducing agents,

and;

  • symptoms (e.g., cough, shortness of breath) of COVID-19 have improved.

A negative repeat of a COVID-19 test-based strategy is no longer used before returning to work because in the majority of cases, it results in excluding people who continue to shed detectable SAR-CoV-2 RNA virus remnants but are no longer contagious.                                                                       

Having Close Contact with an Infected Person

  • Close contacts defined by the CDC is “within 6 feet of the infected person for at least 15 minutes [either at one sitting or cumulative] starting from day 2 before the symptoms start until the time the infected person was isolated.”
  • Self-quarantine for 14 days after their last contact with the infected person.
  • Seek Medical care if you develop COVID-19 symptoms.
  • Permitted to return to normal activities after 14 days of self-quarantine and without symptoms.

Contact Tracing

The State Department of Health has an obligation to conduct contact tracing.  A public health staff worker will conduct the contact tracing by working with you to retrace your recent steps and helping you to recall who you may have had close contact with during the timeframe of your infection.  The Public health staff then notifies those potentially exposed individuals (contacts) as rapidly and sensitively as possible.  The identity of the individual who may have exposed them is not disclosed.  Contacts are then educated to self-quarantine themselves for 14-days and monitor for emergency warning signs.  They are warned that they could possibly spread the infection to others, even if they do not feel ill.  

The Leading Offenders of Transmission

           Not as much as outside the home where people tend to mask and socially distance themselves (except at President Trump’s maskless rallies), but the informal home get togethers:  birthday parties, sleep overs, home parties, as well as weddings, and funerals have been implicated as sources of spread from contact tracing.  Bars and nightclubs where drinking is served are another source of clusters.  These are places where people tend to closely congregate with one another, standing shoulder to shoulder in close spaces without masks or physical distancing. According to a news release by the American Institute of Physics, (12/2020), “A mask definitely helps, but if the people are very close to each other, there is still a chance of spreading or contracting the virus,” said Krishna Kota, an associate Professor at New Mexico State university and one of the articles’ authors, “it’s not just masks that will help. It’s both the masks and distancing. It is also a common misconception that people think if they know all the invitees, then it is safe.  This is untrue because up to 40 % of the disease is asymptomatic or pre-symptomatic.  Dr. Anthony Fauci says people are going to have to make a choice “where they fit in the risk-benefit ratio” as they decide how to celebrate Holidays amid the coronavirus pandemic.  He urged Americans to rethink the usual plans for Holiday gatherings citing increased coronavirus infections and hospitalizations in more than two dozen states across the country.  He said, “Given the rise in cases, we’ve really got to double down on fundamental public health measures that we talk about every day because they can make a difference. If you have vulnerable people, the elderly or people that have underlying conditions, you better consider whether you want to do that now or maybe just forestall it and wait.”

How to Navigate Holiday and Family Gatherings

According to NBC News (10/16, Pawlowski), as the holidays approach, infectious disease experts are worried people might let their guard down when they get into holiday mode, forgetting what is going on in the larger world.

COVID-19 has not gone away so there are difficult decisions ahead for everybody, said Dr. Marissa Levine, Director of the Center for Leadership in Public Health Practice at the University of South Florida in Tampa.  “People want to get back to normal, [but] if we let our guard down now, that could be really problematic going into flu season.”

Consider the Risk

In its guidance on holiday celebrations, the CDC noted that celebrating with members of your own household poses low risk for COVID-19 spread.

Other in-person gatherings may be riskier, depending on where they are held, how long people are together, how many are there, and where they are coming from.

Check the CDC map of community levels of COVID-19 in your state and the state you may be traveling to or hosting guests from.

If there is a high transmission rate, limit the guest list and consider staying within your own social bubble, Levine advised.  Here is what to keep in mind:

  • Keep the windows or doors open if possible:  Indoor gatherings with poor ventilation pose more risk than those with good ventilation, according to the CDC.
  • Encourage people to bring and use masks: “The problem with family gatherings is we don’t keep our physical distance, so it may be a necessary ingredient.  It’s really important not to discount masks.”
  • Practice social distancing:  Space out chairs at the dining table or prepare two dining tables and split the gathering into two groups so people do not have to sit close together. Think twice about hugging your relatives.  I hate to say that it’s a risky activity, but it is.  This may be one of those years where family gatherings(include) lots of elbow bumps.”  If the home is cramped, consider staying at a hotel rather than with a relative
  • Limit the number of guests:  The U.K. has implemented a “rule of six” prohibiting social gatherings of more than six people.  But there is no absolute number that experts know is safe, according to Levine. She could not specify how many people are too many to invite.  She said, “The fewer the better, the risk goes up as you have more people.”
  • Do not come if you are sick:  Do not attend nor assemble a family gathering if you have any symptoms.  If you have close contact with somebody with COVID-19, you also should not attend or host one.
  • Prepare and drop off traditional family dishes for family and friends, especially older and vulnerable relatives, and friends
  • Join a virtual get-together celebration

Deadly Cost of Deferred Care

According to Active Health Management, a leader in providing physicians peer-reviewed alerts, it is critically important to reconnect with your physician(s) safely and effectively for well visits, meds, labs, and routine screenings during this unprecedented time of the Corona Pandemic.  Recently, data shows:

  • a 60% drop-off in outpatient services from Mid-March through Mid-April
  • a 60% reduction in chemotherapy attendance
  • a 76% reduction in specialty referrals for early cancer detection
  • over 60% of respondents to one survey believe that some of their patients will experience avoidable illness due to care if they procrastinate or avoid it entirely.

According to The New York Times (6/16, Abelson), while hospitals and doctors across the country say many patients are still shunning their services out of fear of contagion – especially with new cases spiking– Americans who lost their jobs or have a significant drop in income during the pandemic are now citing costs as the overriding reasons they do not seek the health care they vitally need. 

The twin risks in this crisis — potential infection and the cost of medical care — have become daunting realities for the millions of workers who were furloughed, laid off, or caught in the economic downturn.  It echoes the scenarios that played out after the 2008 recession, when millions of Americans were unemployed and unable to afford even routine visits to the doctor for themselves or their children.

According to a survey last month from the Kaiser Family Foundation, nearly half of all Americans say they or someone they live with has delayed care since the onslaught of COVID-19.  While most of those individuals expected to receive care within the next three months, about a third said they planned to wait longer or not seek care at all.  But the consequences of these delays can be troubling.  In a recent analysis of the sharp decline in emergency room visits during the pandemic, officials from the Centers for Disease Control and Prevention said there were worrisome signs that people who had heart attacks waited until their conditions worsened before going to the hospital.

At Maimonides Medical Center in Brooklyn, doctors have already seen the impact of delaying care.  During the height of the pandemic, people who had heart attacks and serious fractures avoided the emergency room.  “It was as if they disappeared, but they didn’t disappear,” said Dr. Jack Choueka, Chair of Orthopedics.  “People were dying at home; they just weren’t coming into the hospital.”  This may in fact help explain that 300,000 more people died than the typical number reported during the same weeks in previous years. 

In recent weeks people had begun to return to medical care, but with conditions worsened because of the amount of time they had avoided care.  A man with hypertension that did not get his meds refilled had a cerebral stroke and almost died from complications of a cerebral hemorrhage.  A baby with a club foot will now need a more complicated treatment because it was not addressed immediately after birth.  With the recent resurgence of the coronavirus, I suspect people will again defer much needed health care. During this time of Coronavirus pandemic, we find Telehealth visits can be very helpful, especially during surges for regular health maintenance, to communicate concerns, order labs and pertinent x-rays, in addition to getting refills of much needed medications. 

Finally, we hope and pray that we all get through this pandemic together, but we must continue to test and be vigilant with our masks, hand washing and social distancing.  So, keep your guard up, at home and with friends, because after all, you are your brother’s keeper, and especially since the long-awaited vaccine is here, but it will take at least 6 months of continued vigilance with public health measures of masking, distancing, and avoiding crowds throughout the 60-70% vaccination effort to achieve the desired effect. Remember it is not vaccines that saves lives, vaccinations save lives. Would you rather be in a line that gives you 95% protection against this feared virus, or the line that has taken over 300,00 lives? And yes, you are to be vaccinated, even if you have had COVID-19.

Respectfully submitted, 

Frederick D.  Harris, M.D., 

Assistant Professor Cleveland Clinic Lerner School of Medicine, C.W.R.U.

Board-Certified Internist

Cleveland Clinic Community Care

Ohio NAACP Health Care Committee Co-Chair

Greater Cleveland NAACP Health Chair

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