Since the last article there has been more than 300,000 cases in USA, over 8,000 deaths, and over 1.5 million tests completed. We are learning more about this disease as we go on.

The majority of sick people are outpatients, with upper respiratory symptoms such as stuffy nose, sore throat, dry cough, loss of smell and taste, fever, nausea, diarrhea or even asymptomatic. A group of patients may have difficulty breathing or shortness of breath and they may require hospital care.

We have learned that inpatients with mild to moderate disease, can be followed closely with O2 saturation measurements which should remain over 95% on room air or on O2 supplementation. Also, certain inflammatory markers are abnormal such as CRP, LDH, D dimer, and ferritin which can be followed to asses how the patient is doing. Of this group, a minority develops further respiratory problems with severe disease requiring intubation and ventilatory assistance, usually associated wih certain conditions such as diabetes, emphysema, cardiac disease, high blood pressure, obesity, and the elderly.

We are currently using medications such as hydroxychloroquine (plaquenil) and zithromax (Z pack) for mild to moderate cases. This is more from in vitro evidence that it inhibits the viral growth and decreases the inflammation than from clinical trials which are ongoing at this time. Tamiflu and HIV medications have also been tried without any conclusive data that they work.

Investigational agents such as Remdesivir are being used in certain centers (antiviral used before for Ebola virus) as well as Sarilumab (Kevzara). Other options in the near future may be the use of convalescent serum from patients who have recovered from the disease.The sickest patients develop an inflammatory lung reaction (unknown cause at this time) which may require agents such as steroids and tocilizumab (Acterma) for probable cytokine storm.

Testing has improved and we can get results in as little as 6-12 hours. Anxious patients that have recovered and are recovering want to have a repeat test as soon as they can, but in my experience if you repeat it too soon it will be positive again, which would mean that you are still contagious. So my advice is wait for 10-14 days to be completely symptom free (by then your test should also be negative).

Health care workers are being called Heroes, but we are doing our job and trying to help patients to the best of our ability as we learn each day about this disease. The real heroes are the ones who are following the guidelines of staying at home, are quarantining, social distancing, washing their hands, and providing support at different levels so we can better control this epidemic.

Unitl next time, stay safe.

Writen by Dr. Simon M. Edelstein
Infectious Disease Specialist