A Busy Week in Washington

If you’ve been keeping up and I am not sure how you could avoid doing so, it’s been a busy week in politics. There was an IRS issue, the debates, and the announcement that the president and his wife had tested positive for Covid. Now he is in the hospital and his drug regimen suggests a very serious case of Covid but he and his physicians say that he’s doing fine. I have no opinion because I think the scope of Medical Practices differs a little for the president.

Now even more people in his immediate circle are known to be sick and regardless of your political views, this is not good news. I would not wish Covid on anyone and I wish the President and the first lady Godspeed in their recovery. Consider that wanting a new president is a lot different than wanting someone dead.

In our media fatigued nation, we were becoming sensitized to Covid after months of death tallies and counting cases. People are tired and broke and healthcare is still overwhelmed. After the president’s announcement, interest has peaked again making this a very good time to talk to your patients again about Covid, how it is spread and how to protect themselves. Be prepared to discuss the following information that is being widely disseminated on the ever present, 24 hour news channels and the always reliable internet.

1. Testing does not cause the virus. The United States does not have more cases because we test more than other countries.
2. Covid is more dangerous than the flu. More people die and there are serious lingering effects in a small number of patients including strokes and other neurological symptoms and permanent heart damage. This information can be given to patients without creating panic.
3. Masks are effective at preventing the spread of Covid. The masks prevent the majority of droplets from entering the air so the people who do not know they have Covid are less likely to infect others. Masks are not a guarantee that you will not contract the virus and a mask does more to protect others than the one wearing it. Wearing a mask is a way of protecting the community. Your friends and neighbors and even strangers are protecting you when they wear a mask. Masks are at times unpleasant but they are such an easy way to be kind and who doesn’t want to be a little more kind.
4. There are some activities and places that are safer than others. An outdoor porch with two people wearing a mask and sitting six feet apart is a low risk situation. Being in a small room with no masks in use creates a high risk situation if someone is infected with Covid. The problem is that we don’t always know who is infected. One study indicated that people are the most contagious the day or two before they show symptoms.
5. Children do contract and spread the virus. The list of symptoms for children is similar to the list for adults but symptoms may be milder. Death has occurred but at a lower rate than adults. My question is about quarantine and isolation. If anyone has a known exposure to Covid, they should quarantine for 2 weeks. Any parents out there with small children who think that would be an easy task? I didn’t think so.

At this point in time, treatment is directed at symptoms. Information about specific medications should be referred to their physicians unless the medication is Hydroxychloroquine. In that case, your medical director might be called on to intervene. The first two medications given to the president are Remdisivir and Regeneron. Remdesivir has been given emergency approval because it has proven to reduce hospitalization time by a few days and Regeneron is experimental and the President received it following an FDA expanded use exception which provides that an experimental drug can be administered to a patient if the following conditions are met:

• Patient has a serious disease or condition, or whose life is immediately threatened by their disease or condition.
• There is no comparable or satisfactory alternative therapy to diagnose, monitor, or treat the disease or condition.
• Patient enrollment in a clinical trial is not possible.
• Potential patient benefit justifies the potential risks of treatment.
• Providing the investigational medical product will not interfere with investigational trials that could support a medical product’s development or marketing approval for the treatment indication.

The third medication is run of the mill steroids like Solumedrol or Dexamethasone. They have been used in Covid in the past to treat inflammation. Because steroids seriously impair immune responses, these are usually given late in the disease to patients on ventilators.

In other words, there isn’t any one medication or treatment approved for the treatment of Covid so in general, the best advice is not to become infected.

Patients should be advised that the following is a list of symptoms for Covid (and other illnesses):

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Because this looks a lot like the flu, there has never been a more important time to get a flu vaccine. That goes for visiting clinicians, too. Although there is no mandate for home health and hospice providers to offer annual flu shots, the cost of having visiting staff out sick for an extended period more than covers the minimal cost. Fun Fact: Medicare covers flu immunizations for hospice patients, too.

Your patients are at higher risk for serious illness and death from Covid due to age and underlying chronic conditions. Heart and lung disease and diabetes seem to be more prevalent in the underlying conditions category. Again, that can be conveyed to patients without causing panic. You know how to approach your patients because you have spent time with them. No need for police tape blocking off their homes.

Equally as important is educating non-homebound family members about the highly contagious nature of the virus. Teaching of family members is not covered in home health but it is not prohibited when another covered skill is rendered. Hospices are covered when teaching family members.

Should you have any questions, please email us so that we may refer you to someone who knows more like the CDC. Comments are always welcome.