Coronavirus Update 7: COVID 19 Testing, Treatment, Home Essentials, Communication, Shelter in Place

Here is another update to try to keep you as informed as possible.

COVID-19 Testing

For two weeks now, we have been actively testing for and treating COVID-19 infection in our office. Primarily we are focused on patients with fever, cough, shortness of breath, or diarrhea. We are also testing frontline healthcare workers with symptoms or with exposure to a COVID-19 positive patient. Please call the office if you need to be evaluated for testing based on the above criteria

Treatments

I am constantly reviewing available treatment options including hydroxychloroquine, azithromycin, plasma transfusions, HIV medications, anti-viral medications and interferon beta. Additionally, I am in constant communication with Infectious Disease Specialist, Pulmonologists, Cardiologists and Rheumatologists regarding to benefits and limitations of these medications. Many of these therapies are already being used in hospitals when clinically appropriate. These are not currently available or indicated for prophylaxis, prevention, or “just in case” therapies. Please understand that I will guide you through this and advise you when you would need these medications and at this point it would be indicated in the hospital setting only. I ask you to trust me and my clinical judgement on this decision.

Home essentials if you become ill

Please see previous posts for recommendations on what you may need at home for caring for yourself or an ill family member in update 6. Please also note that I have updated recommendations for update 6 and these updates can be seen on our Facebook page. I also want to ad the following essential items for the home, if possible. Please have an oral or ear thermometer at home to measure and monitor your temperature if you begin to have symptoms. I also would like you to have a fingertip pulse oximeter to measure oxygen levels and heart rate if you begin to have symptoms and to monitor your progress if you become infected with COVID-19. The brand of the ear thermometer or pulse oximeter is not critical. Online availability for both may be limited but take your time in purchasing, they will be restocked soon. You will only benefit from these if you become infected, ill and I need to monitor your progress. Please do not purchase many of these. You only need one of each in the home.

Enhancing communication

If you have not already done so please download our OhMD app and Vsee app. Both these apps are free to you. Go to BuckheadMedicine.com and click on top red bar to download these. These are essential. If tested we will send COVID-19 results via OhMD. The Vsee app is essential if you become ill, as I need to be able to lay eyes on you to determine your level of illness and make a decision of treating you at home or sending you to the hospital. Communication over the phone in this situation is inadequate.

Also please make sure you follow our Buckhead Medicine Facebook Page for routine office updates. https://www.facebook.com/BuckheadMedicine/

We also now have up and running a Facebook Group called COVID-19 Frontline. This group is open to the public to read, but limited to comments and posts by Physicians, NP’s and PA’s in the frontline actively caring for patients. This group provides useful information to review as its an active commentary from specialists and primary care providers on the frontline. https://www.facebook.com/groups/covid19frontline/

If you don’t have a Facebook account you can see the updates to both on our website.

Shelter In Place

Please do not leave your home unless absolutely necessary. Absolutely necessary means medical care or to gather food or medications. It is ok to exercise outside, but stay far away from other persons or other persons pets. Essential workers such as police, firemen, and healthcare workers have no choice, but we can help them by staying at home.

Stay Well and Stay Home,

Dr. Edward Espinosa
Buckhead Medicine

Coronavirus Update 6: How to handle COVID-19 infection at home

Many of you are testing positive for COVID-19 or are beginning to have viral illness symptoms or have family members that are having symptoms of fever, cough and or mild shortness of breath. These symptoms are best managed at home, unless shortness of breath becomes more pronounced or severe.
I wanted to give you my general recommendations on how to handle COVID-19 infection at home. Please note these recommendations are in line with the current CDC recommendations but also include what I think is best for you as my patient.
This is IMPORTANT, just because you have been tested for COVID-19 and your results are negative does not mean you do not have COVID-19. If you are having symptoms of fever, cough or shortness breath there is still a high likelihood, given the current pandemic, that you are infected with COVID-19. The sensitivity for the COVID-19 test is around 75 to 85 percent. Sensitivity measures the percentage of sick people who are correctly identified by the test as having the condition. The true positives. The COVID-19 test helps us with surveillance but does not help much clinically. As doctors we have to make clinical judgments on your condition and not rely entirely on the test. Help me with this. If you are having symptoms assume you are positive for COVID-19
My current recommendations for in home isolation are to remain in isolation until at least 10 days have passed since symptoms first appeared AND at least 5 days have passed since recovery of symptoms i.e. no fever, cough or shortness of breath.
These recommendations apply for the following people:
1. Persons who are having symptoms but not yet diagnosed positive
2. Persons diagnosed positive but having milder symptoms that can be managed at home
3.Persons diagnosed positive that have been hospitalized but have been discharged to home
Home isolation applies for all of these cases and a strict inhouse protocols to prevent spread to household members and pets are necessary.
Call me if your symptoms are worsening. During business hours please do not send me a text or call my cell phone. I’m receiving hundreds of calls and texts and its difficult to keep up with the truly sick calls or texts. In order for me to take care of you safely and efficiently, please call the office directly at 404-257-5585. I have staff that are triaging the calls in order of importance. If you are acutely ill you will receive a call back from me within 10 minutes. After hours, please call my cell phone for acute illness.
If you are prescribed a nebulizer treatment, and I will only be prescribing this in special clinical circumstances, please note that these treatments can aerosolize the virus. Do not perform nebulizer treatments while anyone else is in your room. Caregivers should wait 60 to 90 minutes after nebulizer treatment is complete before entering the room and assume that for 3 hours post treatment, the virus is aerosolized in the room so full cover should be used. If possible, nebulizer treatment should be performed in a “dirty room’ that no other person in the home will be using and that does not have air circulating from the home air-conditioning unit or where the ventilation has been covered to prevent transmission of aerosolized particles into the air system. All surfaces should be cleaned after nebulizer treatment is performed. Stop using nebulizer treatments as soon as your symptoms or shortness of breath resolve. If you have questions about this please give me a call.
Monitor your symptoms. If cough or shortness of breath worsens or fever remains high despite Tylenol then call me.
If no allergy, take Tylenol 3 to 4 times per day for fever. Do not take more than 2000 mg of Tylenol in a 24 hour period. Do not use NSAIDS.
Wash your hands with soap and water for 30 seconds frequently. Especially if you are coughing, sneezing, blowing your nose, going to the bathroom, eating or preparing food. Routinely wash your hands every 4 to 6 hours. Soap and warm to hot water is better than hand sanitizer.
Protect your psychological health. Don’t be ashamed of having symptoms or being diagnosed with COVID-19. Most of us will experience infection with this virus at some point. It’s Ok. Stay in constant phone and video communication with your friends and loved ones. We are all in this together. We will beat this.
Stay home.
No visitors.
Avoid touching your eyes, nose and mouth.
Caregivers should wear a mask and gloves when they are around you.
If caregivers do not have gloves available, then ensure hand washing or hand sanitizer use upon entering and leaving room every time.
If caregiver or patient does not have a mask then improvise. Use a scarf or use clothing with elastic bands such as underwear or shirts over the nose and mouth. Wash these in the washing machine with hot water and detergent daily.
Goggles or glasses are also recommended. Ok to use any goggles or glasses even swimming goggles.
Make sure any shared spaces in the home between you and your family have good air flow, if possible open a window.
Have another household member pick up any needed food or medication. Do not leave the home to gather these goods.
Separate yourself from other people and animals in your home.
Stay in a specific room away from other people.
Use a separate bathroom, if available. And only you should use that bathroom.
Restrict contact with pets and other animals.
Wear a facemask anytime you are anywhere near another person or animal.
Don not share any personal household items such as drinking glasses, utensils, or bedding.
Clean all “high touch” surfaces with a disinfectant wipe or spray twice daily including countertops, tabletops, doorknobs, toilets, laptops, keyboards, cellphones.
If you do go out, when you return home, before entering the main part of your house, you should take off your shoes and all your close and place these in a hamper in the garage or foyer, or a separate room. You should then take a shower or bath to reduce the chance of bringing the virus into your home.

Stay Well and Stay Home,
Dr. Edward Espinosa
Buckhead Medicine

Coronavirus Update 5: Social Distancing

As the COVID 19 pandemic continues to evolve, I wanted to continue with our updates. This update is about social distancing recommendations and COVID-19 testing.
Social Distancing
The only way to slow the spread of COVID-19 is to physically distance ourselves from other people. At this point I am asking all my patients to stay home. The only reason you should be leaving your home is to gather any needed essential goods such as food or medicine or to seek healthcare. You should not have visitors at home that are not part of your immediate circle and this should be less than 5 people if possible. It is ok to go outdoors, in an open area such as a park, to go for a walk or for exercise, but keep at least 5 to 8 feet distance from other people to avoid potential transmission of the virus. The other reason you should leave your home is to seek urgent medical care. If you are showing signs of fever, cough, mild dyspnea or shortness of breath DO NOT go to the emergency room or to an urgent care, instead stay home and call me. If you are experiencing more severe shortness of breath or upper respiratory tract symptoms of a more severe or progressive nature then it is appropriate to go to an urgent care or emergency room for evaluation. Still call me.
COVID-19 Testing
We have been testing for COVID-19 at our office location now for almost a week. In general, we are testing people with fever, cough, shortness of breath, diarrhea or known exposure to a confirmed or presumed positve COVID-19 case.
We have been receiving many calls regarding what to do with friends or family members with symptoms who are not existing patients and don’t have a primary care physician or access to testing. Please note even though we are a concierge practice, due to this national emergency we are providing COVID-19 testing to all those who need the test. You do not have to be a concierge patient or an existing patient to be tested. So if you have friends or family members that are experiencing these symptoms first make sure they are isolated from everyone, then have them call our office and we will make a determination on the plan of care.
Keep in mind for everyone’s safety, COVID-19 testing has to be well orchestrated and involves an initial telemedicine call followed by scheduling for a COVID-19 screen at our office site which also requires coordination as the test is not performed inside our office.

Stay Well and Stay Home,
Dr. Edward Espinosa
Buckhead Medicine

Coronavirus Update 4: Limit use of NSIADS

I am passing along some important medical information.
A medical alert has been issued regarding the use of NSAIDs. NSAIDs are nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, Aleve or Advil.
There is some anecdotal evidence that NSAIDs might increase binding opportunities with ACE-2 which is a receptor found in adult lung that serves as an entry receptor for COVID-19.
It is thought that nonsteroidal anti-inflammatory medications may be associated with more severe cases of COVID 19 affecting young people with no underlying illness.
There is also some anecdotal evidence that younger people have less expression of ACE-2 in the lungs and this may be protective for COVID-19.
At this point I am recommending limited to no use of NSAIDs, particularly if you are having active symptoms of fever or upper respiratory tract infections.
Tylenol is okay, acetaminophen is okay

Sincerely,
Dr. Edward Espinosa
Buckhead Medicine

Coronavirus Update 3: Using Telemedicine to support our patients

COVID-19 is now classified as an epidemic. I can tell you firsthand that this virus is now in our community. I can also tell you that if we all do our part we will get through this.
As your medical provider I want to continue to ensure that we minimize exposure and transmission of COVID-19. My general recommendations for all my patients is to stay home if possible. Beginning 3/16/20, as a temporary measure, we will not be performing routine in-office visits, routine in-office annual exams or any aesthetic procedures. We will remain open as a medical practice but will be shifting our focus in the office to handle sick visits and medical issues of a more urgent nature.
Over the next few weeks to months, we will be relying heavily on telemedicine to compliment our sick visit encounters and to handle routine medical concerns.
If you have not already done so, please click on the following link to download the Vsee telemedicine app and sign up in order to have this option available to you on your smart phone. Download VSEE Telemedicine APP
Generally speaking, visits to the clinic will be for urgent vital sign measurements, infection evaluation, urgent blood draws, EKGs, and treatment of acute illness that may require IV fluids or IV antibiotics. All in office visits will be on an as needed basis and based on my medical recommendations.
We will be loosening the requirements for office visit requirements for dispensing controlled substance and other medication refills. If you feel you need 60 or 90 day supplies of routine medications, we will be happy to fill these for you. Please keep in mind that these request should be sent by OhMD and will be turned around as quickly as possible, but please allow our staff a few days to handle these requests.
Please note that due to high call volumes from our patients and in order to maintain appropriate documentation within our office, beginning this week most clinical questions as well as clinical evaluation will be facilitated using the VSee app. For simple questions please continue to use OhMD.
If you have not already done so please download the OhMD app. This is a HIPAA compliant secure texting system that facilitates communication between you and our office.
OhMD.com
For patients that have scheduled appointments for this week we will be in touch to determine if you need to be seen or if we can reschedule your appointment..
We will continue to keep you updated on any changes in our office processes as we adjust and adapt to this epidemic. And we will continue to monitor this situation closely and provide you with pertinent updates.

Sincerely,
Dr. Edward A Espinosa
Buckhead Medicine

Coronavirus Update 2: Office strategy to adjust to COVID-19

This is a follow up on the initial coronavirus update from last week. We are working to ensure that Buckhead Medicine provides you with quality medical care as we face the COVID-19 outbreak. Please see below the strategies that we are implementing in our office.

SOCIAL DISTANCING TO PREVENT RAPID SPREAD
We are implementing a social distancing strategy within our office. We ask that for each appointment or office encounter you wait in your car and call us at 404-257-5585 to notify us that you have arrived. We will then let you know when to come into the office. Our goal is to limit person to person interaction within the office. We believe this strategy will decrease the spread of the virus within our office.

COVID-19/CORONAVIRUS TESTING
Beginning today we are now able to perform COVID-19 testing in our office. Not all patients need to be tested. As before please call the office if you are sick with fever or upper respiratory tract symptoms so we can make a determination if testing is needed.

DEDICATED ROOM & PRIVATE ENTRANCE FOR COVID-19 SCREENING
We have a dedicated room that we are using for patients with upper respiratory tract infections or fever. The entrance is through the back of the office and is completely separate from the main office. To access this private entrance you will call first then walk between our building and the adjacent building under the gazebo to the back of the building and then turn left. The entrance is through the first door on the left. It’s a gray door.
TELEMEDICINE
We have started implementing secure telemedicine visits for certain types of medical complaints. Please click on the following Vsee link to download and sign up in order to have this option available to you on your smart phone.

SECURE TEXTING
If you have not already done so please download the OhMD app. This is a HIPAA compliant secure texting system that facilitates communication between you and our office. Patients love this app.
We will continue to keep you updated on any changes in our office processes as we adjust and adapt to this outbreak. And we will continue to monitor this situation closely and provide you with pertinent updates.
Sincerely,
Dr. Edward Espinosa
Buckhead Medicine

Coronavirus Update 1: Novel COVID-19 Coronavirus is coming

I wanted to give you an update and my recommendations on the novel COVID-19 Coronavirus.
Coronavirus disease 2019, or “COVID-19,” is an infection caused by a specific virus called SARS-CoV2. It first appeared in late 2019 in the city of Wuhan, China. People with COVID-19 can have fever, cough, and trouble breathing. Problems with breathing happen when the infection affects the lungs and causes pneumonia. Fever can be very high. Body aches are not common. Pneumonia is the most common complication associated with COVID-19.
Much like seasonal flu and H1N1, most people who contract COVID-19 will have mild symptoms or be completely asymptomatic.
Over the next few days to weeks we should expect to see an exponential increase in the spread of this virus throughout the world and in the United States. Morbidity and mortality rates in the U.S. will rise.
The vast majority of severe cases and even deaths that we’ll see will be in elderly people who are in poor health and in persons with a compromised immune system. Specifically, patients with heart disease, chronic lung disease, kidney disease as well as those persons with cancer on chemotherapy or immunomodulators.
The best way to avoid becoming infected with COVID-19 is to take the following precautions:
Wash your hands often with soap and warm water for at least 30 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick.
Don’t shake hands with other people.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
If you don’t have tissue to cover you cough use the crook of your arm or inner elbow.
Clean and disinfect frequently touched objects and surfaces.
Stay home when you are sick.
The flu is still widespread and active throughout the state, so if you have not already gotten a flu shot, it is not too late.
As far as face masks go, at this point I am not recommending routine use of face masks for asymptomatic or low risk persons. This recommendation may change as the prevalence of the disease increases. However, if you are sick with an upper respiratory tract infection wear a mask and if possible, stay home to avoid spread.
If you have recently traveled to areas where there are ongoing outbreaks of COVID-19 and develop fever with cough and shortness of breath within 14 days of your travel, or if you have had contact with someone who is suspected to have COVID-19, stay home and call our office.
To prevent spread to others we are asking that you call before coming to our office or before going to the emergency room, or urgent care center to tell us or them about your recent travel and symptoms.
Once notified of a possible exposure we will work to set up medical care in an organized manner, with a focus on appropriate diagnosis, treatment and prevention of further transmission.
Thank you for your trust and confidence as we walk together through this outbreak.
I will continue to monitor this situation and give you pertinent updates as they arise.
Sincerely,
Dr. Edward Espinosa
Buckhead Medicine