‘There’s no need to panic’: What PCPs need to know about COVID-19

Lisa Dabby

The novel coronavirus that originated in Wuhan, China, is having a global impact, raising concerns about a pandemic.

To date, 15 cases of COVID-19 have been confirmed in the United States, according to the CDC. However, Sandro Cinti, MD, professor of internal medicine and infectious disease at Michigan Medicine, told Healio Primary Care that “it’s reasonable to say that there’s no need to panic at this point.”

Cinti noted that while there have been tens of thousands of COVID-19 cases in China, most people who acquire the disease will recover. “Even if this were to become a pandemic, it would be difficult, but most people would do just fine,” he said.

According to WHO, the mortality rate associated with COVID-19 is about 2%.

So far, there have been relatively few cases in children, Cinti said. However, older adults with comorbidities like cardiac, lung or kidney disease typically have a more difficult time handling the disease.

Healio Primary Care spoke with Cinti and Lisa Dabby, MD, an assistant clinical professor of emergency medicine at the University of California, Los Angeles, about what PCPs should know about the novel coronavirus and common misconceptions that they should address with their patients.

Transmission and symptoms

COVID-19 is believed to have originated in an animal and then jumped to humans, “but now it’s clear that we’re seeing person-to-person spread,” Dabby said.

The coronavirus spreads through close contact, or about 6 feet, according the CDC.

However, much is still unknown about COVID-19, including its incubation period. Based on the incubation period seen with MERS, the CDC suggested symptoms of COVID-19 could appear from 2 to 14 days after exposure.

Symptoms are typically mild and can include fever, coughing and shortness of breath, according to the agency.

Asymptomatic spread of COVID-19 is possible, according to WHO. However, they noted that asymptomatic transmission is probably not a major contributor to overall transmissions.

Cinti explained that it is possible to contain the spread of disease, “but the way it’s spreading — particularly if it’s asymptomatic spread — this would go across boarders eventually.”

Misconceptions about COVID-19

One of the most common misconceptions about the novel coronavirus is that wearing masks in public will prevent people from acquiring it.

Cinti noted that “most of the spread isn’t from somebody you pass in the aisle at Kroger’s — it’s going to be somebody close to you who gets sick and you have to take care of.”

Therefore, he said that while masks are helpful for those who care for sick people at home and those who are sick themselves, people should not “hoard” masks because this could deplete supplies for health care workers.

Another common misconception is that COVID-19 is similar to SARS — although there are genetic similarities, Cinti said, “it’s milder than SARS.”

In addition, Cinti explained that many believe that because SARS did not spread to the U.S., COVID-19 will not cause issues here. However, COVID-19 is “likely to cause less disease and death, but more likely to be transmitted,” he said.

Another misconception, Dabby said, is that “if you get coronavirus, you’re going to die, which is not true.”

Therefore, she explained that it is important to tell concerned patients that there is a “spectrum of severity” with COVID-19, and to educate them about “when to seek medical help and how to prevent spread to other people.”

Physicians should tell patients that if they feel sick — just like with any other virus — they should avoid going to work or out in public where they would be in close contact with others, Dabby noted.

Many people also fear that COVID-19 can spread through packages or imported goods; however, the CDC stated that the risk for this is very low as similar viruses have had poor survivability on surfaces, and coronaviruses are believed to spread primarily through respiratory droplets.

Because there have been very few cases of COVID-19 in the U.S., Cinti stressed that it is important to remind concerned patients that influenza is a larger threat to their health.

“More people will probably die this season of influenza than anything else, and so patients who haven’t gotten their flu shots should get those,” he said.

Incorporating COVID-19 into practice

Cinti said it is important for PCPs to “educate their employees about the novel coronavirus early, and not wait until it starts to spread.”

Therefore, he said that PCPs should develop messaging about COVID-19 to send to patients. Specifically, patients who have recently travelled from China should be told to postpone regularly scheduled visits until 14 days after they return if they do not have symptoms, and those with symptoms be told to call ahead before visiting. Then, the practice can prepare to put a face mask on the patient when they arrive and have a separate room available to test them for the virus.

According to the CDC, physicians can work with state health departments to determine if testing is needed, send swabs to the CDC for testing and then have patients who do not require hospitalization quarantine in their homes.

Interim home care guidance released by the CDC states that patients with mild symptoms can be cared for at home if they have appropriate caregivers, a separate bedroom to recover in and access to personal protective equipment like masks.

Dabby said that patients who need supportive care, like supplemental oxygen or breathing treatments, should be sent to the ED.

She stressed that it is important for PCPs and patients to call EDs ahead of time so that health care workers “can prepare for the patient and be ready to isolate them and minimize any kind of contact with anybody else in the waiting room.”

“The reality is that most [PCPs] should be able to handle mild cases from their office,” Dabby said. – by Erin Michael

References:

CDC. 2019 novel coronavirus: frequently asked questions and answered. https://www.cdc.gov/coronavirus/2019-ncov/faq.html. Accessed Feb. 12, 2020.

CDC. Interim guidance for implementing home care of people not requiring hospitalization for 2019 novel coronavirus (2019-nCoV). https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html. Accessed Feb. 12, 2020.

CDC. Interim U.S. guidance for risk assessment and public health management of persons with potential 2019 novel coronavirus (2019-nCoV) exposure in travel-associated or community settings. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Accessed Feb. 12, 2020.

WHO. Novel coronavirus press conference at United Nations of Geneva. https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-script-ncov-rresser-unog-29jan2020.pdf?sfvrsn=a7158807_4. Accessed Feb. 13, 2020.

WHO. Novel coronavirus(2019-nCoV) situation report – 12. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200201-sitrep-12-ncov.pdf?sfvrsn=273c5d35_2. Accessed Feb. 12, 2020.

Disclosures: Cinti and Dabby report no relevant financial disclosures.