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> COVID19 Notes from the Medical Director

2019 Novel Coronavirus (COVID-19)
Notes from the Medical Director

Photo of Dr Klepack

William Klepack, M.D. is the Medical Director of the Tompkins County Health Department. This page collects information that is essential for a complete understanding of how the coronavirus and COVID-19 disease impacts our community and its members.
 



How long should I wait to be tested after a potential exposure to COVID? (7/17/20)

This is a common question from people who miss their grandchildren or those that have been at a mass protest for example. It is also important for people who have traveled within the U.S. or internationally.

Let me start by saying that anyone who has symptoms consistent with COVID illness should be tested right away. This article is only for persons who have no symptoms.

If you were at a large gathering or traveled to a place where the virus is common, or know you were near a person with COVID, you are at higher risk of getting it. You are at even a higher risk if you and/or the other person or people were not using face coverings, social distancing, and the other public health prevention measures. Your first reaction should be to quarantine yourself.

Quarantine is the way people who may become contagious from a disease prevent infecting others. Since the incubation period (the time from exposure to becoming sick) is 14 days from the last exposure to the virus, you need to be quarantined that long. At the end of your quarantine period, if you have a COVID PCR test (not an antibody test) you will know if you are contagious.

But, what if you need to know sooner whether you became infected? When is it sensible to have a test? First, do not get a test right away. Since it takes a few days for infection to start after an exposure and for the test to become positive, a test done right away will be falsely negative. Get tested 3 to 5 days after exposure. Half of people infected will have a positive test by 5 days from exposure. Others will take longer to be positive (up to 14 days after exposure).

If you test too short a time after exposure, your test will be falsely negative. If you wait too long to test, you risk being contagious and infecting others. There is no perfect answer. A good strategy is:

  • Go into quarantine right after exposure
  • Get tested 3-5 days after exposure. Learn how to get tested here.
  • Stay in quarantine for a total of 14 days
  • Get tested at the end of your quarantine

If you never have symptoms and your test(s) are negative, then you can be very confident you are not contagious.

Suppose you need to work; how does work mesh with quarantine? Many types of work have guidelines which provide for people to work if they are not symptomatic (check with your employer). The worker must, of course, follow prevention measures carefully. If you are an “essential worker” then follow NYS guidelines for your type of job. In all cases, keep your employer informed. If you have questions, go to our website or call the Health Department.


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Face Coverings and masks: What do they do and how do they do it? (6/22/20)

By now the sight of us wearing face coverings has become commonplace. However, not all of us use them and some of us are unclear about what they do for us. As time goes by, some of us are getting lax about using them. They are still needed.

Face coverings decrease the number of COVID germs that you can spread to others around you. Some of the virus gets trapped in the fabric of the face covering. Some of it leaks out with your breath at the covering’s sides, and the top of it alongside your nose. The virus that does leak out is slowed down by being blocked by your covering, so it does not travel as far.

Without a face covering studies have shown the virus can travel many feet if we are talking, more if we shout or sing and even a little way if we are just breathing. Face coverings change all that. With the covering, people who are not right up close to you are safer. And people who are six feet or more away have very little to be concerned about.

We know that most people are infected indoors. In contrast, outdoors tends to be a far safer place – if you are keeping at least 6 feet of distance and wearing a face covering - usually there is some breeze occurring which helps to disperse any virus. It is Ok to go without a mask outdoors if you keep your distance. But, if there is a chance other people will be getting close, pull that face covering out and put it on before they get near. Your face covering helps protect them and theirs helps protect you.

Every measure of this type recommended by public health is designed to reduce or eliminate the number of virus particles that can get into our nose, mouth, eyes, and lungs. Studies are being done to determine exactly how many virus particles it takes to make us sick,  but anything we can do now to lower the number makes us safer.


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Ask yourself: “As businesses reopen, should I?” (5/29/20)

WE ARE IN a phased reopening of businesses in our region. Measured steps are being taken to let our economy restart while still protecting the health of our community. The steps progress from allowing the less public-facing businesses to open, to allowing ones with more inherent risk to do so. The hope is the time between phases allows us to control the spread of COVID-19 enough to mitigate the increase in risk. But as businesses reopen – should I?

Some business owners will view the risk of their establishment as too high even though the category of their business is included in the approved industries. Knowing the details of how their business must operate, their judgement might be that the mitigation measures that are possible for them to take do not lower the risk sufficiently for them, their employees, and/or their patrons. Those businesses should follow their judgement and not reopen. When the time is right for them to open, they will know it. Data we are collecting will, hopefully, indicate whether our control of the disease is sufficient or not. This data, along with new medical developments, will give a business owner the sense of when the time is right.

Some of us private citizens should also not “reopen” as businesses do. Some of us are over 65 and our risk is greater. We have diabetes, are taking medications that decrease our immune response or have other conditions that our medical practitioner says make us more vulnerable. We should not “reopen” at the same rate as businesses do. For some of us, we may need to wait for an effective vaccine. For others, it may be when medical treatments are found that can modify the course of COVID disease. For all of us, the use of face coverings, hand washing, social distancing and all the other precautions will be necessary measures for as far out as anyone can see at the present.

The decision whether to reopen for businesses and for individuals needs to be an individualized one.


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Be sure to keep early childhood vaccination schedule on track (5/13/20)

I REMEMBER Meningitis as a devastating and too often fatal disease of children in the early years of my career as a doctor. We at the Tompkins County Health Department urge you to not let your babies and children get behind in their vaccinations during this time of coronavirus. The vaccinations given in the early years protect against many devastating types of meningitis and other serious and life-threatening infectious diseases. Even in this time of coronavirus concern keep your child’s vaccinations up-to-date. Don’t get behind. Please make an appointment with your doctor today. See the recommended vaccination schedule here.


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Antibody blood tests for COVID-19 as compared to Swab tests for COVID-19 virus (4/24/20)

A BLOOD TEST for COVID-19 is as different from a Swab test for the virus as a photograph of a person is from seeing them face to face.

The blood test detects the body’s memory of having seen the virus. The Swab test picks up molecules of the virus itself from your nose and throat.

The blood test tells us that, at some time, your body had the virus. The Swab test shows the virus is still in and on you, and you are contagious to others around you. If your blood test is positive, you may or may not still have the virus. The blood test alone cannot tell you this important detail. Only the Swab test can tell you if you are contagious.

As of right now, the blood test cannot tell you for certain if you are immune to (protected from) COVID-19. We hope that a positive blood test means you are immune; but studies are just being done on this and it is too soon to say. If you are immune, the blood test does not tell us how long you will be immune. Again, studies are just getting underway that will answer this question. It will take months or perhaps a year for an answer. So, don’t let your guard down. A positive blood test does NOT mean you can afford to stop social distancing, hand washing, wearing masks and all the other important measures that have helped control this pandemic.

A negative Swab test does give some assurance that you are free of the virus. But, not 100% assurance since false negatives can occur in a small percentage of people. So, if you have a negative test and you do not have COVID symptoms but later develop them, or have a negative test but then your symptoms persist or get worse, you need to be retested.

On the other hand, a positive Swab test is highly reliable and shows you are contagious and that your symptoms (if any) are due to COVID. If your test is positive and you have no symptoms, you are still contagious. You should isolate yourself (see our video on isolation and quarantine) and get advice from your healthcare practitioner.

Some people who are infected with COVID-19 are interested in donating their blood to the Red Cross or a medical center for the purpose of it being used in the treatment of severely ill, hospitalized COVID patients. In that case, the COVID blood test is used to determine if you have enough antibodies (the body’s chemical way of remembering infection) to do any good. This use of the blood test is almost the only one that is useful currently.

So, to summarize: You are much more likely to need a COVID-19 Swab test than a blood test. A Swab test for COVID virus allows you to “see” the virus in and on your body “face to face.” The blood tests are like looking at its photograph – you do not know where it is right now or if it is even alive in and on your body.

We need a lot more studies and the good science that will come from them to answer many of the questions that we now have about blood testing and the finer details regarding how COVID-19 behaves.


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Medications and coronavirus (COVID-19): Know the Risks Before Taking Any Medications (4/15/2020)

AS OF THIS writing there are no medications that are proven to work against the COVID-19, unfortunately.
However, there is much said about some medications and some supplements by prominent political officials, marketers of supplements and the press. They usually miss making a very important point.

If medications and supplements did not have adverse effects, we could take them freely with no fear of harm in hopes they might help. (The only bad effect would be on our wallet.) But they all do have adverse effects and they are often serious ones. Medications and supplements should only be used when your situation is severe enough that taking these risks is justified.

Let’s take the drug being talked about the most, hydroxychloroquine. Its adverse effects include:

  • Irreversible eye damage to the retina
  • Decrease in kidney function
  • Life-threatening and fatal heart effects (atrioventricular block, pulmonary hypertension, sick sinus syndrome or other cardiac complications). The drug often prolongs the QT? interval which can lead to ventricular arrhythmias and torsades de pointes? which are life threatening.
  • Psoriasis and porphyria are worsened
  • Muscle weakness and nerve damage are reported
  • Severe and dangerous drops in blood sugar
  • Digestive side effects and liver impacts
  • Rashes, some of which can be due to serious bodily reactions to the drug
  • In persons with already existing problems, it can worsen them.
  • It interacts with many other drugs such as for diabetes, seizure control, heart medications and cancer treatments.

Patients should be fully informed of the potential risks of the use of it, especially in pregnancy, during breast feeding and in children.  Risks in the elderly may be even greater due to aging effects on kidney function.

This is not the only drug or supplement with such a long list of adverse reactions. Most have such potential problems associated with them.
You should never accept the statements of anyone advising you to take a drug or supplement without first demanding proof. Your body is precious. It can easily be damaged.

  Reference: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/009768s037s045s047lbl.pdf


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Pregnancy and Pregnancy Outcomes Regarding Coronavirus
Submitted as an Op-Ed to 14850.com, Apr 15, 2020

THE DATA WE currently have about pregnancy and COVID-19 is encouraging. The Cochrane database, a well-respected resource of reliable medical information, reports that a pregnant woman is no more susceptible to COVID-19 virus than anyone else; but, on the other hand, no less susceptible to coming down with it. The risk of severe illness appears to be the same as a non-pregnant woman. Continue to use social distancing, hand washing and all the other measures that are recommended.

Pregnancy outcomes seem to be minimally affected if one is mildly to moderately ill. However, severe illness does increase risk. In the 138 pregnancies reported, the baby’s birth weight was usually normal and, with rare exception, infection of the baby was not reported. (A second study of 38 women and babies published on March 24 confirms this). Of course, pregnancies and babies were still subject to the various troubles that can occur normally. For example, the information still shows the expected number of premature births and unfortunate outcomes. But, (so far) coronavirus is not showing itself to be a devastating issue except if you become severely ill.

Take all precautions against acquiring coronavirus. Advise your family and friends to do so as well and, if it you meet the criteria, get tested. Several international authorities are advising against people becoming pregnant until the coronavirus is past. A conversation with your personal physician is advised before planning a pregnancy. If you are already pregnant, as always, your obstetrical practitioner knows you best. Your health care should always be individualized.

Additional information: coronavirus.health.ny.gov/protecting-public-health-all-new-yorkers.


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