SAN DIEGO SPORTS MEDICINE AND FAMILY HEALTH CENTER IS OPEN AND HELPING PATIENTS
Please call our office first as we seeing most patients via telemedicine. Virtual or telemedicine appointments with Physical Therapists and Pilates Instructors are also available, so please call and we can continue to assist in with your care.
Newsletter March 27, 2020
Dear Patients and Friends,
We are clearly now in the middle of an expanding crisis, which by most experts’ opinions will continue to expand for at least the next three to four weeks. We are being updated by all of our local and national medical resources by phone calls, scientific webinars and real-time communications on a daily (sometimes hourly) basis, so that we are continuously abreast of the latest facts and guidelines that inform our clinical care for all of you. Everyone is being flooded with a plethora of reports, facts and advice. We want to make everyone aware of several “hot” issues so that you understand the position of the most well-respected clinical researchers and scientists to date:
1. The pandemic status: We are now in a logarithmic growth mode of transmission and infection. This novel coronavirus has never existed before, so we have NO immunity to it. It is more easily transmitted than previously expected and it can be transmitted by people that don’t even yet know they are infected. We can no longer hope to conquer it. The only strategy now to stem the tide for this crisis is CONTAINMENT. Since society does not have the supplies, resources or personnel to perform widespread and timely diagnostic testing, social distancing for everyone is the most powerful tool we have for containment.
2. What can YOU do?
• Wash your hands frequently with soap and water. Warm and cold water are equally effective.
• Sanitize shared or communal surfaces: countertops, handles (all kinds), doorknobs, keyboards, phones, desks, chairs, etc.
• Cover your coughs and sneezes with your elbow or tissue.
• Isolate yourself if you have any signs of infection – even common cold or flu symptoms.
• Abide by the six feet distance between people to avoid inhaling viral droplets.
• Please honor the lockdown status for non-essential service providers.
• Essential service providers: do NOT go to work if you have any symptoms of fever, chills, shortness of breath or difficulty breathing, sore throat, cough, congestion, unexplained headache, muscle aches or gastrointestinal upset.
• If you feel you need to see a doctor, know that San Diego Sports Medicine and Family Health Center is open and ready to help you.
3. Should I see my doctor if I am sick?
If you feel sick, please call and we will set up you up for a video visit with your primary care doctor or another available provider. We are utilizing video visits for all of our patients with symptoms of illness, and they love it! We can evaluate and treat any symptoms you are experiencing. Much of our care and communication can safely and effectively be handled by telemedicine.
One of the biggest risks we face is having health care providers become infected, or health care facilities becoming contaminated. There is a very real risk of quickly running out of available medical providers or facilities. If you are experiencing fever, cough, or shortness of breath, please do NOT go to a doctor’s office or emergency room, unless your symptoms are severe. If you are experiencing significant shortness of breath, then you should go to the emergency room to be evaluated and potentially tested.
4. What if I’m not sick? Can I still see my doctor for other reasons?
The short answer is Yes! Video visits work for a variety of reasons beyond respiratory illness. One of the dangers of placing all of our attention on COVID-19 is neglecting our health in other important areas. We can happily take care of you via video visits for managing chronic conditions, medication management, lab work follow up, some dermatology conditions, annual health assessments, care for anxiety and depression, and care for other health conditions.
The longer answer is Yes! If you have medical needs that are not best met by video visits, San Diego Sports Medicine and Family Health Center is open and ready to provide you with care. We have physicians available on site every day to see you in person for non-respiratory illnesses as needed. If you have a condition that needs an exam, lab testing or imaging, we will make those decisions on a case-by-case basis and will be happy to have you come in for proper medical care and management – just not if you have any symptoms of a cold, as those are handled by the video visits.
Some medical issues require hands-on care, such as treatment of new musculoskeletal injuries, and we are open and ready to serve you. This is also a great time to get your annual physical. Our in-office wait times are short and we are following strict protocols established by the CDC to provide a clean and disinfected environment. We are also taking logistical measures to provide social distancing for patients within our office.
5. What’s the latest on testing?
As of today, testing COVID-19 is currently available at hospitals for patients with severe symptoms requiring hospitalization. Unfortunately, due to inadequate supplies, testing is currently limited to those with more severe symptoms (unless you are an NBA athlete). After evaluating your symptoms, we will direct you to test locations if we believe you qualify for testing at this time. Testing will become more readily available in the coming weeks and months.
6. What about medications like NSAIDS, hypertensive medications, Chloroquine and Zithromax?
The information below is from Dr. David Morens, the Senior Scientific Advisor to Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Disease at NIH:
• NSAIDS (ibuprofen, naproxen, etc.): There is no scientific proof that these make us more susceptible to COVID-19 infections or make the infections more severe. This data was theoretical and was derived from a very severely sick cohort of patients, not prove, and there actually have been other reports that indicate a possible protective effect from them. Until we know more definite information the best advice is to use acetaminophen (Tylenol) as first-line treatment and if that doesn’t control your fever, then go ahead and use NSAIDS as the next step, in addition to adequate hydration.
• ACE Inhibitors and ARB medications for Hypertension: There is no valid data that supports the need to stop or change these medications in patients who are taking them to control hypertension. A joint statement from the American Heart Association, American College of Cardiology, and the Heart Failure Society of America on March 17 gave full, unqualified support to maintaining patients on drugs that work this way, specifically the ACE inhibitors and angiotensin-receptor blockers (ARBs), which together form a long-standing cornerstone of treatment for hypertension, heart failure, and ischemic heart disease.
• Chloroquine, hydroxychloroquine and Zithromax:
There are over 20 current drugs being studied nationally and more internationally which all have been shown to have potential promise as treatment or prophylactic agents. The reports of positive results have been in such small numbers as to be clinically not significant. Dr. Morens sees no data that would support the rationale for widespread use of any of these drugs at this time other than in clinical studies or because of intensive care needs. He hopes these or others might be shown to be helpful but it’s way too soon to be advising them at this stage. We should know with much more validity in several weeks whether any of these drugs might be indicated. Until then he discourages use of them.
SDSM’s advice regarding use of these medications for COVID-19:
These drugs are currently not recommended for prophylactic use. Local pharmacies are essentially out of these medications because of the “toilet paper mentality” and we are being asked to prescribe them only for patients with documented COVID-19 infections who need hospitalization where they can be appropriately tried and also monitored for potential serious side effects. These medications have not been recommended for prophylactic use or for the 80+ percentage of patients who have mild symptoms and are most appropriately cared for at home. It is important to save the necessary medications for those who need it most right now. We are not prescribing them and are leaving that to the hospitalists who will make those decisions on a case by case basis for admissions. Thanks for your understanding and for helping us to maintain critical medical supplies for those with the most need. We are keeping abreast of recommendations from our infectious disease consultants and may modify our decisions based on their updated recommendations.
We are here for you and want to do everything possible to be your trusted partner in health and wellness. Thank you for your respectful cooperation and helpful feedback as we face this unprecedented medical crisis together. As always, it is a privilege to be on your medical team.
Yours in health,
The Physicians and Staff of San Diego Sports Medicine and Family Health Center