June 14, 2020 / Happy Flag Day!
Your Weekly COVID-19 Updates
Paradise Valley Medical Clinic, Douglas M Lakin MD
9977 N 90th Street, Suite 180, Scottsdale, AZ 85258
480.614.5800 (ph), 480.614.6322 (Fax)
PLEASE READ THIS ENTIRE DOCUMENT AS IT IS OF
IMPORTANCE TO ALL PATIENTS

"We will be emailing you weekly during the COVID-19 PANDEMIC. We will provide you with the latest information and instructions to deal with the current outbreak as it develops in Phoenix."
  We Have Expanded Our Telehealth Visits During The Increased Number Of COVID-19 Cases,
But Are Still Seeing Patients In The Office.  

See Below For More Information

A MESSAGE
FROM THE DOC


COVID-19 LEVELS CONTINUE TO RISE STATEWIDE AND AT HONOR HEALTH HOSPITAL…….


COVID LEVELS ARE CONTINUING TO RISE.  HONOR HEALTH HOSPITAL HAS INCREASING COVID PATIENTS BUT THERE IS STILL CAPACITY, AND THEY ARE PREPARED FOR FURTHER INCREASES.  
IN OUR OFFICE WE STILL SEE ZERO SIGNS OF COVID…. BUT THERE HAVE BEEN MORE EXPOSURES AND THUS MORE NEED FOR TESTING TO MONITOR.
 
ZERO POSITIVES for the past 11 WEEKS IN OUR OFFICE.
 
This disconnect between the general community and our patient group is due to:
·         Increasing but lower levels of COVID in the areas of Scottsdale our patients frequent
·         Attention to masks, hand washing, and physical distancing
·         Reducing exposures compared to the rest of the Valley
 
All these efforts will reduce risk, but they will not eliminate it, and as the prevalence of the virus increases in the community, exposure and risk of infection increase due to asymptomatic carriers.
 
Please continue to be vigilant!
   
The arc of the current increase will remain unclear for a few more weeks, but there are projections based on modelling. This website offers useful metrics to follow the course of COVID in MARICOPA COUNTY.  To monitor go to:       https://covidactnow.org
 
 
 
Outdoor interactions remain very acceptable as it is 20 times less likely to get COVID with outdoor as opposed to indoor exposures. This means 1 minute indoors exposure is equivalent to 20 minutes outdoors.
 
Do know that if you have maximum interactions (multiple meals out, daily visits to the gym, casino visits), your exposure rate is greatly increased during higher levels of COVID prevalence. Such behaviors with multiple and repeated outings become increasingly risky with the rise of COVID levels. Read this article on how to approach different locations you might consider exploring and to understand risks and ways to reduce risks.   https://www.erinbromage.com/post/the-risks-know-them-avoid-them
 
Current COVID ANTIBODY (BLOOD) tests show approximately 1-3% of people in Arizona have had a COVID infection. This is a low percentage. Current testing IN OUR OFFICE this past week, with the COVID ANTIBODY TEST, still reveals ONLY ONE IN 450 patients with previous COVID. This means asymptomatic COVID infections in Scottsdale have been very low, even among people who thought they had a viral infection that could be COVID; these in fact WERE NOT COVID.  
 
I DO NOT ADVISE COVID antibody testing to determine your status as we have virtually a ZERO SIGNAL FOR PREVIOUS COVID INFECTION among our patients.   That said, we will continue to do the COVID ANTIBODY TEST for any patient that is concerned about past infection or current immunity.
 
The BLOOD TEST will identify people who have had COVID infection in the past and who now have immunity from infection.  The exact degree to which this immunity is effective is unclear, but we believe that people who are COVID POSITIVE BY BLOOD WORK will have protection for at least several months or longer.
  
It is 99% likely you HAVE NOT HAD COVID…. that is what we are seeing in our patient test results.
 
NASAL TESTING RESULTS ARE DELAYED WITH THE INCREASE IN TESTING AND IN COVID CASES.  RESULTS ARE NOW TAKING 7 DAYS AGAIN.    Nasal testing for acute COVID infection is available at the office, but during the rest of June, Sonora has a delay in processing these results. Previously we were getting results in 24-48 hours; now we are getting results in 7 days. This will improve by August but be aware of this delay.
 
An alternative to testing in our office is to use CVS pharmacies that are doing testing. You can find locations and make an appointment. Here is the list of sites. They will ask questions prior to providing the test. You must ‘qualify’ per their criteria.
 
 
 
How to proceed now that ARIZONA HAS OPENED UP…….
 
For low and medium risk patients during this time when COVID is very low in the community:
1.     Continue to maintain physical distancing when in public spaces or with groups of friends/family.
2.     Wear a mask or face cover in closed spaces. In open area spaces, masks are not necessary if space is maintained.  This is done more to protect the community than it is to protect ourselves.  When you wear your mask, you reduce the possibility that you will spread COVID unknowingly.  When the people in your immediate community wear their mask, they are preventing the spread from them, to you.  Encourage others to wear a mask for all our protection.
3.     Wear gloves regularly when in public or do repeated hand cleansing and washing…. or do all the above.  This is critical to prevent silent spreading of COVID.
4.     Protection of the eyes is a consideration. Data on this is supportive but not conclusive as to the degree of protection.
5. Expanding your interactions can begin to take place, following the above preventive strategies and considering the following risk profiles.  Do observe the places you are going to make sure they are maintaining appropriate practices.  If you do not see people interacting appropriately, you should reconsider your exposures in such venues during this time of transition to higher levels of community COVID. Until it is clear what level of increase, we are seeing, we must remain conscientious:
a.  Open Air Venues/Public Spaces (parks/trails/patios/open air malls) provide excellent ventilation and have a low risk of spread.
b.  Stores that are large/cavernous, which allow for distancing, and which demonstrate proper protective practices among their employees are lower risk.
c. Smaller businesses that are employing excellent protective practices and which provide for distancing are lower risk.  Do not linger longer that is necessary in such public spaces….do your business and leave .
d.     Read this practical guide about public spaces & exposure…. https://www.erinbromage.com/post/the-risks-know-them-avoid-them
6.     If you have symptoms of any sort that might concern you for COVID…. get tested so that you know your status.
7.     If you are doing all the above and are not in a high-risk group (see below) then you can expand the amount of activities and outings you participate in over the coming weeks.  High risk patients should continue to limit activities to a greater extent.
 
High risk groups include:
·        Age 75 or over
·        Obesity (BMI 40 or above)
·        Lung disease (emphysema/COPD) or current significant smokers
·        Chronic kidney disease (Stage 4 disease or greater)
·        Diabetes…. not well controlled
·        Congestive Heart Failure
·        On immune suppressing medications for cancer or rheumatologic/inflammatory conditions
 
Medium Risk groups may want to be more cautious but can increase activities. These include:
·         Men Age 55 to 75
·         Hypertension
·         Diabetes…well controlled
·         Asthma
·         Obesity (BMI 35 or above)
 
Know that our office is responding to COVID, and we are here to help. Reach out for assistance if you are not feeling well. We will develop a plan of action for you to move forward.
 
Yours in good health,
Dr. Lakin
 

RECOMMENDED LINKS IN THIS NEWSLETTER AND IN GENERAL FOR COVID INFORMATION:







"We Are Keeping Covered In Our Office!"
In order to keep the infection rate down, it’s important that we continue to stay home, practice physical distancing, wash hands regularly, and wear a mask if you must leave your home. At our office, we are following CDC guidelines and strive for ways to keep our patients and staff safe.
We are requiring that all patients and visitors entering our offices cover their nose and mouth.
You can do this with a scarf, a homemade cloth mask, or your own surgical mask.
Masks have been shown to decrease the spread of coronavirus from infected people, even those who do not have symptoms.
We have a limited supply of paper mask and will make these available to patients while they last, however, we strongly encourage you to bring your own covering.
 
If you would like to help and are making homemade cloth masks or know of anyone that can donate patient masks, please contact my office manager, Leslie.


New Survey: How often do you wash your hands?
Very aware and wash my hands every time I touch something different.
Try to wash my hands if I leave the house and before I eat.
I wear gloves so I don't think there is a need to wash my hands.
When I think they are dirty.
I wash my hands the same amount as before COVID-19.


Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.
Follow these five steps every time.
  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.
REMEMBER IF YOUR ARE ILL AND CONCERNED
YOU MAY HAVE COVID INFECTION:
Contact the office via phone or email 
480-614-5800

We will contact you and review a plan of action for you.
•          Since most people will have mild symptoms (80+% will do well with cold symptoms only), very little will be done other than routine measures to treat a cold.
•          If you need to be seen we will consider a video visit or see you at a time designated for such visits.
Our Patient Portal Tips
Recently our IT support team encountered an attempted spam 'Bot' attack on our patient portal, MyHealthrecord.com.

To ensure your medical record's privacy, we have installed additional security measures, and a second layer of security when logging in. This is to deter 'non-human' login attempts.

More Tips:
If you are having trouble logging in, please follow these instructions:

First, clear your cache and cookies (browsing history) in whichever browser you’re using (such as Google Chrome, Firefox, Microsoft Edge, etc)
Once cleared, close and reopen the browser and click on the link.

You can also access the portal directly using our URL of Myhealthrecord.com
ATTN PATIENTS:
Dr Lakin is using FaceTime ,
WhatsApp and Zoom to connect with you
for a 'Telehealth' visit. You can connect using your iPad, iPhone, android phone, a laptop, or a PC with a camera.

Please watch these videos so you can be prepared and know how to connect with Dr Lakin for a 'Telehealth' visit.

CLICK ON THE PICTURES
 
  We Are Here to Take Care of Your Healthcare Needs.
We Are Here to Serve!
 
Our office is using all techniques to reduce exposure to a minimum during your visit. These include: 
·        Temperature checks of all patients and staff.
·       Masks for all people in the office.
·       Cleansing of hands and surfaces repeatedly.
·       Multiple Super-HEPA filters to filter out potential virus and particles in the office.
·       High Level UV light air cleansing in the office to eliminate bacteria and viruses in the air.
 
  We have expanded our Telehealth Visits during increased COVID-19 cases, but are still seeing patients in the office.  
In addition, we are connecting with you via
phone, fax, email, and telehealth.
 
 
OUR CURRENT UPDATED
OFFICE SCHEDULE
 
DOORS OPEN     
7AM - 4PM Monday through Thursday
7AM - 11AM Friday
 
IN OFFICE APPOINTMENTS: MONDAY - FRIDAY
7AM - 10:30AM & 1PM - 3:00PM
 
MONDAY - FRIDAY from 10:30AM - 12 Noon
We will be conducting TELEHEALTH/PHONE visits with patients.
 
MONDAY - THURSDAY
WE WILL BE SEEING POSSIBLE COVID-19 PATIENTS 3:00PM - 4:00PM (IN YOUR CAR…APPOINTMENT ONLY…. IN PROTECTIVE GEAR)
 
  COVID-19 SUMMARY:
 
REDUCE RISK BY REDUCING CONTACT WITH THE VIRUS
 
REDUCE CONTACT WITH THE VIRUS BY:
1.   Washing hands frequently….20 seconds is advised, but any hand washing is helpful.
2.   Wear a mask or face covering when out in public.
3.   Use hand cleanser in between washings…if available.
4.   Clean your cell phone daily with a cleansing wipe or UV light.
5.   Shower or bathe daily.  Twice daily if you want to feel more relaxed.
6.   Do not Pick Nose, Rub Eyes, or Pick Teeth with your fingers
7.   Do not go out or to work if you are ill…. or think you are ill.  If you are unsure, check your temperature. If over 99.8 you should not be going out.
8.   If someone in your house is ill, treat them as though they have COVID.  Have them get tested and you should quarantine as well.
9.   Stay away from people who are sick with COVID. Only caregivers should be in contact with COVID patients and they practice high level cleaning to prevent spread.
10. Maintain physical distancing practices, avoid getting within 6 feet of people (other than immediate household occupants)
11. Limit your activities to the minimum interactions you can do to maintain your daily living.
12. Leave mail and other paper products for one to two days on the shelf or in the garage (outside the house) …then bring them in after sitting for 24-48 hours to reduce the potential for transmission.
13.  Groceries should be prepared as per the video link below, with attention to cleansing before putting them in cupboards and the refrigerator/freezer.  See this video link for excellent detailed information:   Click Here
 
IF YOU ARE SYMPTOMATIC AND HAVE BEEN TOLD YOU MAY HAVE COVID ……BUT TESTING HAS NOT BEEN DONE YET …….DO AS FOLLOWS:
·        Self-Quarantine for 14 days from the start of illness and FOR at least 3 days after fever and major symptoms have resolved. 
·        Do not share a bathroom with housemates if possible. Use your own bathroom.
·        Do not share utensils with others and clean your own utensils and/or use paper/disposable eating materials.
·        Wait 1 day to wash the clothing you wear. Clothing can be washed after sitting out for 24 hours (virus is not transmissible at that point via clothing).   Others can wash your clothes using this approach.
·        Avoid sharing living spaces with housemates, to the extent your living situations allows.
·        Wash your hands frequently. Use cleanser on surfaces frequently.
·        Wear a mask & gloves when in the presence of others. Wear when you are with others as much as possible.
·        Shower/bathe twice daily if possible.
·        All household contacts should self-quarantine as well with only minimal outside interaction.
 
MORE EXPANSIVE TESTING IS CURRENTLY AVAILABLE IN OUR OFFICE. Results within 24-36 hours generally.
It is being done at the end of the day, in your car, by myself…. wearing protective gear. We are focusing on at risk individuals with mild symptoms or patients with more significant symptoms.  We are not screening asymptomatic patients unless they have had COVID exposure.
 
Symptoms for testing:
·        Fever (100.4 or above) and cough (without other explanation)
·        Fever (100.4 or above) and sore throat (without other explanation)
·        Fever (100.4 or above) and chest pains (without other explanation)
·        Milder fever and symptoms with recent travel from NYC or SF/Seattle.
 
We have completed hundreds tests and have now had 7 positives (no new positives in 11 weeks).    All our patients are doing well (one needed IV fluids & resolved his infection.) 
 
Testing is returning more slowly in JUNE. Positive & negative test results are now reporting back in 4 days (this is a delay compared to previous. Sonora Quest is developing new systems to handle increased throughput, and we anticipate the delays will lessen with time, but for now, we are having to wait longer for results.)
Do remember that asymptomatic people are spreading the virus, so you must be vigilant and protective around all people you are exposed to.
 
IF YOUR ARE ILL AND CONCERNED YOU MAY HAVE COVID INFECTION OR SIGNIFICANT COVID EXPOSURE:
Contact the office via phone or email first for instructions:
480-614-5800
 
Please do not walk into our office if you think you have COVID infection . We will not see you in the office. Only in your car, and with that, you should contact the office to be seen end of day.
If you think you have COVID and are truly short of breath, you need to go to the Emergency Room, not to our office. We are not equipped to handle low oxygen levels.
 
WHAT IS OUR CURRENT EXPECTATION FOR THE COURSE OF COVID?
At this point in time the are many uncertainties about the course of COVID in the US and in Arizona, but I can provide some educated speculation:
 
1.     The virus has increased with reopening in ARIZONA but is declining in many other states. Current peak in ARIZONA is projected in mid-July, although this is subject to change and we will update you weekly on these expectations.
 
2.     In September and into the fall and winter we are likely to see a recurrence of infection broadly in the state, country, and world. More significant restrictions will become necessary at that time.
 
3.     Using increased testing (swabs and blood work) we will be able to tune plans more finely for physical distancing in different locations based on results of the presence of infection and its frequency areas. This will allow for waxing and waning restrictions in local areas based on data from testing and mathematical projections.
 
4.     If OPENING UP is to be safe, we all must maintain distancing, wears masks, not go out if sick, and wash our hands repeatedly.
 
5.     Nature is immunizing us more generally, and when we have blood work to confirm previous infection, we will find a great number of asymptomatic individuals having been infected and this will provide ‘herd immunity’ which will be very helpful as time goes on.
 
6.     Antiviral medications will be found through clinical studies and we are likely to see effective treatments made available within 6 months. Remdesivir (Gilead Pharmaceuticals) has already demonstrated some effectiveness in highly ill patients and it is anticipated it will be effective in more mildly symptomatic patients.  Remdesivir is available currently at Honor Health for patients who require treatment. Additional studies are demonstratin g more effectiveness. Production is being ramped up and it will become more generally available.  Additional competing compounds are under development as well and a recent study of other antivirals compounds (a combination of 2 antivirals + interferon) was just shown to reduce duration of infection.  Unfortunately, a recent large study of Hydroxychloroquine failed to show positive effects.
 
7.     Immunizations will be developed, but will take 12-18 months to come ‘online’
 
8.     This paper is an excellent summary about expectations for the future of COVID. There are many unknowns, but this paper is sophisticated and approachable for those who want an expert perspective      https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf
 
9.     This paper is a great summary of information for risks to consider in public spaces:  https://www.erinbromage.com/post/the-risks-know-them-avoid-them
 
 
CARING FOR YOURSELF IF YOU THINK YOU MAY HAVE COVID OR IF YOU HAVE BEEN DIAGNOSED WITH COVID:
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
 
Common/Hallmark symptoms:
·        High fever (over 100.4, but can range from 99’s to 104+)
·        Fatigue
·        Cough
 
Other symptoms can include milder issues:
·        Loss of Smell and/or Taste
·        Nausea without Vomiting
·        Sore Throat
·        Aching muscles throughout the body
·        Headache
·        Occasional diarrhea …
·        Nasal congestion (occasional)
 
TREATMENT:
Symptomatic treatment for the most bothersome symptoms
 
Aches and Pains and Fever:
·        Tylenol 650 – 1000mg four times per day is preferred for treating these symptoms, but if not working well, you may use:
·         Advil (Ibuprofen 200mg), 2 – 3 tablets….2 – 3 x per day or Aleve (naproxen 220mg), 1 – 2 tablets...1 – 2 x per day,
·        Drink good amounts of clear liquids (anything you can see through)
 
Sore Throat:
·         Saltwater gargling
1.    Dissolve 1 teaspoon of salt in a glass of warm water.
2.    Gargle for 15 seconds and spit.
3.    Repeat during the day every 2 – 4 hours to relieve pain.
·         Pain relief medications: Advil (Ibuprofen 200mg), 2 – 3 tablets….2 – 3 x per day or Aleve (naproxen 220mg), 1 – 2 tablets...1 – 2 x per day, or Tylenol 650 – 1000mg four times per day.
 
 
Cough:
·        Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
·        Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
·        You may require a prescription cough syrup with Codeine.  Contact me if that is the case.
 
 
Sinus Congestion and Drainage (RARE SYMPTOM):
·        Use a decongestant such as Sudafed 30mg, 1 – 2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
·         Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
 
 
Nausea Treatment:
This is the most difficult issue to treat at home as there is very little one can do to settle the stomach. Coca-Cola with the carbonation eliminated (Flat Coke), Ginger Ale, or Ginger Root…. can be tried, but these are often inadequate, and the key to getting the stomach to settle is getting a good nausea medication.
 
If nausea is persistent, then calling for a prescription medication is often a good idea. Phenergan (Promethazine), Compazine (prochlorperazine), Zofran (Ondansetron) are very effective in treatment.  Sometimes we use them in combination either as a pill or a suppository.
 
The KEYS are:
 
1.   Settling the Stomach…so that liquids can be taken
2.   Focusing on Liquids…so that dehydration does not set in
3.   Eating light foods… if possible (to provide energy for healing). This is not a requirement for healing from an acute GI illness; so, do not feel that the sick person needs to eat food. The only requirement is liquid intake!
 
When to Seek Medical Assistance
•          There is no medication to treat this virus, so the resolution takes time.
Worsening symptoms/Signs of Complications:
•          If you are getting significantly short of breath please be in touch.  If progressive and worsening, you need to be seen and possibly hospitalized.  Best to go the ER if shortness of breath is a significant symptom
 
How Long to Recover
•          The COVID is a viral infection that will generally take from 3–7 days to develop, 3-7 days to improve and then from 3-7 days to completely resolve.
 
Stay Healthy & Safe!