COVID-19: End of July Update

COVID-19 - End of July Update

Here we are, another month into the pandemic and it’s time for an update. First, we appreciate the opportunity to engage with you when you have questions about COVID. Many of you have reached out when you have questions about a potential exposure, or asking what to do to protect yourselves and family. This hasn’t been easy for us as health care professionals, so navigating it without a medical background must be extremely difficult. 
 
Guarded progress. This is the first thought that comes to mind when I think about July. The number of cases in Illinois has been fairly stable over the past month as we moved from Phase 3 to Phase 4. Admittedly, I was concerned. I was worried that as we opened up, we would see a serious resurgence such as what we’ve seen in California, Arizona, Texas, Florida, etc. and we would end up needing to go back to Phase 3. Yet we’re having the highest number of tests statewide and the rates overall in Illinois are staying in the below the 5% warning zone. The following is a table I took from a Facebook group I'm a member of, The Illinois COVID-19 Medical Collective. 

The graph shows that our state is doing much better than the overall US with regard to test-positive rates. However, as you can see, from our nadir in early July, we have been creeping up. Not as quickly as I had been concerned about, but as of August 2, eight of the 11 regions of Illinois have been flagged for having increasing numbers for seven of the past 10 days. That includes Chicago, suburban Cook, the northern suburbs such as Lake County and the Northwest suburbs like McHenry. DuPage sneaks under the wire with only 5 of 10 days of increase, but the county is on an upward trend. We need to stay vigilant.

These increasing numbers aren't a surprise. While gratefully we have not had anyone severely ill in a while, we have had a number of patients who have tested positive, and quite a few folks have been exposed. Here are some stories:

1. “We’ve been really good. Haven’t been out much at all. On Sunday we had dinner with a couple, just the four of us at a table for four, so we all weren’t six feet from each other. I got a call two days later that my friend tested positive after she started having symptoms the next day.” The patient is in his 60s. Gratefully, he and his wife ended up testing negative.

   Key: People are infectious up to 48 hours BEFORE they start having symptoms. Don’t assume anything!

2. “I went over to see my son. We didn’t have masks on and chatted for about a half hour. He was having a problem with his sinuses that he thought was allergies. He went to see his doctor the next day who tested him for COVID and he was positive.” The patient is in his 70s and so far so good.

   Key: We need to be on guard! Almost any illness/symptom in someone could be COVID, so don’t interact with sick people particularly if you are in a high risk group. 

3. “We were away for a month and when we got back, our babysitter came to care for the kids again. I found out later that she had traveled to a couple of high-risk states while we were away and she ended up getting COVID and sharing it will all of us.” The patient, his wife, and kids all got COVID. They ended up doing fine, but he's got a nagging persistent cough. 

   Key: ASK! If you’re going to bring folks into your bubble, you need to ask if they have symptoms and/or if they have had any higher risk exposures. 

We don’t want you to get COVID-19! As primary care providers we still have NO direct way to treat you if you get it. Hydroxychloroquine is not recommended by any of us at Harper Health. NO credible research trial has demonstrated benefit over harm for this drug. If people get really sick, then there are strategies used in the hospital that are saving lives: dexamethasone, remdesivir, high flow oxygen, non-invasive ventilation, prone positioning, etc. The death rates are coming down because the intensive care specialists are learning how to care for the really sick. 
 
We are keeping our antennae up for companies researching outpatient treatments. It would be ideal if there were rapid testing and then a treatment that we could provide that would reduce the chances that someone would have severe illness. One example is a monoclonal antibody that binds to the SARS-CoV-2 spike protein and targets the virus for removal by our immune system. If the trial now in Phase 3 goes well, we could see this treatment rolled out in the next couple of months. Another topic you may hear about is “drug repurposing.” Developing a new drug to kill SARS-CoV-2 would take a long time, but what if we used what we know about how the virus works and apply our knowledge of existing medications to this? Maybe a drug we already have can help? Could either of these strategies turn COVID-19 into a nuisance as opposed to a people/economy-killer? That’s the hope.
 
The same outcome could be achieved through a vaccine. Good progress here. Over 100 vaccine trials around the world are underway and encouraging results have been released. There is still a ways to go to determine whether one or more of these vaccines will be effective and safe. We’ll continue to give updates on this. 
 
So, as we head into August, there is some hope on the horizon, but we’re not out of the woods. With school starting back up again the number of interactions will go up, as will the risk. To me, the issue is both the children and the parents. Yes, it’s hard to imagine school aged children keeping their masks on and not sharing germs. But the impact of germ sharing is only notable if one of the children has COVID. Where would the initially infected child get COVID in the first place? Home. And it’s home where parents have control of who we grant access to our bubble. Home is also where we should keep our child if a sniffle starts. Are we as parents ready to exhibit the necessary discipline? It starts at home.
 
Wear a mask. Wash your hands. Keep a social distance. Stay home if you’re sick. 
 
More to come. 
 
Dr. Will