I just learned this morning that Dr. Daniel Lewis, the medical director for both Greeneville hospitals, has been put on a ventilator due to COVID-19. Our prayers are with him that this is just temporary to get him over the hump and that he will be able to come off the ventilator soon. It certainly goes to show that this virus is easily spread and that we all need to minimize contact with others as much as possible during this time, and if you need to go out use a mask and gloves if you have them. Always stand at least 6 feet away as droplets are spewed out our mouths just with talking.
This motto might be a little morbid but it’s effective in helping you to remember the importance of physical distancing when you have no choice but to be out in public at the grocery store or pharmacy:
“6 feet away or 6 feet under”
I am receiving some calls from patients who are concerned that they are infected with the coronavirus – not as I would have thought, at least to this point. From what I have learned, the 3 hallmarks of infection are fever, cough, and shortness of breath. But the virus didn’t read the textbook, and so many patients don’t have these 3 symptoms, and others who have tested positive have had other symptoms. Even people without symptoms can be carrying the virus and giving it to you so that you might also end up on a ventilator.
Other symptoms that have been predominant are chills, body aches, and extreme fatigue – like influenza if you have ever had it, but I’m pretty sure we are out of flu season now. I’ve even read where nausea, vomiting, and diarrhea are prominent symptoms – like a stomach flu. Go figure. The coronavirus is a sneaky little bugger.
Bottom line: You can’t tell that you have had the coronavirus by your symptoms.
Without the coronavirus test, I don’t know if you are infected or not. We don’t have the nasal swab test yet, although right now you can get it at the health department and Ballad, but it might take several days to get an appointment and then another several days to get the result. Any of this information is subject to change. What I can tell you for certain is that if you are not sick enough to be in the hospital, you don’t need to be tested. I have a patient who had (and still has) many COVID-19 symptoms but is not short of breath, so I have advised her to stay home for now. She was tested on April 3 at the Washington County Health Department and we still don’t know the results. Today she is still coughing but not as bad and her fever is gone. I suspect that she had it and survived it at home despite being in her mid-50’s. Most of us will be surviving the COVID-19 at home, some with such mild symptoms that we won’t even know we had it.
The major symptom for which you should go to the hospital is shortness of breath. All the other symptoms – except maybe chest pain if you are at risk for a heart attack – you can survive at home. But with shortness of breath, you might need oxygen and if it gets bad enough, a physician will place a breathing tube through your mouth and into your lungs, then hook you up to a ventilator (as with Dr. Lewis) to assist you with breathing and getting enough oxygen to the rest of your body until your body has successfully fought the virus. The ventilator effectively buys your body time to fight the virus.
Some doctors are finding that the combination of the lupus drug hydroxychloroquine and the antibiotic Zpak helps people fight the virus more quickly. We don’t know this for certain because there haven’t been any “randomized controlled trials” to help us achieve this level of certainty, and some doctors on TV are not recommending it because they “lack the science” to be able to do so. Fair enough. But to be honest with you, these doctors are “blinded by science.” The upside benefit to taking this combination far exceeds the downside risk (they are both basically safe drugs). If it is available, I will take it if I think have COVID-19. The problem is hydroxychloroquine is in short supply. The last I checked, pharmacies in town did not have it. Were we unprepared or what? We hardly have enough N95 masks for healthcare workers!
If hydroxychloroquine were available right now, I would prescribe it to my patients who are short of breath and whom I think have COVID-19 without a test result because it takes too long to get the test result. This might change in the next week or so with Abbot Labs new in-office test. I will keep you posted. I have been prescribing ZPak to some patients with a cough and mild shortness of breath because for all I know they might have walking pneumonia, which ZPak effectively treats. Whether or not a Zpak has any benefit in treating COVID-19, I doubt – but I don’t know for sure.
Bottom line: If you feel like you are getting short of breath, call me on my cell at and we will discuss what you should do – call in a ZPak (or get it here while supplies last) or if you should go to the hospital. It would be helpful to know your pulse oximetry reading, but few of you have that device. You can get a reading here if need be.
Which brings me to my next point – treatment of acute problems. If you have an acute medical problem, call us at 639-9970 during office hours or text me (preferred) or call me on my cell phone during and after office hours. Most of the time we can handle this so you don’t have to come into the office, which is best for you so that you are potentially exposed to the virus and for us for the same reason. If I need to see you, I will have to drive your vehicle behind shed behind our building where I will come examine you and prescribe whatever treatment you need. If you need to come into the office for some reason – such as to drain an abscess which we did today and yesterday – we bring you in through the back door and directly into the procedure room where I perform the procedure.
For chronic medical problems, if you need a refill of medications, we can call them in to your pharmacy or you can come by to pick it up here. If you plan to pick your medicines and / or your prescriptions here, please call ahead of time so that we can have them ready for you. For schedule 2 substances like Adderall, Norco, or Percocet, you need to drive to our parking lot where we will bring the prescriptions out to you in your car. If you are on a Schedule 2 substance, we will try to write enough for 3 months to get you beyond the pandemic unless we have a reason not to. Most lab tests can wait until the pandemic is over. For labs that can’t wait, we will try to draw them in your vehicle behind our shed weather permitting or in the shed if not.
Bottom line: We are still here providing medical care to all of our members, but we are doing whatever it takes to treat you outside of our building unless it’s absolutely necessary such as suturing a laceration or draining an abscess.
Don’t get lulled into complacency because there are only about 20 reported cases in Greene County. I would imagine that there are a lot more cases out there that we haven’t tested. The good news is that even if there are, their infections have not been serious enough to warrant testing or treatment. This is true of the rest of the nation as well. The fatality rate of the patients tested in the U.S. right now is about 3%. But this number is probably high. The number of people who have been infected and now have immunity but didn’t get tested might be as high or higher than the ones who have tested positive. So, the fatality rate – which is the number who die from the virus divided by the number who have had a positive test – is probably a fraction of what the real fatality rate is – which is the number who die from the virus divided by the total number infected (a number we have no way of knowing yet) This is good news because the actual fatality rate is certainly less than what is being reported and might even be less than 1%.
The only way we are going to know for sure who has already been infected is to draw blood from and test people to see if they have the antibody to it. This test is not available yet, but I would imagine that it will be within a month or two. It will be able to tell us who has already been infected even though they might have not even known that they were. They might have had such a mild infection that they hardly noticed it. People who have been infected are almost certainly going to be protected against becoming infected by the virus again, so they will be able to resume their normal life, while those who don’t have antibodies will still need to avoid contacts until there is a drug that cures it or a vaccine that prevents it.
Bottom line: Developing a blood test to detect antibodies will be a game changer. It will be able to tell people if they have immunity or if they don’t and so more people will be able to go back to work.
Stay safe and stay at home if possible!
Robert Berry M.D.