COVID19 Update From Dr. Hall – April 13, 2020

By on April 14, 2020 under Uncategorized

I have gotten so many nice emails from patients who have been enjoying my notes to patients during the pandemic that I was encouraged to write another one for what is now week 5 of the pandemic.

I hope that everyone had a pleasant Easter/Passover week if you celebrate these faiths, and a great week for those who don’t. We missed going to church as a family but watched the Easter mass on Catholic TV. I am happy to report that the Easter bunny surprised us by having Easter baskets with a chocolate bunny for my wife, myself and my oldest son who is sheltering at home with us. It was nice to “Zoom” with our family across the country on Easter. Our “Zoom” call started with my 2 brothers and Sister and their spouses and spread to include most of all of our respective children- pretty soon we had cousins catching up with cousins in Seattle, San Francisco, New York City, South Bend Indiana, Brighton and Detroit Michigan, and Columbus and Zanesville Ohio. The young men were having fun comparing their beards, several new puppies adopted during the pandemic were introduced, and I found out the hard way that you can’t have more than 9 people on a Zoom call at the same time! But it was wonderful. And whether by coincidence or not, the national hospital resource use for Covid19 was reported to peak on Holy Saturday.

I always look forward to the sight and fragrance of the hyacinths that I have planted in front of the house. They bloomed again this year like nothing is amiss. The daffodils should be up soon.

Our two collies Ranger and Shiloh are also enjoying the spring. They are getting accustomed to seeing Amazon drivers stopping by with a few more packages than usual and we have learned the new term “contactless delivery”.

It can seem a little confusing as the recommendations from the experts on Covid19 keep changing. I always remember the Dean of my medical school telling us at graduation “Half of what we taught you is wrong, now it is your job to figure out which half”. My mom joked that I should get some of my tuition back, but we all knew that he was telling us that medical knowledge is imperfect and continues to change. That is why it is the “practice” of medicine. So as recommendations seem to keep changing during the Covid Pandemic, it is because we are all still learning.

For various reasons I have been the one doing the grocery shopping for our household. Even I was a little self-conscious last week being one of only a few wearing a mask at the grocery store but now that the CDC has recommended it for everyone, I thought I should set a good example.
This weekend everyone but one shopper had a mask on. It was a new experience for me, like many of you, waiting in line 6 feet apart to get inside.

I spoke to friends of ours by phone this past week. The wife is being treated for cancer and has been scrubbing all her packages and groceries purchased with dilute bleach. This brought back memories of when I was a medical missionary in Haiti in the late 80’s and the missionaries who housed us would wash all of the produce with dilute bleach, in this case to prevent Typhoid fever which was rampant in Haiti at the time. I can still remember the iceberg lettuce tasting like it had been soaked in an overly chlorinated swimming pool!

So, this got me to thinking, what is the right balance between being too worried/not worried enough with our groceries and packages during this pandemic. I share with you an article from WSJ (spoiler alert-they recommend that you not wash your produce with bleach) as well as one that just came out this week in JAMA. (Journal of the American Medical Association, of which I am a member). They both discuss Food Safety and Covid-19 and give practical advice including how to stay safe while grocery shopping, and what precautions one should take when unpacking groceries and preparing food.

As a follow up to the discussion last week on any recommendations to protect against Covid 19, in addition to hand-washing, social distancing and wearing a mask out in public, some more recommendations for critical care and management of Covid-19 patients were released last week from Eastern Virginia Medical School. I have put the link below which is fairly technical and runs 18 pages long and goes into more depth than many of you may be interested in about their current protocol. I have checked with local colleagues as well as colleagues in NYC and this is similar to what they have been doing. Keep in mind that recommendations keep evolving and may change next week and there are not strong clinical studies yet to support many of the recommendations. But you might find the first page interesting on prophylaxis- i.e., what to do to perhaps prevent a serious infection.
I was surprised to see Melatonin on the list. Some studies came out this week suggesting that melatonin may be of benefit by decreasing the inflammatory response that is thought to cause some of the damage in patients who have Covid 19.

As always, I provide this as information and not advice and I would caution anyone who decides to add these supplements to their regimen to discuss this with your physician.

I am having my family take Zinc, Quercetin and Vitamin D and am not ready to add melatonin to our mix because of the effects on sleep, but if you already take this for sleep you may be interested to hear, as I was, that this may decrease some of the inflammation in patients who are suffering from the infection and potentially decrease the severity.

My staff and I remain busy in the office, answering your calls and concerns. We continue to see urgent cases in the office such as aggressive skin cancers and facial lacerations to help keep patients away from the hospital and emergency room during this surge in cases. But we are also helping patients through our new HIPAA compliant telemedicine platform. This includes follow-ups from recent surgeries that can be managed without an in-office visit but also new patients who are planning now for when it becomes safer to see less urgent problems in the office and at the hospital. We have heard from some new patients who prefer simply to see us first in person and are waiting until this is feasible. But in the last few weeks we have had online consultations with patients who want to get started in their journey such as those who are suffering from symptoms due to overly large breasts who would benefit from a breast reduction, patients with deflated breast implants who are worried and will need replacement, and even patients with split or stretched earlobes who want to plan for repair. If you or your friends have any questions or concerns about old or new plastic surgery issues, please don’t hesitate to call the office and see if this may be a helpful option for you.

We are hopefully / tentatively planning to be able to see non urgent patients back in the office with proper precautions after May 4th, depending of course on guidance from Governor Baker and our state and national medical societies.

According to the “surge calculator “from the university of Washington, national peak hospital coronavirus resource use was April 11. Coronavirus hospitalizations in Massachusetts are expected to surge in the coming weeks and we continue to prepare for the local surge in hospital resource use which is predicted to peak around here on April 26.

I have put a link to the Covid calculator below.

On the good news front,

In a study published this past Friday in the New England Journal of Medicine, 2/3 of covid19 patients improved with the Gilead pharmaceutical companies’ antiviral drug, Remdesivir.

As the studies continue to be done by multiple doctors and scientists around the world, who are cooperating in this fight despite previous academic or national boundaries, we are certain to see more good news in the days and weeks ahead.

My wife and I were FaceTiming this weekend with my youngest son Andrew and his significant other, Petra who are sheltering at home in San Francisco. Now Andrew is an engineer for Apple, and Petra is an engineer for Google. They never discuss with us or each other what they are working on because of their respective companies’ policies. But we were excited to discuss with them what we had learned from an article this weekend in the Wall Street Journal about how Apple and Google have teamed up to create an app for Apple and Android based phones that will alert people if they were in contact with someone infected with the coronavirus. In what is described as an “unprecedented collaboration between two Silicone Valley giants and rivals” you will soon be able to put an app on your Apple or Android phone and if you choose to opt into the app for privacy reasons it can tell by the Bluetooth function on your phone and GPS location data if your phone has passed close enough for long enough to someone to risk a potential exposure within the past 14 days so that you can go and get tested. There are obviously privacy concerns, but this is a brilliant idea and may make it easier to contain future outbreaks as people are allowed to return to daily life.

As always, Stay safe.

Jonathan D. Hall, MD




Additional Information/Links

Helpful WSJ article on staying safe with your groceries

Food safety and Covid 19 article for patients in recent JAMA

Link to updated document with current clinical recommendations for treatment of Covid19

Recent news on Covid-19. Melatonin as a potential adjuvant treatment

Covid calculator from the University of Washington

Link to news on recent progress with Remdesivir

Apple and google team up on coronavirus contact tracing technology

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