Thank you all for joining our virtual town hall sessions last week! More than 150 patients logged in to be part of NVFPA’s teleconference debut, and sent in over 6o questions for our doctors to address. Recognizing the high level of interest in these informative sessions, we’ve launched “Be Well Virginia,” a weekly series to listen and learn about the continued impact of COVID-19 in our community…please continue to check here for details.
In our first town hall, Drs. Natasha Beauvais, Ken Zweig and Cecily Havert provided thoughtful answers to many of the most currently asked questions about the coronavirus, including: the status of antibody testing, serum plasma donations for treating patients with COVID-19, how to care for yourself or a family member quarantined at home with the virus, new recommendations on social distancing, use of masks and gloves in public places, and more.
Dr. Natasha Beauvais (00:00:09):
Welcome everyone. This is the second consecutive Northern Virginia Family Practice town hall. We’re calling this Be Well Virginia. We hope to be doing these once a week. We have been fielding a lot of questions about Coronavirus individually with people on telemedicine visits and by phone and email. We know there are thousands of questions. We want to make ourselves as available as possible during this time of social distancing. I’m Natasha Beauvais. I’m a family physician at Northern Virginia Family Practice. I’ll be your moderator this evening and I will be introducing Dr. Cecily Havert and Dr. Ken Zweig very soon. A quick introduction to the program, the Coronavirus is something that has affected all of us very, very personally and we recognize that you will all have loved ones and family members and neighbors who will be deeply impacted by this virus as it proceeds this year.
Dr. Natasha Beauvais (00:01:16):
We really are hoping to keep all of our patients safe and in their homes and we’ve been able to see almost everyone that we’ve needed via telemedicine. All five of the providers here are available all day long via telemedicine and we would really love to reach out to you that way. If you have any questions, call to schedule a visit so we can talk to you. It’s been surprising how much we are creatively able to handle via video conference instead of in the office. We’re learning a new art of handling things with keeping you at home, but it’s paying off because social distances is working. During this town hall we’re going to stick to the voluminous questions that you sent us via email.
Dr. Natasha Beauvais (00:02:12):
We had a full set of questions this afternoon and then the emails surged and we got a set of new and really interesting questions, which hopefully we’ll be able to get to tonight. If we don’t get to all the questions, we are going to do this next week, so we’ll be back. The science will change next week, so there will be different answers to the questions. Undoubtedly as the science is changing every couple of days. If you submitted questions that involved your personal circumstances, we’re going to defer those to a telemedicine visit because we want to make sure that we answer your question individually and maintain your privacy and also take the time that it will take to really get the full story. You’ll notice that your video has been muted or your audio has been muted. That’s because we are not able to take live questions right now because we just have too many people involved.
Dr. Natasha Beauvais (00:03:11):
We’ll stick to the questions we’ve received. Thank you to all of you who’ve been concerned about us. I’m very glad to report that we are okay. Many of you have dropped off supplies which we were in need of in the beginning. I think we are adequately supplied at the moment but we are helping people know where to divert their supplies. If you have supplies that you want to donate, please communicate with us and we can come up with some suggestions that you can decide between. We have several patients in our patient panel who have COVID and are recovering. Fortunately, none of our patients have been severely ill. We can tell you a little bit about how our procedures have gone and how our experience with COVID is evolving over time.
Dr. Natasha Beauvais (00:04:11):
We’re ready to get started. I’ll briefly introduce first Dr. Cecily Havert. Dr. Havert has been a family physician in Northern Virginia for 17 years. Thankfully she joined Northern Virginia Family Practice about a year ago, after a very, very fruitful career in both Springfield and in Arlington, Virginia. To get to know Dr. Havert, you could click on a few of her podcasts which are on our website and also can be found on her personal LinkedIn account. She has been interviewed by a local podcaster on topics like anxiety, Coronavirus, menopause and women’s cardiac disease. Click on a few of those in your free time while you are going for a walk outside in the nice air. Dr. Havert loves teaching medical students at Georgetown University. She’s also very active in the development of healthcare policy for family physicians and healthcare in general.
Dr. Natasha Beauvais (00:05:15):
She has begun recently doing public speaking events locally on women’s cardiac disease and also on LGBTQ healthcare. She’s looking for more events, so if you need something where you need a doctor to talk to you. Actually all three of us are, willing and interested in developing that skill. We’d be happy to come and talk to your group. Dr. Havert loves painting and music and a secret I learned about her recently is that she has knowledge about the history of ghosts and vampires in Southern Louisiana. She would have traveled to New Orleans recently but her travel plans were coveted. Dr Ken Zweig is a regionally celebrated internal medicine physician. Hi Ken. He is our most recent addition to Northern Virginia Family Practice just joining in December.
Dr. Natasha Beauvais (00:06:16):
He is a passionate expert and educator about sleep disorders. Come on in and see him and then you’ll fall asleep. Dr. Zweig Is also a medical blogger. He has started a blog series that can be found on our website and on his personal LinkedIn account. We’d love to have you take a look at what he’s writing about. Following in the footsteps of his NVFP predecessor, he is very skilled at dermatologic procedures as well as cardiovascular prevention. He has not figured out how to do those dermatology procedures via teleconference, but he’s working on it. Dr. Zweig loves educating patients about how to stay healthy throughout their lives and he really walks the walk. He practices what he preaches and he can be found on bike paths all throughout Northern Virginia in all types of weather. I’m personally tremendously excited and grateful to be working with both of them.
Dr. Natasha Beauvais (00:07:16):
The three of us have a really fun energy together and it was through that energy that we realized we could reach out to you in this format. I will get started on questions. Your questions covered 10 different subtopics. I’m starting with Dr. Havert. She’s going to go over testing guidelines for COVID. What are the CDC guidelines? What we are doing here at NVFP? What is available regionally for patients in this community and who should get tested right now? So Dr. Havert.
Dr. Cecily Havert (00:08:02):
Hi, thanks. Thanks so much for joining us this evening. It’s a true pleasure to be able to connect with all of you during this time of distancing. I’m glad to have you here. Some of the big questions that everybody has on their mind and a lot of the questions that came in were around testing. NVFP is doing some testing. Not a whole lot. It is limited by our resources, our supplies. We are using Quest Diagnostics, which is a commercial lab that has given us a certain number of testing kits. The resources limits how many people we can test and in choosing people to test, we are trying to follow the CDC guidelines of testing people who are symptomatic.
Dr. Cecily Havert (00:08:56):
We’re not quite at the point where we are testing the vast population of asymptomatic people. Even though we do know that there are quite a few asymptomatic carriers of COVID out there. This is important information, but we just don’t have the resources to be able to do this level of testing. So right now we’re focusing on the individuals who are symptomatic. When we have a patient call us and they aren’t feeling well, we’ll do an intake or triage to see if their symptoms fall in line with what we typically consider to be COVID. We would consider testing if this individual is very sick, if they are close to needing hospitalization, if they are high risk, whether it’s a medical condition, their age, basically anything that would predispose them to having a more complicated COVID course, theoretically. These are the people that we want to get tested right away. These are some of the people that we have tested here in our office.
Dr. Natasha Beauvais (00:10:04):
Could you comment on testing centers?
Dr. Cecily Havert (00:10:06):
I was going to do that next. Unfortunately now we don’t have a a lot of testing kits so we have to look elsewhere at this point. There are some testing centers here in the Northern Virginia area. Virginia Hospital Center has been active for a while. That’s a drive through facility. However, you do need a doctor’s order for that. INOVA has opened some respiratory urgent care clinics and they’re located in Tysons,, Chantilly and North Arlington. You can go to those clinics, without an appointment. You will need to register from your car, but you can go there to be evaluated.
Dr. Cecily Havert (00:10:49):
Alternatively, if we evaluate you via telemedicine and we deem that you’d be an appropriate person to be tested, we could send you there with an order to be tested as well. So that’s some of the local testing that’s going on. There’s rapid testing too. Personally, NVFP does not have any rapid testing at this point. Some of the hospitals, I know the INOVA Hospitals as well as, Virginia Hospital Centers have the rapid testing in their emergency departments. If there is somebody who is ill and needs to be hospitalized, and we need to know whether or not they have COVID immediately in order to determine what type of treatment we do in the hospital, that’s, where the rapid testing is being used. Eventually, maybe we’ll get the rapid testing, but right now it’s not being used in the outpatient community.
Dr. Natasha Beauvais (00:11:49):
Cecily, one question that is important to address is the accuracy of the tests why don’t you comment on that first?
Dr. Cecily Havert (00:12:01):
The accuracy, unfortunately, these were developed very, very quickly, for obvious reasons. Unfortunately when you develop a test really quickly, it doesn’t always work perfectly. We’re finding that the testing that we’ve done has more false negatives, meaning you could have the condition and the test has a negative result. We are seeing some of that. Some of the limitations we also find with our testing is that it takes a really long time to get the results. We were seeing sometimes between 7 to 10 days before finding out if our patient had COVID. So your symptoms develop, you’re tested and while waiting for a result, you could be feeling great at that point and past everything. That’s another one of the limitations rapid testing will help, but we need that rapid test to be accurate.
Dr. Natasha Beauvais (00:12:56):
And another important aspect of that if you could comment on from my perspective is what does a positive mean? And what does a negative mean? Does a negative mean you’re in the clear?
Dr. Cecily Havert (00:13:07):
Negative does not mean you’re in the clear. It could mean that at that very moment you’re in the clear, however, you could still have COVID and just haven’t converted to a positive until, three days later. So the testing is a little limited at this point.
Dr. Natasha Beauvais (00:13:26):
So a positive test is helpful, but a negative test is not reliable.
Dr. Cecily Havert (00:13:33):
Exactly. That’s a good way to say that.
Dr. Natasha Beauvais (00:13:37):
Dr. Zweig, I’m going to move to you and we’re going to ask some questions about antibody testing. Once a person has had COVID and they are hopefully developing antibodies, when are we able to test for that? When is that going to be fully available and what does that mean?
Dr. Ken Zweig (00:13:53):
So for those of you who may not know, antibodies are a hallmark of our immune system. One way to think about it is like tagging animals in the wild. The antibodies themselves don’t do the work but they tag foreign bodies. Like if you were to tag an animal that was supposed to be taken away, the antibodies tag foreign bodies, like bacteria or viruses, so our immune system can then notice that they’re abnormal and then can go and kill those off. Antibodies are a good part of our important immune system and a really good marker that we can use to say, hey, we’ve developed some level of immunity for certain diseases. It’s not always reliable though.
Dr. Ken Zweig (00:14:44):
There are times where you don’t have detectable antibodies but still could be immune against something. There are times where you have detectable antibodies but are not immune. One example is HIV. As a condition where people develop antibodies and that’s what we use to detect whether they have HIV or not. But unfortunately in the case of HIV, it doesn’t actually treat the condition, it doesn’t actually help you fight it off with your immune system. So, there’s a lot of hope that antibodies in this case will work. There’s some suggestion that it may. I think we’ll get into that a little bit later about people who’ve gotten over COVID, but, right now we’re still in the very early stages as far as checking antibodies, testing for them, and determining whether that is helpful. We don’t know how good these antibody tests are and we don’t know if you do have antibodies if that means that you’re going to get better or immune or you’re not going to get this condition again.
Dr. Ken Zweig (00:15:45):
Even if it does mean you’re going to get better, the virus may mutate to something where your antibodies don’t work against it. So there’s a lot of unknowns with a lot of things about this virus. COVID is still a very new disease and we’re still just learning a lot about it. The science has moved forward on this faster than probably any disease in the history of the world. The gains that we’ve made in just five months are absolutely staggering and the hope is that we’re going to learn a lot more and really make some good headways in the next few months. Right now, testing certainly is not available to the public for antibodies. It is available in some hospital settings for research protocols. I think we’re a ways away from testing and using that testing to determine whether you’re safe.
Dr. Natasha Beauvais (00:16:40):
A lot of our patients have been asking this question and as soon as we know more about what’s available, we’ll let you know, but it isn’t currently available. As Dr. Zweig said, we don’t exactly know what it would mean. Dr. Havert, can you talk about blood and plasma donation which is an offshoot of the antibody question.
Dr. Cecily Havert (00:17:05):
Well there were a couple of questions that came in asking can I donate blood? What if I’ve had COVID can I donate blood and can that be helpful for people who are fighting off the disease currently? One thing I’ll say is, when you’re donating blood, there’s actually three components to the blood that you are giving. There’s the red blood cells themselves. This is when you’re anemic and you need to have a blood transfusion. This is what is going to potentially save your life. There’s the red blood cells, there’s platelets, which is another component of the serum, and then there’s the plasma.
Dr. Cecily Havert (00:17:50):
Now when we’re talking about the plasma and COVID, we’re really interested in the plasma because that’s where the antibodies are. That’s where, in theory, we potentially could take somebody who has fought off COVID and take their plasma/antibodies and potentially use it in treatment for somebody who is currently fighting COVID. Right now, you can’t just go to the Red Cross and say, I’m going to donate my blood. I don’t know if I’ve had COVID but maybe it’ll help? Right now there are, research studies going on. In fact, there is one at INOVA and we can pass on some information about that for people who have known COVID after this. People who have known COVID, who test positive for COVID can donate their blood products and they’ll use the plasma potentially in some research studies.
Dr. Natasha Beauvais (00:18:48):
Yeah, very active research going on right now probably as we speak. So anyone that needs to know that link, we can provide that to you after this.
Dr. Cecily Havert (00:18:59):
I will say also that just giving blood itself is really important. Whether you’ve had COVID or not. There’s a lot of people in the hospitals. If you can donate blood, you’re healthy enough to donate blood, it’s always something to consider doing.
Dr. Natasha Beauvais (00:19:16):
We’re going to talk a little bit about the disease itself. We’re going to actually start with the more serious cases that people are really worried about and then we will discuss the more mild kind that can still be somewhat, tough to get through. We can help you understand how to get through COVID at home.
Dr. Natasha Beauvais (00:19:38):
One caveat to these questions is that when we’re talking about the seriously ill patients, none of us are ICU doctors. Some of you had very specific questions that really relate to very active decisions being made within the ICU. Although we are aware of those, we’re not really capable of commenting on these. I think we’re going to skip some of those more specific ICU ventilator questions and answer some general questions about what is getting done in the hospital. Dr. Zweig, if you could talk about how surprisingly this virus seems to affect other organs besides the lungs especially since we all came into this hearing from the CDC, if you have a cough and a fever, worry about Coronavirus.
Dr. Natasha Beauvais (00:20:34):
I think those of us who’ve been in medicine for a few decades have seen many viruses that affect many parts of the body. From the provider’s perspective, it’s not surprising that people are experiencing kidney disease, cardiac disease and liver disease that are related to viruses because that is something we see in a lot of viruses. Dr. Zweig if you could talk a little bit about the cytokine storm that throws people into the most severe form of this illness? And then some discussion about some of the experimental treatments that of course, none of which are well-vetted since we’ve only been five months into this.
Dr. Ken Zweig (00:21:19):
First of all, I will say I’m very impressed with our patients. These are some incredibly intelligent and advanced questions. A cytokine storm ventilation strategy. I mean, that’s incredibly specific. We are working with some very intelligent people here, so kudos to you for staying on top of this. To put it into context, one thing that I always tell the patients is that if you have a bacterial infection, you have pain right here , like with sinusitis (points to his sinuses), or you might have an earache. When you have a virus, virus causes symptoms everywhere. Your ears hurt, your nose runs or you have a sore throat, you have a cough and it’s all over your body.
Dr. Ken Zweig (00:22:03):
So that’s one way to think about this. On a more severe scale, Coronavirus goes to your whole body. It impacts many, many different organs. Why it effects different parts? We don’t really know, but it’s very common for it to impact the kidneys. It’s actually common to have GI symptoms, diarrhea too. The other thing is that it may not even be the virus that’s causing this. It could be your own immune system and its efforts to fight off the virus. When overrun, the immune system can actually start causing its own damage and make people so sick. That’s what that cytokine storm is. Cytokines are part of your immune system and if you have a very big infection or a very big immune response to that infection, that can be what makes you so sick.
Dr. Ken Zweig (00:23:01):
Partly, fever is really not the infection. Fever is your response to the infection. Feeling bad is not the infection, it’s your response to the infection, it’s your immune system working. Sometimes the immune system can over respond and cause it’s own form of damage. When it gets completely out of control, that’s what’s called a cytokine storm. We have over-revved the immune system response to a very big infection and that can cause its own real problems. Sepsis if you’ve heard of that, is another form of this. Your blood pressure drops, you can get infections in the heart and the kidneys, and multi-organ failure leading towards the end stage organ failure in people that are in the ICU. It is the very thing to stop.
Dr. Ken Zweig (00:23:47):
We don’t know how to do it. In any real infections, all we can do is support the person until it sort of runs its course and then hopefully let them get better on their own. There are some efforts that are currently underway to help with that. There’s some antibodies against something called interleukin six that look like they might have some benefit in this. Those studies are currently going on at both Virginia Hospital Center and INOVA Fairfax, as Dr. Havert discussed something called convalescent serum or convalescent plasma. It’s the plasma of people who have gotten better who now have antibodies to COVID. If you donate that and give that to people who are in the ICU, there are some small studies that have shown some benefit. One of the more encouraging medications is called Remdesivir, which is an antiviral that was developed for Ebola a couple of years ago. It was put on the back burner and now they’re bringing it back out again because it looks like it has some benefits against COVID.
Dr. Ken Zweig (00:24:51):
There was again, one relatively small study, but bigger than some of the other ones that showed some pretty impressive responses and looks to be the most promising from what I’ve read. But all of it’s still very early. We still really don’t know. The studies are ongoing. Typically under other circumstances, it takes years for these studies and drugs to get to market. We’re only five months in and we’re pushing these through and already seeing some positives. It’s moving at an incredible pace. Hopefully we’ll have some better answers in not too long of a time. We’re in an amazing area for medicine, for inpatient, between Virginia Hospital Center and INOVA and all the hospitals and the Universities downtown. We have incredible resources here and all of these things are all being studied at both Virginia Hospital Center, INOVA Fairfax and some of the other centers around town, so we have access to some of the most advanced medicine in the world really right now, which is encouraging and exciting. Hopefully one of these studies will come through and give us something that we can really hang our hat o. It’s remains to be seen for sure. So stay tuned.
Dr. Natasha Beauvais (00:26:06):
I’m going to take this next question because I’ve worked at NVFP for 12 years and these other two are a little bit newer. So the way we do things is a little more familiar to me. The question is about how does NVFP stay involved in your care when you’re hospitalized? And there’s two answers to that. Under normal circumstances, we would be in touch with your attending physician depending on which hospital you were admitted to. Sometimes we would be working directly with physicians that we work with all the time at Alexandria Hospital because we’re very close to there. We have a husband and wife team that does our inpatient work all the time and we’re texting them every day and talking to them back and forth. If you had been in the hospital for a long time, often we would come in to also oversee your care.
Dr. Natasha Beauvais (00:26:56):
We wouldn’t be entering the orders there, but we would be talking with the specialists, talking with the internist who is taking care of you. We would be regularly involved if you have COVID and even if you don’t have COVID but if you’re in the hospital for any reason right now, no one who is not directly involved in your care is allowed to participate and visit you. So it’s a pretty lonely time in the hospital. I think the ways that we would be helping now would be somewhat similar to the ways that we always did is that we would be in touch with the specialist and the doctors who are working on your care and communicating to your families and making sure that something about your history that we knew that they didn’t know that would be relevant was something that wouldn’t be missed.
Dr. Natasha Beauvais (00:27:45):
I think a lot of times it just really helps to have somebody who’s paying attention to the whole picture. Sometimes the hospitalists change from one week to another, but if we can be that kind of steady, constant, source of awareness of what’s going on with you, then we can be very helpful in your inpatient care. Even though we’re not the people that are directly administering the care. We proudly are not affiliated with any hospital, which means that we can help you in every hospital. We can reach out to wherever you are. If you are admitted to the hospital in Baltimore, we can reach out to the hospital in Baltimore and find those attendings and work with them. And if you are at Virginia Hospital Center, we will find those attendings and work with them. So some places we know people better and some places we don’t, but we work with everyone.
Dr. Natasha Beauvais (00:28:38):
You know, people who’ve been in Sibley Hospital, Alexandria Hospital, Johns Hopkins, Virginia Hospital Center, all of those places. So that’s a long answer to how we would help you even in a time where we’re no longer allowed to come and visit you in the hospital. We’re going to move on to Dr. Havert and talk a little bit more about the care of the more mild to moderately ill people who may be suffering with COVID and handling it at home. What does this look like? How do we stay in contact with you while you’re sick? What can we do to take care of ourselves at home? And what do we do when we are caring for someone who has COVID in our home when we don’t have it?
Dr. Cecily Havert (00:29:30):
Well, thankfully about 80-85% of people who are symptomatic from the COVID infection are mild. Thankfully. this is one silver lining that we have about this virus. It can cause people to get very ill, but most people actually don’t get that sick with it. We’ve alluded to the people who don’t get sick at all. It’s nice not to get sick, but it’s a little bit scary too, to think that you could be passing this on. I think we’ll be talking about that a little bit more with social distancing and why it’s so important to do that. But if you do get mildly sick, what does this look like with COVID? Unfortunately it could look like almost anything.
Dr. Cecily Havert (00:30:16):
Fever is probably one of the most common symptoms that you’ve got. A cough, runny nose, and GI symptoms are something what we’ve been seeing a little bit more often. A little bit of abdominal distress, diarrhea, generally just feeling bad. Just what Dr. Zweig was saying, the virus takes over your entire body. You feel bad, you feel achy and you just don’t feel right. You’re very fatigued. The symptoms that we worry about where we think that you would need higher levels of care would be the respiratory symptoms. It would be the shortness of breath, feeling like you can’t catch your breath or just extreme weakness, fainting or you just can’t stay upright.
Dr. Cecily Havert (00:31:04):
Those would be reasons to seek higher levels of care. When you do get sick, we recommend that you call in. We’ll do a telemedicine visit and determine where you are in that spectrum. If you are really sick. we can make the determination at that point to send you to the hospital. If it seems critical, then you go to the hospital and we notify the ER that you’re coming. If you are otherwise stable and just feeling a little sick, like I was saying we would recommend not getting testing, not going to the hospital and for those people it would be best to stay at home with their illness. You also have to think about when you do come out and we test you, you are exposing the healthcare workers as well. We’re happy to be there for you and test you if need be, but if it’s not anything that’s going to change your care and would potentially expose those working on the front lines, we may recommend not testing to maintain the front lines to take care of everyone else. If we determine you can stay at home, we would check on you regularly through telemedicine or via phone. We invite you to email or call with daily updates. That’s how we’re managing COVID at home or what we think could potentially be COVID at home. What if you’re healthy, but you’ve got a child or maybe you’ve got an elderly parent who has COVID?
Dr. Cecily Havert (00:32:43):
It’s important to isolate that person in their own room. When you’re taking care of them, if they can wear a mask and you can wear a mask when you’re in the room, that would be ideal. Either using gloves or just frequent hand washing, making sure that you don’t share silverware or anything like that. Have the sick person use one bathroom or if you do have to use that bathroom, you’re going to have to clean it extensively. That’s something to keep in mind. Most people do recover from this and, it might take a week, it might take a little bit more than that, but eventually, just like a bad cold you do get over it, you get on the other side of it.
Dr. Natasha Beauvais (00:33:35):
It could be quite serious like a bad flu but still often is manageable at home. Someone wrote in from home, why treat it if it’s kind of the same treatment as the flu? Why figure it out at all? I think the ICU management is quite different for people who have COVID versus who have the flu. The trajectory of what happens to people in the ICU is very different. I think it’s really helpful as we’re learning how to handle the virus and how to anticipate and how to better prevent some of the consequences, the systemic consequences of the virus. They are turning out to look different than the flu, at least in those very ill patients. Maybe we’ll learn about how they’re different in the moderately ill patients as well as this goes further along.
Dr. Ken Zweig (00:34:27):
If you don’t mind, if I could just say one other thing about testing, cause I’ve actually had several patients ask me to get testing just because they have very mild symptoms that don’t even sound like COVID. Besides not wanting to expose essential healthcare workers, we also do not want to expose you . The point is , if you’re having mild symptoms, even if it is COVID, and you have to come in or go to a testing center where you could potentially get exposed to find out if you have this disease and then put you at risk for getting the disease, it is not the right thing for you. So, for everybody involved in milder cases, just knowing is not always the right thing. It’s not always the safest or right course of action.
Dr. Cecily Havert (00:35:14):
Not at this point. Not at this point.
Dr. Natasha Beauvais (00:35:19):
There are those countries who have done almost universal testing. They have a much different profile of prevention. If we could get to that stage, that would be wonderful. Maybe in two months we’ll be there. But not as of today. Next week we’ll have another one of these. Maybe we’ll have a different answer for you. Dr. Havert, just finishing on the more mild cases. What about Hydroxychloroquine?
Dr. Cecily Havert (00:35:49):
This was another big topic. Hydroxychloroquine is a medication where there’s been a few studies. I think there was one study that didn’t show much benefit, maybe another that showed a little bit of improvement. But right now it is not a medication that we routinely would recommend in using, especially in the mildly ill COVID cases. This is a medication that is typically used for people with autoimmune conditions and there can be side effects associated with it. Sometimes the side effects are worse than what you’re potentially treating. Again, this is a medication where they’re still doing research. Maybe there will be some information down the line about benefits, but I think right now the risks out way the benefits, especially in the mildly ill.
Dr. Natasha Beauvais (00:36:45):
And how long do we quarantine after we’ve been sick?
Dr. Cecily Havert (00:36:49):
What we’re typically recommending is that from the time that the symptoms develop, you want to quarantine at least seven days from that. You also want to be fever free for at least 72 hours. That’s what the CDC is recommending. There might be some evidence to show that you’re shedding the virus after that point as well. So I think the longer that you can stay quarantined or isolated or away especially from people who are higher risks, the better.
Dr. Natasha Beauvais (00:37:35):
Dr. Zweig do you want to add to that?
Dr. Ken Zweig (00:37:38):
No, I agree with what she said. I think that the longer you can wait the better. I feel we keep saying this, we just don’t know. We’re still waiting on more information. Part of the reason why we don’t know is because I think it’s very variable. I think some people after seven days are probably fine. Some people 14 days, may or may not be enough and it may even be longer that they’re shedding and we don’t know if that shedding is enough shedding that can still transmit the virus. So, we’re still waiting to get some more information about that. Everything about what we’re doing is all about just trying to mitigate risk. There’s no way that we’re going to make the risk zero.
Dr. Ken Zweig (00:38:23):
Anything that you can do, the farther away from somebody, the more precautions you take, the longer you wait, the less the risk is going to be. What is your risk tolerance? What is your overall risk as far as health? Are you older with other problems then weigh those all into what actions you’re willing to take? The more we do, the less likely it is that any of us will get this disease. The less of us that get it, the less likely it is to spread. We try to do the best we can.
Dr. Natasha Beauvais (00:38:58):
When you actually have that question, I think we should all have a specific discussion about it because next week we’ll have a little bit more information and the following week a little bit more. It depends on where you are in your illness and where we are in the scientific understanding. There are many questions about prevention, which is my favorite topic since, I’m a preventive medicine physician, we would have preferred it if none of our patients had gotten COVID. We would like to prevent all of the rest of you from getting it. We have questions about new recommendations on social distancing and lots of questions about masks and gloves. Dr. Zweig, I’ll have you take over about social distancing recommendation and your thoughts about masks and gloves in public places.
Dr. Ken Zweig (00:39:47):
Obviously I’m sure you’re all aware of this, which is why we’re using this format to have this town hall meeting because we’re all social distancing. The first thing I’ll say is that it looks like it’s working, so far we’re doing pretty well. We had a big surge of cases in the U.S. and we’ve had a lot of cases in the U.S., but at least in Northern Virginia we seem to be doing relatively well compared to a lot of other places, like New York and Detroit. We think that the curve is flattening and that we’re reaching a plateau and hopefully it will be coming down the other side. The efforts that everybody is doing counts. This is not something that just the government does.
Dr. Ken Zweig (00:40:31):
We all are in this together and we all have to do our part and it seems to be working to a degree. We have to keep this up until we can get to the other side of this. To give you more details on this, obviously the social distancing is the one that we’re all doing. The things that you read in the paper and everywhere. The recommendations are six feet. The reason that six feet exists is because that’s the distance that respiratory particles and droplets when you breathe or cough or sneeze tend to be expelled from your mouth. This disease is spread through airborne respiratory droplets and if you’re more than that six feet away, then the risk of you getting the disease is much less likely. Obviously six feet is better than three feet.
Dr. Ken Zweig (00:41:22):
Eight feet is better than six feet, the farther you are, the less likely you are to get it. Staying at home away from anybody else than you are least likely to get it. That’s where the social distancing comes in. There’s a lot that we still don’t know about. The spread indoors seems to be higher than outdoors because outdoors wind and currents can take the droplets away and make it less risky, but there’s no distance that’s absolutely a hundred percent safe. The farther you are, the better. More precautions to take, the better.
Dr. Natasha Beauvais (00:41:58):
Okay, awesome. Can you give us mask recommendations outside and inside?
Dr. Ken Zweig (00:42:02):
This is also a developing thing. Masks, for the most part, protect other people and so rather than protecting yourself when a surgeon wears a surgical mask, he is not protecting himself from what’s inside the patient, but he’s trying to protect the patient from what’s inside of him. So the mask prevents things from going out. It doesn’t do as well for things coming in, but if everybody, or most people are wearing a mask, even if they have COVID, we are preventing the spread from one person to another. Even if you don’t know, you have it. The way you can think about this is like a hose. If you have a hose that was shooting water 10 feet and you’re 10 feet away, you’re going to get wet. If you put mesh over the hose nozzle, it’s going to slow down and the hole is going to have a decrease amount of water that’s coming out to maybe six inches. The water is still going to get out. But if you’re six, eight feet away, you’re not going to get as wet.
Dr. Ken Zweig (00:42:59):
You’re only gonna get wet if you’re right up very close to it. And that’s the way the masks works. They slow down the ingestion of the virus particles. It takes everybody to wear that mask for it to work. The surgical mask., bandanas, dish towels, whatever you want to make, whatever you want to use, any form of cloth or anything that slows your breath out can work. These homemade masks are fine with that, but everybody has to wear it. The difference is that there’s something called an N95 mask, which is a medical mask that we are reserving for the medical community, the hospital workers and people at high risk.
Dr. Ken Zweig (00:43:45):
N95 masks need to be reserved for medical workers in the hospital or the high risk areas. Masks of any kind work as long as everybody wears them. We encourage you anytime you’re out in the community, around other people, shopping at the pharmacy, even if you’re going exercising on a crowded path to wear a mask. It’s a good idea to wear a mask to protect everybody. The more that we do it, the better we’ll all be.
Dr. Natasha Beauvais (00:44:27):
And how about gloves?
Dr. Ken Zweig (00:44:29):
So, gloves can help especially for shopping. The virus is not spread through your hands.
Dr. Ken Zweig (00:44:41):
By wearing gloves, you’re not protecting your hands. You’re not protecting yourself necessarily from getting the virus. But you can spread the virus by touching something that has the virus droplets on it and then touching your face, your mouth, your nose, your eyes. We do recommend keeping your hands away from your face when you’re wearing gloves. You are more likely to be aware of your hands and less likely to touch your face while you’re wearing gloves. Plus if you get virus particles on your gloves, they’re easy to take off and then you can either, if they’re disposable, throw them away or wash them. What I would recommend more is have dish gloves or any kind of gloves that keep you from touching your face that you can then wash either under soap and warm water or with Purel. Anything you can use that’s an extra layer of defense helps, the gloves help keep you from touching your face. They don’t prevent you from getting the virus.
Dr. Natasha Beauvais (00:45:41):
I love the question we had earlier today, which was about a person who had taken her reusable dish gloves to the grocery store and went shopping with them, came back to her car and put them in a bag and was wondering if that was the right protocol. Something that is really not well understood among non-medical people is that you still have to wash your hands when you take the gloves off. Dr. Zweig, what are the best practices when you come out of the grocery store with your arms full of groceries and you’re about to get in your car?
Dr. Ken Zweig (00:46:18):
We all have to assume that we have the virus on us. When you’re going to the grocery store, anywhere in public, people pick up an apple and they look to see if it’s got bruises and then they put it back. You want to be careful about that. When you touch all these things, you could potentially have the virus on your hands. One thing is you want to make sure that you’re decisive. When you’re at the grocery store, don’t pick up a number of different things, look at them and then put them back. You want to just grab something and take it and move on. You want to limit how many things you touch items. Then once you’re done, once you come out, you have to assume that that the virus is on your hand.
Dr. Ken Zweig (00:46:58):
Anything you touch with your hands or those gloves is then going to have the virus particle on it. If you’re wearing gloves before you touched the car you want to take those gloves off. If you have a wipe or Purel, then you want to wash your hands and put the gloves in something safe or throw them away. Preferably wear reusable gloves because we want to save medical equipment for the people in the hospital. You want to put the gloves away in a baggie or somewhere that you can wash later with soap and water. Even if you wash your hands, it’s still reasonable to wipe down the car, the door handle, the steering wheel and other things that you touch because it’s possible that the virus is there. You want to be cautious. The more precautions you take, the less likely you are to get this.
Dr. Natasha Beauvais (00:47:56):
You mentioned soap and water.
Dr. Ken Zweig (00:47:59):
I was going to say the good thing is that the virus is kind of wimpy and that it just dissolves in regular soap and water. You don’t need disinfected, you don’t need something fancy, regular old soap and water washes it away and kills the virus. That’s a good thing.
Dr. Natasha Beauvais (00:48:14):
And Dr. Havert, I thought you did a great job earlier today just explaining that even though it sounds basic hand washing works.
Dr. Cecily Havert (00:48:22):
It really does. I want people to think about that because hand washing is big. If we all get upset or we’re frustrated because we feel like there’s no treatment for this, actually there is, socially distancing and washing your hands can make a difference. The virus likes people to be close together and so it can spread around. We’re almost like a vaccine, saying, no, sorry, you can’t get there. Hand washing is something that you have complete control over. You can wipe down your countertops, you can wipe down your car, you can wipe down your groceries and everything and that will make a difference. All you need to do is if you touch those things, don’t panic, wash your hands and you got the virus taken care of it. You don’t get the virus.
Dr. Ken Zweig (00:49:23):
Dr. Natasha Beauvais (00:49:27):
Okay. So hand washing, hand washing, hand washing, we’re all doing a lot of that and some hand lotion on the side to keep your skin intact. Let’s see, we’re going to move from prevention masks and gloves to how do we interact with others. There’s a lot of questions, Dr. Havert, I think I’ll move to you for bringing people into your home. Really, emotionally poignant questions about can our grandparents see any of our grandchildren anymore? That’s on the more precious side to also, can I let the HVAC guy into my house to fix my air conditioner? Can I get a haircut? Can I let my friend who stays six feet away from me on the porch into my house to use my bathroom? Dr Havert, I’ll turn it over to you?
Dr. Cecily Havert (00:50:18):
Again, we have different gradients of risk that we’re willing to take. Right? I think a lot of that depends on if we are chronically ill or immunocompromised. I think we have to keep that in mind when we’re making decisions about bringing anybody into our home because potentially, even if they are six feet away from us,, they potentially could still be bringing COVID in on their shoes or they touch something inadvertently and can spread it. The simple answer is you shouldn’t be bringing people into your house, but probably the more nuance or the longer answer is, if you absolutely have to, take the necessary precautions in order to protect yourself. If it’s a service repair or something you can wait for, try to reschedule it.
Dr. Cecily Havert (00:51:14):
If it’s something you absolutely need. For example, Dr. Zweig’s refrigerator broke and , his food’s was doing to rot. So if you have to bring these people in, make sure that when you’re around these people, you’re wearing masks, asking them to wear shoe covers or making sure that, everything that they touched something that you’ve cleaned. Obviously we can’t go to the barbershop or bringing people in to cut our hair again, that’s pretty close contact. We’re all going to look pretty shaggy. My roots are coming in. It’s best to avoid this right now.,
Dr. Cecily Havert (00:51:58):
I would be really, really careful with house cleaners. Being very careful, wearing masks. I’m asking them to do that. And again, it’s something you have to decide if you’re going to take that risk. Play dates for kids, absolutely not. We all know, kids. They are wonderful, but they also like to carry germs and they don’t necessarily wash their hands as well. So that’s something, unfortunately we have to say no to. Meeting a neighbor six feet away saying hi, having a Coke or something on the front lawn. That’s probably okay as long as you’re far away. But don’t invite them into your home. If they need to use the restroom, don’t invite them in to use your restroom. Just be smart about it.
Dr. Natasha Beauvais (00:52:59):
And the grandparents and the grandchildren? One of the questions was, would we ever foresee a way that we could ever have our grandchildren around us in the near future?
Dr. Cecily Havert (00:53:12):
That’s a hard one. Kids and people 65 and over are two really challenging demographics and when you put the two together, you’ve got potentially a bad outcome. I don’t personally want to be the one to say no, you can’t see your grandchildren because that just sounds cruel. But I think what we also have to remember is that this is hard and I totally validate that, but this is temporary. Okay. This is not going to be forever. We will get out on the other side of this. I don’t know what things are going to look like on the other side, but it won’t always be this way. The more serious we are about distancing, the quicker we’re going to get out of it. Now I’ll leave it there.
Dr. Natasha Beauvais (00:54:03):
Well said. Dr. Zweig, I heard you went to a restaurant and got some takeout the other night. We have lots of questions about how do we safely interact with food prepared at restaurants. What are best practices for takeout? Do we need to disinfect our food? One patient asked if she should be washing her lettuce in Clorox? I’d like you to answer that too. Even though it’s not a takeout question. Could you just talk about best practices with takeout food?
Dr. Ken Zweig (00:54:39):
Alright, I will talk about my practice. I haven’t read anything about best practices specifically though. I’ve read a lot about how the virus transmits and a lot of the local restaurants are still trying to stay open. You obviously can’t go to eat in them, but they are letting you get take out or delivery. I think it’s really good to help support your local community as best you can. That’s one of the things my family wanted to do. We want our favorite restaurants to still be there when we’re on the other side of this. So we’re trying to support them as best we can. Like I said before, this virus is wimpy. It dissolves with soap.
Dr. Ken Zweig (00:55:22):
It also dissolves easily with heat. One thing you want to do is make sure that whatever you order is hot. It doesn’t seem like this virus lives very well at all on food in general. Even cold food probably is safe, but we know that hot food is safer. So if you get something hot then you’re certainly going to be in good shape. The problem comes in the container and the people who are giving it to you. One of the things that we do when we’ve gotten food is we pull up to the restaurant and we open the trunk and they put the food in the trunk rather than actually interacting with you.
Dr. Ken Zweig (00:56:02):
Pay for it over the phone if possible. If you have to hand them a credit card, just be careful about that. Whatever you can do to limit your interactions with the server is always worthwhile. Then when you get home, rather than putting your bag and the container on your counter, put it on the floor and transfer the food to your own plates and your own containers. The more of these things that you do, the less likely you are to get infected. Also, if it’s a little cool, putting it in the microwave for 30 seconds to a minute, probably sterilizes it very well and it almost certainly kills the virus. Make sure that you keep it warm and it will keep you from getting sick most likely.
Dr. Ken Zweig (00:56:45):
We all want to shake things up and it’s hard to eat frozen food and packaged food all the time. So going out to get food once in a while, again, depending on your level of risk tolerance is really what’s important. If you’re at very high risk person with lots of other medical problems and elderly and high risk, it may not be the best idea. If you’re younger, don’t have a lot of risks and you’re willing to take the chance, It’s probably not that big of a chance. Be smart about it. It’s worthwhile. Like I said, you’re helping out the community, which is also important.
Dr. Natasha Beauvais (00:57:18):
I’m mindful of the time we have, we won’t have a hard stop at eight, but we’re going to try to stop in about three minutes.
Dr. Ken Zweig (00:57:26):
Can I say one thing about the bleach on the lettuce? I’ll say not a good idea.
Dr. Natasha Beauvais (00:57:33):
Yes, we can rinse our lettuce, but we don’t want you eating Clorox. Thank you for remembering that. The three last questions, which we can very briefly answer. One is what are your recommendations for non-COVID medical care? I’m going to just reiterate to all of our patients who are here right now, that we are very anxious to see you on telemedicine visits. We really want to know you in your home. You can just sit like you’re sitting right now and we will have an official medical visit, especially new patients who are new to Dr. Zweig or new to Dr. Havert. If you haven’t had the chance to meet Dr. Zweig yet since he’s only been here for four or five months please schedule a telemedicine visit. We would love it. He would love to meet you via video. Please come and discuss any of your medical needs via telemedicine visit and then we will decide what’s appropriate in your case.
Dr. Natasha Beauvais (00:58:35):
In general, we are deferring our preventive health right now because we are still in the thick of this virus and we want to really make sure we help you keep it away. We want to help the momentum that we already have that’s really doing well to flatten the curve and to let the curve drop. So that’s why we’re trying to defer your preventative care just for a couple of months at this time. There’s a good question about how helpful is it to monitor your temperature? I’ll give that to one of you. And then cleaning supplies. What do we do if we can’t find any in the store? And then we’ll wrap up. So, Dr. Havert, maybe on monitoring temperature and Dr. Zweig on cleaning supplies.
Dr. Cecily Havert (00:59:26):
What’s tricky about monitoring your temperature, is that not everyone has a fever. You could have the virus up to 14 days before you have a symptom. You may not have a temperature or anything like that. It’s okay to monitor your temperature to see if you’re starting to get sick or you can trust how your body’s feeling. But don’t use that as a reassurance of I’m not sick. I don’t have COVID. I am not going to spread this to anybody. My temperature is normal, so I must not have COVID. It just, it doesn’t matter. You could be carrying it. You might never get a symptom at all. There are also people that carry it and never get a symptom.
Dr. Cecily Havert (01:00:13):
But right now, the way that we have to look at this is everybody has to assume that they potentially could have it. I know that’s sort of a scary thing to say, and I’m not saying it to make people scared. I’m saying it to just bring awareness to where we are in this, but also just to make sure that you are coming together as a community and thinking about not only ourselves but everyone else around us because this is how we’re going to get on the other side of this , if we think about our community. This is like a pandemic. It’s a community problem. I guess that’s what I’ll say about taking your temperature. If you want to take it, fine, but don’t necessarily rely on it to say you’re not sick.
Dr. Cecily Havert (01:00:55):
Right. It’s something that they can do in hospitals to monitor people, but it’s not sufficient.
Dr. Natasha Beauvais (01:01:01):
Okay. and then Dr. Zweig on cleaning supplies?
Dr. Ken Zweig (01:01:05):
Again, this virus is wimpy and just regular old soap and water works fine. Any kind of cleaner that you have, whatever you have around the house, as long as you have something, should be fine. You don’t need a special disinfectant, you don’t need Clorox, but that does work. If you have it, that’s absolutely fine. Any kind of cleaning product will work just fine. Whatever you have around the house will work well. If I could piggyback on Dr. Havert’s community comment. What’s going to get us through as a community and the thing that’s going to make you feel better as well is coming together. However you can do your part for your community, by donating blood, donating money to causes around the area, giving extra food or going to the store for a neighbor who’s not able to. Together we can get through this and make a difference.
Dr. Cecily Havert (01:02:14):
It’s important to think about things. It feels like there’s a lot we can’t control and true, I mean there are lots of things we can’t control about this. Lots of things we’re still learning, but there are still lots of things we can control and I think grounding ourselves and doing what we can do is actually very powerful. Like Dr. Zweig was saying, what is going to help push us to the other side is working together so keep doing what you’re doing. I’m so grateful and proud of everybody for their sheltering at home. This is phenomenal. Thank you so much for everything you’re doing for our community.
Dr. Natasha Beauvais (01:02:52):
Well said. So with that, I think we’ll wrap up. One question is NVFP still moving? Yes. Despite the COVID crisis, we are still getting kicked out of our building and we are moving in early May. We will let you know exactly the date when we know. It looks like we’ll be able to be fully functional at our current office until we move. So we will be blasting you with information about that as soon as it’s very clear. But, yes, we are moving. We’ll be in our new house for video video visits in May. Very grateful to all of you for coming today. We will be repeating this next week and please use this moment to send us a message about your responses to this. What worked for you, what you’d like to see next time? Dr. Havert is planning to host in two weeks, a mental health town hall like this. Dr.Havert, if you could let us know who’s going to be participating with you in two weeks?
Dr. Cecily Havert (01:04:02):
In two weeks I will be moderating, a town hall, where we will be discussing the mental health impact of the COVID crisis. There will be a psychotherapist as well as a psychiatrist, two mental health experts. Similar to what we did here, we’ll be asking for, questions beforehand. If you have questions or if that’s something you’re interested in, then send those in.
Dr. Natasha Beauvais (01:04:31):
Please send in questions and comments. We were writing those down and we really want to find ways to reach you, so let us know how we can help you,. How we can help you stay safe and how we can stay connected to each other during this extended social distancing? Thank you so much for joining us. We really appreciate seeing all of you. Good night, everybody.
Dr. Cecily Havert (01:04:54):
Good night everybody.
Dr. Ken Zweig (01:04:55):
Thank you for coming.