As several states across the country start to relax social distancing rules, let’s take a moment to look at the latest news surrounding COVID-19 and how the pandemic has impacted the country’s healthcare system.
RubiconMD partners across the nation are reporting an increase in the use of virtual care, with some organizations reporting that 90 to 100% of their visits are now being done virtually. As time goes on, specialist referrals will also need to be adapted to fit into this system.
To help PCPs adapt to this virtual world, RubiconMD has been hosting bi-weekly webinars across a variety of specialties. Specialists from different areas of expertise share advice for how to diagnose, treat, and manage patients with acute and chronic conditions using telemedicine.
During the latest webinar, Dr. Megan Coffee joined us to provide an update on COVID-19. Below are some of the common questions she answered during the session. Dr. Coffee is a clinical professor at NYU Grossman School of Medicine and an Infectious Disease Attending Physician at Bellevue hospital, where she has been involved in the coronavirus clinical response. She is also an adjunct professor at Columbia University and the communicable disease advisor for the International Rescue Committee, working on the coronavirus response.
The below Q&A has been summarized and edited.
Q: What comes next?
A: There can be a lot of different scenarios. We don’t have the answers yet. We do know that it will probably continue with different waves with different magnitudes. We know that the flu, come winter, will be superimposed on top of this...what we do in response layered upon what the epidemics are in each state, will help determine what is going to be next for this outbreak and what we can expect among the primary care patients. Another big element is how much contact tracing is really put in place in different states. One case can quickly become many. One case in one hospital can really affect a healthcare system, as all of us in New York have seen.
Q: Do you think there’s a benefit of nasopharyngeal testing over anterior nare testing for asymptomatic routine testing?
A: Yes, nasopharyngeal - knowing that you’re still going to have the issue about false positives/false negative - but nasopharyngeal gets such a better sample. We just haven’t been seeing good enough samples with the anterior nares. So although people do not like to have anything in the back of their nasopharynx, it’s important to do it that way.
Q: When will COVID patients start to smell and taste again?
A: This is probably one of the most common indications of COVID-19 and it’s very specific to it. Most people will get it back within the first week. The reason for this is that the viral receptor is in the nose.
Q: In terms of immunity, what do we think the baseline serology is?
A: The most recent test that’s been recorded by our Governor Cuomo is that about 20% of New York City, but only New York City, is positive. We don’t expect anywhere else in the country to even come close to that level. And that still needs to be a peer reviewed study to know that the sampling has been done well and this is a true result.
Q: We have so many different antibody tests. How do we know how to interpret these?
A: A lot of them have ~93 to 96% sensitivity. That looks great. A lot of patients see that and think the test will tell me if I’ve just had asymptomatic infection out of the blue and maybe I’m immune and maybe I can take risks again. And this is the scary part because the [Positive Predictive Value] at a prevalence of 5%, which is probably higher than most places in the US, would only be at about 55%...The real concern is that the PPV is actually quite low with these tests given that we have such a low prevalence of infection here.
The real worry is false positive antibody tests scare us. Patients can have a false sense of security and then may go out and go to the beach, go shopping, not wear a mask thinking, ‘this is silly,’ and then go and infect their grandmother. And so that’s been our concern with this.
Q: How has this pandemic changed the practice of medicine?
A: I don’t need to tell anyone that telemedicine has increased enormously during this period. A lot of people who had not previously used telemedicine have to suddenly adapt and use the techniques we learned traditionally in medicine in telemedicine...I think initially there was a lot of telemedicine use that was just a temporizing measure for one month, two months, but as we know, we need to continue social distancing. It may still be the healthiest option for many of our patients for many months to come, until there is a vaccine.
To view the full webinar with Dr. Coffee, visit https://www.rubiconmd.com/cme.
The next webinar in our series will feature behavioral health and how the COVID-19 crisis and related isolation have particularly impacted this patient population.
Please note this blog was written on May 19, 2020, the post may be updated as the news evolves.
Disclaimer: RMD is not a healthcare provider and the opinions provided by the Specialists are not medical diagnoses, treatments or prescriptions of any kind. In addition, the Specialists never establish a doctor to patient relationship. Any information provided is merely educational material for the clinician to better understand how a relevant Specialist would approach a similar case and use the information for their own knowledge. RMD makes no representations regarding the quality of the information provided by the Specialists. The Specialists are not officers, directors, agents, members, or employees of RMD.