COVID-19 update from the Boca Grande Health Clinic

March 6, 2020
By Boca Grande Health Clinic

SUBMITTED BY THE BOCA GRANDE HEALTH CLINIC
The Boca Grande Health Clinic has provided an update to last week’s Coronavirus 2019 information.
The Coronavirus 2019 outbreak started in December, 2019 in China and has now spread to all continents except Antarctica. There have been over 96,000 people infected worldwide and 3,300 deaths worldwide to date.
Here’s what we know:
There are 162 U.S. confirmed cases in 13 states (this includes repatriated individuals). There have now been 11 U.S. deaths (as of March 5, 2020): 10 in the state of Washington, all but one linked to an outbreak in a long-term care facility outside of Seattle, and the most recent death in California. Florida currently has three confirmed cases of COVID-19. 
The virus can be spread by respiratory droplets (through coughing or sneezing) that land on surfaces, and it has also shown the ability for person-to-person spread in communities.
Approximately 83 to 98 percent of persons infected will have a fever. Other symptoms may include cough, shortness of breath, sore throat, headache, fatigue and feeling achy, like many other viral illnesses, including Influenza. 
There is currently no vaccine or treatment that is available. Investigation and research have already begun on both vaccination and possible antiviral medications to treat the illness. 
Masks should be worn by sick people to help contain secretions in the event of coughing or sneezing. Healthy people are not afforded protection by wearing a mask. 
The outbreak has prompted travel advisories for the countries most heavily affected by sustained community spread. A level 3 travel advisory (no nonessential travel) to China, Italy, Iran and South Korea and a level 2 travel advisory (practice enhanced precautions) to Japan. 
Here’s what we think we know:
In general, the Coronavirus surfaces at ambient temperatures through the five to seven days that are usually needed for international shipping. Therefore, it would be highly unlikely that the virus could be transmitted on packages shipped from areas with high infection rates. From what we know about the SARS-CoV and MERS-CoV viruses that caused other severe respiratory illness outbreaks, the incubation of COVID-19 is thought to be 2-14 days, with an average of five days. 
Here’s what we don’t know:
Coronaviral RNA has been isolated from other body fluids, but we do not know if this confers infectivity of these other body fluids like stool, urine, blood or breast milk.
The fatality rate is estimated as of March 3, 2020 by the World Health Organization as 3.4 percent, but this is likely not accurate. There are likely many infections that are mild in persons not seeking treatment that are undetected, making the true fatality rate much lower. We do know that mortality  in healthy adults and children is nearly 0 percent.
We have not been able to determine the risk factors for developing severe disease. Mortality in older persons with COVID-19 has been seen to be much higher, and it is likely that those persons who are older with underlying chronic medical conditions, especially underlying lung disease or immune-system compromise are more at risk for development of severe symptoms. 
We do not know if reinfection after recovery is possible. With the previous MERS-CoV, reinfection soon after recovery was not seen. 
What we are doing about it locally:
The Florida Department of Health has both a website with information and a call center for information: Floridahealth.gov and (866)779-6121.
There are now three Florida state health department labs that are testing for COVID-19 – Tampa, Jacksonville and Miami – in efforts to decrease the turnaround time of testing, which is now three to five days with a goal of 24 to 48 hours. 
The Boca Grande Health Clinic, as well as other local health care centers, doctor’s offices and hospitals, are following the recommendations of the Centers for Disease Control and Prevention by posting signs for anyone with fever or other respiratory symptoms to CALL FIRST PRIOR TO ARRIVING so that appropriate preparations can be made. At the Clinic we are triaging by phone anyone who calls with these symptoms, and are providing telemedicine visits by phone from one of our physicians for screening and advice on the appropriate treatment or transfer to a higher level of care such as a local emergency department. 
What you can do:
• Most importantly, wash your hands;
• Stay at home if you are ill;
• Avoid others who are ill;
   • Do not touch your eyes, nose or mouth with unwashed hands;
   • Cover your cough or sneeze;
   • Get your annual flu shot;
     • Clean high-use objects and surfaces daily with disinfectant (don’t forget that cell phone, tablet and television remote)
     • Guidance from the CDC’s website recommends that if you develop symptoms you think may by consistent with COVID-19,  call your physician prior to arriving for instruction. Wear a mask. Stay at home except to go out to receive medical care. Isolate yourself in your home from others and from pets.
                          – Lauren Hana, MD