Coronavirus: Nothing to see here! Move along!

What country places sharp limits on testing for the new Coronavirus?  Which country requires testing specimens to be sent to a single location, up to thousands of miles away?  Which country requires doctors to discuss cases with a state health department chief before a test can even be ordered?  Which country is essentially claiming “all is well,” because no one is detecting spread?.  If you don’t look, you don’t know.  If your country demands substantial prior authorization paperwork before you can order a test, the test isn’t ordered.   No evidence of spread must mean there is no outbreak, right? Problem solved!

For the past month, we have criticized China for such behavior.  Unfortunately, this is exactly the scene in the United States.

This flowchart is from the CDC.  It is also being distributed by state health departments. Notice something critical:  The only way you get tested is if you EITHER came from China or had known exposure to Coronavirus AND are pretty darn sick. That’s it.  You won’t get tested otherwise.

Consider this: A huge number of new infections in the world are now in people who had no known contact with someone from China or someone with Coronavirus.   Yet, by decree, these people will never get tested in our country.  Is everyone comfortable with that?

I’m not a big fan of Twitter.  It is hard to distinguish fact from fiction on the site.  On the other hand, there are certain people to follow who have valuable insight. If you want to scare yourself, go on Twitter and follow Laurie Garrett (https://twitter.com/Laurie_Garrett).  She seems to know her stuff and her warnings over the past month have been very accurate.

There are also other messages appearing on Twitter which are coming from doctors who are facing the same issue we are seeing in our office.  Like many, our region is in a serious Influenza A outbreak.  The majority of severe cases did not get a flu shot. In fact, the good news is the flu shot was pretty good this year.

But, we are also seeing something a little worrisome: Only a third of these cases are testing positive on Influenza nasal swabs. Perhaps this is simply the limit of the test.  Maybe our sampling is not so great. Perhaps, however, it is not the flu. Perhaps, we are looking at something bad and we don’t know it.

Would we know the difference between Influenza versus Coronavirus on the basis of physical exam and other generic lab work?  Of course not!

Our area of Northern Virginia is populated with commuters to and from Washington, D.C.  This area is full of people from all countries, riding in packed trains for up to hours at a time in close contact, coughing on each other.  How can we possibly avoid the epidemic?

The time frame with Coronavirus between exposure, mild sickness, bad sickness and maybe death appears to be many weeks.  That means this thing can remain invisible for up to a month while it widens its circle of infection. We can delude ourselves for quite a while.

Because…. We’re not looking.

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Steven Mussey MD

Steven Mussey, M.D. is a physician in Internal Medicine, practicing in the Fredericksburg area for more than twenty years. He grew up in Springfield, Virginia and earned a degree in Physics from The University of Virginia, Phi Beta Kappa. He earned his medical degree at The George Washington University and was inducted into the medical honor society AOA. He is Board Certified in Internal Medicine. He served in the Air Force for four years before entering into private practice. He particularly enjoys geriatric medical care and working with complex patients. For almost a quarter century, he has been practicing with one other Internist. Both doctors enjoy practice in a small, but busy office, and plan on working into their 70s, as long as they can still find their way to the office. Dr. Mussey is also an avid cartoonist and has a weekly cartoon in the local newspaper. He also enjoys cartoon animation and has had several public service cartoons playing regularly on the television cable systems. 

  3 comments for “Coronavirus: Nothing to see here! Move along!

  1. Sir Lance-a-lot
    February 25, 2020 at 5:23 pm

    Right you are, Steve!

    Where we are, it’s mixed Flu-A and -B, with no particular clinical difference between the two (last year, -B seemed a bit pukier) and the test has a huge false negative rate, just like it did last year.

    What a nice coincidence to have a high likelihood of COVID beginning to circulate at exactly the time that EVERYBODY seems to have the flu.
    There is no way in Hell that we will be able to distinguish the corona from the flu, and we won’t even know it’s around until old people start showing up in extremis. By then everyone at the clinic, and everyone who’s spent five minutes in our waiting room in the previous two weeks, will have it.

    I’ve pointed this out to my fellows at work several times over the past two weeks and gotten grunts and shrugs. We’re close to overwhelmed by the flu right now (more than overwhelmed some days). What will happen when we suddenly have three or four times the number of patients, both sick and well, coming in “to see if I’ve got it” or “to get tested”? The easy answer will be, “After three hours in the waiting room, you’ve got it. Next!” The increased patient load, though, will require a completely new “workflow” if we are to see them and go home, rather than just stay at work all night.
    Nobody has considered this.
    We will need to fundamentally change the way we structure a visit, and run through the flu-like patients on a conveyor belt, or we will never be done, and we will begin missing non-viral problems that present as well.

    I’m really not looking forward to the next two or three months, though I guess the RVUs will be good…

    • R Stuart
      February 26, 2020 at 9:07 am

      “though I guess the RVUs will be good…”

      More likely, in an effort to be more efficient, you’ll skip your counseling or wearing bicycle helmets and on removing loose area rugs from the house, so you won’t meet your metrics and will be hit with big penalties – all in the name of “value.”

      No good deed goes unpunished.

      • Sir Lance-a-lot
        February 26, 2020 at 11:19 am

        Urgent Care: No Bike Helmets, No Throw Rugs, No Cigarettes.

        Sometimes I say, “You still smoke?”
        They say, “Um. Yeah.”
        I say, “That’s bad for you.”
        But usually I don’t say nuthin’.

        As far as RVUs, Good point. National RVUs will probably go up, so they’ll raise my “RVU Goal,” so I’ll end up where I started.

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