Coronavirus: Trying to laugh, Getting Angry and Beginning to Worry a Lot

I am certain Coronavirus has visited my office. But, I can’t test for it.  The President says it is available for anyone who wants to be tested. This is a lie.  Maybe if you are super rich and famous, you can find a test, but not for mere mortals.  In my state of Virginia, it is pretty much impossible to get tested at all.  Even if you’re rich and famous, I bet Virginia would still not test you. That’s a problem.  People come in with highly suspicious stories for Coronavirus, but I cannot test them.  As far as the state of Virginia says: They don’t have Coronavirus.  I try to get them to self-quarantine, anyway.  It fails. I urge them to at least not host social events in their retirement community for all of their old-people friends.  I fail and they have the event, anyway.

I keep failing because the Virginia Department of Health reassures them:  “You don’t have documented evidence of Coronavirus. Just take common-sense precautions.  Wash hands, etc.”Then the Virginia Department of Health (VDH) assures everyone we only have 17 documented cases.  Thus, the risk is very small.  Of course, if you barely test, you rarely document.  The Commonwealth of Virginia has no test kits. I understand the dilemma.  What I don’t understand is the fractured science the VDH (Virginia Department of Health)  then uses to claim we have less than 20 cases, so “the individual risk is low.”
 
Meanwhile, the pace of this outbreak feels like I’m in a fast-moving confusing action movie… except…. It’s real life.

We all have our masks for ourselves and the patients.  We have procedures. We also stopped visiting our own elderly parents and relatives.  We’ve also pondered our own vulnerability. We are an older two doctor practice. Our staff is not young, either.  We clean and scrub after every fever and cough patient.  We currently still have a limited supply of masks. I gripe because the masks make me feel like I’m smothering and my face breaks out. Someday soon, patients may be too afraid to come to our office.  Maybe we will all get sick or need to quarantine ourselves and have to close our doors.

Maybe…. We will even run out of toilet paper!

Well… Let’s go!  We have a job to do.  Let’s do this!

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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. 

  9 comments for “Coronavirus: Trying to laugh, Getting Angry and Beginning to Worry a Lot

  1. ARF
    March 15, 2020 at 6:27 pm

    Has anybody read anything on the sensitivity of the coronavirus testing we’re using? What I’d read mentioned a low sensitivity, but it was old, and may have been talking about China’s experience, not sure if USA has better or worse numbers.

    • Sir Lance-a-lot
      March 16, 2020 at 5:40 am

      I’ve seen nothing about sensitivity or selectivity, other than a blanket statement that a negative test does not prove non-infection, which is pretty much true of every test, aside from my highly tuned clinical acumen.

  2. Sir Lance-a-lot
    March 15, 2020 at 10:36 am

    I work for a large “multispecialty practice” (read: everyone thinks it’s a hospital because it looks like a hospital, but it ain’t). I worked Thursday, Friday, and Saturday.

    Thursday we needed state DOH approval to get a swab and send it to the state lab. Criteria were travel to China Japan, S Korea, Iran, or Italy, OR direct contact with a confirmed case.

    Friday we needed approval, but the public health RN on the other end of the phone line had slight leeway to use her judgement to bend the criteria.

    Yesterday, a national commercial lab was approved to perform testing — Everything changed.
    Now, EVERY SINGLE PATIENT who approaches the door is asked about symptoms. If they have ANY ONE of: Nasal congestion, Cough, Rhinorrhea, Chills, Sweats, or Fever, they are given a mask rotated 180°, and told to wait in their cars, and a Dr. or PA comes out in N-95, gown, gloves, OR hat, goggles, and booties, checks RR, HR, SpO2, tympanic temp, & lung sounds, and does two nasal swabs. If the rapid flu swab is Negative, the other swab gets sent for COVID testing and the pt. is told to quarantine for 2 weeks or until s/he gets a negative result.

    Needless to say, this is a major change in one day. In the Urgent Care setting, essentially everyone has a stuffy nose, so everyone is getting tested for COVID, even if they came in for a sprained ankle (and we are not assessing their sprained ankle in their car). From an orthopedic standpoint, this may not be great, but from a public health standpoint, it is fantastic. In 2-3 days, we will begin to have a snapshot into how bad things really are, but people will freak when they see the numbers jump by an order of magnitude.

    We’ll see what we’re doing when I work tomorrow…

  3. arf
    March 14, 2020 at 8:41 pm

    I remain unclear.

    Patient (or yourself, for that matter), has a fever and respiratory symptoms. Coughing, sneezing. You feel the illness is viral in nature.

    Question of coronavirus testing comes up. So does the classic medical student question. If the test is positive, what will you do? If the test is negative, what will you do? If the answer is the same in the negative and positive scenario, then why do the test?

    That seems to be the case with coronavirus. Stay home, fluids, rest, the usual. If influenza is considered, I can see testing if antivirals are in question. To my knowledge, there are none approved for coronavirus, correct me if I misunderstand.

    I can see testing for the purpose of public health disease monitoring, though it’s not going to change my advice to patient or myself.

    My read on coronavirus testing is sensitivitiy is not very good. Meaning, symptomatic patient, coronavirus testing negative, I’m still considering staying home becuase of false-negative.

    And even if true negative, the patient still has fever, cough, sneeze. So you say, what, go out and spray rhinovirus, enterovirus, adenovirus all over? Protecting the elderly, that sick youth will do fine, but might infect Grandma. Fair enough. But immunocompromised frail elderly, any of those viruses could kill.

    Seems to me, the clinical decision is the same, regardless what the coronavirus test shows.

  4. Rando
    March 14, 2020 at 8:12 pm

    I’m a solo FP and get labs through LabCorp. They offer the test so I think I could get one if I had the right patient – LabCorp does recommend we follow CDC guidelines.

    The trouble is if I read the guidelines right I’m supposed to wear a N95 mask while collecting the specimen. I have no N95 masks and can’t get them because there’s a shortage.

  5. HJR
    March 14, 2020 at 2:08 pm

    ???
    Same in PA.
    Deny every test request.
    See. No problem.

  6. Martha Clark, RN
    March 14, 2020 at 12:50 pm

    Good luck to you, Dr Mussey.

    I’m at a home visit / telehealth practice and it’s been difficult. Our practice has providers visiting patients in the home while geared up with masks and gowns. Children freaking out.

    NO TEST KITS to evaluate those suspicious for coronavirus. So we just say, “self-quarantine and wash your hands”.

    We also have “The Liars”. The ones that have flown back home from Italy or Spain. They lie when they call to make appointment at our clinic. Show up in lobby with high fever and cough. We shoo them out to go self-quarantine and evaluate over video.

    This is all so crazy. I wish you the best!

  7. John A Mayer,
    March 14, 2020 at 12:04 pm

    In 1992, I had the misfortune of being sent for 5 weeks to provide medical support to a small USAF C-130 detachment in Angola. I of course spent some effort in trying o research the country. I found that Angola had zero AIDS cases according to the UN. Then I found that Angola did not test for AIDS.

    • Pat
      March 15, 2020 at 1:12 pm

      As we all learned, it is often the body’s reaction to a pathogen that causes the real damage.

      The same appears evident in societies.

Comments are closed.