The Front Line of the COVID-19 Crisis

The news has been filled with the COVID-19 crisis affecting New York City and its surrounding states of New Jersey and Connecticut.  However, most people feel that we in the Arnold and Severna Park area just aren't feeling impacted yet.  Let me give you some hard facts.  Here in our little office in Arnold, Maryland Primary Care has been doing COVID-19 testing and sending their samples to LabCorp.  We have had approximately 25 positive tests come back and probably a few false-negative ones as well.  I will go into that concept of false negatives later in this article. Our own Anne Arundel Medical Center, now Luminis Health Care, has 46 patients in their hospital with COVID-19.  They do not say whether they are in the Intensive Care Unit (ICU) or not, but I have heard that their ICU is full and they have opened another unit to treat all of the COVID-19 patients.  Doctors Hospital, now part of Luminis Health Care has 52 patients in their hospital.  Baltimore Washington Medical Center in Glen Burnie hasn't published their statistics yet, but I am sure that they are also treating many COVID-19 patients.  So, the bottom line is that COVID-19 is here in Anne Arundel County.  But we haven't seen our surge of infection just yet.  

The statistics aren't hard to grasp and they are overwhelmingly on the side of complete recuperation from this disease.  80% of the people contracting this disease recover at home without any problems.  It is just like a bad flu with fever, cough, malaise and muscle aches.  Only 20% of patients with COVID-19 disease requires the acute care services of the hospital, mainly for supplemental oxygen.  Only 5% of those patients in the hospital then require a mechanical ventilator to help them breathe.  

Due to the Governor's orders, which we all should be in agreement with, many routine and non- emergent medical care have now been postponed.  Many physicians are now performing video telemedicine visits on the computer or smartphones.  However, if there is an urgent medical problem your healthcare provider, whether it be a specialist or a primary care, should see you. Many primary care offices have moved 100% toward telemedicine and have essentially closed their offices.  Here at the Arnold office of Maryland Primary Care we have made the decision to see all of our patients who want to be seen.  We are scheduling video telemedicine visits when appropriate but we are seeing all of our patients who have respiratory symptoms outside in our parking lot so as not to contaminate our inside office.  We have set up a mobile 'MASH' unit outside and are evaluating and diagnosing COVID-19 patients.  We have the tests available and are currently sending them to LabCorp for diagnosis.  Initially, we had a 7-9 day turnaround which was terrible.  Now we have a 48-hour turnaround.  Soon we hope to have the 10-minute test but so far that is not yet available in wide outpatient distribution. 

Let me talk a little bit about testing.  Currently, we only have a molecular biologic test called rt-PCR.  It doesn't really matter what those initials stand for but what is most important is that it takes a long time for results to come back.  We have been trying to secure the ten-minute rapid antibody test for a few weeks now.  They are simply unavailable yet.  This has to do with supply as the entire world now is wanting these tests.   The other big snafu is that these new antibody tests require an FDA blessing called Emergency Use Authorization which means that these tests can be used without the full FDA verification process which takes months to years.  

HOWEVER, and I put this in capital letters, there are problems with both the rt-PCR and the antibody rapid test.  Both of them can have 'false negatives' which means that the test is read as negative but the patient really has the COVID-19 virus.  They can also have 'false positives' which means that the test is read as positive but the patient doesn't have the disease. This has to do with many factors.  An excellent article that explains this in more detail in this link:

https://www.msn.com/en-us/news/us/coronavirus-tests-are-being-fast-tracked-by-the-fda-but-its-unclear-how-accurate-they-are/ar-BB12tP0l

The article specifically spells out the most crucial conflict that we have now:

"concerns are mounting that a lack of accurate testing will make it more difficult for America to relax social distancing, as the ability to track and trace new infections will be critical for any strategy to reopen the country"

However, as the saying goes 'Perfection is the enemy of progress'.  Although these tests are not perfect, they are the best that we have at this point in time.  As the virus spreads in Anne Arundel County, we all have to be vigilant.  We ALL have to practice social distancing and put on masks when we are out in public.  Our Arnold office of Maryland Primary Care will use whatever testing that we have in association with the clinical presentation of the patient.  The testing is just one extra tool that we have to make our diagnosis and treat our patients accordingly.  Please stay safe and practice social distancing.  The next few weeks we in the Arnold and Severna Park area may see a significant surge in COVID-19 infections.