San Luis Obispo doctor answers viewers' questions on COVID-19

Posted at 4:58 PM, Mar 30, 2020
and last updated 2020-03-30 21:40:58-04

As the conversation and recommendations around COVID-19 continue, viewers have a number of questions they feel haven't been answered.

We asked you for your questions on social media and took them to Dr. Brad Knox, chairman of Sierra Vista's Department of Emergency Room.

Here is what he had to say.

Q: If you've been in isolation for 14 days, can you assume you don't have coronavirus?

It's a safe assumption, but I'd be cautious making that leap. I think the worst thing we could do right now is break this shelter idea. People saying it has been 11, 12 days and asking when can we get back to our daily lives. I want to emphasize the reason we're doing this is really trying to slow this down and buy us time to better prepare for it.

Q: Does there have to be a fever present to have COVID-19?

I wish that were so, it'd make it a lot easier to find it. But the answer is no, there does not have to be a fever.

Q: What are other symptoms you've seen?

We've seen some patients who have also just experienced some nausea or diarrhea. We also see some patients who experience anosmia (also known as smell blindness) and diminished ability to taste. So sometimes the symptoms can be very mild. In the elderly it can be just a little bit of weakness or fatigue. We are going to know a lot more about the disease as our testing ability ramps up and we'll be able to get more information out to the community once we have that data.

Q: Is it safe to get take-out food? Do you have to microwave it to be safe?

I personally as a practicing emergency room physician have no qualms about getting take-out food. We've been doing it to support our local businesses. I don't feel the need to reheat it. Our local businesses, I'd like to think are practicing the same sanitary measures they always have been.

Q: Can you be reinfected by COVID-19?

I have not heard of cases of reinfection in the short amount of time but I want to caution that this is a new virus. We don't have a whole lot of data on it yet. So the presumption is now that if you had it, you should be immune to it. Again, there are a lot of unknowns there.

Q: Can you define when health officials say a coronavirus patient has recovered?

From a medical perspective, we would say a patient has recovered when symptoms have resolved like if you had the cold and you feel back to normal. But we're going further than that with these COVID cases and patients are deemed recovered when they've had two sequential tests in a 24-hour period which have both been negative.

Q: What underlying health conditions are more problematic to have if you contract COVID-19?

Anyone who has any medical problems or health conditions -- whether it be congenital heart disease or diabetes, hypertension, asthma, COPD, especially things that affect the heart and lungs -- is at an increased risk.

Q: If someone was sick at the beginning of the year, thinking they had the flu but tested negative for the flu, could they have already had COVID-19?

It is quite possible. In Spain, they were testing people in the morgue and they found COVID-19 dating back to February. So it is quite possible it has already been through our community. And the bad flu you may have had a month or two ago may have been it. We don't have the testing ability worldwide to [check if you had already had COVID-19 and recovered]. The other thing that must be taken into consideration is the limits of testing. Whether its for the flu or COVID-19, our tests aren't perfect. If it is positive, it's positive. You can trust the patient has the illness, but if it is negative, there is still a chance they could still have the disease and it was just a poor sample or something wrong with the equipment. So we have to keep it in context. For right now, if it sounds like someone may have it, we're treating them as if they do.

Q: If someone is feeling symptoms, when should they consider it to be possible they have COVID-19 and go get tested?

You can be relatively asymptomatic for the first five days. From there you may start to develop fevers, sore throat, body aches, cough, runny nose. Usually day eight to 10 is the big get better or not time frame. If you're going to get better, you're going to turn the corner, you'll wake up the next morning, feeling kind of back to normal. If you're going to get worse, you'll start to notice an increase in shortness of breath, that feeling that you just ran a mile and can't quite catch your breath. That's when you absolutely need to get your butt to the emergency room. If you feel any respiratory problems, we'd rather see you and tell you you're fine than not see you and wait too long.

Q: What is a common myth of COVID-19?

This idea this predominately affects the elderly, the compromised and the weak. That's where we are seeing the highest mortality. That's where we are seeing the most patients get sick and die throughout the world. But I want to caution the youth out there. The fact of the matter is 40 percent of our hospitalizations in the country right now are between the ages of 20-54. These are people who thought they were healthy and got sick and ended up being hospitalized. Thankfully these people do tend to recover with our aggressive interventions and our current critical care techniques. But I want to caution everyone out there, don't think just because you're healthy, you're immune to this. So take this very seriously.

Q: Who does a mask help and should I wear one to the grocery store?

A patient who is sick, someone out in the community who has a cold, should wear a mask if they are around other people. The people who do not have any symptoms and who are fine and going about their should not wear a mask. It is not going to protect you [against COVID-19]. We need to limit those masks for the healthcare professionals who are actually on the front-lines facing these patients because these are the people we really want to protect so they can take care all of us as we get ill.

Q: Should you have a time limit when at the grocery store during this?

There is no specific time limit when you need to get in and get out. I do want to mention for you to be considered a high risk exposure, you need to spend about spend about 30 minutes, unprotected, within someone's personal space, say 3 feet or less. And that person must actively be with the illness. I think your chances for exposure are much less likely provided you are washing your hands before you touch face, eat, or anything like that.

Q: When do you we start to see social distancing is working?

I think we can say social distancing is working when we start to see our infectious rates slow down. If we can see our rates double every two weeks, three weeks, that's when we'll know our social distancing is really having an effect.

Q: Can more than 50 people get tested each day?

There are outpatient resources through West Pac Labs, Quest labs that can perform tests separately, so more than 50 people can get tested per day, just not through the Department of Public Health.

Q: Are more people contracting the virus or are the numbers a results of more testing?

In regards to the numbers we're seeing, it is hard to know these increase in numbers represent purely an increase in testing or a true increase in incidents of this disease in our community. Right now as the testing ramps up, we're clearly going to see more patients. I will say we haven't seen a lot of critical patients. Most of the patients are the walking well. But as these tests become more available, we are going to see an increase in numbers. And again, I would say most of the time it is going to be purely because we're looking for it more.

Q: What can I do if I get COVID-19 but don't need to be hospitalized?

For people at home who develop COVID-19 symptoms, the treatment is supportive. So make sure you're getting plenty of rest, getting plenty of fluids. Ibuprofen, Tylenol, you can do those things to help with fevers or body aches. Over the counter cough and cold medicines are fine. Contrary to some statements that went out last week, ibuprofen is still safe to take with this disease.

Q: What is the treatment for hospitalized patients?

When you come to the emergency room, we will be screening you looking at the oxygenation of the blood. And that's going to be a big branch point for us. That's where your more intensive treatments start is simply with supportive oxygen. From there, we may do breathing treatments. From there, if the respiratory status becomes compromised further, that's when where ventilators come into play. There is different positioning as far as putting patients on a ventilator on their stomach to try and minimize some of the inflammation that happens in the lungs. And a lot of it is giving the patient's body time get better. We may put antibiotics on board because its hard to tell if this is truly COVID-19 while we are waiting for test results and bacterial pneumonia is something we can clearly treat. And aggressive respiratory therapies.

Q: Is it safe to go to the emergency room if I need to go for something else?

Our ER census numbers, across the county, are down by about 75 percent. I know a lot of people are scared to come to the emergency room. They don't want to get this illness if they are having other issues. I want to point out we are doing multiple precautions to separate these patients out. Here at Sierra Vista, we've actually created a separate emergency room as well as our standard emergency room to take care of broken bones, heart attacks, strokes and trauma patients. As that is continuing to function business as usual. If you feel you have a medical emergency, please don't wait. Come and see us. You don't need to have an unprecedented fear of contracting the illness by coming to the emergency room.

Q: What can people do to help?

Our priority is the community. Please stay home if you can. Limit your contact with others. I know it is frustrating, I know there are no more puzzles. But try and minimize the social gatherings because we really want to just try and stamp this thing down. If we can do that, we can go back to our lifestyle.

Dr. Knox also noted the flu numbers have plummeted with the shelter at home order in place.