March 2020

As Chief Medical Officer I am asked daily about advice to our patients about the Coronavirus; now called Covid-19. Wanting to keep the advice timely and factual, it is very difficult to separate the facts from hysteria. But someone has to do it, so here are the recommendations for Montebello, Ontario and Rialto patients from the Chief Medical Officer.

First realize there are FOUR different bugs currently going around at this time, plus the threat of Covid-19. Let’s look at each…

1. A bacterial infection is currently on the rise: sore throat, productive cough, fever, maybe sinus symptoms. If you are fit and healthy, it may wear itself out in 3-5 days. If you are very young or very old, frail, or sickly, it may lead to pneumonia or sepsis. An antibiotic is effective, and we may be able to swab for it, or do a blood test or x-ray to make an accurate diagnosis.

2. A viral syndrome with a low-grade fever, sneezing, and/or cough, can be difficult to differentiate from a bacterial infection at first. Even an experienced provider may need testing to tell the difference. It is usually less serious and runs its course over 2-3 days. Antibiotics do not work for a typical virus. We are seeing a fair number of these cases now, on par with this time of year.

3. NEITHER of these are the “flu”. Influenza is a totally separate illness. High fevers, aches, abdominal distress, dry cough, and feeling like you’ve been run over by a mac truck are common symptoms. It can be diagnosed via a swab in the office. There are special influenza medications (e.g. Tamiflu) that help reduce the symptoms and duration.

4. Covid-19 begins as a typical viral illness: sneezing, coughing, and/or low-grade fever. But there are serious differences.

Fortunately, we have not had a lot of cases in Southern California–at least not officially diagnosed. But the virus can be spread for two weeks before symptoms appear. In that time, hundreds of people have been put at risk. It is spread by droplets, so simply being near an infected person can spread it if they cough or sneeze. And the 88,000 cases (as of this writing) is misleading since those are CONFIRMED cases. At least 10 times that number have occurred, but they were not tested for Covid-19.

There is hope that as a cold weather bug, it will fade away with warmer weather. Yet it is still growing at over 1,000 cases a day being reported worldwide; the same number as late January when it first appeared. If more kits were available, you can estimate how many new cases are actually occurring.

To hear an official, say “we have this under control” is irresponsible. To hear people say on social media, “There were more flu deaths, life goes on” is just idiotic. For one thing, the flu deaths were over an entire season. This pandemic has just begun. For another, would these same people take a vacation to beautiful downtown Baghdad? Stroll thru the streets of Sinaloa Mexico? Of course, not because we know that is dangerous. Covid-19 should also be considered dangerous.

What is the difference between an epidemic and a pandemic?

An epidemic refers to a condition spreading rapidly. A pandemic is an epidemic spreading throughout the world. We are now in a pandemic. The flu was not a pandemic.

As Chief Medical Officer, I am advising the following measures for our patients at least thru the end of March:

1.If you are sick, don’t travel. In fact, if possible don’t leave the house. Of course, this is always common sense. But now you run the risk of being quarantined if it is considered possible you harbor Covid-19. Many countries are screening passengers for even low-grade fever. Flight attendants are instructed to report anyone they feel is showing signs of infection. If you have a fever you will be detained. and not just sent home but put in isolation.

2. If you are not sick, but very young, very old, frail, or sickly avoid ALL non-essential travel, or areas where crowds circulate. That means malls, theme parks, churches, even ball games. Going to a school or office may only expose you to dozens of close contacts. But a crowded day at Disneyland will expose you to THOUSANDS of people who may be incubating Covid-19.

If you are fit and relatively healthy, use common sense. Avoiding crowds and non-essential travel may seem like overkill but it isn’t just about protecting you- it is keeping an unknowing carrier from spreading the virus to thousands of uninfected people. We do not advise staying home from work or school, but if you can cancel that trip to Europe or postpone the day to Universal Studios, it will go a long way to stopping the spread and protecting yourself and your family.

3. If you do travel in March, realize there is a high chance of disrupted travel. You may be not allowed to leave your area or be house confined. Bring your own thermometer, your own cold meds, and an extra supply of your prescription meds in case you are stuck somewhere for weeks. Have documentation of your health insurance with you. Realize you may find tourist venues closed, events canceled, and long lines at areas where screening is going on.

4. Common sense dictates frequent hand washing. Remember the rule is to wash singing “Happy Birthday” to allow enough time to wash. If you are using hand sanitizers like Purell, five seconds is sufficient. Avoid touching other people if possible, maybe a thumbs up instead of shaking hands. Prepare your own meals as much as possible. If you must cough or sneeze in public, cover the face or turn away. Normal face masks are insufficient to block Covid-19. You’ll need to look for N-95 masks. However, if your coughing enough to need the mask –STAY HOME! If you are wearing the mask to protect yourself it’s probably not necessary if you are fit and healthy.

5. If you feel you may have one of those three conditions at the beginning of this blog, DO NOT ignore the symptoms. If you feel you must come to the office, alert us in advance about your symptoms. ALL respiratory type infections should be seen and worked-up during this crucial time. Covid-19 testing is done at the Health Department.

IF Worldwide screening is effective

IF everyone follows these FIVE simple rules

IF Covid-19 is a cold weather bug only

The pandemic will be history. Otherwise we may witness a pandemic unseen in our lifetimes.

Ruben Ruiz, MD
Chief Medical Officer