The Novel Coronavirus is coming, be prepared, physicians tell South Bay
Illustration by Tim Teebken
, Kevin Cody, Mark McDermott and David Mendez
Seven cases of the novel coronavirus have been reported in Los Angeles County as of Wednesday morning. None were in the South Bay. But local hospitals and urgent care centers are preparing for its arrival, and not provisionally, or “just in case.” They are preparing for its arrival as an inevitability.
“It is more a question of when it will come and not if it will come,” said Dr. Anita Sircar, an infectious disease specialist at Providence Little Company of Mary in Torrance. “But this is not a reason for alarm, but a call for preparedness.”
People everywhere are alarmed. COVID-19, as the illness associated with the virus has been named, has not been declared a pandemic. But the World Health Organization’s warnings are growing increasingly dire. The WHO is specifically sounding the alarm regarding the preparedness of health care systems in every country, including the United States.
“Our determination right now is that health systems around the world are not ready and need to be better prepared to absorb the impact of the virus,” said Dr. Mike Ryan, executive director of the World Health Organization’s health emergencies program, in a news briefing last week. “People need to take a reality check now.”
The Mira Costa High School chorus was forced to take just such a reality check. A trip to Italy was cancelled this week. The Italian government has closed all its schools and universities after the COVID-19 death toll reached 100.
South Bay medical professionals and public health officials are trying to make sure the local population is prepared.
Manhattan Beach Exer Urgent Care physician Dr. Brian Wilbur. Photo
Earlier this week, Dr. Brian Wilbur rejected a hand extended to him in greeting at Exer Urgent Care’s Manhattan Beach office. Wilbur wasn’t being rude: He was setting an example of the medical profession’s attempts to limit the spread of the novel coronavirus.
The Exer physician offered a light-hearted cartoon depicting “handshake alternatives” that could slow the spread of the disease, which health officials believe is spread through respiratory droplets, the material dispersed by coughing and sneezing. Doctors say the best thing people can do to protect themselves from the virus is wash their hands frequently, be aware of contact with shared surfaces like doorknobs, and limit touching one’s face, which can transfer germs from hands to the nose, eyes and mouth.
Wilbur is doing his best to popularize the “foot shake” and the elbow bump. As is typically the case, he said, those who feel ill should stay home and avoid public places. And for most people, that includes a doctor’s office.
“If you’re sick, we want you to stay home and minimize contact with other people. That’s what we recommend for the flu, and for this it’s the same,” Wilbur said.
COVID-19 has been linked to more than 3,000 deaths around the world, with symptoms including fever, cough, and difficulty breathing, but the vast majority of the cases are mild. Some people who have contracted the disease may not even display symptoms, though they are able to pass it on to others. For those experiencing symptoms, Wilbur asked people to consider their condition before going to an urgent care facility or hospital.
“We want you to seek medical help if you have trouble breathing, can’t control your fever, a severe cough, that kind of thing. Come in if you are concerned about your symptoms being life-threatening. But if your symptoms are mild, like with the cold or flu, then stay home, take your home remedies,” Wilbur said.
Wilbur said he frequently checks the website of the Center for Disease Control and the Los Angeles County Department of Public Health for updates, and that Exer’s team talks daily about the disease. According to the CDC, there is neither a vaccine nor a specific treatment for coronavirus. Instead, care is “supportive.” Wilbur said this means people should rely on the same strategies used to fight the common cold or flu: bed rest, lots of fluids, cough suppressants, Tylenol or Motrin if needed for fever, and supplements like echinacea or zinc if desired.
Wilbur said Exer is taking precautions to make sure a visit to the doctor doesn’t sicken people in the waiting room. They are asked about recent international travel or contact with those who have traveled. People with travel contacts are asked to don a mask and use hand sanitizer available at the entrance.
“If they are identified as at risk from the coronavirus, they are given a mask and put into a separate room where they are assessed by one of our providers with a checklist” from the Centers for Disease Control, Wilbur said. “Then based on that risk assessment, we are instructed to call the L.A. County Department of Public Health, who will guide us to either swab the person and send the sample to a CDC lab, or to send the person to an emergency room.”
Like most medical facilities nationwide, Exer’s urgent care centers do not have the ability to conduct on-site tests for coronavirus. The tests can only be done at labs that have received approval from the CDC. The federal agency also recently granted certain academic facilities the ability to conduct tests.
Not everyone with the sniffles needs to be tested. Along with severity of symptoms, the CDC identifies contact with confirmed cases, or recent international travel to severely impacted countries, including China, Iran, Italy and South Korea.
Wilbur said he has received a significant number of inquiries about the coronavirus in the South Bay, particularly from those who have traveled internationally. He recalled a patient who had recently returned from Berlin, who complained of fever and a cough. Tests showed the man had the flu.
Wilbur said public fears about the coronavirus are greater than fears of other recent outbreaks, such as with MERS in 2012, which he attributed to greater awareness. He said it is important people be not just informed, but well informed. The recent mania for masks, for example, may come from a mistaken belief that masks can prevent someone from getting the disease. There is no evidence this is true. Masks are intended to prevent people, including doctors, who may have come in contact with an infected person from spreading the disease to others.
He said the websites of the L.A. County Department of Public Health, CDC and the World Health Organization are all good sources. Asked about recent news reports addressing people rushing to stores and emptying shelves of supplies, Wilbur tread a middle ground.
“There is a need to prepare. Mostly to prepare for things like, if i have to stay home for a week, do I have food, stuff to entertain my kids, that kind of thing. But is there a need to panic? Not at this time,” he said.
BCHD: Keep calm, be prepared
The Beach Cities Health District sees its role in addressing the novel coronavirus as making sure people get the information they need to stay healthy, without causing unnecessary worry.
“It’s a natural response to panic when confronted with something beyond our control,” said Dr. William Kim, BCHD’s Chief Medical Officer. “But we can teach people that there are controls and containments, and to look at the positive side of things.”
Coronaviruses are respiratory viruses, much like the flu.
What makes this strain of coronavirus new is that it hasn’t been seen in humans before — which is why it’s described as “novel.” Since it hasn’t previously been seen in humans, no one has immunity to the virus, and there’s no vaccine yet available to prevent its spread.
“The bonus is not only can we prevent novel coronavirus, but also cases of the seasonal flu — ways to stay healthy during a disease outbreak are as relevant to the flu as they are to coronavirus,” said Kerianne Lawson, BCHD’s Chief Program Officer.
Many of those practices are simple, if not always observed: washing your hands with warm water and soap for at least 20 seconds after using the restroom, before eating and after sneezing, coughing or blowing your nose; avoid touching your face; don’t share close contact with people who are sick; cough or sneeze into a tissue, or failing that, a sleeve. But the most important action for a sick person is just stay home.
“If you can work from home, great. If you can’t, you’re doing everyone a favor by keeping yourself out of circulation until your immune system can knock the infection down,” Kim said. Officials also advise healthy people to get the flu shot if they haven’t already gotten it this season. Not to prevent the spread of coronavirus, though; this season’s vaccines target the H1N1, H3N2, Yamagata and Victoria flu strains.
“If we keep people healthy and reduce the incidence of influenza in our community, that opens up treatment space for coronavirus if it comes here…we want our health systems to be able to respond to those folks,” said Lawson.
If people are sick, BCHD officials recommend they visit an urgent care clinic, “unless you’re really having trouble breathing,” Lawson said. She named South Bay Family Healthcare at 2114 Artesia Blvd., as an option for people who are uninsured or underinsured. They charge on a sliding scale.
One last thing, Lawson and Kim added: there’s no need to clear out stores by stocking up on goods beyond reason.
“It’s not going to be like ’The Big One.’ We’re still going to have power and be able to cook. Just think about what you need to get through a seven to 10 day sickness,” Lawson said. Oh, and leave the N95 respirator masks to the professionals, please.
“For most of us, standard paper surgical masks are just fine…. The most effective use is putting them on the person who is ill, not healthy people.”
Dr. Eric Milefchik is an infectious disease specialist at Torrance Memorial Medical Center. Photo courtesy of TMMC
Torrance Memorial prepares for “a surge”
The novel coronavirus presents a challenging triage decision for hospitals. Physicians must decide who to hospitalize and who to send home.
“We cannot afford to overwhelm the health system. But neither do we want cases to spread unnecessarily,” explained Dr. Eric Milefchik, an infectious disease specialist at Torrance Memorial Medical Center.
“There is a high probability of coronavirus spreading in Los Angeles County. That puts the onus on us to prepare, not just for one or two cases, but a potential surge in cases,” he said.
To triage patients, he said, “We are relying on longstanding preparations for dealing with emerging pathogens.”
Milefchik traced the hospital’s procedures back to the SARS virus (Severe Acute Respiratory Syndrome) in 2002 and the MERS virus (Middle East Respiratory Syndrome) in 2012.
Illness (COVID-19) from the novel coronavirus is thought to have a 3.2 percent mortality rate, almost double that of the seasonal flu. By contrast, SARS had a 10 percent mortality rate and MERS a 37 percent mortality rate. But the earlier viruses had far fewer cases. Approximately 8,000 people contracted the SARS virus, the majority of them in China. The MERS virus infected fewer than 2,500 people, 80 percent of them in Saudi Arabia.
As of Wednesday, this week, novel coronavirus was reported to have infected 95,000 people worldwide, with 80,151 in China and 148 in the United States. It has claimed 3,252 lives, among them 2,915 in China, and nine in the U.S., all in King County, Washington. More than 50, 000 people have recovered from the virus.
“Fortunately, it has a relatively low mortality rate. Unfortunately, it is efficiently transmitted,” Milefchik said.
The difficulty in tracking the mortality rate, said Dr. Michael Mellman, an internist in El Segundo, is we know the numerator (9 dead in the U.S.). But we don’t know the denominator (the number infected with the virus).
Those at greatest risk of mortality are people over 70 with cardiovascular disease, diabetes and other chronic diseases, Dr. Milefchik said.
Patients with coronavirus symptoms who visit Torrance Memorial Medical Center will be met at the door by staff in protective attire and isolated from the general population. County Department of Health guidelines call for patients with flu-like systems to be tested for the coronavirus if they have been in China, South Korea, Japan, Iran or Italy within the past 14 days, Dr. Milfchik said. He emphasized that the guidelines are subject to change, daily.
A Torrance Memorial patient who meets the guidelines will be put in an isolation room and have nasal and oral swabs taken for testing by the County Department of Health. Torrance Memorial has 16 negative pressure isolation rooms and more rooms that can be converted to isolation rooms if needed. As of Wednesday, Torrance Memorial had not seen any suspected COVID-19 cases.
Milefchik advises patients with mild bronchial infections to contact their primary physicians, but stay home. Because there is not yet a vaccine for the coronavirus, doctors are limited to offering “supportive” treatment.
“Don’t spread the disease, but don’t overwhelm the health system either,” he said.
Dr. Anita Sircar is an infectious disease specialist at Providence Little Company of Mary.
No cause for alarm, yet
Dr. Anita Sircar, an infectious disease specialist at Providence Little Company of Mary in Torrance, suggested the triage system begin at home.
“People who are mildly ill with flu-like symptoms, COVID-19 or otherwise, can stay at home during their illness,” advised Sircar.
The Rolling Hills resident has advanced degrees in Public Health and Tropical Medicine and Hygiene. In 2016, she worked in South Sudan with Physicians Without Borders.
“Remember, during an epidemic, people tend to flock to hospitals. Sometimes the hospital is the worst place to go during an epidemic,” Sircar cautioned. “Call off work or school if you are sick. Stay away from others in your family or community until you feel better.”
“Patients who feel they must be seen, should place a facemask on before they enter the hospital, and then inform the emergency room staff that they are seeking medical care for possible COVID-19 infection.”
Sircar said patients who wish to see their personal doctors should call their doctor first and then take the same precautions she advises for visiting a hospital emergency room.
Patients who visit Providence Little Company of Mary with COVID-19 symptoms (Coronavirus Disease 2019) will be given a respiratory virus swab, which will be sent to the California Department of Public Health for testing, Dr. Sircar said.
Like Torrance Memorial, Providence Little Company of Mary had not seen suspected COVID-19 cases, as of Wednesday morning.
“At Providence, we cannot test for COVID-19 in our lab. There are only a few labs in the country as of now that can test for COVID-19. Luckily California State Public Health lab is one of them. As of last week, there were about 1,200 kits (nationwide), but more will become available as this outbreak continues. This is the same thing we saw during the 2009 H1N1 (Swine Flu) pandemic. In the beginning we had to send out all of our testing. A few months later, we had the testing available in the hospital and now it’s on our routine virus respiratory panel that everyone gets. This is the evolution of testing during a virus outbreak.”
“The hope is that the COVID-19 test kits will become more available and we will be able to test at the hospital level instead of sending it to the State Public Health lab.”
Presently, test results take three to seven days, she said.
“As of now, any PUI (Person Under Investigation) at Providence Little Company of Mary who is having COVID-19 testing done, will remain hospitalized in an ‘airborne infection isolation’ room until the results return,” Dr. Sircar said.
“Hospital staff caring for suspected COVID-19 patients will follow CDC (Centers for Disease Control and Convention) guidelines and wear a gown, gloves, respirator and goggles,” she said.
She urged the public not to become complacent.
“The ‘level of danger’ will most likely reflect what we are currently seeing around the world,” Sircar said. “The overwhelming majority of cases will be mild and self-limiting. As is true of many viral infections, the healthier you are before you become infected the faster you are to recover from it.” ER