Updates on Covid-19

The Coronavirus Disease 2019 (COVID-19) outbreak continues to rapidly evolve. We wanted to give you a few updates and answer some of our most frequently asked questions.

 

We understand the COVID -19 outbreak has caused an extreme disruption to your personal and professional lives.  Unfortunately, we think this will be the new normal for the foreseeable future. There has been a lack of coordinated response to the Covid-19 pandemic from federal state and local governments. Different media outlets are reporting different versions of the threat of the pandemic, the effects to the public and what has been done to address the spread of the disease. We realize many of you are concerned about how to prevent the spread of the disease and the lack of testing. We have put together some answers to our most frequently asked questions to help provide some guidance and insight.

 

Why have only a limited amount of people been tested?

The World Health Organization (WHO) test kits were declined and the CDC produced kits with errors the first time around. This has put us months behind on testing. Each state was distributed a limited amount of tests which explains the low number of people tested. Due to the lack of tests, the guidelines for CDC testing are very strict and are only being offered to those who have traveled to high-risk areas or those with known exposure to a patient who tested positive. This does not account for the community spread of the disease and allow for symptomatic patients to be tested. The Federal government is focused more on the strategy of quarantine and social distancing versus testing to combat the spread of the virus.

 

Private labs have to go through the FDA process of approval which is not immediate. However, some private labs have developed approved testing. The test results can take up to two weeks to get the results because positive results have to be confirmed by the CDC.

 

Facilities are required to test under conditions that protect the healthcare staff and other patients. This includes isolation rooms, separate entrances, and personal protective equipment (PPE) like gloves, masks, gowns, shoe covers, face shields, etc. Due to the high demand healthcare facilities are running low or running out of this PPE. All of the healthcare supply sites have these items listed as back-ordered. Thus, many Emergency departments' urgent care and primary care clinics are choosing not to test to protect their staff and other patients. Additionally, the CDC is recommending quarantine for those who have been exposed to a patient who tested positive. This has caused severe staff shortages in hospitals and two-week closures for smaller offices.  Closing urgent care and primary care offices severely affect these small businesses' ability to remain solvent. It also exacerbates the healthcare shortage problem by creating less access to care and more volume in the already overwhelmed Emergency departments.  This is evolving and the recommendations are currently shifting to address the staff and supply shortage. However, relaxed guidelines are putting healthcare providers, staff and patients at greater risk of contracting the virus.

 

We are currently are not testing patients for COVID-19 at Kingstowne Internal Medicine. We do not have adequate PPE. Since we are a very small office we have chosen not to take the risk of prolonged closures for every positive test.

 

Where can I get tested for COVID-19?

Currently, the federal government has not implemented mass testing. Currently, there are no states that have implemented mass testing. All state health departments have limited testing and every state has different testing criteria. Please check your state health department website for further details. Some local governments have implemented testing sites for their county residents.

 

Virginia

 

Loudoun Medical Group (LMG) will begin COVID-19 testing on 3/23/2020. Patients will need to schedule a telemedicine visit for evaluation. If you meet the criteria the provider will place an order for COVID-19 testing. The patient will be given the hotline number to call and schedule an appointment. The testing is located in Loudoun County. We understand this is not convenient for most of our patients however it is the only option for those living in counties that currently are not offering to test. Because we are a part of LMG all of the patients no matter where you reside are eligible for testing once you have been evaluated and referred for testing by an LMG provider. Due to the scarcity of testing kits patients will be sent based on priority. High priority patients include those with symptoms and a known exposure, those with symptoms who have traveled to high-risk areas and high-risk mortality groups including COPD, elderly, chronic kidney disease, chronic heart disease, and diabetes.

 

Arlington County is starting testing for county residents with a doctor’s note. Virginia Hospital Center (VHC), a community-based hospital providing medical services to the Washington, DC metropolitan area for 75 years, has partnered with the Arlington County Public Health Department, the Arlington County Police Department, the Arlington County Fire Department, the Arlington County Sheriff’s Office and Department of Environmental Services to open a temporary drive-through COVID-19 sample collection site at 1429 N. Quincy Street.

 

Testing is for patients with symptoms. Patients will need to schedule a telemedicine visit for evaluation. If you meet the criteria the provider will place an order for COVID-19 testing with the Virginia Hospital Center outpatient lab. This is not meant for asymptomatic patients, even those who have had close contact with a known COVID patient. Due to the scarcity of testing kits patients will be sent based on priority. High priority patients include those with symptoms and a known exposure, those with symptoms who have traveled to high-risk areas and high-risk mortality groups including COPD, elderly, chronic kidney disease, chronic heart disease, and diabetes.

 

Maryland

 

The Maryland National Guard is helping set up an assessment center for people experiencing coronavirus symptoms at FedEx Field.

Medstar Montgomery Medical Center, Suburban Hospital Bethesda, Adventist HealthCare Shady Grove Medical Center in Rockville and Holy Cross Hospitals in Silver Spring and Germantown expect to be treating patients in Tents by the end of the week.

MedChi’s Testing Resources Site for Maryland:

https://www.medchi.org/Your-Resource/Public-Health/Coronavirus-Resource-Center

 

DC

 

George Washington University Hospital in the District’s Foggy Bottom neighborhood erected a tent to treat coronavirus patients.

Allcare DC in the district is performing drive-thru testing for their established patients. Please visit their website for further instructions.

You can also call around to your local urgent care centers to see who has set up testing sites. Based on the current information we have there are no mass testing sites set up for Fairfax county, Alexandria city or Prince William county. We will update you as soon as we get confirmation of additional testing sites.

 

How can I get evaluated if I am sick?

 

Kingstowne Internal Medicine is currently NOT seeing patients with upper respiratory symptoms in the office to protect our providers, staff, and patients. However, we are offering telemedicine visits to all of our sick patients. Please call our office or send us a portal message with your symptoms. If you do have symptoms of an upper respiratory infection you will be given the instructions on how to schedule a telemedicine visit. Symptoms of upper respiratory infections include fever, chills, sweats, cough, runny nose, sneezing, sore throat, and shortness of breath. 

We currently are offering telemedicine visits using our Healow app or using the patient portal in our electronic medical record on your desktop. This is the preferred method of providing telemedicine visits. If you do not have access to the portal or app we can also facilitate visits via Zoom for healthcare and doxy.me.  All patients must have a signed consent form in their chart before we can schedule your visit. Attached we have the consent form and instructions on how to set up a telemedicine visit via or electronic medical record. If you need instructions on how to facilitate other platforms please contact us.

Our office always has a doctor on call after hours for urgent/emergent questions or concerns. Many insurance companies have set up hotlines and surveys for patients who are concerned. Insurance companies have also set up telemedicine visits for evaluation, especially for after-hours care. Please go to your insurance carrier’s website for further instructions.

 

What if I have concerns about coming into the office for my scheduled follow-up visit?

 

We understand that many patients are anxious about coming out and being exposed during this pandemic. However, we must remind our patients that one of the foremost concerns is overwhelming the healthcare system.

Despite this pandemic, we still have more patients in the hospital for other medical problems including other infectious diseases, cancer, and cardiovascular disease to name a few. We started this pandemic with tremendous issues in our healthcare system including a shortage of providers, hospital beds and lack of insurance coverage for millions.  Additionally, one of the biggest stressors to our healthcare system is patients inappropriately using the Emergency Department for nonemergent issues out of convenience or lack of insurance. It is imperative in times such as this to practice prevention and early diagnosis and treatment of disease to slow down the need for emergent care. Providing primary care is essential to address this issue but it requires patients making it a priority to schedule regular visits for physicals, acute problems and to manage chronic medical problems.

To help accommodate as many patients as possible during this pandemic insurance companies have relaxed the rules and are providing reimbursement for telemedicine visits. Telemedicine visits can be used in our office for sick visits, mental health follow up, discuss lab results, follow up questions from a previous visit, general questions including those about COVID-19 and some other follow up visits that do not require a physical exam, labs or other diagnostics including EKG’s.

Not all visit types are appropriate for telemedicine. Telemedicine cannot be used for new patient appointments (except sick visits), visits that require a physical exam (including new problems and exacerbations of chronic problems), visits that require labs or other diagnostic testing and visits that require prescriptions for controlled substances.

What physicians do is much more complex than simply talking to our patients. I am sure it may seem simple since most providers are utilizing decades of training and experience to finalize an office visit in 15-20 minutes (and sometimes less.) However, there are several components to the care we deliver including history, physical exam and diagnostic testing including laboratory studies and imaging. Please remember that the pandemic does not absolve providers from the ethical and legal ramifications of providing inadequate care.  Providers still must maintain the standard of care when giving diagnoses and treatment recommendations.

We want to impress upon you the importance of not succumbing to fear and panic. Please call us and make an appointment if you have any questions or concerns. We are taking steps to mitigate risks while continuing to provide the necessary care for our patients.

 

How is COVID-19 transmitted?

 

Transmission is believed to be person to person with close contact via droplet, and airborne. The virus can be transmitted when people touch an object or surface with the virus present and then touch their mouth, nose or eyes. CDC recommends adherence to standard, contact, and airborne precautions, including eye protection, and good hand hygiene. The symptoms of the virus can cause mild, flu-like symptoms as well as more severe disease. Patients have a range of symptoms such as fever, cough, and shortness of breath. Based on current data, globally 81% of cases seem to have mild disease, about 14% appear to progress to severe disease, and some 5% are critical (WHO 3.4.2020.)

 

How do I lower my risk of contracting COVID-19?

 

To lower the risk of contracting the novel coronavirus or spreading COVID-19, the Virginia Department of Health encourages the following behaviors:

• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer only if soap and water are not available.
• Avoid touching your eyes, nose, and mouth.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Clean and disinfect frequently touched objects and surfaces.
• Stay home when you are sick.
• Avoid contact with sick people.
• Avoid non-essential travel.

 

Telemedicine Consent Kingstowne

eClinicalworks Telemedicine Requirements Kingstowne

Sick visits and telemedicine

 

Please contact us if you have any further questions. 571-384-6304

Kingstowne Internal Medicine

www.kingstowneinternalmedicine.com