North Atlanta Primary Care

Clinical Updates

NAPC Clinical Communication

COVID-19 TESTING

This past week, Georgia Governor Brian Kemp announced a GA DPH policy change in testing persons for the presence of SARS-CoV-2, the Coronavirus.  The GA DPH until recently had reserved testing only for high-risk, symptomatic individuals and patients requiring hospitalization.  On May 7th, Gov. Kemp announced any person desiring testing, including asymptomatic individuals could now request and receive a COVID-19 test.  With only 225,000 tests performed in GA over the last four months, this policy change is a major disrupter for healthcare providers. 

Gov. Kemp recommended two options to receive a test: 

Can you review the current testing policy at NAPC?

Since early March 2020 NAPC has been providing COVID-19 diagnostic testing through its partnership with Quest Diagnostic labs.  It requires a medical evaluation and a nasal-pharyngeal collection that it submitted to the lab.  Results are highly accurate, being a molecular test using nucleic aid amplification techniques and high throughput equipment.

Since mid-April 2020, NAPC has provided COVID-19 serology tests for antibodies through Quest Diagnostic labs.  This particular serology test measures the presence of the IgG antibody, which typically appears 10 days post-infection and continues to increase for many weeks.  It is a highly accurate test and has been approved by the FDA.  More recently, we have acquired serology testing from LabCorp, which measures three types of antibodies: IgA, IgM and IgG.  The Lab Corp test checks for both early and late phase coronavirus antibodies.  Serology testing is NOT a diagnostic of coronavirus infections.  We believe that the presence of antibodies my confers some level of immunity to COVID-19, but more study is required. 

At NAPC, simply call 770-442-1911 to arrange a telemedicine appointment to schedule a diagnostic or serology test for COVID-19.  NAPC continues to prioritize testing for our patients with symptoms and individuals with higher risks, i.e. healthcare workers, first responders, elder care staff and residents.  If you have COVID-19, we recommend testing antibodies four weeks following symptom resolution.  NAPC will continue to communicate with you once testing at point-of-care is available.  

Does NAPC have point-of-care COVID-19 testing? 

 We have not acquired in-office testing kits from Abbott Labs that would allow us to perform nucleic acid diagnostic tests for coronavirus in the office. Abbott continues to regulate the distribution of these test kits to hospitals and first responders. We currently have over 15 ID Now analyzers in our NAPC facilities and will begin rapid office testing when test kits become available.

https://www.abbott.com/corpnewsroom/product-and-innovation/an-update-on-abbotts-work-on-COVID-19-testing.html

On May 9th the FDA authorized the first antigen test for the rapid detection of coronavirus. This is a different method of determining if you are infected with COVID-19. These diagnostic tests quickly detect fragments of proteins found on or within the virus from samples collected on swabs in the nasal cavity.

One of the benefits of this type of test is the speed at which the results can be obtained. PCR tests run by Quest labs can take several days, but antigen tests, similar to rapid Strep A testing, will take just minutes and are very simple to administer. However, they are not as accurate as PCR tests. Antigen tests are very specific for the virus but not as sensitive. This means a negative antigen test may require a confirmation test with a PCR test. Antigen testing will play a critical role in the fight against COVID-19 and we will use them at NAPC to help expand our ability to treat our patients and get persons back to work and school.

https://www.quidel.com/

Are home COVID-19 testing kits available yet?

The FDA authorized the first at-home collection molecular test, called Pixel by LabCorp on April 20th. The test kit contains a nasal swab that you send back to the lab for testing. This is a big step forward as healthcare workers are not involved in the collection of the specimen and lessen exposure risks and spread of the virus. This test may require an Rx and will be available to consumers in the upcoming weeks. The FDA has not authorized any tests to be entirely used and processed at home. Once these tests are available to our patients we will let you know the process to simply have a virtual visit and receive a prescription.

https://pixel.labcorp.com/

Can you provide salvia tests for COVID-19 yet?

Recently the FDA authorized the first molecular test that uses salvia instead of a nasal swab. This test developed by Rutgers’ RUCDR Infinite Biologics is highly accurate and will be very useful in performing large volumes of tests. We expect that home test kits will be available as well. NAPC continues to monitor the availability of all these testing methods and will continue to communicate with you weekly as these tests become available to our patients.

https://www.vaulthealth.com/covid

Can the hospitals provide COVID-19 testing?

Hospitals are reopening to more routine care and surgeries. Health Systems are currently testing all patients admitted to the hospital with COVID like illness. They test all patients that have a surgical procedure 72 hours prior to surgery. NAPC is working with several ambulatory surgery centers to provide COVID-19 diagnostic testing prior to their procedure. If you are planning a major medical, dental, or GI procedure, discuss with your physician getting screened for COVID-19 before your surgery. Do not undergo surgery if you test COVID positive.

https://www.wellstar.org/education/pages/press-releases/2020/wellstar-coronavirus-community-page.aspx

Can you provide testing at the drive-thru testing sites?

Here is the Georgia link for reviewing and getting an appointment at the drive-thru testing sites. In our experience the number of tests that can be done changes regularly. Each site uses a different method for performing COVID-19 testing. Some can give results in 5-15 minutes with the Abbott ID Now molecular tests. Other sites continue to process at Georgia DPH labs and others use private reference labs. If you require an Rx for a COVID-19 test we can provide one to you during a virtual visit.

https://dph.georgia.gov/find-location/covid-19-testing-site

Final Thoughts:

If you are experiencing COVID like symptoms, please call NAPC and we will arrange a virtual visit with your healthcare provider today. We are equipped to treat you and arrange appropriate testing. If you were sick several weeks ago and would like to perform antibody testing to determine your status, we will arrange for a blood draw in our offices. If you are asymptomatic and would like to have a PCR diagnostic test for COVID, we recommend until we have in-office testing, that you consider a drive through testing site. We appreciate the trust you place in us to provide healthcare to you and your family. We are all in this together. Please stay home and stay safe.

Respectfully,

Thomas E. Bat, MD

Medical Director NAPC

Coronavirus Update #12

As medical director for NAPC I am blessed to be surrounded by a team of Primary Care physicians, nurses and PAs that have been delivering care to COVID-19 patients since January. This virus has been spreading unimpeded despite our best efforts. However, we have learned much about coronavirus from experts like Dr. Fauci at NIH and the many frontline medical staff at Wellstar, Emory and Northside Hospitals. At NAPC we have developed comprehensive COVID Care Plans and testing. We have learned much and have had much success in keeping our patients healthy and out of the hospital. Our use of telemedicine tools has expanded our reach to provide daily healthcare. We have kept all 12 NAPC offices open and continue to deliver essential medical care for our patients. Today I would like to review some basics about COVID-19 illness.

First, Assume it’s COVID-19.

If you have a cough, sore throat, body aches, and fatigue, assume it’s COVID-19, and self-isolate for at least 2 weeks and until you feel better. You do not need to be tested as long as your symptoms are mild to moderate. This is also the time to call NAPC, so we can schedule a video or phone call to assess your symptoms and plan any next steps with you. We will monitor you daily and can provide equipment to monitor your temperature, oxygenation level, blood pressure and heart rate.

(2), Day 5 is often when symptoms feel noticeably worse.

The fifth day of symptoms is when we are most often called and when folks realize they are really sick. Unlike with influenza (flu) where you feel it on day 1, COVID-19 appears to sneak up on folks. Our patients have been reporting some of these symptoms during the first 5 days:

  • Raw scratchy throat
  • Weird chills
  • Dry cough
  • Mild headache

Then sometime during days 5 through 7, they reach out and tell us “Dr. I’m sick.” Cough and fatigue seems to really hit around day 5, and for some folks, pressure around the whole chest (like a tight band is squeezing you) and shortness of breath come out in force. Data shows that symptoms usually start 4 days after people are infected, but it can range from 2 to 14 days.

Shortness of breath is clearly the most distressing and worrisome symptom, as it should be. But with COVID-19, symptoms can appear and change over time. According to the CDC, you may have COVID-19 if you have cough and difficulty breathing, or at least two of the following: 

  • Fever 
  • Chills
  • Repeated shaking with chills
  • Muscle aches
  • Headache
  • Sore throat
  • New loss of taste or smell

(3), Diarrhea isn’t as common as you think.

Diarrhea is commonly reported with COVID-19 patients, but it happens around once a day (not 8 to 10 times a day, like some people think). Some complain of mild GI distress with nausea and vomiting. But this is not common.

(4), It’s common to feel body aches through day 11.

Don’t feel discouraged if you still feel bad, and it’s day 11. You are not alone. Many of our patients feel more tired and achy around day 7 to 11. Common complaints include lower back pain or an ache between the shoulders. Acetaminophen may help with this.

(5), Is acetaminophen or ibuprofen safer?

The early warnings about NSAIDs like ibuprofen (Motrin, Advil) being unsafe for patients with COVID-19 have largely been corrected. The World Health Organization (WHO) released a statement saying that they don’t recommend avoiding ibuprofen for treating COVID-19 symptoms. The truth is we don’t actually know if ibuprofen and other NSAIDs are unsafe, but our patients are still cautious. 
For now, rely on acetaminophen (Tylenol) for body aches, headaches, and throat pain. Acetaminophen is generally safe, and most people can take two of the extra strength (500 mg) tablets every 6 to 8 hours, as needed. The maximum recommended amount of acetaminophen is 4000 mg per day.
Every medication comes with some risks, so talk to us about any concerns you have. The usual warnings in folks with liver disease pertain, so if your doctor has told you in the past not to take acetaminophen or Tylenol, don’t do it.

(6), What helps for the cough?

We’ve seen that benzonatate (Tessalon) capsules have helped ease cough in many of our patients. This is a non-sedating medication that numbs the throat and helps reduce the reflex to cough. We will need to evaluate you and give you a prescription for it, but the medication is cheap.

(7), What helps for shortness of breath?

At NAPC, we’ve been doing telemedicine visits with patients who have shortness of breath to see how they’re breathing. For example, we see if they can speak in full sentences and move around without having trouble breathing. For those who are staying at home, albuterol inhalers have helped in some cases to reduce tightness in the chest. Pulse oximetry finger monitors, which can be purchased online and at pharmacies for fairly affordable prices, can also be helpful. This is part of our NAPC COVID Care Plan. We also continue to see patients in the office for evaluation, diagnostic tests, labs and X-rays to asses for complications like pneumonia. If we determine you need intensive care or simply supplemental oxygen, we will arrange a safe transfer to the local hospital emergency room.

(8), Do you need to stock up on hydroxychloroquine and azithromycin?

No, you should not stock up on hydroxychloroquine (Plaquenil) or azithromycin (Zithromax). Clinical trials are still being run on these medications, and we don’t have conclusive data on whether they work. Individual physicians may recommend these to a patient based on their own clinical judgement and the health status of the patient, but we should reserve these medications for hospitalized patients with moderate to severe illness. NAPC is working with our health systems to make sure if you are worsening with COVID-19 you will have access to all experimental therapeutics.

(9), Assume everyone is infected.

Last but not least: Many patients who tested positive and got very sick were fine the 2 days before they were tested, and that’s when they were very contagious. Assume everyone next to you — in the grocery store, at pharmacies, around your neighborhood — are infected, and keep 6 feet apart.

We know that social distancing is absolutely critical to stopping the spread of COVID-19, which includes staying at home and managing mild cases from home. Please call NAPC if you have difficulty breathing even with minimal activity.

Final Thoughts:

May 6th-11th is National Nurses Week. Our nurses are on the frontline every day at our offices, hospitals, testing centers and clinics. Please reach out to thank them- it is the care they deliver that makes the difference. Lastly, please continue to stay home, use a face mask, and continue to social distance. We know there is tremendous pressure to return to work, to school, to shop and to socialize. Georgia has done a great job to limit the spread of COVID-19, but we are far from our goal. We are working to have increased same-day testing, earlier therapeutic intervention and safe vaccines. Thank you for what you are doing. #NAPCSTRONG.

Respectfully,

Physicians and Staff at NAPC

 

Alpharetta: 3400-C Old Milton Parkway, Suite 270, Alpharetta, GA 30005
Braselton: 1255 Friendship Road, Suite 130, Braselton, GA 30517
Cumming: 1800 Northside Forsyth Drive, Suite 450, Cumming, GA 30041
East Cobb: 1121 Johnson Ferry Road, Suite 450, Marietta, GA 30068
Johns Creek: 4235 Johns Creek Parkway, Suite A, Suwanee, GA 30024
Sandy Springs: 1150 Hammond Dr., Building E, Suite 310, Atlanta, GA 30328
Sugar Hill: 4700 Nelson Brogdon Blvd., Suite 250, Buford, GA 30518
West Paces: 3200 Downwood Circle NW, Suite 200, Atlanta, GA 30327
Woodstock: 250 Parkbrooke Place, Suite 300, Woodstock, GA 30189

All locations: 770-442-1911