North Atlanta Primary Care

COVID-19 Update Article

Coronavirus Update #12

Posted on May 08, 2020 by Physicians and Staff at NAPC

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 complaint 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 judgment 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

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