I wanted to provide you with another update so you would know what is going on. I’ve been on multiple doctor only information sites as well as following the CDC and WHO sites and some of the local news. As this situation is changing, some details may have changed when you are able to read these updates.
- Please know that I am here for you and you can text me any questions as they come up. I’ll tell you honestly if I don’t know the answer or if there isn’t an answer yet.
- Social distancing is our best resource to fighting this pandemic as it now stands. That means not attending large events such as meetings, concerts, any gathering of more than 100 people (different sources have different sizes of limitations). If you are near other people, try to stay within 6 feet, as spread of the virus can occur as air droplets and on contact.
- Handwashing remains important as well as all the other usual activities you would employee if you were contagious with a cold or otherwise ill.
- If you are working from home and/or are self-isolating, be gentle with yourself. Take frequent breaks from the internet, social media, and all news. There’s very little that would change what you need to do. Even a day without all the overabundance of information would be just fine. Talk walks instead, get outside if you can, spend time with people that you trust will tell you if they feel sick, read a book, play a game, relax, and take plenty of naps.
- There is no evidence that there is spread of COVID-19 from animals to humans and vice versa, so love on your pets. Especially if they are a source of comfort to help your anxiety.
Now for the technical information:
- Testing: Priority Care will not be testing for COVID-19 due to the dedicated testing sites that will be popping up around the state and the inability to order PPE (personal protective equipment). There is a shortage of PPE nationwide which is another reason why centralized testing centers are critical and being utilized.
- Yesterday the state of NC only tested ~86 people due to the lack of supplies and testing equipment. We are going to see an increase in testing next week as a decrease in some regulations has allowed us to order tests. Do not panic when you see the numbers go up! It is expected that there a lot of people who are positive for COVID-19 and aren’t aware of it. You are safer just treating any symptoms from home than exposing yourself to potential carriers by going somewhere to get tested (although I know the desire to know is huge). The only benefit to knowing is so we can detect how widespread this is, although it’s pretty much assumed that it’s widespread at this point.
Here’s where we stand in NC and is the situation in a lot of other states as well:
As of March 14 at 8:00 a.m., the state of North Carolina has a total of 680 public (i.e., non-commercial) coronavirus test kits.
So the big question is, “Why don’t we have more tests?”
Here’s the situation:
First, there’s a difference between “test kits” and “extraction kits.”
Extraction kits = extract RNA (genetic material) from nasal swabs.
Test kits = test RNA to see if it’s coronavirus.
We started with a national shortage of test kits. That happened because the CDC – after rejecting the WHO kits and deciding to make their own – had a manufacturing error that allowed their test kit to produce false positives. So they had to start over several weeks in.
To make matters worse, while the CDC was fixing their manufacturing error there were many other labs across the country (academic and commercial labs) that wanted to produce their own test kits. But they needed federal approval to move forward, and getting that approval took a couple weeks – a serious amount of time, given the prospect of exponential viral spread.
It appears we are now seeing the production of test kits ramp up from both the CDC and commercial labs like LabCorp (which happens to be headquartered here in North Carolina).
BUT that leads us to our second problem, and the current major bottleneck: extraction kits.
Before you can test the RNA sample from the nasal swab, you have to extract it. Doing so requires a specific chemical. The majority of this specific chemical (called a reagent) is produced by one company with production facilities in Germany and Spain.
And now that specific chemical is in very high demand. The whole world wants it.
A few weeks ago, the FDA started allowing independent labs to develop alternate chemical processes for RNA extraction. It’s unclear how much progress has been made.
So, looking now at the big picture, we basically have a two-track testing system: public testing, which involves our main state lab in NC using the re-manufactured CDC test kits (and in NC, we currently have 680 test kits) and then there’s commercial testing.
Regarding commercial testing, we really don’t know how much is happening. The commercial labs aren’t required to disclose test results unless they’re positive. In North Carolina, we have LabCorp conducting commercial tests. In Charlotte, we also have our two major hospital systems – Atrium and Novant – now saying that they are going to provide “screening.” It’s unclear whether they are simply collecting swabs and sending them to LabCorp (where they may face the same extraction kit bottleneck) or whether they’ve developed in-house capacity to actually produce their own test results.
But it’s important to note that BOTH public and commercial testing appear to be hitting a bottleneck when it comes to extraction.
As a result, we are not screening nearly enough people.
Ideally, anyone who displays flu-like symptoms would be eligible for a public test, free of charge. That’s how we would address this like South Korea and provide for wide-scale testing on the order of tens of thousands per day.
But – due to the shortage – that’s not the case. Instead, the CDC guidelines (which NC is currently following) currently state that you have to 1) display flu-like symptoms AND have had direct contact with a confirmed COVID-19 case OR, 2) you have to display flu-like symptoms AND lower respiratory symptoms (cough, shortness of breath) AND a negative rapid flu test.
A simpler way to say that is we are currently rationing public tests because we don’t have enough capacity.
Congress is now providing more funding specifically for these issues and commercial labs are reportedly innovating rapidly, but this is essentially a race against time and increasing our testing capacity within the next ten days is absolutely critical. It’s also possible that the window of opportunity for containment – at least in some regions – is now closed and we’re going to have to rely heavily on social distancing to slow the rate of infection.
Another piece that I’m unclear on at the moment is the cost of testing. Labcorp has made public that they will only charge $51 for the test regardless of which type of insurance one has or if you are self-pay. Quest is saying around $199. But, because you have to rule out other causes of infections such as the flu first, that could range from fully covered to over $300. And I’m not sure if the for-profit hospital systems and doctors’ offices will charge a fee for the test/visit. In other states that have already set up drive-by tents for testing, people are driving long distances to get to them, and then waiting several hours, and some are turned away once they run out of tests. This is another reason that I don’t want you to think your goal should be to get tested unless it’s absolutely critical.
So now, you hopefully understand why staying at home and social-isolation is key right now. Hopefully, you’ve already battled the lines at the grocery store and stocked up on 2 weeks or so of supplies, over the counter medications, and essentials.
Here are some tips from my doctor resources and my own for if you start getting a sore throat, congestion, cough, etc. And with the weather change-this is very common this time of year.
- Vitamin C 250-500mg every 1-2 hours, stop at the onset of heartburn or stomach ache. I like to get my vitamin C from oranges. They last quite a while and are very tasty-just sticky, but that encourages hand washing, so it’s all good.
- Green tea 2-3 times a day. I think only one of you has actually taken up my offer of green tea when you’ve come for an appointment, so you are probably like me and don’t care for the taste of it much. However, it could help.
- Zinc 20-30mg twice a day for the next couple of weeks. Some food sources of zinc are shellfish like oysters, crab, and shrimp. Chickpeas (in hummus!), lentils, and beans, along with nuts like peanuts, almonds, and cashews. Eggs, red meat, and potatoes are good sources. And my personal favorite- dark chocolate.
- Elderberry extract 1 tablespoon 2-3 times a day for a few days
- Neti-pot (or similar device) for decongestion. I personally can’t use one because of a deviated septum, but it’s amazing how helpful it can be for some.
- Herbal cold remedy steam: 2 bags of chamomile tea with 1 tablespoon of thyme, 1-2 teaspoons of garlic and a few drops of peppermint or eucalyptus oil. Bring solution to a boil, then allow to steep for 1-2 minutes. Inhale stream.
- For sore throats: teaspoon of salt dissolved in warm water 4 times a day (this one is personally tested and true for me) A thick gargle made with honey or a mixture of honey and apple cider vinegar (well known to help) Or, you could steep 1 tablespoon of raspberry leaves or lemon juice in 2 cups of hot water and mix in 1 teaspoon of honey. Let the mixture cool to room temperature before gargling. This recipe and others I’ve mentioned may help with anxiety as you’ll be busy figuring out all these steps and ingredients and it’ll take your mind off things J
Finally, should you decide that you want to know where there is testing available; here are the sites that I know of as of today. Atrium hasn’t announced any sites that I’m aware of possibly due to issue of getting the extraction agent (confirmed from an admin) and lack of PPE equipment. Novant has a couple of sites which I’ll list here that will open next Monday and Wednesday. It is unclear how many tests they have. I haven’t seen anything about CaroMont in Gastonia. Tryon Medical Partners have some kits, but the number is limited and likely will need to be in the parking lot of one of their offices. Definitely CALL AHEAD before going to any of these sites, any Urgent Care facilities, or Minute Clinics in Walgreens, CVS, etc. parking lots. Many places will run out of tests early or turn you away for lack of meeting the criteria for testing. Since these are all private facilities, the requirements for testing will be varied and the adequacy of types of testing remains to be seen. Call me if you have any concerns before heading to one of these places.
- Novant Health coronavirus screening centers: 3330 Siskey Parkway in Matthews, open Monday through Friday 8am-5pm. 16525 Holly Crest Lane, Suite 120 in Huntersville, open M-F 8am-5pm. They also have 2 other sites, one in Winston Salem at 600 Highland Oaks and one in Kernersville 111 Gateway Center Dr. The hotline to call is #1-877-499-1697.
- For the North Carolina Department of Health and Humans Services (NCDHHS) you can go their website at ncdhhs.gov for information. The call # for Mecklenburg County is 704-336-4700. Address is 249 Billingsly Rd, Charlotte, NC 28211.
- The Center for Disease Control has some links and information about testing at cdc.gov
Again, call ahead and know that different centers will have different criteria for testing along with limited resources and you could be turned away. Visiting a screening center will potentially further one’s risk of exposure and put a strain on resources for those who need it most.
That’s it for now. Take care of yourselves and each other. I’m here if needed.