NTPHP COVID-19 Update For Our Patients

NTPHP COVID-19 UPDATE 

Amid the ongoing concerns about COVID-19, we want to reassure you that the health of you, your family and our community remain our top priority.  NTPHP clinics remain open to continue to provide preventive and ongoing care and be an active resource for any questions you have related to the everchanging situation. 

Our goal is to continue to provide you with the most accurate and up to date information.  The physicians of NTPHP urge our patients to rely on trusted, peer reviewed, science-based information rather than personal opinions or anecdotal observations.  As with any new disease, recommendations evolve as science helps us understand this new illness. There are many ongoing clinical trials to help answer some questions we have about therapeutic and vaccine options, and we will provide more information below on those items.  Again, we realize that quarantine fatigue is real, but we are asking you to do your best to prevent the disease by practicing physical distancing, mask wearing, and handwashing.

Helpful information about masks

In the middle of a pandemic, any mask will help slow the spread of COVID-19.  Many mask options exist and process of selecting one can be overwhelming.  Below is the CDC guidance on key things to remember when selecting, wearing, and cleaning your mask.

Selecting your mask:

Do choose masks that:

  • Have two or more layers of washable, breathable fabric. 
  • Completely cover your nose and mouth.
  • Fits snugly against the side of your face and does not have any gaps. 

Do NOT choose masks that:

  • Are made of fabric that makes it hard to breath.
  • Have exhalation valves or vents, which allow virus particles to escape and increases risk to those around you.

Wearing your mask: 

  • Always wear masks in public settings, events, gatherings, and where you are around other people. 
  • Your mask should cover your nose and mouth and sit securely under your chin. 
  • Your mask should be worn consistently for the best protection. 
  • Avoid touching your mask when wearing it. 

Cleaning your mask:

  • All masks should be washed on a regular basis.  This can be done with your regular laundry. 
  • Use regular laundry detergent and the warmest appropriate water setting for the fabric used to make the mask.
  • Use the highest heat setting to dry the mask. 

“How to Select, Wear, and Clean Your Mask.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html.

The hypothesis that wearing a mask has an impact on viral load and disease severity

According to the Centre for Evidence-Based Medicine, viral load is a measure of the number of viral particles that are present in a patient.  It is hypothesized that the severity of COVID-19 could be linked to higher viral loads, implying that the amount of virus that one is exposed to at the start of infection, or the infectious dose, may likely increase the severity of the disease.  Moreover, a perspective article from The New England Journal of Medicine also outlined that “… universal facial masking might help reduce the severity of the disease and ensure that a greater proportion of new infections are asymptomatic”. 

The COVID-19 virus has the protean ability to cause a wide-range of clinical manifestations.  These manifestations can range from complete lack of symptoms to Acute Respiratory Distress Syndrome (ARDS), and death.  There has been recent virologic, epidemiologic, and ecologic data that supported the hypothesized theory that masking may reduce the severity of the disease among those who have become infected.  “This possibility is consistent with a long-standing theory of viral parthenogenesis, which holds that the severity of a disease is proportionate to the viral inoculum received by the infected person”.  While we do not have enough data to confirm the hypothesis that disease severity is linked directly to viral load, we do know that wearing a mask will reduce transmission of the virus.  Which, if complied with, may dictate how sick you get if you contract the virus.  We will continue to keep you apprised of additional research as it becomes available.

Gandhi, Monica, and George W. Rutherford. “Facial Masking for Covid-19 — Potential for ‘Variolation’ as We Await a Vaccine.” New England Journal of Medicine, 2020, doi:10.1056/nejmp2026913.

How should you handle situations where someone might not be wearing a mask?  (Mask etiquette)

There will be situations where you find yourself around those not adhering to the guidelines of wearing a mask.  When that happens, especially as a host or attendee, you will likely ask yourself, “How do I navigate this situation in a way that does not create an awkward moment?”  In such situations where you are the host, you can set expectations early for when and where guests will need to wear masks. Etiquette experts say that “…it is your job to make sure your guests follow the rules during any event”.  They also remind us it is all about your delivery and tone of voice.  For example, if you approach a guest who is not wearing a mask, you could deliver the message in the following way: “I am so glad you were able to come.  I am making sure everyone wears a mask to keep us safe and comfortable.  Can I offer you one of our disposable masks?”  When you find yourself as an attendee or guest, look for expectations from the host on when and where to wear a mask.  It is ok to broach the subject, if the host does not bring up mask-wearing before you arrive.   If you are uncomfortable with the expectations, then it is ok to back out of the invitation and explain that you are staying close to home to socially distance. 

What if you arrive to a gathering and other guests are not complying with the expectations set by the host?  Your next move will depend on how well you know the guests.  If you are well acquainted with those out of compliance, then it is appropriate to address them directly and gently point out their lack of a mask.  For those you are not well acquainted, it is more appropriate to pull the host aside and ask for help handling the situation.  As always, it is appropriate to leave if you feel uncomfortable with the way guests are complying. 

Evidence shows that wearing a mask is extremely important in the fight against COVID-19, and we hope that the guidance provided will help you navigate through future situations.

Field, Anne. The 4 Rules Of Face Mask Etiquette During COVID. 30 Sept. 2020, www.aarp.org/health/healthy-living/info-2020/face-mask-etiquette.html.

Tips for trick or treating and other Halloween activities. 

According to the CDC, there are many activities during Halloween that are high-risk for spreading the virus.  We highly recommend that if you have COVID-19 or have been exposed to someone with COVID-19, you do not participate in in-person Halloween festivities.  Additionally, you should not give out candy to trick-or-treaters, as this interaction may spread the virus.  

We realize these times are difficult, but it does not mean there isn’t a way to enjoy the season.  There are many activities that the CDC has classified as low risk, moderate risk, and high risk.  We have outlined these activities below in hopes you may find them helpful as you begin to think about your weekend activities. 

Low-Risk:

  • Carving or decorating pumpkins with members of your household.
  • Carving or decorating pumpkins with neighbors and friends.  Please ensure that you remain 6 feet away from another and wear a mask.
  • Doing a Halloween scavenger hunt where children are given lists of Halloween-themed things to look for while they walk outdoors from house to house.  Again, ensure that you remain 6 feet apart from those around you and wear a mask. 
  • Have a virtual Halloween costume contest.
  • Have a Halloween movie night with those in your home. 

Moderate-Risk:

  • Participating in a one-way trick-or-treating where individual candy bags are lined up for children to grab as they walk by.  Please make sure that you wash your hands with soap and water before preparing these bags. 
  • Participating in a small group, outdoor, open-air costume parade where people are distanced more than 6 feet apart.  Please do not wear a costume mask over a protective cloth mask because it may be difficult to breathe.  It is best to create a Halloween themed cloth mask. 
  • Visiting pumpkin patches where people use hand sanitizer before touching pumpkins, remain 6 feet apart, and masks are required. 
  • Participating in an outdoor Halloween movie night with local family friends.  It is important to remember that people should be 6 feet apart. 

High-Risk:

It is advised that we refrain from these activities to help reduce the spread of COVID-19. 

  • Participating in traditional trick-or-treating where treats are handed to children who go door to door. 
  • Having trunk-or-treat where treats are handed out from trunks of cars lined up in large parking lots.
  • Attending crowded costumes parties held indoors.
  • Going to an indoor haunted house where people may be crowded together and screaming.
  • Going on hayrides or tractor rides with people who are not in your household. 

Baylor University Medical Center outpatient COVID-19 trials

As you may know, there are numerous clinical trials for patients in an inpatient setting that are diagnosed with COVID-19.  We are happy to let you know that Baylor University Medical Center is offering a few trials in an outpatient setting.  These trials are for patients with early or mild-to-moderate COVID-19. If you are diagnosed with COVID-19, contact your NTPHP physician if you are interested in hearing about the available clinical trials.

Testimonials from the COVID-19 vaccine trial’s – Dr. Alison Sibley

The downtown campus of Baylor Scott and White Hospital is a site for the ongoing Pfizer/BioNTech mRNA COVID vaccine trial. As frontline workers, many of our physicians and staff had the opportunity to volunteer as participants in this vaccine trial. Volunteers received two shots 3 weeks apart and were randomized to either the placebo arm or vaccine arm. Volunteers will be followed for a 2-year period to confirm safety, antibody levels and monitor for COVID-19 illness. The spectrum of side effects in the NTPHP participants included no reaction, mild arm achiness for 1-3 days, mild arm swelling at the injection site, headache, achiness, chills, and fever. We are excited to be a part of this important science that will hopefully help our patients, colleagues, and community benefit from a future FDA approved vaccine.

FLU shot Reminder

NTPHP, along with many other clinics, have seen major delays in receiving flu vaccines this year.  Due to the delay and low inventory, we are encouraging patients to get their flu vaccine at their local pharmacy and provide us with the documentation to update your medical record. 

If you have issues receiving the vaccine from the pharmacy, then we ask that you contact your provider’s office directly to determine the office’s flu vaccine availability.  As a reminder, given the current state of the COVID-19 pandemic and low vaccine inventory, our offices will not be allowing walk-in flu shot appointments and will only be vaccinating patients that are members of the practice. 

How to vote safely during a pandemic

Voting during the middle of a pandemic has raised concerns over how to balance safety and exercising your right as a citizen.  There are many steps you can take to vote and minimize your risk of exposure during the process.  The key factor is preparedness.  The more prepared you are, the less time you will spend onsite casting your vote.  Remember also that you must continue to follow the guidance previously mentioned of wearing a mask properly, staying 6 feet apart from other people, and using hand sanitizer or washing your hands after touching surfaces.  The CDC has provided guidance on the steps you can take to be prepared to vote.

  1. Check that you are registered. 
  2. Check on ways you can vote and what dates those options are available. 
  3. If you are voting in person, then check when and where you can vote.  Remember that your voting location may have changed from the last election due to COVID-19.  Additionally, try and plan to go during a time that may not be so busy, like mid-morning.
  4. Be prepared by completing any registrations forms prior to arriving and look-up sample ballots prior to arriving.  By taking these steps, you will be able to reduce the amount of time spent onsite voting. 
  5. “Tips for Voters to Reduce Spread of COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/going-out/voting-tips.html.

What testing does NTPHP offer?

As previously stated, NTPHP is committed to ensuring you have access to the most up-to-date, accurate, and timely testing options. As appropriate tests become available, we will continue to expand our testing capabilities.  Please see below for a listing of all current COVID-19 related in-house tests.  The COVID-19 PCR test is offered Monday through Friday at all our locations.  The antibody blood test is offered in clinic for those who have recovered or think they have had COVID-19.  Please contact your provider for specific times, if a test is needed. 

BioFire Respiratory Pathogen Panel

NTPHP has invested in additional testing capabilities to ensure that our patients have access to testing that they need.  Our company has implemented the use of the BioFire Respiratory panel.  This test is a nasopharyngeal swab and can detect up to 18 different viral respiratory pathogens and 4 bacterial pathogens, which we have listed below.  Our company has adopted 4 machines which allows us to run up to 40 tests per day.  The current turnaround time on results for this test are same day to next day, depending on daily company volume.  Additionally, the overall sensitivity for this test is 97.1% and the specificity of the test is 99.3% making this an extremely reliable test. 

Virus Detection:

  • Adenovirus
  • Coronavirus HKU1
  • Coronavirus NL63
  • Coronavirus 229E
  • Coronavirus OC43
  • Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
  • Human Metapneumovirus
  • Human Rhinovirus/Enterovirus
  • Influenza A
  • Influenza A/H1
  • Influenza A/H3
  • Influenza A/H1-2009
  • Influenza B
  • Parainfluenza Virus 1
  • Parainfluenza Virus 2
  • Parainfluenza Virus 3
  • Parainfluenza Virus 4
  • Respiratory Syncytial Virus

Bacteria Detection:

  • Bordetella parapertussis
  • Bordetella pertussis
  • Chlamydia pneumoniae
  • Mycoplasma pneumoniae

ID Now Rapid PCR COVID-19 testing:

The ID Now COVID-19 test is a rapid, molecular, point of care test that detects COVID-19.  This test is run in the clinic on our ID Now platforms, which are the same platforms we have always used to run our strep and flu test and comes back the same day.  Additionally, this test is performed by collecting a specimen through a nasopharyngeal swab, nasal swab, or throat swab.  The specimen collection technique will be determined by your provider. 

Antibody testing:

IgG Antibody Testing -- NTPHP offers in-house IgG antibody testing.  These antibodies are released into the blood stream later in the immune response and are considered memory immunoglobulins that may help defend your body against future viruses.  These antibodies typically appear after 7 to 14 days of infection.  The protective effect of antibodies associated with COVID-19 are still unknown.  There are still many studies in process that are tracking how long the COVID-19 antibodies remain in one’s system and how protective they are. 

IgM -- These are immunoglobulins that include the primary antibodies that are released into the bloodstream early in the immune response.  These immunoglobulins typically show up 3 to 7 days after exposure to the virus but eventually disappear.   

In addition to the testing above, we now have the capability to run a combined Influenza and COVID-19 rapid antigen test in the office for patients suspected of having influenza A, B or COVID. 

We know this is a difficult time for everyone.  As always, our team is here for you, and if you need any assistance at all, please do not hesitate to call our office.