NTPHP COVID-19 UPDATE
Throughout this pandemic, the health of our patients and their families remains the center of all decisions NTPHP makes as a group. As case counts have begun to trend downward over the last several days, continued isolation and vigilance is important, especially for our high-risk patients.
Additionally, we recognize that there are numerous myths and opinions circulating that may cause confusion. Our goal is to continue to provide you with the most accurate and up to date information. We are aware of numerous videos circulating on the internet from doctors claiming to have a cure for COVID-19. The physicians of NTPHP urge our patients to rely on trusted, peer reviewed, science-based information rather than personal opinions or anecdotal observations. There are many ongoing clinical trials to help answer some questions we have about therapeutic and vaccine options, and we will provide more information as it becomes available. Again, we are asking you to do your best to prevent the disease by practicing physical distancing, mask wearing, and handwashing.
North Texas Medical Society Coalition COVID Testing, Isolation, and Quarantine Q&A
Q: Does an individual need to get tested if he or she has COVID-19 symptoms?
A: Persons with symptoms of potential COVID-19 infection, including the below listed symptoms, should consider getting tested to confirm COVID-19. Always talk with your physician about the necessity and best method for obtaining a test:
Fever, cough, shortness of breath, chills, muscle pain, new loss of taste and smell, vomiting or diarrhea, and/or sore throat
Anyone over 65
Anyone with chronic health issues (diabetes, asthma, heart issues, etc.);
First responders or essential workers; and
Persons without symptoms who have been actively engaged in large group settings, such as public gatherings or congregations of people, within the past 15 days.
Q: Does an individual need to get tested if they were exposed to someone who is COVID-19 positive but are not showing any symptoms themselves?
A: Probably not. Persons who have been exposed to someone with confirmed COVID-19 but who are not symptomatic do not need to obtain a test unless it is required by an employer, school, or other third party. In all cases the person who was exposed should quarantine themselves for 14 days to ensure they do not develop symptoms. Even if the person obtains a test and it comes back as negative, it is important to complete the 14 days of quarantine since test may give false negatives if the virus has not fully developed in infected individuals.
Q: What is the difference between isolation and quarantine?
A: Individuals who are confirmed positive for COVID-19 but who are not sick enough to require admission to a hospital should isolate themselves to one room in their home and avoid all interaction with family members and pets. Individuals who have been exposed to someone who has COVID-19 but do not know if they contracted the virus should quarantine themselves inside their house for 14 days to ensure they do not develop symptoms.
Q: If someone has COVID-19 and has symptoms, at what point can the individual stop isolating themselves?
A: The individual should remain in isolation until 24 hours after a fever has subsided, respiratory symptoms have improved, and it has been at least 10 days after the first on-set of symptoms. Some employers may require two negative COVID-19 nasal swab tests done at least 24 hours apart before allowing isolated individuals to return to the workplace.
Q: If an individual tests positive for COVID-19, but does not have any symptoms, how long should he or she isolate themselves?
A: Anyone who is confirmed COVID-19 positive without symptoms should isolate for 10 days.
Q: If someone has contact with an individual who tests positive for COVID-19, do they need to quarantine themselves? If so, for how long?
A: Anyone who has been exposed to, or in close contact with, an individual who tests positive for COVID-19 needs to quarantine for 14 days, as it may take that long for symptoms to develop.
Q: What does being in “close contact” mean?
A: Close contact means:
Being within six feet of someone who has COVID-19 for 15 minutes or longer;
Taking care of someone who has COVID-19;
Having physical contact with someone who has the virus;
Sharing eating or drinking utensils with someone who has COVID-19; and
Being sneezed on or coughed on by someone who has the virus.
Q: Where can I get tested?
A: Individuals who need COVID-19 testing should contact their physicians for recommendations. If further resources are needed, they should check Txcovidtest.org to see what options are available.
Popular Myths Debunked
The use of Hydroxychloroquine, Chloroquine and Z-pack to prevent or treat COVID-19
As you may recall from one of our previous messages, the use of hydroxychloroquine or a z-pack seemed to have shown promise in treatment of those with COVID-19. Unfortunately, at this time, those medications are still only recommended to be used for those patients who are part of a clinical trial. Additionally, since that communication was distributed, there have been numerous studies that give a great deal of insight into the use of these drugs as a prevention and treatment option. The American College of Physicians updated their practice points by reviewing the findings from 6 new studies that all point to the same conclusion. That conclusion being that Hydroxychloroquine or Chloroquine alone, or in combination with azithromycin, should not be used as a prevention or treatment measure. As always, our physicians are reviewing the treatment data to remain up to date on the latest evidence-based treatment guidelines.
Source: Qaseem, A., Yost, J., Etxeandia-Ikobaltzeta, I., Miller, M. C., Abraham, G. M., Obley, A. J., Forciea, M. A., Jokela, J. A., & Humphrey, L. L. (2020). Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians (Version 1). Annals of internal medicine, 173(2), 137–142. https://doi.org/10.7326/M20-1998
Does Blood Type Impact COVID-19?
According to a recent study conducted by Harvard Medical School, and published in the Annals of Hematology, they found no correlation to blood type and a severe worsening of symptoms in people who have tested positive for COVID-19. The study included 1,289 patients, spanning across six different facilities, where they were tracked to determine if severity of illness can be attributed to blood type. The results of the study found that there was no association between blood type and any other peak inflammatory markers (WBC, LDH, ESR, CRP). This popular myth is false due to lack of evidence that definitively links blood type and an increased risk or severity of the virus.
Source: Latz, C. A., DeCarlo, C., Boitano, L., Png, C., Patell, R., Conrad, M. F., Eagleton, M., & Dua, A. (2020). Blood type and outcomes in patients with COVID-19. Annals of hematology, 1–6. Advance online publication. https://doi.org/10.1007/s00277-020-04169-1
Use of Zinc to Prevent and Treat COVID-19
As COVID-19 has progressed, there have been several theories that link the use of zinc to the prevention and treatment of COVID-19. Though zinc does possess several antiviral effects, there is no adequate data that supports the use of zinc to prevent and/or treat COVID-19.
Source: Kumar, A., Kubota, Y., Chernov, M., & Kasuya, H. (2020). Potential role of zinc supplementation in prophylaxis and treatment of COVID-19. Medical hypotheses, 144, 109848. Advance online publication. https://doi.org/10.1016/j.mehy.2020.109848
NTPHP COVID-19 Testing Information
NTPHP is committed to ensuring that our patients have access to the most up-to-date, accurate, and timely testing options. Additionally, we are reviewing testing options that may add value to our practice, and we will update you as those tests are adopted. Outlined below are tests that we currently have adopted and have available for use today.
BioFire PCR Testing (In-House Test)
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.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Parainfluenza Virus 1
Parainfluenza Virus 2
Parainfluenza Virus 3
Parainfluenza Virus 4
Respiratory Syncytial Virus
Outsourced COVID-19 Testing
We currently offer three COVID-19 testing options that are outsourced to different companies. GenetWorx, CPL and LabCorp testing detects the presence of SAR-COV-2, the virus responsible for COVID-19. All tests use a nasopharyngeal swab that is sent overnight to the designated testing facilities for processing. We typically see a turnaround from all three companies in 3-5 days. The turnaround times are dependent upon volume being sent to those companies. This test is billed directly by the lab company.
IgG Antibody Testing (In-House Test)
NTPHP now 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.
CDC Guidelines on Isolation and Retesting – As of 08/01/2020
On July 23, 2020, the CDC released updated information pertaining to the isolation period and the need to retest prior to reentering society. Most individuals that have tested positive for COVID-19 can discontinue isolation 10 days after symptom onset, as long as they have improvement of symptoms and have not had fever for the last 24 hours without the use of fever reducing medication.
For those individuals who never develop symptoms, isolation precautions can be discontinued 10 days following the first positive RT-PCR test. Patients with a severe course of COVID-19 and those with underlying conditions including immunosuppression may require isolation for 20 days.
We do recognize that there have been recent articles, and opinions, about the role of PCR testing to discontinue isolation. The CDC guidelines state that “… a test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur under the strategy.…” outlined above.
The physicians of NTPHP recommend that all patients receive a flu vaccine. Stay tuned for more information about NTPHP flu vaccine administration. If you do receive a flu vaccine somewhere else, please let us know so we can update your chart.
As you know, there is a lot of information floating around through various media outlets. We want to ensure that you are reading the most accurate and up-to-date information, so we have listed below a few trusted resources.
Centers for Disease Control and Prevention
Dallas County Medical Society
North Texas Medical Society Coalition
Texas Department of Health and Human Services
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.