Volume 1| April 19, 2020
Your Weekly COVID-19 Updates
Paradise Valley Medical Clinic, Douglas M Lakin MD
9977 N 90th Street, Suite 180, Scottsdale, AZ 85258
480.614.5800 (ph), 480.614.6322 (Fax)
PLEASE READ THIS ENTIRE DOCUMENT AS IT IS OF
IMPORTANCE TO ALL PATIENTS

"We will be emailing you weekly during the COVID-19 PANDEMIC. We will provide you with the latest information and instructions to deal with the current outbreak as it develops in Phoenix."
A MESSAGE FROM THE DOC

……. WHAT'S NEXT? …
COVID levels remain very low in Scottsdale as witnessed by the few patients in the local hospitals with disease and the lack of positives in the office (none for the past three weeks). We have been successful in avoiding a level of infection that overwhelms the local health system, so now we can begin a process of normalizing our activities, but it needs to begin in a graded and progressive manner. Social interactions with more people in your circle should begin. Although this will slightly increase the number of COVID cases, it is the logical next step in our movement forward out of restrictions.

How to proceed for low and medium risk patients:
1.       Continue to maintain social distancing when in public spaces or with groups of
friends/family.
2.       Wear a mask or face cover in closed spaces. In open are spaces, masks are not
necessary if space is maintained.  This is done more to protect the community that
it is to protect ourselves.  When you wear your mask, you reduce the possibility that
you will spread COVID unknowingly.  When the people in your immediate community
wear their mask, they are preventing the spread from them, to you.  Encourage
others to wear a mask for all our protection.
3.       Wear gloves regularly when in the public or do repeated hand cleansing and
washing…. or do all the above.  This is critical to prevent silent spreading of COVID.
4.       If you have symptoms of any sort that might concern you for COVID…. get tested so
that you know your status.
5.       When blood testing for immunity/exposure is available in the next months, get tested
if you feel it is possible that you had COVID silently or minimally over the past few
months.  Patients who should be first to get such testing are those with serious ‘viral
like’ illnesses over the past 4 months who never had a specific diagnosis made or
those who travelled to know ‘hot spots’ in the past 4 months.
6.       If you are doing all the above and are not in a high-risk group (see below) then you
can expand the amount of activities and outings you participate in over the coming
weeks.   High risk patients should continue to limit activities to a great extent.

High risk groups include :
·          Age 75 or over
·          Obesity (BMI 40 or above)
·          Lung disease (emphysema/COPD) or current significant smokers
·          Chronic kidney disease (Stage 4 disease or greater)
·          Diabetes…. not well controlled
·          Congestive Heart Failure
·          On immune suppressing medications for cancer or
rheumatologic/inflammatory conditions

Medium Risk groups may want to be more cautious but can increase activities. These include:
·          Men Age 55 to 75
·          Hypertension
·          Diabetes…well controlled
·          Asthma
·          Obesity (BMI 35 or above)
 
Know that our office is responding to COVID, and we are here to help. 
Reach out for assistance if you are not feeling well. We will develop a plan of action for you to move forward.
 
Yours in good health!
Dr. Lakin
 
PS…. Hot weather will not, in itself, reduce COVID risk.  It is likely that COVID will reduce on a seasonal basis to a degree, but with the heat developing, do not forgo the above preventive measures.  Use the warm weather to your advantage by being out of doors with others to reduce risks but to allow limited social interactions.
 
Celine Dion, Andrea Bocelli,
Lady Gaga, Lang Lang, John Legend beautifully perform "The Prayer"
Enjoy a moment of Zen!
How to Sew a Surgical Face Mask for Hospitals


According to the CDC, fabric masks are a crisis response option when other supplies have been exhausted. The DIY pattern in this post will teach you to make a standard pleated face mask with elastic ear loops. This pattern has 2 layers of fabric, and an internal pocket in which you can add additional layers of disposable filtration material if desired. If you can’t find or don’t want to use elastic, there are also ideas for using fabric ties instead.
Contact your local hospital and clinic to ensure that they are accepting masks, and that any masks you make will meet their individual guidelines.
Follow Five Steps to Wash Your Hands the Right Way
Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.
Follow these five steps every time.
  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

ATTN PATIENTS:
Dr Lakin is using FaceTime ,
WhatsApp and Zoom to connect with you
for a 'Telehealth' visit. You can connect using your iPad, iPhone, android phone, a laptop, or a PC with a camera.

**Please watch this video so you can be prepared and know how to connect with Dr Lakin for a Zoom 'Telehealth' visit.


PLEASE READ THIS ENTIRE
DOCUMENT AS IT IS OF
IMPORTANCE TO ALL PATIENTS!
COVID-19 SUMMARY:


WE ARE HERE FOR YOU DURING COVID-19!

We are available for you during the COVID pandemic.  We are ready to serve.
 
We are expanding office hours for patient visits as COVID levels are low .  In addition, we are connecting with you via phone, fax, email, and telemedicine. We are handling your medical needs.
 
**CURRENT OFFICE SCHEDULE
IS EXPANDING
 
DOORS OPEN     
8AM - 4PM Monday through Thursday
8AM-11AM Fridays
 
IN OFFICE APPOINTMENTS: MONDAY-FRIDAY
8AM---10:30AM & 1PM-3:00PM
 
MONDAY-FRIDAY from 10:30AM---12 Noon
We will be doing TELEHEALTH/PHONE visits with patients.
 
MONDAY-THURSDAY
WE WILL BE SEEING POSSIBLE COVID PATIENTS 3:00PM-4:00PM (AT YOUR CAR…APPOINTMENT ONLY….IN PROTECTIVE GEAR)
 
 
REDUCE RISK BY REDUCING
CONTACT WITH THE VIRUS
 
REDUCE CONTACT WITH THE VIRUS BY:
1.       Washing hands frequently….20 seconds is advised, but any handwashing is helpful.
2.       Wear a mask of face covering when out in public.
3.       Use hand cleanser in between washings…if available.
4.       Clean your cell phone daily with a cleansing wipe or UV light.
5.       Shower or bathe daily.  Twice daily if you want to feel more relaxed.
6.       Don’t Pick Nose, Rub Eyes, or Pick Teeth with your fingers
7.       Do not go out or to work if you are ill…. or think you are ill.  If you are unsure, check your temperature. If over 99.8 you should not be going out.
8.       If someone in your house is ill, treat them as though they have COVID.  Have them get tested and you should not quarantine as well.
9.       Stay away from people who are sick with COVID. Only caregivers should be in contact with COVID patients and they practice high level cleaning to prevent spread.
10.   Maintain social distancing practices, avoid getting within 6 feet of people (other than immediate household occupants)
11.   Limit your activities to the minimum interactions you can do to maintain your daily living.
12.   Leave mail and other paper products for one two days on the shelf or in the garage (outside the house) …then bring them in after sitting for 24-48 hours to reduce the potential for transmission
13.   Groceries should be prepared as per the video link below, with attention to cleansing, before putting them in cupboards and the refrigerator/freezer.  See this video link for excellent detailed information:   Click Here
 
IF YOU ARE SYMPTOMATIC AND HAVE BEEN TOLD YOU MAY HAVE COVID ……BUT TESTING HAS NOT BEEN DONE YET …….DO AS FOLLOWS:
 
·          Self-Quarantine for 14 days from the start of illness and FOR at least 3 days after fever and major symptoms have resolved. 
·          Do not share a bathroom with housemates if possible. Use your own bathroom.
·          Do not share utensils with others and clean your own utensils and/ or use paper/disposable eating materials.
·          Wait 1 day to wash the clothing you wear. Clothing can be washed after sitting out for 24 hours (virus is not transmissible at that point via clothing).   Others can wash your clothes using this approach.
·          Avoid sharing living spaces with housemates, to the extent your living situations allows
·          Wash your hands frequently.
·          Wear a mask & gloves when in the presence of others. Wear when you are with others as much as possible.
·          Shower/bathe twice daily if possible.
·          All household contacts should self-quarantine as well with only minimal outside interaction.

 
MORE EXPANSIVE TESTING IS CURRENTLY AVAILABLE IN OUR OFFICE. Results within 24 hours generally.
 
It is being done at the end of the day, in your car, by myself…. wearing protective gear. We are focusing on at risk individuals with mild symptoms or patients with more significant symptoms.  We are not screening asymptomatic patients unless they have had COVID exposure.
 
Symptoms for testing:
·          Fever (100.4 or above) and cough (without other explanation)
·          Fever (100.4 or above) and sore throat (without other explanation)
·          Fever (100.4 or above) and chest pains (without other explanation)
·          Milder fever and symptoms with recent travel from NYC or SF/Seattle.
 
We have done 60 tests and have now had 7 positives (no new positives in 3 weeks).    All are patients doing well (one needed IV fluids & resolved his infection.) 
Testing is returning more quickly, and more testing is available
Positive & Negative test results are now reporting back in 24 hours
 
Do remember that asymptomatic people are shedding the virus, so you must be vigilant and protective around all people you are exposed to.
 
 
IF YOUR ARE ILL AND CONCERNED YOU MAY HAVE COVID INFECTION:
Contact the office via phone or email first for instructions:
480-614-5800
 
Please do not walk into our office if you think you have COVID infection . We will not see you in the office. Only in your car, and with that, you should contact the office to be seen end of day.
If you think you have COVID and are truly short of breath, you need to go to the Emergency Room, not to our office. We are not equipped to handle low oxygen levels.
 
WHAT IS OUR CURRENT EXPECTATION FOR THE COURSE OF COVID?
 
At this point in time the are many uncertainties about the course of COVID in the US and in Arizona, but I can provide some educated speculation:
 
1.       The virus has flattened in APRIL IN ARIZONA and then will pick up slightly into May and June…. then wane in the summer. It is likely (although not certain) to show a seasonal trend like the flu…. not disappearing, but becoming much less common, in the summer months.
 
2.       In September and into the fall and winter we are likely to see a recurrence of infection broadly in the state, country, and world. More limited restrictions will become necessary at that time.
 
3.       Using increased testing (swabs and bloodwork) we will be able to more finely tune plans for social distancing in different locations based on results of the presence of infection and its frequency in particular areas. This will allow for waxing and waning restrictions in local areas based on data from testing and mathematical projections.
 
4.       Nature is immunizing us more generally, and when we have bloodwork to confirm previous infection, we will find a great number of asymptomatic individuals having been infected and this will provide ‘herd immunity’ which will be very helpful as time goes on.
 
5.       Antiviral medications will be found through clinical studies and we are likely to see effective treatments made available within 6 months. Resdemivir (Gilead Pharmaceuticals) has already demonstrated some effectiveness in highly ill patients and it is anticipated it will be effective in more mildly symptomatic patients. Additional studies are demonstrating more effectiveness. Production is being ramped up and it will become more generally available.  Additional competing compounds are under development as well
 
6.       Immunizations will be developed, but will take 12-18 months to come ‘online’
 
 
C ARING FOR YOURSELF IF YOU THINK YOU MAY HAVE COVID OR IF YOU HAVE BEEN DIAGNOSED WITH COVID:
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
 
Common/Hallmark symptoms:
·          High fever (over 100.4, but can range from 99’s to 104+)
·          Fatigue
·          Cough
 
Other symptoms can include milder issues:
·          Loss of Smell
·          Nausea without Vomiting
·          Sore Throat
·          Aching muscles throughout the body
·          Headache
·          Occasionally diarrhea …
·          Nasal congestion (occasional)
 
TREATMENT:
Symptomatic treatment for the most bothersome symptoms
 
Aches and Pains and Fever:
·          Tylenol 650 1000mg four times per day is preferred for treating these symptoms, but if not working well, you may use:
·           Advil (Ibuprofen 200mg), 2 3 tablets….2 3 x per day or Aleve (naproxen 220mg), 1 2 tablets...1 2 x per day,
·          Drink good amounts of clear liquids (anything you can see through)
 
Sore Throat:
·          Saltwater gargling
1.    Dissolve 1 teaspoon of salt in a glass of warm water.
2.    Gargle for 15 seconds and spit.
3.    Repeat during the day every 2 4 hours to relieve pain.
·          Pain relief medications: Advil (Ibuprofen 200mg), 2 3 tablets….2 3 x per day or Aleve (naproxen 220mg), 1 2 tablets...1 2 x per day, or Tylenol 650 1000mg four times per day.
 
 
Cough:
·          Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
·          Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
·          You may require a prescription cough syrup with Codeine.  Contact me if that is the case.
 
 
Sinus Congestion and Drainage (RARE SYMPTOM):
·          Use a decongestant such as Sudafed 30mg, 1 2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
·          Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
 
 
Nausea Treatment:
This is the most difficult issue to treat at home as there is very little one can do to settle the stomach. Coca-Cola with the carbonation eliminated (Flat Coke), Ginger Ale, or Ginger Root…. can be tried, but these are often inadequate, and the key to getting the stomach to settle is getting a good nausea medication.
 
If nausea is persistent, then calling for a prescription medication is often a good idea. Phenergan (Promethazine), Compazine (prochlorperazine), Zofran (Ondansetron) are very effective in treatment.  Sometimes we use them in combination either as a pill or a suppository.
 
The KEYS are:
1.     Settling the Stomach…so that liquids can be taken
2.     Focusing on Liquids…so that dehydration does not set in
3.     Eating light foods… if possible (to provide energy for healing). This is not a requirement for healing from an acute GI illness; so, don’t feel that the sick person needs to eat food. The only requirement is liquid intake!
 
When to Seek Medical Assistance
•         There is no medication to treat this virus, so the resolution takes time.
Worsening symptoms/Signs of Complications:
•         If you are getting significantly short of breath please be in touch.  If progressive and worsening, you need to be seen and possibly hospitalized.  Best to go the ER if shortness of breath is a significant symptom
 
How Long to Recover
•         The COVID is a viral infection that will generally take from 3–7 days to develop, 3-7 days to improve and then from 3-7 days to completely resolve.
 
IF YOUR ARE ILL AND CONCERNED YOU MAY HAVE COVID INFECTION:
Contact the office via phone or email 
480-614-5800
douglakin@doctordoug.com
 
 
We will contact you and review a plan of action for you.
•         Since most people will have mild symptoms (80+% will do well with cold symptoms only), very little will be done other than routine measures to treat a cold.
•         If you need to be seen we will consider a video visit vs. seeing you at designated times for such visits.

Stay Healthy & Safe!