How to cope with coronavirus: a Q&A with Taos physician Lucas Schreiber

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Just last week a man paying his bill in Kit Carson Electric Cooperative joked about the “Dos Equis virus,” but Taoseños quickly are learning that the novel coronavirus (COVID-19) is not a joking matter.

In order to tamp down disinformation and rising concerns, Taos News  asked Dr. Lucas Schreiber of Schreiber Family Practice in Taos for an update on the current research about the virus as well as what we can do to halt its spread.

Have you noticed your patients are more nervous lately because of the coronavirus?

Oh, absolutely. We have a group of patients who are well and are worried about exposure. They want to know whether they should cancel routine visits. And we have a group of patients who are unwell and concerned that they have contracted the virus.

How are you keeping both groups safe?

At this juncture Schreiber Family Medicine and the other practices in town have taken measures to enhance our safety protocols. For example, we’ve removed all magazines from the waiting room. We’re regularly disinfecting all surfaces, doorknobs, sink handles and employee work stations. All my staff are now wearing masks and, as usual, we are washing our hands and using alcohol-based gel hand sanitizers frequently.

We are also taking measures to limit any entry of the coronavirus (or COVID-19) into our practices. We have posted signs on our front door which stratify patients and direct them according to their level of risk.

Who are the high-risk patients?

Our signs advise patients not to enter the building if they are at high risk for COVID-19. There are two categories of high-risk cases and one category of lower risk patients:

If you have a fever, cough or shortness of breath, and you have had close contact with a confirmed COVID-19 patient within 14 days;

If you have a fever and cough or shortness of breath, and you have traveled from an affected geographic area within 14 days.

With either of these scenarios — the high-risk scenarios — people should contact the Department of Health coronavirus hotline: (855) 600-3453.

If for some reason they cannot access that number then they can go to the emergency room, but they should not enter the building or emergency room. Instead, they should call the emergency room or send a healthy person in to registration rather than present themselves to the waiting room to be evaluated.

Basically, we have to limit exposure to other patients and medical personnel.

What happens if you are a high-risk patient?

If you are a high-risk patient, you will be triaged and cared for in an isolated unit with both patient and medical personnel utilizing proper protective equipment.

What is low risk?

The following qualifies as low risk for COVID-19: If you have a fever and cough or shortness of breath but no known high-risk exposures. Those people don’t necessarily need to call the hotline and don’t necessarily need to call the emergency room. They can present themselves to their primary care clinic or urgent care clinic but should not enter the building.

Again, the patients in this category should call ahead or send in a healthy person so they can be managed safely with the proper equipment in place.

At my office, they will be directed to an extension where we can triage them on the phone to see if they are safe to be evaluated here or whether we should direct them to the department of health and ultimately the emergency room for testing.

Does your office and Holy Cross Hospital have testing kits?

At this time COVID-19 test kits are in limited supply. Each medical clinic in Taos has been provided with two kits. The hospital has additional test kits. We anticipate that more will become available shortly. Currently all testing is done through the New Mexico Department of Health, but samples can be collected locally. All tests must be preapproved by the department of health.

What do you say to those who are well and coming for a well patient visit?

That’s a challenging question because, on the one hand, I don’t want to encourage anyone to put themselves in a situation where they might be exposed to a contagious illness. But, on the other hand, there are three considerations: we have a very low prevalence of COVID-19 locally; the duration of this pandemic is unknown; and I do not want patients to neglect their health care maintenance or fail to address other medical issues out of fear of this virus.

So, generally, I am telling my patients that if they would feel more comfortable, their appointments can be canceled or rescheduled to a later date. However, we do not know how long this virus will remain prevalent in the area and it may prove to be perennial – recurring annually like influenza. And we have employed enhanced safety measures in the office. So, I am comfortable with them keeping their appointments at this time.

What does isolation, quarantine and social-distancing mean?

Isolation is what we do with someone who has a confirmed case. We separate patients with contagious diseases from those who are well.

Quarantine entails removing someone who has been exposed or has potentially been exposed to an infectious disease from the general public. In this case, the person would be separated from others and their movement restricted for a period of 14 days while monitoring for signs of illness. They can self-monitor at home, checking if they have a fever one time or two times a day, with fever defined as 100.4 degrees Fahrenheit or above. They also should monitor for the emergence of cough or shortness of breath.

Social-distancing: Right now, there is still much to be learned about this virus. We are learning that it can transmit via respiratory droplets or can be aerosolized 3 to 6 feet. Close contact is defined as being within approximately 6 feet (2 meters) of a person with COVID-19 for a prolonged period of time.

Why is it called novel coronavirus?

It’s called novel because it is new. Up to 20 percent of common colds are caused by some strain of coronavirus. There are many strains of coronavirus that have been around for millennia. This one just emerged in humans in December, hence it is new to us, or novel.

What are the top three precautions you emphasize to your patients to avoid getting COVID-19?

1. Diligent and frequent hand-washing, 20 seconds with soap and warm water or a hand sanitizer that is at least 60 percent alcohol;

2. Avoid touching one’s face, particularly when out in public;

3. Avoid close contact with people who are ill or appear ill.

If you’ve already had the flu, can you still get the COVID-19?

Yes. There is no protection from having had influenza and no protection from having had the influenza vaccine.

If you’ve been exposed, how long until you develop symptoms?

Again, this is a new disease. Our initial data indicated that the incubation period from exposure to the onset of the disease was up to 14 days. We now believe that the majority of people who do get sick will develop symptoms within five days of exposure.

For how long are you contagious?

That is a difficult question to answer and it is still very unclear. We can measure viral shedding, or how long you can detect the virus in respiratory droplets or secretions and even in other bodily fluids, such as stool. In some cases viral shedding has been detected up to 39 days after initial diagnosis, but that doesn’t necessarily translate to contagion lasting that long. We generally feel that once people are asymptomatic they are probably not contagious. But that has not been proven yet.

Will an antiviral medication work against COVID-19?

At this time, there are no approved medications and there are no medications known to be effective.

Who are the elderly and how can the elderly best protect themselves?

In this case the disease seems to be more severe if you are 60 or older. So people in that age group and others at high risk – those with chronic medical conditions, high blood pressure, diabetes, heart disease or immunocompromise – are the most vulnerable.

So in addition to limiting exposure to COVID-19 as much as possible, it is advisable to protect yourself against other preventable illnesses.

Everyone should get an annual influenza vaccine and people 65 and older or those with other risk factors for pneumonia should get the Pneumovax to protect against certain strains of bacterial pneumonia.

For more information regarding COVID-19 in New Mexico:
 
Call the Health Hotline – (855) 600-3453  if you have symptoms, have been in contact with a confirmed case or have returned from out-of-state travel.
 
Call the Social Services Hotline – (833) 551-0518  if you have questions about school closures, meal programs, child care, unemployment, emergency loans, etc.
Find the latest information, precautions, recommendations and contact numbers regarding COVID-19 at the New Mexico Department of Health coronavirus site and the Centers for Disease Control and Prevention.
 
 

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