Coronavirus (COVID-19) Pandemic

You can find our guidance on testing, masks, how to create a Circle of Safety to reduce your risk of infection at home, general precautions, symptoms, what to do if you are symptomatic and risk factors below. You can also sign up for our periodic newsletter here.

 

If you are interested in learning more about our new COVID-19 offerings to support corporations and individuals during this challenging time, please let us know here. We are here to help.

TESTING FOR COVID-19

RT-PCR AND ANTIBODY TESTS AND WHAT THEY CAN TELL YOU ABOUT YOUR COVID-19 STATUS

APRIL 22, 2020

Testing for COVID-19 has become a critical issue in the social and economic management of and recovery from this global pandemic. Testing is essential for protecting individuals, guiding them in how and when it is safe to engage with others and identifying when new infections are present even in the absence of symptoms so that action can be taken to reduce further transmission. Testing will help businesses determine how to protect their employees, vendors, and customers, how to strategically implement their plans to reopen their warehouses, stores, and manufacturing plants, and how to safely restart their services. 


For testing to effectively facilitate global recovery, it is imperative that tests are accurate and accessible, and that laboratories have the capacity and supplies necessary to perform mass testing over a long period of time. As test results represent only a “point in time” view, a periodic testing strategy should be considered to provide ongoing visibility on infection status.


The information presented here offers an overview of the types of COVID-19 tests available today, their sensitivities and specificities, the timeline of COVID-19 infection and how it relates to testing strategy, and the Private Health approach for COVID-19 testing in this challenging and rapidly evolving environment.

Types of COVID-19 Tests

There are two main methods of testing for COVID-19 infection:

1) RT-PCR (Reverse Transcriptase Polymerase Chain Reaction): Enables direct detection of viral RNA. A positive RT-PCR test indicates that the tested individual is currently infected and that the infection can be transmitted to others.

2) Antibody (Serological) Measurement: Enables detection of specific antibodies, called IgM and IgG, that the body produces in response to pathogens. When testing for COVID-19 infection, a positive antibody test indicates that an individual has mounted an immune response to a prior COVID-19 infection; the test does NOT indicate whether the individual is still infected or contagious.

RT-PCR Testing

  • RT-PCR testing is the gold standard for determining whether viral RNA, and thus an active infection, is present in a sample

  • RT-PCR testing requires a sample from the respiratory tract, most commonly a nasopharyngeal or oropharyngeal (throat) swab

  • RT-PCR technology works by adding specially designed substances to the sample, which bind to and amplify the viral RNA to detectable levels

  • Depending on the specific technology and instrumentation used, RT-PCR testing results can be available between 15 minutes and a few hours after the sample is received, though backlogs at laboratories may increase the wait time for results

  • Thus far COVID-19 RT-PCR testing has had relatively low sensitivity (~60%) (i.e., high false negative rates), in part due to challenges in obtaining high quality samples from patients (please see below)

Antibody (Serological) Testing

  • Antibody testing does not tell you specifically whether you have an active infection, only that you had an infection at one time

  • Antibody testing requires a blood sample

  • Antibody tests work using a method called an immunoassay, in which the antibodies are captured by an antigen, or protein, derived from the virus, and then detected

  • Most antibody tests for COVID-19 look for the presence of two antibodies produced in response to infections: IgM and IgG:

    • IgM antibodies are the first to emerge to fight a new infection

    • IgG antibodies appear later and generally provide longer term immunity to infections

  • Depending on the specific technology and instrumentation used, antibody testing results can be available between 10 minutes and a few hours after the sample is received, though backlogs at laboratories may increase the wait time for results

  • For antibody testing, sensitivities (true positive rates) range from ~60–97% and specificities (true negative rates) range from ~90-94% (please see below)

Sensitivity and Specificity

For diagnostic tests, sensitivity refers to the ability of the test to correctly identify people WITH the disease, and specificity refers to the ability of the test to correctly identify people WITHOUT the disease. High sensitivity tests have low false-negative results; high specificity tests have low false positive results. 


Data on the sensitivity and specificity of RT-PCR1-3 and antibody4-9 tests for COVID-19 is still limited. Here is what we know now:


RT-PCR

  • Although RT-PCR tests can detect very small amounts of the virus and thus have high analytical sensitivity, thus far COVID-19 RT-PCR testing has had high false negative rates, or low diagnostic sensitivity (~60%), for a few reasons:

    • The technique for obtaining the swab varies among healthcare providers; if not done properly, insufficient copies of the virus will be present for detection

    • The amount of virus in different parts of the respiratory system can vary widely, so even properly administered swabs may not contain a sufficient viral load for detection

    • The genomic sequence of COVID-19, which is required for the development of RT-PCR tests, was just recently determined in January 2020; thus, the reagents used in these tests are still being optimized and validated

  • Limited early data suggests that nasopharyngeal swabs are more reliable than oropharyngeal swabs for detecting COVID-19 infection, with sensitivities ranging from 59-70% and 29-60%, respectively


Antibody

  • For antibody testing, early studies have demonstrated sensitivities ranging from ~60–97% and specificities ranging from ~90-94%, depending on the test design used and timing of testing relative to infection

  • False negative results in people infected with COVID-19 could occur for a variety of reasons, including:

    • Individuals with compromised immune systems may not mount sufficient antibody responses

    • Tests taken too soon after infection may not pick up low antibody levels, or antibodies may not be present yet

    • Suboptimal test design (antibody tests are still being optimized and validated)

  • False positive results in people not infected with COVID-19 could occur if a person has antibodies to other pathogens, such as other types of coronaviruses, that are mistakenly detected in the COVID-19 antibody test

 


Timeline of Infection

 

We are still learning about the timeline of COVID-19 infection10-13; here is what we know so far (see Figure 1):

  • Early data suggests that individuals become infectious on average zero to two days prior to symptom onset, and that infectiousness generally declines relatively quickly over the first seven days after symptom onset

  • Symptoms can appear anywhere between two days and two weeks after exposure to the virus

  • RT-PCR testing is most valuable early in the infection, within the first two to three weeks after exposure/symptom onset

  • IgM is produced first, typically appearing between day five and day 11 after COVID-19 symptom onset, peaking between 14-21 days and remaining detectable for up to four weeks

  • IgG production begins approximately two to three weeks after infection and peaks at about four to five weeks. IgG antibodies typically provide longer term immunity; however, it is not yet known how long IgG is produced in response to this virus, and thus how long individuals may be protected from reinfection

How Should We Interpret COVID-19 Test Results?


Figure 2 illustrates our current understanding of the rise and fall of SARS-CoV-2 (COVID-19) RNA and antigen, IgM antibody, and IgG antibody, and the correlation of these levels with the initial time of infection, onset of symptoms, and recovery phase.

Table 1 shows the clinical interpretation of all possible scenarios that can be encountered when testing a patient with both RT-PCR and an IgM/IgG antibody test.

Our Approach to Testing: Know Your Status

A key challenge throughout the COVID-19 pandemic has been the lack of available testing. As RT-PCR and antibody testing becomes more widely available, we believe that it is important to Know Your Status; that is, know whether you have an active infection and whether you have developed antibodies to COVID-19 that may protect you from reinfection. However, as neither the RT-PCR nor the antibody test is perfect, the ideal approach for testing and the interpretation of results can be confusing. For example, the high false negative rates in the RT-PCR test have made it difficult to accurately determine whether a person has an active infection, and potential false positives in the antibody test make it difficult to accurately assess those who may be protected from future COVID-19 infection. In addition, we are currently limited by the availability of test supplies, ongoing validation of emerging tests, and laboratory backlogs in processing samples.

Nonetheless, through studying the scientific literature, evaluating the rapidly emerging data, and partnering with reliable suppliers and laboratories, we see a role for both RT-PCR and antibody testing in many people. In certain situations, serial testing strategies may also be beneficial. For example, if someone has a positive RT-PCR test and a negative antibody test, both tests could be repeated after a short period of time to confirm that the infection is over (negative RT-PCR test) and that an immune response has been mounted (positive antibody test). There are important caveats, however, to note regarding any testing approach:

  1. Testing only provides a snapshot of your status on the day you were tested; a negative RT-PCR test today offers no protection from exposure tomorrow

  2. We don’t yet know whether, and for how long, antibodies will protect people from reinfection, so a positive antibody test only suggests that you may be protected for some unknown period of time

Private Health is Here for You

In this time of uncertainty, reliable testing for active infection with COVID-19 and identifying those with immunity against it will be crucial part of overcoming the pandemic. Private Health is developing custom testing strategies for corporate and individual clients.

 

Please email us at covid19@privatehealth.com if you would like to learn more about how we can assist you.

If you would like to read or download the PDF version, you can find it here:

References

1.       Ai, T. et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 0, 200642, doi:10.1148/radiol.2020200642.

2.       Wang, W. et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA, doi:10.1001/jama.2020.3786 (2020).

3.      Yang, Y. et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. doi:10.1101/2020.02.11.20021493 (2020).

4.       Guo, L. et al. Profiling Early Humoral Response to Diagnose Novel Coronavirus Disease (COVID-19). Clin Infect Dis, doi:10.1093/cid/ciaa310 (2020).

5.       Li, Z. et al. Development and Clinical Application of A Rapid IgM-IgG Combined Antibody Test for SARS-CoV-2 Infection Diagnosis. J Med Virol, doi:10.1002/jmv.25727 (2020).

6.       Xia, N.-S., Wang, G.-Q. & Gong, W.-F. Serological Test is an Efficient Supplement for Detecting RNA to Confirm SARS-CoV-2 Infection. . Preprints doi:10.20944/preprints202003.0184.v1 (2020).

7.       Zhao, J. et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis, doi:10.1093/cid/ciaa344 (2020).

8.       Pan, Y. et al. Serological immunochromatographic approach in diagnosis with SARS-CoV-2 infected COVID-19 patients. medRxiv, 2020.2003.2013.20035428, doi:10.1101/2020.03.13.20035428 (2020).

9.       Liu, L., Liu, W., Wang, S. & Zheng, S. A preliminary study on serological assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 238 admitted hospital patients. medRxiv, 2020.2003.2006.20031856, doi:10.1101/2020.03.06.20031856 (2020).

10.     Li, Q. et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 382, 1199-1207, doi:10.1056/NEJMoa2001316 (2020).

11.    Lauer, S. A. et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med, doi:10.7326/M20-0504 (2020).

12.     Hoehl, S. et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. New England Journal of Medicine 382, 1278-1280, doi:10.1056/NEJMc2001899 (2020).

13.     He, X. et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nature Medicine, doi:10.1038/s41591-020-0869-5 (2020).

Figure 2 and Table 1 modified from: Why Do We Need Antibody Tests for COVID-19 and How to Interpret Test Results. Diazyme Laboratories 2020 <http://www.diazyme.com/covid-19-antibody-tests>

USING MASKS SAFELY AND EFFECTIVELY

Proper Use of Masks to Protect Against Transmission for COVID-19

 

APRIL 1, 2020

 

COVID-19 spreads from person to person via small respiratory droplets. These droplets are spread when a person with the virus exhales, coughs, or sneezes. You can contract this virus if you breathe in these droplets. Respiratory droplets containing the virus can also land on various objects or surfaces. When you touch a contaminated object or surface and then touch your eyes, nose, or mouth this can lead to an infection.

Cloth or paper masks, or any face covering if masks are not available, are better than nothing if used properly because they can help prevent the spread of droplets and remind individuals to avoid touching their faces. There are many resources available online (see below) to show you how to make your own mask. Masks should always be used in combination with frequent handwashing, disinfecting and social distancing. This is especially important because we now know that infected individuals may be pre-symptomatic or asymptomatic and can still spread COVID-19. If everyone is wearing a mask, it reduces any stigma and prevents possible unknowing transmission of droplets — people keep their droplets to themselves.

These basic guidelines can help ensure masks are used safely and effectively:

How to Put on a Mask

Always read the product instructions on how to put on a mask. If instructions for putting on the mask are not available, follow these steps below:

  • Always start with clean hands, washing with soap and water for at least 20 seconds or alternatively by using alcohol-based hand sanitizer

  • Remove a mask from its package taking care not to touch the inside of the mask

  • Check for any obvious tears or holes in either side of the mask

  • Determine which side of the mask is the top. The side of the mask that has a stiff bendable edge is the top and is meant to mold to the shape of your nose.

Follow the instructions below for the type of mask you are using:

 

  • Face mask with ear loops: Hold the mask by the ear loops. Place a loop around each ear.

  • Face mask with ties: Bring the mask to your nose level and place the ties over the crown of your head and secure with a bow. Then take the bottom ties, one in each hand, and secure with a bow at the nape of your neck. Pull the bottom of the mask over your mouth and chin.

  • Face mask with bands: Hold the mask in your hand with the nosepiece or top of the mask at fingertips, allowing the headbands to hang freely below hands. Bring the mask to your nose level and pull the top strap over your head so that it rests over the crown of your head. Pull the bottom strap over your head so that it rests at the nape of your neck. Mold or pinch the stiff edge to the shape of your nose.

  • N95 Respirators: Should be fit-tested. A poor seal can lead to leakage, lowering the respirator’s effectiveness.

How to Wear a Mask for Maximum Effectiveness

  • Cover your mouth and nose with the mask and make sure there are no gaps between your face and the mask. Check to be sure that facial hair does not interfere with the proper fit.

  • Avoid touching the outside of the mask while using it; if you do, clean your hands with soap and water or alcohol-based hand sanitizer

  • Replace the mask with a new one as soon as it is damp or damaged and do not re-use single-use masks. For example, surgical masks are disposable. Don’t reuse them.

 

How to Remove and Dispose of a Single-Use Mask

Always read the product instructions on how to remove a mask. If instructions for removing the mask are not available, then follow these steps below:

  • Clean your hands with soap and water or hand sanitizer before touching the mask

  • Avoid touching the front of the mask because it may be contaminated. Only touch the ear loops/ties/band.

  • Discard the mask immediately in a closed bin

  • Wash hands with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer

 

How to Store a Reusable Mask

Special care should be taken to ensure that the mask removal and replacement be done in a deliberate manner.

  • Carefully fold the mask so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage

  • The folded mask can be stored between uses in a clean sealable paper bag or breathable container

 

How to Clean a Mask

  • Check instructions with manufactured masks for cleaning instructions

  • Generally, paper masks and all surgical masks are intended to be single use only when used for this purpose

  • If you must extend the use of a disposable mask because of a shortage:

    • Do not touch the inside of the mask and store the mask by itself in a bag or breathable container

    • Consider double masking or covering with an outside barrier like a home-made mask or bandana

    • Line with a tissue or other material to absorb moisture and replace frequently

    • Dispose of the mask immediately if it becomes wet or soiled

  • Wash reusable cloth masks with soap and the hottest water possible for the fabric type. Place in dryer 80ºC/190ºF for 5 minutes.

 

Mask Use When Caring for a COVID-19 Infected Individual

There are steps you can take when you are caring for someone:

  • Acquire a supply of masks, particularly if you or your loved one is going to be around others, or make protective face coverings using cloth or paper (see below)

  • Ideally, the infected individual wears a mask when others are providing care

  • Some infected individuals may not be able to wear a mask, because it makes it too difficult to breathe. If this is the case, caregivers should wear masks when providing care

  • Follow guidelines above for save and effective usage

How to Make Your Own Masks

Follow the guidelines below for handmade cloth and paper masks. As well, there are now many sample patterns and instructions available online. Here are links to several examples of simple homemade face barriers that are easy to make.

Sources for Interventions: Using Masks Safely and Effectively:

 

If you would like to read or download the PDF version, you can find it here:

CIRCLE OF SAFETY

HOW TO REDUCE COVID-19 INFECTION RISK AT HOME

MARCH 27, 2020

 

Although a global pandemic of COVID-19 is beyond any one person’s control, we all have an opportunity and an obligation to adapt our behavior to mitigate the spread of this contagion for the safety of our communities, our healthcare workers and ourselves. 

 

In order to insure to the maximum extent possible that you are not exposed to the virus, you can create a CIRCLE OF SAFETYaround your home. The core principal is physical distance— but not social distance-- from people who might be infected and from surfaces that might contain virus particles for many hours or days. Although some of these steps may feel awkward and cumbersome, they must be implemented now to reduce the spread of this highly contagious disease and help ensure your safety and the safety of your loved ones. If you live with others, everyone in your home should follow these guidelines. This is especially important for the most vulnerable populations described below.

 

These guidelines draw upon the scientific literature, practices used by clinicians in other viral outbreaks and the experiences of our infectious disease physicians and former military advisors. All have been adapted for home and individual use.

 

HOUSEHOLD

  • Those who live in your house form your CIRCLE OF SAFETY

  • Do not let anyone into your home who does not have an essential reason to be there

  • If someone needs to enter your home:

    • Do not permit them to enter if they have any symptoms or have reason to believe they have been infected

    • Have them leave their shoes and outer garment outside, sanitize their hands, and if available, put on gloves and a mask (which they should take with them). 

    • After they leave, sanitize any surfaces they have touched and wash your hands

 

At Home

  • Before entering your home, take your shoes off and leave them outside or spray them with a disinfectant. If possible, take your clothes off, especially the outer layer, if you have been to a highly trafficked area like the supermarket or pharmacy or come into close proximity to anyone outside your CIRCLE OF SAFETY. Remove your gloves and use disinfectant wipes on your cell phone, keys, credit cards, wallet, etc. that you used during your trip. 

  • Immediately upon entry, wash hands with soap and warm water for at least 20 seconds, and do so regularly and before preparing and eating meals

  • Wash clothes frequently and bedding and towels at least once a week

 

Provisioning

  • Make a list of products you use regularly, including any prescription medications, and order a two-month supply now for home delivery if possible 

  • Procure supplies that would be helpful if you become sick, such as fever reducers, cold medications, electrolyte replacements, etc.

  • Anticipate shortages and delays both in stores and via e-commerce

 

Accepting Deliveries

  • Prevent the introduction of virus into your home as follows: 

    • Have all deliveries of food, drugs, supplies, etc. dropped off outside your door, without any contact with the delivery person. Postmates and other services now offer this option. 

    • Do not bring any exterior packaging into your home 

    • Before you begin to open the exterior package outside your home, put on gloves and disinfect the package

    • If the contents of the package are likely to have been touched by others, use disinfectant spray or wipes to disinfect the contents

    • For fresh fruit and vegetables, wash them immediately in hot soapy water. For prepared hot foods that are ready to be eaten, put them in a microwave or oven to increase the heat.

    • After processing your delivery, remove your gloves and wash hands thoroughly with soap and water for at least 20 seconds

    • Use disinfectant spray or wipes on doorknob, doorbell, etc., after delivery 

    • Cancel dry cleaning as there is a risk of contamination

 

Cleaning

  • Clean and disinfect your home regularly, especially shared hand-touch surfaces such as doorknobs, light switches, countertops, faucets, etc.

  • A recent study published in the New England Journal of Medicine found that the virus is detectable for up to 3 hours in droplets in the air, up to 4 hours on copper, and up to 2-3 days on plastic and stainless steel. Recent data suggest that the virus may remain infectious even longer, so these precautions are even more important.

  • You can easily make an effective disinfectant by mixing household liquid bleach and water at a ratio of 1 part bleach to 10 parts water. Put it in a dedicated spray bottle, MARK IT CAREFULLY and KEEP IT AWAY FROM CHILDREN. Do not use the bottle for anything else. The mixture can be used for up to 24 hours. Spray on shoes, outer packages, hand touch surfaces, etc.

  • Here is a list of EPA-approved products for use against emerging viral pathogens

 

 

Make a Plan in Case Someone Gets Sick

  • Most people infected with COVID-19 will experience mild symptoms similar to a common cold that do not require care from a physician

  • If someone were to become sick, determine where they can self-isolate within your home to minimize risk of infection for others

  • Determine who will care for the sick person and consult the CDC guidelines for caring for a loved one with suspected COVID-19

  • Contact the sick person’s healthcare provider by calling before they get care and avoid public transportation if visiting the provider

  • If the sick person has trouble breathing, persistent pain or pressure in the chest, becomes confused, is not arousable or has bluish lips or face, seek medical attention immediately 

 

Keep in Touch with Friends and Family

  • Physical distancing does NOT require social distancing 

  • By connecting with each other, we can support everyone’s mental and physical health 

  • We strongly encourage staying in close touch with your loved ones, friends and colleagues via technology-- call, text, email, FaceTime, Zoom, etc.

  • Write a letter – yes, it’s been a long time since we regularly did this; why not bring it back?

 

 

LEAVING HOME

  • Only leave your home for essential needs (work, necessary doctor appointments obtaining food and prescription drugs and supplies) and exercise (running, biking, hiking in a remote area) 

  • Avoid public transportation, if possible

  • When you need to go outside, wear disposable gloves, a face mask, hat, long sleeves and pants

  • Maintain distance from others in public areas (at least six feet)

  • Keep antiviral hand sanitizer with you and use it often

  • Do not touch shared hand-touch surfaces

  • If you must go to the supermarket, pharmacy, or other retail establishment, wear gloves and a mask. Bring antiviral hand sanitizer and wipes with you. Wipe down the cart and wear gloves. Do not touch items at the store besides those you purchase. Ask the sales clerk to sanitizer their hands before double-bagging your items and exchanging payment. Avoid cash transactions if possible.

  • Use credit cards/Apple Pay instead of cash whenever possible

 

 

MOST VULNERABLE POPULATIONS

People who are more likely to become seriously ill if infected should take all possible precautions.

 

There is evidence to show that the following factors increase the risk of a more serious presentation if infected:  

  • Increased Age / Male

  • COPD/Smoking

  • Cardiovascular disease

  • Diabetes

  • Hypertension

 

The following factors likely increase the risk:

  • Autoimmune conditions, particularly those on biological treatments, including:

    • Rheumatoid arthritis

    • Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s disease)

    • Lupus and scleroderma

  • On immune-suppressive medication routines most frequently related to:

    • Organ transplantation

    • Cancer

  • Diabetes

  • Chronic kidney disease

PRECAUTIONS & SYMPTOMS

MARCH 12, 2020

 

 

Private Health Management is providing this COVID-19 report based on the information available and the judgment of experts as of the date of the report. Knowledge about this unprecedented outbreak is evolving rapidly and chaotically and many things once believed to be true have been shown by subsequent developments to be erroneous. While the content herein is based on our current understanding and the current guidance of experts, Private Health expects that there will be rapid, unpredictable and ongoing changes in the course of this epidemic and the measures that are being used or advocated to address it. Accordingly,  we encourage everyone to (i) consult many other sources of information (ii) make decisions based on all of the information they can obtain and (iii) be prepared to make rapid changes in their plans. Private Health Management does not accept any liability or responsibility whatsoever for any decisions or actions based in part or whole on this or other information or guidance we provide.   

In addition, this report and all other information and guidance provided by Private Health Management are not to be used or relied on for any diagnostic or treatment purposes. This report and all other information and guidance are not intended to substitute for individualized medical advice, diagnosis or treatment by a physician who is aware of an individual’s medical history and has had an opportunity to conduct an examination. Do not rely on this report in place of seeking professional medical advice.

 

 

GENERAL PRECAUTIONS

  1. Maintain social distancing. Do not shake hands, hug, kiss or exchange business cards. Avoid contact with people who are sick. Maintain an eight foot distance if you are near someone with symptoms to avoid air droplets from coughing and sneezing. 

  2. Clean your hands. Use antiviral hand sanitizer containing at least 60% alcohol on dry hands once an hour, after handwashing and drying, and after touching any shared surfaces. Wash your hands frequently with liquid soap and water for at least 30 seconds. 

  3. Avoid hand touch surfaces such as handrails, doorknobs, elevator buttons and bathroom fixtures as they have been proven to transmit infections.

  4. Avoid “hand to head” contact to prevent hands from infecting your eyes, nose and mouth. 

  5. Get the flu vaccine. The flu is co-circulating and several flu patients have caught the coronavirus in the hospital because of the compromised immune system.

  6. Practice respiratory hygiene by covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Immediately dispose of the used tissue and wash your hands.

  7. Stay home when sick. If you have a fever, cough and difficulty breathing, call your primary care physician. 

 

SYMPTOMS

COVID-19 typically causes mild to moderate upper-respiratory tract illnesses with symptoms that resemble the flu or a bad cold. Approximately 70% of cases report an initial fever presentation that comes on slowly and a dry, barking cough after the first day. The time from exposure to the onset of symptoms is thought to be about two to 14 days. Approximately 90% of the cases present clinical symptoms by nine days post-infection. There is a chance that asymptomatic patients may be infectious in the 24 hours before they have symptoms. 

Symptoms may include:

  • Fever

  • Cough

  • Runny nose

  • Headache

  • Sore throat

  • General feeling of being unwell

  • Difficulty breathing 

  • More serious: pneumonia, bronchitis, lung lesions

 

If you develop any of these symptoms, don a face mask, go home and call (do not visit in person) your primary care physician.

 

WHAT TO DO IF YOU ARE SYMPTOMATIC

If an individual is at higher risk for serious presentation and is symptomatic:    

  • They should call, not visit, their primary care physician and their relevant specialists and inform them of their symptoms, travel history during the prior 14 days and if they have reason to believe they have been exposed to COVID-19. Those physicians will determine if the individual should be tested and how they should be treated.

 

If an individual is at not at higher risk for serious presentation and is symptomatic:    

  • If this individual does not have any of those factors, they should call, not visit, their primary care physician, who will determine if they should be tested and how they should be treated.

If serious symptoms present:    

  • In the event that people either with or without the risk factors develop serious symptoms, which fortunately happens in only a small portion of cases, they will likely need to be hospitalized. 

 

RISK FACTORS FOR SERIOUS PRESENTATION

The following factors increase the risk of a more serious presentation if infected:    

People with the following conditions:

  • Autoimmune conditions, particularly those on biological treatments, including:

    • Rheumatoid arthritis

    • Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s disease)

    • Lupus

    • Scleroderma

  • Pulmonary compromise, including COPD and smokers

  • On immune-suppressive medication routines most frequently related to

    • Organ transplantation

    • Cancer

  • Diabetes

  • Chronic kidney disease

  • HIV/AIDS

 

People older than 55 years old

 

 

 

Clients may contact the Private Health COVID-19 Task Force at COVID19@privatehealth.com.

COVID-19 Disclaimer

Private Health Management is providing this COVID-19 report based on the information available and the judgment of experts as of the date of the report. Knowledge about this unprecedented outbreak is evolving rapidly and chaotically and many things once believed to be true have been shown by subsequent developments to be erroneous. While the content herein is based on our current understanding and the current guidance of experts, Private Health expects that there will be rapid, unpredictable and ongoing changes in the course of this epidemic and the measures that are being used or advocated to address it. Accordingly,  we encourage everyone to (i) consult many other sources of information (ii) make decisions based on all of the information they can obtain and (iii) be prepared to make rapid changes in their plans. Private Health Management does not accept any liability or responsibility whatsoever for any decisions or actions based in part or whole on this or other information or guidance we provide.   

© 2020 PRIVATE HEALTH MANAGEMENT