She had returned from traveling in Asia and felt awful, so the 25-year-old woman went to her doctor’s office in Edgewater, New Jersey. She told the staff about her flu-like symptoms and asked whether she might have the virus sweeping through China and causing fear of a potential pandemic.
The staff at her primary care practice took her concerns seriously. After all, it was Jan. 23, the first U.S. case of the novel coronavirus had been announced only days before, and everyone was anxious. A hospital would be better equipped to diagnose and treat her, they reasoned, so they called an ambulance to take her to Hackensack University Medical Center.
That first suspected New Jersey case of COVID-19 turned out to be a false alarm. But it still provided a major learning experience for everyone involved in her care.
Steps taken at the front door of the medical system – at primary care practices, urgent care clinics, and doctor’s offices around the country – can make all the difference in the patient’s treatment, the protection of health care workers from exposure, and the spread of the virus to the broader community.
The very first case of COVID-19 confirmed in the United States, in fact, was a 35-year-old man who went to an urgent care center. He complained of four days of cough and fever after a visit to his family in Wuhan, China. Astute clinicians in Snohomish County, Washington had him tested.
“Anybody who’s seeing an ambulatory patient could potentially have somebody walk in” with symptoms of the novel coronavirus, said Dr. Daniel Varga, chief physician executive at Hackensack Meridian Health, which has some 1,000 doctors at 300 clinical locations in New Jersey.
Whether it’s an OB-GYN providing follow-up care to a 30-year-old woman, a cardiologist performing a regular check-up on a 70-year-old man, or a physician at an urgent care center seeing a millennial for the first time, all must be ready, he said.
“The crux is identification, isolation and appropriate transfer” of patients with suspected COVID-19 wherever they show up, Varga said.
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Getting a detailed patient history is ‘crucial’, doctor says
The 25-year-old female patient, who was not identified, didn’t meet the criteria in place at that time for sending a sample of her sputum to the federal Centers for Disease Control and Prevention for testing – she had not traveled in China during the time period of concern. Officials at Hackensack medical center andNew Jersey’s Department of Health said later that night that she did not have the virus.
In the aftermath, “We implemented a protocol pretty quickly,” said Dr. Raj Brahmbhatt, chief medical officer at the patient’s primary care provider, Riverside Medical Group.
He met with managers of the group’s 65 North Jersey offices and talked with all the group’s providers. He said he reminded them that the flu is far more common than coronavirus in the United States at this time, and “there’s nothing like getting a good history from the patient in regard to their risk of exposure.”
“That’s going to be crucial in identifying those patients,” he said.
With the United States reporting the first death from COVID-19 and community spread of the virus in California, Oregon and Washington, patients are concerned about how they will get care.
Here’s what to expect and what doctor’s offices are doing to prepare:
First, take a deep breath, said Dr. Sean Cook, an owner of Green Brook Family Medicine and a member of the New Jersey Academy of Family Physicians.
If you feel you need to consult a physician, call first and be prepared to answer questions about your symptoms, your travel history, and your risk of exposure to the virus. This is called telephone triage, as the questioner assesses the urgency of your situation. Large health systems and hospitals have scripts for their staffs to follow which list the questions they should ask.
“Anyone who calls in with symptoms of upper respiratory infection, we ask: ‘Do you have fever, chills and have you traveled?’” said Dr. Kennedy Ganti, a primary care physician and board member of the Medical Society of New Jersey. The list of countries for which travel is a concern is updated frequently. As of Sunday, it included China, South Korea, Iran, Italy and Japan.
A doctor you see regularly can combine his or her knowledge of your health history with your new symptoms to assess your risk. “We know if they’re old or young, what other medications they take, what other conditions they have,” said Cook. “That plays a great role in triaging people.”
Expect to stay home
“Eighty to 85% (of people infected with the new coronavirus) are going to have low-level, common cold symptoms,” said Varga, of Hackensack Meridian Health. “They just need to isolate, so they don’t spread it.”
As long as patients are stable, the best place for them is home, said Brahmbhatt. That minimizes potential spread of the virus and delays the possible depletion of limited resources, such as face masks, personal protective equipment and test kits.
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Monitor your symptoms if at home
Physicians and health systems have various practices for monitoring their patients, so discuss that during your initial call. Usually, monitoring means checking your temperature and symptoms twice a day. Some will want you to call the office to report, others will expect a call only if problems develop.
Hackensack Meridian’s health system is considering whether to use a “virtual health” platform like Skype or FaceTime to actively monitor patients with confirmed COVID-19 diagnoses whose symptoms don’t require hospitalization, Varga said.
Keep in mind that some patients 15% to 20% – will develop more serious problems, such as pneumonia and shortness of breath. They will need to be hospitalized and may require breathing help. That decline may occur nine or 10 days after symptoms first arise, according to some reports.
In those cases, the patient will be referred to the emergency room. Most doctors want to guide the patient through the admission process. The hospital will want to know you’re coming so you can be isolated.
Identify your risk so you can be isolated
Pay attention to the signs currently posted in doctor’s offices, urgent care centers and emergency rooms that ask patients who have a relevant travel history or suspect coronavirus to identify themselves. Front desk staff are trained to ask questions so that immediate precautions can be taken.
Expect to be given a face mask, if you have respiratory symptoms and are considered at risk. Expect to wait in a separate area or an examination room, or maybe even in your car until it’s time to be examined. Where that is not possible, stay at least six feet from other people.
The nurses and doctors who examine any patients suspected of having COVID-19 are to wear a personal gown, gloves, a face mask and an eye shield.
But dealing with infectious patients is not uncommon for doctor’s offices. “This is very much business as usual,” for his staff, said Cook, the Green Brook family doctor. “We see influenza every day.”
Follow reporter Lindy Washburn on Twitter: @lindywa
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