Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

During these times of uncertainty fueled by the increasing numbers of reported cases of COVID-19, we are planning to write about this epidemic on a regular basis. Even with woefully inadequate testing, today there are 3,642 confirmed cases of COVID-19 in the US according to the CDC. Since we still have no effective production or delivery of millions of test kits, public health officials are certain that the numbers of Americans infected with this virus is far greater than reported. 

Many people will develop respiratory symptoms that are similar to those of early COVID-19 infection and understandably will want a test for this virus. It is important to know that influenza and other respiratory viruses are circulating widely in the US now and are more likely to be the cause of respiratory symptoms. 

Everyone wants to know: “How can I get the test for the 2019 Coronavirus if I have a low-grade fever and sore throat?” Here is the answer. Until the federal government’s new plan to work with private industry actually delivers millions of testing kits to hospitals and labs and we develop drive through stand alone testing units, it will be almost impossible for a patient to have this test, even with symptoms and high risk exposure.

Many emergency departments, even at major medical centers, cannot arrange for the test at this point unless a patient is sick enough to be admitted to the hospital. Even people with real risk factors in terms of exposure to someone diagnosed with COVID-19 or travel to a “hotspot” with significant symptoms, must often wait in a COVID-19 segregated area where other people are waiting (with masks) to be evaluated for further testing.  A healthcare provider will eventually see people for these non-emergent reasons, but the increased number of patients for emergency care has increased wait times in all emergency departments. After an evaluation, a determination will be made in cities, like mine, New York City, to see if the Department of Health will authorize a 2019 Coronavirus test. If patients have mild to moderate symptoms, they are unlikely to be tested for the 2019 Coronavirus. Emergency department physicians do recommend that for these symptoms, patients remain at home and follow up with their primary healthcare provider.

There are alternatives to a worried visit to an emergency department. For example, patients can have a virtual visit with a health care provider at the Weill Cornell-New York Hospital Urgent Care after downloading and installing an app on a mobile phone.This virtual visit will prevent exposure to all the other infected people in the emergency department, allows people to be evaluated without becoming infected with other viruses from patients waiting to be seen and will limit the use of the emergency department during this epidemic to those who are seriously ill. You may want to download the New York Presbyterian Hospital app now in case you need an evaluation for a non-emergent matter in the future. 

Here are the current medical guidelines for the management of mild to moderate symptoms that could be caused by COVID-19 infection:

1. If you have mild to moderate symptoms that could be caused by the 2019 Coronavirus, such as sore throat, dry cough, headache, muscle pain, fever, chills, diarrhea: self quarantine. Sleep alone and use a separate bathroom from others in your household until the symptoms abate or you are evaluated by your primary healthcare provider.
2. Report any exposure to people with the 2019 Coronavirus along with your travel history to your healthcare provider. Ask about the length of self quarantine. 
3. Control fever and general muscle pain with Tylenol.
4. Remain well hydrated 
5. Practice meticulous infection control to prevent transmission of the virus to anyone else in the home. Place all disposable used items in a special garbage bag left in your bedroom. Place all linens and clothes that you have used, that are to be washed, in another plastic bag to be laundered in a careful way. Clorox all non-cloth surfaces that you have used including door knobs and bathroom fixtures. Wash hands with soap and water or hand sanitizer that is 60% alcohol in the correct way. Use Kleenex to cover your mouth if you sneeze. Do not interact with anyone else in your living space.
6. Stay in touch with your healthcare provider and call urgently if you develop shortness of breath or your symptoms worsen.

Certainly prevention is the best cure with this novel viral infection that is now a pandemic.

1. Assume everyone has the virus and exercise preventive measures.
2. Stay home when at all possible.
3. If you must leave your home, follow all the well publicized steps to prevent infection: at a minimum, do not touch your face, eyes, nose or mouth. Do not touch any elevator button or door handle or buzzer with your hands: Use a paper towel or Kleenex that you can throw in the trash when you reach your destination. Immediately wash hands properly upon arrival. Clean computer keyboard with Clorox wipes. Remove your cell phone cover and clean thoroughly with Clorox wipes. Clean your cell phone with alcohol wipes. 

 Finally, consider postponing dinner parties, family gatherings, church attendance, conferences, dining out, gym visits and travel. This is the time for Americans to make small personal sacrifices for our personal health, the health of others (especially those at greater risk) and to slow the spread of the 2019 Coronavirus epidemic. History will judge America’s leaders and the behavior of our citizens during the pandemic of 2020.

Stay safe,

Dr. Pat