My fellow Waco physician colleagues,

As you know the CDC has recently shared information regarding the concerns for public health within the United States due to the novel coronavirus (COVID-19). Many local physicians are independent and do not receive regular updates on this topic, thus the McLennan County Medical Society will help in distributing local, up to date, and accurate information to help keep our members informed. While physicians are being inundated with data and information about COVID-19, we wanted to provide a succinct guide for ALL McLennan County physicians as a synopsis of the local recommendations and protocols.

To be clear, there have been no reported cases in the Waco area. This is a very fluid situation with information rapidly changing. Please see the CDC website or your local hospital websites for the most up to date information.

Situation Update as of 3/3/20

• “Case Counts
  • Worldwide
    • Total confirmed: 92,821
    • Total recovered: Currently data unavailable
    • Total deaths: 3,160
  • US at a glance*
    • Total cases: 60
      • Travel Related: 22
      • Person-person spread: 11
      • Under investigation: 27
    • Total deaths: 9
    • Cases among Persons Repatriated to the United States
      • Wuhan, China: 3
      • Diamond Princess: 45
    • Texas: 11 (All repatriated)
    • McLennan County: 0

*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media.

Community spread is occurring in California and Washington. Community spread in Texas seems inevitable given the spread in the West Coast.” – McLennan County Health Department

 

COVID-19 appears to be more harmful to older individuals than younger individuals.   Those with underlying health problems make them more susceptible to complications from pneumonia.

Local Update

Both local hospitals are prepared for any patient with potential COVID-19 in their ER.

City, County, School, Police and Health officials are meeting weekly to discuss contingency plans and are ready to implement if needed.

COVID-19 Screening Questions

1. Have you recently felt feverish, had a cough or shortness of breath AND close contact to a person with confirmed COVID-19 within 14 days of symptom onset?
2. Have you recently felt feverish, had a cough or shortness of breath AND a history of travel within 14 days to China, Japan, Iran, South Korea or Italy?
3. Have you recently felt feverish, had a cough or shortness of breath AND recently been in contact with a person who may be sick with the novel coronavirus?

IF THE ANSWER IS “YES” TO ANY OF THESE, IMMEDIATELY: a) provide a surgical mask to the patient b) Place in a private room c) Put on appropriate PPE and perform a secondary screen (if you work for BS&W or Ascension) or contact the CDC. Person under Investigation criteria is currently posted here. Clinicians should consult with local public health to determine if a patient should be tested… if all else fails, call 911 for transport to the hospital.  Our local EMS service AMS has the supplies and training to come to your facility and safely transport to either of the local hospitals for further evaluation and testing.

COVID-19 Office Preparation

Place surgical masks near entry points and check-in desk for anyone with cough or fever

Determine a designated private exam room for potentially exposed patients in order to minimize exposure to other patients and staff.

COVID-19 Transmissibility

Based on what is currently known about COVID-19 and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts.

Close contact can occur while caring for a patient, including:

• being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.
• having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.

If close contact occurs while not wearing all recommended PPE, healthcare personnel may be at risk of infection.

What do I do if I have concern a patient may be infected?

If you work at a BS&W or Ascension Providence facility, follow the protocols designated by your hospital.

If independent, follow instructions in above “Screening Questions” and/or contact local EMS.

COVID-19 Testing

Currently, diagnostic testing for COVID-19 is being performed only at the CDC.  No testing is done locally at this point in time.

The Texas Department of State Health Services will be able to conduct testing by the end of this week.

COVID-19 Treatment

There is no specific antiviral treatment recommended for COVID-19 infection. People infected with COVID-19 should receive supportive care to help relieve symptoms.

COVID-19 Prevention

Utilize standard airborne, contact and eye protection (gown, gloves, and N-95 respirator (controversial whether beneficial due to particle size), goggles or face shield)

• Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available
• Use Standard Precautions, Contact Precautions, and Airborne Precautions and eye protection when caring for patients with confirmed or possible COVID-19
• Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled
• Practice how to properly don, use, and doff in a manner to prevent self-contamination

See the CDC website for more information:

https://www.cdc.gov/coronavirus/2019-nCoV/summary.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

DSHS COVID‑19 Call Center: 1-877-570-9779

 

• A call is being conducted for clinicians on Thursday:

Coronavirus Disease 2019 (COVID-19) Update—What Clinicians Need to Know to Prepare for COVID-19 in the United States

Date: Thursday, March 5, 2020

Time: 1:00-2:00 P.M. Central Time | 2:00–3:00 P.M. Eastern Time

https://emergency.cdc.gov/coca/calls/2020/callinfo_030520.asp

This is a consolidation of high impact information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest and Ascension Providence communications.  We advise following the guidelines distributed from your hospital system if applicable. Hope this is helpful and further updates will follow.

 

William T. McCunniff MD, MBA

McLennan County Medical Society President

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