Separating Fact from Fiction With COVID-19

Separating fact from fiction is increasingly difficult in this age of instant information and social media; add in a pandemic where fears are heightened and there are a lot of unknowns, things get even murkier.

Scientists and healthcare professionals are racing to learn all that they can about Coronavirus Disease 2019 (COVID-19) to provide life-saving assistance to patients and evidence-based options for policy-makers.

We, at the Minnesota Academy of Family Physicians, are working hard to raise awareness on the lack of adequate personal protective equipment (PPE) for healthcare workers and lack of testing in the state of Minnesota. We also want to shine a light on the impact that COVID-19 is having on our primary care infrastructure as well as the disparities that are being exacerbated in our communities. And we want to ensure that family medicine has the education and resources necessary to be an important force against the pandemic and trusted source for accurate information.

We asked our Speaker of the House, Deb Dittberner, MD, MBA, to help us separate fact from fiction on some of the commonly asked questions about COVID-19.

WHAT MEDS ARE RECOMMENDED FOR TREATING COVID-19?

Currently, there are NO drugs or other therapeutics approved by the US Food and Drug Administration to prevent or treat COVID-19 (Centers for Disease Control and Prevention).

You may have heard mention of drugs like remdesivir and hydroxychloroquine or chloroquine—these drugs are under investigation but have NOT been approved for treatment. There can be serious health consequences when using medications without a prescription and supervision of a healthcare provider.

You can read more about medications currently under investigation for treating COVID-19 from the Centers for Disease Control and Prevention and American Academy of Family Physicians.

To Family Docs: This subject will grow and change rapidly. Prioritize your studies on the rapid changes that will occur on prevention and treatment of COVID-19.

WHY ARE STAY AT HOME ORDERS NEEDED?

Staying home slows the rate of transmission of COVID-19 and allows time for key preparations for moving through this pandemic, like building our hospital capacity, increasing access to life-saving equipment like ventilators, increasing testing, increasing access to personal protective equipment, planning for how to care for higher risk populations and assessing public health data to determine which community mitigation strategies are most effective (Minnesota Department of Health).

By staying home and limiting face-to-face contact with others, we are reducing the spread of COVID-19, which primarily spreads among people who are in close contact (within about six feet of each other) for a prolonged period. Spread happens when an infected person coughs, sneezes or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies have indicated that people who are infected but do not have symptoms may also play a role in the spread of COVID-19 (Centers for Disease Control and Prevention).

Most people who will become infected will experience minor symptoms, but some will require hospitalization and need resource-intensive care in an ICU. By staying home, we’re allowing for the time we need to build up our healthcare capacity and resources to make sure that everyone who will need care will be able to get it and that our healthcare workers will be able to provide care in a safe environment.

Re-opening of our communities and economy could begin soon, but will happen in small steps.

To Family Docs: Now is the time to formalize partnerships with local public health, government and businesses to be leaders in that revitalization. Your voice at the planning table can ensure healthcare worker, patient and community member safety and verify that re-opening efforts are based on medicine and science.

HOW IS COVID-19 DETERMINED AS AN OFFICIAL CAUSE OF DEATH OR CONTRIBUTING FACTOR ON DEATH CERTIFICATES?

The Centers for Disease Control and Prevention (CDC) has recommended that COVID-19 should be specified, when appropriate, on death certificates.

Why does this tracking matter? Public health officials utilize mortality surveillance, through death certificates, to inform their efforts and to gain an understanding on the impact of diseases. Physicians and healthcare providers can utilize medical history, medical records, laboratory tests, an autopsy report, as well as their clinical training and experience to help inform this medical opinion.

The CDC recommendation specifically states, “When determining whether COVID–19 played a role in the cause of death, follow the CDC clinical criteria for evaluating a person under investigation for COVID–19 and, where possible, conduct appropriate laboratory testing using guidance provided by the CDC or local health authorities. In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as “probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely.View CDC guidelines on determining cause of death.

Minnesota’s Health Commissioner Jan Malcolm has gone on to clarify, There are death records that list the immediate cause of death as COVID-19, because it was confirmed through laboratory testing. When deaths are registered as ‘suspected’ or ‘probable’ COVID-19 we don’t just leave it at that. The Minnesota Department of Health Office of Vital Records…follows up. Staff contact the medical certifiers to ask them if testing came back to confirm COVID-19. When it has, the certifier updates the Cause of Death statement they have previously registered or provided. There may be records that stay as ‘suspected’ or ‘probable’ if the cause of death statement was written but testing was never ordered, or the health record doesn’t get updated by the healthcare provided. These will be updated with ICD-10 codes that are related to but different from the confirmed COVID-19 deaths and will not be counted as COVID-19. This will give us better clarity on the confirmed number of COVID-19 deaths versus deaths that may be but remain in a less certain status.”

Read more about how the Minnesota Department of Health is tracking COVID-19 related deaths.

To Family Docs: Download the Cause of Death mobile app or participate in the Improving Cause of Death Reporting online training for more guidance and training.

IS SIX-FOOT SOCIAL/PHYSICAL DISTANCE REALLY NECESSARY?

Physical distancing is the best tool we have to limit exposure to COVID-19 and slow its spread. This virus spreads among people who are in close contact (within about six feet of each other) for a prolonged period, hence the reason for needing to keep a six-foot physical distance. Spread happens when an infected person coughs, sneezes or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies have indicated that people who are infected but do not have symptoms may also play a role in the spread of COVID-19.

Learn more about guidelines around physical (social) distancing.

WHY THE CHANGING MASK RECOMMENDATIONS?

We are learning more about COVID-19 on a daily basis. As we gather more data, recommendations and guidelines can and should adapt to fit with the best available knowledge.

We now know that people can spread the virus without being aware that they have it and that it can take up to 14 days for an infected person to show symptoms. It is recommended that you wear a cloth mask in public or when you will encounter others outside your home, especially in areas where there has been significant community-based transmission and it’s difficult to maintain physical distancing measures (of six feet). Wearing the mask will help contain your germs and protect others around you.

The recommendation remains that N95 masks MUST be reserved for healthcare workers to enable them to do their jobs safely for themselves and their patients.

Read more about cloth masking.

Additional Public Health Resources on COVID-19

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Authors:

  • Deb Dittberner, MD, MBA, MAFP Speaker of the House, @drdebmd
  • Jami Burbidge, MAM, MAFP Director of Advocacy & Engagement, @jami_burbidge
  • Emie Buege, MAFP communications

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