An Update from us on COVID-19

Dear Member,

First, we have a few housekeeping items we would like to mention:

We do recommend coming in for regular appointments and yearly physical examinations. However, we want to inform you that it may take longer to schedule as we are making sure safety comes first. We are scheduling only a few "well visits" each day in order to maintain social distancing. We want to make sure that we have very few patients in the office at any one time. We also ask that you limit any others that accompany you unless the patient is a minor or needs assistance. Thank you for your understanding and patience during this unprecedented time. Flatiron Family Medical has taken all the essential safety precautions and we remain diligent in enforcing these by not overcrowding our patients. If you have been traveling from any of the states that now is experiencing an increase in COVID-19 cases, we ask that you follow Governor Cuomo's directive and self-isolate for 14 days prior to coming in for any well visits.

COVID nasal swabs: The commercials labs have become very backed up with how quickly they are turning around results. Please note that it is now taking up to 7 days to receive COVID nasal swab (PCR) results (up from 1- 2 days previously). We have now purchased equipment that will give us results in under 15 minutes. However, this testing option won't be available until September due to the backlog. We are trying to find a reliable one to bridge the gap and will let you know if and when we do.

School in the Fall: We have been asked by many of you what we think about your children going back to school in the fall. This is a complex question and at this time there is no specific answer. You must keep in mind that we are the only country that is suggesting to re-open schools as cases are still surging in many parts of the country. Worldwide it seems that elementary school children are less likely to get sick and to infect others than high-school children, however, that is not yet conclusive. This also does not mean that younger children do not contract COVID-19 and have symptoms, it's just at a lower rate than older children and adults. The American Academy of Pediatrics is in support of schools re-opening for the social and mental health well-being of the children. Economically, it is also a necessity for many families to have their children in school so they can return to the workforce. Also, there is a racial inequality of the type of education children receive from home compared to when in school due to lack of access, resources etc.

Infectious disease protocols must be in place at all schools if they do re-open. Most models of school re-opening involve reductions of class size, increasing physical distance between students, and keeping students in defined groups with limited interaction between groups to reduce the potential for wide-scale transmission within schools and the surrounding community.

This week the World Health Organization (WHO) came out with a statement, after pressure from scientists, that COVID-19 can be aerosolized. This means, it can stay in the air longer than previously suggested and that it travels farther especially in an indoor environment. Masking and ensuring that there is adequate air exchange between the inside and outside is essential. We are watching and waiting to see what the recommendations for the Tri-State area will be. It will likely be a personal decision for each family whether you send your children to school or continue with virtual classrooms. It is definitely not an easy or straightforward question to answer.

Persistence of symptoms: We have a few patients we call "long haulers" from COVID-19 infections. They have persistent symptoms long after their infection. It ranges from recurrent fevers, fatigue, palpitations, to shortness of breath. A recent study from Italy found that 87.4% of patients who were hospitalized and then discharged, still complained of at least one symptom (mostly fatigue or shortness of breath). This was a small study and only one study, but we are seeing more evidence that this illness can linger in some patients.

Why are some who were sick still testing negative for antibodies?: Despite switching to a more accurate antibody test, we are still seeing quite a few patients who were very sick with COVID-19- like symptoms who are testing negative for antibodies. This is obviously very frustrating for everyone. A new study out of Sweden shows that patients with severe COVID-19 often developed a strong T-cell response and an antibody response; in those with milder symptoms it was not always possible to detect an antibody response, but despite this many still showed a marked T-cell response. They found that up to 30% of the population showed T-cell immunity and past exposure to COVID-19. Unfortunately, T cell analysis is more difficult to perform and as of now usually only done in specialized labs.

Asymptomatic and pre-symptomatic transmission: We now know that people can spread COVID-19 while asymptomatic and pre-symptomatic. Asymptomatic means people are infected with COVID-19 and never have symptoms. Pre-symptomatic means people are infected with COVID-19 and it is the day or two prior to when they show symptoms. One study estimated that 40% of COVID infections were spread during the pre-symptomatic phase. This just underscores the importance of wearing a mask whenever you are unable to socially distance even if you feel fine. It protects you and others. #wearamask

We leave you with this video which shows how to improve your mask wearing. As cases surge all over the country, now is not the time to become complacent. Wear your mask and continue to social distance. Remember, outdoors is much safer than indoors, but you still need to wear a mask and keep socially distant. Stay well and stay safe!