My Dear Colleagues:

The whole nation has been gripped with fear and anxiety about the Corona virus outbreak, fueled by a lot of media speculation.  

Though this is indeed something not to be taken lightly my personal opinion is that we as health care providers should remain calm and instill some confidence in our patients and support staff.

Now is not the time for panic, which will only get in the way of what you need to be doing. While it’s completely understandable to be worried, your best bet to getting through this unscathed is to channel that anxious energy into doing what you can to stop SARS-COV-2 from spreading.

Though I do not, even remotely, consider myself an expert in this I have put together a summary of what we know so far.  

This new coronavirus—dubbed SARS-CoV-2—is unquestionably dangerous. It causes a disease called COVID-19, which can be deadly, particularly for older people and those with underlying health conditions.  All that said, SARS-CoV-2 is not an existential threat. While it can be deadly, around 80 percent of cases are mild to moderate, and people recover within a week or two.  Those with mild disease tend to recover in about two weeks, while those with more severe cases can take three to six weeks to recover, according to WHO Director-General.

On average, it takes five to six days from the day you are infected with SARS-CoV-2 until you develop symptoms of COVID-19. This pre-symptomatic period—also known as “incubation”—can range from one to 14 days.  The most common symptoms are Fever (88%), Dry Cough (68%) diarrhea & abdominal pain (touted now to be a common first symptom) and shortness of breath, which would need immediate medical care.

 A crude calculation puts the Case Fatality Rate around 3 percent, but this calculation will likely drift throughout the outbreak.  There is a possibility that the CFR might be lower as more asymptomatic or mildly symptomatic patients are diagnosed.

This is a link to the latest stats 
https://www.aapiusa.org
https://ncov19.wiki/

As physicians we are in a dilemma whether to close our practices.  
We are here to serve our sick and will have to be available for those in need.  I want to share a few tips that I have incorporated in my office with consultation of our infectious diseases specialist.  Some of this you might be doing already.

1. Limit your patients to only the ones that have to be seen.  Reschedule others at least a month away.  (If your state is in lock down then you might have to send them to ER and rely only on telemedicine).

2.  Have your receptionist call all your next-day scheduled patients and have them read a scripted note asking them if they have dry, cough, fever, shortness of breath or have come in contact with anyone who have these symptoms and if so, reschedule their appointment and have them contact their PCP or Flu clinic.  Let everyone know and add that to your after-hours message that you will waive any “No-Show fees” even if they cancel without notice.

3. Rapidly incorporate telemedicine in your practice   We can bill for this at a regular office visit codes and also can use media that might not be fully HIPPA compliant devices (Check with your EMR/Billing service they may have put one in place).  If you need help getting this set up please text back and I will refer you to one that I am using that is easy to use and HIPPA compliant. 

Please click on this link for latest updates on telemedicine
https://www.nixonlawgroup.com/covid-19-telehealth-and-rpm-resources

4. Treat every patient as if he has the virus. Try to keep a distance from your patients when talking to them.  Wear a N95 mask if you come in close proximity to the patient (CDC now has said that if you are not dealing with an active case you may wear a regular mask as N95 masks are getting harder to find).
Here is the link to CDC for latest updates
https://www.cdc.gov/coronavirus/2019-ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html

5.  Wipe down the exam room tables and chairs with bleach wipes after each patient visit.  Wipe the exam room chairs, doorknobs and other frequently touched surfaces at least every hour.

6.  Use hand sanitizers liberally before and after seeing any patient.  Keep hand sanitizers available in all rooms. (Be careful these tend to disappear these days)

7. Encourage patients to come to the office without any accompanying person, unless absolutely necessary

8.  And above all instill discipline and sense of attention to detail in your support staff.  Tell them to practice self-quarantine during after-office hours and avoid public places.  They should be vigilant when shopping for essentials and use extra precautions.  Let them know that if one gets the virus the office will have to be closed and it is in their combined interest that we continue to function and continue getting our paychecks.

This is the email that I am sending all my patients:

1.  Our office will be closed on Mondays and Fridays. If you have an appointment scheduled on those days between March 24th and April 24th, 2020, we will call you to reschedule it or conduct the visit via telemedicine (details will be explained to you by our receptionist). 

2. We will be rescheduling annuals, follow-ups and non-urgent appointments until April 24th, 2020. 

3. If you need medication refills please leave a message for us and we will refill your prescription so that you have enough to get you to your next appointment.

4. We encourage to come to your appointment alone.  If it is not possible we will limit to one accompanying person per patient and, unless absolutely necessary, we will have them wait outside and not come into the exam room with you.

5. All patients and visitors must sanitize their hands at arrival.

6. All patients and visitors who accompany the patient to the exam room will have their temperatures taken.

As always, if you are experiencing cough, shortness of breath, difficulty breathing, fever and/or flu like symptoms, please reschedule your appointment.  We will waive any “No-Show Penalty fees”

Print this and place in your reception areas.

• Wash your hands often for 20 seconds with soap and water
• Do not touch your face
• Practice social distancing
• Cover your coughs and sneezes
• Limit travel to that which is ESSENTIAL
• If you do feel sick, stay home and contact your doctor or flu clinic 

So my simple take on this is to remain vigilant and calm. 
Hope this helps.  I would welcome any of your suggestions and feedback.  

Best regards,

Amit Chakrabarty, M.D., M.S., F.R.C.S., F.I.C.S.