Answering Your Questions About What To Do If You Start Showing Symptoms

Stan Bunger
April 09, 2020 - 12:21 pm
Doctor With Stethoscope

As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic. Every morning at 9:20 a.m. Monday-Friday we're doing an "Ask An Expert" segment. Each day we'll focus on a different aspect of this situation. 

Today we spoke to Dr. Jahan Fahimi, director of UCSF Emergency Medicine, all about what you should know if you start developing symptoms.

Q: You must be bombarded with questions daily. Do you find that people are having more questions as we are going along or fewer?

That’s a really good question I think that initially there was a lot of uncertainty and a lot of questions. I think people were in some ways a little bit panicked and were rushing to the ER to get tested, to be evaluated. I think people have calmed down for the most part and realized that the best source of information might just be to watch the news, talk to their doctor, do a little bit of reading online. 

But showing up to the ER right away with symptoms doesn’t seem to be the right answer for most folks. I think people realized that you don’t want to unnecessarily show up to the hospital or to a healthcare setting if you don’t have to at this time.

So I think people are turning to the news, programs like this to get information and get a sense of where things are at and what they should be worried about. 

Q: There have been these anecdotal reports from all over the country that emergency rooms have become rather quieter places - fewer traumas, fewer walk-ins. Is that going on from where you sit?

Yes that’s absolutely true, I think there’s a couple of things that’s driving that.

The first is the shelter in place orders make it so that people stay home, and when you stay home perhaps you’re a little less likely to be out and get injured, fewer car accidents as a result of decreased traffic. I think there are people who maybe pre-coronavirus would have thought ‘I’m having a complaint, maybe I should get it checked out right now’, would think twice about that right now and call their doctor or perhaps use something like telemedicine, video visits in order to get evaluated. 

The other part of it I think is also that we have been very intentional about trying to keep people out of the hospital to the extent possible. So fewer surgeries, fewer procedures. Trying to get the hospital empty and prepared for a potential surge. And overall decreasing the amount of traffic through the hospital is inevitably going to result in decreased visits to the ER.

Q: Let’s get to some of these listener questions, sent in via email to askus@kcbsradio.com. What do you do if you think you’re experiencing beginning or minor COVID-19 symptoms?

At the first symptom of something you are worried about, I would highly recommend trying to check in with your regular doctor. If you don’t have a regular doctor there are lots of urgent care options around the Bay Area, many of whom will now offer video visits. That would be the first place to start in my opinion.

It is also allergy season and I know that many people have confused their symptoms. Something they would have attributed to allergies a year ago, now causes a little bit of anxiety because it’s hard to know. So I think that’s why it’s important to get it vetted by a healthcare professional. 

By no means should you rush to the hospital if you think you might have early COVID-19 symptoms if you’re not having severe symptoms. If its a scratch in the throat, a dry cough, maybe even a low grade fever these are perfect symptoms to bring up with a doctor via telephone or video visit. And if its decided that you need to get testing, then you can be referred into a place to get a test performed. 

Q: Does anything we do at home to treat symptoms prevent escalation, and of course the scenario nobody wants to see, an ICU visit and intubation?

Once somebody has the infection I’m not aware of any home remedies or best practices at home to try and prevent the progression of that illness.

I think if you have been diagnosed with COVID-19, all the more reason for you to be to be in touch with your physician, to be following your symptoms closely at home, probably every day or every other day be checking in to kinda see how things are going. And for any worsening of symptoms you may need to be referred into the hospital.

But for those that haven’t been diagnosed, the number one thing that you can do is stay at home to the extent possible. If you do have to go out, wearing a face covering is good practice - a mask if you have it - and lots and lots of hand washing.

Q: Let’s talk about fever - is a high fever emblematic of COVID-19? Is any fever? Are there people who have COVID-19 but don’t have a fever?

Yes. So, what we know is that about half of folks who present with COVID-19 to the hospital won’t have a fever at the time of arrival. Now, most will at some point go on to develop a fever, but the absence of a fever does not rule out COVID-19.

Now that being said, the degree of fever or the pattern of a fever - I don’t think these are predictive of COVID-19 infection. So I think if someone has a fever without an obvious other explanation for that fever, then that’s something that we would want to take seriously - again, checking in with your doctor, getting in to see somebody. But I don’t think that necessarily a high fever or low grade fever helps me differentiate between who might have it and who might not.

Q: So if you have one, are there things you definitely shouldn’t or definitely should be taking, in terms of over-the-counter or home remedies?

The number one thing is to stay very well hydrated, plenty of fluids, plenty of water.

Tylenol, or acetaminophen, is considered to be probably the safest medication you can take to decrease the fever and make you feel a little bit better. 

Ibuprofen - medications like Advil or Motrin- those can also be taken, however, there’s a little bit of controversy about whether or not that medication in particular - how it might interact with the virus. That being said one dose, two doses I don’t think is a particular concern.

I think if someone has been diagnosed with COVID-19 and they can manage their symptoms with just taking acetaminophen or Tylenol, that would be preferable. But I think taking a dose of ibuprofen now and again is probably not going to hurt, if that’s what’s necessary to manage the fever. 

Q: Let’s talk about cough - does the cough go to dry to wet with pneumonia?

As with fever, it’s not like there’s one particular brand of cough that is emblematic of the coronavirus infection. The classic description has been the dry cough as a presenting symptom, and certainly this can turn into more of a productive or wet cough. But I don’t think that is criteria that any of us would use to decide whether or not someone has a COVID-19 infection.

I think if somebody has a cough - certainly a cough with fever or other symptoms - the chest x-rays helps us a lot. We’ll be able to see if there’s early signs of pneumonia on the x-ray and if we see that, that definitely triggers us to want to get a test.

Q: That test now - in a clinical environment - how fast do you get the results back now if somebody is being tested in the hospital?

If somebody’s being tested in our hospital, we sort of have two speeds at which we can do the test and this is probably true for many places.

The fast turnaround time is usually in the order of hours. So some facilities will be able to do it in as fast as two to three hours, in some cases it might take as long as eight to 12 hours.

Many listeners may have heard about these very very rapid 15-minute tests that can be done and those do exist. We at UCSF are currently evaluating them. The thing to keep in mind is that no test is perfect, so just because you take a test and it comes back negative does not necessarily guarantee that there’s no infection. And some of these faster turnaround time tests, we worry, are less accurate than the ones that might take a little bit longer. So the ones that take a few hours, we think are more accurate than the ones that many provide results in a matter of minutes. So that’s an important caveat to know as people talk about these rapid tests or at some point people have been talking about doing home tests. We need to validate if these are accurate before we start allowing people to take them.

The second speed of tests - there’s a longer version of the tests which takes a few days to come back. And the reason for that is because we only have a certain amount of capacity for testing inside our laboratories. So once we exceed that, we then have to send the samples to outside laboratories and so it will take longer for those test results to come back.

And the way we determine who gets a rapid test versus who gets a test that might take a day or two to return, depends on the risk. If someone is being hospitalized, we want to know the answer right away. If someone is a healthcare worker we definitely need to know the answer right away. Certainly if someone lives in a household with lots of other members who are potentially at risk, somebody who’s immunocompromised, those are people that we need to know the test results right away. We’ll try to get those within a few hours. 

Q: Back to the cough - should you take over-the-counter cough medicine? Does it prevent progression to pneumonia?

No, in this scenario any of home remedies or over-the-counter medications just to suppress the cough are not going to change the disease course. If it’s going to progress on to a more severe pneumonia, then it’s going to progress on to a more severe pneumonia.

Q: Over the years a lot of people have been told to take a look at the color of their phlegm. Is it typically clear? Should you look for some color?

The color of phlegm traditionally has not been a very good predictor of whether somebody has a little bronchitis or viral infection versus bacterial pneumonia.

Certainly as the disease becomes more severe, we may tend to see a cloudier phlegm, occasionally streaks of blood. These are not atypical findings from more severe disease.

But just because somebody has a clear phlegm does not exclude a COVID-19 infection, especially early on in the course.

Q: A lot of questions about what level of difficulty breathing is a matter of concern. People who have had asthma or COPD may have one feeling about that, those who haven’t may not know. Is there a good way of putting in words what compromised breathing or difficulty breathing feels like? A test you can give yourself?

My advice would be generally that if somebody gets up to walk around their own home and feels significantly winded by doing an activity that would have been otherwise very very easy, they wouldn’t have thought twice about it - so walking around the home, sometimes even having a prolonged conversation, just talking vigorously for a minute or two causes someone to feel winded - these might be concerning symptoms, and that might be something where I would recommend in-person evaluations.

Q: People are asking questions about what I should have on hand, so any recommendations regarding thermometers, pulse oximeters - are those useful?

I think the pulse oximeter could be of value in somebody who is diagnosed with COVID-19. But I think if you otherwise don’t have symptoms then I think that there is  little utility to having that. Quite honestly that’s the kind of thing where you’re just going to be looking at a number in isolation. What is the oxygen saturation - that doesn’t provide me with much information.

But if someone has been diagnosed with COVID-19 and has mild to moderate symptoms, at the discretion of their physician you may want to have a pulse oximeter if you can get one just to track the progression of the oxygen saturation in the blood. That could have some use, although not routinely.

A good thermometer is a great thing to have, I know they’re very hard to find nowadays. But what I would say is everyone should have a thermometer and know how to use it. 

Just for listeners reference, in healthcare we consider 100.4 to be a fever. So below that - if somebody has a temperature of 99.9 we don’t considered a fever. It may be that if we check again in an hour it’s going to go higher, but I notice frequently that patients start to feel worried when temperatures hit 99. And I just want to reassure people that those low grade temperatures are something to keep an eye on but not particularly worry about.

Q: Two people have asked about ivermectin - this is an anti-parasitic used in both dogs and humans and it’s been FDA approved for those purposes. The question was, what’s the process for repurposing such drugs for off-label use?

There’s a lot of interest right now in off-label use for a lot of different medications. Studies need to be done before we can make any recommendations about these drugs. And so I don’t know of any data that suggest ivermectin has any efficacy in treating COVID-19. That doesn’t mean that there aren’t studies aren’t being done, and it doesn’t mean that if those studies were positive that it wouldn’t subsequently get FDA approval. But that process takes some time. Doing high quality research in order to get at the truth of whether a medication works, going beyond anecdotal evidence takes time if you want to do it right.

Q: This person wants to know, what percentage of people who wind up on a ventilator survive?

That number is highly variable. In a place that is completely overwhelmed by the number of cases coming into the hospital, that number is going to be lower. When you have a workforce or healthcare system that is completely stressed, that can’t provide really intensive monitoring to patients who have a severe COVID infection the mortality goes up and the likelihood of being taken off a ventilator goes down.

In facilities - and this is the case currently in San Francisco and at our hospital UCSF - patients that get put on a ventilator, we’re having pretty decent success in getting them off of a ventilator. And it’s because we are paying very very close attention to every single COVID-19 infection in the ICU and we have the manpower and bandwidth to be very very mindful and attuned to each individual patient. 

Speaking to colleagues in New York, they don’t have that luxury. When the system is completely overwhelmed, patients don’t get the same level of scrutiny and moment-to-moment monitoring that we can provide here right now.

And this just completely underscores the importance of social distancing, it underscores the importance that we slow down the spread of this infection so that when people do get it and they come to the hospital, we are not overwhelmed. We have the luxury of time and preparation to take care of everybody very very carefully.

So the percentage is highly varied depending on the overall number of cases. Generally speaking, people have been floating this number of about 50% of people will get off of a ventilator, but again that number remains to be seen when get more data.

Q: My 22-year-old niece has been sheltering in place with a friend in Chicago after going there a month ago for a now cancelled project - a lot of people have been caught up like this - she needs to be home for some medical diagnostic tests in May. We’re weighing the risk of virus exposure in transit to postponing those tests. 

She’s been careful about any outside activity but at least gets out to walk the dog. If she gets home anytime soon, would she need to be quarantined for two weeks and if so, suggestions from the medical field?

This is a tough question. I think if you’re in a place like Chicago where there’s more transmission of the COVID-19 infection than there is here in the Bay Area, then you need to be careful.

Now if someone has really truly been isolated and sheltering in place and anyone they’ve come in contact with has also been appropriately isolating themselves, then perhaps they’re out of the window. And you could say you successfully have observed yourself through this process and you are at very low risk, so maybe you’re in the clear.

The traveling part is going to pose another wrinkle here. So you get on a plane and you fly here - and I assume the question is, does that person then need to quarantine for two weeks - I can’t necessarily provide strict guidance. I think that when somebody does travel - whether they travel or not - they should be isolating to the extent possible.

Certainly if I were to get on plane and fly someplace right now if I had to, I would be extra mindful about watching my symptoms for a couple of weeks, just to see if I picked up anything during that period of travel. I would absolutely wear a mask and probably gloves and bring sanitary wipes to wipe down the surfaces on the plane. I would absolutely not touch my face to the extent possible and do lots of hand-washing.

Q: I don’t want to overwhelm the system but I want to be safe. At what point do I call the doctor or go to the ER?

If you have access to a doctor, to urgent care - if you have concerns, if you have fever, cough, unexplained body aches, new or severe headaches, those kinds of things, 

certainly we’re now realizing loss of taste and smell for some people, loss of appetite, or GI distress might be a presenting symptom - if you’re developing any of those symptoms, I think it’s reasonable to call your doctor, get on a video visit, check in at an urgent care online and get an initial evalulation and see if you need to be tested.

The people I want to see in my ER are people who are having trouble breathing or having more severe versions of those same illnesses that can’t be managed by a doctor as an outpatient, that can’t be managed at home. I want to see people who are having difficult breathing. Certainly if anybody is having bluish lips, feeling faint or like they might pass out, those are things I’m concerned about and I’d like to see those patients.