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 In HearSway

As the coronavirus hits home here in Moore County, we all have questions. So we reached out to FirstHealth and asked for answers. Dr. Paul Jawanda, Infectious Disease Specialist, provided them.

Dr. Jawanda, an Infectious Diseases specialist, was Moore Regional’s 2008 Physician of the Year.

Q: Is there really a way of knowing how many people have coronavirus in Moore County?

In short, no. As testing expands in North Carolina and other states, we will get a better idea of how many people are infected and how COVID-19 may be spreading in communities. The World Health Organization has announced COVID-19 as a pandemic, and one gets the sense that the COVID-19 activity in the United States has not yet reached its peak.

IF there is a confirmed case in Moore County, the Moore County Health Department will make that announcement.

Q: Could I spread it without knowing it?

We know that people are contagious when they have symptoms. Whether the virus can be spread before someone has symptoms is being considered. 

Q: Would I know if I have the cornavirus?

The new coronavirus causes symptoms like the flu (a cough that may or may not be productive, fever, and shortness of breath). It typically causes mild to moderate respiratory illness.

Symptoms may appear 2 to 14 days after exposure (median 4 days). Most people with COVID-19 have mild symptoms that do not require hospitalization, although some experience severe illness requiring hospitalization. A minority require ICU care, with some estimates of mortality risk being roughly 2 percent.

Q: Since coronavirus presents as the regular flu, how do you decide who to test? 

That’s the rub, isn’t it? As of this writing, North Carolina has 15 confirmed cases of COVID-19 and is not currently experiencing widespread activity. We are still experiencing significant influenza activity, as well as illness from other respiratory viruses (RSV, rhinovirus, enterovirus, others).

This is a fluid epidemic. Testing is becoming more widely available. Certain national reference labs are offering testing. Real-world current availability is such that there should be ongoing criteria for who to test. 

You do not do yourself or your community a favor if you walk into a health care facility and request COVID-19 testing because you have a runny nose and a hunch it could be coronavirus.

Q: OK, So who should be tested?

The NC Department of Health and Human Services has expanded testing criteria and suggests that only those who meet the following criteria should ask their doctor or local health department about being testing for COVID-19 through the NCSLPH: 

  • 1) have fever (temp >100.4°F) or lower respiratory tract symptoms (cough, shortness of breath) and close contact with a confirmed COVID-19 case within the past 14 days, or
  • 2) have fever (temp >100.4°F) and lower respiratory tract symptoms (cough, shortness of breath) and a negative rapid flu test.

The current priority would be hospitalized patients, as well as those with symptoms and known exposure to a case of COVID-19. As testing becomes more widely available, and as guidance changes, doctors’ approach to testing and screening will evolve.

Q: What happens if the outbreak spreads to Moore County? Are we prepared?

With this pandemic, we all have responsibility to our friends and neighbors to use social distancing to interrupt transmission of COVID-19. We’ve already seen the cancellation of several events, which indicates people are taking it seriously.

FirstHealth has implemented visitor restrictions, and testing for the novel coronavirus can now be conducted by commercial laboratories in North Carolina, expanding opportunities for testing.

Q: What is the coronavirus test?

The NC State Laboratory of Public Health (NCSLPH) is using the test kit developed by the Centers for Disease Control and Prevention. This test kit contains specific reagents for polymerase chain reaction (PCR) detection of the novel coronavirus, which works by detecting genetic segments unique to the new coronavirus.

As of right now, if there were a circumstance where a patient had medical indications to get a test for COVID-19, and NCSLPH testing was not available, the medical community that you depend on will make sure that you get a test.

Several days turn-around-time would be expected to get results. To send a sample to the health department, this involves the health care provider calling and discussing with the state communicable disease branch, getting approval, creation of an NC Patient Under Investigation (PUI) file, and applying the NC PUI number to paperwork submitted with the sample that is sent to the NCSLPH.

Q: If I get sick, what do I do?

If you have mild respiratory symptoms (like a common cold), practice social distancing. If you have symptoms of fever, cough and shortness of breath and need medical evaluation, then it is important that you call ahead before visiting your doctor, the ER or a convenient care/urgent care clinic.

Health care providers are also collaborating on how to best test individuals, which involves considering risk to others in the waiting room, as well as avoiding the risk of infecting nurses and doctors. In past outbreaks of other “novel” coronaviruses (SARS in 2003; MERS, initially seen in 2012), health care workers were disproportionately affected, ultimately limiting the availability of medical care to those in need.

Emergency room time is valuable for those in need in our community, and we want to be careful that those with minor symptoms and concern don’t seek care in the ER.

NCDHHS has established a coronavirus hotline with access to a nurse and general questions about coronavirus. The number to call is (866) 462-3821.

Q: What procedures are in place if someone in Moore County tests positive for the coronavirus? 

If that person is acutely ill and needing hospitalization, they would stay in an “Airborne Infection Isolation Room” (AIIR). They would also receive all indicated medical treatment. Along with a health care worker wearing necessary personal protective equipment, an AIIR helps decrease risk of an infection being transmitted through the air.

Most individuals with COVID-19 would be able to recuperate at home, and isolation as well as counseling would be overseen by the county health department.

Q: How do I protect myself and others in Moore County?

Coronaviruses like COVID-19 are most often spread through the air by coughing or sneezing. It quite likely can also spread through close personal contact (including touching and shaking hands). Here’s what you should do:

  • Wash hands frequently with soap and water for at least 20 seconds
  • Avoid touching your eyes, nose and mouth with unwashed hands
  • Avoid close contact with people who are ill
  • Cover your mouth and nose with a tissue when you cough or sneeze
  • Do not reuse tissue after coughing, sneezing or blowing your nose
  • Clean and disinfect surfaces that are frequently touched
  • Don’t wear a face mask if you’re healthy.
  • Do wear a face mask if you’ve been diagnosed with COVID-19 or other respiratory illness, like the flu, to protect others from getting infected. 

Q: Kids are germ factories. As a parent, how can you keep your school-aged child safe? 

As of this writing, North Carolina students do not need to be kept out of school due to COVID-19 concerns. The Division of Public Health is closely monitoring the situation and will work with school systems around the state to protect the health and well-being of students. 

Parents should encourage children to follow common-sense measures such as washing their hands frequently, covering their mouth and nose with a tissue when they cough or sneeze and avoiding contact with people who are ill.

Public officials will continue to consider this question.

Q: How long will the COVID-19 outbreak last? 

It’s unclear at this point. We appreciate that this is a new virus, just discovered and described three months ago. We will continue to look for guidance from the CDC and NCDHHS.

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