Dr. Lindsay Carter, Devoted Health medical director, answers member questions about coronavirus. This Q&A was recorded on March 27, 2020.
Because the situation changes daily, details and tips about coronavirus in this recording could already be outdated. Check the CDC website for the latest information.
[Kristen Hipp, Moderator and team member on Devoted Health]: Hello and welcome to the coronavirus Q&A with Dr. Lindsay Carter the Medical Director here at Devoted Health. My name is Kristen, and I'm on the Devoted Health marketing team.
We're very fortunate to have. Dr. Carter speaking with us today. Dr. Carter is the Medical Director here at Devoted Health. She received her MD from Harvard Medical School and her MBA from Harvard Business School. She's been practicing medicine for eight years and also teaches at Harvard Medical School. For today's session, Dr. Carter will give a quick overview of what you need to know about coronavirus, and then she’ll take questions. You can feel free to start typing in your questions at any time.
If you've joined us for one of our other coronavirus Q&As, this will be a very similar format with plenty of time to ask your coronavirus questions. And just as an announcement, we will also be holding regular webinars on new topics. So stay tuned for details on those.
Before we begin, let's go over a few notes on how to best participate in today's event. Your microphone will be muted during this QA. When you want to ask the question, click on the chat button. This may be located at the top or bottom of your screen. A chat box will appear. Type in your question and hit enter.
While we hope to answer as many questions as possible, please provide your name and phone number with your questions so we can follow up with you if we don't get your question during this time.
A technical note as well: since we at Devoted Health are all doing our part to stop the spread of coronavirus by working from home, our internet maybe slightly spotty. We apologize in advance for any audio drop offs. If audio is cut off we'll do our best to answer the question again. For your privacy, please do not share any personal health information. When you ask your questions, if you have any specific health questions about your personal situation, call our guides at 1 800-DEVOTED. That's 1-800-338-6833. If you think you're exhibiting symptoms of the coronavirus, we recommend calling your primary care doctor as soon as possible.
Now, I'm going to hand it off to Dr. Carter to get us started.
[Dr. Carter]: Thanks so much Kristen. My name is Lindsay Carter and I want to thank you all for joining us today. I'm going to first speak a little bit just generally about coronavirus and ways you can stay healthy and what to do if you start feeling sick, and then we'll open it up to questions, as Kristen said.
So the coronavirus and the disease it causes, COVID-19, represents an extraordinary new kind of challenge for all of us. We at DEVOTED are committed to caring for you like family, and so we hope to do everything we can to help you through this challenging time. I hope this webinar and the opportunity to ask questions will be helpful to you all.
I'm going to start by talking about COVID-19, more generally why we worry about it and how you can help prevent transmission and then we'll open it up for questions. And just a quick note, I'll use the terms coronavirus and COVID-19 interchangeably.
So COVID-19 is the name of the disease caused by a newly recognized Coronavirus. Coronaviruses are viruses that typically cause mild upper respiratory illnesses like the common cold, and this new coronavirus is causing a range of respiratory illnesses from mild flu or cold like symptoms, to more serious respiratory illnesses, and in rare cases, death. The most common symptoms that people have include fever, cough, and shortness of breath.
We worry about this new coronavirus because it tends to cause more severe symptoms like a severe pneumonia or severe breathing problems in people who are older - anyone over 65. but especially those over 80, and in those with chronic medical problems, like chronic lung disease such as COPD or asthma heart disease and diabetes. So if this sounds like you it's especially important to take extra precautions to spread to prevent the spread of the virus. The best way to prevent illness is to avoid being exposed to the virus. The virus is thought to spread mainly from person to person through respiratory droplets. which are produced when an infected person coughs or sneezes. This happens mostly when people are in close contact with each other -within six feet. You can also get infected if you touch a surface that's infected and then touch your mouth, your nose, or your eyes and spread it that way. The best way to prevent being exposed to the virus is to stay at home and limit contact with others.
By now, I'm sure you've heard a lot about the idea of social distancing and this is really crucial, and it’s the only way that we're going to slow the spread of the virus. It means that you need to avoid any unnecessary contact with people outside of your immediate home. And yes, in the strictest sense, which is what we are currently recommending, that means even visits from family members who are outside your home as well. It means that you can go out when absolutely necessary to get food or to go to necessary doctor's appointments, but we also want you to think about ways to minimize these things as much as you can.
We want you to rely on delivery services or having your family drop things off for you. We also want you to speak to your providers about canceling or postponing anything that might be non-essential or routine or any elective procedures. Many providers are now doing telephone or video visits and these are an excellent alternative right now. You should all call your provider to find out if they're doing these so you can continue to get your routine care that way.
It's also important of course to practice really good hygiene practices. So a few things - this means wash your hands often with soap and water for at least 20 seconds, especially after you've been out or after blowing your nose, coughing or sneezing and definitely before eating. If soap and water are not available, we recommend using a hand sanitizer that contains at least 60 percent alcohol. It's also important to clean and disinfect surfaces in your home daily. And especially those that are high touch surfaces that multiple people might touch.
Disinfecting means that you try to kill the germs by disinfecting and cleaning that way, and the CDC website has an excellent list of products that are effective at disinfecting the coronavirus, and I recommend people to check out that website, cdc.gov to see if their specific product is listed there. generally speaking things like Lysol and Clorox products do tend to work effectively against the coronavirus, but again for specific details on your specific product, I do recommend checking out the CDC Centers for Disease Control website to find out details.
There have also been a lot of questions about how to disinfect groceries and food. So I do want to spend a minute on that now as well since it's a question on everyone's mind. We're still learning about the transmission of this new coronavirus. It's not clear that it can be spread by an infected person through the food that they’ve handled or prepared. But to be safe, we do want to assume that that is a possibility and take good precautions. So the CDC is recommending thoroughly washing fruits and vegetables with warm water as the safest option. A lot of people ask questions about whether they can use other products to help clean. So if you're used to watching your produce with soap, which some people do, you can continue to do that, but I want you to take caution definitely not to ingest the soap. It's really important to make sure that you thoroughly rinse it so that you don't actually eat the soap, which could potentially be dangerous to you as well. So again copious amounts of warm water is what the CDC is recommending now. If you do choose to use soap just make sure you're really careful about rinsing thoroughly.
Another possibility that has come up a few times is white vinegar-based solution. Again, I want to be clear that this is not currently recommended by the CDC, but for people looking to do more, a solution with three parts vinegar and 1 part water is considered safe. And again you want to be sure that you're just rinsing everything thoroughly.
Cooking also kills the virus. We do have evidence that heat up to 133 degrees or higher will kill the virus. So your typical temperatures that you use to cook foods will do the job there. And just to be super clear, you don't want to use things like disinfect things [audio drops for a few seconds]
[Kristen]: Sorry to interrupt you Dr. Carter, but your audio was caught up cut out there. Would you mind going back to talking about disinfecting sprays?
[Dr. Carter]: Oh, of course. So what I said was that you do not want to use things like disinfecting spray or wipes on your food. These are not able to be consumed, so you don't want to have them on your food.
I'm going to shift now and talk a little bit more about what to do if you feel sick. So if you feel sick, meaning you start to have symptoms of fever, cough, shortness of breath or any other respiratory symptoms, it's really important to call your doctor first before going anywhere like an Urgent Care center. Testing is limited and it's very dependent on where you live and what the local health scene is, so there's a good chance your doctor will want to talk to you on the phone. As well as the fact that if your symptoms are quite mild, your doctor will likely recommend that you stay at home and treat it home instead of going anywhere specific for treatment like the hospital.
If you feel sick, it's also really important that you stay at home until you feel better to help prevent a transmission of the virus. So that means for at least 72 hours after your fever has gone away and at least seven days since the symptoms first started. So for many who end up getting sick and having symptoms, this means that you would need to stay at home and not be exposed to other people for about two weeks even three weeks sometime.
You should quarantine yourself if you know you've been exposed to a known case of coronavirus, and the recommendation is to quarantine for 14 days because sometimes it takes that long for symptoms to show up.
So at this point, I'll pause and I'm going to open it up for questions. And just a brief recap before we get started with that: you can submit your questions by clicking on the chat button. Please do include your name and your phone number, so in case we don't get to your question, we will be able to follow up with you. And again, please do not submit any personal health details through this platform. If you have any questions about your personal situation, we'll be happy to talk to you at 1-800-DEVOTED. Without further Ado, We'll go to the questions.
[Kristen]: Thanks so much. Dr. Carter. As Dr. Carter said, please don't hesitate to enter your questions into the chat bar and we'll get to as many as we can.
So the first question we have is “do the surgical masks help protect against the transmission of the virus?”
[Dr. Carter]: Great question. The mask question is one that comes up a lot, and a lot of people are curious about that. So masks are not proven, surgical masks specifically which are the ones that you see, they are not proven to help to protect you from getting the virus. So if you're otherwise healthy and you don't have symptoms, the surgical masks are not proven to help protect you from getting the virus. That's because the mask doesn't fit snugly against your face. So because the viruses can be airborne, the virus particles can still get through. So surgical masks are not recommended.
As a prevention measure surgical masks are however recommended for people who are exhibiting symptoms, so that they can help prevent transmission to other people. So if you're feeling sick or anyone in your home is feeling sick, a surgical mask can be helpful if that sick person wears them to help prevent other people from getting sick.
[Kristen]: So one question that is probably high on people's minds is what should we do if we have symptoms?
[Dr. Carter]: Yeah great question. So if you have any symptoms at all, best thing is always to call your primary care provider. They know you and your specific Health situation the best. Of course as mentioned, many Primary Health Care Providers are now offering Telehealth and so they'll talk to you over the phone instead of bringing you in for a visit, and that's really important. We want to minimize having people go into the office. If you're unable to reach your primary care provider, we are always available for you at 1-800-DEVOTED, and we have a team of nurses that's ready to talk to you and make sure that you get the care that you need.
So the first stop should be trying to get in touch with your primary care provider, but then we are always here for you as well. I want you to call 800-DEVOTED if you're unable to get through or you have any further questions or concerns that weren't answered by your provider, we would be happy to help you as well.
[Kristen]: It looks like one of the hot topics is, and you kind of touched upon it in your introduction, but people are concerned about whether or not they can go visit family or they can have them visit them. Can you talk a little bit about that?
[Dr. Carter]: This is a really hard one, and it's very difficult to give this suggestion. But the social distancing in the strictest sense means that you should not be exposed to anyone who's not in your immediate household. So unfortunately for many that means not being able to have their children or grandchildren visit, and I think that really is the safest thing for right now. And the reason why that's really important is because people can either be carrying the virus on their own on their hands or their clothes or they could be carrying the virus actually themselves and are about to get sick in a few days, but they're not they're not yet exhibiting symptoms.
We think it actually takes between 2 and 14 days for someone to get sick after they were exposed. The average time is usually somewhere from 5 to 7 days, meaning after the exposure you would get sick 5 to 7 days later, but that can be variable, and there has been evidence that people can be contagious for a few days even before they start having symptoms. So that's why it's really important to be strict about about distancing. And it's so difficult to do this, especially with family members and I wish this weren't the advice that was given. I'm giving the safest thing at this point, especially if you're older and you have chronic medical conditions that put you at slightly higher risk of being sicker, the safest thing to do is to limit your contact to the people in your immediate household.
The hope is that of course this is not forever and that's really important to remember. But for right now, while we're really worried about the disease being spread, it's the safest thing to do is to limit contact.
You know, we're talking about social distancing as being really important, but that doesn't mean social isolation. So it's really important that if you can't see your family in person that you figure out ways that you can stay in touch. And now fortunately with technology these days we have a lot of options to do that. I just strongly encourage everyone to practice good social distancing but not social isolation.
[Kristen]: One of our members is asking about having someone come to their home to help with chores and errands. Should they still have those people come and help them?
[Dr. Carter]: This is a another another tough one, and I think the answer depends on how dependent you are for those chores and tasks. So if it's something that is sort of a nice to have somebody come in and help you but it's not necessary, I would potentially delay that for a little while. So again if it's sort of a nice to have but it's not critical that you have that person coming in then it's best to delay that, but if it's something that you need that you can't do on your own and you really need that help, by all means you should keep having somebody help you. But it's important to make sure that you take extra precautions. So if it means it's just somebody for example who's dropping things off for you, have that person drop things off outside if they can. If they don't need to come inside your home then try to prevent that. If they do need to come in your home, that's okay. Just make sure that that person of course isn't having any symptoms - that's really important. And when they do come in it’s really, really important to practice excellent hand hygiene.
When a person enters a home make sure you're wiping down your surfaces like door knobs and things like that. Disinfecting some of those surfaces and making sure that everyone is practicing good hand hygiene, is really going to minimize your risk a lot.
So I think that the lens that you should think about this in is: is it necessary for the person to come? And if it is ,that's okay, but just think about ways to maybe minimize the exposure.
[Kristen]: Switching gears slightly. We received a question from a member who's interested in Telehealth and how much they'll pay for telehealth services.
[Dr. Carter]: Great, great question and it's on everybody's mind. We are covering Telehealth Services as if it were a regular visit. And so the co-payments that you pay for a normal PCP visit would apply.
[Kristen]: For those who might not know what Telehealth is, can you just briefly describe what it is?
[Dr. Carter]: Absolutely, and thank you. Telehealth is the broad idea that that you don't have to be in person to see your provider, and some providers use the term slightly differently. Your provider might just offer telephonic visits meaning, you know, you get on the phone with them at a specified time and you basically have a visit. Some providers are having more video-enabled Telehealth so that there are platforms that you can use to sign on and actually have a video conference with your provider. So a couple different possibilities and your specific provider may offer one or both of those. Again, a great option for you guys to continue to get your routine care as well as urgent needs during this time.
[Kristen]: One other question we received is people are wondering if they can't leave their house, how are they going to get their prescriptions?
[Dr. Carter]: Yes, so something on everybody's mind. So there are a number of ways fortunately that you can now get your prescriptions without going out to the pharmacy. So one way to do that is through mail order and if you are not familiar with mail order or you don't currently have that, we would be happy to help you with that. If you call 1-800-DEVOTED, we can help set you up with CVS Caremark for mail order.The nice thing about mail-order as well is you get 90 days of your prescription, and so it's nice to not have to worry about the refills quite as often.
So mail-order is one way. Another way to get prescriptions is that many local pharmacies are now doing local delivery. And so it's a good idea to call your local pharmacy to see if they are indeed doing local delivery. Again, if you're not interested in mail order, the local delivery is a good option as well. And so between those two options, there are really great ways for you to be able to get your prescriptions now in your home without having to go out.
[Kristen] For people joining us today, please don't hesitate to ask any and all coronavirus questions that you have. Just type them in the chat box and we'll get to them as soon as we can.
So the next question is, and I feel like this is kind of something on everybody's mind as well. Is it safe or advisable to go outside and get fresh air?
[Kristen]: Absolutely, and not only is advisable, it is recommended. So, you know, it's super important that everybody gets outside for some fresh air. It not only feels good, it's also just good for your health and to stay active. Socially distancing does not mean you have to stay in your home. So if you're able to get out, and I recognize that that might not be everyone, but if you're able to get out, I definitely recommend getting out of the house.
Going for walks is perfect. Just be sure that you practice the recommended social distancing. So you want to stay about six feet away from people as you're passing them, and I think you'll find that a lot of people are really serious about that and are taking caution on the sidewalks and the streets. So absolutely get out. Just remember to continue to practice safe social distancing when you do that.
[Kristen]: Now my question is about getting supplies. It's safe to do takeout or go through the drive-through, and can you speak to the safety of those ways you would get your food?
[Dr. Carter] I mentioned towards the beginning that we still are learning about the transmission of the coronavirus and it's not yet clear if coronavirus can be spread through food. We think the best thing is to just take take precautions, and if takeout and delivery for your food is the way that you need to get food, then and absolutely fine for you to do. But we want people just take to take precautions in doing so.
For example a few things you might think about: instead of actually greeting the person delivering your food, you might ask them to leave it outside on your doorstep. And then it's also important to think about the surfaces that may have been touched. So we do have some evidence that the coronavirus can live on cardboard boxes for up to a day. And so if you're getting delivery, usually they'll put it in something like a cardboard box or paper bag. You just want to think about the fact that that surface is potentially infected and take precaution that way. Maybe you take the inside contents out right away and make sure that the cardboard goes into the trash.
Again, and I'll underscore this over and over, just practicing really good hygiene is important, so even if you touch something that might be infected, it doesn't mean you're going to get infected. So the short answer is yes, it's safe to do things like take out, just be sure that you're thinking about just other ways to stay safe and to prevent transmission. And it’s important to think about just again limiting contact with people who might be delivering your food as well as just being cautious about the surfaces, and practicing good hygiene around that.
[Kristen]: Switching gears a little bit: do things like pneumonia or flu shot help prevent coronavirus?
[Dr. Carter]: Glad you asked and it's a great time to plug: if you haven't got your flu shot yet, it's really important to do so. And the short answer is no unfortunately the flu vaccine and the pneumonia vaccines do not prevent the coronavirus however, staying healthy and protected from those illnesses is really important because you’re potentially at risk not only for coronavirus but also for the flu. If you haven't been vaccinated, we want to prevent you from getting multiple illnesses and making sure that you stay strong and healthy. So those do not directly prevent coronavirus, unfortunately, we don't have a vaccine yet for coronavirus. But those vaccines [flu and pneumonia and other regular vaccines] are still really important measures to make sure that you're taking care of yourself and keeping yourself as strong and healthy as possible.
[Kristen]: Great, and this is actually a question that's sort of along the same vein. So we've been hearing in the news about potential uses of an anti-malaria drug. Does it hold any water?
[Dr. Carter]: I'm really glad you asked. There unfortunately is no treatment to date that has been proven to help treat coronavirus. There's a lot of studies that are ongoing right now to try to figure that out. One of the drugs that is being investigated is an anti-malarial drug that's been around for a time and so medical researchers are currently looking into that. As of right now there is not strong evidence that it does help prevent it, and so we do not recommend taking this malaria drug for prevention or for treatment of coronavirus. We hope to have information from these research studies soon. But right now there is no treatment that's proven. And there's no treatment that is recommended specifically with a malaria drug or another antiviral drug.
What it is recommended is the medicines that you would take just to help with symptoms if you were to get a cold or the flu, and I'll talk for a second specifically there. There is potentially a little bit of emerging evidence that things like ibuprofen or Advil might be associated with worse outcomes, meaning patients are getting sicker if they take those drugs instead of something like Tylenol. So if you do have a fever or aches and pains associated with coronavirus, we recommend that you take Tylenol, which is also acetaminophen, instead of ibuprofen or Advil. Again, if you are sick with symptoms of coronavirus best to stay on the safe side and use Tylenol or acetaminophen instead of ibuprofen. The only treatment at this point is just symptomatic treatment for any symptoms you're having, and we unfortunately do not yet have any specific coronavirus treatments.
[Kristen]: We received another question about if is there a way I can see how many people are affected in my area?
[Dr. Carter]: Many local state and county websites will have this information. So your best bet is to try looking on say for example, the Department of Health for Florida website or the department of Texas which are two areas for Devoted members. Your best bet is to look on those local Health Board websites that have the most up-to-date information. That information is not perfectly up to date, so I'll just caution you with that. And the other thing is as we all know, there's been a problem with the ability to get testing. So it's very likely that there are many more people infected with the virus in your local area than is being reported. So just take those numbers with a grain of salt.
[Kristen]: Along that same lines as what you just said, how is it possible that an asymptomatic person can affect somebody else?
[Dr. Carter]: Great question. So I think I mentioned a little bit earlier that the time period from an exposure to actually exhibiting symptoms ranges anywhere from 2 to 14 days with the average being 5 to 7 days. And so we found through some studies, especially through early experience and some of the countries who were hit earlier in the United States, is that people who didn't have symptoms actually did carry the virus and were infected with the virus, but just didn't have symptoms yet. And when those people were tested they actually did have evidence of the virus in their secretions or the respiratory droplets. So it's possible that you're actually passing along the virus without having any active symptoms and sometimes some people never really ever develop much by way of symptoms, especially young children really aren't getting very sick. So it's very possible that young children can be carriers as well, but not have any symptoms. And some older people as well are having very mild disease and are not showing much by way of symptoms. So it's possible that people just never present with symptoms, but the more likely scenario is that you just actually have the virus in your system for a day or two before you actually start showing the symptoms and that's when you can be asymptomatic but still able to spread the virus.
[Kristen] This question actually goes back to what we were talking about originally with visiting family and friends. But what can we do to fight an inevitable feeling of social isolation?
[Dr. Carter]: I mentioned previously I want us all to think about this as social distancing but not isolation. And I know that's easier said than done. But a few ways to think about that, with technology now, it's amazing what different places or groups are doing. And so, you know, there are a lot of different [audio cut for a few seconds]
[Kristen] Dr. Carter, your audio cut out there right at the beginning of your answer.
[Dr. Carter]: I'm so sorry about that everyone. Thank you for your patience. I'll start to from the beginning and I apologize. So what I'm saying is again to really encourage everyone to think very hard about that it's social distancing but not isolation. And we're lucky that we now live in a world where it makes it possible to actually still connect with each other, but not in person. A lot of different groups and places are doing really cool things on the internet.
So for example things like virtual opera or virtual music classes. I know that the Cincinnati Zoo for example has a tour every day at 3 o'clock, and we can sign on and see a tour of the zoo. There were lots of different things like that and I encourage you to talk to friends and family about different options like that. Classes that are now being offered online that you can do in your house and lots of different ways that you can stay active and engaged through online activities. And then of course, there's talking to family and friends, of course, you know, you can't see them in person, but you can always speak to them on the phone. Now, there are of course things like FaceTime with capability - there’s all different sorts of video conferencing technologies that you can connect with family members on and still talk to them and see them on the video. I think exploring a lot of those different options would be great.
I know also, if faith is important to you and you belong to a church, a lot of churches are doing online services as well. So there are lots of different ways that you can still stay connected with people and with various elements of society without being there in person. I recognize it’s really hard. I know. I'm saying this is easy, but we really are all in it together and the better we do early on, the more we’ll all be safer and healthier.
[Kristen]: This next question is a hypothetical situation.
[Dr. Carter]: We talked a little bit about just what the symptoms are. So I'll just review that a little bit again. So, you know most of the symptoms that people have, or the most common symptoms I should say, are the fever, cough and shortness of breath and 90-plus percent of people will have a fever. Shortness of breath I worry more about. The reason why we worry about more severe symptoms is pneumonia which impacts your ability breathe, and that's really what we worry about.
Red flag symptoms meaning to call your provider right away would be things like if you were having shortness of breath - really any shortness of breath that is different from your baseline is important. So shortness of breath is really important. Other things would be inability to eat or drink. If you're feeling really ill and you're just unable to eat or drink anything it’s a reason to call your provider. If you're feeling light-headed ,that might suggest that your blood pressure is low, and that will be a reason to call. And then of course any confusion or anything like that suggests that you're more sick as well. So for any of those things always touching base and calling your providers is important, and of course if you've ever feel that anything is emergency always calling 9-1-1.
[Kristen]: That brings us to the end of our member questions. So I just wanted to end it with where should people go to get the most up-to-date information about coronavirus?
[Dr. Carter]: Our website at devoted.com has continuously updated information. So that's a great place to go. We also get our information from authorities like the Centers for Disease Control and the World Health Organization. The Centers for Disease Control, which Cdc.gov is a great place to go for lots of up-to-date good information and is a really a wonderful place to go. We try to distill some of that down for you at our devoted.com site. And so I encourage you to head there for lots of information about ways to stay safe and for resources to call about questions about benefits. That's all on the devoted.com website, but the CDC site as well has tons of information if we don't cover it on our devoted.com website.
[Kristen]: hat brings us to the end of her Q&A session. Thank you so much. Dr. Carter and thank you to everyone who joined and ask such great questions. Thanks again for joining us and please stay safe.