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Telehealth and Prescriptions Q&A


Dr. Lindsay Carter, Devoted Health medical director, discusses telehealth, prescriptions, and coronavirus. This Q&A was recorded on April 2, 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Because the situation changes daily, details and tips about coronavirus in this recording could already be outdated.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.

Video Transcript

[Kristen Hipp, Moderator  and Devoted Health Team Member]: Welcome everyone! Thanks for joining us today for the Telehealth and Prescriptions 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 8 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, 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 questions.  And just as an announcement - we’ll also be holding regular webinars on new topics. Our next event is on Thursday April 9 with a topic of Staying Positive during a Pandemic. Following that, we will have a webinar on Friday, April 10 with a topic of how to safely get groceries in the FL area. And for our members in TX, we’ll be talking about how to safely get groceries the following Friday, April 17. To keep up with our schedule, visit devoted.com/coronavirus/webinars.

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 Q&A. When you want to ask a question, click on the “Chat” button. It 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 do not get to  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 may be slightly spotty. We apologize in advance for any audio drop offs. If audio is cut off, we will do our best to answer the question again.

For your privacy, do not share any personal health information when you ask your questions. If you have 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. Lindsay Carter]: Hi everybody. My name is Lindsay Carter and I want to thank you so much for joining us today. 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!

Before I get into the topics of telemedicine and getting your medications safely, I want to briefly discuss the coronavirus more generally. If you’ve been on our previous webinars this will be familiar to you, but it’s always good to review again. 

COVID-19 is the name of the disease caused by a newly recognized coronavirus (SARS-CoV-2). Coronaviruses are viruses that typically cause mild upper respiratory illnesses like the common cold. The new coronavirus is causing a range of respiratory illnesses, from mild flu- or cold-like symptoms (or even no symptoms) to more serious respiratory illness, and in rare cases, death. The most common symptoms that people have include fever, cough, and shortness of breath.

We worry about COVID-19 because it tends to cause more severe symptoms like severe pneumonia or breathing problems in people who are older (over 65, and especially those over 80) and in those with chronic medical problems, like chronic lung disease (COPD, asthma), heart disease, and diabetes. If this sounds like you, it’s especially important to take extra precautions to prevent the spread of the virus.

The best way to prevent illness is to avoid being exposed to this virus. The virus is thought to spread mainly from person-to-person through respiratory droplets produced when an infected person coughs or sneezes. This happens when people are in close contact with each other (within 6 feet). You can also get infected if you touch a surface that is infected and then you touch your mouth, nose, or eyes.

The best way to prevent being exposed 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 week, the governors of both TX and FL, which is where you all joining us on this webinar live,  issued executives orders to stay at home for the next month, allowing residents to go out only to obtain or provide essential services or conduct essential activities. This is really crucial and is the only way that we are going to slow the spread of this virus. Not only does it mean that you should stay at home, but it also means  that you need to avoid any unnecessary contact with people outside of your immediate home-- and yes, that unfortunately means visits from family members too. 

It’s also important to practice really good hygiene practices. This means: washing your hands frequently with soap and water for at least 20 seconds, especially after you've been in public places, before you eat, or after blowing your nose coughing, or sneezing. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. You also want to try 

Cleaning the surfaces in your home daily, especially high-touch surfaces like doorknobs, counters and tables. 

If you feel sick, it's really important to call your doctor first before you go anywhere like an Urgent Care center. Testing is still unfortunately very limited and is very dependent on where you live and the local Health Department testing guidelines. So there's a good chance  your doctor will want to talk to you over the phone and provide guidance. That way that's very important to prevent the spread as well. 

There is unfortunately still no specific treatment for the coronavirus.  [Audio drops for a few seconds and moderator Kristen informs Dr. Carter]

[Dr. Carter]: I'll start with just the part when you're feeling sick and I apologize if it's a repetition. So if you feel sick, it's important to call your doctor first before going anywhere like an urgent care Center. It's important to prevent spread by doing your part and staying home that way as well. 

There is unfortunately still no specific treatment but a lot of research is going on, which will hopefully give us some answers soon. Nothing that has been proven formally. It's also important that if you feel sick, you want to make sure that you stay home until you are better. This means 72 hours after your fever has gone away and at least seven days since the symptoms started. Then a general overall improvement in your symptoms, like cough. And for many this means that you might need to stay at home for about two to three weeks. 

We will have an opportunity to ask questions on all of this and more towards the end of the webinar, but for now,  I would like to transition to the topic of today's webinar, which is telemedicine and prescriptions. We've chosen these two topics because getting Medical Care and getting your medications safely can be challenging during this time. It’s critical to stay healthy and safe. 

Today we're going to talk a little bit just about what is Telehealth and telemedicine, why it’s useful and how you might utilize it. Then the second topic will be really more around prescription medications and obtaining those safely. 

Telemedicine is the diagnosis and treatment using remote telephone or video technology. Telehealth and telemedicine are often used interchangeably, but Telehealth typically includes more healthcare activities and services: things like remote patient monitoring. So for example, you might have a scale or a blood pressure cuff that  actually transmits information directly to your doctor. Or a smartphone app through which you can track your blood glucose level or any other data about your health. A patient portal would also qualify under Telehealth as well, where you might be able to directly reach out to your care team. 

Those are all examples of Telehealth, the broader term. Again, telemedicine is what we refer to more when we're talking about directly getting diagnosis and treatment through the telephone or video. 

Telehealth is useful for so many reasons. It lets you communicate with your doctors more often without having to depend on in person visits. It can definitely save time by cutting out the travel time that you need to get back and forth to your doctor, and it makes it easier and safer for doctors to see patients in certain situations. 

One example is if you live in a rural area and you don't have ready access to a specialist or a certain kind of doctor, it's a nice way that you're able to actually get access to those doctors. And then of course in the current coronavirus pandemic, Telehealth and telemedicine are crucial. It is safest to stay out of the office to avoid exposure to the virus and many offices have minimized in-person visits and have leaned heavily on Telehealth to be able to achieve this can keep everyone  safe. 

Accessing telemedicine is actually really easy. You can talk to your provider just like if you were there in the office, and there are very few requirements or steps. There are two types of visits to think about. One would be a pure telephone visit, for which you only need a phone, and your provider will basically call you at a designated time that you've set up with your provider. And then there are video visits and, for that you will need a smartphone or a computer - something that will connect to the internet. There are a variety of different platforms and programs that now do video visits. So it will very much depend on what your provider has chosen, but for most programs it's as simple as clicking on a link to enter a virtual waiting room. There isn't downloading or any account specifically needed. Again, it will vary depending on the program but many are as simple as that: clicking on a link that your providers send you. 

A lot of people have questions about whether their information is safe, and it's a good question. When platforms offer Telehealth, they do need to make sure that they are HIPAA-compliant which stands for the health insurance portability and accountability act. It ensures that all of your personal health information is kept confidential. There are also a lot of layers throughout these programs to help protect your information. Your identity needs to be authenticated as well as the doctor’s and the data that the program receives is encrypted and protected. Again, every program differs, but the common themes are that they are HIPAA compliant and they do take several steps to protect your information. 

So, how can you use Telehealth Services? Most groups are now offering telemedicine if they didn't already, and have quickly figured out how to do it in the face of this coronavirus pandemic so they can continue to care for you. Every group, again, is going to be different. So we encourage you to contact your primary care provider as well as your specialists directly to learn more about what they're offering. 

If you live in Florida, Devoted Health has a team of doctors and nurse practitioners who can do phone and video visits for you at no cost to you. And we of course will work closely with your PCP. So we want you to know about that option as well. We unfortunately don't have this option yet in Texas, but we are working hard to bring it there as well, so please do stay tuned. The phone number on the bottom of the screen is where you should call to make an appointment if you're interested.Again, if you're interested in a virtual visit with our devoted team in Florida, please call the number at the bottom of your screen which is 954-526-9743. And again, that's 954-526-9743. 

I'm going to shift a little bit now and talk more about how you can get your medication safely during this time. So we want to make sure that you get them safely and on time, and our goal of course is to keep you at home. And so there are several different ways that you can do that. There are ways that you can pick up your medication, ways that you can do local delivery and ways that you can do mail order. We'll go through each of those and a little bit more detail. 

Picking up at your local pharmacy - that's the one that we're most worried about right now. We want to minimize trips outside the house [Audio drops a few seconds and Kristen asks Dr. Carter to repeat. Dr. Carter apologies and continues]

[Dr. Carter] We worry about picking up medications at your pharmacy because we do want to minimize trips outside the house, especially to the pharmacy, where others might be sick. So if you do have to pick up your meds, you can look into a few options that could make that safer. A few of those options include: drive through - many pharmacies actually do have that - or special senior-only hours. Some pharmacies are now opening  towards the beginning of the day for an hour only for seniors or at the end of the day and that allows pharmacies to not only be less crowded but also allows them to do a deeper clean, again, just making things safer for you. 

I encourage everyone however to think about the second and third options, local delivery or the mail order because these are much better in terms of keeping you at home and minimizing exposure. One thing with local delivery is that many local pharmacies are now doing this to help people avoid trips to the pharmacy. It's very pharmacy-specific, so I’d encourage you to call your local pharmacy to see if this is an option. But one thing I can share as an example is that most CVS locations are now waiving the $4.99 fee for their home delivery during this pandemic. So it's another great option for you to look into to have your meds delivered directly to you.

The last thing is mail-order. There's several mail-order options that I'm going to actually go into in a little bit more detail, but generally speaking mail-order is a great way to have your meds safely and conveniently delivered to your home. Some options might help you remember to take your medications, like packaging all your meds for the day in one place so you know exactly what to take and when. We also think that these mail-order options may have a lower risk of shortages of medication. So that's another reason to think about it in general.

I'm going to go into the mail order information in a little bit more detail. There are three that we've been looking at closely at Devoted and I want to share some information with you. So the first is CVS mail-order. That's one that you all may be familiar with. We recommend it because of its safety and convenience. You'll get a 90-day supply all at once, and under your plan you may have lower co-pays as well. 

CVS mail-order can also deliver refrigerated medications and controlled substances like opioids, so that's an important thing to take into consideration. There is one drawback, which is you do have to leave a credit card on file with CVS. Some people prefer not to do that. The other thing to note of course is it is a 90 day supply. So if you and your doctor are in the middle of adjusting some of your medications, it might not be the best choice for you, but a wonderful choice for people who are on stable doses of medication. 

The second option is Pillpack. Pillpack is a company that basically packages your medications into daily doses and it makes it much easier as a result to remember when to take your medication and what you take. This option is great if you have lots of medications to keep track of or if somebody else helps you take your meds. The service itself is free, so you just pay your normal 30-day prescription copay for your medication. Just like if you went to a regular pharmacy. And the nice thing is as well is they review all of your medications with you to make sure everything is accurate, and that typically takes about 20 minutes over the phone. 

The third service we want to let you know about is a company called MedMinder, and this one really helps you remember to take your pills. They provide a free electronic pill box that can tell you whether or not you took the medication when you were supposed to. This is a great option if you have trouble remembering to take your meds or, again, if someone else helps you with your medication. Again, this service is free just like Pillpack so you would pay your normal 30-day prescription copay just like if you went to a regular pharmacy. 

So I will pause there. That's the end of our presentation, and we'll open it up to questions. I will say actually before I move on, if you're interested in any of these medication delivery options, we would be happy to help you with any of them. Please give us a call at our 1-800-DEVOTED number up on the screen and we'd be happy to walk you through the steps to get you set up with some of the mail order delivery options for your medication.

So before we move on and open for questions, I'll just remind you again in order to ask a question, you can submit it via the chat button. Please include your name and your phone number so that in case we don't get to your question, we can follow up later with you individually. As a reminder as well, please don't submit any personal health details. If you have any questions about your personal situation, we'd be happy to talk to you at 1 800-DEVOTED and go from there. So I'll pause there and we'll go for questions. 

[Kristen]: Thanks so much, Dr. Carter. Nust as a reminder, like Dr. Carter said, please feel free to enter any and all questions that you have about Telehealth or telemedicine or COVID-19 in general. We're here to answer questions about both topics. 

Since we're already on the topic of telemedicine and Telehealth, I'll start with some questions about that. So the first question that we got was can my doctor prescribed my medication From a Telehealth visit?

[Dr. Carter]: Great question, and absolutely. That's again one of the nice things about Telehealth is you basically do everything that you could do in the visit with your doctor. The exception, of course is they can't directly examine you. There are some things that they still might be able to do if it's a video visit in terms of the exam, but in terms of a traditional exam, you know, listening to your heart and your lungs, of course, they won't be able to do that. But everything else that you would do in a normal visit you'd be able to do in a Telehealth visit, including having your medications prescribed. 

[Kristen]: Great. Also about medications, if I have my medications delivered, isn't there a chance that they could be contaminated? What can I do to protect myself from coronavirus when I'm receiving the package? 

[Dr. Carter] I'm so glad you asked because this is something that everyone is really worried about in terms of contamination and packages, and I think it it’s a question that is sort of broadly applicable to any kind of deliveries. So I'll answer it from that one lens. 

You know what we're really trying to do overall is of course minimize your exposure to the virus, and we think that the highest risk of being exposed is when you're out around other people who might be sick, or you're touching surfaces that lots of other people have touched out in public. And so by minimizing trips outside of your home, nwe really do feel that you're minimizing the exposure to the virus. 

There are additional steps we could think about taking to minimize the risk because potentially some of the surfaces might be contaminated by the virus as well. One example is when you think about if people are coming to actually deliver things, you don't need to actually go meet the delivery person.  Ask them to leave it outside your door, and then you can go get it. That minimizes your contact with another person that might not be necessary. So you can minimize exposure that way, and then the next piece is packages. Packages potentially have the risk of carrying the virus. There is some evidence that coronavirus can live on things like cardboard for up to 24 hours. So we do want to take caution with packages. The best thing to do is remove your items from the package. Dispose of the external packaging that might have been exposed to the virus, and then they make sure that you take extra special care to wash your hands right away. And again washing your hands frequently throughout the day is the way that you will be most successful in preventing transmission of the virus. So so while we can't a hundred percent eliminate the risk [Audio cuts out, Kristen asks Dr. Carter to repeat]

[Dr. Carter] I'm sorry everyone. As I said at the beginning, you know, we are all doing our best to do social distancing ourselves, and I thought we had our Internet situation figured out. I even got a new cord.  I'm so sorry for the cutting out and thank you all for your patience. So what I was saying is we cannot hundred percent eliminate the risk of transmitting the virus, but we reduce the risk of transmission by eliminating trips outside of the house. So by taking advantage of the delivery and then by taking a few extra steps of precaution, that will reduce your risk further. So the idea of not meeting the delivery person, but just having them leave something, and then to be sure to dispose of any packaging right away so that it’s out of your home, and just most importantly washing your hands. 

And so if you take nothing else home, know that frequently washing your hands is really the key to help prevent transmission. If the virus happens to make its way into your home for some reason, washing your hands frequently and practicing excellent hygiene will be the way to continue to prevent it. 

[Kristen]: Another Telehealth question. Can I use Telehealth for issues or appointments that are not related to coronavirus? 

[Dr. Carter]: Absolutely, and that is what we're probably going to see a lot of in the coming months. Telehealth visits can be for anything - coronavirus related or chronic diseases, or you might have a new symptom or issue that you need to discuss with your provider. And that's something that's so important throughout the next few months. We don't know how long restrictions for staying at home will last but we do think it will be a few months. And so we want to make sure that you're getting all the needs for your chronic illnesses as well. 

We highly, highly encourage you to reach out to your providers to make sure that you can continue to get your routine care in a safe way over the phone or over video. It's available for anything, and we highly encourage you to make sure that you're able to still get the care that you need on an ongoing basis.

There will of course be some circumstances where your provider might decide that you really need to be seen in person for a specific reason. And so again, that will be between you and your provider to decide, but for the most part a lot of carem including care for chronic diseases will move to Telehealth for the next few months.

[Kristen]: Okay, great. And also just a reminder that any questions about coronavirus or telemedicine are welcome. Please feel free to put them into the chat feature. And once again, please include your name and phone number so if we don't get to your question, we can call you back after this. 

The next question is what should I do if my doctor doesn't do telemedicine? 

[Dr. Carter] Great. So, if your doctor doesn't do telemedicine, as I mentioned a little bit earlier in the presentation, if you live in Florida, we at Deoted have a team of nurse practitioners and doctors who can do the telemedicine for you, and we will work closely with your PCP and communicate, but we would be happy to provide that service. So please call  - I'm going to go backwards on the PowerPoint - using the number on this slide: 1-954-526-9743 to make an appointment with our group that does these telemedicine visits. Again for Texas we are working hard to bring this to Texas soon so do stay tuned. But for Florida, this is a great option if your primary care provider does not do Telehealth. 

[Kristen]: It looks like the last question we have right now for Telehealth, and please chime in if anybody thinks of anything before we move on to the general coronavirus question section, but what if I don't have a computer or smartphone? 

[Dr. Carter]: Great question, and not everyone does have computers or smartphones. So the good news is that most providers are now allowing telephone visits as well. And that's one of the options that you can use for telemedicine. It’s more just like a telephone conversation with your provider. And so you should definitely again speak to your provider about the option of doing a telephone visit if you don't have the capability to do it on the computer.

[Kristen]: Great. Like I said, please if anyone thinks of any Telehealth or telemedicine questions as we move on, feel free to type them in and we can circle back, but for now we're going to move on to general questions about coronavirus and COVID-19. 

So the question we received was how long does the virus remain on inanimate objects or humans? I know you touched upon it earlier, but can you elaborate?

[Dr. Carter]: Good question, and we’re still learning  so much about the coronavirus because this is such a new virus. All of this evidence that we're learning is still new and we're still in the process of gathering a lot of this evidence, but I can share with you what we do know from preliminary research. 

There was a study that was published recently that looked at how long coronavirus lived on various surfaces, and they found that for things like cardboard, which I mentioned briefly before, the coronavirus can live on cardboard for up to 24 hours. Then in terms of other surfaces, things like plastic or stainless steel, it can live a little bit longer: up to 72 hours. Other surfaces can be sort of in that ballpark as well. So 24 to 72 hours the virus can live on things like doorknobs and countertops and things like that. 

Again, we're in the process of learning a lot about that now, but it looks like it is possible that it lives on surfaces for 24 to 72 hours. And so that's why it's so important again to make sure that you’re disinfecting your surfaces in your home frequently, especially those that are touched frequently like doorknobs and countertops. 

[Kristen]: The next question we got was what's recommended for people who live in apartment buildings or close quarters like that? 

[Dr. Carter]: I think the question is asking  are there extra precautions that you might take to get out of your apartment and things like that, and  I’ll answer it that way. But if I'm not getting your question, please leave another comment, and we can try again. 

If you live in an apartment building, of course, you're around more people in the building itself much more than if you’re living in a separate home. However, the recommendations are the same - that you want to stay in your home or in your apartment, unless you need to go out for essential things like groceries or medications. 

But again, as we talked about, with medications are lots of ways that you can avoid going out. So unless you need to go out for essential things, really, most people whether they live in homes or apartments should be staying in their home and houses or apartments. 

Of course, there's a new challenge if you live in an apartment and you do go outside: the doorknobs and things to get in and out are obviously touched by many more people than just your immediate family. Hand hygiene is really the take-home message for this as well. You want to make sure that you're practicing excellent hand hygiene whenever you exit or enter the apartment building, and so that will likely mean having a bottle of hand sanitizer with you. Or when you come back inside, make sure that you wash your hands right away. If you use an elevator in your apartment building, I would recommend not taking it with anyone else outside of your immediate home. So extra focus on the hand hygiene when you're coming in and out and then think [Audio cuts out and Kristen asks Dr. Carter to repeat. Dr. Carter apologies and continues]

[Dr. Carter]: Elevators would be the other place that you might come in contact with people, and it's okay to be rude and take the next elevator if it’s to avoid taking the elevator with somebody else outside of your immediate home, because those are close quarters. And if someone were to be sick, that could be a place where you could get exposed to the virus. 

I guess the two things that I would do to be extra cautious if you live in an apartment building: just really good hand hygiene coming in and out of the building and then trying to avoid taking an elevator with someone else in the building that is not in your immediate family so that you minimize exposure. 

I will take this opportunity to say that the executive order to stay home unless you need to go out for essential things does not mean that you can't go outside to get exercise, and we highly encourage you to do that. It's so important in order to stay healthy, to stay fit that you continue to get the exercise. And so please do go outside. Don't take this as an order not to go outside. Please do go outside, just of course exercise caution when you do so, and make sure that you practice good social distancing when you're outside as well. 

[Kristen] This question seems to be a common concern in these seminars about coronavirus, but should people visit their family? Is it okay to have family visit them?

[Dr. Carter]: This is just the hardest question because we all want to be with our family during this time, but the guidance, and if you were to follow the guidance strictly, which we really recommend that everyone do at this critical point in the pandemic, is just stay at home and limit contact with anyone outside of your immediate home. So that does unfortunately mean family members who might live outside - grandchildren, children. 

That's so hard during this time. We all want to be there for each other. But the safest thing to do is to take these precautions now, so that in the future, we're all much safer. So it does mean that we need to limit visits to any family members outside of your immediate home. That doesn't mean of course that you can't connect with people. 

Social distancing does not equal social isolation, and it's really important that we all think about ways to stay connected with your family during this time as well. Fortunately we live in an era where there's a lot of technology, and on top of just using the phone to stay connected you can of course do things like Zoom meetings. Your family might be setting things like that up as well. There are a lot of different ways that you can connect with your family and stay socially distant but not socially isolated. 

[Kristen]: The next question is are there any over-the-counter remedies that could be taken to prevent the coronavirus? 

[Dr. Carter]: Great question and something that's on a lot of people's minds. So again our experience with the coronavirus is limited because it's so new, so we don't know a lot about it, and we hope to learn a lot more even just in the coming weeks to months as we get more experience. Right now, there isn't anything that's been proven and studied to prevent this new coronavirus. There is evidence that with other coronaviruses, and viruses that we've known about for a long time, things like the common cold, that taking over-the-counter zinc supplements like Zicam for example can actually prevent getting a cold, and also can improve the trajectory of the cold and and lessen the duration. So make it last shorter as well. There has been some suggestion that we might extrapolate from the regular coronavirus experience to this new coronavirus and say that maybe using supplements would work. Again, no specific direct evidence that zinc supplements work for prevention, but it is certainly promising and that's something that's worked for other coronaviruses, but it is certainly promising and safe and easy to use and available over the counter. I would say that this is really the one thing that we've seen is that Zinc is a possibility, but again, unfortunately, nothing has been proven over the counter as of yet. 

[Kristen]: Thank you. So along the same vein, we have a question about the safety of taking Advil or Ibuprofen when you have the coronavirus. 

[Dr. Carter]: Another great question. You may have heard on the news that there was some evidence or some information pointing towards the fact that ibuprofen or that NSAID class of medicines  (non-steroidal anti-inflammatories) that includes things like Motrin, Aleve, Naproxen, medicines like that, there’s some suggestion that when a person with the virus takes one of those NSAID medicines like Ibuprofen, that it can actually lead to worse outcomes. Again still very, very early in the experience and it's not clear yet if that's really true. But again, there was a signal showing that maybe that was the case: that when you took the NSAID, the coronavirus illness was more severe. 

So as a result, until we know more, we would recommend alternatives when possible. If the only reason that you were taking the ibuprofen was to lower your fever that you have because of the coronavirus, we'd recommend instead taking Tylenol, so long as it’s safe for you, as an alternative to ibuprofen. 

Again, the information is still very preliminary, but if there's a good alternative to Ibuprofen, then we recommend it.  In this case if you had a fever or body aches or anything like that associated with coronavirus, then we are recommending that you do not take ibuprofen or another NSAID and instead take Tylenol, also called acetaminophen. 

[Kristen]: Another question about treatments or preventatives. Do things like the flu shot or the pneumonia shot help prevent coronavirus?

[Dr. Carter]:  Great question and on a lot of people's minds as well. The flu shot and the pneumonia shot do not directly prevent the coronavirus itself. There unfortunately is no vaccine yet for the coronavirus, although scientists are working very hard, around the clock to develop it. 

So while there is no vaccine for the coronavirus, staying up to date with your flu and your pneumonia vaccines is really, really important. It's by staying up to date on those vaccines you may prevent different infections, and those different infections, if you got sick with the flu, for example, could put you at higher risk for either getting sicker from the coronavirus or just having your immune system be depleted. We highly recommend everyone stay up to date on their flu and pneumonia vaccines in order to just stay healthier generally speaking, so that your risk of the coronavirus goes down. 

I’ll just make a brief note that the flu vaccine is  one that you all know happens every year. A new seasonal flu vaccine comes out every year. Pneumonia vaccines are one that you only get once or maybe twice in your lifetime as an adult, and so if you have any questions about whether you're up to date on your pneumonia vaccines, you should call your primary care provider to find out about that. But the pneumonia vaccine is not a vaccine that you need to get every year. Instead, it's usually one that you get around age 65 and then you no longer need any further. 

[Kristen]: Switching gears a little bit. So it seems like in the news there's so much questioning about asymptomatic people potentially passing it on to people. Can you talk a little bit about how asymptomatic people infect other people? 

[Dr. Carter]: Yes, and this is something that's gotten a lot of attention in the news very recently. We're seeing as we study patterns of people getting infected that it's become clear that people can spread the virus either before they show symptoms or sometimes they never show symptoms at all. And so, scientists are trying to learn and understand exactly the timing of that, and how long people might spread the virus if they're not showing symptoms. 

What we think is that people can likely spread the virus for a few days, one or two days, before they exhibit symptoms, and that's of course a scary thing. And again one of the reasons why this stay-at-home order and the social distancing is so important. Because even if people appear well and healthy, they may still be spreading the virus. 

This goes for everyone individually as well. You also could be infected or spreading the virus without knowing it. So again minimizing contact with other people and not going out of the house unless you need to is really important both to prevent you from getting it from other people, and also to help prevent transmission if you were also infected. And so the evidence to date is that we think that people can shed the virus and spread it for a few days before they show symptoms. Again, really driving the recommendation [Audio cuts out. Kirsten lets Dr. Carter know and Dr. Carter apologies and thanks attendees for their patience]

[Kristen]: I think you were just ending your thoughts, and I think it's probably okay to move on. If anybody needs further clarification, please chime in in the chat. Our next question is do you have any recommendations for how people can disinfect their houses, especially now when stores are kind of running out of things? 

[Dr. Carter]: Great question. One thing that I will point towards is the CDC does actually have a website with an excellent list of products that they believe to be effective in disinfecting and killing the coronavirus. So if you haven't checked out the Centers for Disease Control website, the link is on the screen right now: cdc.gov/coronavirus. If you haven't checked that out, I encourage you to do so. There's actually a link to products that are safe. 

For the most part I would say things like Lysol and Clorox-based products do adequately disinfect. But again, I encourage you to double-check [the CDC website]- the stores as Kristen mentioned are running low on a lot of a lot of products. [Audio cuts out and Kristen asks Dr. Carter to repeat]

[Dr. Carter] I was saying that because stores are running low on a lot of products, you can also make your own homemade diluted bleach solution. The recipe for this is also on the CDC website. So if you don't have a chance to write this down or forget, you can always look there as well. It’s four teaspoons of bleach per 1 quart of water will make a safe diluted household bleach solution, which is thought to be a good disinfectant as well. So if you're unable to buy a store-bought product like Lysol or Clorox products, you can try making your own bleach solution at home. 

[Kristen] I feel like this next question is another hot topic that we get frequent questions on, but is it recommended to wear masks, especially, you know, when you enter buildings with other people or if you even have to wear masks while you're out and about nature.

[Note about the response. On April 3, the day after this webinar was held, the CDC released official guidance asking people to wear cloth face coverings in public when possible. Surgical and N95 masks should remain reserved for medical professionals. FAQs here: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-faq.html]

[Dr. Carter]: Another great question and something that has been getting a lot of press recently as well. The mask question is something that the CDC has been a little wishy-washy on and we're hoping for some firmer guidance to come out soon. And again, encourage everyone to stay up to date with the news. Right now, the CDC does not recommend routine use of masks when you go outside or when you're around other people for prevention of the coronavirus, but what it does recommend is to use a mask, like a surgical mask, if you are ill so that you prevent the spreading. 

Now you can ask me well, you just finished telling me that people who aren't symptomatic can still spread the virus, and that's exactly right. And that's where there's a lot of discussion right now about should everyone just wear masks when we’re around other people to help prevent spread? This is mostly a measure to help prevent spread to other people. The surgical masks and masks you can buy at a pharmacy or make yourself are actually not great at preventing you from getting the virus. Those masks need to be the really tightly fitted masks, like the N95 masks that medical professionals are using. That’s what’s really used to prevent you from getting it, and those [the N95 masks] are really reserved right now, of course for medical professionals because of the great shortage we have. So discussion around the surgical masks and whether or not everyone should wear either a surgical mask or a homemade mask is really more about what can we all do to help prevent the spread of the virus between people who either are symptomatic or asymptomatic - don't have the symptoms and may not realize they’re passing it on. 

The CDC is going to come out, I hope, with more firm guidance very soon about whether or not we should all be wearing masks to help prevent transmission from one person to another. In the meantime something to think about. This is not yet CDC recommended, but I think it's just good common sense to help prevent transmission: when we go out in public like to the supermarket, think about doing something that covers your mouth and your nose like maybe putting just a t-shirt over your mouth and your nose so that you can do your part in helping to prevent the spread of the virus. That's not going to be perfect in preventing you from getting the virus. But if everybody were to do that, that would mean that the spread of the virus would go down significantly. 

I'm hoping that the CDC will come out with more firm recommendations on the use of masks. But for now there is not a recommendation unless you are actually sick to help prevent it, but I think we can all use common sense and maybe think about ways that we might be able to use just things that we have around the house like a t-shirt to help prevent spread of the virus when we're out amongst other people. Now, that doesn't mean you need to wear something or that I'm suggesting you wear something or cover your mouth whenever you go outside. So if you're going outside to walk your dog or to get some fresh air and exercise and you're not close to other people, then I do not think that you need to wear anything over your mouth. It's more that I'm suggesting we think about covering your mouth and nose when you're in close quarters, like at the grocery store to really prevent you from spreading things to other people. If everyone did that that transmission would go down significantly. 

[Kristen]: I'm actually coming to the end of our time for this webinar. I'll just ask one final question and that is where should we go for the most up-to-date information about coronavirus? 

[Dr. Carter]: There are a number of places that you can go. Our Devoted.com website has a banner across the top leading you to coronavirus information. We are continuously updating that and also taking our information from trusted authorities like the Centers for Disease Control or the World Health Organization. So you can always go to our website. The other places that you can go are the Centers for Disease Control website as well as the World Health Organization. These are agencies that are continuously updating all the information and are trusted sources of information. And your local Health Department website as well may have more local information for you to access as well. So I’d encourage you to look there as well for things like number of cases in your area and other information like that.

[Kristen]: Great. So, I think that brings us to the end of this session. Thank you so much. Dr. Carter and thank you to everyone who joined and asked such great questions. If we didn't get to your question today, please make sure you enter your question along with your name and phone number, and one of our guides will follow up with you. As always you can also give us a call at 1-800-DEVOTED if you have additional questions. That's 1-800-DEVOTED, which 1-800-338-6833. Thanks again for joining us and please stay safe.