This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/03/23/health/coronavirus-doctors-specialists.html

The article has changed 28 times. There is an RSS feed of changes available.

Version 11 Version 12
These Doctors Have Specialties. Fighting Coronavirus Wasn’t One of Them. These Doctors Have Specialties. Fighting Coronavirus Wasn’t One of Them.
(about 1 hour later)
Dr. Scott Isaacs has worked as an endocrinologist for more than two decades, focused on the medical needs of adults with diabetes in the Atlanta area. He never expected to be serving on the front lines of a pandemic.Dr. Scott Isaacs has worked as an endocrinologist for more than two decades, focused on the medical needs of adults with diabetes in the Atlanta area. He never expected to be serving on the front lines of a pandemic.
For weeks, his phone has been ringing off the hook. His diabetes patients, a high-risk group for coronavirus infection, want to know: How can they get tested? How can they stockpile extra medication? And can he write to their employers to recommend they work from home?For weeks, his phone has been ringing off the hook. His diabetes patients, a high-risk group for coronavirus infection, want to know: How can they get tested? How can they stockpile extra medication? And can he write to their employers to recommend they work from home?
Last week, Dr. Isaacs saw a patient with Type 1 diabetes, a nurse who is 10 weeks pregnant. She asked him how long she should stay home from work to avoid possible exposure, and he had to respond honestly: “I really don’t have an answer to that.”Last week, Dr. Isaacs saw a patient with Type 1 diabetes, a nurse who is 10 weeks pregnant. She asked him how long she should stay home from work to avoid possible exposure, and he had to respond honestly: “I really don’t have an answer to that.”
Dr. Isaacs is used to relying on his medical expertise, but the coronavirus has suddenly put him in new territory, an experience shared by many medical specialists who may serve as the primary physicians of patients with particular medical needs. Physicians across every field who are trained to care for very specific medical problems are confronting a surge of patient questions and scrambling to keep up with rapid changes in case numbers and advisories from governments and health agencies.Dr. Isaacs is used to relying on his medical expertise, but the coronavirus has suddenly put him in new territory, an experience shared by many medical specialists who may serve as the primary physicians of patients with particular medical needs. Physicians across every field who are trained to care for very specific medical problems are confronting a surge of patient questions and scrambling to keep up with rapid changes in case numbers and advisories from governments and health agencies.
“We’re hearing a lot of anxieties from specialists who don’t know what the right thing to do is for their patients,” said Dr. Megan Ranney, an emergency physician in Rhode Island. “Dermatologists, ophthalmologists, we’re even hearing from dentists.”“We’re hearing a lot of anxieties from specialists who don’t know what the right thing to do is for their patients,” said Dr. Megan Ranney, an emergency physician in Rhode Island. “Dermatologists, ophthalmologists, we’re even hearing from dentists.”
Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists, said the coronavirus outbreak had made it immediately clear how much Americans rely on medical specialists.Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists, said the coronavirus outbreak had made it immediately clear how much Americans rely on medical specialists.
“It has exposed that not every person has a primary care provider,” she said, referring to people who may not regularly see an internist or family doctor.“It has exposed that not every person has a primary care provider,” she said, referring to people who may not regularly see an internist or family doctor.
Their first calls to the medical system could be to a specialist they’ve been seeing for a particular health problem. Specialists in heart medicine, lung care and obstetrics have training that is highly pertinent to treating the effects of the coronavirus. But specialists in other fields are hearing queries they may not be used to answering.Their first calls to the medical system could be to a specialist they’ve been seeing for a particular health problem. Specialists in heart medicine, lung care and obstetrics have training that is highly pertinent to treating the effects of the coronavirus. But specialists in other fields are hearing queries they may not be used to answering.
Endocrinologists like Dr. Weber are helping their patients coordinate extra supplies of medication, in case they need to self-isolate. And psychiatrists, especially on campuses, are facing a barrage of questions on an array of topics, like potential virus exposure and the sudden upending of work and academic schedules.Endocrinologists like Dr. Weber are helping their patients coordinate extra supplies of medication, in case they need to self-isolate. And psychiatrists, especially on campuses, are facing a barrage of questions on an array of topics, like potential virus exposure and the sudden upending of work and academic schedules.
For Dr. Gauri Khurana, a psychiatrist who works predominantly with college students, the coronavirus questions began as a trickle from patients with family in China. In recent weeks, it’s become a flood of anxious phone calls from young people wondering about how they’ll complete graduation requirements or whether they might be infected.For Dr. Gauri Khurana, a psychiatrist who works predominantly with college students, the coronavirus questions began as a trickle from patients with family in China. In recent weeks, it’s become a flood of anxious phone calls from young people wondering about how they’ll complete graduation requirements or whether they might be infected.
“I don’t think a lot of them have primary care doctors and at this point everyone is terrified, wondering what’s going to happen,” she said. “I have patients that want to drop out of school, move to Canada. They’re grateful for any advice, especially coming from a doctor because there’s so much misinformation.”“I don’t think a lot of them have primary care doctors and at this point everyone is terrified, wondering what’s going to happen,” she said. “I have patients that want to drop out of school, move to Canada. They’re grateful for any advice, especially coming from a doctor because there’s so much misinformation.”
So Dr. Khurana, reading news articles nonstop to educate herself on the virus, has done her best to counsel her patients on practical steps to prevent exposure: using credit cards instead of cash, wearing gloves when going outside and carrying personal items in sandwich bags. “I wish I had taken sandwich bags to work and given everyone a sandwich bag,” she said.So Dr. Khurana, reading news articles nonstop to educate herself on the virus, has done her best to counsel her patients on practical steps to prevent exposure: using credit cards instead of cash, wearing gloves when going outside and carrying personal items in sandwich bags. “I wish I had taken sandwich bags to work and given everyone a sandwich bag,” she said.
For specialists who treat high-risk demographics, the best medical advice for the coronavirus outbreak can feel contradictory: To stay safe, try to avoid the doctor’s office. Both the Surgeon General and the American College of Surgeons have advised that hospitals cancel elective procedures in the coming weeks, and some states have ordered postponements.For specialists who treat high-risk demographics, the best medical advice for the coronavirus outbreak can feel contradictory: To stay safe, try to avoid the doctor’s office. Both the Surgeon General and the American College of Surgeons have advised that hospitals cancel elective procedures in the coming weeks, and some states have ordered postponements.
Dr. Rajeev Jain, a gastroenterologist in Dallas, sees a large number of patients with autoimmune disorders like Crohn’s. To help minimize their risk of coronavirus exposure, he has canceled appointments that aren’t immediately necessary — on a normal Monday and Tuesday he would see 30 patients, and this week he’ll see six.Dr. Rajeev Jain, a gastroenterologist in Dallas, sees a large number of patients with autoimmune disorders like Crohn’s. To help minimize their risk of coronavirus exposure, he has canceled appointments that aren’t immediately necessary — on a normal Monday and Tuesday he would see 30 patients, and this week he’ll see six.
Much of his time is now spent fielding calls from patients who wonder if they should stop taking their immunosuppressive medications in order to minimize risk of serious infection. Following a joint advisory from American gastroenterological associations, Dr. Jain has told patients to continue their course of normal treatment.Much of his time is now spent fielding calls from patients who wonder if they should stop taking their immunosuppressive medications in order to minimize risk of serious infection. Following a joint advisory from American gastroenterological associations, Dr. Jain has told patients to continue their course of normal treatment.
He worries that if his patients stop taking medications, they could contract other illnesses and be hospitalized. “That’s where a large reservoir of Covid-19 is at the moment,” he said. “That’s the last thing I want to do.”He worries that if his patients stop taking medications, they could contract other illnesses and be hospitalized. “That’s where a large reservoir of Covid-19 is at the moment,” he said. “That’s the last thing I want to do.”
As physicians brace for what they realize will be an increasingly challenging period, representatives of medical associations say they are moving quickly to develop and distribute resources to support their members. Patrice Harris, president of the American Medical Association, said the association had developed a Covid-19 online resource center and physician’s guide. She added that the association was aware of and working to address shortages in protective equipment for physicians, like N-95 respirators.As physicians brace for what they realize will be an increasingly challenging period, representatives of medical associations say they are moving quickly to develop and distribute resources to support their members. Patrice Harris, president of the American Medical Association, said the association had developed a Covid-19 online resource center and physician’s guide. She added that the association was aware of and working to address shortages in protective equipment for physicians, like N-95 respirators.
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
As fears about the virus spread in local communities, physicians are also facing unanticipated stress. Dr. Isaacs said his clinic had been robbed four times of masks, sanitizing wipes and hand soap. Dr. Supriya Mahajan, a neurologist at a private practice in Ohio, said that she’s had to confront the financial losses of converting most in-person appointments to telemedicine because her partner in the practice is her father, whose age makes him at high-risk for severe Covid-19.As fears about the virus spread in local communities, physicians are also facing unanticipated stress. Dr. Isaacs said his clinic had been robbed four times of masks, sanitizing wipes and hand soap. Dr. Supriya Mahajan, a neurologist at a private practice in Ohio, said that she’s had to confront the financial losses of converting most in-person appointments to telemedicine because her partner in the practice is her father, whose age makes him at high-risk for severe Covid-19.
And some specialists wonder whether, in the weeks to come, they might be called in to assist with front-line care. Dr. Jain works at a Dallas hospital that treated Ebola patients in 2014 and recalls when I.C.U. doctors were put in quarantine.And some specialists wonder whether, in the weeks to come, they might be called in to assist with front-line care. Dr. Jain works at a Dallas hospital that treated Ebola patients in 2014 and recalls when I.C.U. doctors were put in quarantine.
“We don’t know if in two weeks there will be a surge and we’ll be pulled in to take care of patients in the E.R.,” he said. “The system is already starting to get overwhelmed.”“We don’t know if in two weeks there will be a surge and we’ll be pulled in to take care of patients in the E.R.,” he said. “The system is already starting to get overwhelmed.”
Dr. Jain’s days are now filled with all sorts of new precautions: designating clothing just for work, removing his scrubs before coming home, hand sanitizing more often than he already did. It’s an adjustment, he said, to his routine life as a gastrointestinal specialist.Dr. Jain’s days are now filled with all sorts of new precautions: designating clothing just for work, removing his scrubs before coming home, hand sanitizing more often than he already did. It’s an adjustment, he said, to his routine life as a gastrointestinal specialist.
But foremost on his mind is the health of his patients.But foremost on his mind is the health of his patients.
“I’m reminded that this is why I got into medicine in the first place,” Dr. Jain said. “I need to step up now and do what I can to help.”“I’m reminded that this is why I got into medicine in the first place,” Dr. Jain said. “I need to step up now and do what I can to help.”
[Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.][Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.]