She had returned from traveling in Asia and felt horrible, so the 25-year-old woman went to her doctor’s office in Edgewater, New Jersey. She informed staff of her flu-like symptoms and asked if the virus could cross China and raise concerns about a possible pandemic.
Staff in his primary care office took his concerns seriously. After all, it was January 23, the first American case of the new coronavirus had been announced a few days earlier, and everyone was worried. A hospital would be better equipped to diagnose and treat her, they said, so they called an ambulance to take her to the medical center at Hackensack University.
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This first suspected case of COVID-19 in New Jersey turned out to be a false alarm. But it still provided a major learning experience for everyone involved in his care.
The actions taken at the gateway to the medical system – in primary care offices, emergency care clinics and doctor’s offices across the country – can make all the difference in patient care, protection health workers against exposure and spread of the virus to the wider community.
The very first confirmed case of COVID-19 in the United States, in fact, was a 35-year-old man who went to an emergency care center. He complained of four days of cough and fever after visiting his family in Wuhan, China. Clever clinicians from Snohomish County, Washington have had it tested.
“Anyone who sees an outpatient could potentially bring in someone” with the symptoms of the new coronavirus, said Dr. Daniel Varga, chief medical officer of Hackensack Meridian Health, which has approximately 1,000 physicians at 300 clinical sites in New Jersey.
Whether it is an obstetrician-gynecologist offering follow-up care to a 30-year-old woman, a cardiologist performing regular check-ups on a 70-year-old man, or a doctor in a health care center. emergency seeing a millennium for the first time, everything must be ready, he said.
“The crux is the proper identification, isolation and transfer” of COVID-19 suspect patients wherever they arise, said Varga.
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The 25-year-old patient, who was not identified, did not meet the criteria in effect at that time to send a sample of her sputum to the Federal Centers for Disease Control for testing – she had not traveled in China during the period of concern. Officials at the Hackensack Medical Center and the New Jersey Department of Health said later in the evening that she did not have the virus.
Subsequently, “we implemented a protocol fairly quickly,” said Dr. Raj Brahmbhatt, chief medical officer of the patient’s primary care provider, Riverside Medical Group.
He met with managers of the group’s 65 offices in north Jersey and interviewed all of the group’s suppliers. He said he reminded them that the flu is much more common than the coronavirus in the United States right now, and “there is nothing like having a good patient history regarding his risk of exposure. “
“It will be crucial to identify these patients,” he said.
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Here’s what to expect and what the doctors’ offices are doing to prepare you.
Telephone triage
First, take a deep breath, said Dr. Sean Cook, owner of Green Brook Family Medicine and a member of the New Jersey Academy of Family Physicians.
If you feel you need to see a doctor, call first and be ready to answer questions about your symptoms, your travel history, and your risk of exposure to the virus. This is called telephone triage because the interviewer assesses the urgency of your situation. Large health systems and hospitals have scripts for staff to follow that list the questions to ask.
“Anyone who calls with symptoms of upper respiratory infection, we ask,” Do you have a fever, chills, and have you traveled? “” Said Dr. Kennedy Ganti, a primary care physician and board member of the Medical Society of New Jersey. The list of countries for which travel is a concern is updated frequently. On Sunday, it included China, South Korea, Iran, Italy and Japan.
A doctor you see regularly can combine their knowledge of your medical history with your new symptoms to assess your risk. “We know whether they are old or young, what other drugs they are taking, what other conditions they have,” said Cook. “It plays a big role in sorting people.”
Expect to stay at home
“Eighty to eighty-five percent [of people infected with the new coronavirus] are going to have low and common cold symptoms, “said Varga, of Hackensack Meridian Health. “They just need to isolate, so they don’t spread it.”
As long as patients are stable, the best place for them is at home, said Brahmbhatt. This minimizes the potential spread of the virus and delays the possible depletion of limited resources, such as face masks, personal protective equipment and test kits.
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Watch your symptoms at home
Doctors and health systems have different practices for monitoring their patients, so discuss them when you call for the first time. Usually monitoring means checking your temperature and symptoms twice a day. Some will want you to call the office to report, others will only wait for a call if problems arise.
Hackensack Meridian’s healthcare system plans to use a “virtual health” platform like Skype or FaceTime to actively monitor patients whose COVID-19 diagnosis has been confirmed and whose symptoms do not require hospitalization, said Varga.
Keep in mind that some patients – 15-20% – will develop more serious problems, such as pneumonia and shortness of breath. They will need to be hospitalized and may require respiratory assistance. This decline can occur nine or 10 days after the first symptoms appear, according to some reports.
In these cases, the patient will be referred to the emergency room. Most doctors want to guide the patient through the admission process. The hospital will want to know that you are coming to be isolated.
Identify your risk in order to be isolated
Pay attention to the signs currently posted in medical offices, emergency care centers and emergency rooms asking patients who have a relevant travel history or suspect a coronavirus to identify themselves. Reception staff are trained to ask questions so that immediate precautions can be taken.
Expect to receive a face mask if you have respiratory symptoms and are considered at risk. Expect to wait in a separate area or exam room, or maybe even in your car until it’s time to examine it. When this is not possible, stay at least six feet from other people.
Nurses and doctors examining any patient suspected of having COVID-19 should wear a personal gown, gloves, face mask and eye shield.
But dealing with infectious patients is not uncommon for medical offices. “This is a business that goes on as usual,” said his staff, said Cook, the family physician for Green Brook. “We see the flu every day.”
Follow reporter Lindy Washburn on Twitter: @lindywa
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