CMO Covid Blog Orange County- Latest numbers from the Caduceus Covid Treatment Team

Last week, we gave a special bulletin on five items relating to the pandemic. To update this week, we enlisted the help of one of the most famous doctors of all time. He did this by eavesdropping on Annie, a young adult who sported a “good Annie” on one shoulder, and a “bad” Annie on the other. 
 
#1- A new symptom, diarrhea, had taken over as the most common symptom for Caduceus patients. That has not changed in a week, with the proviso that headache has now become the second most common. And those that have diarrhea typically do not have headache, and vice versa. Yes, we still have a lot of respiratory presentations. 
 
The issue is the raw volume. It is very difficult to keep up. The first 12 days of December we accepted 208 new positive patients into our treatment program.  It took four months in the spring to hit 250 cases. Today as I type this, we just assumed an additional 36 new cases.
 
In one day. 
 
A new issue is the challenge hiring new staff and doctors fast enough to take on this volume. So if you interact with our staff, realize many are putting in 12 hour days, 7 days a week with no vacation this year. 

The current spike was predicted by many (including this blog), with the Thanksgiving holiday being the main culprit. But another culprit has emerged- most new cases were due to invalid quarantining.  Far too many patients went back to work, went to gatherings, and went out with friends despite not confirming a negative test after a positive one, or after a close contact. 
 
Let’s ask our guest doctor, Dr. Seuss, about the conversation with Good Annie vs. Bad Annie—Bad Annie has lost her sense of taste and smell…Good Annie advises to quarantine while being tested.
 
BAD ANNIE:   
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE: 
Would you, could you in your house?
Maybe even with a mouse?
 
BAD ANNIE:
Not in my house
Not with a mouse
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you with a mask?
Maybe if we fill a flask?
 
BAD ANNIE:
Not with a mask, not a flask
I can’t believe you’d even ask
I do not like Covid 19
I do not want to Quarantine!
 
#2- We mentioned that tests were becoming scarce last week. We are pleased that we now have collected enough swabs to resume our usual testing advice.  Many labs are still warning about low supplies, so if you try to find tests close to Christmas at other facilities it may be difficult without symptoms. 

We have more PCR tests than the rapid antigen tests. But we do NOT advise rapid antigen tests in most cases, so try to ask for the more accurate PCR. We still offer same day or overnight results with the expedited test for a fee. We will continue to work hard to always have enough tests for our loyal patients.
 
So bad Annie, while you wait for your result; be sure to quarantine!
 
GOOD ANNIE:
Would you, could you play a game?
Pick up Stix is not that lame
Oh! I know a real fix
Find a series on NetFlix!
 
BAD ANNIE:
I do not play Pick up Stix
I don’t have NetFlix
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you in a car
Maybe you could drive real far
Or better yet on a fancy train
Enjoy the view, out of the rain
Or better yet in a tree
Way up high, where no one can see!
 
#3 We mentioned last week that saliva testing may become available with another choice for a rapid result. We are still researching this. It still isn’t ready for prime time.  We will keep you posted on social media and our website. 
 
BAD ANNIE:
Not in a car, not on a train, not in a tree, just let me be
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you wearing socks?
Would you, could you with some Crocs?
 
BAD ANNIE:
Not with socks, not with Crocs
And I don’t want to hear from any docs!
 
GOOD ANNIE:
Here’s an idea, a fancy hotel
With food a plenty – just ring the bell
 
BAD ANNIE:
I cannot taste! I cannot smell!
I don’t want a fancy hotel!
You can keep your food a plenty
I’m so sick of Twenty Twenty!!
 
#4- Vaccine questions—Here is what we know now:
 

• The Pfizer vaccine is FDA approved for all persons 16 and older to prevent Covid 19 
• Our Federal government has allocated 6.4 million doses to be shipped now intended for hospitals and government health systems (eg. VA, etc). Their intent is to vaccinate health care workers, high risk seniors, residents of nursing homes, and assisted living residents. 
• As supplies increase, the wider population will be able to obtain them at no charge at urgent cares, pharmacies, and physician offices. We are told this can optimistically occur in February or March.

We are on it.

 
Only the Pfizer messenger RNA vaccine has been approved. Found to be 95% effective, side effects were uncommon, naming the usual site pain, fatigue, headache, and chills. These were more common after the second dose that is required with the Pfizer vaccine. More traditional antibody vaccines are also asking for approval, and may become available through the spring. Patients could then pick their personal choice. 
 
We DO NOT know the duration of the immunity from the vaccine. An annual vaccine, much like the flu shot should be planned for most likely. 
 
The vaccine does nothing once the virus infects you. 
 
WHAT?  I’M POSITIVE???
Quarantine???
If you make me, if I must
For the better good I trust!
 
I’ll wear a mask, bring on the flask
I will take Covid to task!
 
I’ll take my meds and stay away
And quarantine all night and day!
 
I’ll nest and rest and then re-test
Because Caduceus says it’s best!
 
#5- How to reach us–We mentioned in last blog the issues with our phones. And with the huge spike this last weekend, answering calls timely is a challenge. However, we have hired more staff and will continue to make answering the phones a top priority.

On the positive side, we have seen a much higher volume over our website and app live chat feature and the email feature we call Mousecalls. Those continue to be the fastest way to talk to us.  With hundreds of tests a week, even calling back all the negative tests is challenging. 
 
WHAT?  I’M NEGATIVE???
 
I still don’t like Covid 19
But I survived the quarantine!
 
Hooray, hooray I’m finally free!
 
Now to build  IgG……
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group

(With special thanks to Mary DeNicola, DNP, and Theodore Seuss “Ted” Geisel helping provide smiles in the midst of the worst part of the pandemic.)