In a recent interview with Assist America, Consulting Medical Directors Dr. Eugene Delaune and Dr. James Evans share their thoughts and expertise to demystify many queries they've received about COVID-19 as we enter this fall season.
Treatment and Prevention
Q. Are there certain home medicines that can prevent someone from getting infected with COVID-19 or, alternatively, are there certain home remedies that can help you recover?
Avoiding exposure to the coronavirus is the best preventative measure according to Dr. Evans who confirms that there are no “magical chemicals, vitamins, or medicines to prevent or protect from the virus.” However, some preventative measures to avoid getting infected with COVID-19 include the following:
- Wash your hands often with soap and water or use hand sanitizer.
- Cough into a tissue that you throw away immediately in a plastic-lined wastebasket.
- Clean touched surfaces daily; some may need it several times a day.
- Don't share personal items, like dishes, towels, or bedding.
- Make sure your clothing and linens are washed thoroughly.
- Avoid close contact with people who are sick and maintain 6 feet between the person who is sick and other household members.
Dr. Delaune also shares that there are not many home remedies to treat the coronavirus. If you have a mild case of the virus, the best thing to do is to “treat the symptoms – Tylenol for fever, cough medicine for cold and cough, and practicing standard isolation measures.”
Q. What are the different COVID-19 tests available today? How are they different?
In general, there are two categories of lab tests that test for COVID-19: Molecular tests, which look for evidence of active infection; and Serology tests, which look for previous infection by detecting antibodies and are mainly used for investigational purposes and not for diagnostic purposes. According to Dr. Evans, the three main types of tests within these categories include, “the molecular, the antigen, and the antibody tests.”
According to Dr. Delaune, “Molecular tests are looking for the core of the virus, the DNA, that is by far the most accurate to detect an active virus as you are looking for the virus particle. This type of test is generally conducted by collecting saliva or mucus from the back of the throat and usually takes a couple days to get a response. It is the most accurate form of testing. If it comes back positive, you have COVID-19 and if it comes back negative, you probably do not have COVID-19.”
Dr. Delaune explains that “rapid tests are frequently used in the emergency department and these tests are one of the initial tests conducted when diagnosing patients as results can be determined within an hour of conducting the test. Instead of checking for the core of the virus, these tests are checking for the parts of outer shell of the virus to see if antigens exist. Personally, we have seen a lot of cases where this test comes back negative and, if we still hold a strong suspicion for COVID-19, then we run a molecular test which may be positive. This test is conducted by taking a swab in throat or the back of the nose, much like the PCR test, but quicker and easier to do. These are the two ways to check for active infections.”
As far as testing for the body’s response to COVID-19, Dr. Delaune explains that, “the antibodies test is far more effective for seeing if immunity for the virus exists. This is not testing for the active infection; it is testing for your body’s response. Therefore, if this person has had COVID-19 at some point, this testing can be used, but it takes days, weeks, and even months for the body to develop antibodies. This test is worthless to check for an active infection, but if it comes back positive, it implies that your body has been exposed to the virus.”
Exposure and Quarantine
Q. Can someone who has had COVID-19 become infected again?
Not much information about reinfection and the immune response, including duration of immunity to COVID-19 infection is currently available according to the United States Centers for Disease Control and Prevention (CDC). Patients infected with other betacoronaviruses (MERS-CoV, HCoV-OC43), the genus to which SARS-CoV-2 belongs, are unlikely to be re-infected shortly (e.g., 3 months or more) after they recover.
Dr. Delaune confirms that there are not many confirmed cases of reinfection and shares, “presumably what happens is that after you survive infection, your body builds antibodies that attack infection when you get it again, assuming the exposure is to the same or a very similar virus as your body identifies the antigen. For example, the flu changes from year to year and the antibodies change as well, so you need a new vaccine every year but the same cannot be said about the coronavirus because it has not been around for that long to mutate. Alternatively, there is also the possibility that antibodies may not last very long in patients with coronavirus. A year from now they could be gone and if you are exposed now, the body will have to go through the process of making those antibodies again. We are still new to the game.”
Dr. Delaune adds that there may be some immunity to the coronavirus as, “a treatment called convalescent plasma therapy was recently approved by the United States Food and Drug Administration (FDA). The treatment takes plasma (the fluids) from the blood of a recovered patient of COVID-19 and injects it into someone who is very sick. The plasma has antibodies which can help a sick patient feel better. The fact that they are using convalescent plasma proves that there is some immunity involved in people who have had COVID-19 and their blood can be used for antibodies.”
Q. What are some measures that need to be taken when sharing living space with someone who is infected with COVID-19? If two people are positive, can they quarantine together, or do they have to be separated?
When sharing living space with someone who has been infected or exposed to COVID-19, you should follow the same procedures as you would follow while you are out in public. Dr. Delaune confirms, “you have to avoid any contact with the air they breathe, any fluids they may spread through cough, and be careful about common surfaces in case they have touched anything. This may be harder to do as you are sharing the same space, but still be careful about getting droplets from their cough into your eyes, nose, or mouth.”
Dr. Evans adds that the best method for avoiding an infected person sharing the same household is, “strict isolation and keeping yourself and others away from the infected person of the household. It means going to an isolated part of the house, staying in a room that is isolated from everyone else, maintaining the 6-foot rule, and cleaning all frequently touched surfaces.”
If two people have tested positive for the coronavirus, Dr. Evans confirms that, “it is alright to quarantine together as long as you stay away from everybody else.” Dr. Delaune mentions, “similar to chickenpox, you do not need to isolate yourself as it should not worsen the case of coronavirus, but you should extend the quarantine period until both people have tested negative for the virus in case someone is a carrier. It’s fine to share everything when you already have the germ.”
Q. What measures should be taken if someone comes into contact with a patient that was recently diagnosed with COVID-19 and how soon should someone get tested after being exposed to the virus?
If someone comes into contact with a patient that was recently diagnosed with COVID-19, they should consider themselves as a probable case of infection and self-isolate to monitor their condition over the next few weeks. Dr. Delaune strongly believes that if someone comes into contact with a patient of COVID-19, testing does not affect the outcome of the test results. The infection can still spread as you may be an asymptomatic carrier or get sick with mild symptoms after a few days, and it may be too late to stop the spread of the infection if you come into contact with other people who do not have the virus.
Dr. Delaune recommends that “if you have close exposure to the point where you think you have contracted the virus; you should consider yourself positive and quarantine for two weeks. Generally, you will develop symptoms three to five days after exposure. There is also the chance that you got the virus and didn’t develop symptoms. Although you might test negative, you could still have a mild case of the virus, so no matter the scenario, the advice will be to quarantine yourself up to 2 weeks after exposure.”
Dr. Evans confirms that, “you need to take this by a case to case basis where you do not need to get testing for exposure within the first few days as tests may be less accurate, but more so quarantine yourself for the first few days if you think you may have been exposed. Essential workers can have a case of COVID-19 without symptoms but if they think they had a known exposure, they should wait 5 days before returning to work, even if they test negative as they could still be positive. Most people will have symptoms within five days of exposure.”
Q. After being infected and testing negative for the virus, how long does a person have to quarantine from work and social life?
Dr. Delaune advises that, “every country has different rules about when they consider somebody cured or not active. I would say that you want to have two tests each a day apart that are negative. Remember that there are some false negative tests as well. You could have tested negative because maybe there was not a good sample or maybe because you have a very small amount of the virus that can go undetected. In general, after two weeks from when you were exposed and after two negative tests a day apart, that’s when you are okay to go out and live a normal life.”
Dr. Evans instructs emergency room patients that have tested negative for COVID tests, but still have runny noses and sore throats, that they should not consider themselves negative for the virus. Instead, they should “return home and quarantine for a few days before doing another round of testing to make sure the result is negative.”
COVID-19 and Travel
Q. What should a traveler do if they believe they're infected while in a foreign country?
Travelers should respond to COVID-19 infections the same way they would if they were at home. If someone becomes sick and tests positive for COVID-19 while away from home, they will need to isolate from others, including their travel companions, and delay their return until they are recovered and cleared for travel. Dr. Delaune recommends that if travelers “feel sick, hunker down and avoid contact with others, treat the symptoms. Once you are feeling better, get tested. Same as anywhere else.” He adds that “if travelers start experiencing more severe symptoms such as shortness of breath, they should seek local medical help immediately.” Travel companions will also need to quarantine and delay their return until 14 days after their last contact with the infected patient.
Travelers should contact the local health authorities for local public health guidance and inform their hotel. Some countries have partnered with hotels and/or health facilities to provide isolation rooms for patients. Patients should also contact their health insurance back home for further guidance. Members of Assist America can contact the Operations Center for assistance in finding a local healthcare provider or testing facility. Finally, if travelers require consular help, they may contact their country’s local embassy or consular office.
Q. How do you explain the recent spikes in new cases across the world, including European countries?
Health officials in a number of countries are reporting sharp increases in COVID-19 cases. In Europe, several countries, including the United Kingdom and France recently tightened their restrictions, limiting gatherings to 6 persons, imposing a 10-pm curfew on restaurants and bars in urban areas, and asking for people to work from home, when possible. The spikes in coronavirus infections can be explained by the relaxation of the restrictions throughout the summer, the boredom people are experiencing over social distancing measures, and the greater access to testing.
Dr. Delaune explains “people are tired of being isolated and feel better, safer, about the virus as hospitalization and death rates go down. That leads to people going out and about more, so there certainly has been more exposure. Testing has also become much more available.”
Thankfully, the troubling rise in new cases has yet to cause a significant surge in deaths and hospitalizations. Dr. Evans recommends “a much more relevant indicator to look at is the hospitalization rates which reveals more accurately the intensity of the new spikes.” He clarifies “we need to look at who is being tested positive: some are asymptomatic, and some are younger patients who have little risk to become very ill. That’s not necessarily a problem, as long as they are not spreading the virus to other people who may be more vulnerable. Remember what we are trying to do with all the COVID-19 restrictions is to reduce the burden of the hospitals.”
Q. How has the pandemic affected medical evacuations and repatriations? What new policies have been established as a result?
The pandemic has deeply affected the way medical transportation services such as evacuations or repatriations are organized. Dr. Delaune shares “it changes week by week, day by day. We have to adapt as we go along. Domestic transports remain easy. For international evacuations however, this is where it gets complex. Canada, for instance, requires two negative test results before transporting a patient. For other countries, our escorts may be subject to quarantine rules. Some governments are implementing health visas.”
Dr. Evans adds “our medical escorts usually meet the patients at the hospital. During the pandemic, we’ve had to work with local medical teams to transfer the patients from the medical facility to the airport and arrange the handoff at Customs. This is one way our escorts avoid entering the foreign country.”
“We have to research and understand the rules and stay constantly updated,” explains Dr. Delaune. “It requires great flexibility. We had several transports from India that were ready to go, that needed to be rearranged overnight to comply with new restrictions. Recently, we repatriated a Japanese patient from Canada. We could not send one of our U.S. nurse escorts as she would have needed to quarantine in Canada for two weeks. We had to hire a medical escort from Canada. After the mission, this person had to quarantine for two weeks, so we needed to make sure they were not actively working at a medical facility.”
The New Normal
Q. As we enter the fall season, should we expect a seasonal resurgence of the virus as the weather gets colder and what advice do you have for people as they return to work or school?
COVID-19 is unlike other respiratory viruses known to humans, but in time it could evolve into a seasonal scourge like the flu. The scenario depends on many unknowns and assumes the new coronavirus will bend to weather factors. This would not happen until enough people have been exposed to the virus -- or vaccinated -- to provide a level of herd immunity. Until scientists know for certain how the weather will affect SARS-CoV-2, people must continue to apply strict prevention measures.
To people who may feel a sense of boredom or exhaustion over COVID-19 measures, Dr. Delaune suggests, “we need to appeal to people’s sense of community. A lot of what we are doing is not to protect ourselves, but to protect others. Children at school may complain about wearing a mask. I explain to my kids that they are not wearing their masks for their own safety. They are young and healthy and will probably not get sick. And if they do get sick, they will be fine. They are wearing masks to protect their teachers and should think about the people that can get infected because of them.” Dr. Evans adds that this fall, “people need to especially stay away from vulnerable groups and older adults. Children are less likely to get severely sick, although there may be some cases. However, elderly adults are at a much greater risk from this illness.”
To best prepare for this unique fall season, Dr. Delaune recommends “people get their flu vaccine this year. One way we can diagnose a patient with coronavirus is by eliminating the possibility that they are sick with the flu. Symptoms between the flu and COVID-19 are very similar. If a patient has been vaccinated for the flu, then we know we’re certainly looking at the coronavirus. Getting vaccinated will help healthcare providers clear up the confusion from the get-go. We can diagnose and respond with appropriate treatment more quickly.”
Q. As frontline emergency doctors, what has this pandemic be like for you?
In parallel to their roles as Assist America’s Consulting Medical Directors, Dr. Delaune and Dr. Evans are also active frontline healthcare workers who practice emergency medicine in various hospitals around the United States. Like many of their peers, they have had to make sacrifices during this pandemic to protect their loved ones, their patients, and themselves. Dr. Delaune explains “we work two or three times a month for two to three days for hospitals around the country. It’s been an adjustment for our families as we have to quarantine when we come home after each mission.”
Dr. Evans adds that he has been most impressed and thankful for the hospital general staff, from nurses to the cafeteria employees, the cleaning crew, and desk employees. “There is a high level of fear associated with this new virus, especially at the beginning of the pandemic. No one really understood what was going on and whether we could get sick. All these people still came to work and stepped in when they were needed. It was impressive and inspiring.”
SentinelMED’s Delaune and Evans are consulting medical directors for Assist America.
SentinelMED is an experienced provider of domestic and international medical transport, evacuation and repatriation services. Please contact us to learn more about the services that SentinelMED offers or its staff.
