[Author’s note: This post was written on the afternoon of Friday, March 20, 2020. The subject matter is rapidly changing, and the recommendations below may be out of date in a few days. Find the latest recommendations from the LA County Dept of Public Health and the Centers for Disease Control.]
In these turbulent times I’ve curated the most common questions and requests I’ve received and attempted to answer them.
This is totally unprecedented! Crazy times! I can’t believe it.
Yeah. It’s pretty disorienting. There’s nothing to compare this to.
Is your office closed?
No. We’re open. We’re seeing only urgent appointments in the office. We’re handling everything else by phone and video chat. We’re here.
You must be swamped!
Am I supposed to stay inside?
Yes. Yesterday the Governor ordered the entire state to stay indoors except for essential activities. The details are here.
Can I go outside for a walk?
Sure. That’s a very good idea. Just stay at least 6 feet away from others. Daily exercise will help keep you fit. And during this stressful time it’ll be a terrific distraction.
I feel fine. But I heard that there are medicines that will help if I get sick. Can I have a prescription for hydroxychloroquine (or azithromycin, or remdesivir, or lopinavir-ritonavir)?
Hydroxychloroquine (Plaquenil) is used to treat lupus and malaria. There have been tantalizing anecdotes of people with COVID-19 improving very quickly on it. There are similar anecdotes of people taking Plaquenil plus the antibiotic azithromycin. Unfortunately, anecdotes don’t prove anything. There are currently trials testing these medicines in patients hospitalized with COVID-19. Plaquenil also has side effects and can cause dangerous EKG changes. Let’s be sure it’s effective before prescribing it.
But I’d like it now, in case the pharmacies run out.
There are rumors of doctors prescribing unproven medicines to asymptomatic patients. If these are true, the doctors should be exposed to public disgrace. Did they check an EKG on every patient prior to prescribing Plaquenil to assure that it will be safe? If one of my lupus patients has a hard time refilling her Plaquenil prescription because these bozos prescribed an entirely experimental medicine to people who were feeling fine, they should have to answer to her. Anyway, what were you going to do with the Plaquenil if you don’t get sick?
I was going to keep it right here next to the Cipro I didn’t take for anthrax.
Oh. I see. Well, as soon as it’s proven safe and effective for COVID, and as soon as you get COVID, I’ll be happy to prescribe it for you. Until then, let’s let the lupus patients have it.
I heard the President say…
What’s all this I’m reading about the dangers of ibuprofen and naproxen?
There were reports out of France that patients who were sick with COVID and took ibuprofen and other non-steroidal anti-inflammatory medicines (NSAIDs) had worse outcomes. That’s a problem, because for many patients who are sick with COVID and are not hospitalized, treating their fever and aches is about all we can do. NSAIDs are a mainstay of symptom control. First, this mini-controversy has nothing to do with what patients were taking before they got sick. So there’s no reason to avoid NSAIDs when you’re healthy. Second, US and UK experts challenged the data out of France and currently there seems to be no evidence that NSAIDs worsen COVID illness.
I’m washing my hands constantly. I’m staying home. I’m staying away from others. What else can I do?
Donate blood. Many blood drives have been cancelled, so donating at the medical center of your choice would help a lot. Call your elderly neighbor who lives alone. Ask if he needs anything. Make a trip to the grocery store for your friend who is going through chemotherapy (and leave her groceries on her doorstep). If you’re young and healthy you can do the critical errands for all the old and not-so-healthy people you know. Be that hero.
Hang in there. There’s no way to know for how long our lives will be like this. And there’s no way to know what the world will be like at the other end of this. But we’ll probably all remember this for a long time. So behave like the character in a story that you’ll want your children to tell. Stay healthy. I’ll try to write again soon.
California Orders Lockdown for State’s 40 Million Residents (Wall Street Journal)
Stay home except for essential needs (CA.gov)
A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19 (New England Journal of Medicine)
COVID-19: Could Hydroxychloroquine Really Be the Answer? (Medscape)
Are Warnings Against NSAIDs in COVID-19 Warranted? (Medscape)
Cedars Sinai Blood Donor Services