Please call (650-851-4747) before coming to The Village Doctor if you have any symptoms of a respiratory illness (fever, cough, congestion, trouble breathing), so we can determine the best course of evaluation and treatment. Since March 11, we have been primarily using a telemedicine platform, however we continue to be available to our patients 24/7, including for clinic visits, but only after a screening call with your physician.
Welcome to The Village Doctor’s resource page on COVID-19 (Coronavirus Infection Disease 2019) and the virus which causes this illness, SARS-CoV-2. We have tried to highlight the most relevant messaging in an easy to digest format and on a platform which we can keep up to date. NOTE we have added SEARCH functionality! Click on either the magnifying glass at the top right, or the Search box at the bottom left, to search our entire website. Please contact me directly for feedback on this site: Eric Weiss, MD (Last Updated: July 20, 2020).
Although SARS CoV-2 is a novel virus, coronaviruses have been around for a long time. At the moment, we need to balance the anxiety, geopolitical, and economic actions regarding COVID-19 with the impending health crisis looming for our communities. There is a tremendous global effort underway to develop the same for SARS-CoV-2 and we will get there. Until then, we call for education, calm, and preparedness, as outlined below. If interested, there are excellent videos describing COVID-19 here and here. This is also an excellent overview out of Cal Tech. More recently (April 29th), The Atlantic published an article by Ed Yong which one of our team described as “one of the most cogent, insightful articles I have yet read incorporating so many facets of the situation we are in.”
CVNews: Weekly TVD Coronavirus Newsletter
All five TVD physicians collaborate together in weekly Internal Medicine, Emergency Medicine and Pediatrics Grand Rounds and Town Hall meetings at Stanford and UCSF, please find our weekly family and patient facing updates here.
HEALTH OFFICER STATEMENT JULY 20, 2020: Today, San Mateo County Health Officer Dr. Scott Morrow released the following statement:
Why is the virus spreading here at it’s current higher level now? I don’t know exactly, but it appears to me that there are 3 major factors. In order to understand what’s going on completely with transmission risks, we don’t have the resources to do case-control studies. We don’t have the wherewithal to do case-control studies given the enormous burden on all the staff at the health department at this time, but we can take some educated guesses based on patterns that we are seeing here.
- The virus appears remarkably, even surprisingly, transmissible. At pretty much every point over the last 6+ months, I’ve been surprised, and impressed, at how capable this virus is at moving itself between people. It spreads in households like wildfire and it spreads in other indoor environments too. It seems to be everywhere we look. I know this is hard, we’re all exhausted and frustrated by having to take precautions, but the implication of this fact is that you can’t let your guard down, or be careless, even once, especially if you are at high risk.
- Fundamental structural failures of the US economy are being laid bare by the pandemic. These structural issues seem to be a major cause of the transmission we’re now seeing, at least in San Mateo County. Many elements of the US economy can be viewed as illogical, even immoral in my opinion, in that so many people are forced to live lives of economic desperation, live pay check to pay check, are not paid a living wage, live with no workplace safety nets, like healthcare, like paid sick leave, or other wage protection programs. While these structural issues are illogical in good times, they are downright inexplicable in times of a pandemic. These structural problems are at such a massive scale, they can not be ignored. A majority of people we are seeing infected now are front line workers (people who allow the rest of us to eat, and have electricity, and have our garbage picked up, etc), live in crowded multigenerational conditions, live with lack of trust in, and in fact have downright fear of, government. Remember to stem the spread of this very transmissible virus, people who are infected need to be separated from others (isolation and quarantine), not go out in public, and not go to work while they are infectious. Try getting compliance with isolation and quarantine when the infected person is the breadwinner for the family and the family will be out on the street if they don’t go to work. And when they go to work they will, perhaps, interact at that job with you. There is not enough enforcement capacity in the world to stop this from happening. The implication of this is that the current business focused restrictions will do little to stem the spread of the virus when the spread is exacerbated by these conditions. This requires rapid policy and systems changes at every level of both public and private sectors, from the feds on down, and from the largest corporations to the smallest business. We need to see much more work in this area, and we need to have less reliance on business sector closures and restrictions, beyond getting businesses to do the basic transmission control measures. Failure to fix some of these issues will prolong our collective pain.
- Complacency is the other majority factor enabling spread. This is either born of belief systems (this is all a hoax, this isn’t that bad for me, let’s go to a party and get infected), or born of just not paying attention. Many, many of our infections are related to fairly small gatherings of family and friends. Birthday parties, picnics, eating at restaurants with mixed households, etc, without the basic precautions being taken. Most of these gatherings are innocent, no doubt, not intending to spread the virus, but they do spread it, and with far reaching implications. Please note, your seemingly innocuous get togethers are driving the spread and are a major reason why you can’t go to a restaurant, why you can’t go to the gym, why you can’t go get your hair cut, why kids can’t go to school. Until, or unless more people get this fact, we will continue to be stuck in the situation we are in. To get out of this situation depends on all of us. Our collective best course of action: No gatherings outside of immediate households, use facial coverings extensively, and social distancing.
NEW RESTRICTIONS FOR STATE OF CALIFORNIA. July 13, 2020. Today, Governor Newsom is ordering a statewide shutdown of indoor dining, movie theaters and family entertainment centers in response to increasing COVID-19 cases statewide. While San Mateo County is not on the “watch list” and thus is not facing more widespread shutdowns like some other counties are, Dr. Scott Morrow reminds us that “Governor Newsom’s measures further emphasize the need for all of us to do our part in stopping the spread of COVID-19. That means wearing a face covering, maintaining social distancing, and limiting our activities. It’s up to us to determine our future.”
The following must close statewide – including in San Mateo County – under the governor’s emergency order:
- Dine-in restaurants (indoor)- outdoor dining is still allowed.
- Wineries and tasting rooms (indoor)
- Movie theaters (indoors)
- Family entertainment centers (indoors)
- Zoos and museums (indoors)
- Cardrooms (indoors)
- Brewpubs, breweries, bars and pubs (indoor and outdoor)
You can read the press release here.
LOCAL TESTING OPTIONS: As of July 8, 2020 testing for active COVID-19 (by nasopharyngeal swab) for symptomatic patients continues to be available at Stanford through their Express Care program by appointment. Drive-through testing at the Emergency Department is no longer available. Appointments for Express Care can be made online through MyHealth or the MyHealth app, or by calling (650) 498-9000. Note there has been a significant increase in demand for testing since July and there are longer wait times to get an appointment and receive results. We’re seeing this nationally, not just in our county.
With Express Care, our experience is that you will first get a call back from a nurse to screen you clinically, who will then schedule you for your drive-by test, which takes only a few minutes. The testing sites are at the Hoover Pavilion and at the Galvez Street location in Palo Alto from 9 a.m. to 6 p.m., seven days a week. Patients with positive results will be called back and care plans established. Negative results can be found online on MyHealth after 24 – 36 hours.
There is also testing at GOHEALTH, which is part of the Dignity Health system. They have an urgent care site in Redwood City that tests adults and children and also require a video visit with their MD prior to scheduling your nasal swab for viral testing. Again, there is high demand and limited availability. It is IMPORTANT to note that Dignity Health uses the COVID PCR test developed by Abbot. This test has less sensitivity than the Stanford and Labcorp tests. A lower sensitivity test means there is a higher percentage of false negative results. Bottom line, while this test is faster (typically same day results) it is less accurate.
Testing is also available through PAMF (Palo Alto Medical Foundation) Urgent Care “drive through”, but only in selected locations (Palo Alto and San Carlos), and only to PAMF patients with an order from their PAMF primary care doctor. Kaiser has a similar program for their patients.
If you live in San Francisco, you can learn here about the test sites available throughout the city.
And lastly, and a newly discovered option which includes availability for children (see more below), Santa Clara County Testing — no video visit or doctor’s order required, multiple sites located in Santa Clara, San Jose, and Morgan Hill. Testing is for ASYMPTOMATIC patients only. Residency in Santa Clara County is not required. Again, for children and adults who DO NOT have symptoms of COVID-19. Testing appointments are made through their website, or download Santa Clara County’s MyHealth App for iOS or Android.
**If you get tested through any of the above pathways, please be sure to keep your phone handy and answer unknown numbers to avoid delays in processing and getting your results**
Asymptomatic patients (people with no symptoms) who would like to be screened for active disease (“asymptomatic shedding”) with a nasal or nasopharyngeal swab test now have many options of varying quality. We recommend the following two for their combination of convenience and reliability. NOTE these options do NOT test children under the age of 18 (See the next FAQ below!) We are actively monitoring testing options for more availability and will be adding to this area as soon as we have reliable information:
- LabCorp Pixel: A home test, this is most convenient and has a fairly quick turn-around. Ordered online, it is shipped via FedEx for next-day delivery, picked up from your home by FedEx to be shipped back with next-day delivery upon notification by you that it’s ready for pick-up, and results take 24 hours after arrival back at their lab. If you swab the same day you receive the kit, it’s a total turn-around time of 72 hours (labs are processed over the weekend as well), and we found the whole process to take only about 15 minutes of total coordination time (ordering, collecting specimen, calling for pick-up by FedEx).
- Project Baseline / Verily (working with the county public health system): With drive-through testing options in Redwood City and San Mateo, appointments can be scheduled online 48-72 hours in advance, and results take 3-4 days.
REVISED SHELTER IN PLACE ORDER JUNE 17, 2020: Effective immediately, San Mateo County Health Officer Dr. Scott Morrow has issued a new order to align the county with Gov. Gavin Newsom’s Resilience Roadmap. Businesses will now follow the state’s schedule for reopening, but must adhere to the local order’s COVID-19 safety measures and follow state guidance. “The June 17, 2020, order limits gatherings to no more than 50 people, outlines social distancing and face covering requirements, allows for social bubbles, and requires businesses to implement a social distancing protocol and written health and safety plans. Dr. Morrow says, ‘We are moving away from opening businesses according to certain categories and instead focusing on behaviors and practices. As we ease restrictions, the power to control the spread of the virus lies with individuals and communities. Collective behavior will determine our destiny. If enough people, businesses, or organizations in the community do not follow the protective recommendations, the virus may spread with abandon.” Businesses including dine-in restaurants, salons, gyms, hotels, zoos and museums may now resume operations if they produce and post health and safety plans and as of June 19, other personal services will be able to open as well.
It continues to be very important to follow guidelines for face coverings and social distancing. Face coverings continue to be required inside or in line for grocery stores, hospitals, health care and veterinary offices and on public transportation. In general, it is best to have a mask on whenever you might be closer than 6 feet away from another person that is outside of your household or family. The county now allows people to create “social bubbles,” which are described as groups of 12 or fewer people from different households who agree to only socialize with members of the same stable group for a minimum of three weeks. While masks and social distancing are encouraged even in these groups, they are not required when members are in outdoor settings. You can read more info here or the complete order here.
FACE COVERINGS ARE REQUIRED. As of April 17 at 11:59PM, the San Mateo County Health Officer, in coordination with other Bay Area health departments, is requiring residents to cover their nose and mouth with a face covering, such as a bandana, scarf, towel, or other piece of cloth or fabric, when leaving home in many situations. These include doctor appointments, grocery shopping, pharmacy visits and riding on public transit, among others. Children aged 3 to 12 years are not required to wear a face covering, but if they do, they should be supervised by an adult (those under 2 years should not wear masks). Enforcement began at 8AM on April 22, 2020 and violations of the order are punishable as a misdemeanor. Read more here.
CORONAVIRUS ANTIBODY TESTING. As we noted last week, the news continues to be dominated by the challenges with testing patients for coronavirus, or COVID-19. Recall that on April 10, Stanford University announced a blood test for coronavirus serology, a potential game changer. These new blood tests measure coronavirus antibodies (IgM, IgG) that the body makes in response to COVID-19 infection. These antibody tests, also called ‘serology’ tests, are different than the nasal swab “PCR” tests used to detect the presence of SARS-CoV-2 genetic material currently present in respiratory secretions. It can take 1-3 weeks before an infected person makes enough antibodies to be detected by antibody tests. Testing too early could yield a falsely negative result.
We know many people would like to know if they have been exposed and may have immunity to COVID. While Stanford does now have a serology test, we are not yet recommending our patients have this test done.
While we all hope a positive serology test means a person is immune and “safe,” we do not yet know if, or for how long, that immunity may last. Doctors worry that knowing you have a positive IgG response could lead you to feel more comfortable being less careful with social distancing, decreasing protection of at-risk loved ones or yourself, which could be harmful until we know more about how protective an IgG response is.
SOCIAL (PHYSICAL) DISTANCING IS CRITICAL: Since March 11, 2020, we have recommended that people do their best to stay away from others and since March 17, we have been ordered to do so. We prefer the term “Physical Distancing” as it is important to stay “social” and support each other, but remotely using phone, social media, and video chat. Physical Distancing is practicing behaviors to lower the risk of spread, you can read more here. Yale epidemiologist Jonathan Smith spells out how one person “cheating” breaks the chain for our entire community here. We have to get very serious about this, “business as usual” is not an option.
If you have questions about what this really means for your life and habits and how the power of Physical Distancing can radically change the face of this pandemic, please take a look at the articles below. P.S. STAY HOME.
Watch How the Coronavirus Spread across the United States — NY Times
“Why outbreaks like coronavirus spread exponentially, and how to ‘flatten the curve’” — Washington Post“Social distancing is not a snow day”- The Medium
Eric L. Weiss,
Prerana R. Sangani,