July 19, 2020 / View as Webpage
Your Weekly COVID-19 Updates
Paradise Valley Medical Clinic, Douglas M Lakin MD
9977 N 90th Street, Suite 180, Scottsdale, AZ 85258
480.614.5800 (ph), 480.614.6322 (Fax)
PLEASE READ THIS ENTIRE DOCUMENT AS IT IS OF
IMPORTANCE TO ALL PATIENTS

"We will be emailing you weekly during the COVID-19 PANDEMIC. We will provide you with the latest information and instructions to deal with the current outbreak as it develops in Phoenix."
  We Have Expanded Our Telehealth Visits During This Increase In Number Of COVID-19 Cases,
But We Are Still Seeing Patients In The Office.

FROM THE DOC

COVID-19 LEVELS REMAIN QUITE HIGH
IN ARIZONA AND IN SCOTTSDALE
THE SAME STORY AS THE LAST FEW WEEKS
BUT WITH SOME EVIDENCE THAT
WE ARE IN A BIT OF A DECLINE…….

HONOR HEALTHCARE HOSPITAL HAS INCREASING COVID PATIENTS BUT THERE IS STILL CAPACITY, AND THEY ARE PREPARED FOR FURTHER INCREASES (APPROXIMATELY 23% OF PATIENTS IN THE HONOR HEALTHCARE HOSPITALS ARE BEING TREATED FOR COVID).
  
IN OUR OFFICE WE NOW HAVE 1 CASE OF COVID THIS PAST WEEK….14 CASES TOTAL IN THE PAST FIVE WEEKS. THERE HAVE BEEN MORE EXPOSURES THAT REQUIRE TESTING.  
 
APPROXIMATELY 1% OF OUR PATIENTS CONTINUE TO BE TESTED WEEKLY FOR EXPOSURES OR SYMPTOMS.
APPROXIMATELY 1.5 % OF OUR PATIENTS HAVE HAD COVID POSITIVE TESTING IN THE PAST 4+MONTHS.  THAT IS VERY LOW COMPARED TO ARIZONA AVERAGES.
 
FOR THOSE BEING VERY CAREFUL THERE IS STILL NO SIGN TO LET UP…BUT IF YOU ARE LETTING YOUR GUARD DOWN……PUT IT BACK UP. WE NEED TO CONTINUE TO BE MAXIMALLY VIGILANT.
 
ONE POSITIVE IN WEEK 16 IN OUR OFFICE… .  (and several tests from last week still pending due to delays in test results)
 
REDUCE RISK BY REDUCING CONTACTS!!!!    You will not eliminate risk as the prevalence of the virus increases in the community, but reducing your exposure remains highly effective.
 
Please continue to be vigilant!
   
The arc of the current increase is marked. We are remaining one of the HOT ZONES for the country right now. This website offers useful metrics to follow the course of COVID in MARICOPA COUNTY.  To monitor go to:  https://covidactnow.org     
24% of tests STATEWIDE are POSITIVE. OUR OFFICE IS MUCH LOWER AT 3-5%.
 
Outdoor interactions remain most acceptable as it is 20 times less likely to get COVID with outdoor as opposed to indoor exposures. This means 1 minute indoors exposure is equivalent to 20 minutes outdoors.
 
Do know that if you have maximum interactions (multiple meals out, daily visits to the gym, casino visits), your exposure rate is greatly increased during higher levels of COVID prevalence. Such behaviors with multiple and repeated outings become increasingly risky with the rise of COVID levels. Read this article on how to approach different locations you might consider exploring and to understand risks and ways to reduce risks.    https://www.erinbromage.com/post/the-risks-know-them-avoid-them
 
Current COVID ANTIBODY (BLOOD) tests show approximately 1-3% of people in Arizona have had a COVID infection. This is a low percentage. Current testing IN OUR OFFICE this past week, continues to show very little asymptomatic COVID among our patients.  Only 0.2% of COVID ANTIBODY (BLOOD) tests are positive in our patients. 
 
I DO NOT ADVISE COVID antibody testing to determine your status as we have a virtually ZERO SIGNAL (0.2%) FOR PREVIOUS COVID INFECTION among our patients. That said, we will continue to do the COVID ANTIBODY TEST for any patient that is concerned about past infection or current immunity.
 
The BLOOD TEST will identify people who have had COVID infection in the past and who now have immunity from infection.  The exact degree to which this immunity is effective is unclear, but we believe that people who are COVID POSITIVE BY BLOOD WORK will have protection for at least several months or longer.
  
It is 99.8% likely you HAVE NOT HAD COVID…. that is what we are seeing in our patient test results.
 
NASAL TESTING RESULTS CONTINUE TO BE DELAYED WITH THE INCREASE IN TESTING AND IN COVID CASES.  RESULTS ARE NOW TAKING 10+ DAYS FOR POSITIVES.    Nasal testing for acute COVID infection is available at the office, but during the rest of July, Sonora has a delay in processing these results. Previously we were getting results in 24-48 hours. NOW POSITIVES RETURN IN 10+ DAYS…. Negatives usually in 10+ days as well. 
 
The only good news with the delay in testing results is that by the time you get your results…you are already done with the vast majority of the infection if not all of it. You know if you had it or not, and you are recovered. That has been the case with all recent infections that have had delayed results. We have had no serious issues.
 
Alternative testing sites will be listed weekly and expanded. You can find them on our website on the rotating screen and the list is linked below as well. 
 
LOCATIONS FOR COVID TESTING OTHER THAN OUR OFFICE…SEE OUR UPDATED LIST:
 
How to proceed day to day in ARIZONA …….
 
For low and medium risk patients during this time:
1.     Continue to maintain physical distancing when in public spaces or with groups of friends/family.  This remains the most important preventive strategy…. far better than even masks.
2.     Wear a mask or face cover in closed spaces. In open area spaces, masks are not necessary if space is maintained.  This is done more to protect the community than it is to protect ourselves.  When you wear your mask, you reduce the possibility that you will spread COVID unknowingly.  When the people in your immediate community wear their mask, they are preventing the spread from them, to you.  Encourage others to wear a mask for all our protection.
3.     Wear gloves regularly when in public or do repeated hand cleansing and washing…. or do all the above.  This is critical to prevent silent spreading of COVID.
4.     Protection of the eyes is a consideration. Data on this is supportive but not conclusive as to the degree of protection.
5. Expanding your interactions can begin to take place, following the above preventive strategies and considering the following risk profiles.  Do observe the places you are going to make sure they are maintaining appropriate practices.  If you do not see people interacting appropriately, you should reconsider your exposures in such venues during this time of transition to higher levels of community COVID. Until it is clear what level of increase, we are seeing, we must remain conscientious:
a.  Open Air Venues/Public Spaces (parks/trails/patios/open air malls) provide excellent ventilation and have a low risk of spread.
b.  Stores that are large/cavernous, which allow for distancing, and which demonstrate proper protective practices among their employees are lower risk.
c. Smaller businesses that are employing excellent protective practices and which provide for distancing are lower risk.  Do not linger longer that is necessary in such public spaces….do your business and leave .
d.     Read this practical guide about public spaces & exposure…. https://www.erinbromage.com/post/the-risks-know-them-avoid-them
6.     If you have symptoms of any sort that might concern you for COVID…. get tested so that you know your status.
7.     If you are doing all the above and are not in a high-risk group (see below) then you can expand the amount of activities and outings you participate in over the coming weeks.  High risk patients should continue to limit activities to a greater extent.
 
High risk groups include:
·        Age 75 or over
·        Obesity (BMI 40 or above)
·        Lung disease (emphysema/COPD) or current significant smokers
·        Chronic kidney disease (Stage 4 disease or greater)
·        Diabetes…. not well controlled
·        Congestive Heart Failure
·        On immune suppressing medications for cancer or rheumatologic/inflammatory conditions
 
Medium Risk groups may want to be more cautious but can increase activities. These include:
·         Men Age 65 to 75
·         Hypertension
·         Diabetes…well controlled
·         Asthma
·         Obesity (BMI 35 or above)
 
Know that our office is responding to COVID, and we are here to help. Reach out for assistance if you are not feeling well. We will develop a plan of action for you to move forward.
 
 
Yours in good health,
Dr. Lakin
 
 
RECOMMENDED LINKS IN THIS NEWSLETTER AND IN GENERAL FOR COVID INFORMATION:
 
INTERNET SITES WITH BEST INFORMATION:
 
TOP PODCAST DONE WEEKLY BY DR. MICHAEL OSTERHOLM (UNIVERSITY OF MINNESOTA).  He is a world-renowned epidemiologist who was credited with first elucidating TOXIC SHOCK SYNDROME in the 1980’s, and he provides comprehensive and understandable/actionable ideas related to COVID:
 
Listen to this week's PODCAST HERE:
 
Dr. Osterholm’s Summary Thoughts :
·        Viral Gravity: The virus works at its own pace and time. It will seek out people to infect. Nobody is risk free, all situations have some risk, and ‘everyone’s bucket leaks.’
·        Assess the risks of various activities and choose accordingly.
·        Physical distancing is the most important method of avoiding infection. Far and away the most affective.
·        Masks are somewhat effective…. use them.
·        We are in the 3 rd.    inning of a 9-inning baseball game…. So be patient and continue to be vigilant.
·        This is not like the flu pandemic of 1918. There will not be a quiet summer and second wave in the fall…. the summer will not let up, and we will see various locations coming and going with increasing and decreasing infection and risk.
 
According to Dr. Osterholm this week……
·          SCHOOL OPENINGS WILL BE DONE IN VARIOUS MANNERS.  THIS POSES A NEW THREAT OF EXPOSURES AND SPREAD. THIS WILL KEEP THE COVID FIRES BURNING IN LOCATIONS THAT ARE ACTIVE AND WILL IGNITE ACTIVITY IN AREAS THAT ARE QUIETER.
 
Other COVID Internet Links:
 
Risks with different activities…how to gauge risk:
 
Accurate US statistics by age on COVID infections:
 
What we can expect of COVID in next 1 year:
 
Can follow here for ARIZONA UPDATES DAILY and best trending information to know what is out in the community:
 
Most informative graphics:
 
Get your Mask up to N95 Level:
 
If you have symptoms of COVID…. you can run through a simple checklist on-line to see if you should be concerned:

 

 
Johns Hopkins' Dashboard: The People Behind the Pandemic's Most Visited Site
I f the year 2020 is good for anything, it's the lesson that during a crisis, anyone who builds a better mousetrap will find the world beating a path to his door.
A humble team at Johns Hopkins University in Maryland reminded the world of late poet Ralph Waldo Emerson's phrase when they created a real time tracking map of coronavirus cases and deaths.
And the world came to their door. They report that the site, plus downloads of its data, hosts three to five billion interactions daily. By their measurement, interactions include uses of the public dashboard and requests from a separate website for the underlying data used by news outlets and others who design their own maps and graphics..... Continue reading here.

"Please Wear Your Masks In Our Office!"
I n order to keep the infection rate down, it’s important that we continue to stay home, practice physical distancing, wash hands regularly, and wear a mask if you must leave your home. At our office, we are following CDC guidelines and strive for ways to keep our patients and staff safe.
We are requiring that all patients and visitors entering our offices cover their nose and mouth.
You can do this with a scarf, a homemade cloth mask, or your own surgical mask.
Masks have been shown to decrease the spread of coronavirus from infected people, even those who do not have symptoms.
We have a limited supply of paper mask and will make these available to patients while they last, however, we strongly encourage you to bring your own covering.
 
If you would like to help and are making homemade cloth masks or know of anyone that can donate patient masks, please contact our office manager, Leslie.
The Do’s and Don’ts of Wearing Masks and Gloves
States That Require Face Masks Across the Country
July 17, 2020
Arizona To Provide Free Masks To Vulnerable Individuals: How To Submit an Order
Vulnerable adults in Arizona -- those 65 and older and those with medical conditions -- who either do not have a mask or have been unable to get one amid the COVID-19 pandemic, will be able to request some from the state, Arizona Gov. Doug Ducey said Thursday.

The state has partnered with Hanes to provide two million cloth masks to those in vulnerable populations, according to the Arizona Department of Health Services.

For more information >> CLICK HERE
REMEMBER IF YOUR ARE ILL AND CONCERNED
YOU MAY HAVE COVID INFECTION:
Contact the office via phone or email 
480-614-5800

We will contact you and review a plan of action for you.
•          Since most people will have mild symptoms (80+% will do well with cold symptoms only), very little will be done other than routine measures to treat a cold.
•          If you need to be seen we will consider a video visit or see you at a time designated for such visits.


So we can appropriately schedule your visit with Dr. Lakin,
please be sure to complete our
Appointment COVID-19 Pre-screening Questionnaire.

ATTN PATIENTS:
Dr Lakin is using FaceTime ,
WhatsApp and Zoom to connect with you
for a 'Telehealth' visit. You can connect using your iPad, iPhone, android phone, a laptop, or a PC with a camera.

Please watch these videos so you can be prepared and know how to connect with Dr Lakin for a 'Telehealth' visit.

CLICK ON THE PICTURES
Survey July 5, 2020:
If you become ill with COVID-19 symptoms, what would you do first?

Continue with my daily activities, thinking it will go away.
2%
Call Dr. Lakin for advice.
41%
Go through all Dr. Lakin's COVID-19 Newsletter for advice.
10%
Quarantine, wear a mask, arrange to get tested, treat symptoms as needed.
46%
Panic! Go to the ER immediately.
1%

Survey July 12, 2020:
How are you coping with anxiety during this pandemic?

Connecting more with friends and relatives.
24%
Reading books I have always wanted to read.
16%
Virtual travel to places that I have never visited.
3%
Exercising, going for walks to clear my mind.
18%
Staying informed, but limiting watching/listening to the News Media
12%
Finding household activities to keep busy
26%
Business as usual, no change.
1%
Do you have a topic specific to COVID-19 you would
like us address in future newsletters?
We Are Here to Take Care of Your Healthcare Needs.
We Are Here to Serve!
 
Our office is using all techniques to reduce exposure to a minimum during your visit. These include: 
·        Temperature checks of all patients and staff.
·       Masks for all people in the office.
·       Cleansing of hands and surfaces repeatedly.
·       Multiple Super-HEPA filters to filter out potential virus and particles in the office.
·       High Level UV light air cleansing in the office to eliminate bacteria and viruses in the air.
 
  We have expanded our Telehealth Visits during increased COVID-19 cases, but are still seeing patients in the office.  
In addition, we are connecting with you via
phone, fax, email, and telehealth.
 
 
OUR CURRENT UPDATED
OFFICE SCHEDULE
 
DOORS OPEN     
7AM - 4PM Monday through Thursday
7AM - 11AM Friday
DO NOT JUST ‘DROP IN’…YOU MUST HAVE A SCHEDULED APPOINTMENT FOR THIS COMING WEEK.
 
IN OFFICE APPOINTMENTS: MONDAY - FRIDAY
ARE BEING ADJUSTED…..WE WILL CALL YOU TO CONFIRM IF APPOINTMENTS WILL BE KEPT OR CHANGED TO A TELEHEALTH VISIT
 
MONDAY - FRIDAY from 10:30AM - 12 Noon
We will be conducting TELEHEALTH/PHONE visits with patients.

MONDAY - THURSDAY
WE WILL BE SEEING POSSIBLE COVID-19 PATIENTS 3:00PM - 4:00PM (IN YOUR CAR…APPOINTMENT ONLY…. IN PROTECTIVE GEAR)
 
  COVID-19 SUMMARY:
 
REDUCE RISK BY REDUCING CONTACT WITH THE VIRUS
 
REDUCE CONTACT WITH THE VIRUS BY:
1.   Washing hands frequently….20 seconds is advised, but any hand washing is helpful.
2.   Wear a mask or face covering when out in public.
3.   Use hand cleanser in between washings…if available.
4.   Clean your cell phone daily with a cleansing wipe or UV light.
5.   Shower or bathe daily.  Twice daily if you want to feel more relaxed.
6.   Do not Pick Nose, Rub Eyes, or Pick Teeth with your fingers
7.   Do not go out or to work if you are ill…. or think you are ill.  If you are unsure, check your temperature. If over 99.8 you should not be going out.
8.   If someone in your house is ill, treat them as though they have COVID.  Have them get tested and you should quarantine as well.
9.   Stay away from people who are sick with COVID. Only caregivers should be in contact with COVID patients and they practice high level cleaning to prevent spread.
10. Maintain physical distancing practices, avoid getting within 6 feet of people (other than immediate household occupants)
11. Limit your activities to the minimum interactions you can do to maintain your daily living.
12. Leave mail and other paper products for one to two days on the shelf or in the garage (outside the house) …then bring them in after sitting for 24-48 hours to reduce the potential for transmission.
13.  Groceries should be prepared as per the video link below, with attention to cleansing before putting them in cupboards and the refrigerator/freezer.  See this video link for excellent detailed information:   Click Here
 
IF YOU ARE SYMPTOMATIC AND HAVE BEEN TOLD YOU MAY HAVE COVID ……BUT TESTING HAS NOT BEEN DONE YET …….DO AS FOLLOWS:
·        Self-Quarantine for 14 days from the start of illness and FOR at least 3 days after fever and major symptoms have resolved. 
·        Do not share a bathroom with housemates if possible. Use your own bathroom.
·        Do not share utensils with others and clean your own utensils and/or use paper/disposable eating materials.
·        Wait 1 day to wash the clothing you wear. Clothing can be washed after sitting out for 24 hours (virus is not transmissible at that point via clothing).   Others can wash your clothes using this approach.
·        Avoid sharing living spaces with housemates, to the extent your living situations allows.
·        Wash your hands frequently. Use cleanser on surfaces frequently.
·        Wear a mask & gloves when in the presence of others. Wear when you are with others as much as possible.
·        Shower/bathe twice daily if possible.
·        All household contacts should self-quarantine as well with only minimal outside interaction.
 
MORE EXPANSIVE TESTING IS CURRENTLY AVAILABLE IN OUR OFFICE. Results within 24-36 hours generally.
It is being done at the end of the day, in your car, by myself…. wearing protective gear. We are focusing on at risk individuals with mild symptoms or patients with more significant symptoms.  We are not screening asymptomatic patients unless they have had COVID exposure.
 
Symptoms for testing:
·        Fever (100.4 or above) and cough (without other explanation)
·        Fever (100.4 or above) and sore throat (without other explanation)
·        Fever (100.4 or above) and chest pains (without other explanation)
·        Milder fever and symptoms with recent travel from NYC or SF/Seattle.
 
Testing is returning more slowly in JUNE. Positive & negative test results are now reporting back in 4 days although negative tests can take up to a week (this is a delay compared to previous.) Sonora Quest is developing new systems to handle increased throughput, and we anticipate the delays will lessen with time, but for now, we are having to wait longer for results.
Do remember that asymptomatic people are spreading the virus, so you must be vigilant and protective around all people you are exposed to.
 
IF YOUR ARE ILL AND CONCERNED YOU MAY HAVE COVID INFECTION OR SIGNIFICANT COVID EXPOSURE:
Contact the office via phone or email first for instructions:
480-614-5800
 
Please do not walk into our office if you think you have COVID infection . We will not see you in the office. Only in your car, and with that, you should contact the office to be seen end of day.
If you think you have COVID and are truly short of breath, you need to go to the Emergency Room, not to our office. We are not equipped to handle low oxygen levels.
 
WHAT IS OUR CURRENT EXPECTATION FOR THE COURSE OF COVID?
At this point in time the are many uncertainties about the course of COVID in the US and in Arizona, but I can provide some educated speculation:
 
1.     The virus has increased with reopening in ARIZONA but is declining in many other states. Current peak in ARIZONA is projected in mid-July, although this is subject to change and we will update you weekly on these expectations.
 
2.     In September and into the fall and winter we are likely to see a recurrence of infection broadly in the state, country, and world. More significant restrictions will become necessary at that time.
 
3.     Using increased testing (swabs and blood work) we will be able to tune plans more finely for physical distancing in different locations based on results of the presence of infection and its frequency areas. This will allow for waxing and waning restrictions in local areas based on data from testing and mathematical projections.
 
4.     If OPENING UP is to be safe, we all must maintain distancing, wears masks, not go out if sick, and wash our hands repeatedly.
 
5.     Nature is immunizing us more generally, and when we have blood work to confirm previous infection, we will find a great number of asymptomatic individuals having been infected and this will provide ‘herd immunity’ which will be very helpful as time goes on.
 
6.     Antiviral medications will be found through clinical studies and we are likely to see effective treatments made available within 6 months. Remdesivir (Gilead Pharmaceuticals) has already demonstrated some effectiveness in highly ill patients and it is anticipated it will be effective in more mildly symptomatic patients.  Remdesivir is available currently at Honor Health for patients who require treatment. Additional studies are demonstratin g more effectiveness. Production is being ramped up and it will become more generally available.  Additional competing compounds are under development as well and a recent study of other antivirals compounds (a combination of 2 antivirals + interferon) was just shown to reduce duration of infection.  Unfortunately, a recent large study of Hydroxychloroquine failed to show positive effects.
 
7.     Immunizations will be developed, but will take 12-18 months to come ‘online’
 
8.     This paper is an excellent summary about expectations for the future of COVID. There are many unknowns, but this paper is sophisticated and approachable for those who want an expert perspective      https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1_0.pdf
 
9.     This paper is a great summary of information for risks to consider in public spaces:  https://www.erinbromage.com/post/the-risks-know-them-avoid-them
 
 
CARING FOR YOURSELF IF YOU THINK YOU MAY HAVE COVID OR IF YOU HAVE BEEN DIAGNOSED WITH COVID:
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
 
Common/Hallmark symptoms:
·        High fever (over 100.4, but can range from 99’s to 104+)
·        Fatigue
·        Cough
 
Other symptoms can include milder issues:
·        Loss of Smell and/or Taste
·        Nausea without Vomiting
·        Sore Throat
·        Aching muscles throughout the body
·        Headache
·        Occasional diarrhea …
·        Nasal congestion (occasional)
 
TREATMENT:
Symptomatic treatment for the most bothersome symptoms
 
Aches and Pains and Fever:
·        Tylenol 650 1000mg four times per day is preferred for treating these symptoms, but if not working well, you may use:
·         Advil (Ibuprofen 200mg), 2 3 tablets….2 3 x per day or Aleve (naproxen 220mg), 1 2 tablets...1 2 x per day,
·        Drink good amounts of clear liquids (anything you can see through)
 
Sore Throat:
·         Saltwater gargling
1.    Dissolve 1 teaspoon of salt in a glass of warm water.
2.    Gargle for 15 seconds and spit.
3.    Repeat during the day every 2 4 hours to relieve pain.
·         Pain relief medications: Advil (Ibuprofen 200mg), 2 3 tablets….2 3 x per day or Aleve (naproxen 220mg), 1 2 tablets...1 2 x per day, or Tylenol 650 1000mg four times per day.
 
 
Cough:
·        Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
·        Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
·        You may require a prescription cough syrup with Codeine.  Contact me if that is the case.
 
 
Sinus Congestion and Drainage (RARE SYMPTOM):
·        Use a decongestant such as Sudafed 30mg, 1 2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
·         Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
 
 
Nausea Treatment:
This is the most difficult issue to treat at home as there is very little one can do to settle the stomach. Coca-Cola with the carbonation eliminated (Flat Coke), Ginger Ale, or Ginger Root…. can be tried, but these are often inadequate, and the key to getting the stomach to settle is getting a good nausea medication.
 
If nausea is persistent, then calling for a prescription medication is often a good idea. Phenergan (Promethazine), Compazine (prochlorperazine), Zofran (Ondansetron) are very effective in treatment.  Sometimes we use them in combination either as a pill or a suppository.
 
The KEYS are:
 
1.   Settling the Stomach…so that liquids can be taken
2.   Focusing on Liquids…so that dehydration does not set in
3.   Eating light foods… if possible (to provide energy for healing). This is not a requirement for healing from an acute GI illness; so, do not feel that the sick person needs to eat food. The only requirement is liquid intake!
 
When to Seek Medical Assistance
•          There is no medication to treat this virus, so the resolution takes time.
Worsening symptoms/Signs of Complications:
•          If you are getting significantly short of breath please be in touch.  If progressive and worsening, you need to be seen and possibly hospitalized.  Best to go the ER if shortness of breath is a significant symptom
 
How Long to Recover
•          The COVID is a viral infection that will generally take from 3–7 days to develop, 3-7 days to improve and then from 3-7 days to completely resolve.
 
Stay the course & keep safe!