1. Careful pre-visit symptom screening so that you know who is coming in with what and when.
2. Taking advantage of Telehealth and phone visits which most insurers are supporting but to varying degree as you suggest with HMSA ; Medicare has specific guidance on components of its Annual Wellness exam which can be done by Telehealth.
3. Using appropriate PPE for those with symptoms.
4. Masking the patient if they can tolerate upon entry to your office as source control

1. Specimen collection should be performed in a normal examination room with the door closed.
2. HCP in the room should wear an N95 or higher-level respirator (or face mask if a respirator is not available), eye protection, gloves, and a gown.
3. If respirators are not readily available, they should be prioritized for other procedures at higher risk for producing infectious aerosols (e.g., intubation), instead of for collecting nasopharyngeal swabs.
4. The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.
5. Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below. A simple throat culture is not considered an aerosol-generating event.

• There is no published data on the transmission risks of COVID-19 from crying or singing of which I am aware.
• If you are wearing a face shield or goggles and an N95 or surgical mask your risk is low. Face shields can be wiped down between visits with the usual disinfection wipes. Iolani School continues to make face shields for health care providers free of charge. Let me know if you need these. PMAG is assisting with its members with PPE.

• It's always a good idea — even when there's no pandemic — to rinse fresh fruit and vegetables with water to remove dirt, debris and pesticides, and reduce levels of foodborne germs.
• There's no need to wash food with soap. "Soap is for hands, not for food,"
• If you are concerned about food packaging, you can wash your hands after handling the packaging. If you are concerned about your food, you can cook it at 149 degrees Fahrenheit (65 degrees Celsius) for 3 minutes, which will significantly reduce levels of any virus particles. Takeout:
• Should be low risk as the food industry has a heightened awareness about food safety. To further reduce the risk,wash your hands after handling food packaging or takeout bags This is a good opportunity for people staying at home to prepare their own healthy food that they have stood in line for for so long at Costco! Also could you comment on the role of transmission from symptomatic persons?

1. Early data out of China suggested a low rate of co-infection. However a study published in JAMA last week looked at a larger number of patients in Northern California that found a much higher rate of co-infection with rhinovirus /enterovirus in about 12% and influenza A about 3%.
2. As above hydroxychloroquine is not necessarily a benign drug
3. Treatment efficacy is not proven
4. There is now a limited supply as there seem to have been hoarding going on just like toilet paper and rice. Physicians in particular were writing large prescriptions for themselves in the hundreds of tablets. Patients who take the drug for rheumatologic diseases on a chronic basis for which HCQ has proven efficacy should be the prioritized recipients of HCQ.
5. Patients with mild symptoms who are not sick enough to warrant hospitalizations should be managed with symptomatic care.

1. PMAG Physicians submit questions regarding COVID-19 Patient Care using this link.
2. PMAG will collect the questions and forward to Dr. Bello.
3. Dr. Bello will answer your questions as soon as she is able.
4. PMAG will share the COVID-19 Q&A collected via email and post the Q&A on our website www.pmaghawaii.org.