DocTalker News Alerts

Questions & Answers on Antibody testing from the desk of Alan Dappen, MD:

posted 5/20/2020

Q: Can I get an antibody test? Is it reliable?

A: Antibody testing (also called serologic testing) is already available but because of the rush to the market, not a single lab (over 100 companies) offers one that is fully vetted by the FDA. The presence of SARS-CoV-2 IgG antibody level in the blood should be able to detect with a high degree of certainty if a person has been infected with COVID-19 in the past.

Q: Who, What, Why, When, Where, How of testing for antibodies?

A: It takes at least 2 to 6 weeks after getting sick before the specific SARS-CoV-2 IgG antibodies levels to be detected. Testing at 6 weeks or even later is preferred to reduce false negatives.

How? We can order the test and send you to a lab of your choosing, or draw the blood at our office. Assuming consult time and the cost of drawing the blood for our office, it should cost $120.00. The test should be covered by insurance but if you don't have insurance, we estimate the current negotiated price of the antibody test to be around $75.00.

Q: If my lab test for SARS CoV-2 antibodies is positive, does that mean I am immune to COVID-19 now?

A: First, we are not 100% sure whether or not you can get SARS CoV-2= COVID-19 again. For now, based on similarities to other viral infections, we assume that developing IgG antibodies to Covid-19 means you have developed immunity, at least in the short term (months to years.) Second, there is a chance of false positives on the antibody tests - since they have not been fully vetted by the FDA. In a nutshell, even if you test positive for antibodies, it doesn't guarantee you are immune until we know more.

Q: How close are we to having herd immunity?
A: So far, about 2% of the population has been infected by Covid-19. The current contagiousness of one Covid positive person means, on average, they will spread the infection to two or three people. Herd immunity (protection to vulnerable non-immune people who are protected by everyone else’s immunity) requires about 75% of the population to be immune to Covid-19 to prevent its spread. We are still a long way from herd immunity.

Until we have a vaccine, the only people who are likely safe to wander without much fear are those immunized by the virus, assuming this critter doesn’t have any more surprises in store for us.

Q: Where can I learn more about this test since it’s not FDA approved yet.
A: Important Information on the Use of Serological (Antibody) Tests for Covid-19 - Letter to Health Care Providers

https://www.fda.gov/medical-devices/letters-health-care-providers/important-information-use-serological-antibody-tests-covid-19-letter-health-care-providers

Got questions? Call us! 703-938-4600

What's the latest research on hydroxychloroquine?

Does it work when treating serious COVID-19 infections?


Question: Does hydroxychloroquine (an antimalarial drug) work when treating serious COVID-19 infections (the 20% of individuals with severe symptoms)?

Answer: NO.


From the Desk of Alan Dappen, MD*. The anti-malarial drug, hydroxychloroquine, has been a hot topic in the media lately with President Donald Trump promoting the drug as almost a miracle drug in the war on this pandemic. However, a new study suggests this may not be the case. If you read the details of the study that was done below, they discovered that using hydroxychloroquine on people with severe cases of Covid-19 may not simply lack benefits, but could actually increase mortality rates.



These study results on hydroxychloroquine were not surprising. Attempts to save people from tragic Covid-19 deaths have been ongoing for four months throughout the world. To date, the entire medical community has cautioned optimism about this antimalarial drug despite the enthusiasm of few promoters on Fox News. Even though this is was not a large study, it reflects the international medical community's general consensus.



Since the virus is presenting about the same worldwide, if this medicine had worked really well we would have heard a big "WOW!" from countries all around the world. Unfortunately, the international consensus on this medical treatment has not reported any real "wow"s at all — meaning it does not appear to be a reliable treatment option. However, there are still studies going on to determine if using hydroxychloroquine before infection or early on in the infection cycle would be a reliable treatment.



My guess is, "No." But the urge for humans to do something, take something, believe in a talisman when looking into uncertainty, overwhelms their ability to just sit patiently and wait.



The Research. In a study conducted by Veteran Affairs and a group of academic researchers, 368 male Covid-19 patients across the nation were analyzed. Among this group, 97 received hydroxychloroquine, 113 received hydroxychloroquine in combination with the antibiotic azithromycin, and 158 did not receive either treatment. The results of the study presented a higher death rate for patients who were treated with the drugs—a death rate of 27% for those who received only the antimalarial dying, and 22% for those who received the combination of drugs. In contrast, the death rate for those who did not take anything was only 11.4%. Patients on ventilators also demonstrated no benefit from hydroxychloroquine .



The Summary. This study, which was published on the site medrxiv.org by researchers affiliated with the University of Virginia, the University of South Carolina, and the Veteran Affairs system, highlights the fact that hydroxychloroquine may not simply lack benefits, but could actually increase mortality rates. While no concrete conclusions can yet be made regarding the drug, this continued research demonstrates the importance of waiting to adopt use of hydroxychloroquine for Covid-19 until it has been sufficiently studied—otherwise, it may do more harm than good.



*Special thanks to Kirsten Fagan who did the lion's share of authoring this DocToid.

Important Things You Need To Know To Protect Yourself
and Stop the Transmission of Covid-19


From the desk of Alan Dappen, MD:
Now that Covid-19 has been around for three months, we're able to learn first-hand what sort of measures are working for protection. I know that knowledge of these safety precautions will help you feel more in control and will help keep you safe.

Watch this video
The CDC is now considering recommending that Americans wear masks in public. This sounds like a contradiction from past information but I think this video of Dr. David Price, an ICU doctor at Weill Cornell Medical Center in New York City, will help you understand why we're all changing our thoughts about masks. Dr. Price shares information on how Covid-19 is contracted and spread. He also gives simple but effective guidelines on how to protect yourself. The video is long, but you’re probably at home and can't wait to watch educational TV. So watch it -- Doctor’s orders!

Here are the vital takeaways from the video:

What you should know about the contagious aspects of Covid-19


· Assume you/they could be infected: People can spread the virus before knowing they’re sick, while they’re sick, and even a few days after their symptoms dissipate. When interacting with others, assume that they could be infected and that you could be infected.

· Think of glitter when you sneeze/cough/talk: When infected people cough, sneeze, or talk, they continually expel tiny droplets of saliva carrying the virus. These droplets fall from the air and infect whatever they land upon.

Think of the droplets as specks of glitter. The glitter projects outward a few feet before drizzling downward. The virus does not remain suspended in air for long, but it’s important to maintain a 6-foot distance from others so as not to be in each other’s glitter stream.

· Greatest danger = touching your face:The video maintains that the greatest majority of infections are caused by touching something contaminated and then touching your face, allowing the virus (glitter) access to the body through the nose, mouth, or eyes.

· Virus can remain on surfaces: Under the right circumstances and on the right surfaces, the virus remains virile up to 72 hours. That means live glitter can lie almost everywhere. Make sure to disinfect** the things that you touch often and carry around hand sanitizer when no sink is readily available.

· Use acetaminophen not ibuprofen: Dr. Price acknowledges that acetaminophen (Tylenol) works better than ibuprofen (Advil/Motrin) for Covid-19.

** Here's a link for the a list of approved disinfectants to use against Covid-19. Click HERE. (Note the amount of contact time that each cleaner has to sit on the surface to fully disinfect it.)

Three Steps for Protection


The 3 most important rules:

1) Wash/disinfect your hands - scrupulously and constantly

2) DON’T TOUCH YOUR FACE unless you are sure that your hands are germ-free. Dr. Price believes that 99% of all transmissions of Covid-19 are from hand to face. Gloves can get germs on them just as easily as your hands, but wearing gloves are helpful if they help remind
you to not touch your face.

3) Avoid sustained contact with people outside your safe circle - being within six feet of someone who has the virus for more than a few minutes puts you at risk. However, don't treat your neighbor or delivery person as an enemy. The most common enemy is on your hands.

To Wear a Mask or Not to Wear a Mask...


Dr. Price suggests that people should wear some kind of homemade mask, or even a bandana or scarf - but cautions against hoarding the specialized N95 masks. His video helps explain why.

A mask over your mouth and nose has three major benefits:

1) Germ catcher: You might be carrying the disease without knowing it and even a loose mask catches much of the germs you could be expelling.

2) Helpful reminder: Masks remind you that anyone and everyone could be spewing germs. This will help you maintain proper distance and proper safety protocols.

3) Face protector: Masks remind you: DON’T TOUCH YOUR FACE. Maybe masks or wearing a clear plastic face shield should be normalized.

How To Make a Mask


Homemade masks can work well for times when you need to go out. One of the most impressive masks I've found was on a YouTube video that one of my patients made out of 3M Filtrete 1500 AC Filter. You can find it HERE.

How to Sanitize Your Mask

Although homemade masks can be laundered to be sterilized, Stanford University just released a study explaining that N95 masks can be sterilized under low heat (158 degrees) for 30 minutes.

Updates on Covid-19 Testing


Posted on March 28, 2020


There have been a few updates that we thought you should know about:


1) Have Symptoms? Call DocTalker!
All Federal, State, and County health departments are still recommending that you call your primary care physician if you have symptoms indicative of Covid-19.

2) We can test you
We have the capability to test you at your convenience. You must call us in advance and let us know your symptoms and we will arrange a time for you to come to our parking lot. Just stay in your car and one of our medical team members will come to your car in our safety gear (see picture to the right) and take the required nasal and throat swabs.

IMPORTANT NOTE about drive-thru testing sites: Even though they are setting up "drive-thru" testing sites in parking lots, they will not test without permission from your doctor. We can save you the long wait and submit the test just as quickly. We also have your medical background and contact information already in our records so you don't have to fill out any additional forms.

3) Who can be tested?
Due to limited testing capacities, the CDC recommends that people not be tested unless they are starting to experience severe symptoms and/or have certain risks..

There is a CDC self-checker quiz (click HERE to see it) to help people decide if they have Covid-19 symptoms, but calling your medical team at DocTalker is always the best first step.

4) How long does it take to get the results of the Covid-19 tests?
Currently LabCorp has informed us that, due to the large influx of tests they need to process, the expected 3-day turn around time is now a 7-day turn around. However, we are hoping that the testing support system will improve soon.

5) Avoid the ER
It's obvious that the Emergency Departments at all of the hospitals are becoming jammed up with Covid-19 patients. Fortunately, we are able to handle 65% of all medical concerns that could be handled in an ER.

6) Any questions?
Don't hesitate to call us at 703-938-4600 or email us at doctor@doctalker.com


How DocTalker can serve you safely during this pandemic.


Posted March 18, 2020


DocTalker’s use and advocacy of telemedicine for eighteen years was not developed in anticipation of a global pandemic. But telemedicine is now the recommended way to get as much of your medical care as possible during this challenging time. We want to update you on several changes we are making to help you and others while the crisis continues.

#1 We will expand the telemedicine reach of our services and relax some policies. This means:

A.
No Check-up Required for Service: People who have not seen us in over a year will not be required to come to the office to continue getting telemedicine services. They are free to call whenever they need help.

B. Past Patients Welcome: People who have not used DocTalker for some years are free to call if they have medical issues or medications that require refills.

C. New Patients Welcome: People who have never used DocTalker as their medical source can call us for help. This means family members, relatives, and friends in the local community, or within the Commonwealth of Virginia. Feel free to recommend this to anyone who you know who might need medical help.

Preferably, new patients looking for medical help should go to our website and register on our portal https://doctalker.md-hq.com/ before calling us. We can help new patients with prescription refills but cannot prescribe or refill controlled medications for them.

D. Controlled Substances:Existing patients and those known to our medical providers who need regular controlled substances (schedule II medications) will not be required to make a face-to-face visit to fill their prescriptions. We can renew the medications at the provider’s discretion via telemedicine for a month at a time until the crisis abates.

E. Office Hours: We will continue with office hours as needed and continue housecalls, which may be preferable in many cases. These will be done by appointment only. For now, we will want anyone to be screened via telemedicine first to determine who needs to be seen face-to-face. Our purpose is to provide the same seamless care as before but reduce unnecessary exposure to DocTalker staff, patients, and our community.

#2 If you are sick with an upper respiratory illness that has you concerned, the recommendations by the Centers for Disease Control and other experts is to call your primary care doctor (i.e. DocTalker). (See side bar to the right.)

#3 Stay updated, using reputable information.
Here are two websites working hard to keep us all informed.
Centers for Disease Control:

https://www.cdc.gov/coronavirus/2019-ncov/index.html



COVID-19 - What your doctor wants you to know


Posted March 5, 2020


#1 MOST IMPORTANT THING TO KNOW...
DocTalker medical team is here for you via Phone/Email/Secure Portal & House Calls Whenever you need us: 24 hours a day/7 days a week

One advantage of being a patient of DocTalker Family Medicine is that our practice has been using email, phone, house calls, and a secure medical portal for communications between our patients and medical team since we opened our practice. These methods of communicating with your doctor are now highly recommended during times when you want to have access to medical advice without exposing yourself to germs in a waiting room, clinic, or emergency room.

What can I do to protect myself from COVID-19?
Washing your hands thoroughly (for 20 seconds) and remembering not to touch your face or food without hand-washing is the best way to protect yourself. A face mask may not necessarily protect you, since most masks leak around the edges. (But if you are sick, it is strongly recommended that you wear a face mask to prevent cough droplets from spreading into the air which might spread the virus to others.)

What are the symptoms of COVID-19?
For approximately 80% of those who become infected with COVID-19, it appears that the symptoms vary from that of a regular cold to symptoms that resemble "a bad case of the seasonal flu." If those flu-like symptoms do not resolve and start to affect your breathing, it is important to call your doctor immediately.

Right now, it appears that healthy children are not especially vulnerable to the serious side-effects of this virus, but the elderly and people who are immunocompromised are at an increased risk.

What should I do if I suspect that I may have been exposed to COVID-19?
The best practice is to isolate yourself from others who have not been exposed to the best of your ability. Try to stay home and limit contact with family members or others. Try not to go out to public areas where others may contract it. Wearing a medical mask may help prevent exposing others.

What should I do if I suspect that I have COVID-19?
The safest thing to do if you suspect that you may have COVID-19 is to call your DocTalker medical team at 703-938-4600. We can help you decide what to do based on the most recent medical research.

Since it is more likely that most Americans who are exhibiting flu-like symptoms will have this year's aggressive seasonal flu, it is important to call DocTalker to get an anti-viral prescription for that within 48 hours of the onset of symptoms.

Will getting the flu shot help protect me from COVID-19?
Since there is no current vaccination or anti-viral for COVID-19 yet, getting the flu shot won't be effective against COVID-19. However, the flu shot can protect you - and others around you - from getting the seasonal flu. Remember, the seasonal flu is still rampant, the fewer cases of seasonal flu that are out there, the less strain on our medical system.

Questions?
If you have any questions, please feel free to contact us via phone, email, or through our secure patient portal. 703-938-4600.

DocTalker is here for you, any time, anywhere

DocTalker Wins Checkbook's Top Rating for Quality

DocTalker Wins Family Physicians Who Are Changing Our World award

The Family Medicine Education Consortium, Inc (FMEC) has announced that DocTalker Family Medicine has been awarded the 2014 FMEC "Family Physicians Who Are Changing Our World" award.

The award is given annually to a Family Physician who has shown leadership, strength and outstanding service to his community and the field of Family Medicine.

The award was given during the 2014 FMEC Northeast Regional Meeting on October 25, 2014.

The Family Medical Education Consortium, Inc. is an organization that works to improve the health of the community by strengthening Family Medicine/Primary Care services and medical education programs.

This is the second award for DocTalker Family Medicine in 2014 and the third award since 2013. In April, 2014, DocTalker was awarded the Global Health Award in Richmond, VA for their innovative and effective approach to practicing medicine that could be duplicated on an international level. In 2013, DocTalker was named Fairfax Top Doctor by the Sun Gazette.

DocTalker is honored to have been chosen as the winner of these awards. Truly, the awards belong to our patients and community who supported and helped us to learn and grow a new delivery model that is now being called "direct primary care."

We are also grateful that the larger primary care community is embracing the idea that talking with a doctor anytime and anywhere is something everyone deserves.

DocTalker Wins Global Health Award

On Thursday, April 24, Dr. William Hazel, Jr., the Secretary of Health and Human Services for Virginia, and Dr. Jennifer Lee, the Deputy Secretary of Health and Human Services for Virginia, presented DocTalker Family Medicine of Vienna, VA with The Global Health Award.

The Global Health Award is annually bestowed on companies or organizations that are innovative leaders in the industry of healthcare or global health. DocTalker Family Medicine was awarded this honor due to their patient-centered business model of delivering quality healthcare in a manner that can be emulated internationally.

By integrating a direct pay system that includes in-office visits, house calls as well as telemedicine, DocTalker has formulated an expandable model of personal health care delivery that can be easily duplicated in other parts of the country and the world.

DocTalker Family Medicine has been in business for over 11 years in the Metropolitan Washington, D.C. area. Their practice only charges their patients for the amount of time that the doctor spends with the patient. After an initial assessment, DocTalker believes that 60% of all medical issues can be handled over the phone or by email. DocTalker also make housecalls for those that can't come to their office. This allows patients immediate, direct access to their doctors 24/7/365 days a year.

For more information about DocTalker Family Medicine, please contact Patty Whelpley at Patty.Whelpley@doctalker.com or call the office at 703-938-4600.

To see the full video of the award presentation, click here.

See DocTalker in the Vienna Patch

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