Is there a doctor in the room?

Memorial Hospital of Carbon County (MHCC) hosted a social media livestream on March 27 with several of their clinical staff as they worked to provide answers to residents of Carbon County amid the ongoing novel coronavirus (COVID-19) pandemic. 

During the course of the one hour question and answer session, the medical providers on the panel answered questions relating to treatment of COVID-19 and testing for the virus.

Edward Zimmerman, who works in the MHCC emergency room and serves as county health officer for Washakie County, began by informing those listening that the number of confirmed cases in the state would continue to rise. 

“As of this morning, we have 56 cases in Wyoming. That’ll continue to blossom because we now have the ability to test and we could not previously. Many counties, including my home county, we had no testing material for quite some time so we have probably had some cases we weren’t able to catch and we couldn’t isolate people the way we wanted to and keep them from having contacts,” said Zimmerman.

He stressed that it was due to the unknown number of cases that Governor Mark Gordon had issued three public health orders in an effort to promote social distancing and self-isolation. While there were 56 cases as of 9 a.m. on Friday, the time the livestream started, by 7 p.m. on Monday there were 95 confirmed cases in the state.

Zimmerman added that, while COVID-19 was similar to influenza in how it is spread, the two should not be compared due to their infection rates.

“This virus is spread similar to the flu, it’s just more contagious. Everyone with the flu might spread it to one or two other people. People with this coronavirus might spread it to three or four other people, so it’s twice as bad as the flu. When you hear people saying, ‘It’s just the flu’ it’s not just the flu and that’s the big point I want to make, is I don’t want people to minimize this as not being that dangerous,” Zimmerman said.

Another point stressed by Zimmerman was the danger that COVID-19 posed to residents over 80 years old. While, statistically, the virus has had little impact on younger populations, at least one in five people over 80 who contract the novel coronavirus have died due to complications associated with the virus. 

In terms of MHCC’s ability to test, Duane Abels, who works in the emergency room and at the Hanna Basin Clinic, informed those listening that, at the time of the livestream, the hospital only had 40 tests.

“The testing will be done when you meet the criteria but also we have to depend on the clinical judgement of the ER doctor, the clinic doctor, the OB (obstetrician) doctor to decide ‘Is this test going to be necessary to help treat you.’ If we suspect you have it, home isolation will be strongly recommended and you must adhere to it to protect your family (and) other people,” said Abels.

Greg Johnson, who also works in the emergency room and at the Hanna Basin Clinic, stressed that Wyoming was not alone in having limited ability to test for COVID-19. While he admitted that it was frustrating to many that testing was limited, he reminded those listening that it was a nationwide issue. Johnson also addressed recent reports about the use of hydroxychloroquine, chloroquine and azithromycin for the treatment of the novel coronavirus.

Both hydroxychloroquine and chloroquine are used in the treatment of malaria and lupus while azithromycin is used to treat infections such as pink eye and bronchitis.

“Even though that’s being studied, that’s not something that’s being used for routine outpatient cases. That is reserved for people hospitalized on ventilators. Recommendations may change going forward,” said Johnson.

On Sunday, it was reported by multiple national outlets that the Food and Drug Administration (FDA) had granted “emergency use authorization” for the use of hydroxychloroquine and chloroquine. The emergency use authorization by the FDA does not count as approval of the two drugs, which are still going through clinical trials for their effectiveness against COVID-19, but adds them to the strategic national stockpile to make them more readily available.

“It is not recommended for prophylaxis, which is prevention of the disease, either. People are buying that and trying to use it thinking that will keep them from getting it. There’s no indication that does anything for that,” Ables added.

It was reported on March 25 by national outlets that a man in Arizona had purchased chloroquine phosphate in an apparent attempt to self-medicate against COVID-19. Instead of purchasing the pharmaceutical version of the drug, he had purchased an additive used in the cleaning of fish tanks at aquariums. The Phoenix-area man died due to the additive and his wife was in critical care.

Later in the livestream, it was asked by a viewer about the use of the three drugs and Abels again stressed the lack of study done on the effectiveness of the novel coronavirus. He added that, due to limited supply of hydroxychloroquine and chloroquine, the current supply would be used on cases deemed necessary by medical staff at MHCC.

Other information presented by the panel of five physicians included requests that patients call before arriving at MHCC to limit the spread of COVID-19 and to limit use of the emergency room to only acute cases. Charles Cunningham, obstetrician at MHCC, stated that the women’s clinic was either rescheduling or pushing back appointments and that only one support person would be allowed during labor.

“There are places, such as certain hospitals in New York, who actually had to cut that out and do no visitors even when a patient is in labor. We’re not there yet. Not saying we won’t get there, but we’re not there yet,” said Cunningham.

As the novel coronavirus continues to increase its grip on the country and the state, the physicians admitted that there are still a number of things about the disease that is still unknown as attempts are made to study it.

“This will be filling the medical journals for the next five years, probably,” Cunningham said.