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The index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge.
NEW YORK, NY, March 22, 2020 /24-7PressRelease/ -- As the novel coronavirus (COVID-19) pandemic continues to grow across the world, the need for testing and monitoring of potential patients has never been more important. In theory, the pandemic could have been halted or significantly curtailed if patients infected with this virus presented early with symptoms and signs specific for this particular corona strain, and/or if large population of potentially exposed patients could be rapidly tested and isolated. In places like South Korea early testing has proven vital in helping to reduce the spread of the disease. Not only does late testing (or no testing at all) exacerbate the global effort to stem the outbreak, it also creates a situation where it's virtually impossible to gain an accurate statistical reading.
Unfortunately, overlapping symptoms and signs of exposure among many viral diseases make it challenging to pinpoint the specific pathogen responsible. In addition, we were poorly equipped for mass testing in the United States. Amidst the growing confusion and panic, you might be asking yourself, How many people around me could have this? or How do we know the actual death rate if we don't know the number of cases?
According to a model for proposed outcome, the CDC showed as many as 1.7 million Americans could die from the virus, and between 160 million and 210 million Americans could contract COVID-19. Emerging research is beginning to suggest that many patients may not present early with some of the more typical symptoms or signs of COVID-19 such as cough, shortness of breath and fever. Some studies and authors report that digestive symptoms such as nausea and diarrhea are common with this pathogen. Moreover, these patients have a longer time from onset to admission and their progress is worse than patients without digestive symptoms.
"Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19," explains Carl Nicoleau, MD, Ph.D., whose Queens, New York medical practice has just begun offering COVID-19 testing. "The index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings."
How does a physician respond to a plea from a healthy patient for testing because of concerns about exposing an elderly parent to COVID-19? In Italy, life and death decisions are being made based on the patient outcome because of a strained medical system that is unable to keep up with the deluge of patients needing care. How long will this pandemic last and on what basis is testing decided when the resources are scarce?
Americans have become increasingly concerned about all this and more as this situation has spiraled increasingly out of control in recent weeks. As with any new disease we're still learning as we go, and piecing it together while hurdling toward a common goal for literally all of humanity: To Kill COVID-19.
Dr. Nicoleau understands the importance of being involved first-hand, but is also mindful of the risks involved. Lately, his days have involved treating hundreds of patients while worrying about where he can possibly find enough N95 masks and protective gear to cover his whole team and, of course, himself.
Despite scarce materials and gear, Dr. Nicoleau is feeling more confident than he was even one week ago now that tests are becoming readily available, and there is at least some cracking down on the price gouging for protective gear. Nicoleau understands that testing can help alleviate the fear and worry that many patients might experience when displaying symptoms that could just as well be sings of the common cold or flu. Patient well-being is of utmost importance to Dr. Nicoleau and with a career as a sleep medicine expert and internist physician, he is no stranger to the human body in total and he understands exactly how our bodies react to various conditions; how that can lead to behavioral patterns and conditions such as depression. In fact, his patient care has earned him countless accolades over the years.
Recently, Carl Nicoleau decided to join the incredible effort of doctors nationwide trying to stem the spread of COVID-19. To that end, he has converted a portion of his Queens medical facility, East Elmhurst Primary Medical Care, into an isolated testing area. For those patients displaying symptoms and who might be worried about traveling through the city, he has also launched a new telemedicine service. This will enable patients to book a virtual telemedicine appointment, allowing them to liaise with the doctor by way of video-conferencing tools. Thanks to this technology it can be determined whether or not they need further testing, in addition to providing information regarding patient vitals and information that used to require face-to-face meetings. If additional testing is required, the patient will then be given an appointment and brought to a special quarantine area of the office away from other patients and staff, where the proper care and provisions can be made. This will ensure the usual exemplary treatment that Dr. Carl Nicoleau's patients have enjoyed for so many decades in various other areas of medicine.
As the world faces its biggest crisis arguably since the Second World War, the work of practitioners like Carl Nicoleau will be vital in helping to keep the virus contained and in check.
Dr. Nicoleau's official webpage has yielded a special, satellite website dedicated solely to these urgent coronavirus concerns. To learn about the office's COVID-19 testing and telemedicine services please visit the new page here.
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