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Ask Dr. Halverson: COVID-19: When to consult your healthcare provider and what to expect

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With cases of COVID-19 significantly increasing in Ventura County, let’s review the steps you should take to be evaluated and what recommendations are likely to occur if you are tested.
STEP 1: Know the symptoms and exposure risk
Signs and symptoms of COVID-19 may appear two to 14 days after exposure. Reasons to consider testing are cough, shortness of breath  or two of the following symptoms: fever (subjective or confirmed 100.4 or higher), chills, muscle pain, fatigue, headache, sore throat, new loss of taste or smell, nasal congestion, nausea or vomiting, or diarrhea.
Significant exposure is defined as spending more than 10 minutes within 6 feet of an infected person who is not wearing a mask and includes household contacts, co-workers and health care workers not adequately protected with mask, gowns and gloves while in contact with the patient. 
In addition, if you were around that person 48 hours before they started to experience symptoms or tested positive without symptoms, they may have been contagious and you should talk to your health care provider about testing. Also, if you were directly exposed to infectious secretions (coughed on, shared utensils with or shared food or drink with a person who tests positive) you should be tested.
Step 2: Contact your health care provider
Tell them you are seeking advice about possible testing for COVID-19 and the symptoms you have or known exposure you are concerned about and the details of that exposure. They will advise you to come to the office for evaluation and possible testing (often done in your car with your health care provider in appropriate protective gear); seek testing at a testing center; or if you are extremely ill,  go to the Emergency Department for further evaluation. They will advise the Emergency Department that you are coming or have you call ahead. You will enter with a mask and the person or people who take you will likely not be allowed in.

 

Step 3: Self quarantine after testing
Your health care provider or the testing center will give you the specifics on this. You will likely be asked to quarantine at home until your test results are known. Due to high testing currently being appropriately done, laboratories are taking up to 10 days to get results back. You will be told to wear a mask at home unless you are home alone, stay at least 6 feet from household members at all times, use a separate bathroom if possible and stay away from pets in your home if you live with others. Pets do not get ill but can carry the virus from you to household members.
Step 4: If you test positive
 You will be advised to continue quarantining until you have had no fever for at least 72 hours, improvement in respiratory symptoms (e.g., cough, shortness of breath) and at least 10 days have passed since symptoms first appeared.  You will also be made very aware of the warning signs of worsening illness as approximately one in six people may become significantly worse several days after symptoms start. These symptoms include chest pain, worsening shortness of breath, confusion, inability to stay awake or bluish lips or face. Notify your health care provider or seek medical attention immediately if any of these symptoms occur. Please notify the first responders who help you that you are COVID-19 positive so that they will be appropriately protected.
Step 5: If you are hospitalized with COVID-19
You will be quarantined in a private room with no visitors allowed, to protect them from the virus. All of your health care providers and hospital support staff will wear full protective gear every time they are in your room. You will receive IV fluids, supplemental oxygen if required, medication to prevent blood clots and very likely be offered treatments that may include intravenous remdesivir, intravenous or oral dexamethasone and/or infusions of convalescent plasma. All hospitals in Ventura County currently have these treatments available. IV antibiotics will be given if pneumonia is suspected. If your condition worsens, ICU admission and possible ventilator support will occur. Monitoring of heart, kidney and neurological function will be done continuously.
 Most patients will survive, but hospital mortality still is between 5 to 10%. Risk factors for higher mortality include age over 65, diabetes, obesity, immune suppression from cancer or chronic rheumatological conditions such as rheumatoid arthritis or lupus, and underlying heart, lung, liver or kidney conditions. Length of hospitalization can be days to several weeks. Some survivors may need prolonged rehabilitation in a skilled nursing facility following hospital discharge, or long-term care at home.
CONCLUSION
 The possible severity of COVID-19 can be very frightening. Fortunately, due to the efforts by most of our Ojai Valley residents to socially distance, properly wear masks when required, avoid crowds and crowded indoor spaces and use appropriate hand-washing and sanitation practices, Ojai and Oak View have very low numbers of reported cases compared with all other areas  of Ventura County. 
Please continue to stay committed to protect yourself and others. Stay positive, appreciate the efforts of your family, friends and neighbors and take good care of yourself. Many areas in our world are succeeding in dealing with this virus. The Ojai Valley can continue to do so, too.
Stay positive, stay committed, stay safe and stay well.
 
— Dr. Jim Halverson, a longtime Ojai physician, writes a weekly column on COVID-19 for the Ojai Valley News.