UPDATED: MARCH 16, 2020:

Dear DPC Healthcare Employers and Members:

We would like to provide each of you an update on the current COVID-19 situation in the US and reiterate to you what you can do to protect yourself and others from the virus. On Friday, March 13, 2020, President Trump declared a national disaster in response to the COVID-19 Pandemic.

*** Updated Situation Summary (from the CDC website in summary – as of March 16, 2020) ***

As we mentioned before, the complete clinical picture is not fully known.  COVID-19 has been designated a World Pandemic as of March 11, 2020 by the World Health Organization.  A pandemic happens when a new virus emerges and spreads worldwide due to no pre-existing immunity.  Currently, the US is in the initialization phase of the pandemic, approaching acceleration phase because of community spread.  Eventually, the US will reach the deceleration phase, where there will be a reduction in illnesses.  The current COVID-19 activities include:

  • CDC and state and local public health laboratories are testing for the virus that causes COVID-19.
  • More and more states are reporting cases of COVID-19 to CDC.
  • U.S. COVID-19 cases include:
    • Imported cases in travelers
    • Cases among close contacts of a known case
    • Community-acquired cases where the source of the infection is unknown.
  • Three U.S. states are experiencing sustained community spread.
  • View latest case counts, deaths, and a map of states with reported cases.

The risk from COVID-19 to Americans can be broken down into risk of exposure versus risk of serious illness and death.

Risk of exposure:

  • The immediate risk of being exposed to this virus is still low for most Americans, but as the outbreak expands, that risk will increase.
  • People in places where ongoing community spread of the virus that causes COVID-19 has been reported are at elevated risk of exposure, with the level of risk dependent on the location.
  • Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
  • Close contacts of persons with COVID-19 also are at elevated risk of exposure.
  • Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure, with level of risk dependent on where they traveled. 

Risk of Severe Illness:

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:

  • Older adults, with risk increasing by age.
  • People who have serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease

What May Happen

  • More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.

CDC Response

  • Global efforts at this time are focused concurrently on lessening the spread and impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.

CDC Recommends

  • Everyone can do their part to help the CDC respond to this emerging public health threat:
    • Individuals and communities should familiarize themselves with recommendations to protect themselves and their communities from getting and spreading respiratory illnesses like COVID-19.
    • Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness.
    • We, as your healthcare provider, must use our best clinical judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Factors to consider in addition to clinical symptoms may include:
      • Does the patient have recent travel from an affected area?
      • Has the patient been in close contact with someone with COVID-19 or with patients with pneumonia of unknown cause?
      • Does the patient reside in an area where there has been community spread of COVID-19?
    • If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, contact us and tell us about your symptoms and your exposure. We will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home. (see below on what to do if you believe to be infected)
  • For people who are ill with COVID-19, but are not sick enough to be hospitalized, please follow the guidance below, based on the CDC recommendations.
  • If you have been in China or another affected area or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement.  Please see the CDC website for instructions.  Your cooperation is integral to the ongoing public health response to try to slow spread of this virus.

State of Texas Statistical Information as of March 16, 2020

Governor Abbot announced that there are 57 confirmed cases across 15 counties in Texas. Hundreds more are being tested as the state increases access to testing kits.

UPDATED: MARCH 10, 2020:

What is COVID-19? (from the CDC website in summary)

Most of you have heard about this virus by now, but simply, COVID-19 is an outbreak of a respiratory disease caused by a novel (new) coronavirus that was first detected in China and has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”). Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. COVID-19 is a betacoronavirus, like MERS-CoV and SARS-CoV. All three of these viruses have their origins in bats.

Early on, many of the patients at the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. A growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Some international destinations now have community spread with the virus that causes COVID-19, as do some parts of the United States. Community spread means some people have been infected and it is not known how or where they became exposed.

Illness Severity

The complete clinical picture with regard to COVID-19 is not fully known. Reported illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. Older people and people of all ages with severe underlying health conditions — like heart disease, lung disease and diabetes, for example — seem to be at a higher risk.

Symptoms

The following symptoms may appear 2-14 days after exposure.*

  • Fever
  • Cough
  • Shortness of breath

What should you do?

Call or message us in Spruce if you have the three symptoms above and have been in close contact with a person known to have COVID-19 or have traveled from an area reported to have had a COVID-19 outbreak. Please go to the following website for a list of these areas: https://www.cdc.gov/coronavirus/2019-ncov/travelers/after-travel-precautions.html

The CDC Recommends:

“Social Distancing” – Stay home except to get medical care

  • Stay home: People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care.
  • Avoid public areas: Do not go to work, school, or public areas.
  • Avoid public transportation: Avoid using public transportation, ride-sharing, or taxis.

Separate yourself from other people and animals in your home

  • Stay away from others: As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.
  • Limit contact with pets & animals: You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus.
    • When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask.

Call or Spruce message us ahead before visiting your doctor

  • Call ahead: If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

Wear a facemask if you are sick

  • If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office.
  • If you are caring for others: If the person who is sick is not able to wear a facemask (for example, because it causes trouble breathing), then people who live with the person who is sick should not stay in the same room with them, or they should wear a facemask if they enter a room with the person who is sick.

Cover your coughs and sneezes

  • Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
  • Dispose: Throw used tissues in a lined trash can.
  • Wash hands: Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

Clean your hands often 

  • Wash hands: Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
  • Hand sanitizer: If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.
  • Soap and water: Soap and water are the best option if hands are visibly dirty.
  • Avoid touching: Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing personal household items

  • Do not share:You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home.
  • Wash thoroughly after use:After using these items, they should be washed thoroughly with soap and water.

Clean all “high-touch” surfaces everyday

  • Clean and disinfect: Practice routine cleaning of high touch surfaces. High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
  • Disinfect areas with bodily fluids: Also, clean any surfaces that may have blood, stool, or body fluids on them.
  • Household cleaners: Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

Monitor your symptoms

  • Seek medical attention: Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing).
  • Call your doctor: Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19.
  • Wear a facemask when sick: Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.
  • Alert health department: Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.
  • Call 911 if you have a medical emergency: If you have a medical emergency and need to call 911, notify the dispatch personnel that you have, or are being evaluated for COVID-19. If possible, put on a facemask before emergency medical services arrive.

Discontinuing home isolation

  • Stay at home until instructed to leave: Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low.
  • Talk to your healthcare provider: The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments.

What we will do

  • Our doctors will discuss with you on the phone your symptoms.
  • TESTING
  • If one of our doctors believes your symptoms warrant a laboratory test for the COVID-19 virus they will discuss with you your options.
    • DPC Healthcare is following the CDC guidelines for testing.
    • We have an extremely limited testing ability (just like most healthcare providers in the area.)
      • We will not be able to test members who have not previously talked with one of our doctors to discuss testing criteria and process.
    • If testing is approved by one of our physicians, tests through Quest Laboratories cost the following:
      • With insurance: patient pays their co-pay and insurance will be billed $199.  Quest will bill your insurance for the test.
      • Without insurance: patient pays $95.  DPC Healthcare patient the Quest Lab cost plus a 2.5% processing fee using the payment method on file.
  • If you test positive for COVID-19, our doctors will work with you on a plan of action that includes the CDC recommendations listed above.
  • PLEASE NOTE: We are required to report all suspected and positive cases of COVID-19 to local and state health departments and agencies as well as the CDC.

What are we doing in our clinics to protect you from potential exposure?

We are following the CDC guidelines to minimize exposure within our clinics. This includes but is not limited to implementing new protocols, implementation of drive up testing and alternative location testing, immediate triage upon arrival of suspected cases, protective wear requirements as well as increased disinfection practices.

Anyone with respiratory symptoms, cold symptoms and flu-like symptoms will be required to wear a mask before entering our clinics.

If you have any questions, please feel free to reach out to us via Spruce or via a phone call at (682) 200-0022. For additional information, please go to the following websites:

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

Tarrant County Health Department: https://www.tarrantcounty.com/en/public-health/disease-control—prevention/coronaviruas.html

Sincerely,

Paul A. Fabela MD, DABIM
Chief Physician Officer

Tram Anh Nguyen, MD, DABFM
Medical Director