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Q: “Are you going to keep your clinic open through this?

A: Great question! The answer is YES. We know this is the sort of time when you really want to have a doctor available, and we will be available. 24/7. That said, we might be changing the way the clinic operates, especially as cases become more prevalent here on the Big Island. If you need to be seen in person – for example, if we need to check your home cuff because your blood pressures are alarmingly high, or you are having abdominal pain – we plan on keeping the clinic physically operational for visits like this. But we will increasingly plan on conducting visits via phone or video call for concerns not requiring a physical visit. We much prefer medicine face-to-face – but not when that increases the risk to ourselves and other patients and the community as a whole. 

Q: “What do I do if think I might have COVID19?

A: Call us. Right away. And stay home and self-quarantined – including and especially with your family, as most spread happens within the home – until you talk to us. Testing is now finally available at testing centers, which is the ideal way to be tested. We will stay abreast of their capacity. If we deem it necessary to have you come in and be seen, we definitely need to make a plan over the phone first, so we can come out and meet you in the parking lot before you might share your germs with our clinic staff and other patients!

Q: “There’s only one case on the Big Island – what’s all the fuss?

A: Sigh. OK, none of our patients have actually asked us this, but we hear it from others! It’s hard to know the amount of COVID19 on our island right now as there are no deaths, or confirmed ICU cases, at this point. We have just been alerted to the fact that we have one positive case on the island.  We all know by now that the testing has been grossly inadequate until now. Given the lack of confirmed community spread, it is a fair bet there may still be <50 cases circulating – but it is a better bet this will become a very high number soon! The data we have from other countries and localities is that the sooner a place shuts down public interaction, the better their chances of avoiding the vivid scenes of suffering we have witnessed in Bergamo and Wuhan.  Places that shut everything down, but were just a little slow in shutting it down, have not fared well. Stay home!

Q: “How likely am I to get this? Angela Merkel told me that I have a 60-70% chance of getting COVID19!

A: The important thing to remember is that there are a lot of “worst case scenarios” being floated around out there – and that’s just what they are. They are also avoidable if people take this threat very, very seriously. Once the rest of China got the memo from Wuhan to STAY HOME, their death rate tumbled almost by a factor of 10. Where people make uninformed decisions like, “I feel like going to a concert because COVID19 has got me down,” the infection rate stays high – probably not 70%, but perhaps 5-10%, and this is enough to cause hospital overwhelm, rationing of ventilators, and a death toll well beyond that of a bad flu season. Where people are asked/forced to stay home, the infection rate appears to drop down to more like 1% of the population. This results in mortality figures more like a typical flu season. If someone tries to point out to you that there are many places where the COVID19 death toll is lower than the influenza death toll, THAT IS BECAUSE EVERYONE STAYED HOME THERE! If Wuhan had never shut down, and tried to pretend it was “business as usual”, then perhaps Angela Merkel’s number could have come to fruition. If 70% of the population contracted a virus with a mortality rate of 1%, this would make indeed lead to many millions of deaths in America alone. However, if everyone is smart about this – keeping schools closed, avoiding unnecessary socialization, practicing good hygiene and social distancing – the first wave of this illness should end up being more like Beijing than Wuhan. To answer the question directly, the chances that you contract COVID19 are probably less than 1 in 20 if you (and everyone else!) stay home and Hawaii is smart about limiting all non-essential social gatherings. So – just stay home – and encourage others to do the same! 

Q: “Should I still go out to my favorite restaurant/take my trip to California/see my hairdresser?

A: Short answer: NO. While the odds as of mid-March that you will contract COVID19 are still quite low from any given trip out into our community, it’s best to look at it from a broader  perspective. What if you are the approximately 20% who might have the virus and don’t have symptoms yet? What if your hairdresser is? Every new case leads to exponential spread. From a personal health perspective, you can probably get away with a few extra forays into the community with the odds in your favor (for now); but from a public health perspective, the less everyone goes out and shares respiratory droplets, the more likely we are to not feel like northern Italy in a few weeks. Is that worth it to you? I hope so. And for goodness sake – don’t fly to California!!!

Q: “I heard that an HIV medicine cures COVID19 – can’t you order a bunch of it for me, just in case?

A: Negative. For a couple reasons. One, there is nothing with very convincing data yet, although it’s our job to follow this closely, and we do have people all over the country whose brains we are picking regularly about such things. Two, in case you have not tried to buy toilet paper or hand sanitizer lately, things are in short supply right now. Since our best guess is that, as long as Hawaii and our patients are smart about this, we will only have a handful of patients actually get COVID19, and fewer still get serious disease from it, it would be downright irresponsible to order potentially helpful meds for hundreds of patients when only a few might even possibly benefit from them. Trust us – we have ordered an adequate supply of readily available “promising” agents to treat our patients, and we will find a way to get them to you if you are the 1/10th of 1% that might actually benefit from them. But please don’t ask for them to put in your medicine cabinet! We have to take the larger view right now, all of us.

Q: “What natural supplements or herbs can I be taking now, or if I get sick, since you are telling me that pharmaceuticals might not help?

A: With regard to the novel coronavirus, Dr Suber is actively collaborating with her colleagues who are in the research realm to answer this as factually as possible. We can tell you that the usual caveats apply to keep your immune system strong: get eight hours of sleep every night, spend time outside, eat a wholesome diet, manage your stress as well as you can, and try to enjoy this time as an opportunity to do some of the things that really matter to you. Several natural products would appear to have potential benefit against coronavirus, but, of course, there is no randomized, controlled evidence to help guide our recommendations. Some that show signs of promise include: green tea and its EGCG components, garlic, stinging nettle, cinnamon, and elderberry.  There are many other botanicals with excellent science behind them for preventing viral illnesses in general.  Dr Suber will be highlighting some of these, as well as other recommendations for keeping yourself healthy, on our blog site shortly.

Q: “I called Tuesday about my cholesterol results and it’s Friday and still no call from the doctor – what’s going on?

A: It is our goal to be as prompt as possible in response to your queries, whether life-threatening or simply of concern. But, we imagine you can understand that the couple hours a day we are now spending researching COVID19, communicating with colleagues about it, and answering COVID19 questions from patients, were not built into our normal workflows! We will try to be as timely as possible in the realm of non-COVID19 issues, but things might run a bit more slowly than we all like.  Thank you in advance for your patience!

Q: “I just got laid off from my job because of all this – can I still be your patient if I can’t afford my fees?

A: YES – please talk to us so we can make a plan. Now is not the time to be looking for new doctors!

Q: “I don’t have any symptoms but I am just worried sick I might have COVID19 because I went out shopping 3 days ago – can you order me a test?

A: Negative – well, we could, but should not. The reason we are being told not to test asymptomatic people is not just to make testing more efficient for people with actual symptoms; but also because it appears the false positive test rate for people without symptoms might be very high. In other words – if we get that test on you, and it comes back positive, you might still be more likely to NOT have COVID19 than actually have it! Keep in mind that <1% of the Big Island probably has this right now; and perhaps 80% of people have symptoms when they test positive; so the odds we start down a public health rabbit hole of tracking contacts and a strict quarantine are greater than the odds that we do any real good with this test. If you have cold or flu-like symptoms – then let’s talk testing!

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