April 8, 2020

1. Weitzman ECHO on COVID-19
April 8, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.

3. Weitzman ECHO on COVID-19
A Primary Care Perspective cont’d
Stephen J Scholand, MD
Infectious Disease Consultant
8 April, 2020

4. Objectives
- Update on epidemiology (2019-nCoV, SARS-CoV-2)
- Review some good news
- Focus on case presentations
- Symptom review of COVID-19
- Remind everyone to continue the fight!

5. COVID-19 in the United States
368,533 cases 4/7/20 – up from 174,476 cases last week (3/31/20) -
https://coronavirus.jhu.edu/map.html

6. Any good news?
• Ivermectin shows good antiviral activity in vitro
• Masks!
• Europe showing early signs of improvement

7. Case of dizziness, GI symptoms
• Wife calls on behalf of husband -patient
• Emigrated out of New York City last week
• Feeling ill with GI symptoms, dizziness
• Patient agrees to ‘FaceTime’ evaluation

8. Virtual visit
• Preparation
– Reviewed what I knew about the patient:
– Age, medical morbidities
– Anything else relevant from the chart
– “Image” – get ready to appear professionally

9. Virtual visit
• Guidelines
– Consent
– https://www.aafp.org/practice-
management/health-it/telemedicine-
telehealth.html
– National Telehealth Resource Centers
• Center for Connected Health Policy(www.cchpca.org)

10. The encounter – History
• 54 yo Caucasian male
• Alcoholic liver disease, overweight
• CC: dizziness
• HPI:
– Very weak, fatigued
– Subjective fevers, since resolved
– Abdominal pain, nausea, copious diarrhea
– Some DOE
– No cough
• Other history: PMHx, SHx, All, MEDS

11. The encounter – Physical
• General: appearances
• Vitals if possible
• HEENT – mucous membranes
– No conjunctivitis
• Respirations
• Extr – no cyanosis
• Derm – no rash
• MS – ambulated well

12. COVID-19 expanded clinical
presentation
Typical: Fever, dry cough, SOB
• Fever (82%, 95% confidence interval (CI) 56%-99%; n = 4410)
• Cough (61%, 95% CI 39%-81%; n = 3985)
• Dyspnea (26%, 95% CI 12%-41%; n = 3700)
• Anosmia
• Conjunctivitis
• Muscle aches and/or fatigue (36%, 95% CI 18%-55%; n = 3778)
• Headache in 12% (95% CI 4%-23%, n = 3598 patients)
• Sore throat in 10% (95% CI 5%-17%, n = 1387) and
• Gastrointestinal symptoms in 9% (95% CI 3%-17%, n = 1744)
Borges do Nascimento IJ1, et al. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. J Clin
Med. 2020 Mar 30;9(4). pii: E941. doi: 10.3390/jcm9040941.

13. Stay safe -- Stay up to date
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• https://www.who.int/emergencies/diseases/novel-
coronavirus-2019
• https://covidactnow.org/
• https://coronavirus.jhu.edu/map.html

14. 14
Free COVID-19 eConsults
• Web-based portal
• Free to all Safety Net Primary Care Practices
– FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the
Homeless, Free Clinics
• No Protected Health Information (PHI)
• Consults Addressed by:
– Infectious Disease Specialists
– Public Health Nurses
* This initiative is supported by

15. 15 * This initiative is supported by

16. Thank You!
www.weitzmaninstitute.org/coronavirus