Potential changes within office visits for COVID-19 and influenza.
Peter Salgo, MD: We were giving professionals and patients advice at the peak of the COVID-19 pandemic that if you’re sick, don’t come in. If you’re sick, call your doctor. And that way, the message was, don’t get tested. Don’t come to your PCP [primary care provider] or urgent care office. Is that message now changing? Now that our staffs are vaccinated, are we urging everybody to go to the office and get tested or go to a testing center? Bill, where do we stand on that?
William Schaffner, MD: Everybody is still trying to work out their own protocols for that. At the moment, we’re still urging people to contact their primary care providers, whether by email or phone, have a discussion, and then something will be told to the patient. They’ll be told they don’t need testing or where to get a test. There may be more of that. Things will get intense when we have flu in the community. There may be some doctors who revert to what they used to do in the old days. If there’s flu in the community, you just assume it’s flu and prescribe the antiviral to prevent further development and avert more serious disease. But you can’t do that with COVID-19. It’s going to get tricky. At Vanderbilt [University], we haven’t sorted out exactly what our protocols are going to be. I’d be interested in George’s experience.
George Loukatos, MD: I’d echo what you said, that everybody is doing their own thing and sorting through that. I’m also practicing in some emergency departments [EDs], and 1 thing that we saw in the ED was that when we gave people that messaging of stay home and don’t come in, people were coming in too late. It’s one thing for the mother to keep her 3 children who have fever at home. Those kids aren’t going anywhere. They’re not going to expose the public. They’re not going anywhere without mom. When you have a 70-year-old who’s got a fever and cough, I want to see that person and make sure they don’t need chest x-rays, antibiotics, or hospitalization. That carte blanche messaging of stay home was something that we learned from that we could have probably done better.
Jason Gallagher, PharmD: Something else that has changed since then is that there weren’t tests available. There wasn’t enough testing, and then the delay before test results came back were such that sometimes they were useless. There were also no therapies available for COVID-19. As we’ve moved forward, we don’t have easy ambulatory, just prescribe a course of oseltamivir, like you can for influenza. But there are now monoclonal antibody therapies, which are effective in the right people. Now we actually have a way to treat. That’s another reason why knowing that they have COVID-19 is important.
Peter Salgo, MD: How have the pop-up testing centers affected all of this? Where I live in Manhattan, you can walk down Lexington Avenue—I’m just thinking in my neighborhood—and there are 3. You can walk in and say, “Hello, I’d like to be tested for COVID-19, please.” They’ll ask you, “Are you symptomatic?” If you are, they’ll give you a time, and if not, they’ll just test you. The testing is available. There are enough tests to go around. Whatever we tell people, is that going to affect their behavior at this point, Bill? Or are they just going to do it on their own?
William Schaffner, MD: It’ll be a mix. It’s not quite as available in Nashville as it is in New York City, but testing is available. You have to work a little harder to get to the testing center. We used to have more. They’ve been reduced now that all the focus has been on vaccination. But as all of us have been saying, the need for testing is going to become much more abundant as we approach the flu and other respiratory virus season.
Peter Salgo, MD: I want to thank all of you out there for watching this Contagion® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your in-box.
Transcript edited for clarity.