Practical Steps for Reducing COVID-19: Q&A With Dr Niket Sonpal

As the number of cases of coronavirus continues to grow in the United States, more hospitals and practices are implementing strategies to prevent its spread among medical staff and patients. In addition, more patients are calling in with questions about social distancing, isolation, and concerned they may have the virus. Niket Sonpal, MD, discussed common questions, best practices for hospitals to follow, and gastrointestinal symptoms in an interview with the Autoimmune Learning (ALN) Network.

Dr Sonpal is an NYC board-certified internist and gastroenterologist, assistant clinical professor at Touro College of Osteopathic Medicine, and assistant clinical professor at St. George University School of Medicine. 

ALN: From patients what are some of the most common questions and how are you answering them?

Dr Sonpal: The most common questions we have been getting, which are predominately clarifications on specific situations, are:

1. Do I need to be tested?

2.  Should I avoid taking certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDS)

3. Is there anything I can eat or what can I do to boost my immunity?

4. What does social isolation mean? Can I hang out with a friend or other people who are isolated?

People are concerned about the symptoms they are getting because, in addition to COVID-19 being rampant, they are getting sick from other illnesses and conditions, such as influenza, or allergies. 

We are stratifying visits now between people who need to be seen because their issue has to be addressed in person, those who we can treat through tele-health platforms, and ones we can easily address with a phone call, such as refilling a prescription.   

For patients who think they might be symptomatic, we ask them about their symptoms to get a sense of what is going on and stratify them based on that. We tell patients who ask about boosting their immunity or food to follow the classic good practices and hygiene for viral illness, such as washing their hands, getting enough sleep, drinking a lot of fluids, eating enough vitamins and minerals, staying emotionally happy by talking to friends and family via apps and the phone.

Part of the reason why the lockdown period is so difficult for people is because they are used to working and being out, so now they are unsure what to do with themselves. People are having problems with anxiety, depression, etc, so we are providing as much counseling as we can at this time.

For ibuprofen, physicians are following the national recommendations from the Centers for Disease Control and Prevention and World Health Organization. They are suggesting patients avoid ibuprofen, so we are recommending patients take paracetamol or acetaminophen, especially if they have a fever. Also, we are recommending patients continue medications, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBS), and immunosuppressant therapies, and to be very vigilant about their medication usages, such as taking them on time and to contact their provider if they experience any symptoms or were exposed. 

Primarily, my colleagues and I are prioritizing keeping patients informed and staying up to date on regulations, and reassuring patients. For example, coughing and sneezing can be caused by other things. However, we are also encouraging people who feel ill and are experiencing the symptoms of the virus (cough, shortness of breath, fever) to contact us and get tested.

ALN: What procedures are in place to protect providers and patients from the virus? 

Dr Sonpal: First, the hospital ancillary services are disinfecting and cleaning rooms such as removing garbage bags, providing hand sanitizer and masks for everyone, although most patients are actually wearing their own, along with personal protective equipment. Physicians are wiping down patients’ rooms between visits, and we are essentially treating everyone as a sterile visit each time as best as we can.

Also, physicians themselves are being very mindful. They are self-isolating and getting tested if they start experiencing symptoms and withdrawing from the environment to make sure they don’t get other people sick.

ALN: Could you discuss how some new study data that showed some patients are reporting gastrointestinal symptoms may change the way patients are screened for COVID-19? 

Dr Sonpal: There was a recently published study that assessed symptoms among about 99 patients in China.¹ It showed that about 48.5% of patients’ chief complaint was gastrointestinal symptoms. Basically, the patients subjectively reported that the gastrointestinal symptoms were worse or more notable to them than respiratory symptoms.

What is notable about this study is that the gastrointestinal symptoms were not alone but were concomitant with respiratory symptoms. Six cases reported only gastrointestinal symptoms.¹ For the overwhelming majority of patients, if they have gastrointestinal signs that accompany respiratory symptoms then we do need to be mindful that this could be a part of the disease presentation. Now, a lot of physicians are being very vigilant and making sure they are not forgetting that coronavirus is not just a sinus, throat, and lung disease, but it can also cause gastrointestinal symptoms.

ALN: Are there any other important considerations physicians should keep in mind during this pandemic? 

Dr Sonpal: We should stress that handwashing is paramount, and social isolation is critical. Patients who have to travel for a doctor’s appointment or need to visit the emergency department for an urgent matter should contact their physician beforehand and reroute their visits to avoid contact with other people.

Reference

1. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional multicenter study [published online March 18, 2020]. Am J Gastroenterol. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf