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Frequently Asked Questions about COVID-19 Disease Caused by the Novel Coronavirus SARS-CoV2

This is a rapidly changing situation with frequent federal and local updates as the knowledge about the disease evolves. Check the Centers for Disease Control and Prevention (CDC) for the latest updates at cdc.gov/coronavirus. Questions? Contact AAHPO at info@aahpo.org.

AAHPO board member Tsoline Kojaoghlanian, MD, a pediatric infectious diseases specialist, is helping us sort through the flood of information.

COVID-19 disease caused by the novel coronavirus SARS-CoV2 that originated in China in December 2019, has been declared a pandemic as of March 11, 2020, which means it has spread to a wide geographic area worldwide affecting a high proportion of the world population. “We’re all in this together and we can only stop it together. This is the time for facts, not fear. This is the time for science, not rumors. This is the time for solidarity, not stigma. Now everyone, everywhere must use this short window of opportunity to intensify and maximize all efforts to contain this virus, prepare our health systems and communities for the inevitable impact. Decisions made today will be crucial. We can still change the course of this pandemic and save lives. But it needs all of us.” – WHO (World Health Organization).

Q. What are the symptoms of COVID-19?
A. COVID-19 ranges from mild to severe. Symptoms appear anywhere between 2 and 20 days after exposure to the virus, majority within 7 days. Data from other affected countries show that up to 75% of people with COVID-19 will not need to be hospitalized; their symptoms will be similar to “the flu” and will include fever, chills, cough, fatigue, headache, stomach upset. However, up to 25% of people with COVID-19 progress to a pneumonia caused by the virus which manifests as shortness of breath, fast breathing, difficulty breathing which need hospitalization. When pneumonia is severe, it necessitates stay in an intensive care unit, other complications, and death may occur in 1-4% of people with COVID-19. This makes it a much more lethal disease than the seasonal influenza virus. Those who are at high risk for severe disease, hospitalization and death mostly are the elderly (> 65 years of age), people with conditions such as heart failure, chronic lung issues, poorly controlled diabetes, weak immune system (undergoing cancer treatment, on steroids or other biologics), and the pregnant.

Q. What is the current status of COVID-19 in the US?
A: A major hindrance in the US, including in New York and New Jersey, has been the lack of enough available testing for the virus in people, making it difficult to estimate the true number of infected people. The increasing numbers reported daily are now inevitable in our area and will continue rising, but these numbers may be an underestimation because likely many people with COVID-19 who are mildly ill haven’t been tested for the virus and are moving around in society. Thus, our necessary social distancing efforts now in cities with just a few cases, combined with our massive mitigation measures now in cities with sustained ongoing community spread (such as New York and New Jersey), are meant to slow down the spread of this new virus. By slowing down spread, we aim to:
a) protect the substantial vulnerable population amongst us at high risk for severe disease (as described above) who may succumb to COVID-19, and
b) reduce the burden on hospitals and doctors’ clinics so that health care workers can meet the needs of the sick, don’t run out of resources, and don’t fall ill themselves. A measure of success is avoiding a sudden spike of hospitalizations in the coming weeks, which would be the medical equivalent of a tsunami hitting our hospital system preventing it from saving lives.

Q. What are social distancing and mitigation and how do I apply them in my day-to-day life?
A: Social distancing means avoiding close contact thus avoiding virus transmission and spread:
– Stop going to ALL crowded, enclosed spaces. Crowded for the vulnerable is any gathering with people close together
– Stop going to all non-essential events
– Stop person-to-person interaction such as shaking hands, hugging and kissing hello and goodbye
– Postpone all non-essential travel domestically and internationally

Mitigation measures are government mandated measures such as canceling public events, asking people to work from home, closing schools – all intended to reduce virus transmission.

Community leaders such as church priests and charity organizations should:
– Identify the vulnerable in their communities, especially those who live alone
– Establish remote communication lines with the vulnerable via phone, email, webcams and schedule routine check-ups with them via these methods to assess their needs for food, comfort, connection and the like
– Ensure that all those in need on medications have enough supply to last 3 months
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Q. How does COVID-19 spread?
A. Person-to-person spread is occurring mainly via respiratory droplets produced when an infected person coughs or sneezes. Those in close contact (within 6 feet) with an infected person for a prolonged period of time are at high risk of getting infected. Extent of transmission via contact with surfaces touched by infected people remains to be determined, even if virus has been detected on surfaces such as steel and plastic and in stool.

Q. What to do if a person exhibits symptoms of COVID-19?
A. Symptoms of fever, chills, cough, headache, sore throat are similar to the flu and it is hard to distinguish the two.
– If a healthy person develops symptoms suggestive of COVID-19, and the symptoms are mild, they should stay home, and call their health care provider for instructions whether they should visit them. If and when testing becomes more readily available, we will update you with any changes in this approach.
– While sick at home, they should keep themselves isolated from their family members who are vulnerable (as described above): do not share cups, utensils, towels, and bedding with them; do not hug and kiss them; do not stay in the same room with them, clean all commonly shared surfaces.
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– If a person in the high risk group has any symptoms suggestive of COVID-19 OR if a healthy person’s symptoms worsen to shortness of breath and/or difficulty breathing, they should call their health care provider, nearest emergency room or 911 immediately and let them know of their symptoms so that the doctors can take appropriate precautions before their arrival.
– If a person has come in close contact with a person with confirmed COVID-19, they should stay home in quarantine for 14 days, and call their health care provider if they develop symptoms. Quarantine means separating a person, who has been exposed to the virus but has not developed illness (symptoms), from others who have not been exposed, in order to prevent the possible spread of the virus.
– If a person has confirmed COVID-19, they should stay home in isolation and follow their health care provider’s instructions.

Q: What can I do to protect myself and my family from COVID-19?
A: People of all ages should engage in preventive actions to avoid infection:

  • Wash your hands often with soap and water for at least 20 seconds (singing “Happy Birthday” twice), especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. Dry your hands thoroughly after washing
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Allow the sanitizer to dry/evaporate. If you are allergic to soap, use sanitizer, and vice versa
  • Avoid close contact with people who are sick- keep a distance of 6 feet between you and a sick person who is coughing and sneezing
  • Avoid touching your eyes, nose, and mouth
  • Clean and disinfect frequently touched objects and surfaces, such as cellphones, doorknobs, tabletops, using a regular household cleaning spray or wipe. Throw the dirty wipe in the trash
  • Cover your cough or sneeze in your elbow sleeve or with a tissue, then throw the tissue in the trash immediately.
  • Teach the same to your children
  • Get your vaccinations, including the influenza vaccine
  • Avoid stress – stress reduces immunity and may make you more vulnerable to infections
  • Eat healthy and drink plenty of fluids
  • The CDC does not recommend that people who are well wear a facemask in their daily lives to protect themselves from COVID-19

Q. What are good websites health care providers can use to counsel their patients and take care of infected patients?
A:
https://www.health.ny.gov/diseases/communicable/coronavirus/providers.htm
https://www.who.int/health-topics/coronavirus
Tri-state Department of Health phone numbers: New York state 518-473-4439, New York City 866-692-3641, New Jersey 800-222-1222, Connecticut 860-509-8000

This is not a drill and many are understandably anxious and fearful. Let us reach out and help each other – since it cannot be in person, this is the time to rely on technology to connect and communicate with credible and trusted sources as well as loved ones. This is the time to play board games and watch movies at home, and go to outdoors parks for fresh air. Let us prepare calmly because panic hinders smart decision-making. Let us be socially responsible for not just our families but for all citizens of humanity. It will take an all out community effort in which our individual participation is vital. What is most important now is for each of us to do our level best to slow down the rate of spread of this new virus. Inevitably, many of us may be exposed to it over the next several months but our concern is for the most vulnerable amongst us who may succumb to COVID-19, including our health care providers. AAHPO is here to guide and help answer all your questions.

Call AAHPO: 908-914-5549
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COVID-19 Vaccines are Rolling Out. Should I Be Worried?

By William Moss, Executive Director | Published by John Hopkins University of Medicine Coronavirus Resource Center

The views and opinions expressed here are those of the authors and do not necessarily reflect the position of either Johns Hopkins University and Medicine or the University of Washington.

  • Rumors and conspiracy theories about Covid-19 vaccines are circulating, but it is critical to separate fact from fiction.
  • As with shingles and flu vaccines, the Pfizer and Moderna mRNA vaccines cause expected and temporary side effects – local inflammation (redness and swelling) at the site of injection or more generalized reactions such as fever and muscle aches.
  • We will learn much more about side effects associated with the mRNA vaccines as more people are vaccinated – including more about vaccine safety in children younger than 16 years of age, pregnant and lactating women, and immunocompromised individuals.

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Congratulations to Anahit Avanesyan

Anahit AvanesyanCongratulations to Anahit Avanesyan for being the first woman ever appointed to the position of Minister of Healthcare of Armenia by President Armen Sarkissian. Her previous positions include serving as Deputy Minister of Health since May 2018, and as First Deputy Minister since May 2020.

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Feasibility and integration of an intensive emergency pediatric care curriculum in Armenia

Published by Aline Baghdassarian, Al M. Best, Anushavan Virabyan, Claire Alexanian, Shant Shekherdimian, Sally A. Santen & Hambartzum Simonyan | International Journal of Emergency Medicine
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Background
Emergency pediatric care curriculum (EPCC) was developed to address the need for pediatric rapid assessment and resuscitation skills among out-of-hospital emergency providers in Armenia. This study was designed to evaluate the effectiveness of EPCC in increasing physicians’ knowledge when instruction transitioned to local instructors. We hypothesize that (1) EPCC will have a positive impact on post-test knowledge, (2) this effect will be maintained when local trainers teach the course, and (3) curriculum will satisfy participants.

Methods
This is a quasi-experimental, pre-test/post-test study over a 4-year period from October 2014‑November 2017. Train-the-trainer model was used. Primary outcomes are immediate knowledge acquisition each year and comparison of knowledge acquisition between two cohorts based on North American vs local instructors. Descriptive statistics was used to summarize results. Pre-post change and differences across years were analyzed using repeated measures mixed models.

Results
Test scores improved from pretest mean of 51% (95% CI 49.6 to 53.0%) to post-test mean of 78% (95% CI 77.0 to 79.6%, p < 0.001). Average increase from pre- to post-test each year was 27% (95% CI 25.3 to 28.7%). Improvement was sustained when local instructors taught the course (p = 0.74). There was no difference in improvement when experience in critical care, EMS, and other specialties were compared (p = 0.23). Participants reported satisfaction and wanted the course repeated. In 2017, EPCC was integrated within the Emergency Medicine residency program in Armenia.

Discussion
This program was effective at impacting immediate knowledge as well as participant satisfaction and intentions to change practice. This knowledge acquisition and reported satisfaction remained constant even when the instruction was transitioned to the local instructors after 2 years. Through a partnership between the USA and Armenia, we provided OH-EPs in Armenia with an intensive educational experience to attain knowledge and skills necessary to manage acutely ill or injured children in the out-of-hospital setting.

Conclusions
EPCC resulted in significant improvement in knowledge and was well received by participants. This is a viable and sustainable model to train providers who have otherwise not had formal education in this field.

Best Practices

Best PracticesInfectious disease specialist Dr. Tsoline Kojaoghlanian is a case study in giving back to the community.

When COVID-19 began its inexorable spread across the United States, with mass anxiety and confusion rising with
every uptick in what came to be known as “the Curve,” Armenian health professionals and communities across the country had an inside edge: the eloquent and compelling Dr. Tsoline Kojaoghlanian. Despite an increasingly overwhelming professional reality in front of her, one that comes once a century, Dr. Kojaoghlanian felt an urgent call to service, determined to arm her own community with relevant and practical information.

From that point on, this persuasive dynamo, who appears week after week on household Zoom screens and Facebook pages across the Internet, is prepared to take questions, explain the science, vet the data, and give no-nonsense advice as to how families can stay safe and healthy. As a longstanding board member of the Armenian-American Health Professionals Organization (AAHPO) with a mission to promote and advance the science and art of healing and to educate and improve the health of the Armenian community, Dr. Kojaoghlanian felt an urgent call to service as soon as the news of the virus began circulating through the medical community in early 2020.

“I contacted key members of the AAHPO board. Speaking as an infectious disease specialist, I explained that this virus needed to be taken extremely seriously and urgently.”

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Examining Continuing Medical Education In Armenia

AAHPO member Gevorg Yaghjyan MD, PHD, recently co-authored an informative article published in the Journal of European CME, examining medical education and continuing professional development in Armenia, from past to present.

The article describes the phases of evolution of continuing medical education chronologically and details the legislative and regulatory framework surrounding each stage of development.

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What You Need To Know About The Ebola and Enterovirus D68

Ebola Virus

The CDC asserts that Ebola does not pose a significant risk to the U.S. public. Ebola is spread only through direct contact with bodily fluids, and people infected with Ebola are not contagious to others until symptoms have appeared. CDC has very well-established protocols in place to isolate people who may have been exposed and monitor them for appearance of Ebola symptoms. These protocols are being enforced in Texas.

Q. What is Ebola?
A.
Ebola virus is the cause of a viral hemorrhagic fever disease. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.

Q: Are there any cases of individuals contracting Ebola in the U.S.?
A.
No.

Q. What about Americans ill with Ebola who are being brought to the U.S. for treatment?
A.
CDC has very well-established protocols in place to ensure the safe transport and care of patients with infectious diseases back to the United States. These procedures cover the entire process — from patients leaving their bedside in a foreign country to their transport to an airport and boarding a non-commercial airplane equipped with a special transport isolation unit, to their arrival at a medical facility in the United States that is appropriately equipped and staffed to handle such cases. CDC’s role is to ensure that travel and hospitalization is done to minimize risk of spread of infection and to ensure that the American public is protected. Patients were evacuated in similar ways during SARS.

Q. Can Ebola be transmitted through the air?
A. No. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air.

Q. Can I get Ebola from contaminated food or water?
A.
No. Ebola is not a food-borne illness.  It is not a water-borne illness.

Q. Can I get Ebola from a person who is infected but doesn’t have any symptoms?
A.
No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms.

Ebola Virus Q&A

Q. What is Ebola?
A. Ebola virus is the cause of a viral hemorrhagic fever disease. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.

Q: Are there any cases of individuals contracting Ebola in the U.S.?
A.
No.

Q. What about Americans ill with Ebola who are being brought to the U.S. for treatment?
A.
CDC has very well-established protocols in place to ensure the safe transport and care of patients with infectious diseases back to the United States. These procedures cover the entire process — from patients leaving their bedside in a foreign country to their transport to an airport and boarding a non-commercial airplane equipped with a special transport isolation unit, to their arrival at a medical facility in the United States that is appropriately equipped and staffed to handle such cases. CDC’s role is to ensure that travel and hospitalization is done to minimize risk of spread of infection and to ensure that the American public is protected. Patients were evacuated in similar ways during SARS.

Q. Can Ebola be transmitted through the air?
A.
No. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air.

Q. Can I get Ebola from contaminated food or water?
A.
No. Ebola is not a food-borne illness.  It is not a water-borne illness.

Q. Can I get Ebola from a person who is infected but doesn’t have any symptoms?
A.
No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms.