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CORONA VIRUS/COVID-19 UPDATE

By Bus and Train

B8: Take the B8 to 18th Avenue and Ocean Parkway.
Walk up the Service Road to end at 591 Ocean Parkway
(Between 18th and Ditmas Ave).
http://www.mta.info/nyct/maps/busbkln.pdf

F Train: Take the F train to 18th Avenue. 
Walk east 5-blocks towards Ocean Parkway.
Cross Ocean Parkway and turn left onto the service road.
Walk up the Service Road to end at 591 Ocean Parkway
(Between 18th and Ditmas Ave).
http://www.mta.info/nyct/maps/submap.htm

By Bus and Train

B48: Take The B48 Bus To Nassau Ave/Manhattan Ave
http://www.mta.info/nyct/maps/busbkln.pdf

G Train: Take The G Train To Nassau Ave/Manhattan Ave
http://web.mta.info/maps/submap.html

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Learn more about Coronavirus

What is a Coronavirus?

Coronaviruses are named for the spikes that protrude from their surfaces, resembling a crown or the sun’s corona. They can infect both animals and people, and can cause illnesses of the respiratory tract. At least four types of coronaviruses cause very mild infections every year, like the common cold. Most people get infected with one or more of these viruses at some point in their lives. Another coronavirus that circulated in China in 2003 caused a more dangerous condition known as Severe Acute Respiratory Syndrome, or SARS. The virus was contained after it had sickened 8,098 people and killed 774. Middle East Respiratory Syndrome, or MERS, first reported in Saudi Arabia in 2012, is also caused by a coronavirus.

The new virus has been named SARS-CoV-2. The disease it causes is called Covid-19.

How dangerous is it?

It is hard to accurately assess the lethality of a new virus. It appears to be less often fatal than the coronaviruses that caused SARS or MERS, but significantly more so than the seasonal flu. The fatality rate was over 2 percent, in one study. But government scientists have estimated that the real figure could be below 1 percent, roughly the rate occurring in a severe flu season. About 5 percent of the patients who were hospitalized in China had critical illnesses. Children seem less likely to be infected with the new coronavirus, while middle-aged and older adults are disproportionately infected. Men are more likely to die from an infection compared to women, possibly because they produce weaker immune responses and have higher rates of tobacco consumption, Type 2 diabetes and high blood pressure than women, which may increase the risk of complications following an infection. “This is a pattern we’ve seen with many viral infections of the respiratory tract — men can have worse outcomes,” said Sabra Klein, a scientist who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health.

How is the new coronavirus transmitted?

Experts believe that an infected animal may have first transmitted the virus to humans at a market that sold live fish, animals and birds in Wuhan. The market was later shut down and disinfected, making it nearly impossible to investigate which animal may have been the exact origin. Bats are considered a possible source, because they have evolved to coexist with many viruses, and they were found to be the starting point for SARS. It is also possible that bats transmitted the virus to an intermediate animal, such as pangolins, which are consumed as a delicacy in parts of China, and may have then passed on the virus to humans. People infected with the virus produce tiny respiratory droplets when they breathe, talk, cough or sneeze, allowing the virus to travel through the air. Most respiratory droplets fall to the ground within a few feet. People who are in close contact with those infected, particularly family members and health care workers, may catch the virus this way. Scientists don’t know how long the new coronavirus can live on surfaces, and preliminary research suggests that hot and humid environments may not slow down the pathogen’s spread. Warm weather does tend to inhibit influenza and milder coronaviruses. Infected people may be able to pass on the new coronavirus even if they have few obvious symptoms, a study in Germany has found. That’s “bad news,” said Dr. William Schaffner, an expert in infectious diseases at Vanderbilt University Medical Center in Nashville. When people don’t know they are infected, “they’re up and about, going to work or the gym or to religious services, and breathing on or near other people,” he said. Still, a report by the World Health Organization suggests that asymptomatic cases are rare.

What symptoms should I look out for?

Symptoms of this infection include fever, cough and difficulty breathing or shortness of breath. The illness causes lung lesions and pneumonia. But milder cases may resemble the flu or a bad cold, making detection difficult. Patients may exhibit other symptoms, too, such as gastrointestinal problems or diarrhea. Current estimates suggest that symptoms may appear in as few as two days or as long as 14 days after being exposed to the virus. If you have a fever or a cough and recently visited China, South Korea, Italy or another place with a known coronavirus outbreak, or spent time with someone who did, see your health care provider. Call first, so the office can prepare for your visit and take steps to protect other patients and staff from potential exposure.

Is there a test for the virus? What is the treatment?

There is a diagnostic test that can determine if you are infected. It was developed by the Centers for Disease Control and Prevention, based on genetic information about the virus provided by the Chinese authorities. In early February, the C.D.C. sent diagnostic test kits to 200 state laboratories, but some of the kits were flawed and recalled. Now other laboratories are making their own tests. Other countries are using test kits manufactured locally or sent out by the W.H.O. The C.D.C. announced that anyone who wanted to be tested could, if a doctor approves the request. Private companies, such as LabCorp and Quest Diagnostics, are also rushing to provide tests at various labs across the country, but the supply has yet to meet public demand. Many patients complain that they still cannot get tested. Once a coronavirus infection is confirmed, the treatment is mainly supportive, making sure the patient is getting enough oxygen, managing his or her fever and using a ventilator to push air into the lungs if necessary, said Dr. Julie Vaishampayan, chairwoman of the public health committee at the Infectious Diseases Society of America. Patients with mild cases are told to rest and drink plenty of fluids “while the immune system does its job and heals itself,” she said. Most people with mild infections recover in about two weeks. More than half of those who have been infected globally have already recovered. A number of drugs are currently being tested as potential treatments, including an antiviral medication called remdesivir, which appears to be effective in animals and was used to treat the first American patient in Washington State. The National Institutes of Health is testing the drug on infected patient in a clinical trial in Nebraska. The drug’s maker, Gilead, has also begun trials at various sites in Asia.

How long will it take to develop a vaccine?

A coronavirus vaccine is still months away — and perhaps years. While new technology, advancements in genomics and improved global coordination have allowed researchers to act quickly, vaccine development remains an expensive and risky process. After the SARS outbreak in 2003, it took researchers about 20 months to get a vaccine ready for human trials. (The vaccine was never needed, because the disease was eventually contained.). By the time of the Zika outbreak in 2015, researchers had brought the vaccine development timeline down to six months. Now, they hope that work from past outbreaks will help cut the timeline further. Scientists at the National Institutes of Health and several companies are working on vaccine candidates. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said a preliminary clinical trial might get off the ground in as little as three months. But researchers would still need to conduct extensive testing to prove a vaccine was safe and effective.

How can I protect myself?

The best thing you can do to avoid getting infected is to follow the same general guidelines that experts recommend during flu season, because the coronavirus spreads in much the same way. Wash your hands frequently throughout the day. Avoid touching your face, and maintain a distance — at least six feet — from anyone who is coughing or sneezing. The risk of infection with the new coronavirus in the United States “is way too low for the general public to start wearing a face mask,” said Dr. Peter Rabinowitz, co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security. But, he added, “if you have symptoms of a respiratory illness, wearing a mask reduces the risk of infecting others.”

Should I cancel my international travel plans?

The C.D.C. has warned Americans not to travel to China, Italy, Iran or South Korea unless it is absolutely essential. The State Department on Sunday warned Americans not to travel on cruise ships at all.

Is it too late to contain the virus?

W.H.O. officials have credited lockdown measures China imposed in late January for averting the spread of more cases from Wuhan. China sealed off cities, shut down businesses and schools, and ordered residents to remain in their homes. Officials use cellphone data to track and intercept those who have been to Hubei Province. In recent weeks, government workers have gone door-to-door to round up people who are infected, placing them in stadiums and other buildings that have been converted to makeshift hospitals. Now, official reports suggest that new cases in China are waning. But there is growing fear that containment may no longer be possible. Clarence Tam, an assistant professor of infectious diseases at the School of Public Health at the National University of Singapore, said the surge of cases in multiple countries was “concerning because we know the transmissions are spreading at a fast rate.” “We’ve learned some things of this new virus for the past couple of weeks that make it seem unlikely that containment will be a strategy that will completely stop this virus,” he added. There is benefit to delaying its spread as long as possible. Containing the virus may buy health officials more time to stock hospitals with test kits and respirators, and for local governments, companies and schools to enact strategies — telecommuting and online classes, for instance — that may reduce the spread. But the ability of nations to prepare for the arrival of coronavirus cases will depend largely on the strength of their health systems, capacity to conduct tests and effectiveness in communicating updates to the public. “We have been dealing with flu for decades, and even now it seems some countries don’t even have a policy for influenza preparedness,” said Leo Poon, head of the University of Hong Kong’s public health laboratory sciences division. “Not to mention something which is new to them. That’s a problem.”

From The New York Times; https://www.nytimes.com/article/what-is-coronavirus.html

[Knvul Sheikh] [Roni Caryn Rabin]

By Knvul Sheikh and Roni Caryn Rabin March 10, 2020

Information for Patients with Inflammatory Bowel Disease/IBD (excerpted from CCFA website, 3/15/2020)

The information that is known so far about the 2019 novel coronavirus is based on what has been reported from cases in Wuhan, China, and we are learning more as the virus has spread to other countries. Based on the reported cases, we know that there may be individuals that are at higher risk. Individuals in high risk groups defined by the CDC are being advised to take extra precautions. In many communities where there are a number of local cases, the health departments are recommending that individuals from high risk groups stay at home and avoid participating in public gatherings. The specific recommendations are listed below: 

Adults over 60, especially men 
Individuals with underlying health conditions like heart disease, lung disease (including asthma), diabetes, chronic kidney disease, chronic liver disease, endocrine and metabolic disorders, neurological, neurologic and neurodevelopment conditions
Individuals who are pregnant or had a recent pregnancy
Individuals with weakened immune systems

Individuals with IBD may have weakened immune systems—see section below

As of 3/11/2020, the CDC recommends that individuals in high risk groups avoid attending public events with greater than 10 people.

How do you know if you have a weakened immune system?  

The terms weakened immune system or immune suppression are general terms that describe the lack of an appropriate response by the body to fighting diseases and producing organisms that may be harmful such as viruses and certain bacteria. Having a weakened immune system can occur for many reasons including medication, recent surgeries, age, genetics, or having a chronic illness. Patients with IBD experience many of these factors, and can have a weakened immune system.

However, not all IBD patients have a weakened immune system. Each IBD patient is different and may be taking different medications. Talk to your GI provider about your medications, your health status, and any precautions you should be taking related to COVID-19. 

Updates and recommendations on IBD medications

Stay on your IBD medications. Inflammation due to IBD can lead to complications and damage to your intestinal tract. Your medications aim to keep this inflammation under control. Always talk to your doctor about your treatment plan if you have concerns or questions.
If you are taking a mesalamine (Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®) or other aminosalicylates, these are all safe and are not immune suppressant medications.
While taking these medications, you do not need to take extra precautions beyond CDC recommendations regarding proper hygiene (see What IBD patients should know about the 2019 novel coronavirus (COVID-19) .
If you are taking steroids (prednisone/prednisolone) for any reason, be sure to take extra precautions by following the CDC’s recommendations for risk reduction and talk to your healthcare provider, because steroids can suppress your immune system.

Please discuss with your healthcare provider options to lower your dose or get off steroids (which is always a recommendation in managing IBD).

Immunomodulators like thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate), and the JAK inhibitor tofacitinib (Xeljanz®) tend to inhibit the body’s immune response to viral infections 

Do not stop taking these medications. If you have concerns, talk to your provider. 

Biologics/Biosimilars including certolizumab pegol (Cimzia®), adalimumab (Humira®), infliximab (Remicade®), golimumab (Simponi®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™), ustekinumab (Stelara®), and vedolizumab (Entyvio®) are immune suppressing drugs (see our biologics factsheet for a full listing of anti-TNFs and other biologic therapies):

Do not stop taking these medications.
Talk to your healthcare provider before making any adjustments to these medications.

Reference: https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Links/IBD Resources:

Crohn’s and Colitis Foundation/CCFA

https://www.crohnscolitisfoundation.org/coronavirus/what-ibd-patients-should-know

International Organization for the Study of Inflammatory Bowel Disease/IOIBD

https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Other Links/Resources:

Centers for Disease Control and Prevention/CDC

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

A list of publications referenced by the CDC can be found here:

https://www.cdc.gov/coronavirus/2019-ncov/publications.html

World Health Organization/WHO

https://www.who.int/

New York State Department of Health

https://health.ny.gov/diseases/communicable/coronavirus/

New York City Department of Health

https://www1.nyc.gov/site/doh/health/health-topics/coronavirus.page

Published 3/15/2020

 

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Kensington/Ocean Parkway

William Erber, M.D. & Jonathan Erber, M.D.
591 Ocean Parkway
Brooklyn, New York 11218
Phone: 718. 972.8500
Fax: 718. 972.0064

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Greenpoint/Nassau Ave

Jonathan Erber, M.D.
115 Nassau Ave
Brooklyn, New York 11222
Phone: 718. 972.8500
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