Covid FAQ: straight from a frontlines nurse practitioner

• Why are oral steroids not recommended prior to hospitalization?
  
  • We were sometimes sending them in the beginning because let’s be honest, we got caught with our pants down and we had no clue how to treat Covid. We now know we better save them for when a patient declines and they are used during an inpatient stay and patients are often discharged on them for a short period of time. Sometimes a COPD or asthma patient may need them pre-hospital but we are trying to save them.

• What about antibiotics for outpatient Covid infections?
  
  • Covid is a virus 🦠 and antibiotics treat bacterial infections. Sounds like a simple answer, but it’s not. We do take into account conditions like COPD and asthma and immunocompromised status and other comorbidities that may lean us in the direction of protecting against a secondary bacterial infection.
    
  • Have I sent them in for Covid? 🙋🏼‍♀️🙋🏼‍♀️🙋🏼‍♀️ yes. But I probably need to follow the evidence and save them for special circumstances. Again, in March of 2020 we knew nothing about treating Covid so we all did what we thought might work, but we are smarter now IF we read the literature. 🧐

• I have Covid and have continued to breastfeed. Will my nursing infant build antibodies to Covid?
  
  • Good news! Yes, baby should receive passive immunity from your vaccinated or Covid-infected breast milk. Baby would also receive passive immunity in your uterus via the umbilical cord if you were vaccinated or infected. What we don’t know is how much immunity they will build. I had 2 pregnant patients with Covid in 2020 and I’ve had one in 2021. I also know of pregnant women on the ventilator right this second where we didn’t really see that in 2020.
    
  • Mamas, I know you want to make the right decision for yourself and your baby. ACOG (American College of Obstetrics & Gynecology) and SMFM (Society for Maternal-Fetal Medicine) issued a statement on July 30, 2021 recommending ALL pregnant women receive the vaccine. ACOG recommended it back in Dec 2020 but now SMFM has joined them.  www.acog.org/news/news-releases/2021/07/acog-smfm-recommend-covid-19-vaccination-for-pregnant-individuals
    
  •  Be aware, newborns can get Covid. My colleague in pediatrics had to tell a family their 2-week old had Covid and likely got it from them as both parents were also +.

• What are the criteria for MAB (monoclonal antibody) IV infusion?
  
  • you must be within 10 days of symptom onset and meet at least one of the following criteria:
    
  1. BMI>25
     
  2. age over 65
     
  3. pregnancy
     
  4. Diabetes
     
  5. Heart disease (including high blood pressure)
     
  6. high risk for hospitalization
     
  7. Immune compromised
     
  8. Lung diseases (including asthma, COPD, etc)
     
  9. chronic kidney disease
     
  10. You must be 18 or older
      
  11. your provider must send a copy of your + test with your order.

• Why are some medical providers against this vaccine, especially if they are not against vaccines in general?
  • I would ask if they read any of the 3 trials: pfizer, Moderna, or J&J. The data is hard to ignore. I practice evidence-based medicine which means I rely on studies and data to guide my medical decision making. I think that’s what we are supposed to do 🤷🏼‍♀️
  • Perhaps they have a personal agenda for being an outlier: fame, notoriety, ego. I am not sure. Money since people will get and stay sick?
  • I would ask them what they tell the families of unvaccinated patients who die. It’s hard comforting any family after a loss, but if I felt culpable I would imagine that would be much harder.
  • I am more than happy to speak with any of them if you know them. I would love to know their reasons.
  • Maybe it’s like a bad Yelp or Amazon review? The product gets 5 stars but there’s always that one person ranting and raving how terrible it is. Unfortunately this isn’t a toaster. These are humans. 😞
  • 96% of American physicians are vaccinated.

Bonus question: what can I do to help? I feel so helpless!

• Send pizza to your ICU, ER, urgent care, doctor’s office
• Buy your HCW (healthcare worker) in your life a coffee
• Make or send a meal to a family who has a parent in the house working the frontlines
• Send a card to a HCW you love
• Pray for all HCW and all patients battling Covid
• Gift a HCW a massage
• Drop off a goodie bag to a HCW you love
• Offer to clean a HCW house or car, offer to walk their dog, offer to grab their ClickList
• Ask your HCW if they need to talk or vent and just listen
• Lastly but most importantly, give your HCW some grace if we are snappy 😬. We have never been tested this hard for this long. 😞

***as always, consult your PCP for your healthcare. I’m trying to raise awareness. Let’s not bicker and judge over vaccine status. Let’s educate ourselves and let’s come together to get out of this public health crisis!!!***

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