March 12, 2020

Dear Inland Valley Cardiovascular patient,
            I am writing today in response to the recent outbreak of coronavirus (COVID-19) that is causing a global pandemic. As you might be aware, there are several cases confirmed in Riverside county as of this writing, March 12, 2020. I am very concerned about its eventual spread to the community, and especially for its effects on the elderly. The mortality risk increases for patients above the age of 50 and is significantly lethal for those in their 70-80s. This disease is very contagious and can spread among patients without symptoms. We used to track for possible COVID-19 patients based on recent travel history to high risk locations. Now that the disease has spread into the community, it will not be possible to distinguish patients with disease versus those without disease. This virus is probably at least 10 times more lethal than the common flu and based on the rate on infection can reach 40-70% of the population. Depending on how aggressive the US responds, the deaths from this virus can reach up to the millions. 

            The symptoms for coronavirus are similar to those of a flu or cold, which include fever, coughing, and shortness of breath. Having recent travel history to high risk locations within the past 14 days or contact with someone who recently traveled can increase the risk of having the disease. The virus spread mainly from person-to-person through respiratory droplets but can also spread by touching contaminated surface with the virus on it. 

            These are my recommendations for all patients, especially those in their 70-80s.

1. Avoid all non-essential travel and self-quarantine by staying at home. Social distancing is the best method to limit the spread of this disease. This means avoid non-essential meeting with friends or even family members who do not live in the same household. Instead I would encourage communication with friends and neighbors with phone or email, or video chat, i.e. Skype or Facetime.
2. I would avoid all community activities such as poker nights, parties, social gathering, religious activity or church service, concert or sporting events, movie theaters, restaurants, gym, and shopping malls. I would not fly both domestic and international at this point. Postpone all social function until the fall when this virus will hopefully be contained.
3. Set up a large storage of food at home to minimize going to the grocery store.
4. Clean and disinfect frequently touched objects and wash your hands often with soap.
5. If you have flu symptoms, which can be from COVID-19, please call your primary care provider and ask for further instructions. Going to the provider’s office can expose the virus to other patients and the staff, which can further exacerbate the problem.
6. Create an emergency contact list and emergency plan. Prepare an updated medication list and medical history in case you have to seek outside medical assistance. I am expecting a lot of disruption at work, school, daycare center, and every other facets of our current lives.
7. CDC.GOV has a lot of useful information about this disease. I would encourage all patients to visit the site if you want to learn more about it.

            My recommendations are more aggressive than the current guidelines, but they are meant to minimize the sources of infection and enhance your probability of surviving through the outbreak. I believe this is the most important public health crisis in our lifetime. The most important goal at this point is to stay safe and minimize the impact of disease on our health. I hope you take my recommendations seriously and I pray for your good health in the coming months.

Sincerely yours,

Hoang Lai, MD