Dr. Caren and Dr. Urman's Heart Health e-Newsletter

SPECIAL EDITION - Monday, May 18, 2020

The latest from Drs Urman and Caren regarding the coronavirus pandemic as well as staying heart healthy

This complimentary monthly educational service is for our patients and their families but please forward it to anyone who might find it of interest. It usually is sent out the first Friday of each month but since March, in order to keep our patients educated with the latest updated information on the COVID-19 pandemic, we have had additional special editions as well. Click here to enter our website and learn more about our practice. We encourage you to contact us if you have any questions or wish to make an appointment. 

Dear patients and friends,

We hope this finds you and your families safe and well.

As health care providers, there is nothing more important to us than the well-being of our patients. This unprecedented situation is challenging for all of us but we continue to adapt to the "new normal."  It is important to keep you and your heart healthy while trying to remain safe.

If you would like to see our prior COVID-19 Heart Health e-Newsletters, click below:

March 22, 2020

March 29, 2020

April 6, 2020

April 12, 2020

May 1, 2020

[Author’s note: This e-newsletter was written on Sunday, May 17, 2020. The subject matter is rapidly changing, and the recommendations below may be out of date within a short period of time. Find the latest general recommendations from the LA County Dept of Public Health and the Centers for Disease Control by clicking on the links.]. In addition, this link is quite thorough and complete in giving you the latest statistics not only for LA county but also how we compare to the rest of the country: https://corona-virus.la/data 

Are We Open? - Yes, we never closed. We Remain Open to Serve You

Yes, we have remained open to meet the needs of our patients. While initially, we were seeing only urgent appointments in the office that could not be handled by other means, we are slowly expanding in-office appointments whether for seeing one of our doctors or for having testing that should not wait.  This is in line with the guidance from the California Department of Public Health as of April 27, 2020 regarding resuming the state's deferred and preventive health care. All in-office appointments will be screened to make sure that an in-office appointment is preferable and more appropriate rather than a telemedicine appointment.

Commitment to Cleanliness and Safety

We are taking precautions to keep all patients safe when they come into our office. Our standard cleaning procedures have always used EPA-certified cleansers and disinfectants to maintain the cleanliness of our offices and equipment. We practice universal precautions and continue to be diligent. You can feel safe and secure in our office. Our entire premises, including the lobby, patient rooms, and bathroom, are thoroughly cleaned and disinfected at regular intervals throughout each day. This regimen will include all surfaces, workstations, keyboards, telephones, handrails, door handles, writing utensils, and other devices. Hand sanitizer, disposable wipes, and no-touch disposal receptacles will be easily accessible throughout our office. Disposable masks and gloves will be available at the front desk for all visitors. Our staff will continue to maintain strict personal hygiene measures throughout the day. Hand-shaking is discouraged.

To ensure YOUR safety and the safety of our staff and doctors

• To minimize patient density in the office and maintain safe social distancing, and to service those patients who cannot come in, we can schedule telemedicine appointments to address your needs if it is felt to be appropriate
•  In order to enter the office, you must come to the appointment wearing the MOST protective face mask you have.
• Only patients with scheduled appointments will be allowed to enter the office. It is important to be ON TIME to your appointment as we are scheduling our appointments spaced out to help ensure adequate social distancing
• You will have to have your temperature taken as all of our staff will have had done on their arrival to the office. 
• The waiting room will be used only as necessary with the appropriate 6-foot distances between seating for social distancing. To minimize person to person contact we have installed Lucite barriers at the front desk
• The building elevators allow only a maximum of 3 people at a time but lately the building has been empty enough that often one can easily ride the elevator by themselves

 Please be aware all of this will take extra time and personnel power (while our daily staffing is down to ensure adequate social distancing in the office) and, therefore, we can accommodate fewer patients per day.  We will do our very best to book new appointments as quickly as possible to ensure safety standards are maintained.  We appreciate your loyalty and patience during this time. 

 Regardless of all these necessary and functional changes in the office as well as in our lives - we will continue to be devoted to offering you the highest level of cardiac care possible.

Do Not Delay Your Potentially Life-Saving Cardiac Care

While purely elective testing had initially been put on hold for the safety of everyone, as you might imagine, when it comes to cardiovascular care, today's preventive or elective test might become more urgent if delayed for too long (click here to read about the pandemic delaying routine medical care). Thus, we are assessing each patient's situation on a case by case basis to determine if it is important to proceed with testing (whether cardiac testing or lab work) sooner rather than later. Please call our office to discuss if you have any questions or concerns.

Are We Performing SARS-CoV-2 Antibody (Serology) Testing?

Yes. We are now testing for COVID-19 / SARS-CoV-2 antibodies in the office. We are sending our tests out only either to labs performing the Roche or Abbot antibody assays or to Cedars with a validated assay.  Please be aware that there are many non-FDA-approved tests that are publicly available right now, but may not be proven as accurate. 

However, it is important to note that we still do not fully understand exactly what percentage of COVID-19 patients develop antibodies and how much cross-reactivity from other much less serious coronaviruses there might be (that is many, if not most of us likely have had "colds" from other coronaviruses in the past). While we assume there will be some degree of immunity, and thus protection, from COVID-19 if we have SARS-CoV-2 antibodies, we do not know for sure how strong that protection is or how long the immunity will last. Based on experience with other coronaviruses (including much more serious but rarer types such as SARS-1 or MERS), it likely will not be lifelong, it likely will be more than just a few months and perhaps it will last a few years but this is still uncertain. So arguably, antibody testing is more important now for us to continue to study and learn how most people react to the virus. Thus, we do not suggest all patients should get it done just "out of curiosity." In statistically, a positive test likely is more likely to be a false positive given the still low prevalence of COVID in our local population and would require retesting to validate the results.

In response to numerous requests we have been receiving from patients regarding COVID-19 serology (antibody) testing, we wanted to provide current recommendations, knowing that this topic is evolving rapidly.

In summary, the current recommendations, knowing that this topic is evolving rapidly.

Current knowledge:

• The clinical utility of antibody tests is not yet known. There are ongoing concerns about the quality of antibody tests and how to interpret the results of the serology testing, which provides qualitative, not quantitative results.  For instance, what does it mean to have antibodies? Do they confirm immunity? How should physicians advise patients who are positive or negative? Are persons with antibodies still infectious and require isolation/quarantine? How often would it make sense to test antibodies?
• The Los Angeles Department of Public Health has provided guidance (attached), advising that people should get these tests "as part of studies aimed at better understanding the background rate of disease in the community."
• Cedars-Sinai has been validating a few different assays for COVID-19 IgM (indicating recent or current infection) and IgG (indicating prior infection). The Cedars lab has confidence now in its assays, though the positive predictive value of any of them (the likelihood that a positive test is a true positive) depends on the pre-test probability, including overall prevalence in the area. As community prevalence is thought to be low in Los Angeles, asymptomatic persons may be more likely to have false positives than true positives. 
• There are ongoing concerns that some commercial insurance payers will not cover the serology test because it is generally viewed as having primarily a public health purpose unless it is truly being used for medical decision-making purposes.

What you need to know:

• Antibody testing may indicate, if present, that a person has had the novel coronavirus, though particularly for assays with unknown specificity, could be positive due to other coronaviruses like the common cold. 
• Antibody testing cannot be used to predict individual immunity. In other words, we do not know with any certainty that you cannot get COVID-19 again. If there is any immunity, we also don't know how long the potential immunity could last.
• The test should not be offered for low-risk patients or the general public with no suspicion of recent infection who may just be curious.
• With this in mind, patients should continue to practice physical distancing, wear appropriate face coverings, wash hands frequently with soap and water, and monitor themselves and their family's health for COVID-19 symptoms.
• The antibody test may not be covered by health insurance and could result in the patient having to pay cash.

No doubt, even under the best of circumstances, life for us will not be entirely back to normal anytime soon. However, no matter what, we are here for you.  Let us know if you have any questions or concerns and take advantage of technology to stay medically connected with us to keep you healthy.

 Share Your Experience

Please help get the word out about our doctors and our practice. It will only take a minute and we will be so grateful! Share your experience in our office by clicking on your cardiologist:

If you Yelp review your healthcare encounter with Dr. Urman by clicking here.

On Google, look Dr Caren or Dr Urman up in Google, on the right of the screen you will see a picture of the office, a map, hours and other reviews, if you look just above the review section toward the bottom and to the right you can click on the button ‘Write a review’

On Vitals, here is the link for Dr Caren: https://www.vitals.com/doctors/Dr_Jeffrey_Caren.html

On Vitals, here is the link for Dr. Urman: https://www.vitals.com/doctors/Dr_Mark_Urman.html

Following a Heart-Healthy Diet and Lifestyle