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The science behind coronavirus testing

Coronavirus testing– the science

Ever been tested for the flu? If you have, you may have noticed there are two different types of tests: the quick one that comes back with an answer within minutes, and the longer one that takes 45-60 minutes. These same techniques are used for coronavirus testing, with PCR testing being the long one, and antigen testing the quick one. Then there’s antibody testing, which is used to help determine if a person has previously been infected, and in certain cases, can identify patients with current infection (see details below). 

In this article, we’re going to break down the science behind how each of these tests work—for somebody with a non-medical background, of course. Want the high-level overview on these three tests, their reliability, and how to access them? Check out our post on “Coronavirus testing: what you need to know”. If you’re looking for a more in-depth explanation, however, keep reading below.

PCR or Diagnostic testing

The PCR test takes a sample of mucus from your nose or mouth and then puts the sample through what’s called a “polymerase chain reaction” (PCR). This is a laboratory process that helps identify if any of the virus’ genetic material (think DNA) is present in the mucus. This process takes a bit longer than the antigen test (the “rapid flu” or “rapid strep” test of coronavirus) because it requires a lab technician to literally run the sample through the PCR process. In order for the test to be positive, the virus must have enough time to multiply and actually get into the mucus in your nose and throat. Said another way, the test may be negative for the first few days after you are infected. 

Antigen testing

Antigen tests identify the presence of certain proteins from the virus in upper respiratory secretions from your nose or mouth (e.g. saliva, mucus, and of course, “boogers”). It uses the same technique as the rapid strep test, which you may have previously done for yourself or your children. 

Unlike the rapid strep test, which has been around for awhile and is relatively accurate, the coronavirus antigen test is fairly new (the Food and Drug Administration only approved the first test of its kind in early May of this year) and the jury is still out on how accurate it will be. For example, the rapid flu test, which also uses this type of lab technology, isn’t as accurate as the rapid strep test. In summary, we still need to learn more about the effectiveness of this type of coronavirus testing before we can truly rely on it. 

Antibody testing

Finally, we get to antibody testing, the one that seems to be always in the news. But what is it exactly and can we trust it? Antibody testing has been around for a long time, so this method of testing is well known and tried and true. Unlike PCR and antigen testing, which looks for evidence of the virus, antibody testing is completely different and measures specific parts of your immune system. Unfortunately, this type of testing is only done with a blood specimen (ouch). 

See, whenever you get infected with a virus, your immune system says to itself, “how can I kill this virus now? How can I ensure that I’m ready to prevent it from coming back in the future?” To answer these questions, your immune system starts creating what’s called “antibodies”. 

The really cool thing is that (through a pretty complicated process that isn’t worth explaining here) your immune system makes a few different types of antibodies: an antibody for actively fighting off the infection (let’s call that Antibody A), and an antibody for after you fought off the infection to help prevent future infections (let’s call that Antibody B). Why is that cool? Well, because it makes it easy to test both types of antibodies and come up with one of the following conclusions:

  1. You have never been infected with coronavirus (you don’t have either type of antibody against coronavirus, neither A nor B)
  2. You currently have coronavirus (you only have Antibody A but not Antibody B)
  3. You had coronavirus in the past, but not now (you only have Antibody B, as Antibody A slowly went away as the infection passed)

With all that said, it is a bit unclear how effective antibody testing for coronavirus actually is at the moment. We simply don’t know if this virus will act like other viruses when it comes to the way antibody testing is looked at (as above). Early reports show that it takes several days to weeks for your body to produce the initial antibodies to coronavirus (the Antibody A type ones that come when you are actively fighting the infection). One study showed it took 12 days from the first sign of symptoms. This means antibody testing may not be great at telling us if someone has an active coronavirus infection. 

But isn’t antibody testing great at telling us if someone has had COVID-19 before and is now immune to it (i.e. they have the Antibody B type)? Well, honestly, the jury is still out on this question too. Yes, antibody testing should be pretty reliable at telling us that someone has had the infection before, but, unfortunately, there isn’t enough evidence yet to prove that having had the infection before actually protects you from future infections by a similar, yet different form of COVID-19. 

This can be complicated to think about, especially if you are worried about being sick, so feel free to leave the thinking to us! Chat with a nurse if you are unclear about what to do next. We can help! 

– Igor Shumskiy, MD

Coronavirus testing: what you need to know

I’m sure by now you’ve probably heard the words “coronavirus” and “testing” in the same sentence. Yet, for most people, coronavirus testing is still somewhat of a mystery. We’ve broken down the expert information in one place for clarity on what tests are out there and what it all means.

What types of coronavirus tests currently exist?

  1. PCR or Diagnostic Testing – PCR tests can tell you whether or not you are currently infected with COVID-19. They are the type of test patients are most likely to encounter right now. They test for the presence of genetic material from the actual virus within mucus in your nose and mouth, which means the virus must be in your body (and in sufficient enough quantity) at the time of the test. If you test positive, you are currently either sick with coronavirus or infected but not having symptoms. If negative, you do not currently have the virus in your body, meaning you are not infected with coronavirus and not contagious.
  2. Antigen Testing – Antigen tests can also tell you whether or not you are currently infected with coronavirus. They are easy to use and return results rather quickly (usually, while you wait), but aren’t as foolproof as PCR testing. For that reason, and until more research is done to ensure quality, they may be typically used as a screening tool for large groups of people, and then the PCR test will be used for anyone who tests positive by the antigen test. 
  3. Antibody Testing – This is a blood test that measures whether your immune system is creating or has created immunity (aka “antibodies”) against the virus in question. It does not test for the actual virus. In this case, the virus does not have to be in your body at the time of testing (but could be). It gets a bit complicated on what “positive” means in this case, so I’ve left that explanation for another blog post (check out “The science behind coronavirus testing”). But, basically, if positive, you either currently have the virus in your body or have had it in your body in the past.

How reliable is each test?

Generally, PCR tests are very reliable. However, in order for this test to accurately detect the virus in your body, it’s necessary that the virus has had enough time to multiply and actually get into the mucus in your nose and throat. Said another way, the test may be negative for the first few days after you are infected. If you think you have the virus, have been exposed and/or are exhibiting symptoms, even with a negative test you should still self-isolate to prevent possibly spreading COVID-19 or whatever is causing your current symptoms. 

Antigen tests are not as reliable as PCR tests, so may be used as a screening tool and the step before PCR testing. Keep in mind that the same goes for antigen testing as it does for PCR testing—it may take a few days (after you are infected) before this test becomes positive, as it requires a sufficient amount of the virus to be in your mucus. 

While antibody testing has been around for a long time, it is still unclear how effective antibody testing for coronavirus actually is at the moment. Unfortunately, there just isn’t enough evidence yet. We still need to prove that having had the infection before will protect you from future infections by a similar, yet different form of COVID-19. Per the Centers for Disease Control and Prevention, “We do not know yet if having antibodies to the virus can protect someone from getting infected with the virus again, or how long that protection might last.”

How can I access coronavirus testing?

COVID-19 testing is more available now than when the outbreak first occurred. There are fewer restrictions on testing so if you are worried that you need a test, and have symptoms, you are more likely to be able to access one. If you are currently having symptoms, you should talk to a nurse first (assuming it’s not an emergency; if it is you should get help by calling 911 or going to the ER), or call your primary provider to decide if you should be seen for a visit or just need the testing.  

Many places may require a medical order from a provider in order to get the test done so don’t expect to drive up like at a Dunkin’ or Starbucks to order yourself that test. Call ahead to the testing site or check with your provider first. Some providers want to rule out other, more common reasons for fever, especially in pediatrics, so they may have you come into the office for a strep or influenza test first, for example. In some cases, you may be able to do an online screening to determine if you need the test.  Some high risk patients such as health care providers, immunocompromised patients, elderly, those experiencing severe symptoms and those with exposure risks are likely to have testing more available to them.  

Per the Coronavirus Aid, Relief and Economic Security (CARES) Act, antibody testing should be covered by your insurer. Many insurers are also waiving copays or deductibles for coronavirus related testing. However, we suggest calling your insurer to confirm or checking this website to get specific information regarding your insurer as some coverage is time limited.

The CDC lists each state’s health department website for more specific information on testing sites available in your area along with other COVID-19 resources.  

– Igor Shumskiy, MD

Time to Celebrate Kangaroo Mother Care

Kangaroo Mother Care Awareness Day is celebrated every May 15th, and with good reason. It’s a natural method of post-birth baby care that’s been shown to help premature babies stabilize, promote a close parental bond, and improve breastfeeding outcomes.

What is Kangaroo Mother Care?

While the term “kangaroo care” often makes us think of just holding baby skin-to-skin, there’s a bit more to the Kangaroo Mother Care method than that. When practicing KMC, parents strive to have as much skin-to-skin contact with their baby as possible. For some premature babies, this may require the use of assistive technology.

KMC also includes breastfeeding techniques and improves breastfeeding outcomes by allowing baby to naturally find their way to the nipple when they’re hungry and learn to latch without pressure. This is achieved through natural skin-to-skin contact when holding baby or wearing them in a sling. The care method is also centered around early hospital release when possible, allowing parents to care for their child in the low-stress, comfortable environment at home.

KMC’s ability to stabilize premature babies, some as early as 28 weeks gestational age (3 months premature) was illustrated in a noteworthy 2004 study in which Dr. Nils Bergren observed two groups of premature babies; one group received Kangaroo Mother Care, while babies in the other group were supported in an incubator. While all the babies in the KMC group stabilized within six hours, only half of the incubated group were able to stabilize within that time.

Why does Kangaroo Mother Care work?

Skin-to-skin contact between parents and baby stimulates the development of neural pathways, and allows for a connection that makes baby feel safe and calm. This steadies breathing and heart rate, stabilizing vital signs and preventing the stress that’s caused by separation. When premature babies are removed from their mother in an unstable state, they’re unable to access the benefits that Kangaroo Mother Care can offer, and they may be worse off for it: this 2017 study from the Official Journal of the American Academy of Pediatrics indicated that KMC had significant, long-lasting social and behavioral protective effects even 20 years after the intervention in adolescence and young adulthood.

Wearing your baby makes Kangaroo Mother Care a breeze, and there’s plenty of good reasons to continue on with babywearing as they grow. We The Parents have detailed the science behind 23 ways babywearing can benefit you, so take a peek at their infographic to get educated.

Kawasaki Disease in Children

If you have been listening to the news or reading articles online lately, you may have heard some reports that COVID-19 can cause Kawasaki Disease-like symptoms. What is Kawasaki anyways? We don’t know exactly if or how Kawasaki and COVID-19 are linked, but what we can do is go over Kawasaki Disease, what you need to know, and when to get checked out.

What is Kawasaki Disease?

Kawasaki Disease (KD) or Kawasaki Syndrome is the most common cause of acquired heart disease in children in developed countries, according to the American Heart Association. It usually affects children younger than five years of age but can affect children of all ages. It is also more common in boys than girls, and although it can affect any race or ethnicity, it is more commonly seen in those of Asian descent. 

Kawasaki causes inflammation of the heart vessels and different tissues of the body, including the hands, feet, mouth, nose, throat and whites of the eyes. It can cause damage to the coronary arteries, which are the blood vessels that supply the heart with oxygen, and this can worsen if undetected. 

Early detection is important, as the sooner the treatment for KD starts, the more likely your child will fully recover with no lasting effects. Most children don’t have long term damage to their coronary arteries, so don’t panic. However, in some cases KD can cause permanent damage such as weakened vessels, coronary artery aneurysms and very rarely, death.

Although this sounds scary, remember that Kawasaki Disease is quite rare! Most children with high fevers and other symptoms that may sound like the disease most likely have some other infection that is way more common in childhood, such as a viral infection (most common!). 

How do I know if I have Kawasaki Disease?

Kawasaki Disease is rare but we do see it here in the US. The exact cause of the disease is not super clear and it’s likely that there are multiple factors that put certain children at an increased risk of having the disease. For some children, it occurs after being ill with viral-type symptoms, such as with cold symptoms or stomach bug symptoms like diarrhea and vomiting. 

To meet the criteria for Kawasaki Disease, one of the major indicators is a fever that won’t break, or go away. This means that the fever lasts more than four days, which is when most fevers associated with common illnesses will break. This means the child in question must have a fever of at least 100.4 degrees Fahrenheit for five days before we even start considering Kawasaki Disease. In our experience however, children that truly have the disease have very high fevers for five or more days – fevers of 102 and above on a daily basis.

Fever for five days or more is the main symptom of Kawasaki Disease, but it’s commonly accompanied by four out of five of the following symptoms:

  1. Rash often seen in genital area, but also on arms, legs, back, belly and chest
  2. Swollen lymph nodes (small painless bumps under the skin usually around your neck)
  3. Red eyes (with no eye goop)
  4. Swelling or redness in any part of the lips or mouth such as cracked red lips or swollen tongue (sometimes called “strawberry tongue”)
  5. Swelling or redness or peeling of the skin on the hands and feet

If your child has a fever for more than five days (must be consecutive!) you should always get checked out, but if you have any of these symptoms as well as a fever, it is important to call your doctor’s office right away. In our experience, children with this disease, in addition to the symptoms above, are also incredibly fussy, uncomfortable, and agitated. If your child has daily fevers but is happy as a clam, it’s probably not this disease (though best to still get checked out). Some children have something called “Atypical Kawasaki Disease”, and have only a few of these additional symptoms with their prolonged fever. 

Your provider may order some additional testing, such as a blood or urine test, and you may need an Echocardiogram, which is an ultrasound of your heart. If there is suspicion of KD, they will send you to the hospital to be evaluated and treated.

Tell me about Kawasaki Disease treatment

If you are diagnosed with KD, your child will be hospitalized for treatment. According to the American Academy of Pediatrics, patients with KD are treated with a few medications. One of these is called Intravenous Immunoglobulin (IVIG) and the other is a small amount of aspirin. Occasionally a steroid is also given. These medications are specially dosed for your child and given based on criteria for your specific situation and child. These medications are thought to help decrease inflammation, and can decrease damage to the coronary arteries in some cases. Most children do not have lasting heart damage from KD. 

Should I be worried about Kawasaki Disease?

Kawasaki Disease is very rare and presents with very specific criteria. If you think your child has these symptoms, it is very important to get checked out. In general, it is important to know about this disease, but it is significantly less common than other illnesses that children get such as Coxsackie (Hand, Foot and Mouth Disease), Strep Throat, or the common cold

What does COVID-19 have to do with Kawasaki Disease?

Recently, there are increasing reports of children hospitalized with symptoms of Kawasaki Disease who are also testing positive for coronavirus or testing positive for antibodies against coronavirus (meaning they had coronavirus previously). One theory is that children who fight off coronavirus (even if they don’t have symptoms) may then go on to get a Kawasaki-like syndrome. NPR reports “The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation and evidence of one or more organs that are not functioning properly, says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children’s Hospital.” Why this happens is complicated and not entirely clear, but is sometimes related to the body’s immune system going haywire. 

So far, it seems that the Kawasaki-like syndrome related to COVID-19 is impacting children’s bodies differently than the disease prior to the coronavirus outbreak. It’s too early to tell exactly what the differences may be. 

We hope that you never have to experience Kawasaki Disease. We know things we read in the news can be scary, and it is very important to be knowledgeable so that you are aware of the facts. You can always ask a nurse first if you are worried about any symptoms or concerns. 

Kim Liner, PNP

Nurse-1-1 Chief Nurse Practitioner

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to prevent concussions in kids?  What should parents know about screen time for toddlers? What’s the best way to approach shingles prevention in the elderly? Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Patients can now chat with a nurse for free to receive live, personalized healthcare guidance

Nurse-1-1 and Zocdoc have come together to help patients gain peace of mind while reducing the strain on the healthcare system during a critical time

In light of the recent spread of the novel coronavirus (COVID-19), the team at Nurse-1-1 is leveraging its existing on-demand nurse chat platform to provide every person in the United States with immediate access to a trusted nurse, regardless of their insurance status or ability to pay. This tool will allow all patients to contact a nurse digitally, remotely, and faster than trying to reach their existing provider, ultimately reducing the increasing burden on our healthcare system during this time of uncertainty.

As part of this nationwide effort, Nurse-1-1 is enabling chats – free through Zocdoc’s platform – with its network of over 750 experienced nurses, nurse practitioners, and physician assistants to support patients’ questions related to COVID-19 in addition to any other medical questions or concerns they may have. Chats are live, instant, and text and photo-based. To access the free chats, patients in the U.S. can visit zocdoc.com/coronavirus and click “Chat now” to ask their personal, health-related questions. From there, they’ll get real-time support from a network of highly experienced licensed nurses, nurse practitioners, and physician assistants for free. 

“At a time when the healthcare system is increasingly strained and public health efforts are focused on mitigating community spread, we feel it is our responsibility to quickly introduce new ways to help patients digitally access care,” said Oliver Kharraz, M.D., Zocdoc founder and CEO. “By teaming up with Nurse-1-1 and their experienced network, we can help patients instantly get free guidance on their health-related questions and concerns when they need support most.”

“Nurse-1-1 is a new way of delivering personalized, secure and immediate healthcare information and guidance to worried patients,” said Michael Sheeley, co-founder and CEO of Nurse-1-1. “We are proud to partner with Zocdoc to provide free chats through their platform with our network of over 750 nurses during a time when patients and families are struggling for answers.”

In line with Nurse-1-1’s mission to provide accessible and compassionate healthcare for all, this free offering aims to help patients quickly feel more informed and assured when it comes to their healthcare concerns – regardless of whether they’re at-risk, the ‘worried well’, or in good health. It also helps reduce unnecessary visits and call volumes to healthcare providers by giving people with non-urgent cases a faster, easier way to get healthcare information and guidance remotely.

Launched from Harvard University’s Innovation Lab, Nurse-1-1 is the digital doorway to healthcare for the billions of worried patients searching for information about their health concerns every day. Its proprietary smart-routing technology connects anybody with a licensed nurse within seconds. Outside of this partnership with Zocdoc, chats are either free or cost $12.50, depending on whether the patient’s provider, insurance plan, digital health service, or any local clinic is partnered with Nurse-1-1. If those aren’t available, patients can pay $12.50 (which is less than most consultation copays) to chat with an independent nurse. Nurse chats will not result in a prescription, diagnosis, or be a replacement for visiting a provider. However, they will provide helpful guidance and follow up instructions. 

Nurse-1-1 partners with providers, health plans, and digital health services to guide patients on how best to navigate the healthcare system at a fraction of the cost of traditional nurse call centers. To learn more about how you can partner with Nurse-1-1 to provide free nurse chats to your patients or members, click here.

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About Nurse-1-1

Nurse-1-1 is an on-demand nurse chat that allows anybody to chat securely and immediately with a nurse 24/7 for healthcare information and guidance. Our mission is to provide accessible and compassionate healthcare to the billions of worried patients searching for information about their health concerns every day. With a network of over 750 highly experienced nurses, nurse practitioners, and physician assistants, we reach patients through personalized, live, text and photo-based nurse chats, providing trusted health information so they can make better decisions about where they should turn to for care. Visit nurse-1-1.com for more information.

About Zocdoc

Zocdoc is the tech company at the beginning of a better healthcare experience. Each month, millions of patients use Zocdoc.com or our iOS and Android apps to find in-network neighborhood doctors, instantly book appointments online, see what other real patients have to say, get reminders for upcoming appointments and preventive checkups, fill out their paperwork online, and more. With a mission to give power to the patient, Zocdoc’s online marketplace delivers the accessible and simple experience patients expect and deserve.

Redness around the eyes

Ever wake up with redness around your eyes? Do you have a rash around your eyes? Eyelid swelling or drainage? 

Redness on the skin around the eyes can be from a multitude of things. Don’t panic. Here is what you need to know.

What causes eye redness?

First, get up, wash your face and assess the situation. Did you cry all night about your spilled milk? If the answer is yes, then the redness is likely from all of your crying. Grab a bag of peas and ice those eyeballs. 

Do you notice redness under your eyes? Dark circles? Are you super tired? Dark circles under your eyes can be from lack of sleep or rubbing your eyes from being tired. Rest those eyes and try some cool cucumbers to soothe those tired eyes!

When should I worry about redness around my eyes?

Redness around your eyes that seems more like a circle of redness can be a big deal. (Unless you dressed as a clown yesterday or your kid drew on his face with a marker, then disregard). Redness of the skin can be caused by infection. Cellulitis is an infection of the skin tissue. Periorbital cellulitis is an infection that occurs around the eye, in the tissue in the eyelids and below the eye. Usually with cellulitis, the skin feels warm (or even hot!), it can be puffy and you can experience fever and pain. You will need to be seen right away for this. Cellulitis may be accompanied by swelling of the eye or eye drainage. If you are experiencing pain with just moving the eyeball, then you need to be evaluated ASAP! Send us a photo and we can help you with your symptoms.

Redness around the eye from an eczema rash 

A rash around the eye can also be a cause of redness. Common rashes can be caused by eczema, which is dry, scaly skin that can occur on sensitive skin around the eye. Eczema can be caused by inflammation that usually occurs when something is irritating the skin (rubbing your eyes or an irritating substance or allergy). The skin around the eyes is delicate and more sensitive than other areas of the body and can become red or irritated quickly. 

Skin irritation around the eyes is common in babies and kids who rub their eyes when they are tired. I’m sure tired parents rub their eyes too, but likely not enough to cause a rash! Dry scaly skin around the eyes from eczema is usually easy to remedy. First, try not to rub and itch the eyes. You can also try applying a thin layer of Aquaphor to your itchy dry patches. Try not to glob it on too thick or you will get ointment in your eyes. A thin layer goes a long way. Following our eczema guidelines will help too, especially avoiding products that contain fragrance. 

Eye redness from an infection

Redness around the eye that is accompanied by goopy eyes can be due to germs in the eye. If you are noticing yellow goop, or your eyes are sticking together and you feel like they are about to be swollen shut (ew gross), this could be conjunctivitis. 

Now, conjunctivitis can be caused by a virus or bacteria. If it’s a virus, it will typically move from one eye to the next over about a day and then start to clear up. Usually, it’s bright red and runny. It clears as quickly as it starts. Normally if you wait 24 hours you can save yourself a visit to the office. 

If you find that you have nice pink eyes 👁, your eyelids are swollen, you have yellow drainage from one or both eyes 👀 and it lasts more than 24 hours with no end in sight, this is probably bacterial conjunctivitis and you will need antibiotic drops or ointment. Some people call this “pink eye.” 

Pink eye is easily treated with a prescription. Call for an appointment and get your infection taken care of if you think you could have bacterial conjunctivitis. This is the type of illness that can easily be treated over a video visit with a provider. If you have access to an affordable telemedicine service through your insurance or primary care provider, definitely consider it. If you have pain with these symptoms you should be seen right away as eye pain is not typical with straightforward bacterial conjunctivitis. 

Eye redness from an allergy

You can also get redness around the eye, symptoms of eye discharge and sticking together just like an infection, but instead it could be caused by an allergy. Seasonal allergies can often cause red, itchy eyes. We also call this conjunctivitis (just like the paragraph above), but this time it’s “allergic conjunctivitis”. It is caused by airborne allergens (usually the invisible kind) contacting the eyeball and causing your eyeballs to react. Allergic conjunctivitis usually consists of redness in both eyes, watery discharge, and itching (lots of itching!). Itchiness usually means it’s an allergy problem and not an infection. 

Start by avoiding rubbing the eyes, washing your eyes out with clean lukewarm water, using cool compresses, and trying artificial tears (aka visine). Try to avoid whatever you think you might be allergic to. If that doesn’t help, oftentimes trying some over the counter antihistamine remedies such as diphenhydramine (benadryl) or loratadine can help if you have allergy symptoms beyond just the eyes. You can also find over the counter antihistamine eye drops, specifically for itchy eyes, such as ketotifen. Remember to check with your doctor and pharmacist to ensure safety for any long term use! 

Eye redness prevention

Eye redness can be serious so any time you have redness accompanied by pain, fever or warmth, or it seems like you have a circle of redness, it’s important to get checked right away!

One of the biggest ways to keep your eyes healthy and germ-free is by good hand washing! 🖐🏻 Good hand washing is a great way to prevent the spread of germs. It can keep you from getting eye infections as well as introducing other germs into your body that can give you cold symptoms or the flu. Ask a nurse first, if you have concerns or want us to take a look!

Kim Liner, PNP

Nurse-1-1 Chief NP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to prevent concussions in kids?  What should parents know about screen time for toddlers? What’s the best way to approach shingles prevention in the elderly? Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Prepping the general population for COVID-19

How should I prep for the great Coronavirus of 2020, aka COVID-19?

So unless you live in complete seclusion, you are aware of the current fears and realities surrounding Coronavirus that are currently happening across the globe. A simple Sunday Funday trip to Costco this weekend proved to me that people are not following the CDC guidelines. Some people are panicking. We witnessed people in masks pushing and shoving each other to check out and a line that was snaking around the entire store. I mean who goes to Costco on a Sunday anyways?? First mistake made.

So I wanted to think about this virus and how the general population, including my own family, should prepare. Here is what we have done to get ready and what I think that you should do too.

Check your soap supply, and wash those hands!

First is the “soap check”. Make sure that you have soap next to all of your sinks—this will encourage handwashing. Seems like a no brainer, right? Just a simple task to help you feel ready. 

Next, remind your family that simply wetting their hands with a splash of water after using the bathroom or sneezing and coughing into their hands is not going to do much of anything. Handwashing success is based on the amount of time that you wash, the friction that you use and the surface of your hands that you actually wash. 

Here are the 5 steps the CDC recommends every time you wash your hands:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Make sure you get the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

Now that you have handwashing checked off your list, let’s move onto the next.

Update your health care to the extent possible

Make sure that you are up to date on your health care. What exactly does this mean? Well for starters, have you had your annual flu shot? Have you had your physical visit this year? How about those daily medications? Do you have refills left? 

Right now, influenza is getting forgotten about. Influenza, or the flu, is still in season and deserves some continued attention. The flu is still hitting hard. If you really want to protect yourself and your family, get your flu shot. Wash your hands. Stay clear of sick people. And hey, wash those hands! 

Do you have asthma or a history of wheezing with illness? Now would be the time to make sure you have refills on your albuterol and flovent inhalers and make sure you are familiar with your asthma action plan. Call for refills of your asthma medications so that you have them on hand in case you do catch any sort of respiratory illness (flu anyone?). The last thing that you will want to be doing is going into a germy pharmacy or waiting for a call back from your primary care provider if you suddenly realize you need a new inhaler. Check how many puffs of albuterol are left. Don’t wait until 2am for your refill. Be prepared. 

This goes for anyone with any health conditions. Make sure that your health is tip top. Follow your plan that you were given for your health issue and make sure that you are up to date on medication refills, appointments and hey, while you’re at it, set up auto-delivery of your medications. This will make things easier for you as things get busier around here. 

If you’re already sick…

If you or a member of your household is sick, your best bets in order to prevent the spread of germs are to:

  1. Clean all surfaces, especially door knobs, light switches, and anything else you regularly touch
  2. Wash your hands. Seriously, you can’t wash your hands enough during this time.
  3. Sneeze into your arm or a tissue!
  4. Stay home! Don’t go out and spread germs to others when you are sick with any illness. 

What not to do 

It is not a good idea to scour the internet and pay hundreds of dollars for some strange masks resembling the n-95 mask from Amazon. You really only need a mask if you are a health care provider or if you have COVID-19 and are going out on the town (which you shouldn’t). If you have a respiratory illness and need to be seen in the office or ER, they will give you the appropriate mask. If you happen to catch Coronavirus, then worry about the mask if and when you need it. It will not do you any good now in terms of prevention as they need to be fitted properly and can’t be lifted up for every itch or to talk on your cell phone. The hospital will provide you with the appropriate gear if and when it is time. Masks right now should be saved for providers and personnel taking care of sick patients. Besides, how will you activate your facial recognition on your cell? Better get that passcode ready! 

Also, do NOT go running into the ER with the sniffles or for any old fever for that matter. The Emergency Room was named that way for a reason. It is for emergencies. If you or your loved one look like a wet noodle, won’t perk up, are not drinking at all, have had no urine in over 8 hours, have persistent or worsening pain, are very ill appearing or you are concerned and feel like you should be seen, then head to the ER. Just remember the ER is not a walk-in clinic. Call your primary care provider or pediatrician for your general sick care needs. 

Leverage telehealth tools

The CDC recommends “Leveraging existing telehealth tools to direct people to the right level of healthcare for their medical needs.” Hey, that’s US! Talk to a nurse first, and get the right care. We are also on standby if you can’t get in touch with your provider, or their wait times are too long. We are here to help! Chat with us so we can help you decide the best plan for you and your loved ones. 

The CDC is keeping close tabs on current illnesses and how to keep yourself and loved ones safe. We agree with the CDC and their personal health habit recommendations for your home and hope this gentle reminder will help you too. Keep calm and wash your hands…

Kim Liner, PNP

Nurse-1-1 Chief NP

Answering Your Patients’ COVID-19 Concerns

Here at Nurse-1-1, we recognize we are uniquely positioned to support the public health response to the COVID-19 outbreak. That’s because we’ve developed a HIPAA-compliant text and photo-based chat platform that meets patients where they are—online—and gives them the option to chat with a live, trusted nurse offering education and care navigation. In fact, if you’re a healthcare provider in the Massachusetts area, it’s likely we’ve already helped some of your patients, for free. During a time when patients and families are struggling for answers, let’s work together to ensure your patients are well educated and accessing care correctly.

Nurse-1-1 has already been helping our patients, for free? How’s that possible? 

Well, tens of thousands of patients find us when they search online for health information and see our content. Turns out that many patients who already have established PCPs are still using Nurse-1-1 to help with their health concerns. We know because they tell us! 

Wait, my patients call me first before going online!

How sure are you of that? These days, many offices and call centers are facing hours-long queues. As a nurse practitioner who does plenty of triage in an Urgent Care setting, I know this firsthand as I’ve had to call patients back 3, 4, even 5 hours after they called on a busy weekend during flu season. Do you really think patients are waiting hours without going online to educate themselves? Studies show 80-90% of patients use online health information to make their healthcare decisions. 

By the time you’ve called your patients back, they may have already sought care elsewhere such as a walk-in clinic, urgent care, or ER. Nurse-1-1 diverts patients away from fear-inducing websites and into a live chat with our 675 trained nurses, who then help guide them to the right care location.

Is your practice ready for what is coming with the COVID-19 outbreak? 

The CDC currently recommends that patients with low risk of being infected with COVID-19 that have symptoms or exposures should seek telephone health advice to determine if medical evaluation is needed. This likely means a large increase in patients contacting their providers for advice on whether evaluation is needed is coming. Are your triage systems ready? 

Because of the crisis and our company’s mission, we are now offering Nurse-1-1 for free to as many patients as possible during this time. We can’t help everyone, but we can do our part in the public health response. If you’d like to ensure your patients are able to use Nurse-1-1 for free during this period of uncertainty and confusion, contact us. A partnership with Nurse-1-1 can help your patients make proper healthcare decisions, avoid unnecessary visits to alternative sites of care, and educate them on appropriate preventative measures. 

Why trust Nurse-1-1 during this time?

We only staff experienced triage nurses and nurse practitioners ready to chat with your patients 24/7. We are also HIPAA-compliant and can share patient notes under a BAA. Our real strength? We meet patients where they are—online—and connect them within minutes to a trusted nurse. 

During this critical moment in history, more and more patients will be searching for information and answers to their health questions. Let’s work together to ensure your patients stay calm and feel cared for. Reach our below for more information.

Kim Liner, PNP

Nurse-1-1 Chief NP

Vomit Color– Green, Yellow, Brown, Black, Clear

So you are puking.  Ugh. I’m sorry to hear that.  Not to be a Debbie Downer but you might have the stomach bug.  Yuck.  Not all funky vomit colors are from the stomach bug though! 

Let’s talk about common vomit color concerns.  Disclaimer: do not read if you get queasy easily 🤣🤣🤣

Green/Yellow Vomit

Green vomit could be the green frosting your kiddo just ate way too much of… or could be something else if they didn’t just smash back three pieces of Green Monster themed cake.

Green vomit after having a few episodes of vomiting can be from bile in the stomach which is typically green/yellow in color.  Bile is made from the liver and stored in the gallbladder until it is used by the stomach to break down food. Green vomit or bile is usually seen when the stomach is empty, either because you have been vomiting all night, or you just woke up and have nothing to vomit, except the bile sitting in your belly waiting for breakfast.

People with morning sickness for example can wake up with an empty stomach and vomit bile.  Someone who vomited all night will also wake up with a similar empty stomach. Make sense?

If this green vomit lasts more than a few days, or is accompanied by severe pain, fever, weakness, constipation, or any other concerning symptoms, you should get checked out right away.  Chat with us about your green vomit.  We can help figure things out!

Brown Vomit

Brown vomit can be the cause of eating too many chocolate brownies… Or can be associated with more serious issues.  It is most commonly going to be because of brown food. Let’s talk about more serious issues in case you are having brown vomit.  

The first serious issue we worry about is whether this brown vomit is actually blood.  Old blood turns to a dark brown color and can sometimes look like dark coffee grounds. If you have brown vomit (and didn’t eat a ton of brownies),  especially if it looks like coffee grounds, then you should be concerned. Bleeding in the stomach can cause there to be blood that darkens up by the time it is puked out.  This can be a serious issue.  

If you have abdominal pain or a history of ulcers or acid reflux (AKA heartburn) then you should be checked out to be sure this brown vomit isn’t blood. Most offices can do a simple test that will tell you if there is blood in the vomit or if it’s just a brownie…(you can always bring in a sample for them to test if you are courageous). 

Now sit down for this one.  Ok, are you sitting? If there is severe constipation, and stool (poop anyone?) is backed up, you can vomit brown poop-smelling vomit.  Gross, right?? But think about it… What comes in, must come out! If the poop isn’t getting evacuated properly (through the normal exit), it can come back up.  If this is the case, you likely haven’t pooped in a while. If you have poop smelling vomit, bloating, and abdominal pain, then get yourself seen. You will likely need a cleanout for your constipation.

Get checked right away if you are experiencing these symptoms.  

Black Vomit or Coffee Ground Vomit

What if you are throwing up black? Very dark brown or black vomit can be old blood, again, especially if it appears to look like coffee grounds.  If you are unsure of the actual color, take a bit of vomit and smear it on a white paper towel. This should help you to see if it is really dark green, or truly black.  Maybe it’s just from all the kale and spinach you have been eating, or the black frosting you ate at the Halloween party yesterday.  

But if this appears red at all or truly black (and you didn’t eat black frosting or have been taking Pepto Bismol), you need to get checked out.  Old blood, likely from further down the digestive tract, can turn black over time. Get checked right away, especially if you have any pain or history of stomach or digestive issues.  Black vomit is not normal, unless of course, frosting.  

Clear Vomit

Do you have the stomach bug? Just chugged some water on an empty stomach?  It’s going to look like water. Vomiting clear liquid like this is a common result. Don’t panic. You will likely have green/yellow vomit soon, see above.  Clear vomit can be normal when you have an empty stomach and are vomiting.

If you hit your head and are suddenly vomiting clear fluid, or vomiting at all, get looked at.  This can be a sign of a serious issue. Another red flag is clear vomiting that persists and doesn’t seem to improve after 24 hours or when accompanied by inability to ingest food or liquids.

Pink or Red Vomit  

Bloody vomit deserves a check by a medical provider.  Unless of course you had a bloody nose or smashed your lip and swallowed some blood.  In that case, a small amount of blood is ok, as blood is pretty irritating to the stomach. Once you swallow it, it’s likely to come back up. Don’t get too worried if it happens once or twice but then stops when you’re no longer vomiting. Vomit that has a little blood once but then clears up right after usually isn’t an issue. 

It also isn’t abnormal to have a little tiny amount of blood in your vomit once it’s the 15th or 16th time you vomited from a stomach bug. With that constant retching, you can also get tiny tears in your esophagus that lead to a little bit of blood. As long as it goes away quickly (like only 1 or 2 episodes of vomit with a little blood), don’t panic. Check with us or your provider. 

If you notice large amounts of blood, like filling the toilet bowl, or coffee ground or dark red vomiting, then get checked right away.  Large amounts of bloody vomit can be a sign of a serious issue with your liver, a tear in your esophagus, or some other life threatening emergency. Large amounts of bloody vomit are never normal. Also, persistent bloody vomit is never normal either. Unless… you guessed it, frosting! Or red Kool-Aid. Or pepto-bismol. Or that red popsicle you were craving. 

Vomiting the Colors of the Rainbow

Don’t panic.  Don’t google. Talk to us about your vomit! We are here to help you.  Searching the web about vomit color can be scary without taking into consideration all of your current symptoms.  Ask a nurse first.  

Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to prevent concussions in kids?  What should parents know about screen time for toddlers? What’s the best way to approach shingles prevention in the elderly? Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Shingles prevention– What you need to know

Shingles is caused by a virus known as the varicella-zoster virus. It is the same virus that causes chickenpox. Once you get chickenpox, the varicella-zoster virus lays dormant in your body, aka takes a nap, until the virus reactivates or wakes up causing shingles. About 1 in 3 people in the US will develop shingles according to the CDC. Here is what you need to know about shingles prevention, symptoms, and other important aspects of this illness. 

What are the symptoms of shingles?

You will know when the virus wakes up! Shingles usually starts as a painful area on one side of the body that then develops into a strip of a blister-like, painful rash. The rash can be accompanied by fever, achiness, headache, fatigue and sensitivity to light. The blisters will break open and then crust over in around 7-10 days. Shingles can last 2-4 weeks. It can make you miserable and very uncomfortable. Not everyone will present with the same symptoms. Some people do not develop a rash, and some will get a rash over the face instead of the back or chest or arms/legs. 

Can I catch shingles from someone with shingles?

Ok, get ready for this super confusing statement. You may have to read this a few times:

You can only get shingles if you have had the chickenpox or chickenpox vaccine in the past. Once your body has had exposure to the virus that causes chickenpox in any way, the virus becomes dormant and sleeps in your body until it wakes up again as shingles.You can not catch shingles from someone with the shingles. Shingles only appears when it wakes up in your body, usually when you are older, run down or stressed. 

You CAN however get chickenpox from someone with shingles since it is the same virus, IF that is, you haven’t gotten chickenpox before or haven’t been vaccinated. Phew!

SO BASICALLY:

  • If you or your child HAVE NEVER HAD the chickenpox (or the vaccine), don’t hang with anyone who has shingles
  • If you or your child HAVE HAD the chickenpox (or the vaccine), you can hang with someone who has shingles— you won’t catch shingles or chickenpox! 

When I say “hang” I mean don’t get near the fluid blisters or touch them. The virus is spread by direct contact with blister fluid. It is important to keep the blisters covered especially if you are around babies who have not been vaccinated yet or adults who have never gotten the chickenpox vaccine or chickenpox. 

Shingles exposure

If you are around someone with shingles, they are most contagious when they have blisters. The virus is not contagious prior to blisters developing nor after the blisters crust over. Do not touch the blisters! I mean, who would do that? But babies or unsuspecting adults might get close enough to get exposed to the blisters and the shingles virus. If you have shingles, keep the blisters covered, avoid scratching the rash and wash your hands well and often. Avoid coming in contact with newborns, with pregnant people who have not had the chickenpox or the vaccine, and with immunocompromised people such as the elderly, people with HIV, those with cancer or with chronic illnesses, or people who take immunosuppressant medications or steroids. 

What happens if I get shingles?

Shingles is painful and you can be pretty miserable when you have it, but once it goes away you should be ok. It usually resolves within 2-4 weeks. Now, the virus is worse for adults over 60 years of age, and especially those with complicated health problems, those on certain medications, and those who are immunocompromised. 

One complication that is more common over the age of 60 years is post-herpetic neuralgia (PHN). This is when the pain from shingles lasts longer than the illness lasts. Once shingles clears, the pain should clear as well. If not, you may have PHN. It is best to follow up with your provider for any pain that persists after the blisters crust over, or pain that lasts more than 2 months.

Shingles prevention— Is there a shingles vaccine?

YES! There is now a shingles vaccine to help with shingles prevention. Zostavax and Shingrix are shingles vaccines recommended for all adults over 60 years of age. Getting the shingles vaccine is thought to provide protection for about 5 years. The vaccine reduces the risk for getting shingles by 50%, and post-herpetic neuraliga by 67%, according to the CDC. The shingles vaccine is recommended for anyone over the age of 60 years for shingles prevention, even if you don’t recall getting the chickenpox. 

Remember, you can’t get shingles if you haven’t gotten chickenpox (or the chickenpox vaccine) but almost everyone over the age of 40 years of age has gotten the chickenpox! Hello?! chickenpox parties anyone? You don’t hear about chickenpox much anymore, but those younger than 40 years of age likely got the chickenpox vaccine, and some of us, good old fashioned pox. No offense to those over 60, but it’s during those “older” years that you need extra protection.

Is there treatment for shingles?

There is no treatment to completely eradicate the virus, but there is medication called an antiviral medicine that can weaken it. Antiviral medications can reduce the symptoms that you experience and may shorten the duration of the illness. Using steroids along with antivirals can help with inflammation and pain. You will need to start these medications right away. Antiviral medications work best when started ASAP. Call your provider right away as soon as you think you may have shingles. Let us help you figure out if your symptoms could be shingles. 

Shingles can be painful and itchy. Using a bag of cold peas or a bag of ice can help relieve some of the pain and itching. But don’t feed the peas to unvaccinated baby Sue…make sure to toss them after! Also: 

  • A lukewarm oatmeal bath can provide some relief to the rash.
  • Some people suggest using calamine lotion for itching and the blistery rash.
  • Wearing socks over your hands may prevent you from scratching the blisters in your sleep. 

Rest, good nutrition and lots of fluids can also help you recover faster as your body fights the virus! Take care of yourself and your body. Don’t hesitate to chat with us if you have any questions!

Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like is there a Coronavirus vaccine?  What should parents know about screen time for toddlers? Do I have a cold sore or a canker, and is it contagiousWell we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.