A Conversation with Dr. Daniel Soffer About COVID-19
Dr. Daniel Soffer. Photo courtesy of Penn Medicine
Dr. Daniel Soffer practices internal medicine and cardiology at Penn Internal Medicine in Media and the Hospital of the University of Pennsylvania in Philadelphia. He lives in Swarthmore. The Swarthmorean called him for his perspective on the COVID-19 outbreak. The conversation has been lightly edited for space and clarity.
Swarthmorean: What’s your sense of the evolving situation with COVID-19, particularly what’s going on in Delaware County and in Swarthmore?
Soffer: I’m part of a medium-sized internal medicine group doing primary care medicine, but I’m also part of a large health system, and I get emails from two other health systems. There’s a consistent message from all of them, which is the message you’re seeing in the media too: Social isolation is crucial to contain the outbreak and not overwhelm healthcare delivery in the places that need it most — like intensive care units and hospital beds — all at the same time.
The real question is always going to be, is your infection due to COVID-19 or is it something else? We have no way of discerning the difference in clinical practice. We do not have the capacity to test people in our office. We have tested people, but we used up our resources for doing so over the course of about three days.
We may also have to completely limit all face-to-face contact with anybody with a respiratory infection. Not only do we not have ways to test people, we don’t have ways to protect the healthcare workers. We are almost all out of gowns and face shields.
There is definitely a supply issue with regard to testing supplies. There’s a disconnect between what you hear on the news and what’s available medically. Once you get the specimen to the laboratories like Quest and LabCorp they have assays to do the tests. The problem is that health systems like ours are all out of viral swab containers. So I don’t have a way to do a swab. I don’t have a viral culture medium that I can put it in.
Do you have a sense of when you’ll be getting more testing equipment or gowns?
It’s a very fluid process. New information comes out literally every couple of hours.
We have a number of employees who are immunocompromised and who have been told they should not be coming to the office under any circumstances. We have a number of employees who live paycheck to paycheck and are concerned that, if they stayed home one day, they wouldn’t be able to pay their mortgage or their rent. We have a number of employees who have family members who, if they go home and infect them, that could be a problem. It turns out that the people who work for us are people also — just like our patients and the physicians. Two of the casualties nationally have been frontline physicians who were middle-aged, healthy people without any medical problems before they succumbed to COVID-19.
What advice do you have for people who think they have symptoms?
To quarantine. Unless their symptoms are severe enough that they require hospital-level care.
And they can contact the office of Vice President Mike Pence to let him know they have a problem, and there’s no one around who can help them.
If they have a respiratory infection they feel they can manage on their own, they don’t need to contact anyone other than the health department to let them know that they are another statistic. If they are having symptoms that are severe enough, they should present to an emergency department. Medical offices like mine can’t accommodate them.
And they don’t need me to determine whether they need a hospital. They can make that determination on their own. Shortness of breath: that’s the principal symptom. High fever and a severe productive cough is something where there’s more wiggle room.
Should people be calling ahead to ERs if they think they have COVID-19 symptoms?
They need to. I haven’t been down to the ER but I imagine they have something set up outside to make sure people don’t just walk in and mingle with patients who are not having respiratory symptoms.
Are you generally advising people to keep social distance?
Yes. I had a number of friends and family contact me about what they should do as if I knew something about it that the news media did not. I get the impression that people just don’t really get it. That when the Surgeon General is telling people to stay home and self-isolate, they think that’s a soft recommendation. It’s a strong recommendation.
I drove around a little bit yesterday. There are people visibly out there, not self-isolating. There was a glom of elementary school kids standing in front of Renato’s in Swarthmore. There must’ve been 15 of them altogether. You see all these reports of people going into bars and restaurants.
We’ve been talking to moms who are making rules about what their kids can and cannot do: like, no sleepovers, no Xbox in the basement, no contact sports, but Ultimate frisbee is okay. Do you have any sense of what’s reasonable and not reasonable?
I haven’t thought about those kinds of details. But I know someone somewhere has written it down in some website somewhere. I would guess it’s the World Health Organization and Centers for Disease Control.
Dan Soffer’s Internal Medicine and Lipidology practices are offering their patients video and telephone consultation until the COVID-19 crisis passes.
