Episode Details

Vitamin D deficiency screening recommendations by USPSTF and other organizations is discussed. CDC announces “no masks required” for vaccinated people. Question of the month about fever and cough answered.

Introduction: Mask use no longer required for vaccinated people
By Hector Arreaza, MD

Today is May 17, 2021.

Did you receive your COVID-19 vaccine? If you did, we have good news for you, well, this may not be news for you anymore by the time you listen to this episode.

The CDC director, Rochelle Walensky, announced a few minutes ago that vaccinated people no longer need to wear masks indoors or outdoors and no longer need to keep social distance[1]. A person is considered fully vaccinated 2 weeks after one dose of J&J vaccine or two weeks after second dose of Moderna or Pfizer vaccines.

Fully vaccinated people are required to wear masks in airplanes, trains, buses, other public transportation, health-care settings, and where required by local authorities or businesses. These mask and social distancing guidelines may change in the future because we have seen the behavior of the coronavirus is unpredictable. These guidelines are dynamic.   

This announcement came one day after CDC endorsed administration of the Pfizer vaccine to persons between 12 and 15 years old. We do not know if this is the beginning of the end, but for sure we are starting to see a light at the end of the tunnel. 

As of today, about 117 million Americans are fully vaccinated (35% of the population). The effectivity of vaccination has been remarkable. The rate of breakthrough infections (it means infection after full vaccination) is rare, and severity of disease is mild after vaccination. For the record, the federal government has set a goal of vaccinating 70% of Americans by July 4th, 2021. 

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.

Question of the Month: Fever and Cough
Written by Hector Arreaza, MD

This is a 69-year-old male patient, who comes to clinic for acute onset of fever (102 F), cough, and shortness of breath which has progressively worsened over the last 3 days. 

He does NOT smoke tobacco. He takes benazepril 10 mg daily. His immunizations are not up to date. Physical exam: Tachycardia of 110 bpm and fever of 101.5 F (38.6 C). He has bibasilar crackles, White count is elevated 13.5, and chest x-ray shows a right lower lobe consolidation. He has a negative rapid COVID-19 test. 

What are your top 3 differential diagnoses and what is the acute management of this patient’s condition?

First, we want to announce the winner. I am the winner [applause].

The top 3 differential diagnosis are: 1. Community acquired pneumonia, viral or bacterial (no surprises there, the symptoms are typical of CAP); 2. COVID-19 pneumonia (the rapid COVID-19 test was NEGATIVE, but the confirmatory test is pending, this patient may have COVID-19 until proven otherwise); and 3. My third DDX is pulmonary coccidio-idomycosis (also known as Valley Fever in California, or simply cocci). If you are not familiar with the diseases in the Central Valley of California, you may think this is a very unusual differential, but for us is not that uncommon. One day we will talk more about that disease.

Acute management:

The first decision you must make is where to treat this patient. Will you treat him at home or in the hospital? If sent to the hospital, can he be treated on the floor or requires ICU admission?

You have to determine is the patient is experiencing septic shock or respiratory failure. If septic shock and respiratory failure are not likely, and CURB-65 score is zero, then