Subject: Office Update 4/24/2020

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Office update - Greetings...
Friday, April 24

Hello patients and friends,

I’ve heard from a number of you who missed our weekly email last week and appreciated the feedback. I may reduce the frequency of our notices because I know that many are suffering information overload these days, but I promise to reach out periodically and any time important information comes to my attention. If you have any specific questions or need guidance on making good COVID decisions, don’t hesitate to reach out to me (many of you have been reaching out and I appreciate it!).

We have a few updates this week.


Thanks to all for your willingness and flexibility during our transition to virtual visits. We have been able to see patients virtually for periodic follow ups, new medical concerns, and Medicare Wellness exams. While any new technology can offer challenges, overall, we have seen a smooth transition and heard positive feedback about our platform.

We will be watching carefully for the appropriate time to move toward regular office visits. In the meantime, we can still see you in the office as needed, often after a virtual visit to set up quick blood draw, immunization, exam etc.

For your convenience, we will plan to maintain the option of virtual visits indefinitely as long as insurance allows.


Oregon continues to do well with our Covid-19 response. St Vincent now has 8 patients in the hospital with Covid-19 related disease, and is looking forward to restarting elective surgeries next week. We have significant excess capacity in our hospitals and are continuing to coordinate efforts on a regional basis with the state (Oregon Health Authority) and with the Kaiser, Legacy and OSHU systems.


Testing (nasal swab) for active Covid-19 is available a little more widely, and interestingly only about 5% of tests state wide have been positive. We have tested 5 patients thus far, mostly in the circle in front of the hospital (one in a nursing home). Only 1 in 5 have been positive. 

Quest labs now offers an IgG antibody test for the SARS COV-2 virus, that causes Covid-19 disease. If you have reason to suspect you may had the infection in the past it is possible to test your blood. I would NOT encourage everyone to simply test now for curiosity, as we DO NOT yet understand how well IgG antibodies will confer protection from the virus in the future (but we’ll get there!).

You may have seen the news that many New Yorkers in one study had antibodies. Similarly Providence state-wide is testing over 3,000 caregivers for antibodies in what will be an important contribution to the literature. Physicians and staff are being tested every two weeks for 8 weeks. My first test came back negative, no exposure. 


I promised last letter to summarize some information on emerging treatments. Unfortunately, treatment for COVID-19 is still very much in the research phases. There is A LOT of unsubstantiated information on the internet and throughout the community regarding treatments that might have some effect. If this were not enough, you saw our president suggest Thursday that using disinfectants “internally” might help fight the disease. Some of the suggestions are unhelpful or (like this last one) very dangerous.

I’ll keep these remarks short for now. The latest set of guidelines for treating COVID disease, published by the NIH, summarized in this MEDSCAPE article.

Two specific areas are worth special mention at this time. The anti-malarial drugs chloroquine and related hydroxychloroquine have received huge attention and press. There are multiple well-designed trials of these drugs ongoing and set to be finished in record time (for medical treatments). There are questions about timing (whether it is most useful for prevention, for mild early disease, or for sick ICU patients only) and dosing. This study from the VAMC was one of the latest and best designed trials and suggests strongly (disappointingly) that these drugs with or without the addition of azithromycin (Zithromax) led to poorer outcomes with higher mortality. Much more to come but for now suffice to say that making a decision like this for treatment of thousands or even millions of patients often leads to unexpected outcomes. 

One other newsworthy study was done on patients with hypertension and on the drugs like Lisinopril called ACE inhibitors. This study showed that among patients admitted to the hospital with hypertension (a known risk factor for worse outcomes in COVID-19) that patients on these drugs bad BETTER outcomes. So we won’t suggest anyone change from their current ACE for hypertension or the closely related ARB’s (drugs like Losartan or Irbesartan). 

While a number of vaccinations are actively being studied all around the world, a useful product is still likely12-18 months from use. Most are in the phase of the trial wherein the efficacy and safety of the vaccine are studied.  Unfortunately, nothing can replace the passage of time.


In the absence of a vaccine, my recommendations remain consistent. Follow social distancing regulations and Oregon Health Authority’s best practices recommendations for safety. Consider wearing a mask when you do go out into public for your own protection as well as for the protection of those around you.

Also take the time to care for your mental health. The stress of a pandemic along with the challenges of social distancing can certainly take a toll. Try to incorporate some activity into your days. Give some thought to diet, sleep, and stress reduction. Reach out to friends and family by phone or Skype. Just because your distant does not mean you need to be isolated.

Hope you are all well and please don’t hesitate to be in touch. We are here for you.

Dr. Biemer, Julia Jones NP, and the team

James Biemer, 9135 SW Barnes Rd, Suite 863, Portland, OR 97225, United States
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