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COVID-19 Update 5/22/20

· COVID-19

Dear Signature Patient,

We have received questions from some of you who wonder whether COVID-19 can cause illness twice. There have been reports from other countries about patients with documented disease having a second positive result several weeks after recovery from the initial infection. Most researchers agree that these results reflect the presence of non-infectious viral parts and thus represent false positive test results. Animal studies have been done which corroborate this belief.

The number of new infections (as a percentage of those being tested) continues to level off. Of the 80 Signature patients tested for active COVID-19 infection, 5 (6.25%) have tested positive. Of the 108 Signature patients tested for prior COVID-19 infection, 4 (3.7%) tested positive. These numbers are small, but they align with the data from Mecklenburg County. As we mentioned in our last update, the vast majority of us continue to remain susceptible to this virus. Accordingly, our public health policies must remain focused on protecting the vulnerable among us. This policy will likely remain in effect until a vaccine is developed or effective medications are available.


  • Hydroxychloroquine, so far, appears to be ineffective in preventing or treating COVID-19.
  • Remdesivir has shown promise in shortening hospital stays of infected patients.
  • There are multiple other “designer drugs” that target specific proteins in our immune system, as well as newer inhaled medication and even trials looking at a medication used to treat OCD.  None of these has moved beyond investigative status.
  • No medication has been shown to prevent infection.


There have been early reports from clinical trials on several of the dozens of vaccine candidates. So far, the vaccines can prevent infections in mice or pneumonia in monkeys. In humans, all we know is that one of the vaccines has produced antibodies. We don’t know if this confers immunity to infection or not. Although this is all encouraging, our best estimate is that a widely available vaccine is still at least 12 months away.


Most of our patients have stayed at home and have practiced social distancing and masking when leaving the home for necessities. We’ve done this for 56 days. Until we have a vaccine, should we continue to do this for 356 days? Can we even do it? Already, stores and streets are a little more crowded than they were 3 weeks ago. Up until now, we have been forced to base recommendations on theory rather than data. Now that data is starting to trickle in, policies can be based on epidemiologic studies.

Infection = Exposure x Time.

What the data is showing us is that infection is extremely unlikely to occur when two joggers pass on the sidewalk. Infection is also unlikely to occur walking through a supermarket (assuming they are following the 1 patron per 1000 sqft policy). Similarly, infection is unlikely when several asymptomatic friends meet on an outside patio.

Infection is most likely to occur when groups of people congregate indoors for a significant period of time. This duration depends on the activity, the size of the group and the size of the room. The larger the group or the more confined the space, the shorter that time period needs to be. The more talking (or singing) that occurs, the higher the risk for infection. Typical scenarios include: Celebrations (birthdays/weddings/funerals), Religious gatherings, sporting events, networking events, restaurants, open-plan workspaces.

Even a sit-down meal in a restaurant with “only” 20 other patrons may be a high-risk environment if dinner lasts 2 hours. (Keep this in mind when Phase 2 takes effect.) Conversely, it is possible that two unmasked individuals – one of whom is infected but without symptoms – can have a quiet, face-to-face conversation with a low risk of passing the infection from one to the other. While we don’t yet recommend having this hypothetical conversation, it shows that our understanding of this virus continues to evolve and eventually our policy should follow.

Until we are sure we can protect those who need it the most, we should err on the side of caution. Continue to avoid leaving your home if you are symptomatic. Continue to practice social distancing when you do leave home and wear a mask in situations where social distancing is not possible, especially when indoors. Continue to practice good hand hygiene.

As always, your family at Signature is available to take care of your health-related needs. Please do not hesitate to contact us if you have questions or concerns.


The Signature Healthcare Team

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