A 32-year-old man presents to the emergency department (ED) for one day of fever up to 103.5°F and joint pains affecting both knees and both ankles. He is also having a generalized headache. About 2 weeks ago he was at this ED for dysuria that began approximately 5 days following unprotected sex with a new partner. Urinalysis was negative and he was treated with azithromycin and ceftriaxone, but the urine culture, chlamydia, and gonococcal (GC) tests were all negative. He denies any vomiting, cough, sore throat, rash, or other complaints.

Vital signs are normal except for an elevated temperature (100.4°F). Physical exam is normal except for slight pain when moving eyes side to side and a

 Examination of the knees and ankles and other joints is unremarkable.

CBC was completely normal but there was a high normal WBC and elevated PMN percentage. Results of basic metabolic panel were normal.

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Fever is up to 103.5°F, joint pain is affecting lower extremities, bilaterally, and the patient complains of headache. Could sex have anything to do with it? 

Fever, Joint Pain, and Positive Jolt Sign in a Young Man 

The Food and Drug Administration (FDA) issued on February 20, 2021, 

 for establishments that oversee blood donation. 

The update stresses that there have been no reported cases of transfusion-transmitted SARS-CoV-2 virus worldwide, and that respiratory viruses, in general, are not known to be transmitted this way. 

"We need people to start turning out in full force to give blood," said Peter Marks, MD, PhD,  director of the FDA's Center for Biologics Evaluation and Research (CBER). The concern stems from the increased variability the Red Cross has seen in blood donation during the COVID-19 pandemic, as fear about virus spread keeps people from wanting to engage in the process of donating. 

The information on if and when blood can be donated by persons who have been infected with COVID-19 or have been vaccinated against the virus could be valuable for physicians to share with patients. The Red Cross encourages educating the public. The FDA explains, below.  

For more COVID-19 coverage for primary care, visit our

The FDA provides details on how COVID-19 infection or vaccination against the virus affects a waiting period to donate. Please share the information with your patients. 

FDA Update: Blood Donation During COVID-19 Pandemic   

How many cases of coronavirus disease 2019 (COVID-19) have been confirmed in the US?

, as of today, January 22, 2021 at 10:22 AM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 41 787 reported fatalities, followed by 

 with 1 763 247 people who have recovered, followed by 

 California leads in number of persons tested

 with 39 512 756 people tested, followed by 

How many cases of COVID-19 have been confirmed globally?

Global confirmed cases of COVID-19 have surpassed 97 million. We summarize more of today's data from the Johns Hopkins COVID-19 interactive map.

COVID-19 Update: US and Global Cases, Deaths, and Recoveries as of January 22, 2021

Primary care physicians may have patients who are ready and willing to receive vaccination against the SARS-CoV-2 virus when the shot is available to them and others who will simply refuse.

There will likely be a group in the middle, too, that needs reassurance and answers to some questions from you.  

Your job is made harder because of true unknowns about both the virus and about the only-months-old vaccines 

 the significant amount of misinformation in wide circulation. 

To help you stay current on the type of misleading statements your patients may be hearing and reading and to counter them with facts, 

® collected 2 sets of Myths and Facts drawn from government and other authoritative online sources. 

Following is the second group. You can review the first slide show with 8 additional Myths and Facts 

Patients trust primary care providers for accurate information on the COVID-19 vaccines. Here are 7 of the many myths now widespread you may need to explain to your patients.


7 Myths and Facts about the COVID-19 Vaccines for PCPs and Patients 

Results from a new study confirm that antibodies stimulated by the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine can neutralize the more transmissible variant of SARS-CoV-2 identified in United Kingdom.

The study—published on the preprint server

while awaiting peer review—is among the first to suggest that existing vaccines are not weakened by the UK variant, dubbed B.1.1.7, that has already 

that antibodies from people who received the vaccine, BNT162b2, effectively neutralized one of the key mutations (N501Y) in the UK variant, which also appears in another variant, first identified in South Africa (B.1.351).

In this new study, researchers from both companies created non-replicating pseudoviruses that featured the full set of B.1.1.7 spike mutations. Researchers then tested blood taken from 16 participants who had received BNT162b2 against the variant and found the vaccine could neutralize the variant as well as it could the earlier form of SARS-CoV-2.

“The preserved neutralization of pseudoviruses bearing the B.1.1.7 spike by BNT162b2-immune sera makes it very unlikely that the UK variant viruses will escape BNT162b2-mediated protection,” wrote study authors.

The study also notes that, unlike the influenza vaccine, “the reduction in neutralization that might indicate the need for a strain change has not been established for COVID-19 vaccines.”

One potential limitation to the study is the use of the non-replicating pseudovirus system, but previous research has shown concordance between pseudotype neutralization and SARS-CoV-2 neutralization assays, added authors.

“Additional experiments will confirm efficient neutralization of B.1.1.7 lineage clinical isolates. The ongoing evolution of SARS-CoV-2 necessitates continuous monitoring of the significance of changes for maintained protection by currently authorized vaccines,” concluded authors.

Results from a new study confirm that the Pfizer-BioNTech COVID-19 vaccine works against the fast-spreading UK variant of SARS-CoV-2.  

Pfizer-BioNTech COVID-19 Vaccine Found Effective Against UK Variant

, as of today, January 21, 2021 at 9:23 AM, EDT, there have been:

 with 41 587 reported fatalities, followed by 

 with 1 739 136 people who have recovered, followed by 

 with 39 288 363 people tested, followed by 

Data from the Johns Hopkins COVID-19 interactive map on coronavirus cases, mortalities, recoveries, and more.

COVID-19 Update: US and Global Cases, Deaths, and Recoveries as of January 21, 2021

Patient Care recently spoke with Michael Myers, MD, an expert in physician mental health, about the unprecedented psychic and emotional challenges faced by front line clinicians caring for patients infected with the SARS-CoV-2 virus.

In this short video, Myers comments on clinicians who have been so deeply affected by the pandemic conditions -either emotionally or materially - that they are ready to leave practice.

Dr Myers, speaking from his clinician point-of-view, explains how important it is--and will be going forward--to engage in treatment the clinician who is ready to leave a practice or shut the doors, evaluate the individual for a nascent mental health issue such as major depression, treat any mental illness with medication and counseling and, when they are feeling better, revisit the desire to leave their life work behind.

The following transcript has been edited for clarity.

So, sort of on the flip side of that we hear and see a fair amount of talk about physicians saying. “This is it, I'm, I'm leaving medicine. It's been ruined for me.” And some feel abandoned, some feel victimized, as I said earlier, by patients who won't follow precautions; many smaller solo practice or small group practice physicians are actually having to close their doors. I guess this all may add up to my question about PTSD in the wake of the crisis, which is not anywhere near over. But, from what you’ve said, it sounds to me as though there's going to be a group that will that is resilient, that will move on from this and maybe weren't as deeply touched. But for those who were, what do we have to look forward to for them?

 Well, what I would suggest in a situation like that, and I'm, now I've got my clinician cap on, because when I was in private practice, it wasn't unusual for me at all to have a new patient come in and describe exactly sort of what you were saying; it was before the pandemic, but, in a sense, they’re sort of saying, “Should I give it all up? I feel like I need to, I want to,” etc, etc. And it became my job to help them sort that up. Because what I wanted to make sure, of course, was that they weren't perhaps, maybe slipping into what we call a clinical depression, a major depression, or some other type of illness that was contributing to the way they were feeling. So, in other words, when and if that was the case, and we successfully treated it, then their vision and their outlook was quite different. They say, “You know, now that I'm feeling better, I've got my mojo back. Yes, yes, my work is stressful, but I don't think I need, I don't think I need to leave it, or I don't think I need to retire completely. I think I need to make some changes, because so much of this, I think, got me into trouble in the first place. But I'm going to I'm going to, I'm going to have a second look at that,” that sort of thing.

I would suggest that anybody who's considering that would you know, there are physician coaches out there, they also assist with something like that. And because this is often the person's life work, and they want to make sure that if they are going to…others are very clear. They feel they feel done, you know, “I’ve given many years to this, I'm going to retire early and I’m going to become a farmer.”

Videos

Michael Myers, MD, a physician to physicians, urges any clinician who, worn out by COVID-19, has thoughts of leaving medicine to seek counseling first. 

A Doctor's Doctor Counsels on the Decision to Leave Practice 

Patients with cardiovascular disease (CVD) who on hospital discharge believe they have a high risk for readmission are, in fact, at higher risk for 30-day readmission than those who perceive the risk to be low.

 are based on data published earlier this month in Circulation: Cardiovascular Quality and Outcomes, by researchers at Duke University Medical Center in Durham, NC.

Lead author Hanzhang Xu, PhD, RN and colleagues recruited 730 patients who received treatment for CVD from January 2015 to August 2017. Before hospital discharge, patients completed a standardized survey that documented their perceived risk of returning to the hospital along with sociodemographic, psychosocial, behavioral, and clinical data.

Nearly 1 in 3 patients perceived a high risk of readmission and those patients had significantly more 30-day readmissions (22.8%) vs those who thought their risk of readmission was low (15.8%; p=0.016).

Among those who perceived their readmission risk to be high, those more likely to be readmitted: 

 -- Were non-white 

 -- Had been hospitalized in the past year

Among patients who believed readmission risk was low, those still more likely to be admitted included those who were widowed or reported difficulty accessing care.

The authors suggest their findings are strong evidence for the clinical utility of assessing this perception to help identify those at greater risk of being readmitted. 

“Our study also identifies important nonclinical factors that are associated with 30-day readmission in patients with different perceptions of their risk," they wrote. "These findings have important implications for targeting patients with CVD at high risk of 30-day readmission and for developing interventions that are responsive to patient-reported needs and perceptions.”


Thirty-day hospital readmission was found to be higher among cardiovascular patients  who believed readmission was highly likely vs those who did not believe so. 

Thirty-day Readmission Rate Higher for CVD Patients Who Believe it will Happen 

Test your knowledge on guidelines for the nonpharmacologic vs pharmacologic treatment of major depressive disorder (MDD), issued by the American College of Physicians (ACP) in 2016.

Treating Major Depressive Disorder: 7 Questions on Guidelines from the American College of Physicians

Are you caught up on the latest guidance for the nonpharmacologic and pharmacologic treatment of major depressive disorder? Find out with this quick quiz.

Just 5% of primary care clinicians are required by their employer to get the new COVID-19 vaccine, but the majority (89%) responding to a recent survey said they will voluntarily get the vaccine when it becomes available.

, primary care clinicians noted that many patients are hesitant to receive the vaccine and don't trust vaccine information from a variety of sources, including the Centers for Disease Control and Prevention. 

The survey, conducted December 11-15, 2020, by the Primary Care Collaborative, in partnership with the Larry A. Green Center, also found primary care clinicians continuing to manage staff absences and PPE shortages while patient visits become more complex and take more time. 

Top line results follow in our slide show.  

A majority of primary care clinicians report their patients worry about COVID-19 vaccine side effects and the speed of vaccine development. Most do plan to be vaccinated themselves. 