Medical view: A Q and A with Dr. Steven Murphy, Murphy Medical Associates

From the start of the pandemic, Murphy Medical Associates has been active in setting up drive-thru coronavirus testing locations. Murphy Medical holds testing in Darien on Monday afternoons and Friday mornings. Their testing sites launched in mid-March in Greenwich, Stamford and Stratford. They also held testing in Westport and added two days in Darien later that month. They also currrently do testing in Westchester County. The group also does antibody testing.

The Darien Times recently had a Q and A with Dr. Steven Murphy about his medical group’s thoughts and experiences with COVID-19 and what he expects the future to look like. Dr. Murphy completed his internship in medical genetics and pediatrics at Mount Sinai Hospital in New York, New York. He subsequently served as the chief resident in internal medicine at Greenwich Hospital-Yale New Haven Health in Greenwich, Connecticut. Read more below.

At what point did Murphy Medical realize how big this virus was going to be and how did you realize it?

As an organization, I had been giving updates since the initial cases happened in China. We had been reviewing how that health system was handling this outbreak. When we began to see the governmental response we recognized that it was likely going to be a pandemic.

That being said, we didn’t mobilize to prepare for drive-through testing until the first week in March. Once we were notified that there was a private lab offering testing for novel coronavirus we sprung into action. We opened our first drive-through March 10. That previous weekend, we worked 24/seven to create a website and develop our processes.

When did you diagnose your first patient?

Our first patient results came back on the 13th of March. Everyone who was tested was instructed to quarantine until they received results. I truly believe that quarantine letter and our daily telemedical advice saved lives in the county and in the state.

We had received multiple patients from a party in Westport that first few days of testing. In addition we received a significant amount of Westchester, New York patients that had been exposed.

What is different about this virus than illnesses you’ve treated previously?

The significant immune response that was triggered was surprising. This response was much higher than in previous conditions we’ve treated, such as influenza. In addition having upper respiratory symptoms and gastrointestinal symptoms present as primary issues confounded simple clinical diagnoses without having testing. Put simply, what we were told was not so cut and dry. We had to have a higher index of suspicion and consider all unusual symptoms. By testing, treating, isolating and tracing, we were able to get earlier results than most.

Why did Murphy Medical feel strongly about being proactive in the testing sites?

As I said before, we were closely following the story in China and Korea. We were able to watch the benefits of being very aggressive with testing despite recommendations from the centers for disease control. I had reviewed a few stories on drive-through testing centers and it was clear that the risk to healthcare workers was much lower. Our employees are like family to me just like the patients are. I have a strong desire to protect our own. That is reflected in our mission and our coat of arms. Despite significant push-back from our property managers which resulted in legal letters of cease and desist we knew that the right thing to do was to Test, Treat, Isolate and Trace. It was working in Korea, and we were certain we could make an impact here in Fairfield County.

I notice on your answering service you have a personal message for callers that reassures them about their fears and encourages them by saying they are like family —why is that important? Is that something additional you are doing for this virus treatment or is that your general approach to health?

We have always treated our patients like family. Unfortunately, during this time of uncertainty We are seeing increased exacerbations of depression, anxiety and post traumatic stress disorder. I knew that in these times our patients are turning to us for advice and a steady hand. Normally, my voice is not on the phone service at all. I want all of our patients to know that it is my mission to make certain we will all get through this together.

Do you see the testing you have in place remaining?

I believe there is always going to be a place for drive-through testing. We will likely see the service ramp up during times of elevated infection risk. They hopefully will wind down as we get control of the R0 (AKA infectivity rate). We currently are working with a laboratory to validate at home saliva testing. If that ever becomes predominant, we likely will not have to do drive-through testing again. That being said, we are seeing an outpouring of demand for antibody testing. Antibody testing is complicated and nuanced. Unfortunately, we have seen employers request antibody testing for return to work. That is not an appropriate use for antibody testing. We still are not certain that antibody production results in full immunity. There are many different things required for “immunity” antibodies are only a piece of that puzzle.

Do you see pulling back or adding?

I think that demand for drive through testing centers are really like real estate. All markets are local. Currently we are running drive through testing in Westchester County at Bedford Hills train station in New York where the availability of testing had been restricted to the very symptomatic and healthcare workers unlike our drive thrus in Fairfield County. The numbers there are increasing for testing demand. We really were ahead of the curve in Fairfield County.

As I said before, as risk for infection and case numbers go up we will see more demand for testing. But as case numbers in the hospital go down, we are seeing less demand in our county.

Do you foresee a surge?

Given the highly infectious nature of this virus I believe we will see a second peak and we may even see a third. I really have to commend First Selectman Jayme Stevenson and Health Director David Knauf on being ahead of the curve here. Their mitigation planning to protect the town is impressive. I think they will be well prepared for the second and perhaps the third surge.

Where do we go from here?

The world will be forever changed with this global pandemic. We are nowhere near the numbers required for full herd immunity. Most experts place this near 60 percent of population immune —some higher, some a little lower. The difficulty in this, put simply, is that we cannot be certain who is fully immune. The preliminary data coming out is promising. I’m hopeful as our businesses adapt and our society adapts for the next 24 months or so, we may actually see a reduction in other infectious diseases. I believe we will see a greater focus on proper hygiene in places where it matters most: restaurants, close quarters businesses, gyms and salons. This will place an increased demand on local departments of public health and will require a true commitment by business owners to make certain they do not put their customers (our citizens and patients) at risk.

With medical care, it means that we will have to be duly cautious with infectious diseases. This will mean extra caution before colonoscopies, heart procedures or elective surgeries. It will mean additional preoperative testing likely on the day of procedure, and no further apart than 24 hours prior to the procedure.

Lastly, private practice primary care has been decimated over the years, and, unfortunately, this pandemic has not done anything to help the community back bone. It was clear that we needed to step up here. We answered the call. I hope that our country rallies around the private practice physicians in the community. They truly are public health in our towns and cities.

Do you think people will take their physical health less for granted going forward?

The junk food companies reported increased sales throughout the first month of our quarantine. I think everyone was searching for “comfort food” to spike their dopamine levels and ease their nerves. Unfortunately, we saw worse outcomes for patients who were overweight and who had problems with their blood sugar. “Junk food” was the order of the day.

I’m certainly hopeful that will change as we begin to see the health benefits of exercise, vitamin D and good hydration. As a board-certified obesity medicine and weight loss specialist, it is clear to see that diet and weight are playing a role in the inflammatory cascade that lead to worse outcomes with COVID-19.

I am hopeful that people will begin to recognize that being in shape and having a healthy diet is not just essential to fighting off this coronavirus, but is also essential to a life well lived.

Do you have any advice for how people should do that?

It’s so nice to finally be able to give advice about some thing that I used to give advice on every day. Thirty minutes of exercise a day is exceedingly helpful. You don’t need to get your heart rate up over 110, you just need to move more and consider lifting weights.

But more important than that is fueling your body with the right foods. I founded an organic food and juice business in 2013 dedicated to providing that right fuel. Not all foods are good for all people but we do know as a general principle carbohydrates mixed with fats are essentially ice cream. It is not a good combination on its own. If we can avoid this combination, and instead focus on healthy fats, good proteins and good fiber we can avoid many of the untoward effects of the “western diet.”

Stress relief with prayer or meditation helps lower blood pressure and reduce anxiety. Lastly, In this time of social distancing, it is always important to turn to family and loved ones as time permits.

We are all in this together and social support is essential to good health.

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