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The emergency room physician says it's too soon to prescribe hydroxycloroquine, or to relax social distancing.

PMG FILE PHOTO - Drive-in testing for the coronavirus was available at the Gordon Farber Rec Center in Hillsboro on March 24.The worst may be yet to come with a surge of COVID-19 cases in Oregon, but the fact that it will come later than expected is a good sign, according to Dr. Christopher Strear.

Strear, president-elect of the local chapter of the American College of Emergency Physicians, said a late peak in confirmed cases would mean social distancing is working.

"The latest projections now target April 21 as our state's surge. That's only a projection and that's only if the social distancing that has been so effective to this point stays that way," Strear told a virtual town hall convened by State Rep. Andrea Salinas, whose district includes Lake Oswego and portions of Southwest Portland. "We have to hunker down and be patient. We have no doubt it's coming. It's just a question of how bad (it will be) when it does come and if we will really see it April 21 or if that's going to keep changing."

State Rep. Andrea Salinas of House District 38 convened a virtual town hall on April 2 featuring Dr. Christopher Strear."Oregonians have done an amazing job," he said. "By all accounts we are better positioned and doing a better job than almost any other state right now. For those of us who are watching the projections throughout the day, almost obsessively, when this all started we were expecting a surge somewhere between the first and second week of April. Now we're expecting a surge toward the end of the month and that surge is expected to be much smaller than the one we originally imagined,"

In other parts of the country, he said, that surge will cause a peak of COVID-19 cases much sooner.

"In the country we're expecting the peak to occur in another week and a half and we're projecting the shortfall at 36,000 hospital beds and 16,000 (intensive care unit) beds," Strear said. "Right now, knock on wood, across the whole state of Oregon we should be doing OK with hospital beds and ICU beds."

Now is not the time, he said, to backslide and abandon practices that are working.

"We've been able to flatten the curve with social distancing. But the only way it will stay that way is if we keep up the vigilance. It's going to be a long haul. It's not going to be a question of a couple of weeks, it's going to be a question of a couple of months. If we keep at it, we're going to be saving lives and making the surges much more manageable."

Strear, a Portland emergency physician and an executive with Northwest Acute Care Specialists — which staffs a number of local hospital emergency rooms — spoke as the controversy over President Trump's endorsement of the anti-malarial drug hydroxychloroquine was developing. While some of his political advisers were urging its use, medical advisers cautioned that it hasn't been tested adequately.

Strear said he agrees with the doctors and worries that demand for the drug would make it hard to get for people who really need it: those suffering from chronic diseases such as rheumatoid arthritis and lupus. According to the Oregon Board of Pharmacy, pharmacists in the state have been temporarily prohibited from dispensing chloroquine and hydroxychloroquine for presumptive treatment or prevention of COVID-19 infection in an attempt to preserve supplies for treatment of chronic inflammatory conditions and for documented COVID-19 infections in hospitalized or residential patients.

For those who think they have coronavirus symptoms, Strear had this advice: Call your primary care provider.

"If you get COVID, you're going to feel poorly but that doesn't in and of itself mean you need to come to the emergency room. Using your primary care provider as a gatekeeper to determine if you should come to the ER is a good idea. However, if you feel like you can't wait to speak with your PCP and you think you need the ER, then you should come in. Especially if you're short of breath," he wrote in an email.

"When people are getting sick it's from respiratory complications," he said. "Fever. Coughing. Shortness of breath. That triad is a good sign that maybe it's time to come in. But for the most part, people don't need to come in. Your PCP is a great gatekeeper for telling you whether you need to come to the ER.

"If you feel like you have the symptoms, then I would assume you do," he said. "Don't wait for a positive test to tell you. Especially since the tests are not 100% accurate. They're closer to 75% accurate. So with symptoms, even when the test comes back negative, we're assuming that they're really positive.

"Reports say as many as 25% of the people who are carrying it don't have any symptoms," Strear said. "So now the only way to effectively combat it is to keep people from getting it and the best way to do that is with social distancing."

Speaking before the U.S. Centers for Disease Control and Prevention began urging all Americans to wear something to cover their mouths, Strear said scarves and bandanas will do. "That helps prevent you from giving it to other people and it's a good reminder not to touch your face."

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