March 23rd Update from Dr. von Elten

Covid-19 is a disease caused by the SARS CoV2 virus. Below is a brief summary of what we know. I have reviewed many different sources of information. This is the best summary we can provide this point of time. Much of this will be what you already know but I have tried to be compulsive and record all that I’ve read.

What We Know


This virus is more infectious than influenza. That means it spreads more easily than the flu. For each patient infected with the influenza virus they will infect approximately 1.5 patients. The Coronavirus patient will infect approximately 2-2.5 patients.

The virus is spread mostly by droplets- that is particles greater than 5 microns. These have a tendency to settle out of the air being pulled down by gravity. Hence social distancing requires keeping a distance of 6 feet from others.

However, there is some concern about aerosolized particles being able to spread the virus and under ideal conditions may last up to 3 days. These particles can be generated by the use of nebulizers. So if you think you are possibly infected, avoid using your nebulizer. If you need to use your nebulizer for asthma, COPD, etc.- don’t worry. If you live with others, use your nebulizer in your bedroom, not out in the family room. Keep your door to your room shut and others out of your room.

Experts suggest the level of infectiousness is greater after the onset of symptoms. Therefore, if you are feeling ill- self-quarantine until you can be evaluated. We are worried about the possibility of transmission occurring before the onset of symptoms. Therefore, avoiding going out in public or to ANY social gathering at this point in time unless it is absolutely necessary.

Incubation Period

The incubation period is the time from exposure until an individual develops symptoms. The peak of developing symptoms is about 5 days from being exposed. If you know you have been exposed, self-quarantine for 14 days. If you develop respiratory symptoms, self-quarantine for 14 days or until you are without fever for 72 hours and your respiratory symptoms are resolving. If you are known to have Covid-19, self-isolate for 14 days. The Virginia Department of Health will become involved in your monitoring if you are positive. You will need two negative tests before you can return to normal activity.

Originally it was hoped the infectiousness would diminish as the temperature became warmer with summer approaching. We do not know if this is true at this point.


Symptoms can vary widely from none to severe respiratory distress. 80% of patients will develop mild disease, but 10-20% can have more severe disease requiring hospitalizations, ICU admission or ventilatory support. The younger you are, the less likely you are to have symptoms or severe disease. Some patients will have no symptoms but can carry the disease and still be contagious. Some patients will think they have just a common cold yet will be contagious. Some patients will develop a fever, perhaps a cough or shortness of breath. The symptoms may develop into viral pneumonia. Or the symptoms may develop to a severe complication of respiratory failure and Adult Respiratory Distress Syndrome. Children for the most part have mild disease. Pneumonia in children is typically mild.

As providers we want to evaluate patients who are ill, especially those with fever, cough and shortness of breath. If the oxygen saturation rate is less than 94% patients should be evaluated.

Risk of severity

Who is at the greatest risk? Risk increases with age, gender and underlining health issues. Those patients over 60 years old enter the greater risk category, especially those over 80 years.  But recently there was a report of a significant percentage of patients between 20 and 64 years who developed serious illness. The risk in this group seemed to be those older- more middle aged than in the younger end of the range. 

Co-morbidities: what is meant by that term? Co-morbidities can also mean underlying medical conditions or ailments such as respiratory disease: COPD (emphysema), asthma, bronchiectasis, cystic fibrosis, etc. Cardiovascular disease is also a co-morbidity as have well as hypertension. Diabetes seems to be a frequent disease process that makes patients susceptible. Immunosuppressive therapy certainly places patients at risk. Or any disease process that might weaken the immune system, along with increasing age.


As of the moment we have no known effective proven therapy for this illness, Prevention is the best therapy. What therapies are being explored? Anti-viral drugs, especially anti-HIV drugs are being tested. Biotech companies are trying to develop monoclonal antibody therapy. These companies are attempting to get the blood from recovered patients, isolate the antibody, and then manufacture the antibody. This form of therapy would be most useful to decrease the severity of the disease.

Originally it was stated Acetaminophen (Tylenol) as safer to use than non-steroidal anti-inflammatories Ibuprofen (Advil) or Naproxen (Aleve). This is no longer felt to be true. Non-steroidal anti-inflammatories can be used as safely as acetaminophen according to recent reports.


Unfortunately, there are no vaccines at this time. Pharmaceutical companies and Biotech firms are madly trying to develop a vaccine, but that appears to be 1-2 years out by the time one is developed, tested for efficacy and safety.


The tests to diagnose the presence of the Coronavirus are in very short supply. At this time what available tests we have in the U.S.A. are for the most part being diverted to the hot spots. Commercial labs are increasing the availability of the tests in our area. We are hoping to see a ramping up of supplies here shortly, within a week or two.

 Presently we are following the Center of Disease Control Guidelines as instructed by the Virginia Department of Health: testing is being reserved for those who are symptomatic (fever, cough and shortness of breath) as well as having a history of exposure (close contact). Close contact is defined as being within 6 feet for a significant period of time. Testing of symptomatic patients at this time is problematic. A patient could be early in the course of the disease and the test could be negative giving that individual a false sense of security. The individual could then be very contagious shortly thereafter, perhaps in a day or two.

We are hoping to have an increase of testing supplies here shortly. This will allow us to expand testing to symptomatic patients that do not meet the stringent criteria of the CDC. That could possibly occur as early as this week.

Prevention and Mitigation Strategies

Prevention is key to staying well. We recommend stay at home as much as possible, avoid going out unless for necessities. When out, practice “social distancing” (staying more than 6 feet away from someone) but it is better to avoid going out at all. Avoid social gatherings. Limit visiting the elderly including your parents if they live alone. If you do need to see them to drop off supplies, etc. leave the children home. Wash your hands or use hand sanitizer before seeing them. Stay at least 6 feet away. Limit your visit to do what is absolutely necessary. No hugging, etc.

Don’t take your kids to the stores to get groceries. Don’t let your kids go out and socialize. This will be a difficult time for everyone, but the more we can stay in and stay healthy, the better off everyone will be. We not only want to stay healthy ourselves, but we will want to avoid spreading this to others.

Stay healthy: Eat well- nutritious foods especially fruits and vegetable. Get a good night’s sleep. Exercise. And DON’T SMOKE or allow anyone around you to smoke.

Wash your hands or use hand sanitizer when available. Soap works well as the outer coating of the virus is made of lipid (a fat). Twenty seconds of vigorous hand washing can kill the virus (but not scrubbing as that may damage the barrier protection of the skin).

Hand sanitizer may be made from ¾ parts of 90% isopropyl alcohol and ¼ part aloe vera gel.

Avoid touching you face, especially your eyes and your nose where the virus can find an entry into your body.

Bleach (10% Clorox solution) applied for 1 minute on surfaces or hydrogen peroxide for 30 seconds can kill the virus.

The virus can live on different surfaces for various amounts of time. It can survive on copper about 3 hours, other metal (stainless steel) and plastic surfaces perhaps up to 3 days. We think it can survive on cardboard up to 24 hours. The duration of the survivability of the virus greatly depends on the temperature and the humidity. However, we do not know how contagious viral particles on objects will prove to be. Certainly, exposure to droplets in the air from coughing of infected individuals will pose the greatest risk.

Use common sense, be extra cautious, follow these guidelines and stay healthy.

Steven von Elten, M.D.

Coronavirus Updates and Suggestions

Fortunately, our Regional Health Departments (Fauquier, Culpeper, Rappahannock, Orange and Madison County’s ) have no reported cases of proven COVID-19 disease, as of this morning.  However, the limitation is that healthcare providers are only able to screen high risk patients as defined by the Center for Disease Control. Most tests available at the national level are being diverted to the so-called “hot spots”, such as New York, Washington, California, etc.  We are anxiously awaiting increased availability of tests to be able to screen our patient population. We are working diligently to increase the supply of COVID-19 tests, but regionally these remain quite limited. Therefore, we continue to follow the CDC guidelines.

What should we be doing?

We should be taking this very seriously.  However, there is no need to panic. We should stay calm and carry on.  As the media has been educating the public, certainly the elderly (over age 60), men more than women, and patients with coexisting diseases such as cardiovascular disease, emphysema or asthma, hypertension, and altered immune systems) are at a higher risk. Fortunately, children don’t seem to be as affected as much.  The danger here is that the younger portion of our population can become infected but be asymptomatic, and spread it throughout the rest of the population. Therefore, we should be very serious about avoiding group gatherings. I know the authorities have said that we should not gather in groups of more than 10. Personally I feel that even that number is excessive. 

Seek out reputable information such as and  Don’t let social media disseminate rumors and false information.

 We should limit social contact as much as possible.  Being mindful of the suggestion to maintain 6 foot “social distancing.”  Stay home and stay put! Limit going out. Avoid social engagements. Keep your kids and young adults home.  This is no time for them to go out and get together socially or go partying. Don’t bring your kids to visit your elderly parents.  If you need to go to the store, try to leave your kids at home and have somebody watch them.

Wash your hands with soap and water for at least 20 seconds.  Do this frequently, and whenever you think you may have come in contact with something that could be carrying the virus.  Clean your hands before going into a store, and upon leaving a store when picking up necessities.

Cover your mouth completely when coughing.   Then immediately wash your hands. Avoid touching your face.  This is when you are most likely to inoculate yourself with the virus, should your hands be contaminated. 

Don’t get overly stressed.  Stress can alter your immune system function.  Go outside to exercise daily, meditate, read or pray.  Eat well. Get a good night’s sleep. Avoid staying glued to the TV and media hype.  Certainly, do not smoke as this will put your respiratory system at risk of being infected.

Buy the necessary supplies you and your family need.  Don’t hoard; so that everyone has access to the supplies they will need.

Work remotely if possible.

Take this seriously, but don’t get overly stressed.  It will come to pass sooner than later. Exactly when, we do not know unfortunately.  But all these pandemics and epidemics do come to an end. Fortunately, we are in a much better place to handle this situation,  than when the Spanish influenza epidemic of 1918 occurred over a 100 years ago. 

Piedmont Family Practice is open 7 AM-4 PM Monday-Friday.  Piedmont Urgent Care is open every day from 8 AM-8 PM with walk-in availability.  Please refer to our websites and Facebook pages for the procedures we have in place should you suspect you have the coronavirus.  Each location has a number to call should you need assistance.

We have taken deliberate precautions to limit exposure to our regular patient’s during their routine visits.  We are still open for business. Remember, as of this time we have no documented cases in our community.

Stay calm, stay healthy and stay vigilant.  Soon this will be merely a memory.

Piedmont Family Practice and Piedmont Urgent Care at WARF Open House

Piedmont Family Practice and Piedmont Urgent Care spend the day at the WARF Open House, March 30.

Saturday, March 30th, Piedmont Family Practice and Piedmont Urgent Care set up a table at the 6th Annual WARF Open House. The Open House was an opportunity for the community to learn all about what the Town of Warrenton Parks and Recreation Department has to offer as well as event sponsors having exhibits at the open house.

PFP and PUC’s exhibit area included blood pressure checks, samples of Ideal Protein’s food (Ideal Protein is monitored weight loss protocol) and free goody bags for all that stopped by.

It was a wonderful day! Kaylea and Jessica, MA’s from Piedmont Family Practice, said that they were happy to have had the opportunity to speak with so many wonderful people in our community.

Celebrating 1 Year Serving Fauquier County

Warrenton, Virginia – Piedmont Urgent Care, a subsidiary of Piedmont Family Practice will be celebrating one year of serving Fauquier County on March 15, 2019 at their facility located at 493 Blackwell Road, Suite 101B, Warrenton, VA.

The partners, providers, and staff are proud of the last year in which they have:

  • Seen and treated over 12,600 patients.
  • Piedmont Urgent Care offers treatment to patients from all over the community regardless of home or primary care practice.
  • Remains open to the community for nearly 365 days/year.
  • Piedmont Urgent Care provides a cheaper alternative to the Emergency Room and more professional experience from Urgent Care chains.
  • Piedmont Urgent Care works closely with other local health care providers through our years of experience in the community.

A recent patient review on Facebook provides a wonderful summation on how Piedmont Urgent Care is helping our community.  This was my first time at any urgent care, and this place was awesome. Very friendly caring staff, and the doctor did a great job stitching up my foot.”  Providing easy, affordable access is one of many reasons Piedmont Urgent Care opened their doors one year ago.

Piedmont Urgent Care extends an invitation to members of our community in celebrating our one year anniversary on Friday, March 15th.  Please stop into our office at 493 Blackwell Road, Suite 101B (Bottom level, by the Wound Care Facility) to visit our facility, and receive a free gift and cupcake.

Weather Closing – 2/20/19

We’re sorry to say, but Mother Nature and poor driving conditions have made it so that we will close today. We want our providers, staff and patients to stay safe and warm. We will look forward to assisting you with your healthcare tomorrow, Thursday, February 21st.

Winter Weather – The Dangers of Playing in Winter Wonderland

Winter Weather – The Dangers of Playing in Winter Wonderland

We’ve been hearing for days now that our weather is going to turn bitterly cold.  While this deep freeze won’t last long this time, we want you to be aware of dangers that extreme cold temperatures can bring as winter is just getting started.

Exposure to cold can cause frostbite or hypothermia and become life-threatening. How quickly it can happen depends on how cold it actually is, one’s existing health and the length of time exposed to drastically low temperatures.   Infants and elderly people are most susceptible.                                                                                                                                  

Frostbite is damage to body tissue caused by extreme cold. A wind chill of -20° Fahrenheit (F) will cause frostbite in just 30 minutes. Frostbite causes a loss of feeling and a white or pale appearance in extremities, such as fingers, toes, ear lobes or the tip of the nose. If symptoms are detected, get medical help immediately! If you must wait for help, slowly rewarm affected areas. However, if the person is also showing signs of hypothermia, warm the body core before the extremities.

Hypothermia is a condition brought on when the body temperature drops to less than 95°F. It can kill. For those who survive, there are likely to be lasting kidney, liver and pancreas problems. Warning signs include uncontrollable shivering, memory loss, disorientation, incoherence, slurred speech, drowsiness and apparent exhaustion. Take the person’s temperature. If below 95°F, seek medical care immediately!

If medical care is not available, warm the person slowly, starting with the body core. Warming the arms and legs first drives cold blood toward the heart and can lead to heart failure. If necessary, use your body heat to help. Get the person into dry clothing and wrap in a warm blanket covering the head and neck. Warm broth is the first food to offer.  Piedmont Urgent Care is open every day from 8AM – 8PM to assist with non-emergency care.  If you feel a person is suffering from frost bite or hypothermia, we recommend going to the emergency room.

For all non-emergency medical needs, we look forward to assisting you and your family.  Walk-in Availability 8AM – 8PM Everyday with your Trusted Community Providers for the Expected, Unexpected and Everything in Between.  540-347-5200

Happy Holidays!

Wishing you and your family a Wonderful Holiday season filled with much love and laughter.  We also want to take a moment to thank all of our armed service men and women, police and firefighters that will not be able to celebrate with their families due to their commitment to protect and serve us.  We thank you for your service and dedication.

If you or your little elves are not feeling well enough to celebrate the holidays, Piedmont Urgent Care is open every day from 8AM – 8PM every day with walk-in availability.  Christmas Eve, December 24th will follow 8AM – 8PM schedule.  Christmas Day, December 25th, PUC will be open from 10AM – 4PM.

5 Tips for Combating Fatigue during Holidays

The holidays are upon us.  The holidays bring us plenty of hustle and bustle, gatherings with family and friends, office parties and plenty of opportunities for us to get worn down and possibly sick.  We have provided 5 tips that can help combat fatigue during a very busy time of year.

Should you get worn down and sickness settles in, Piedmont Urgent Care is open every day from 8AM – 8PM every day with walk-in availability.  Christmas Eve, December 24th will follow 8AM – 8PM schedule.  Christmas Day, December 25th, PUC will be open from 10AM – 4PM.

  1. EXERCISE: The last thing you may feel like doing when you’re tired is exercising. But many studies show that physical activity boosts energy levels.
  2. YOGA: Although almost any exercise is good, yoga may be especially effective for boosting energy. After six weeks of once-a-week yoga classes, volunteers in a British study reported improvements in clear-mindedness, energy, and confidence.
  3. EAT MORE FISH: Good for your heart, omega-3 oils may also boost alertness.
  4. EAT FREQUENT SMALL MEALS: Some people may benefit by eating smaller meals more frequently during the day. This may help to steady your blood sugar level.
  5. DRINK PLENTY OF WATER:  Dehydration zaps energy and impairs physical performance.

From Everyone at Piedmont Family Practice and Piedmont Urgent Care, we wish you and your family a most blessed holiday season!

Happy Thanksgiving

We have so much to be thankful for this year, most of all YOU!  We don’t wish anyone injuries or sickness.  But, when things happen and you’re in need of Urgent Care, we are very honored that you come to Piedmont Urgent Care and trust us with your health care.  This Thanksgiving, we want to share our genuine appreciation for our patients. We’re so thankful for all of your support throughout the year. We hope you have a joyous holiday and when needed, we look forward to serving you again.  Piedmont Urgent Care is open 7 days a week from 8AM-8PM with walk-in availability.