How Do We Prepare for the Next Big Pandemic?

Michael Osterholm, PhD, MPH is an infectious disease public health expert from the University of Minnesota. In his new book, “The Big One” he discusses the fact that the next big pandemic is a certainty. He then questions whether we are prepared for it.

Dr. Osterholm makes it very clear that many of his suggestions and recommendations during the Sars II COVID Pandemic did not work out well while others saved lives. He reviews what worked and why and also discusses what could and should have been done differently.

Using fictitious characters located all over the world he illustrates how the next pathogen will spread and kill with the current level of preparation. The detailed information about the roles international physicians, researchers and public health officials play as well as the process makes it tedious at times.

The overwhelming theme is how under prepared we were for COVID and still are for the next big one. He suggests that Congress convene a bipartisan commission to review what happened, what worked and what failed. He cites the 9/11 Commission as an example of reviewing what needs to be done to prevent a major terror attack on US soil. First, you have to examine how this occurred and why it was able to be accomplished.

I say this because having just reviewed the Senate hearings with Dr. A. Fauci, paid for with our tax money, nothing was done to prevent the next pandemic. No questions were asked about what worked and what did not and why.

I think a bipartisan scientific review will determine where the virus came from and how it spread. If the investigation reveals criminal behavior by individuals or groups, then refer it to the Department of Justice. If no criminal behavior is unearthed let’s at least determine how best to prepare for and prevent the next “big one”.

HIPAA DIPPA – CHOOSING YOUR BATTLES

I received a phone call from my patient of over 40 years who happens to be a dentist. His longtime office manager, an acquaintance of mine for the same period had become acutely ill and was now in the critical care unit of a local hospital. She had developed fevers, chills, shakes and gone into infection related shock. She was transported to the hospital by EMS and discovered to have a kidney stone blocking the flow of urine out of one kidney. An emergency procedure was performed to drain that kidney until the patient was healthy enough to remove the stone. Her kidneys had shut down in shock, and she was receiving dialysis with the hopes her kidney function would return.

She was being treated in a critical care unit under the care of an intensive care physician, an infectious disease physician, a kidney specialist and a urologist. The patient’s adult daughter is her legal health care surrogate and she got on the phone line and requested that I review her mother’s chart and explain what happened and comment on anything else that can be done. The daughter said her mom was in bad shape and might not survive.

I explained to the daughter that although I was a member of the hospital staff in good standing, and had access to everyone’s medical record, it was illegal, unethical and unprofessional to view the chart of a patient you were not caring for. I did suggest that if she or her mom gave me written permission to view the chart as a consultant, I would take a look.

The daughter understood and agreed to do that. Usually when a consultation is requested you receive a call notifying you of the request. I received nothing. Several hours later my cell phone rang again, and it was the patient. She sounded tired but competent and asked if I had looked at her chart yet. It was now close to 10:00 p.m. on a Friday evening and I explained that I needed written permission to proceed. She said she and her daughter had signed a written request hours ago and given it to the nurse and unit clerk. I promised to contact administration immediately and texted the Chief Medical Officer (CMO) of the hospital. I additionally listened to her version of what occurred and what was done to treat her. I felt the care and treatment was outstanding and made sure she understood that.

When you access a patient chart and are not one of the physicians of record security intervenes and asks who you are and why you are accessing the chart. If you proceed without permission, you are violating a federal privacy law, HIPAA and hospital medical staff rules leaving yourself vulnerable to fines, suspension of privileges even loss of license.

For this reason, I texted the CMO explaining the situation, informing him I was formerly requested in writing and asking for administration’s permission to view the chart. In the recent past, if you identified yourself as the patient’s outpatient doctor you gained access. That option has disappeared in recent weeks.

The CMO got back to me quickly denying my access to the patient chart. He said it would be a HIPAA violation and concluded, “Please dont access the patient chart.” I let him know I thought he was incorrect but did nothing. He suggested I talk to her physicians but avoid the chart.

The next morning, I made a few phone calls to health care attorneys I know well. When you practice in the same area for 50 years you develop relationships. They all felt with certainty that I could legally access that chart. Each agreed to represent the patient and me if we chose to challenge the CMO’s order.

I declined their offer considering the options when the patient called me again. She was completing dialysis and her fever was normal for several hours. She said nursing and intensive care were wonderful. She asked if I had reviewed the chart and I explained why I had not. She was furious at the situation and said she was calling her attorney. I asked her not to do that.

“You are improving and the care, attention and concern from the staff are excellent. Let’s get you healthy and home. If we pursue the legal action word will filter down to your care group and I don’t want them to be spooked. When you recover, we can evaluate the pros and cons of fighting this skirmish on our terms. Let’s get you healthy first.”  She accepted that and agreed to call daily with updates and more often if she needed to. Getting her healthy is the priority. This affront by administration will not be tolerated by me but I will just wait to engage until I have the advantage, and the battle won’t put a sick patient at risk

Night-time Beverage Considerations

I had a wonderful meal with several of my physician colleagues and spouses and when it came to time for coffee and dessert everyone wanted coffee in some form, but they all wanted decaffeinated products. The lattes and cappuccinos and good old fashioned American coffee all were ordered without caffeine. Everyone was concerned that if they had the caffeine they would not sleep that night.

By chance, while reading the newspaper the next morning an article in the food section reviewed by the food editors talked about a new breed of delicious night-time drinks that not only would not keep you awake but might encourage sleep. Most of the sleep drinks are functional cocoa, herbal teas, and calming seltzers. They rely on magnesium and zinc glycinate minerals associated with relaxation and sleep regulation. L-theanine, found in tea, is an amino acid. Chamomile contains apigenin which is a plant compound associated with calming the nervous system. Valerian root is an herbal remedy for insomnia. Warm milk contains amino acid tryptophan which is converted to serotonin and melatonin. None of these products are pharmaceutical sedatives.

The article recommended Moonbrew Hot Cocoa made with a L-theanine, magnesium glycinate and chamomile plus zinc glycinate. They described the brew as “delectable”. They also mentioned Beam Dream Powder, Mindful Evening Cocoa, and Clevr Sleeptime Latte.

Cecelia Snyder, MS, RD writing in Healthline suggests Valerian Tea. It comes from the honeysuckle family of flowers and is known to promote sleep and relieve insomnia. “To make Valerian root tea, steep 2-3 grams of dried valerian root in one cup (237 ml) of hot water. Let it sit for 10 -15 minutes before straining and serving.

Lindsay Fencl, RD, CD, feels that chamomile tea is a far gentler option with its active compound apigenin. It binds to brain receptors aiding reduction in anxiety and promoting sleep.

Warm milk is a tried-and-true favorite. It contains tryptophan, the amino acid involved in the production of serotonin and melatonin. If a hot bedtime drink is not for you try chilled functional seltzers. Tru Dream combines tart cherry juice with chamomile and produces a pleasant sedation effect in about 15 minutes.

Shop for Prescription Medications Prior to Refilling Them

Like most senior citizens, my health insurance includes expenses for traditional Medicare, a supplement to Medicare and a prescription Drug Plan. I am paying almost $900 a month for my insurance and a similar amount for my wife’s insurance. That is a great deal of money for seniors but fortunately for me I am still working and generating an income.

This week my wife saw her physician for a chronic sinus problem. She was prescribed a Medrol dose pack (corticosteroids) and a generic antihistamine nasal spray. The scripts were sent electronically to her chain pharmacy locally. The next day she returned home showing me a bill of $151 for the three months of the nasal spray or about $50 per month. I looked it up on GoodRx.com and the 30 ml supply was listed at $20 per month. I looked it up on Drugs.com and it was listed at $17.37 per month. I looked it up on Mark Cuban’s Cost-Plus Pharmacy and it cost $8.61 a month plus shipping. At Amazon Pharmacy it was $10 for a month’s supply.

I took the three inhalers plus the receipt back to the chain pharmacy and requested a pharmacy supervisor. I explained what they had charged and what my research had uncovered. “Well, she did not ask for the GoodRx price” they said. “I am asking for the GoodRx price,” I said. They refunded the $151 to my credit card and charged me $30 for the three months’ supply. I thanked them for being “honorable,” but they are not. My wife should have been given the best prize the first time. With the money we saved I took my wife and grandkids out for a meal! Trust me, we will research pharmaceutical costs prior to refilling prescriptions so this does not happen again.

Don’t Let the Heat Beat You Up!

As the temperatures rise and humidity climbs the likelihood of heat related illness and death increase. Our bodies generate heat as our muscles perform their work. When the temperature rises and the humidity increases, we sweat more. As that sweat evaporates, we cool down. When the air is full of moisture and the sweat cannot evaporate our cooling mechanism is far less efficient. Many of the medications we take daily for chronic conditions impair our ability to dissipate heat so the chance of a heat related illness in the elderly and chronically ill is much higher. For these reasons we make common sense recommendations to avoid heat illnesses.

1. If you must be outside, try to do your work before 10:00 a.m. or after 4:00 p.m.
2. Work in the shade if you can.
3. Wear a wide brimmed hat.
4. Your clothing should be loose, baggy and light colored.
5. Hydrate well before going outside and please drink a glass of cool water or nonalcoholic beverage every half an hour.
6. Apply sunscreen to protect yourself from sunburn.

If you or a loved one feel lightheaded, dizzy, weak and/or nauseated while working outside, it’s important to stop and be taken to a cooler area immediately. If air conditioning is unavailable get into the shade and under a fan. A cool shower or bath, a dip in a cool pool or lake or an ice bath is a fast way to lower body temperature. If those are not available, then placing ice under the arms, in the groin and on the body should be tried. Importantly, stay well hydrated by drinking plenty of cool water or Gatorade.

If nausea is an issue, chop up ice cubes into ice chips and let the patient suck on a teaspoonful of ice chips which will melt in the mouth and enter the stomach in a small quantity limiting the chance of it being regurgitated or thrown up. When in doubt about the patient having adequate blood pressure or being confused call 911 immediately while you try and lower the core body temperature.

Heat kills. With daily heat advisories and the heat index greater than 100 degrees most days, we must take precautions. The same applies to our pets, especially dogs. Before you walk your dog or cat reach down and touch the sidewalk. If it’s too hot for your hands it’s too hot for their paws. Stay in the shade or on the grass.

Outdoor activities are enjoyable and healthy. Just take the proper precautions to protect yourself from the heat, the sun and pests which potentially carry disease.

Cyclospora Parasite Causes Diarrhea Outbreak in the USA

A patient approached me yesterday asking if they should stop eating salads, fresh fruit and vegetables because of the current outbreak of a parasite driven diarrhea illness in the United States. She had seen information about it in a local newspaper and on the local news.

I had read about the outbreak of diarrhea illness in southeastern Michigan and along the Michigan/Ohio border. Public Health officials were reporting on it due to a parasite named “Cyclospora”. Normally this parasite is screened for at the farm and packing plants under a mandatory Federal public health law through the Food and Drug Administration that also requires screening for salmonella and shigella. The current administration in Washington, DC, eliminated the requirement for screening for Cyclospora.

Cyclospora infections occur primarily in Latin America, South America and occasionally the Southwestern United States – typically in the warmest months of the spring and summer. The very fastidious parasite clings fast to fruits, vegetables, and berries. Human beings seem to be their only host causing cramps, nausea, and diarrhea of an explosive nature within a week of ingestion. Infection does not usually lead to fatalities unless we are dealing with the very old, very young, very ill and immunosuppressed. There have been about 1,500 infections in the Michigan/Ohio area this month we are aware of so far. The State of Florida has had 41 reported cases with one locally in Palm Beach County. Public Health officials believe it is being transmitted through pre-washed prepackaged salads, fresh fruit, and berries such as raspberries. Due to cutbacks in funding and personnel they have not been able to pinpoint the source.

I advised the patient to purchase full heads-of-lettuce and wash them well in cold water and dry them prior to using it in salads or on sandwiches. I suggest taking a break from eating pre-washed precut salad and from eating berries until Public Health can identify a source. Eating cooked vegetables for the time being will eliminate the risk.

If in fact you develop an explosive diarrhea illness, we can do laboratory testing on a fecal specimen to identify Cyclospora and then treat it with seven to ten days of an oral antibiotic. I am hopeful that the Food and Drug Administration will resume the requirement to screen food for Cyclospora as it previously has.

This reminds me of the recent order by Secretary of War Peter Hegseth eliminating the requirement for military recruits to receive vaccinations against the flu. An outbreak of influenza sickening over four hundred troops with influenza last month accompanied by one death and the realization that they were not combat ready led to reintroduction of the requirement to be vaccinated against influenza.  I wonder why proven science and history are ignored by authorities exposing us to preventable illnesses.

BRIDGE Coverage Program for Ozempic, Mounjaro and Foundayo

The Center for Medicare Services (CMS) under the initiative of the Trump Administration is beginning an 18-month demonstration project that began on July 1^st and is running through calendar year 2027 to supply these diabetic and weight loss medications for $50 per month.

The program requires your physician to gain preauthorization by submitting a prescription under certain conditions:

1. If your body mass index (BMI) is 35 or greater you qualify. If you began taking one of these weight loss medicines when your body mass index was 35 or greater and have lost weight you still qualify.
2. If your BMI is 30 or greater and you have been diagnosed with heart failure, uncontrolled high blood pressure, or kidney failure.
3. If your BMI is 27 or greater making you “overweight” but you have been diagnosed as prediabetic, have a history of a previous heart attack or stroke or have symptomatic peripheral artery disease.

These are the criteria and only criteria. To obtain the medication at this price your physician will need to apply with the pre-approval process expected to take 24-72 hours. The program is called the BRIDGE Program.

Please contact the office if you believe you qualify and wish to apply for preauthorization.

Canes and Walkers: Professional Help is Highly Recommended

I receive phone calls from patients every week asking me to write them a prescription for a cane or walker to assist them with gait and balance while walking. I always suggest that a cane or walker be fitted by a trained physical therapist or physiatrist. That fitting should include instruction on how to correctly use the product safely. My suggestions are frequently poorly received with the patients not realizing the number of falls, muscular strains and injuries we see from incorrect use of a product or using the wrong product.

The sale of canes and walkers is minimally regulated. Most sales are online. Few, if any, suggest consulting a professional to assist in selecting the correct product and its use. Setting the correct height of the hand grips on a walker prevents back and shoulder injuries. Selecting the correct cane size and instructing which hand to use it in based on your condition prevents falls. Studies show that if you purchase the incorrect product, you don’t use it. In one study, 75% of fall victims admitted they had a mobility assistance device (cane or walker) and were not using it when they fell because it was inconvenient.

Most medical supply stores have trained personnel to assist you, fit you correctly and instruct you. Physical therapists and physiatrists (medical doctors trained in physical medicine) can do this as well.

Be smart. Get the needed cane or walker and the help of a professional to help with the selection and training. You will be glad you did.

Infusion Therapy for Alzheimer’s Disease

I have been receiving phone calls from the adult children of elderly patients concerned about their parents’ failing memory and slowing down. They express concern about Alzheimer’s Dementia. In several instances they have taken their parent directly to “for profit” neurology programs that conducted the research on the use of monoclonal antibody infusions and are now administering these two medicines regularly to individuals with minimal cognitive dysfunction, blood markers for amyloid and tau protein and PET scan imaging which show findings associated with Alzheimer’s Dementia. The results of these infusions are not encouraging, suggesting that over many years they “may” slow down the rate of cognitive decline. They clearly do not improve or restore lost function.

These new medications require frequent injection administration and close monitoring for micro brain bleeding known as ARIA (amyloid related bleeding abnormalities). The monitoring is done by frequent imaging studies.

The protocols for administration and imaging monitoring are different for Kisunla and Leqembi, the two products currently approved by the FDA. To date the brain bleeds and brain swelling seen from administration have not been serious but long-term effects are unknown. A 12-month treatment can cost $26,500 – $32,500 for the medication alone.

A Cochran Library review of the 17 existing published scientific papers on infusion of monoclonal antibodies was run by a group from the medical university in Bologna, Italy. The lead author, Francesco Nonino, and coauthors looked at over 20,000 patients in their early seventies participating in the 17 studies. Their data was inclusive through August 2025. They concluded that at 18 months of treatment, these infusions:

1. Result in little or no difference in cognitive function.
2. Result in little or no difference in dementia severity.
3. May result in a small improvement in functional ability depending on what criteria are used.

M. Fotuhi, MD, PhD, of Johns Hopkins neurology department chose to compare lifestyle interventions, in the same age group, with interventions including exercise, cognitive training, social engagement, dietary intervention and stress reduction. This study showed cognitive improvements with lifestyle changes as opposed to possible slowing of decline with monoclonal antibody infusions.

We are very early in our understanding of Alzheimer’s Disease and how to prevent and treat it. Many of my affluent patients going for infusions are ill with other chronic issues which will kill them long before any benefit of infusion therapy will be noticed. Pointing this out to the family members, pushing the treatment for their parents, is typically not well received.

Alzheimer’s dementia is a horrible disease but currently, unless you are a younger senior with no other life-threatening illnesses, this infusion therapy risk just isn’t worth the small benefit.

Adult Children’s Concerns Over Their Parents Mental Acuity

I have been receiving regular phone calls from the adult children of elderly patients concerned about their parents’ failing memory and slowing down. They are concerned about Alzheimer’s Dementia.

In several instances they have taken their parent directly to neurology programs that conducted the research on the use of monoclonal antibody infusions for profit and are now administering these two medicines regularly to individuals with minimal cognitive dysfunction, blood markers for amyloid and tau protein and PET scan imaging showing findings associated with Alzheimer’s Dementia. The results of these infusions are not especially brilliant or encouraging, suggesting that over many years they may slow down the rate of cognitive decline. They clearly do not improve or restore lost function.

These new medications require frequent injection administration and close monitoring for micro brain bleeding known as ARIA (amyloid related bleeding abnormalities). The monitoring is done by frequent imaging studies. The protocols for administration and imaging monitoring are different for Kisunla and Leqembi, the two products currently approved by the FDA. To date, the brain bleeds and brain swelling seen from administration have not been serious but long-term effects are unknown. A 12-month treatment can cost $26,500 – $32,500 for the medication alone.

A Cochran Library review of the 17 existing published scientific papers on infusion of monoclonal antibodies was run by a group from the medical university in Bologna, Italy. The lead author, Francesco Nonino, and coauthors looked at 20,000 plus patients in their early seventies participating in the 17 studies. Their data was inclusive through August 2025. They concluded that at 18 months of treatment these infusions:

1. Result in little or no difference in cognitive function.
2. Result in little or no difference in dementia severity.
3. May result in a small improvement in functional ability depending on what criteria are used.

M. Fotuhi, MD, PhD, of Johns Hopkins neurology chose to compare lifestyle interventions in the same age group with interventions such as exercise, cognitive training, social engagement, dietary intervention and stress reduction. This study showed cognitive improvements with lifestyle changes as opposed to possible slowing of decline with monoclonal antibody infusions.

We are clearly very early in our understanding of Alzheimer’s Disease and how to prevent it and treat it. Many of my affluent patients going for infusions are ill with other chronic issues which will kill them long before any benefit of infusion therapy will be noticed. Pointing this out to the family members pushing the treatment for mom or dad is like adding gasoline to a fire.