Time for Some Positive News

I drove home from my medical office, walking through the building with my N-95 respirator mask and wiped my hands with Purell as I entered my vehicle. I turned on the sports radio talk show only to learn how many of my baseball, football, hockey, basketball and soccer teams were curtailing practices due to COVID-19 infections while they question whether their season would start. Arriving home, I entered through my garage with my pandemic routine of rigorous hand washing, clothes worn outside go right into the washing machine and find a fresh mask in case I need it on my community dog walk.

“Hi honey, how are you and what’s on the agenda tonight?” My wife was keeping her distance because on one of my office medical staff stayed home after her dad tested positive for coronavirus. The practice staff were all near her and now we are all on 14-day self-quarantine while we await our COVID-19 test results.

Standing there as I changed into some clean clothes, I heard my wife say, “Dinner is a salad, steamed broccoli and reheating last night’s leftovers. I have us set up to watch Ozark, Breaking Bad, and House of Cards after you watch the half hour national news.” These were all brilliantly written shows we had missed seeing when they came out, with not one character you could root for or say they are a good person. The shows are smart but negative – about flawed people exhibiting more negative than positive character traits. The evening news was not much better covering the unchecked spread of the coronavirus, brawls about wearing a mask, financially strapped small businesses looking at closing up shop for good and one more look at the death of George Floyd in Minnesota.

I decided my best option was to look for some positives, so I found some. Yesterday we sent my 71-year-old patient with bilateral pneumonia from COVID-19 home from the hospital on his road to recovery. With heart disease, obesity, chronic lung disease and multiple intrabdominal abscesses as a complication of emergency surgery; he should not have survived. He did not require oxygen, or convalescent plasma, or remdesevir, which isn’t even currently available in Florida, or dexamethasone which is also in short supply. He should not have lived but he did!

On the same day Regeneron announced that its antiviral monoclonal antibody cocktail called REGN-COV2 was moving into human phase 2 and 3 trials at multiple sites in the US, Mexico, Brazil and Chile. Regeneron believes this medication can be used to treat sick COVID-19 patients and to prevent infection. If this phase goes well, they are prepared to introduce the product to patients in late August or early September.

This was followed by the news that the vaccine being developed in the UK at Oxford and the vaccine being developed in the USA at Moderna had both produced antibody responses in human volunteers at multiple dosage levels and they too are moving into phase 3 trials in humans . Both companies are so sure their product will be successful they are producing it for distribution now. Late fall or early winter are their target dates for distribution.

There is a light at the end of a dark pandemic tunnel. Our job is to stay healthy physically and mentally and do what we can to protect ourselves and others. Wear your mask, social distance, wash your hands frequently, stay home, be kinder to everyone else who is stressed out, worried and lonely. Call your physician and make sure you a get a flu shot this fall. We can get through this together and build a better world!

Volunteering for the COVID-19 Vaccine Trials

My civic-minded daughter in California asked me what I thought about her volunteering for one of the drug trials or vaccine trials involving COVID-19. She asked me if I knew how they found volunteers for these research studies. I told her I had no idea, but I would investigate it.

The Center for Disease Control and Prevention (CDC) and the National Institute of Health (NIH) websites directed me to a volunteer network formed to find volunteers to test treatments for HIV disease. I was directed to a website being run by the Fred Hutchinson Cancer Institute in the Midwest.

Mr. Hutchinson was a former major league baseball player and the manager of the great Cincinnati Reds baseball team that lost to my beloved New York Yankees in a World Series in the 1960’s. Fred had contracted cancer and been involved in philanthropic works in cancer research. After his death, the center took on his name. It is a first-class extraordinary cancer research and care facility. They are supervising the COVID-19 Trials Prevention Network.

If you access the site at http://www.coronaviruspreventionnetwork.org you have an opportunity to volunteer for prevention and treatment studies. There is a short questionnaire to fill out asking you about your health, height, weight, exposure to COVID-19 and contact information. If you are selected for a trial, you will be contacted and at that point have a chance to review what is being studied and what the risks and benefits are for your participation.

Filling out the form does not obligate you to participate but does put you in the pool of individuals willing to consider participating in a prevention or treatment trial.

Good Advice and Quality Care Is Not A Negotiation!

In this era of the “Art of the Deal” many in my patient population seem to believe that dealing with science, math and physical laws of nature is a negotiation.  They seem to believe as it’s the same as if you hired a contractor to work on your home and he wants a 20% down payment when you sign the contract and you only want to pay 5%.

I’ referring particularly to the laws of transmission of respiratory viruses, droplet particles and aerosolized viral particles. We are supposed to be wearing masks or facial coverings when indoors or when we are within a few feet of each other (six feet or less). We are supposed to stay six feet or more apart.

If exposed to the coronavirus or COVID-19 you are supposed to go home, stay home and self-quarantine for 14 days. You can contact your physician and discuss the circumstances and ask for advice.

What you are not supposed to do is go home, get anxious and agitated and spend hours on the phone trying to get tested immediately. The tests are only about 70% accurate (nasopharyngeal swabs via PCR). The quick tests, with turnaround times of hours, are wrong 48% of the time.

I explain this to concerned individuals and try to soothe their fears but the negotiations begin. I am flattered by the degree of confidence and power they believe I have but just because you want me to say something contrary to what the scientific facts show, doesn’t mean it is correct or good advice.

Sometimes my patients try and make me feel like I am a priest in a Catholic Church during confession, but I have neither the training nor the connections with the good Lord. Sometimes they try and make me feel like the supreme leader who can grant them a special dispensation. I am not that powerful or good and this is Mother Nature we are dealing with and laws of science.

As an example of what I mean, let me use a personal situation as an illustration. My daughter, son-in-law and 2.5-year-old grandson live south of Miami in Dade County in an affluent community of young well-educated individuals called Palmetto Bay. They both work full-time and have been working from home due to the COVID-19 pandemic. My grandson is cared for, watched, taught, loved and instructed during the day by his loving grandmothers so the kids are free to work without incurring childcare expenses.

Both grandmas’ have master’s level early childhood teaching degrees and one is a psychologist who recently retired from the Dade County School system. Seeing my grandson grow up with his grandmothers doing what they love to do most is a joy. When COVID-19 raged in March, they closed the pre-school my grandson attended. Unexpected exposure to others resulted in both grandmothers having to avoid my children because they are both older with chronic illnesses and considered high risk for COVID-19.

The pre-school sessions resumed a few weeks ago bringing joy to my wife and grandson. My daughter’s neighbors show little or no respect for the coronavirus. When I last visited three weeks ago there was a party going on next door and four adult men in their thirties or early forties were out on the lawn without masks or social distancing puffing away on cigars while a band of young children intermingled on the lawn. We all waved hello but kept our distance.

Two days later my son-in-law left his home through a side door to take a stroller out of his SUV parked 30 yards deep in his driveway without a mask. The neighbors five-year-old, playing freely on her lawn saw him and ran over to say hello while his back was to the child. He turned around and this well-meaning child was right there in his face. He jumped back, thought nothing of it because they were outside, and he is three feet taller but realized that the close encounter was worrisome. Two hours later they received a phone call from the neighbor saying that unfortunately they had just been informed that all their friends who visited over the weekend were now ill and tested positive for COVID-19. The neighbor was concerned about the encounter between my son-in-law and her child because my daughter happens to be pregnant.

My daughter called her obstetrician who told her what I tell my patients. Your husband needs to self-distance and self-quarantine for 14 days. When my daughter said they had been in contact several times since the incident, the obstetrician repeated the original advice. They all went into self-quarantine for 14 days. The grandma nanny visits stopped. I received a frantic phone call that night after my daughter spoke to her OB and supported the advice she had been given.

Living in Dade County they tried to get tested beginning five days after exposure, but the lines were horrible, and supplies ran out while waiting several times. With no symptoms, they did not need the test. The strain of working full-time from home and caring for a toddler was an issue once the grandma’s stopped helping because they were afraid of catching the disease if the kids were exposed. They tried multiple times to negotiate another route or plan with the OB, with me and with their mothers. I finally said, “This is not a negotiation. These are the facts. These are the suggestions of the World Health Organization, the Center for Disease Control and your own doctors.“

On Day 15, the grandmas agreed to return. The neighbor’s child never tested COVID-19 positive nor did the child’s parents.

Missing your loved ones is a terrible price to pay for the unchecked virus. I feel horrible for those in quarantine who miss their loved ones dearly.

However, I cannot give you a “Get Out of Jail Free” card like they have in Monopoly. I cannot tell you that if you are recovering from a lymphoproliferative cancer it is safe to pass through an airport, take a commercial airliner and visit your kids or folks if it really isn’t. I cannot safely tell you after arriving it is fine to not self-quarantine for 14 days before seeing high risk relatives. I cannot tell you the same-day quick COVID-19 test they are performing at the local private walk-in center or your community board is providing is fully accurate when in fact science shows it is not.

I will discuss with you the facts and if asked for an opinion give you an honest opinion based on science and data. I will not negotiate however so please don’t ask me to anymore! As a famous detective said on a famous black and white TV show , “Just the facts.“ is what I will tell you because it is best for you even if it is not what you want to hear.

COVID-19 Reality Check

My wife and I drove to the FAU campus to be tested for COVID-19. Testing is by appointment only. The process was so efficient and so on-time that we were finished within 10 minutes. The actual nasopharyngeal swab being inserted high into the nasopharynx is uncomfortable but tolerable.

Approaching others donning maximum personal protective equipment with masks, face shields and gloves was even intimidating for me – a longtime member of the medical profession used to observing this equipment. Viewing it in the open confines of an outdoor tent located on an airport runway on a clear, warm, sunny beautiful morning just makes it more surreal. Results should be available in 5-7 days.

After the test, that nostril began to run with clear drainage and a postnasal drip. A tickle in the back of my throat led to a dry cough.

So, why did I go and get tested? One of my office medical assistants lives at home with her working parents. Her dad came home from his construction job on Friday with a cough and fever. He went to the ER where a quick COVID-19 test was positive, but he was sent home per CDC protocol since he was not experiencing any breathing difficulty. His daughter was exposed to him and we were all exposed to her as she performed her duties in our medical office. We wore masks in the office and washed hands repeatedly but for the safety of our patients and our families it was time to be tested.

I have been more than social distancing and wearing a mask for months now. My hands are raw from washing. I have avoided restaurants and restaurant take-out food.  My food, medications and supplies are being delivered. I have not seen my children or grandchildren except on FaceTime calls. I cannot imagine what more I can do to self-quarantine, but I will make sure that for the next two week period, until July 25, I will avoid contact with people.

COVID-19 is raging through South Florida. I received an email from my local hospital telling me that they have run out of swabs and reagents to perform their quick in-house COVID-19 detection test. All tests will now be a send out with a 4-7 day wait for results. What a crime that is.

Available beds and ICU beds are diminishing. Nurses and ER doctors are complaining again about lack of personal protective gear. Fighting a virus pandemic like this takes leadership, organization, sacrifice, compassion and caring.

In Western Europe, Thailand, New Zealand and South Korea; they found a way through a lockdown and mandatory masks to stop the rapid spread of COVID-19. In the USA, especially in the South and West, people went to bars, restaurants and large social gatherings and the carnage, as a result of poor discipline, is beginning to pile up.

Hopefully, our citizens and leaders will develop some maturity and exhibit the behavior needed to stop this dreadful disease before we kill off 250,000 victims.

More Steps Per Day Associated with Milder Irritable Bowel Symptoms

The association between emotions, the brain and the intestines has always been of great interest to me. As a young medical student facing the stress of having to succeed academically, I developed irritable bowel syndrome. I have written previously about my encounters with IBS and discussed how my symptoms diminished as my coping skills improved. I have always loved to aerobically exercise for stress reduction but never really appreciated how that activity may have diminished my irritable bowel discomfort.

Toyohiro Hamaguchi, PhD, of the School of Health Sciences at Saitama Prefectural University reported on a study discussed in Plos One showing that with increased walking irritable bowel symptoms seemed to diminish. The study looked at 100 students, 78 of whom were women with a mean age of 20 years old. They were recruited for the study based on their diagnosis of irritable bowel syndrome between the years 2015-2018.

The participants were not obese based on Body Mass Index (BMI). They answered a GSRS (Gastrointestinal Symptom Rating Scale) document at the start of the study and again while participating in the study. The rating scale evaluates the severity of abdominal pain, indigestion, reflux, diarrhea and constipation. Walking patterns were then tracked using a pedometer.

They found that with increasing daily steps, the severity of the symptoms markedly decreased based on the GSRS rating scale. Based on their findings, the severity of symptoms decreases by 50% when increasing your daily step count from 4000 steps to greater than 9500.

Dr. Hamaguchi explained that “mild physical activity helps clear intestinal gas and reduces bloating. Thirty minutes of daily walking is recommended for increasing colon transit time in adults with chronic constipation. Recent research has found that inflammatory biomarkers were reduced after 24 weeks of moderate -intensity aerobic exercise”.

This is one more study showing that low to moderate intensity exercise, on a regular basis, allows you to feel better. During this Covid19 Pandemic the stress level for all is so much higher. Take a 30-minute walk at your own pace, maintaining social distancing and with a mask available if someone starts to get close . It will reduce your stress and improve your health!

A Perfect Storm Setting the Stage for a COVID-19 Catastrophe

The last week in June always means the recent medical school graduates have just begun their first days as real physicians working in the halls of our nation’s hospitals. With youth comes energy, altruism, enthusiasm and inexperience.

The first year was once called an internship and is now called Post Graduate Year 1. Directors of training programs and their teaching colleagues work overtime to orient, teach and supervise closely so that inexperience does not interfere with excellent patient care. Excellent programs have layer after layer of patient care review to prevent the development of judgement and experience from adversely affecting outcomes in care.

We are in the middle of a health care crisis of previously unseen proportion by old timers like me and newly minted physicians. As the coronavirus surged in the state of NY, state officials accelerated the graduation of fourth year medical students and sent them into the fray to care for COVID-19 patients on the front lines. A general call for extra help went out to the medical community nationally to bring back retired physicians but to also reassign specialty doctors to COVID-19 care even though they had little recent experience in infectious disease and respiratory care.

Some news stories talked of dentists and podiatrists being drafted to provide medical care for ailing New Yorkers. The death toll in the NY hospitals was exceptionally high and some critics believe the use of inexperienced clinicians, with minimal supervision, contributed to these extremely high death and complication rates. I believe that while that may be a factor, the real issues were lack of familiarity with a new pathogen, lack of effective medication, lack of personal protective equipment as well as a lack of sleep and rest and mental health counseling all contributing to the inexperience but valiant efforts made by NY health care personnel.

With new medical school graduates on the wards here in Florida, we now face many of the same issues our colleagues in the NY Metropolitan area faced several months ago. What they did not face months ago was a population unwilling to follow the safety measures outlined by Public Health officials, infectious disease specialists and scientists.

The financial hub of the USA, perhaps the world, closed quickly to save lives and slow the spread of disease. Our south Florida hospitals have prepared extensively for the arrival of the new medical graduates. Our best faculty members are out teaching and supervising. Despite this, they are at a disadvantage because there is no governmental leadership by example at the county, state or Federal level.

The number of Florida residents who continue to treat wearing a mask as a civil liberties issue, rather than a deadly public health issue, is astounding. The number of Floridians who do not believe that keeping a safe social distance apart prevents disease spread and fail to observe the recommended guidelines as a protest about loss of freedom is mind boggling.

 Instead of Floridians demanding a comprehensive and organized program to stop COVID-19 while meeting the financial. food, educational, safety, housing, childcare and supply needs of the populace, we have politicians telling us that the increased rate of infectivity is safe in young people. Young people give it to middle aged and old people, and they have a greater chance of getting sicker, ending up hospitalized and dying.

The daily local hospital case load is increasing. The available beds are decreasing. We have not even factored in that we are now in hurricane season which might call for evacuations and mass movements of Floridians for storm related safety.

This is the perfect storm scenario. If you are happy with it then carry on. If you are not then please call, write, text and email your elected officials at all levels of government and tell them in no uncertain terms what your needs are.