A Perfect Storm Brewing: Flu Season Plus A COVID-19 Resurgence

I was asked by a colleague what I thought influenza seasonal infections coupled with a predicted second wave of COVID-19 would look like locally? Influenza A arrives locally around Thanksgiving and peaks the last two weeks in January and first two weeks in February. I suspect it is fueled by seasonal visitors coming to Florida bringing the disease from their home locales. We see a low level of influenza B year- round in our pediatric population.

A full-page ad appeared in all Florida newspapers today sponsored by every major health system in the state including Baptist, Tenet, HCA, Cleveland Clinic, Broward Health, Jackson, U M Health, Memorial Health and others. It stressed wearing masks, social distancing and frequent hand washing.

If you get sick with mild symptoms, they encourage remote telehealth care. If you have moderate symptoms, they suggest going to their urgent care facilities. For severe symptoms call 911 or go to the ER. At no time did they suggest calling one of their employed physician offices or visiting your private doctor which is all consistent with CDC recommendations. Private independent and employed physicians just don’t have the ventilation systems, sanitizing systems, personal protective equipment or trained staff to see potential COVID patients in their offices. If a patient is positive, or a staff member converts, what is their responsibility to the next patient or to the other tenants of their building? Is a 14-day quarantine in order?

Much depends on unknown factors. How effective will this year’s flu shot be? In my area, the chain pharmacies already received their supply of influenza vaccine and have shamelessly been pushing it on customers since July. Scientific research shows that in senior citizens the flu shot immunity begins to subside 90 days after you receive the shot. Given that, if your pharmacy tech gives you the flu shot in September, then how much immunity will you have by the time the flu arrives around Thanksgiving?

Quick, accurate and inexpensive testing availability for flu and COVID 19 is an important factor as well. We have had a quick influenza test for years requiring a nasopharyngeal swab. A similar test for COVID -19 has just been released by Abbott Labs and received Emergency Utilization Authorization from the FDA. That means Abbot Labs researchers say it works and the FDA takes them at their word. This test, called “a game changer” by many, will be available in October.

When $15 per hour medical assistants start performing the test rapidly, in volume, I hope the accuracy results are similar to Abbots claims. Our health and lives depend on that. At the same time a finger stick blood drop test is heading to market to quickly detect flu and COVID -19 on the same test card. Finnish scientists and Israeli researchers have quick breathalyzer tests coming soon as well. I hope they work and get here soon. I will test everyone at the door as will restaurants, theaters, sports arenas and most businesses.

All of this information really skirts the issue. With no treatment and vaccines available yet, I expect this flu COVID-19 season to be a human health disaster. With no national plan in place and no close coordination with state and local elected and public health officials, I see the fall and winter as a time of continued disease surges and deaths while the political influence on disease treatment supersedes scientific research and public health realities. Without a coordinated program of PPE and medication distribution, coordination of testing availability and results with contact tracing and specific shutdowns of hot spots without challenges related to loss of freedoms the outlook is grim.

Protecting senior facilities without a coordinated program and funding for it will not work for residents or employees. Opening schools and day care without similar precautions, training and funding for materials and tracing will lead to hotspots as well. There are members of the student population such as special needs children who need to return too, in person, learning safely and creatively. Others need to learn remotely or be given a chance to catch up later when safe return to in person learning is possible.

Without a plan to assist renters, homeowners, landlords, small business owners, farmers, restaurateurs, etc.; any shutdown for disease will be met with overwhelming resistance. I see a bleak and dangerous health picture developing in the fall/winter creating a perfect influenza/COVID storm.  I hope I am wrong but, if right, the disease surge will overwhelm ERs and hospitals.

Safety for Patients First

In the heat of the ongoing pandemic, my associate and I suspended in-person routine office visits for the safety of our patients. To get to our office, patients walk through a revolving glass door into a common lobby and then take a small elevator up to the second floor. There are stairs which are well hidden and not easily accessible. A sign is posted next to the elevator suggesting facial covering, but not requiring it, despite an executive order in Palm Beach County mandating their use.

This is a multiuse building with numerous offices. Many of the other tenants do not social distance or wear masks routinely. There have been multiple tenants who have tested positive for COVID. For this reason, we participated in telehealth visits exclusively to protect our older, chronically ill and vulnerable patient population. It was safer to keep them in their home than bring them into our practice. We were willing to forego practice revenue and income to do so. Our first priority is the safety of our patients.

The office has been open daily, answering calls, refilling prescriptions, filling out forms and scheduling telehealth visits. The criticism from patients for doing this has been scathing. The worst criticism has been from those requesting blood draws for visits to other doctors. We performed this as a courtesy in Pre- COVID days but believe the risks far outweigh the benefits for non-ill individuals at this time.

The COVID-19 hospitalization rate and percentage positive rate locally have declined to a level that is allowing us to begin safely seeing patients again in our office. The building management still will not enforce the Palm Beach County mask mandate so we urge you to social distance and wear your mask.

Do not enter the elevator unless it is empty. Wait for the next one to ensure safety. Hope to see you soon. Call with any questions.

Caregivers & Health Care Aides are Underpaid & Underappreciated

It’s been years since I lost my mom and retired as a hands-on personal caregiver. The care I provided her was supervisory, not physical, and it was exhausting.

As a physician caring for my patients who end up in a skilled nursing facility for post hospital rehab, I have always been amazed at how under paid, under trained and overworked these well-meaning caregivers and aides truly are. It’s easy to see why burnout is common amongst them and turnover is ranges from 50% – 100 % annually with these jobs.

The devastation created by COVID-19 at senior care facilities brought this all into sharp focus. These poor employees living in multi-generational homes, and not having the luxury of working remotely, have suffered staggering losses due to this disease. With no quick accurate test for this virus available, they show up at work not knowing if they are infecting their elderly patients inadvertently or being infected and bringing it home to their loved ones. There has certainly been no organized program on a national or state level to protect the patients or the caregivers.

With lockdowns in place at these facilities, these hardworking aides are now functioning to some degree as mental health counselors as well.  But it’s the physical nature of their work that amazes me – routinely lifting and grooming men and women weighing a hundred or more pounds.

My poor little 24-pound rescue pug suffered a neurological catastrophe last weekend with an embolus to her spine leaving her paralyzed in her rear legs. I have a harness and soft belt to support her so she can walk on her front paws and squat to void and defecate. If I don’t hold her up high enough, she scrapes the skin off her knuckled rear paws and they bleed. She hates the booties I tried to protect her with.

The canine neurologist asked that we don’t use the rear rollers you see paralyzed animals use for mobility because she wants her to walk again or at least give her a chance. Once a day I go into the pool with her and support her midsection while she paddles away with her front paws and I move the rear legs through their normal range of motion. Lifting those 24 pounds is exhausting for this 70-year old but she is making progress pushing back now against my hand in those previously flaccid limbs.

I do this out of love. I can’t imagine how difficult it would be to lug a 100+ pound person around all day while risking COVID-19 exposure, all for $15 per hour.  I tip my hat to these health aide angels who are the glue that keeps elder care together in a dreadful profit driven system.  They do it to give their loved ones a roof over their heads, food on the table and a chance at a better future.

As the U.S. population ages, we need to find a way to compensate them fairly and appropriately to show our appreciation for what they do and recognize how difficult and dangerous their essential work is.

Chocolate and the Risk of Coronary Artery Disease

Chayakrit Krittanawong, MD, of the Baylor College of Medicine, was part of a group of physician scientists conducting an observational study involving regular chocolate consumption and the risk of developing coronary artery disease. Their research was recently published in the European Journal of Preventive Cardiology. In what was called “a systematic review and meta-analysis” they analyzed data from 336, 289 participants, participating in six studies, looking at chocolate consumption, coronary artery disease, acute coronary syndrome and acute myocardial infarction.

If you consumed chocolate 3.5 times or more a month, or more than one time per week, you were considered a high chocolate consumer. High chocolate consumers turned out to have a lower risk of coronary artery disease of about 8%.

This is great news for chocolate lovers. However, readers must remember this is an observational study and cannot link cause and effect. It did not factor in obesity, lipid levels, presence of diabetes, cigarette smoking history, activity level, family history of premature coronary artery disease or other dietary habits.

Is it possible that chocolate lovers eat more fruits and vegetables than non-chocolate consumers? Could it be that chocolate lovers eat a healthy Mediterranean Diet more frequently than non-chocolate consumers?

This study clearly didn’t answer those questions. What it does say to me is that if you reduce your cardiovascular risk factors, as best you can, eating chocolate occasionally may not hurt.