COVID-19, Phase III Reopening & Influenza Vaccine

Watched the Presidential debate last evening which resembled a sequel to the movie Animal House with Chris Wallace of Fox News doing his best Dean Wermer impression. The moderator had the right and duty to allow each participant to answer the question in their allotted time and could have turned off the microphone of the offending participant but chose not to. The American Public was cheated by his ineffective leadership.

This occurred on the same day columnist Fabio Santiago, of the Miami Herald accused Florida Governor Ron DeSantis of threatening public safety by opening the state completely before the state has met any of the recommended safety benchmark goals of the CDC.

An article in the Jerusalem Times forwarded to me discussed a large series of Israeli COVID-19 survivors who developed antibodies to COVID-19 and then became ill with it within the three-month recovery period. Their presumed second round of COVID was far more serious and complicated than the first bout raising questions about whether they ever cleared the disease or not. It underscores the tremendous lack of knowledge we have about this pathogen.

I understand the frustration of small business owners, stay at home working parents who now have to supervise their kid’s education while working remotely and; the unemployed who cannot break through the inefficient computer systems to obtain the benefits they deserve and need to survive. In my mind these issues just highlight the need for a national program to fight the spread of COVID-19, protect the most vulnerable, support those out of work as well as the businesses who need to pay rent and salaries to survive while we wait for a vaccine or medication. To say that its fine to come to Florida, and safe for tourism purposes, is a lie exposing Floridians to the COVID-19 they bring from their homes and exposing their friends and neighbors to the COVID-19 of the Sunshine State.

Which brings me to the influenza vaccine. Do yourself a favor and get your influenza shot. No, the vaccine does not make you more susceptible to coronavirus as one Midwest couple read on a disinformation website. No, it is not 100% effective, but it will reduce the intensity and the severity of the disease if you are exposed to it.

We are currently experimenting with the safest way to immunize our patient population. The tenants in our building, with the support of building ownership and management, did not enforce the indoor mask mandate when we were in Stages I and II. Now the younger, more casual tenants, are even less likely to observe social distancing CDC guidelines. We are experimenting with three different ways of administering the vaccine on site, which I believe is still far safer than the exposure in a commercial pharmacy.

My advice to my patients remains:

1. Stay out of restaurants and country club dining rooms despite the efforts of management and the board to keep these places spotless. CDC studies show restaurant attendance is associated with catching the disease.

2. Stay out of gyms – both public gyms and gyms in your apartment complex. Take walks outside. Use a chlorine pool. Walk at the beach. Bicycle ride.

3. Stay out of hair salons and nail salons.

4. Cook and prepare your own food. Restaurant workers, who must come to work to get paid, are often asymptomatic spreaders of COVID.

5. Suppress the urge to use commercial air travel to visit your relatives. Airport terminals and inconsiderate and uncaring passengers are your biggest threat. If you do go, you will need to quarantine for 14 days before you see your vulnerable loved ones or; wait at least four days after arriving before being tested for the COVID-19 antigen indicating an ongoing infection.

Stay home. Wear masks when in public. Wash your hands frequently and stay 12 feet or more away from others. That is our best option for staying healthy and alive until a treatment or vaccine is available. Get your flu shot. Listen to science not politicians.

Another Anti-Vaccination Myth Put to Rest. Pregnant Women Can Safely Take the Flu Shot

Vaccinations have been blamed for causing autism in children and used as an excuse to permit school age children to opt out of receiving vaccinations and immunizations but still attend school. The result has been a reemergence of measles and other preventable childhood illnesses in multiple areas of the world.

Anti-vaccination advocates have extended their arguments to claim pregnant women receiving the flu shot are increasing their off springs’ chance of developing a disease on the autism spectrum. To study this question Jonas F. Ludviggson, MD, PhD of the Karolinka Institute in Stockholm, Sweden explored this question. They followed large numbers of pregnant women in Sweden during the 2009-2010 influenza season and then followed their newborns for almost seven more years. Over 39,000 pregnant moms were vaccinated with the standard inactivated flu vaccine that season. Only 1% of their children, 394, had developed illnesses on the autism spectrum by 2016. Conversely, over 29,000 moms did not receive the flu shot that season and 394, or 1.1%, of their offspring developed diseases on the autism spectrum. There was NO statistical difference in the groups. Their research paper was published in the Annals of Internal Medicine Journal.

As we head into influenza immunization season; the voices of scientists, public health experts and physicians will be encouraging everyone to take a flu shot. The voices of those who believe these vaccinations will cause harm will also be loud.

Look at the data and scientific evidence and please take your flu shot this season. It certainly is not a perfect preventive treatment but it reduces symptoms and severity in those unfortunate enough to catch it. Call your doctor and make an appointment to receive your flu shot.

Pandemic Cabin Fever and Risk Tolerance

It’s Labor Day and I am so grateful to be alive and have my family tell me they are healthy and well. As part of the COVID-19 pandemic, my wife and I have been isolating since February.

Our major risk of disease transmission is I go to work and see patients face to face. I dread the thought of being the one to pick up the coronavirus and sicken my loved ones. I often feel like a quick change artist changing into special scrubs, masks, gloves, face shield and gown or lab coat to see patients . My pants, shirt, tie and belt get hung up and my shoes and socks get put into a plastic bag. My sneakers never leave the office. In between patients, while my staff clean the exam room, I am shedding one outfit and changing into another. The used one goes into a netted laundry bag which gets washed on the hot cycle each evening.

My wife and I have not been to restaurants. We pay for shoppers picking up supplies and bringing them to our front door. We have a receiving decontamination process by our front door. We bring in no prepared meals. Trips for haircuts, nail and toe trimming and even some non-critical physician visits have been put on hold. The goal is to stay alive until a vaccine or treatment makes the risk less.

We miss our friends greatly. We are all over 65 years old and considered high risk for COVID complications. There have been no socially distanced meals or gatherings. We talk on FaceTime or Skype. Our regular Friday night dinner with family friends for 30 plus years is on hold for now. Our schedule is structured and revolves around work responsibilities, pet care responsibilities, exercise to keep the mind and body fit and home cleaning responsibilities. We speak to our adult kids and their kids daily.

We are more fortunate than most having a daughter and her family an hour away south of Miami in the “ 305.” She has been pregnant during the pandemic, preparing to deliver shortly so she is high risk too. We respect her protective bubble and when we drive down we stay more than socially distant, all with N95 masks on surpressing the urge to pick up our toddler grandson, hug him and smother him in love and kisses. In the pandemic with his brother or sister in utero, being able to visibly see him, smell him and see his growth is enough to refill our tanks and maintain our COVID plan.

Many of my friends and patients believe we are crazy for being so isolated. I see the wives go out to lunch with the girls, go for hair coloring and cuts. They tell me how safe and clean it is at the site they are visiting until I get the phone call about the fever spike, the dry cough, the headache, the diarrhea. Then the frantic quest for accurate and reliable testing begins for individuals.

At times it is the golf game, or tennis and a meal “ at the club.” I always get a lecture from them on just how many precautions “the board“ put in place to protect them. That is, until it doesn’t and they too are sick with COVID.

Other times it is the younger adult families with school age kids traveling out of state to the mountains with “safe and responsible friends” only to end up COVID positive, survive and be dragging six weeks later with new EKG changes a health conscious 40-year old did not have pre-COVID. When I get the patient call from the high-risk individual now positive with COVID 19 there is little I can do other than pray and root for them. Knowing the multi system diseases these individuals must overcome I suppress the urge to just cry. Yes fluids, Tylenol, rest and cough syrup are available but not much else unless they get much sicker and hopefully that won’t occur.

When they get worse it’s off to the hospital where the COVID team armed with not much more (steroids, convalescent plasma, remdesevir for some) does the same. When the patient thankfully does not get worse, and should be grateful, instead they complain foolishly about “why am I here if you are not doing anything for me?”

A vaccine is closer than further. Treatments with monoclonal antibodies and possibly prevention are closer than further. With the opening of in-person schools, in-person college attendance and our Governor pushing safe air travel and tourism, I expect the infection numbers to climb in late September early October.

Putting our lives on hold may be extreme and overreacting. I will continue that plan and advise you to suck it up, tough it out and do the same. I pray that my efforts and family’s efforts continue to keep them well and healthy. Even with their efforts there are no guarantees – just our prayers.

Conversations Overcome Concerns & Strengthen Relationships

When I organized my medical practice, I tried to find individuals with great customer service skills plus the medical knowledge to work in an internal medicine practice. We all do our best to meet the needs of our patients but sometimes, even with the best of efforts, we fall short.

For example, a patient requested a large quantity of a medication as a refill early one morning. I saw the fax as I walked in the door, picked it up, signed it and returned it to the pharmacy for the refill. It only took about five minutes to send it to the pharmacy.

When the pharmacy received the refill authorization, they did not have the quantity of the medication the patient requested. When the patient went to pick up the medication, they were given a 90-day supple, not requested 180 days.

The pharmacy incorrectly told the patient we only ordered 90 tablets. Angry, the patient called the office and was abrasive – not giving my staff a chance to investigate the matter to see if it could be settled to her expectations. Unfortunately, the pharmacy never told the patient their supply of that medicine was short.

The angry patient left our receptionist in tears and our office manager flustered. It takes a great deal to fluster our office manager, given her background. I tried to call the patient, but she did not take the call.

Having a personal conversation is the preferred way to understand and overcome concerns, issues or complaints. Email is too impersonal and rarely conveys the tone properly and a handwritten letter is less personal than a face-to-face meeting.

The same applies to those unexpected release of records forms you receive from patients requesting their records be sent to another internal medicine or family practice. You never want to learn your patient has left your practice without knowing why. How do you fix a problem and prevent it from happening in the future if you were never made aware of it in the first place?

I encourage my patients to contact me if they are unhappy with me, my staff or the way I provide care so we can address their concerns. Better communication makes for better care – even if the original message is unpleasant.

Give us a chance to hear your point of view and address the issue. That is what relationships are all about.

Although this article is based on my patient experiences, I encourage everyone to have a conversation with their doctor to share their concerns.