Consulo Indicium - 4/28/20

Information for your Consideration…

 Telehealth Explodes – I was recently as a meeting where I was informed that one of the dictums of Silicon Valley is that “change happens” when the elements of changes in the LENS appear.  LENS is the acronym for Laws, Economics and National Security. I pass it along because the LENS has not appeared, but it happened at hyper-speed. Over the months of March and April, the number of virtual health-care interactions were on pace to top 1 billion by year’s end, according to analysts at Forrester Research. That would represent a massive expansion from telemedicine usage before the coronavirus pandemic. Then, to compound the LENS argument, an announcement was made by the Centers for Medicare and Medicaid Services (CMS) to suspend “…several regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the coronavirus pandemic” – the telehealth movement exploded. The reasons for the proposed CMS changes was to “reduce certification requirements for clinicians, with the aim of expanding workforce flexibilities and enabling practitioners to be hired quickly and ‘perform work to the fullest extent of their licenses.’” I have been arguing for years that once CMS made a move on telehealth, the rest of the payors would likely follow suit.  In fact, that is the case. In fact, multiple analysts are predicting general medical care visits to top 200 million this year, up sharply from their original expectation of 36 million visits for all of 2020. Frost and Sullivan came to essentially the same conclusion noting that March telehealth visits surged 50% amid the coronavirus pandemic. Telemedicine providers like Teladoc were reporting video visits of more than 15,000 per day. So, finally, the revolution has started.

But, wait: “Houston – we have a problem!” One of the concerns I’ve been highlighting for those who will listen is the resulting “disintermediation” of primary care.  Dismembering, taking apart, disintermediation – whatever you want to call it – is an unanticipated tragedy in American health care.  Why?  It’s because primary care has traditionally served as the “coordinator” and “manager” of all the basic health care problems that exist across a populace. By removing the 70% of primary care that can be accomplished using tele-technologies, we are removing the financial base for most primary care practices. And, it’s important because primary care has been shown repeatedly over the decades to be the main contributor to reducing overall costs in health care.  Now, I realize that I’m a Family Physician and I’ve drunk the Kool-Aid but the data supports my argument. Rather than removing the telecare portion, we should be integrating it with the primary care providers which is most often an afterthought.  As a result, patients see Tele-Whoever and come into the office noting that they were given “such and such” medicine but they “don’t seem to be much better” – and, the face-to-face primary care provider has no information for managing the problem effectively.  Disintermediation is a tragedy and, it’s happening. 

Now, as a final note – I’m clearly bullish on telehealth and telecare. But, telemedicine is just one component of the overall picture.  We should take advantage of the pandemic and the CMS decisions to move forward as quickly as possible with the entire spectrum of telecare. There will be lots of mistakes; however, we must consider the long game while we move to solve the short game.  

Mythology, Mistakes and Misery – Having grown up in the heartland, the mythology is that “it’ll never get here”.  The mistake is not ordering prudent and proven approaches toward managing wide scale public health emergencies. And, the misery is the disease burden that could be reduced through the appropriate application of those proven approaches. So, when the bump in the number of cases from the rural areas was announced last week, it wasn’t a surprise.  The largest increase in coronavirus cases was clearly among those states that ignored the CDC and proceeded to manage the crisis without stay at home orders. South Dakota was the winner with a massive 205% increase in cases. It was followed by Iowa with 82%, Nebraska at 74%, Arkansas at 60%; and, Oklahoma with a 53% increase in cases over the prior week, The data was compiled by Johns Hopkins University. My home state of North Dakota along with Utah and Wyoming experienced a slight increase even though they also had not issued “stay-at-home” orders. I guess I could try to forgive North Dakota – after all, with roughly a population of 762,062 spread over 70,762 square miles or 10 people per square mile – it’s easy to get to the six feet apart rule (Governor Burgum, I’m giving you a break J and, a friendly nudge).  And, for Wyoming, I’ll forgive ‘cause it’s a family consideration. But, Utah – no excuses. Perhaps we should look at Salt Lake City alone? So, we’ll keep a watchful eye on the Plains States.  They are likely to succumb as well and if it happens it won’t be pretty.  The resources in the rural areas are weaker when it comes to the management of the coronavirus symptoms and disease.  Then, came the announcement that the Nebraska Crossing Mall was going to open in Nebraska as “a test”. My crimminy (that’s a rural term for, “Are you kidding” ☹).

Managing The Spread of Coronavirus – Many of you probably saw the graphic on CNN. However, the CDC recently released a study that originated in China showing how a single patron infected nine others at an air-conditioned restaurant in China. The infected patron did not show any symptoms until after the luncheon at a Guangzhou restaurant.  All of the infections occurred in among the guests at her table (4 patrons) or in the adjacent tables (5 patrons). If that doesn’t make you anxious about the transmission of the virus – nothing will.  In fact, the data is clearly pointing in the direction that not only open coughing but also simple breathing can disperse the virus from an infected person.  Hmmm – the ability to do massive, public-wide testing might be a good idea. 

Visualization of the COVID-19 Spread in America – Sometimes a visual can convey a problem more effectively than all the words you can must.  Check out this graphic which depicts the growth of the COVID-19 spread in the USA over the last 6 weeks.  Then, consider the implications…  Enough said!!

Now, Despite the Visualization – Perhaps the most disturbing part of the “realization” that society has been consumed by a pandemic is the fact in a Pew study nearly a third of Americans believe in a conspiracy theory about the origins of the coronavirus with a full 30% of Americans believing scientists were involved in the spread of COVID-19 and 23% that it was created by them. That isn’t what happened. 43% concurred with that opinion noting that the virus “came about naturally.” Even more baffling, 1% said the virus didn’t actually exist.

The Probable Unanticipated Surge – A new study from Australia revealed a massive 67% increase in online gambling in the weeks following the shutdown of all non-essential services in that country due to COVID-19 across the nation. The online social poker site – Global Poker – showed a similar increase of 43% for online poker. The data also revealed a 255% increase in first-time poker players. According to their data, about 40 million Americans, or 6.8% of the adult populace use online poker either alone or with friends on a regular basis.

Family violence is yet another potential disruptive problem that may rear its head in the current pandemic.  Andrew Campbell published a paper in Forensic Science International Reports in early April highlight the possible increase in family violence around the globe due to the pandemic. I would cite his article as a cautionary “warning” on the “potential” for family violence erupting as the pandemic continues its course. Why? He points to considerations like the need for social-distancing, sheltering in-place, restricted travel, and the closure of key community resources supporting the victims of family violence as potential risk factors. He also noted that alcohol abuse is a frequent concurrent problem in the household and that “with bars and restaurants being limited to take-out service only in many communities, family violence perpetrators who abuse alcohol may be even more likely to do so in the home, likely increasing risk for the entire household.”

On top of that problem is the fact that there are now reports of increasing gun and ammunition sales in the U.S. This availability of guns and ammunition in the home – which is a concern for the vast majority of health care professionals – has been shown to be clearly linked fatal domestic violence incidents [2]. Where the guns and ammunition are managed properly, the problems are infrequent. However, most households don’t engage in such precautionary measures.  While there are not yet any reports in the academic literature, it would be unlikely that we get through the current pandemic without an increase in family violence given the results of past disruptive events (e.g. hurricanes, regional fires, etc.). So, we will need to keep an eye out for this potential problem. An additional – undocumented – consideration is the likelihood that in addition to increased problem with alcohol abuse, we will also see an increase in drug overdose deaths. The risks are high and, I predict, the rural areas will be hardest hit with this problem. EMS services are more likely to be volunteer in nature (that’s how I got started in life BTW) but “timely” access to services can be compromised.  We will see.

 

Consulo Indicium - 4/17/20

Information for your Consideration…

Nothing Like a Crisis to Bring Us Together – I don’t think there’s a lot of folks out there that would have predicted that Apple and Google would become fast collaborators – even with a coronavirus crisis!  But, here we are…  They’ve teamed up to take advantage of one another’s expertise to provide a public service – tracing those infected with the Covid-19 virus via their respective iOS and Android operating systems.  They announced the collaboration and indicated that the app would be available in May. The new system will allow the public health types to be able to track who we’ve been near or spent time with as a form of digital contact tracking which is at the core of effectively managing the spread of diseases be they slow moving (e.g. syphilis) or rapid (e.g. Covid-19). It’s an approach that has been used in Hong Kong and Taiwan – both of which have had exceedingly low rates of infection due primarily to the aggressive identification of individuals with whom those with the infection have been in contact.  Yes, there are privacy issues but the manner in which they are going at it seems to mitigate those risks.  And, with a failing economy and other elements of a major catastrophe on our hands, it’s worth trusting (but verifying) that the collaborators are keeping the “public health” front and center as part of their solution.  Now, we need to go the next step.  Testing needs to be brought on board as a primary initiative as well.  Any collaborators out there?  I’ve probably been watching too much CNN but I’m with Chris Cuomo – “Let’s get after it!”

The More We Learn, The More Anxious We Become – The health care community is working hard to try and figure out this virus.  It now appears that we are “infective” a good couple of days before we show symptoms – not a good sign for those who advocate going back to work if you feel all right :-( .  The good part is that it appears the surgical face masks work to prevent transmission of the virus from symptomatic & non-symptomatic carriers.  So, in our household the use of the mask has become de rigeur – along with good handwashing technique.  But, the anxiety does not stop there.  We’re also learning that it appears the virus precipitates a micro-embolic process that first shows up as a frostbite-like lesion in fingertips. There’s also a vasculitis appearing process on the skin in some patients. There’s the lost of smell or a neurologic process. We’re even seeing reports of liver function being disrupted.  All of this portends some of the internal inflammatory response which some are attributing to a cytokine storm where the where in the body reacts to the coronavirus entering our body and our immune response kicks into to secrete a whole group of different “cytokine” molecules that create inflammation inside the body.  The inflammation then causes the vasculitis and it’s a downward spiral from there.  It’s possible to stop it. But, it’s possible to accelerate it.  Then, there is the issue of the lung or pulmonary response to all of these factors.  It’s complicated but, I’m confident the physicians with expertise will figure it out – the sooner the better!   This is where confidence in science matters…where focusing resources on testing matters…where putting resources on the table to support the scientists matters.  Let’s hope the message is getting through.

Travesty Upon Travesty – If the pandemic were not enough, a report came across the wire in Newsweek about a week ago noting that “more than 7 million Americans are expected to lose their health insurance during the coronavirus pandemic, while more than 1.5 million are already estimated to have lost coverage” And, the states with the worst coverage were naturally those that made the decision to decline Medicaid expansion under ObamaCare. It’s also getting worse as more and more individuals move toward the unemployment lines, they are losing what little health care coverage they have along with their jobs.  It’s a downward spiral. Hopefully, the nation will now realize that health care is a right, not a privilege. The major looming question is how to make the right real. The time has come to answer the question – most likely in the aftermath of Covid-19. 

Capturing Your Creative Side – The new fashion statement is a mask.  I’ve got a new “blue puzzle” mask that goes with my denim Canadian tuxedo. It’s stylish but the blue doesn’t go with the red, plaid shirt and an assortment of other clothes. With all of the clamor to wearing masks it’s become de rigeur to be wearing masks in public. In fact, I was rather upset this morning when I arrived at the local grocery to find that half the folks were not wearing masks – down from the nearly 100% a week ago.  How quickly we forget :-( .  To help you with the task, Fast Company in its most recent issue provided a description on the four best masks you can make at home – a simple mask, a filter pocket mask, a vacuum cleaner mask; and, a cotton mask.  Check it out!  You’ll be stylin’.  And, by the way, even if the pandemic slows down – don’t throw out your newly made masks when all seems to clear up.  Fall is just around the corner and the pandemic is expected to flare again.  Here’s how to make the most effective mask possible, using stuff you have lying around the house. NOW – the unfortunate aspect of this new solution is that it does nothing for those working in the acute or chronic care setting.  It’s gotten so bad in some hospitals that, sadly, they nurses and other hospital workers are making their own masks from office supplies.  How pathetic is that?  

The Importance of Touch – I was really “touched” this last week when I read an article in The Lancet by a physician on the topic of “touch”.  It resonated with me.  Perhaps I’m becoming an old fuddydud. Or, perhaps it is because whenever I think about caring for a patient I remember the words of Dr. Mann – who trained in the United Kingdom – when he explained to me in no uncertain terms that one could not be a good physician without touching someone and examining them.  His words ring loud in my experience because with his Scottish brogue it was more of a dictate than a consideration for me as a newly found clinician.  Here is but one snippet from the article, Touch…The First Language:

“Touch signifies the human nature of the predicament patient and doctor both face. Touch humanizes that predicament. Touch builds trust, reassurance, and a sense of communion. Touch is about fostering a social bond of sympathy, compassion, and tenderness between two strangers. Touch can even convey the idea of survival. Margaret Atwood wrote in The Blind Assassin (2000), ‘Touch comes before sight, before speech. It is the first language and the last, and it always tells the truth.” 

Read the whole article; however. It’s worthy of your consideration… 

The Top 1% are The Bottom of the Barrel – In a recent study reported in the British Medical Journal, researchers from Stanford University described the patterns of opioid prescribing in the US between 2003 and 2017. This period represents the dramatic uptick in opioid addiction across the nation. The finding? 1% of the providers accounted for 49% of the doses and 27% of prescriptions for all of the opioids distributed in the US in 2017. In fact, the top 1% averaged 758,000 morphine milligram equivalents (MMEs) – or, about 1000x more than the middle 1% of prescribers.  In essence, this means that a sliver minority of physicians created the massive addiction problem we have across the nation. These are physicians that obviously did not read nor care about the Hippocratic Oath. I must say that the only word that comes close to describing this situation is “pathetic”. This is a travesty against society and, in today’s world of machine learning and artificial intelligence – a result that should never have occurred.  Technology should not only be used to ferret out good results but also, to define and ferret out bad results.  Let’s use this failure as a learning for the profession and advocate the appropriate use of technology to help us find the bottom of the barrel before they do an injustice to society again.

And, Now – For A Lighter Moment…

50

Consulo Indicium - 3/23/20

Information for your Consideration…

Did You Know? – The word “quarantine” is of Italian origin derived from quaranta or, “forty” which gave the Italians the word quarantina for “forty days” which when put together with the word giorni or, “days” in the mid-17th century as quaranta giorni or, “40 nights”.  This was the amount of time that Venetian authorities required for a ship to stay in dock if a potential presence of plague was detected among the shipmates.

Did You Also Know? – As part of the transition from the Obama to the Trump Administration – a required process that occurs between a change of administrations – the Trump team was taken through a potential pandemic scenario as one of the lessons to be learned.  The briefing focused on a hypothetical N9N2 virus with all the appearances we are facing today with Covid-19.  According to Politico, as part of the scenario the Trump officials were informed that: “Health officials warn that this could become the worst influenza pandemic since 1918.” But, it was merely a scenario and – in spite of the fact that the scenario looked incredibly like Covid-19 – when the leaders took office they dismantled the National Security Council’s Global Health Security and Biodefense office. One of the key problems it seems  is that about two-thirds of the Trump representatives who were present in the room and participated in the scenario discussions are no longer in the administration. The hollowing out of leadership during the last three years due to turnover, dismissals and other factors made the pandemic seem unreal or, they simply lost sight of the possibility.  Regardless, we are now where we are… 

The Big Turn – As those of you who have been following my blog for a long time know, I’ve been a big proponent of the need for health care organizations to adopt digital capabilities for delivering effective and efficient care. The advent of potential use for telecare technologies has exploded in recent years. But the Covid-19 crisis has made an explosion seem minor compared to the nuclear growth anticipated for the coming period of time.  A just released study on the telehealth market predicts we will see a growth from the $2.78 billion market in 2016 to a $9.35 billion market in 2021 or, a CAGR of 27.5%.  According to the report, “The growth of the overall market can be attributed to growth in geriatric population, dearth of healthcare professionals worldwide, improvements in telecommunication infrastructure, technological advancements, increasing utilization of connected devices for the management of chronic diseases, and need for affordable treatment options due to rising healthcare costs.”

The critical component of these changes is our ability to remotely manage care through the use of various devices. Not only are we able to directly monitor biophysical markers (e.g. cardiac rhythms) but also remote biological testing (e.g. blood glucose) and even ambient air pressures changes where people live (e.g. falls, breathing patterns, cardiac status) can be used for monitoring individuals in the home or other environments.  With the Covid-19 crisis, we are now seeing the big turn where all of sudden health care organizations have gotten religion. The move toward wanting to deploy and use remote patient monitoring (RPM) and telehealth/telecare/telemedicine capabilities as well as remote support (e.g. chatbots) is exploding. We are fundamentally moving toward a change in how and where health care will be delivered.  It’s an unstoppable tsunami wave and those health care systems and clinical practices that ignore the signals will be left at the station as the big turn gains momentum in the coming year. 

Consumer Testing for Covid-19 Begins – February 29th marked a significant change in direction for the US Food and Drug Administration (FDA). It’s ironic that it occurred on the 29th – which only occurs every fourth year during “leap year”. On that date the FDA leaped at the opportunity to allow certified labs and commercial lab testing companies to develop and distribute Covid-19 tests along with those under development by state and local public health labs.  It’s a big change and it accelerated industry’s efforts to develop consumer-oriented lab tests.  The first to roll out a product was Everlywell, a home testing company offering an array of consumer-focused lab tests such as fertility, STD and cholesterol testing began offering a Covid-19 test on March 23. They even arranged for oversight using a network of telemedicine physicians to review the health and symptom data before ordering the tests – a continuing FDA requirement.

The Most Important Graph – On the following page, you will see the most important graph you can find related to the current Covid-19 pandemic. It comes from a 2007 proceedings from the National Academy of Sciences. In 1918, the city of Philadelphia decided to host a parade in support of the war effort (See the solid on the graph).  City officials ignored warnings of a probable flu outbreak among the soldiers who were preparing to be sent off to Europe in support of the US war effort during World War I.  The march brought several hundred thousand supporters who stood next to one another throughout the parade.  Within three days, the health care institutions of the city were overwhelmed with patients suffering from the Spanish flu. On the other hand, St. Louis made a different decision.  Because of the flu warnings, the St. Louis city officials closed schools, churches, libraries, playgrounds and such in steps to limit public interaction.  They even went so far as to ban public gatherings of 20 or more people.  Sound familiar?  The results of flu in St. Louis reveal a “flattening” of the curve (See dotted line on the graph).

graph

Elective Admissions and Procedures Put On Hold – In anticipation of the need for use of beds for patients with the Corona virus a large number of hospitals based in ”hot spots” around the country (e.g. Greater Boston, New York City, Seattle, San Francisco and others) have place elective admissions and procedures on hold.  This is not an unanticipated move. In fact, I was on the phone this past week to a relative who was planning an elective surgery to “put it on hold”.  Emergency admissions and procedures will be continuing as usual. 

Medicare For All Projected to Cut Healthcare Expenditures and Save Lives – A recent study published in the journal Lancet projected that a Medicare For All healthcare system holds the potential “to improve the availability of services and efficiency of care in the United States.” According to the study, the massive restructuring of the health care system would save about 13% in total or about $450 billion in annual costs.  And, $450 billion can be used in a lot of different ways from providing additional social services to education to infrastructure to you name it!  That in the parlance of the Central USA where I grew up is a chunk of change.  In addition, the study also projects that we would save about 68,000 lives on an annual basis because patients would have uniform access to care delivery across the US. In reading the study, it did seem to address the transition costs.  The Sanders Campaign has proposed a two-year window for transition. As a proponent of change but a realist when it comes to moving the health care system forward (after 40 some years of experience), the speed of that transition is far too optimistic. It would be good to have some health care professionals come together and have this debate instead of a bunch of politicians. We should organize it. Inquiring minds want to know the consensus among the implementors and, that’s us!

AI Projected To Improve Patient Access To Care – In a recent article in Healthcare IT News a report prepared by KPMG (the consulting group) revealed that across five industries, healthcare was a leader in the potential for artificial intelligence to maximize outcomes and results.  The showed that “91% believe it is increasing patient access to care” and, that another 89% felt that the use of AI would benefit the industry, in general.  Those are significant findings. As the nation moves toward the use of digital technologies for enhancing outcomes, the overlay of effective AI is an essential component if we want to drive in further improvements in how, when, where, and who is involved in the care delivery process.

Consulo Indicium - 3/16/20

Information for your Consideration…

 Happy Birthday Maine – March 15th was our 200th birthday celebration as a member of the United States of America.  We are thankful or, at least most of us…

Spreading the Word – The Seattle Times recently published two good graphics that you should share with friends and family.  I did not find a copyright so share away... 

Covid1

Covid2

Anthony Fauci, MD Speaks – Dr. Fauci was recently interviewed for an article in this week’s NEJM entitled “Talking with Patients about Covid-19”. When Authony Fauci speaks – we should listen!

Basic Covid-19 Facts – Amidst the cacophony of information, here are some basic facts you need to know that are published by the World Health Organization:

  • The World Health Organization has calculated the doubling time for Covid-19 and up to and including 8th March 2020 it as follows:
    • If China is included = 20 days
    • If China is excluded = 4 days
    • Why? The difference is attributed to the fact that the total number of daily cases has declined following the lockdown of China.
  • The predictive value of the doubling time is unreliable since how each country responds will be different PLUS the doubling time is calculated based on a fixed amount of time for the period. However, it can be used as a reminder of the exponential nature of the growth in incidence of the disease.
  • To give you a sense of what exponential growth means, if you take 500 cases and double it over time, it will become 1 million cases after 11 doubling times. And, if you add 10 more doubling times to that block of cases, the world would be experiencing 1 billion cases.
  • In the USA, it appears that the cases are doubling about every 2 – 5 days depending on geographical location and origin of the outbreak. The average doubling rate for the USA (as of March 14, 2020) was 3 days – and, that’s a very rapid growth rate with 1,678 cases reported as of that date [SEE “Country by Country Growth” at Our World In Data].
  • The current rate of hospitalizations of cases in China are classified as:
    • 18% severe
    • 15% as hospitalization only
    • 3% result in death 
  • In comparison to the N1N1 respiratory or “common” flu, the death rate among severe cases is 5.8% for N1N1 and 13% for Covid-19. 13% of severe cases result in death as opposed to about 5.8% for H1N1.
  • It is two times plus more dangerous for hospitalized cases than the “common” flu in circulation in 2020.  This is in no way a prediction for the number of cases we need to expect; it is simply a reminder that exponential growth leads to very large numbers very quickly even when starting from a low base.

Johns Hopkins Leading the Way – The Johns Hopkins University website on the coronavirus is now universally considered one of the best available resources for monitoring and managing the Covid-19 outbreak.

TP Madness – In the midst of madness, it’s a time to also step back and consider a bit of humor. Dark humor can help us get through the tough times but taking us to the edge of reality.  This morning, I learned that a colleague stopped at the gas station on the way to church only to discover that toilet paper was selling for $1 per roll. Somebody out there is sitting on a gold mine! 

Unmasking America – It is times of crisis that we often unmask other significant issues in society.  The list for the USA keeps growing.  Here are just a few examples

  • New York City may not totally represent the USA but – it does represent a problem we have in the country that has been unmasked by Covid-19. In “the City”, 1 in 3 children live below the poverty line.  The very sad part of this statistic is that these children rely upon the school system to provide them for adequate nutrition where they often receive three meals a day – breakfast, lunch and dinner plus a backpack full of food for the weekend.  With the imposed cancellation of schools, these kids will NOT get adequate nutrition!
  • Anecdotes abound about “what’s a parent to do”. Working Moms and Dads can’t afford to stay home because without pay, their bills mount up and quickly overwhelm them. 
  • It’s become clear to all of us that the USA lacks a “national” public health system. We rely entirely upon local and state governments to respond to national health emergencies like the Covid-19 pandemic.  Unfortunately, the “distributed” model of public health in times  of needs reveals the very disjointed nature of our response.  Unlike China – which has an entirely different, mandatory, no-exceptions-to-not-following-the state-mandated (which I am not advocating) approach – the USA public health model is a free-for-all.  Surely, there is a more coordinated approach that can be developed and deployed.  Not surely, actually there are models…
  • We knew the pandemic was coming. It was only a matter of time.  In fact, the national office established as part of our national security apparatus was funded and in place through multiple generations of political parties until Trump took over.  The dismantling of our response system for the expediency of building other things has thwarted our efforts to adequately respond as a nation. 

DO THE FIVE… 1   HANDS Wash them often, 2   ELBOW Cough into it, 3   FACE Don't touch it,       4   FEET Stay more than 3ft apart; and, 5   FEEL sick? Stay home

Cognitive Decline Accelerates Among Widowers – A recent report appeared in JAMA Open Network reporting that researchers discovered over a three year period following the death of a spouse, the surviving spouse had cognitive declines that were 3X faster than a population of comparable married couples.  The decline was apparently independent of beta-amyloid levels – a major marker used for monitoring Alzheimer’s. The implication was that losing your spouse accelerated your cognitive decline regardless of biometric markers that were measured.  So, message received.  Keep your spouse healthy!  Lots of fruits and vegetables. And, wash your hands, keep your distance, cough into your elbow, don’t touch your face and if you feel sick – stay sequestered in the bedroom.  And, I’ll add another one – no heavy kissing :-)  . 

Diet Is Important – In a separate study reported in JAMA Internal Medicine, it was noted that the low-carb and low-fat diets which have become the rage actually only contribute to a longer life if followers maintain a healthier intake of foods, in general. So, what does that mean?  It means a diet consisting of more plant proteins (think legumes), unsaturated fats and high-quality carbohydrates like fruits and vegetables (see above) and whole grains.  The 20-year study followed nearly 40,000 participants. It noted that “people who got the most calories from unhealthy foods were 16% more likely to die during the study…” BTW, unhealthy foods means fast foods (in general), high fat, high carb loading type foods.

Testing for Covid-19 – Qiagen is a company that most everyone had never heard of except in the nether world of genomic testing until the past few days.  Why it did it become so prominent?  It seems that Qiagen has been designated by the CDC as the only listed source of “RNA Extraction Options” to be used in Covid-19 testing.  There are a few other companies out there but Qiagen is the one designated for testing by the CDC. The end result is that the company is boosting its production of a chemical that is essential for the testing and that has been “challenging” according to a company press release.  They are ramping up production at their factories in Germany and Spain – which are also in the midst of a Covid-19 outbreak. The problem is that the chemical produced by Qiagen is a key element used in the RNA extraction kits and without it, there is likely to be a delay in coronavirus testing across the USA or, we will need to find an alternative.  BTW, Thermo Fisher Scientific Inc announced last week that it had agreed to acquire Qiagen in a $11.5 billion deal. Nothing like a pandemic to seal a deal…

Consulo Indicium - 3/12/20

Information for your Consideration…

Greetings – Rather than the usual American handshake or the Middle Eastern/South European hug or the double (even triple) kiss on the cheek, there are some new greetings to consider.  In case you missed it, there is the Elbow Bump (touching one another’s elbows), the Wuhan Shuffle (touching your shoe-covered toes together) or the Fist Bump (exactly what it says). Try it.  You’ll be hip! 

Humor Amid A Pandemic – Sometimes when events turn very serious, humor can be a stress reliever.  So, when I received this meme on Twitter, I felt compelled to forward it for those who may not have received it.  It was a simple message that said:

“TEXAS CORONAVIRUS PREVENTION – Wash your hands like you just got done slicing jalapenos for a batch of nachos and you need to take your contacts out. (That’s like 20 seconds of scrubbing, y’all)”  It’s OK to smile or even laugh out loud…

Hope On The Horizon – But, while much of the medical community is shaking its head at the management of the crisis, there is some hope on the horizon. On March 6th, President Trump signed into law a major supplemental appropriations bill which allocates $8.3 billion for the Covid-19 pandemic fight at the local, state, national, and international levels. In addition, the legislation included an important waiver giving authority to the Secretary Azar of Health and Human Services to waive on a temporary basis the Medicare telehealth requirements to assist in managing the Covid-19 crisis by paying for services provided on a virtual basis. The waiver will make it possible for Medicare recipients to receive telehealth care from their homes and through use of mobile devices. The waiver provides a dramatic shift in policy and removes many of the obstacles which many of us have been complaining about for some time. The one limitation is that the waiver will apply to services provided by providers only if they have cared for the beneficiary at least once in the last three years. No doubt, many will be following the results of the waiver closely with the interpretations on the outcomes driving these changes either forward or into reverse following the pandemic.  I suspect we will see a move to move forward even more rapidly.  In fact, the Covid-19 crisis has probably done more to change the future of care delivery than virtually any other event over the last couple of decades. 

In Case You’re Interested – I heard a statistic the other day that I found troubling – in large measure, because it sounded incorrect.  And, I was right.  The statement made was that “…in the whole of Congress, there are only two humans with degrees in science or technology.”  My response was: What?  So, I looked it up.  Here are the results from Wikipedia under the category of Occupational Background of Congressional Members:

  • 24 members were health care professionals with 16 as medical doctors (14 Representatives and two Senators) distributed among the following specialties: family medicine (Reps. Vic Snyder, John Fleming, Paul Brown, Donna Christian-Christensen), Psychiatry (Rep. Jim McDermott), Ob/Gyn (Sen. Tom Coburn and Rep. Michael C. Burgess, Ron Paul, Phil Roe and Phil Gingrey), Allergy (Rep. Steve Kagan), Gastroenterology (Rep. Bill Cassidy), Cardiovascular Surgery (Rep. Charles Boustany), Radiation Oncology (Rep. Parker Griffith), Orthopedics (Sen. John Barrasso and Rep Tom Price).
  • Three Nurses (Reps. Carolyn McCarthy, Lois Capps and Eddie Bernice Johnson)
  • Two Dentists (Reps. John Linder and Mike Simpson)
  • Two Veterinarians (Rep. Kurt Schrader and Sen. John Ensign)
  • One Psychologist (Rep. Brian Baird),
  • One Optometrist (Rep. John Boozman)
  • One Dietician (Rep. Kathy Dahlkemper); and,
  • One Pharmacist (Rep. Robert Marion Berry).

Beyond the medical side, there are also the following:

  • Five Engineers (Rep. Joe Barton, Cliff Stearns, Pete Stark)
  • Six Scientists listed as: Three Physicists (Rep. Rush Holt, Bill Foster, and Vern Ehlers), a Chemist (Rep. Ed Pastor), a Microbiologist (Rep. Louise Slaughter; and, a Physiologist (Rep. Roscoe Bartlett). 

There is also an astronaut, an aviator, a battle group commander, West Point instructors, a pilot of Marine One and probably a few others that I may have missed.  So, the message to all of the science-based political leaders is: STEP UP TO THE PLATE AND PROVIDE SOME SCIENTIFIC LEADERSHIP!! 

CountMeIn – I just learned about this wonderful initiative and thought that we need to share widely.  CountMeIn is a website where people who have cancer can sign up to participate in cutting edge research. It’s a nonprofit organization. The mission statement states that it’s “pursuing a new approach to cancer research – bringing patients and researchers together as partners to accelerate discoveries.”  In essence, the website allows individual patients to become involved in various breakthrough cancer research project so that biomedical research can occur at a quickened pace. It’s a new way of empowering people to help others that may help themselves as well. 

The Missing Vaccine – One of the big issues we are facing in the task of preventing further spread of the Covid-19 virus is the lack of a vaccine.  Anthony Fauci, MD – probably the most sensible leader on the President’s Task Force – has noted that it will take upwards of eight months before a vaccine is available. However, researchers at Moderna Therapeutics have pursued a very new and innovative model for creating a vaccine.  According to The Wall Street Journal they sent information on their approach to the National Institute of Allergy and Infectious Diseases (NIAID) in Maryland on February 24th.  In addition, the company is evidently recruiting healthy volunteers to participate in a clinical trial for an experimental COVID-19 vaccine which they hope to begin in late April.  The approach is very different than traditional models.  Usually, pharmaceutical companies use “killed” or “weakened” virus as the template for creating a vaccine that attacks the virus.  In this case, the company used messenger RNA (mRNA) which they created in the lab.  The mRNA then encodes the details of the protein structure of the virus which can be used to build out the vaccine.  This approach is entirely new so, it is cutting edge.  The intent is to build a protein that essentially replicates the virus and can be used as a template for getting the individuals who receive the vaccine to create sufficient antibodies that target, attach and kill the virus in the body, thereby preventing the complications of the viral infection.  In essence, it’s creating artificial proteins that look like the virus so that the body is tricked into creating antibodies to the Covid-19.   By using the approach, Moderna has been able to fast-track the development process.  Why?  Because they did not have to go through the arduous process of isolating live samples of the Covid-19 virus and modifying them so that they could be used for creating a more traditional vaccine.  The description for the initiative is at ClinicalTrials.gov. Check it out…

Healthcare Consultants

    ...Inspiring creative change to benefit the human condition