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…


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