Consulo Indicium - 9/3/20

A Proposed Official Mascot for the Ongoing Pandemic – I received a copy of this pic via my Twitter account and felt compelled to pass it along here in the blog. The picture speaks for itself. Pass it along!!

Swamp Happenings – The humidity and heat have been on the rise in Washington, DC as both the Democratic and Republican conventions came together virtually. Of the topics mentioned by each party – there’s one that was on both lists = “health care”. In fact, in mid-August, the Trump Administration launched the Pledge to Embrace Technology to Advance America’s Health. The intent of the pledge was to get ahead of the political dialogue by promoting telehealth as a permanent part of the care delivery for patients and by providers. The response of the telehealth and care delivery communities has been strong with enthusiastic commitment for further expansion of coverage. Reports by The Washington Post have noted a 4300% increase nationwide in the telehealth and telecare utilization compared to pre-pandemic use. In other news, the Trump Administration signed an Executive Order for expansion of telehealth services for rural areas of the nation with the intent that CMS will continue its efforts to expand telehealth on a permanent basis for Medicare and Medicaid. If the big gorillas (= Medicare and Medicaid) go virtual, the rest of the nation will likely follow and, in fact, that seems to be happening.  

Readings to Consider – I don’t usually point to the large number of readings I peruse as part of my literary wanderings. However, there’s a very good overview of the pandemic evolution and projected outcomes in the March 2020 Atlantic. While The Atlantic Perspective is long, it’s definitely worth reading. The article provides an overview of the current state, a perspective on how we are managing the pandemic and projections on the longer term. 

Responses on Partisanship –As my regular leaders know, I recently experienced some backlash because I was accused of being “too partisan” – so, I ask the readers. I really do try to stick to the facts but at the same time believe that health care – how we fund it, how we deliver it, how to regulate it, etc. is a highly political concern and will be so increasingly in the years to come. The U.S. Congress recently passed a 3 trillion dollar (yes, that’s a “t”) mega-spending bill in an effort to help those who are suffering economically from the effects of the pandemic. I’m fully supportive. Now, they are looking at an additional $2 trillion package. That total investment of $5 trillion will go on top of the largest deficit in U.S. history – about $1+ trillion – accumulated by our last 3 Presidents. Now, if you were a legislator trying to stem the tide of deficits and examined the U.S. budget, it would become clear that just shy of 50+% is consumed by health care and entitlements. Hmmm. It seems to me that healthcare has a big target on its back. Change is coming…

Now – as for comments on my “partisanship”, here are a couple that I thought I should share that point in the direction of my sentiments:

• It’s okay to be partisan if you are partisan for science, evidence, fair process, compassion, empathy. If that leads you to support one person or ideology over another, so be it. To not take a stand is to take a stand. 
• It cannot be accepted that talking about facts is partisan. Mentioning a person who is partisan who has made facts a partisan issue is not a partisan comment, it is a fact about reality. We cannot let ourselves be drawn into an argument over whether facts are partisan. We must continue to state facts, including facts about what people are saying about facts, the lies they are promoting, and be unashamedly clear that we are NOT being partisan. Disagreeing with a lie is not partisan. Lies and facts DO NOT warrant equal time in a discussion, any discussion.
• Don’t flog yourself about others concerns about the two sidism trap. Hate to break it to everyone but healthcare is political and economic. It has always been and will always be. Certainly in this pandemic we are seeing even more nakedly the confluence of healthcare, politics and economics. 

Thanks to all the readers for your ongoing comments, thoughts, perspective and ideas. Also, a little secret. The best read portion of the blog is “The Weekly Whisk” where I share my favorite restaurant of the last couple of weeks or, more recently, my favorite recipe. The recipes have taken over because of the pandemic. For the first time in more than 35 years, I’ve been home for more than 3 months at a single stretch. It’s a new life without travel. And, I’m lovin’ it!! More later…

Covid-19 Research Findings for Your Consideration – It seems like on a daily basis there are new findings on the way we should be managing the pandemic crisis. Here are a few miscellaneous items you may want to have the organizations you are involved with consider as part of their protocols:

• The Pharos Global Health Advisors, a Boston-based not-for-profit focused on global health issues recently announced that indoor dining has been linked to 10% of new infections in various states around the nation. Disease experts in the state have also pointed to indoor dining as an area of concern, with some calling for a rollback of reopening.
• In a study reported in Health Affairs by Lyu and Wehby the effects of state government mandates in 15 states related to the use of masks were studied in the period of April to May. The researchers reviewed the rate of county-level increases in in Covid-19 incidence in the 1-5, 6-10, 11-15, 16-20 and 21 or more days following the state order to use masks. Based on the study, it was estimated that more than 200,000 infections were averted through the use of masks. For details review the study.
• One of the findings from research is how Covid-19 is spreading. In the vast majority of cases where an individual becomes infected, they infect – on average – one to two other individuals – but that’s it! So where are all of the cases coming from? It seems that “superspreader events” are the primary source. Evidence from around the world is showing that the superspreader events are the source for 80+% of all Covid-19 infections. So, what are these events? They are the typical indoor gathering = large events (e.g. rallies for political candidates, the Sturgis gathering of motorcyclists in South Dakota), churches (e.g. yes – all of them: Protestant, Catholic, Jewish, Muslim – pick your favorite faith), bars (e.g. especially those packed with younger folks having the time of their life late in the evening), restaurants (e.g. closely packed ones are especially vulnerable), confined locations where people are together for protracted periods of time (e.g. cruise ships, Navy carriers, etc.), worker commons or those open area work places where large numbers of co-workers gather to connect and work on projects; and, other similar venues. I know that for our family, we’ve gone from 1 – 2 meals out at a restaurant per week to only 2 outings since February – AND, both were at outside venues a bit after hours when the vast majority of people had gone home for the evening. An example of such a superspreader event was the Biogen conference held at a hotel in Boston in late-Februaryfor the biotech company Biogen. Researchers in a study of the conference looked at the specific genetic mutation of the virus among those who became infected at the conference. Through that analysis, they were able to determine that this one event led to an estimated 20,000 Covid-19 cases across the county. in total. BTW, I was at a different conference at the same hotel just a few days after the Biogen conference in the same area of the same hotel. Whew!!! Missed it…

Why Are Superspreader Events a Problem? – If we look at how the Covid-19 virus spreads, researchers have determined that the “primary” (i.e. not only but “most often” by a long shot) mode of transmission is through microscopic droplets that are spewed forth when an infected person coughs or sneezes — or even speaks. The people close to these individuals then breathe in the droplets and become infected. This the is reason that the CDC has stipulated that we should maintain “social distancing” of at least 6 feet away from people AND wear a mask in public. The microdroplets generally do not travel in the air further than about 4 – 5 feet creating a “bubble” near a person. So, if we stay outside of the bubble range – the odds of infection are markedly reduced. But, that’s not the end of the story. Researchers have more recently discovered that the Covid-19 virus also spreads through even smaller, longer-lasting aerosols particles caused by simply breathing, speaking or, even flushing the toilet [Commentary: Oy Vey!!]. The aerosols are so small they can hang in the air after an infectious person has left the room for a period of up to three hours [Commentary: Double Oy Vey!!!!]. This may be the reason that the superspreader events are such a significant reason in the spread of Covid-19 – which brings me to my last point – the asymptomatic or pre-symptomatic individuals. In particular, this group of people are the highest risk for the rest of us. It is these individuals that unwittingly spread the virus among those who don’t quite get it and refuse to wear masks. We, in general, are wearing masks even among family members on the notion that if members have been out and about, they may have been exposed So, consider it.

The Alzheimer’s Horizon Holds a Glimmer of Hope – Alzheimer’s Disease is absolutely the worst disease in the world. Our family is afflicted with my Mom suffering from the ravages of end-stage disease. I’ve been a physician and worked in lots of situations both traumatic, chronic, acute and the like but – in my personal experience – Alzheimer’s is the worst!! But, there is hope on the horizon. The New York Times and other news outlets recently reported that researchers have developed a diagnostic blood test that can accurately determine the presence of Alzheimer’s. It measures the level of a tau protein (= p-tau217) that is linked to the presence of Alzheimer’s in patients. The new test is just as accurate as the more expensive or invasive diagnostic procedures used in today’s encounters. But, the added fact is that the new blood tests can make the diagnosis up to two years earlier than the other procedures! The findings were published in JAMA.