Consulo Indicium - 11/5/20
Information for your Consideration…
An Update on the Definition of “Consulo Indicium” – Since the beginning of my blog I’ve used the words “Consulo Indicium” to describes these short overviews. The words are Latin with the following meanings: Consulo = “to seek counsel or consult”; and Indicium = “signs or indications”. So, please be advised that the following missives are just that – “signs or indications of counsel or consultation” we should consider. I offer a repeat of the definition because these pieces of information are just that – pieces. They are meant to point you in the right directions. They are not perfect but…they are good indicators of the directions we need to consider.
Kudos For Fauci – The National Academy of Medicine (NAM) announced last week that they are awarding the Academy’s first-ever Presidential Citation for Exemplary Leadership to Dr. Anthony Fauci, MD – the Director of the National Institute for Allergy and Infectious Diseases (NIAID). He’s also the one we listen to in the health care professions due to his sound advice and willingness to step forward with his professional thoughts in a period of stress and strain. In making the award, the Academy made the following statement:
“In recognition of extraordinary service and outstanding contributions to biomedical science, health care, and public health in the United States, in particular: Pioneering advances in the field of human immunoregulation and lifesaving therapies for rare immune disorders; Seminal research and groundbreaking leadership in prevention and treatment of HIV/AIDS, impacting countless lives now and in the future; Enduring, visionary guidance to the field of biomedical research globally and nationally; Unprecedented public service as director of the National Institute of Allergy and Infectious Diseases for nearly four decades; Distinguished service as a trusted advisor to six U.S. presidents during public health crises including HIV/AIDS, SARS, anthrax, influenza, and Ebola; and Firm and steady leadership during the COVID-19 pandemic, offering an unwavering, trusted voice to the nation and world on behalf of science-based policy and public health.”
Notes from Tom Frieden, MD – The former head of the Centers for Disease Control sent out the following Tweet that seemed worth sharing on the impact of the Covid-19 pandemic. Here’s the data for the cumulative hospitalizations for people >65 in US:
And, Eric Topol, MD – Then, came the alarming Tweet from Dr. Topol: "In a young, low-risk population with ongoing symptoms, almost 70% of individuals have impairment in 1 or more organs 4 months after initial symptoms of infection.”
New Federal Guidance from CDC – Last week, the Centers for Disease Control and Prevention issued a guidance that considerably expands the pool of people considered at risk of contracting Covid-19 by changing the definition of who is a “close contact” of an infected individual. It will no doubt cause a big impact on schools, office work environments and other places where extended group activities are common (e.g. churches, bars, restaurants, etc.). The guidance clearly emphasizes the importance of mask-wearing to prevent spread of the virus despite alternative thoughts emanating from political positions in the Trump Administration or, The White House. Specifically, the new CDC guidance now defines a “close contact” as someone who was within six feet of an infected individual for a total of 15 minutes or more over a 24-hour period [emphasis added]. The other point made in the guidance is that as many as half of people who are infected don’t show symptoms with the CDC further stating: “…it’s critical to wear a mask because you could be carrying the virus and not know it. While a mask provides some limited protection to the wearer, each additional person who wears a mask increases the individual protection for everyone. When more people wear masks, more people are protected.”
COVID-19 Is Decimating Primary Care – The stark reality is that declines in the number of patient visits during the pandemic are projected to cost primary care providers an estimated $15 billion in revenue or about $65,000 per physician according to a study in Health Affairs that I missed back in June among the piles of reading materials on my floor. It’s also projected that the numbers are going to go up substantially if there is a second viral peak or if the reimbursement rates for telehealth visits revert back to pre-Covid-19 levels – which is likely to happen without Congressional intervention. In a prior article in JAMA back in 2019 by the researchers, they documented that the availability of primary care services saves lives. This has been my mantra for decades not only as a Family Physician but also as someone who has continued to monitor the literature on how to improve the quantity and quality of care across the nation, especially for underserved areas. Primary care is the focal point for entry into the health care system and how it is managed and supported has a huge impact on cost, quality, service and all the other important elements of a service industry. Russell Phillips, one of the researchers involved in the study made the following important observation: “The coronavirus pandemic is a pointed reminder of the importance of primary care to our society. Primary care is critical to limiting the spread of the virus, in treating the comorbidities that can make Covid-19 so deadly and in helping people navigate the social and psychological challenges of social distancing and of living with the pandemic.”
To Mask Or Not To Mask, That Is The Question! – Back in late July/early August, I wrote a short piece with the same title. The started with the following note:
“The Mask” has taken on new meaning in society writ large. We can now order masks that convey our favorite symbol or topic du jour. There are Trump masks and Joe masks. There are peace masks, BLM masks, puzzle masks, and the latest – “your face” masks which duplicate the bottom half of your face as a mask. Then, there are just plain old blue surgical masks, N95 masks and an assortment of other personal protective gear designed for those with chronic exposure to the Covid-19 virus.
This past week, I talked with a fellow doctor and relative who also happens to be a physician. We were discussing the pandemic and the use of masks. I was disheartened by his response that the “public panic” by everyone on getting the Covid-19 viral infection is “blown out of proportion”. He cited all sorts of data – which I honestly was not able to capture as quickly as I wanted – to support his contention that wearing masks was not helpful. So, I decided I needed to review the literature once again. Back in the summer I noted that the question we need to be asking regarding the wearing of masks is: What do the studies show? So, I went back to the literature and, it’s clear, the data is extrapolated not definitive. However, the studies cited from that July 29, 2020 Fickenscher Files still hold true. The data is not perfect but, the data offer clear indications that: USING MASKS MAKES A DIFFERENCE!
First, the Centers for Disease Control and Prevention (CDC) and the World Health Organization both recommend the use of cloth masks by the general public despite the fact that earlier in the pandemic they recommended the exact opposite. Oy vey!! But it has become clear over time that wearing masks does – in fact – make a difference!! Just last week there was another study published online Nature Medicine on October 23rd highlighting the need for Americans to adopt the wearing of masks. It is yet another study from the University of Washington Institute for Health Metrics and Evaluation (IHME) – a leading group on predicting viral spread using cumulative data. They predict that a cumulative 511,000 lives could potentially be lost from Covid-19 by the end of February 2021 if masks are not universally worn. However, if we could get to 95% of Americans wearing them in addition to appropriate social distancing, we could save almost 130,000 lives. With 85% compliance, the IHME predicts that nearly 100,000 would be spared over the same time period. So, are not that many lives worth saving? Isn’t that what practicing medicine is all about – making lives better and saving them when we can? I’m on statins not because my cholesterol is very high (It is actually a bit low) but, because there are studies showing that the statins provide a stabilization of the capillary structure which reduces the formation of clots thereby making it less likely that I’ll have a stroke, heart attack or other similar problem. It seems worth it to me! It’s not perfect data but, it’s indicative data.
The naysayers of the Washington study offer the critique that their predictions are mere “thought experiments” because near-universal mask wearing – particularly in the USA – is not going to happen. I mean after all – just look at the attendees at the recent Trump rallies. But also look at the surge in Covid-19 cases about 3- 4 weeks after those rallies. The data, again, is not perfect but it sure points in the direction of “superspreader” events. Hmmmm… Here’s some additional data to consider that I found in my review of the literature:
- Mask wearing may reduce the dose of virus a wearer receives resulting in a milder or even asymptomatic infection. The evidence suggests that a larger viral load results in a bigger inflammatory response.
- Surgical and comparable cloth masks are about 67% effective in protecting the wearer of a mask and those cloth masks with multiple layers also seem to be more effective especially if different materials are used in layers [NOTE: I wear a cloth mask that allows me to insert a disposable paper filter – it was designed by one of my medical school classmates and made of material with the “peace sign” in multiple colors – a sort of retro-1960s/70s look 😊)
- A study of hamsters – where all of the variables can be controlled unlike their human counterparts – showed that those hamsters who wore barriers had a remarkably lower rate of infection and were less sick from Covid-19 (= 25%) compared to their non-barrier wearing counterparts (= 66%).