Consulo Indicium - 12/7/22

Information for your Consideration… 

Omicron Subvariants Are Shifting – In mid-November, the CDC reported that Omicron subvariants BQ.1 and BQ.1.1 were accounting for about 44.2% of all COVID for that time period. This was compared to 32.6% of cases during the first week of November. According to the CDC report, the two variants “…made up less than 10% of total cases in the country” in October. This probably explains while – yet again – despite my precautions and withdrawal from socializing except for close friends, I was again infected. Yikes!! The only good part was that I was totally boosted and with the help of Paxlovid, the symptoms did not last that long and I was back in the saddle in about 4 days and testing COVID negative.

Waning Measles Vaccinations Creates A Potential Measles Outbreak As An Imminent Threat Worldwide. Oy! Just when we are making progress worldwide with the vaccination of children, the CDC issued a Thanksgiving warning that the nations of the world  “could be on the verge of a [measles] comeback after a lull in the immediate months following the emergence of the coronavirus. The potential for a measles outbreak was described as “an ‘imminent threat in every region of the world’…” Why? Because nearly 40 million children missed their measles vaccinations in large measure because of the pandemic. The details are ominous. Worldwide there were 9 million measles infections and 128,000 deaths in 2021. The other element that adds to this problem is the fact that a recent poll revealed that while 82% of parents in the USA have discussed existing immunizations or vaccination schedules with their primary care provider, only 68% had discussed influenza vaccine and 57%, COVID-19 vaccine. 

The Burden Of Healthcare Costs – A recent ranking by Forbes on the burden of health care costs continues to point to disparities across the nation. On average in 2020, healthcare costs averaged $10,000 per person. Regardless of your personal economics that’s a chunk of change! The study also pointed to the fact the problem is worse in the eastern USA with five out of ten of the highest cost states located in that region, including: West Virginia, Florida, Maine (where I live 😊), Delaware and New Hampshire. This was in comparison to the least expensive states which were western, including: Washington, Nevada, Hawaii, New Mexico and Oregon. What was particularly disturbing from the report is that Americans are increasingly delaying care due to unaffordability. 27% of survey respondents said they have delayed a doctor’s visit, 19% delayed a medical procedure and 19% avoided a prescription refill. The data was derived from a Kaiser Family Foundation analysis. It’s increasingly clear to me that we are headed toward a financial cliff related to health care costs. The combination of the stress of high health care costs coupled with the number of elders entering the Medicare market are creating stress points across the system and moving us toward a clear focus on value-based care delivery programs that increasingly are demonstrating better outcomes and results at lower costs. 

And Now, Burnout Is A Problem – A recent Commonwealth Fund report documents one of the major factors behind the growing shortages of physicians, nurses and other care givers in the wake of the COVID-19 pandemic. Here are some of the important statistics from the study:

• Just over half of USA primary care physicians under age 55 report being burned out and 45% plan to stop seeing patients within the next three years.
• 61% of the same cohort have experienced emotional distress since the start of the pandemic
• Compounding the loss of PCP providers, medical students are less likelyto pursue a career in primary care – in large measure because of the stress conditions and, instead are opting for specialty fields. 
• As a result, by 2034 the USA will be facing a shortageof 17,800 to 48,000 primary care physicians. 

The Commonwealth Fund report is worth a review by all health care leaders that are working to create a sustainable health care delivery organization. Without adequate primary care providers, my fear is that the system could implode. We’re moving in that direction.

The SuperAgers – I recently read some work done by Marc Milstein, Ph.D., a brain health researcher based at the University of California Los Angeles and wanted to pass along his thoughts on how all of us can work to maintain good brain functioning as we get older. It’s an area of research that has caught my interest of late 😊 and – will no doubt – be an area of continuing interest in the months and years immediately ahead. Long story short, Dr. Milstein has noted that it’s not just our genes, it’s also our behaviors that can impact on our brain’s ability and functionality.  And, one of the biggest factors in maintaining good brain health is engaging inlearning behaviors. He notes that while Wordle, Soduko, crossword puzzles and the like are useful in maintaining capabilities through the use of “existing” knowledge, it is critically important to also engage in activities that “increase” our knowledge pool through learning behaviors – outside of our existing areas of expertise. He suggests that we need to approach brain health like we do physical health and create a plan for maintaining our capabilities. His first three suggestions for cross-training the brain include:

“Day 1: Learn something mentally stimulating, such as listening to a podcast or taking an online course,

“Day 2:  Do something that requires learning through movement, such as a new sport, dance or yoga pose; and,

“Day 3:  Be social. Grab coffee with a friend or go to a dinner party.”

It appears “socialization” is a good way of staving off dementia. So, I should be good to go on that front!! Other activities that come to mind are like my wife, Suzanne, who is enhancing her language skills in Greek. Or, one of my physician friends who has taken up piano. The latter is a skill that my adopted son, Michael, keeps after me to consider since we have a rather large piano sitting in the parlor that needs attention. If you want more details, I suggest that you consider reading The Age-Proof Brain: New Strategies to Improve Memory, Protect Immunity, and Fight Off Dementia by Marc Milstein, Ph.D. BTW – good luck!! 

Traditional Flu Spiking and COVID-19 May Not Be Far Behind – The flu as we’ve come to know it over the last century – the seasonal, respiratory type – is gaining speed with a more extended spread across the USA (NOTE: if you want to check the spread in your state go here). In particular, according to Dr. Peter Hotez we are facing the confluence of multiple different bugs that are becoming disseminated throughout the populace, including: rhinovirus, pneumococcus bacterial, the respiratory syncytial virus or RSV, flu virus, as well as the multiple COVID-19 variants which all seem to be the culprits. These bugs spread easily and primarily – if not exclusively – through human-to-human contact spread. In fact, the overall rate of flu (rhino and RSV types) is the highest we’ve seen in more than a decade and children are especially vulnerable. With cases on the rise, many of the flu experts are suggesting that the precautions we undertook during the pandemic (i.e. masking, reduced human-to-human contact, etc.) may have contributed to increased vulnerability toward traditional flu while at the same time protecting us from COVID-19. That may be true…but…But…BUT…that does not mean we should undo those practices – especially, the masking part. It’s an absolutely necessary precaution for preventing a resurgence of COVID-19 or its subsequent variants!! AND, MOST IMPORTANTLY – IT IS CRITICAL THAT EVEREYONE GET THEIR REGULAR FLU SHOTS, in addition to your COVID-19 booster. This is especially important for: 1) adults over the age of 65, 2) individuals who are immune compromised for any reason; and, 3) children under the age of 4. The troubling news with the ongoing surge is a recent survey shows that nearly 40% of the American public do NOT intend to become vaccinated. The misinformation, distortion and outright lies about vaccination is a very troubling phenomenon that will magnify the problem and create unnecessary disease and death. If we all do the right thing – get vaccinated and engage in appropriate protective behaviors – the resurging flu epidemic will not be a problem for our families and loved ones. Get tough. Insist on vaccination and appropriate masking!! We can make a difference if we all work together…

On the COVID-19 front, there is also some major concern. According to data released by the CDC, hospitalizations have increased by 25% in the last week. Much of the increase has been seen in the elder population – especially among those who have not been vaccinated OR who have missed getting their boosters. In fact,  less than one-third of seniors AND, we are among the lowest among the countries throughout the world with bivalent booster vaccinations. Folks – the data is absolutely clear!! Getting vaccinated PLUS maintaining your booster status is critical to preventing bad outcomes if you do become infected. Take it from me. Despite my best efforts to prevent an infection, I got COVID again for the second time but barely had the sniffles. However, I’m fully boosted and combined with Paxlovid treatment, I was up and running in about four days. 

Americans Are Increasingly Exasperated With Health Care – The Beryl Institute recently completed a survey that reported about 60% of Americans as rating the quality of their health care experiences less than “good” or “very good”. That means the vast majority believe it’s average or below average. And, to make matters worse, the results show a continuing decline in public attitudes toward health care. At the same time, the survey also revealed that about the same number rate their personal health care as “good” or “very good.” Hmmm… There are lots of reasons why these results are prevalent including: the pandemic, more generally; supply chain considerations; inflation; workforce shortages, wait times and fatigue; staffing problems; and, the like. Having interacted with the health care system of late on a personal level, I can see why patients are frustrated. Call systems put you into long queues, staff are not available, timely responses are often delayed to the point of frustration, etc. But, I also know from personal interaction with health care providers that once you connect with them – they are still, by and large, the humane people who went into health care because they wanted to help people.

The Canary In the Coal Mine – Recent reports from the Cleveland Clinic show that one of highest rated health care organizations in the country is now reporting massive financial losses for the third straight quarter. Their report is increasingly typical of health care organizations throughout the nation. Cleveland Clinic reported losses of $1.5B compared to 2021 when they realized a profit of $1.7B due in large measure to rescue funds provided by the federal government via the PRF [Provider Relief Fund], ARP [American Rescue Plan] and ERC [Employee Retention Credit] programs.