Friday, June 5, 2020

600 Physicians Say Lockdowns Are A ‘Mass Casualty Incident’

by Grace Marie Turner,  Forbes contributor

More than 600 of the nation’s physicians sent a letter to President Trump this week calling the coronavirus shutdowns a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non COVID patients. 

“The downstream health effects...are being massively under-estimated and under-reported. This is an order of magnitude error," according to the letter initiated by Simone Gold, M.D., an emergency medicine specialist in Los Angeles. 

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties:  “150,000 Americans per month who would have had new cancer detected through routine screening.”

From missed cancer diagnoses to untreated heart attacks and strokes to increased risks of suicides, “We are alarmed at what appears to be a lack of consideration for the future health of our patients.”  

Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

The physicians’ letter focuses on the impact on Americans’ physical and mental health.  “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people.  Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” 

While all 50 states are relaxing lockdowns to some extent, some local officials are threatening to keep stay-at-home orders in place until August.  Many schools and universities say they may remain closed for the remainder of 2020.

“Ending the lockdowns are not about Wall Street or disregard for people’s lives; it about saving lives,” said Dr. Marilyn Singleton, a California anesthesiologist and one of the signers of the letter. “We cannot let this disease change the U.S. from a free, energetic society to a society of broken souls dependent on government handouts.” She blogs about the huge damage the virus reaction is doing to the fabric of society

“Even patients who do get admitted to hospital, say for a heart problem, are prisoners. No one can be with them. Visitation at a rare single-story hospital was through closed outside window, talking via telephone,” she wrote us.  “To get permission to go to the window you have to make an appointment (only one group of two per day!), put on a mask, get your temperature taken, and get a visitor's badge of the proper color of the day.”

How many cases of COVID-19 are prevented by these practices? “Zero,” Dr. Orient says.  But the “ loss of patient morale, loss of oversight of care, especially at night are incalculable.”

Virtually all hospitals halted “elective” procedures to make beds available for what was expected to be a flood of COVID-19 patients.  Beds stayed empty, causing harm to patients and resulting in enormous financial distress to hospitals, especially those with limited reserves. 

Even states like New York that have had tough lockdowns are starting to allow elective hospital procedures in some regions.  But it’s more like turning up a dimmer switch. In Pennsylvania, the chair of the Geisinger Heart Institute, Dr. Alfred Casale, said the opening will be slow while the facility is reconfigured for COVID-19 social distancing and enhanced hygiene.  

Will patients come back?  COVID-phobia is deathly real.

Wednesday, May 27, 2020

Big Pharmacy Chains Also Fed the Opioid Epidemic, Court Filing Says - The New York Times

Are some Pharma's Evil ?
(The Medical Quack)

The story about Opana

New details emerge in a lawsuit asserting that chains including CVS, Rite Aid and Walgreens sold millions of pills in small towns but rarely flagged suspicious orders to authorities.

Opana (trade name) Oxymorphone extended-release is used to help relieve severe ongoing pain. It belongs to a class of drugs known as long-acting opioid (narcotic) analgesics. It works in the brain to change how your body feels and responds to pain.

Through years of lawsuits and rising public anger over the opioid epidemic, the big American pharmacy retailers have largely eluded scrutiny. But a new court filing Wednesday morning asserts that pharmacies including CVS, Rite Aid, Walgreens and Giant Eagle as well as those operated by Walmart were as complicit in perpetuating the crisis as the manufacturers and distributors of the addictive drugs.

The retailers sold millions of pills in tiny communities, offered bonuses for high-volume pharmacists and even worked directly with drug manufacturers to promote opioids as safe and effective, according to the complaint filed in federal court in Cleveland by two Ohio counties.

Specifically, the complaint lays out evidence that:

CVS worked with Purdue Pharma, the maker of OxyContin, to offer promotional seminars on pain management to its pharmacists so they could reassure patients and doctors about the safety of the drug.

In partnership with Endo Pharmaceuticals, CVS sent letters to patients encouraging them to maintain prescriptions of Opana, a potent opioid so prone to abuse that in 2017 the Food and Drug Administration ordered its extended-release formulation removed from the market.

From 2006 through 2014, the Rite Aid in Painesville, Ohio, a town with a population of 19,524, sold over 4.2 million doses of oxycodone and hydrocodone. The national retailer offered bonuses to stores with the highest productivity.

Walgreens’ contract with the drug distributor AmerisourceBergen specified that Walgreens be allowed to police its own orders, without oversight from the distributor. Similar conditions were struck by CVS with its distributor, Cardinal Health.

The companies could not immediately be reached for comment on the early-morning filing. In the past, they have maintained that they were merely filling doctors’ prescriptions of legal medications.

Federal law requires manufacturers, drug retailers and suppliers to report suspiciously high orders to the federal Drug Enforcement Administration. But despite being repeatedly fined by the D.E.A. for failing to do so, the chains continued to sell outsize quantities of opioids, the complaint contends, only rarely sounding alarms, a charge also made against the drug distributors in numerous other lawsuits.

But relatively few cases against the retail pharmacy chains have advanced. Like most of the lawsuits in the sprawling national litigation, those cases are on hold, pending the outcome of the bellwethers. Judge Polster recently gave bellwether status to retail pharmacy cases brought by San Francisco and the Cherokee Nation. Those lawsuits will now proceed in the plaintiffs’ local federal courts.

The first case to advance against retailers, brought by Cuyahoga and Summit Counties in Ohio, is scheduled for November 2020. But those counties are only suing the chains in their capacity as distributors of opioids to their own drugstores.

If this is proven it provides a basis for a vast conspiracy again patients in the name of profit. CVS and Walgreen's will follow the likes of Purdue, which paid a multi-billion dollars setlement to the government and for personal injury cases.  It is an attorney's gold mine.

Federal law requires manufacturers, drug retailers and suppliers to report suspiciously high orders to the federal Drug Enforcement Administration. But despite being repeatedly fined by the D.E.A. for failing to do so, the chains continued to sell outsize quantities of opioids, the complaint contends, only rarely sounding alarms, a charge also made against the drug distributors in numerous other lawsuits.

Walmart devised a workaround to that reporting requirement, the complaint says. In mid-2012, it fixed a hard limit on opioid quantities it would distribute to its stores, foreclosing the need for its pharmacists to report excessive orders. Yet Walmart simply allowed its stores to make up the difference by buying the remainder of their large opioid orders from other distributors.

Until now, the focus of thousands of lawsuits across the country related to the opioid health crisis has largely been on drug manufacturers and distributors. A handful of those cases have settled. Representative cases, called bellwethers, selected by Judge Dan A. Polster in Cleveland from thousands of similar federal lawsuits to test both sides’ arguments, are moving through early stages in Chicago and West Virginia.

Cases brought by New York State and two New York counties are awaiting a joint trial date; originally set to begin March 20, their trial was postponed because of the pandemic lockdown.

Tuesday, May 26, 2020

The Age of Covid-19 and Beyond

Is this a new world order?

Has the covid-19 pandemic put a light on the cracks in our system ? (Arlen Meyers)

Arlen Meyers, MD, MBA, is Emeritus Professor of Otolaryngology, Dentistry, and Engineering at the University of Colorado School of Medicine and the Colorado School of Public Health, and founding President and CEO of the Society of Physician Entrepreneurs at He is a serial entrepreneur and life science technology commercialization consultant and advisor. Connect with him on LinkedIn here.

Expertise in global bio entrepreneurship, education, and bioscience technology transfer led Arlen Meyers to the Fulbright Specialist Roster in 2007 and took him on two trips abroad between 2007-12. His work in the Business/Development Office at Kings College focused on comparisons and understandings of differences between the American and British approach to these globally significant areas of research and development. Meyers was also invited to spend time at the NHS Innovation Office in Manchester and the Institute for Medical Devices at Strathclyde.

Will the system change ?   Will you change ? Can we afford change ?

System changes can originate from the top to bottom, or from bottom to top.  Often it comes from both directions.   Take electronic health records for instance.  A few visionaries implemented electronic health records in their medical practices.  As this base grew other entities took note, vendors, government regulatory agencies, and large organizations, such as Health and Human Services, and even Congress.  The typical adoption cycle, the five stages of adoption are shown in the graphic here:

At the moment Covid-19 is the center of attention and all hope the outcome can be positive and wishful thinking indicates these changes may be a catalyst for good things in health care.  We all look for the silver lining on the cloud

Hope springs eternal....the power of.humanity.

Wednesday, May 20, 2020

There is an App for That: The US is amassing an Army of Contact Tracers to Contain the Covid-19 Outbreak.

Why contact tracing may be a mess in America

High caseloads, low testing, and American attitudes toward government authority could pose serious challenges for successful efforts to track and contain coronavirus cases.

Alaska, California, Massachusetts, New York, and others are collectively hiring and training tens of thousands of people to interview infected patients, identify people they may have exposed, and convince everyone at risk to stay away from others for several weeks.

Contact tracing is a proven tool in containing outbreaks of highly infectious diseases. But this particular virus could pose significant challenges to tracing programs in the US, based on new studies and emerging evidence from initial efforts. Stubbornly high new infection levels in some areas, the continued shortage of tests, and American attitudes toward privacy could all hamstring the effectiveness of such programs.

The chief challenge with this coronavirus is its potential to spread exponentially: absent containment measures, every infected person on average will infect two or three others, according to most estimates (although some studies find it could be higher).

A team in any given region would have to detect at least half of new symptomatic cases, and reach at least half the people they were in close contact with and encourage them to stay away from others, in order to reduce the transmission rate by 10% or more, according to a new model.

 If they successfully detected 90% of symptomatic cases and reached 90% of their contacts—and tested all of them regardless of whether they had symptoms—it could reduce transmissions by more than 45%, the researchers found.

In other words, if social distancing in a given region had reduced infections per person from 2.6 to 1, this level of contact tracing could push it down to .55. Or the region could ease distancing measures by about half and keep infection levels constant.

Will technology help? Smartphone apps are playing a role in many countries but not the U.S.A.

The American psyche

Successful contact tracing efforts also require people to accept calls and heed advice from complete strangers.

Unfortunately, years of robocalls and telemarketing have conditioned many Americans to ignore calls from numbers they don’t recognize. Jana De Brauwere, a program manager with the San Francisco Public Library who is working with the city’s contact tracing task force, says that at least half the people she calls simply don’t answer. Others hang up once she starts asking for personal information, like addresses and dates of birth.

Americans pride themselves on privacy and freedom, another hindrance to gathering public health information, as well as conspiracy theorists.  In a Twitter thread earlier this week, Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford, argued that public health officials are underestimating how much US attitudes toward government authority could undermine national testing and tracing programs.

Americans have already defied the orders of health officials in several prominent incidents, including assaults on store workers who asked people to wear masks, armed demonstrators protesting stay-at-home restrictions, and businesses that have reopened before their local government gave the go-ahead.

Public health orders work only when there’s a public that will abide by them.

Tuesday, May 19, 2020

Alphabet Verily is launching an antibody research study for Covid-19

Verily is adapting its existing clinical trial technology, Project Baseline, to the coronavirus. 

Its initial focus will be to study antibody testing. 
There are still many unknowns when it comes to antibody tests. 
And there’s a wide variation in the accuracy of the tests.  

Alphabet’s life sciences company, Verily, is launching a research project with an initial focus on understanding how the human immune system responds to the coronavirus. 

The company is adapting its existing study, Project Baseline, which aims to use the latest technology for longitudinal health care research, to support the pandemic. Its first initiative, Baseline Antibody Research, offers serology testing to those who have already received a nasal swab test from Verily’s testing program.

Verily, which spun out of Google Life Sciences, has already rolled out testing sites across various sites in California for those who suspect they might have the virus. 

A serology test is designed to detect antibodies, which circulate in our blood to help fight off infections. Researchers see some potential in using antibody testing to understand how prevalent Covid-19 is in a community, and studies are already underway.

But there are wide variations in accuracy across the various test markers. These tests are producing a lot of false positive and false negative results. For that reason, many public health experts are wary about overly relying on antibody testing for so-called “immunity passports,” as we don’t yet know whether a positive result means there’s conferred immunity. 

An Alphabet/Google study designed as a Project Baseline is the quest to collect comprehensive health data and use it as a map and compass, pointing the way to disease prevention.  Project Baseline is partnered with Stanford Medicine, Duke University School of Medicine, The American Heart Association is already studying numerous other diseases and is enrolling participants for ongoing studies in heart disease, skin disorders, gastrointestinal diseases, sleep disorders and mood disorders.  

The Covid-19 Pandemic adds a new sense of urgency for Verily's project.

As a Project Baseline member, you can...

Choose to contribute through clinical research, surveys, focus groups and more
Be the first to know when studies matching your preferences open.
Test new tools, technologies, and treatments and shape the future of healthcare.
Get exclusive access to updates, thought leaders, and community events.
Ultimately, learn about your own health and help improve health for all.

COVID-19 Research Project

Verily COVID-19 PathfinderIf you want to learn more Click here.

Automated support for frontline teams
Verily is developing digital tools to support health systems, hospitals, ACOs and others on the front lines of the COVID-19 pandemic.

Verily COVID-19 Pathfinder is an easy-to-embed tool that provides information about the virus, helps patients understand symptoms and their possible severity, and guides them to the most applicable information based on their inputs -- all from your website. Information is sourced from public guidance from the CDC, WHO, Johns Hopkins Medicine, the American Lung Association, the American Heart Association and the American Diabetes Association. 

Designed by Verily, this tool can be customized based on your organization and available resources. We want to streamline management on the front lines so your teams can focus on delivering care.

COVID-19 Pathfinder features:
Customize the tool to blend seamlessly into your website and incorporate local contact information 
Implement quickly and easily with a small embeddable code snippet 
Collaborate with Verily’s team of technologists and clinicians to inform future tools and development 
Automatically provide access to content that’s sourced from official public health organizations like the CDC and updated regularly by Verily 

Verily COVID-19 Pathfinder FAQs

Who is this tool intended for?

This tool is designed for health systems, hospitals and other organizations delivering care during this pandemic. We want to relieve some of the burden on staff managing thousands of inquiries from their communities, and re-deploy them to deliver care.

How can our system get access to the Verily Covid-19 Pathfinder?
Fill out this brief form and our team will reply as soon as soon as possible. 

What technical capabilities are needed to implement this tool?
We make it easy to deploy our tool with simple cut and paste code. We’ll work with your team to customize the tool with your branding, local contact information or your requests to your community for supplies.

Alphabet Verily is launching an antibody research study for Covid-19

Monday, May 18, 2020

Why Medical Writing is Essential to Medicine

I wasn’t as happy as I expected to be when I walked out of the hospital on my last day in medical school. But then again, there was little to celebrate — my last few patients had terminal cancer, a stroke, and end-stage liver disease from alcoholism. I signed off my patients to my resident, and so, my medical school career came to an unceremonious end. I thought to myself that I was finally done with my schooling.

How many times have we told ourselves that we reached the last milestone — that it’d be smooth sailing from now on? I remember telling myself that I was done with medical school when I finished my first board exam. Then, I repeated those words to myself when I finished my second board exam. And then again when I finished my last residency interview and once more after Match Day.

But it’s never done. The reality of being responsible for patients slowly took shape during these past few weeks. Maybe that’s why my last day of medical school came and went without any fanfare — even eventually with an MD after my name, nothing will have really changed. I’ll still be learning and taking care of patients just as I’ve done over the past year.

Some special aura appears around you when you don a white coat. Suddenly to outsiders, you’re seen as a healer and sometimes a last resort. Magically, you possess the backstage pass to delve into the lives of strangers and hear about their most intimate details. I’ve had patients tell me many times about their joys and worries, their relationships and vices, and even their sex lives, all unprompted. There is no other relationship comparable to that between a doctor and the patient — at least not one that can form so swiftly and built on blind trust and confidence.

The clarity of a clean white coat soon becomes less distinct as time passes. With time the title 'doctor' loses some of it's brilliance.  The early thrill of hearing Doctor Smith diminishes as time passes as I carry more responsibility and automatically make decisions with less time thinking about them than when I was a wet behind the ears healer. The clean pristine white coat would become altered, much like my own sense of worth.

Still, there hangs a thick and opaque curtain between us — patients know so little of what goes inside our heads, and we devote so little of our time to figuring out what their thinking and feeling. That’s why medical writing is essential to medicine. The goal of my columns over these last four years was never to persuade, or to convert, or to proselytize. After all, you can’t do that in a 600-word monthly column — you can’t change anyone’s opinion these days even if you handed them a thick binder filled with scientific facts.

Instead, the goal was simply to teach, to inform, and to reveal. To let patients know that their doctors cared for them and are invested in their lives, even if they manage to see them for only 15 minutes after an hour of sitting in the waiting room. These pieces intended to tell patients that we know that being a patient not easy, but neither is being a doctor.

Every patient and doctor have untold stories that deserve to be exchanged. My columns were a collective attempt to build a two-way bridge between those who were being cared for and those who cared for them.  

Friday, May 15, 2020

California's Governor Newsom Proposes Painful Cuts to Health Care Programs to Close Budget Shortfall

Disaster is coming to some patients on MediCal.   Despite the recent restoration of some MediCal benefits in January 2020, before the Covid-19 pandemic, Governor Newsom now reports a major shortfall in California tax revenues that support many Medi-Cal benefits.  

Unfortunately this reduction in benefits falls most heavily upon those least likely to be able to afford it.

The number of Medi-Cal recipients increased. With so many Californians losing jobs and health insurance because of the pandemic, the state estimates 2 million more people will sign up for Medi-Cal coverage this year, bringing the total caseload in the health care program for low-income Californians to 14.5 million people.

To pay for the increase in enrollment, Gov. Gavin Newsom wants to cut back on some of the benefits patients will receive and the rates doctors will get paid to see them. 

Services like vision care, hearing aids, speech and physical therapy,
podiatry will no longer be covered by Medi-Cal under the Governor's 

Other items projected are a decrease in senior citizen benefits (another reduction on those who can least afford reductions, since most are on fixed budgets from social security, and are at most risk from the Covid-19 pandemic. 

Doctors groups, which spent millions to help pass the tobacco tax, say this cut to reimbursement rates will create more pressure and uncertainty on physician practices at a time when many are already facing big drops in revenue because of canceled surgeries and appointments. Doctors say this could force them to limit the number of Medi-Cal patients they see. 

There are many items in the California budget, sent to the legislature, which could be eliminated or put on hold to save our low income population from disaster. Our representatives need to do a line by line analysis and make their recommendations, and not blindly stamp an approval on Newsom.s proposals.  Read the link here

Thursday, May 14, 2020

The Hunt for Covid-19 The secret to why some people get so sick from covid could lie in their genes |

23andMe is searching for genetic clues to why some get sick from Covid-19 and others don't even have symptoms.

by Antonio Regalado


While it is known that older people and those with health conditions such as diabetes are most at risk, there could be hidden genetic reasons why some young, previously healthy people are also dying.  

23andMe operates a large gene database with more than 8 million customers, many of whom have agreed to let their data be used for research. The company has previously used consumer data to power searches for the genetic roots of insomnia, homosexuality, and other traits. 

In April the company, based in Sunnyvale, California, sent covid-19 questionnaires out to a swath of its members. So far, says a company spokesman, about 400,000 have enrolled, including 6,000 who say they have confirmed cases of the pandemic disease.

The 23andMe gene hunt will complement efforts from university researchers to obtain genetic profiles of covid-19 cases and pair them with detailed medical records, says Andrea Ganna, who coordinates the Covid-19 Host Genetic Initiative. The international consortium is sharing genetic data on covid-19 cases from Italy, the UK, and the US and regularly making results public. 23andMe has an enormous database of genomic information at it's command.

Scientists hope to find a gene that strongly influences, or even determines, how badly people are affected by the coronavirus. There are well-known examples of such genetic effects on other diseases: for example, sickle-cell genes confer resistance to malaria, and variants of other genes are known to protect people from HIV or to norovirus, an intestinal germ.

According to Ganna, however, an initial peek at the genes of 900 covid-19 cases turned up no significant genetic hits. His consortium is now preparing an analysis of twice as many cases, which could improve their chance of spotting an association.

Over the counter testing company Ancestry  has recruited 250,000 participants from its own database for the same evaluation.

In the meantime the search for The Vaccine is ongoing.  Click on link below:

Wednesday, May 13, 2020

IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

CEO and founder Tim Fitzpatrick is leveraging the latest in neuroscience research and VR filmmaking to radically improve health education and patient confidence. 

Kidney disease is a large and growing health challenge, in the United States and globally, thanks in part to rising rates of diabetes and high blood pressure. A full 37 million Americans (15% of the adult population) suffer from kidney disease, according to the National Kidney Foundation, and in 2016, more than half a million people had to be put on dialysis at least 3 times a week just to survive. 

This represents a huge cost to Medicare ($114B in 2016) and efforts are now underway to transition dialysis patients to in-home care, a cheaper and more comfortable alternative. This need for this transition to home became even more acute during the COVID-19 pandemic, but how can resource-strapped dialysis clinics — which currently only spend a few minutes on patient education through paper pamphlets — safely and efficiently transition hundreds of thousands of patients to home care?

Levin is a former CEO of Time Warner

It has been said that necessity is the mother of invention. Jerry Levin, ex CEO of Time-Warner shares his own personal experience with dialysis. Following a severe injury from a fall, with multiple injuries he eventually was placed on hemodialysis while rehabilitating in a skilled nursing facility.  The experience was an eye-opener and less than optimal for his condition and many others.

The Centers for Disease Control and Prevention has also provided specific guidelines to address a similar deathtrap: dialysis centers, due to their comparable high volume of older patients (50% of all dialysis patients are over 65) and their history of infections are a very high risk for heightening the spread. More than 725,000 Americans suffer from kidney failure, otherwise known as end-stage renal disease (ESRD). Of these, at least 500,000 individuals are on dialysis.

Receiving home dialysis treatments in a nursing home is not something that is only available to people like me (former CEOs). It could be provided to any patient who needs it. Unfortunately, right now it’s not available to many, which is mainly a function of the red tape and bureaucracy in healthcare. Our current system is characterized by slow decision making, limited willingness to try new and innovative therapies, and stubborn adherence to the status quo of where and how healthcare should be delivered.

But there is a safer way to administer this lifesaving care, and we must urgently make plans to deliver dialysis within nursing home and long-term care facilities, and further to accelerate the provision of dialysis for those able to do it in their home. We must save our elderly and our broader population from this deadly blind spot.

Say Hello to IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

Monday, May 11, 2020

Covid-19 The Risks - Know Them - Avoid Them

People are hoping and anticipating a return to some form of normalcy.  I have been reading and sourcing many opinions.  I found a well written colloquial article by 
Professor Erin Bromage. If you are about to venture out into the world with or without the permission of the 'experts' this may give you some guidance. A precautionary Waiver.  I  provide this as information only and not my recommendation to do so.

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That's what's going to happen with a lockdown. 

 As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I've said before, if you don't solve the biology, the economy won't recover. 

 There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained. 

So throughout most of the country we are going to add fuel to the viral fire by reopening. It's going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk. 

Where are people getting sick?   We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.   But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks.... are these places of concern? Well, not really. Let me explain.

In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with MERS and SARS, some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

How much Virus is released into the environment?
A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk. 

 A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds. 

A cough at 6 meters (18 feet)

A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).

Speaking: increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose. 
If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.

 A breath: A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled. 

 Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don't have a number for SARS-CoV2 yet, but we can use influenza as a guide. We know that a person infected with influenza releases about 3 - 20 virus RNA copies per minute of breathing. 

Remember the formula: Successful Infection = Exposure to Virus x Time. In other words if you have to go somewhere, do not linger.   Have a list for grocery shopping and plan your visit.  Do not  "window shop'.

Air filters may offer additional protection. Hospitals use them all the time, especially in the ER, ICU, and Operating Rooms.  Air Cleaning Technologies An Evidence-Based Analysis

The Risks - Know Them - Avoid Them

Saturday, May 9, 2020

Covid Restrictions rescinded in Riverside CA

Good morning, it is 8 AM  Saturday morning on the "Left Coast".  Our restrictions are being loosened, however we are all still wearing masks.  Personally I like it as it gives me a false sense of security, however it reminds me of how close we cam to an even worse disaster with far more deaths that we already have suffered.  It also should remind us it is not over by a long shot.  Numerous predictions about the long term outcome vary greatly from utter destruction of world economics, to it will rebound quickly.  The. stock market seems to have largely ignored the pandemic, after showing an initial decline.  Perhaps no one is working at the NYSE. (Was it determined to be non essential?). It makes a few very rich, and no longer reflects real value of a company.  Social media has more predictive value. The stock market is like a horse race, all bets are off, and chances are the odds are worse in the stock market, and better at the Kentucky Derby where there are less than 20 horses.  You have a far better chance of. picking a winner out of a field of twenty than hundreds of stocks. 

 Woman wearing a MAGA hat (near exit sign)

With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered.

The Board of Supervisors voted to lift the closure of vocational and higher-education schools, end the restriction on golf courses, eliminate limitations on short-term lodging, and remove the requirements to wear face coverings and engage in social distancing.

Comments from the Supervisors.

Officials also voted for the use of face coverings to be “strongly recommended” by the county, instead of being mandated as Kaiser implemented last month. The use of masks is only a recommendation on the state level.

During the meeting, 5th District Supervisor Jeff Hewitt said that he didn’t feel he needed to wear a mask, citing conflicting evidence of its benefits, but that he would continue to do so if certain businesses require it.

Like his colleagues, 4th District Supervisor V. Manuel Perez, the board chair, called the guidelines unattainable and impossible for Riverside County and any other urban counties with large populations.

When 1st District Supervisor Kevin Jeffries said the county didn’t have the power to revoke Newsom’s orders, Hewitt countered: “The funny part is we do all the enforcement, so his power is powerless if you don’t enforce it.”

Sheriff Chad Bianco had said Tuesday that he would not be enforcing any of the county’s restrictions, which he believed to be unreasonable. During public comment on both days, many protesters voiced their support of him.

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Kaiser about potentially amending the mask requirement.

On Tuesday, Kaiser said his position hadn’t changed, and he credited the county’s lower-than-expected COVID-19 cases and deaths to the strict orders. (conflicting statistics from the Los Angeles Times) (see below)

"With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered. He was not available for comment Friday night, and it was not clear if his position had changed, though he apparently plans to sign the recission orders."

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Cameron Kaiser M.D., County Chief Public Health Officer, about potentially amending the mask requirement.

Comment from an octogenarian

A 78-year-old man, who spoke in support of rescission, agreed with Hewitt said that he wears a mask only when he’s around people who are afraid. “I’m not afraid.... People get old and they die.”