Trump signs order expanding use of virtual doctors

Trump signs order expanding use of virtual doctors

© Doug Mills

Physicians and patients sigh a breath of relief.  Telehealth, something pressed into service due to the Coronavirus pandemic has become a way of affording relief and more health care accessibility to more patients will become a standard of care

President Trump on Monday signed an executive order seeking to expand the use of virtual doctor visits, as his administration looks to highlight achievements in health care. 

The administration waived certain regulatory barriers to video and phone calls with doctors, known as telehealth when the coronavirus pandemic struck and many people were stuck at home. Now, the administration is looking to make some of those changes permanent, arguing the moves will provide another option for patients to talk to their doctors. 

The order calls on the secretary of Health and Human Services to issue rules within 60 days making some of the changes permanent. 

“Today I’m taking action to make sure telehealth is here to stay,” Trump said during a White House news briefing. 

It is unclear when any of the changes proposed by these orders will actually take effect, though, given that there are still regulatory processes that take time to play out.  There are regulations still in existence for payers to reimburse for telehealth charges after the pandemic ends. These include restrictions in urban areas, telehealth limited to established patients in a doctor's panel, and other limitations.

“In an earlier age, doctors commonly made house calls,” Centers for Medicare and Medicaid Service Administrator Seema Verma said in a statement. “Given how effectively and efficiently the healthcare system has adapted to the advent of telehealth, it’s become increasingly clear that it is poised to resurrect that tradition in modern form. Thanks to President Trump, the telehealth genie is not going back into the bottle.”

The order also calls on HHS to propose a new model that can be tested for how Medicare will pay for some health services in rural areas, with the goal of improving care in rural areas. 

Telehealth Services: What Medicare Covers

Tags:  CMS CENTERS FOR MEDICARE AND MEDICAID SERVICES DONALD TRUMP TELEHEALTH CORONAVIRUS COVID-19

https://tinyurl.com/y5rfymgq

Body mass index (BMI) is a miscalculation

 

Most of us recognize BMI as a calculation for body mass index.  Physicians like the term since it gives them a number indicating obesity.

However, BMI has ignored the weight of evolution and elementary physics according to Alan Finkel (Alan Finkel is an electrical engineer, neuroscientist, and Chief Scientist of Australia.).

It naturally got me wondering: how scientific is the BMI?

It may be a 188-year-old staple of health statistics, but modern health professionals have documented many flaws. For starters, the BMI doesn’t distinguish whether body weight comes from fat or muscle, so Michelin Man and the Terminator might have the same BMI despite their very obvious differences in fat and muscle distribution. Neither does it factor in other key health criteria such as age, gender, or body type. For instance, people who deposit fat around their waists are at a higher risk of disease than people who deposit it on their hips and thighs.

My concern, however, is that the BMI ignores elementary physics.

The problem traces back to Lambert Adolphe Jacques Quetelet, the Belgian statistician who invented the BMI in 1830. Quetelet failed to consider the mathematics of scaling. He defined the BMI as weight divided by height squared. Note, however, that weight is proportional to volume, which is proportional to height cubed. The upshot of this is that all other things being equal, BMI varies directly with height, which it clearly should not.

For instance, observe the formula

Perhaps the fault goes back to Jonathan Swift’s wildly popular 1726 tale of Gulliver’s Travels. Swift’s giant Brobdingnagians and tiny Lilliputians could not actually exist. 

For example, consider a giant twice as tall as myself but with exactly my shape and looks. If the giant was standing on a beach with no other objects in sight, a far-off observer could not tell that he was not me. Because his mass would be proportional to my height cubed, my double-height doppelganger would weigh eight times more than me. However, the cross-sectional area of his legs would be proportional to my height squared, so they would be only four times stronger. Those poor bones! They would be over-stressed by carrying eight times the weight. My giant double would collapse under his own weight. Now create a version of me half my height. He would weigh one-eighth of what I weigh, but his leg bones and muscles would be twice as strong as they needed to be. 

Nature understands this, which is why elephants look like elephants and ants like ants. The BMI formula does not share this insight. It can make tall people appear overweight when they are not. Compared with a 152 cm (five foot) individual with a ‘normal’ BMI of 22, an identically proportioned 183 cm (six foot) person would have a BMI of 26.5 – overweight.

Based on BMI ranges, most Australians are too plump: 28% are classified as obese, 35% overweight, 35% normal and a mere 2% underweight. No doubt this skewing towards being overweight reflects a genuine health problem. But it might be affected by the increase in the average height of the population since 1830. 

Fortunately for Quetelet, there were few Terminators back then to question his BMI. And fortunately for Jonathan Swift his satire was not questioned by an incurable engineer who would have pointed out that the Brobdingnagian giants, at 12 times the height of Gulliver, would have weighed more than 100 tonnes, with a BMI in the hundreds.

I don’t suggest changing the way the BMI is calculated, despite its flaws, because we would not want to throw out the past 188 years of BMI records (noting that in most cases the raw data – height and weight – will not have been kept). Instead, we could adjust the standard BMI numerical ranges for underweight, normal weight, overweight and obese based on height, and perhaps even gender and body shape.

Body mass index miscalculation - Cosmos Magazine

Sudden Death at Home. As coronavirus surges, Houston confronts its hidden toll:

HOUSTON — When Karen Salazar stopped by to check on her mother on the evening of June 22, she found her in worse shape than she expected. Her mother, Felipa Medellín, 54, had been complaining about chest pains and fatigue, symptoms that she attributed to a new diabetes treatment she’d started days earlier.

Medellín, who had seen a doctor that day, insisted she was fine. But Salazar, 29, noticed that when Medellín lay down, her chest was rising and falling rapidly — as if she couldn’t catch her breath.

“I grabbed her hand and I said: ‘I’m sorry. I know you don’t want to go to the hospital, but I’m calling the ambulance,’” Salazar said.

While Salazar was on the phone with a 911 dispatcher, her mother suddenly passed out. Then she stopped breathing.

“Mom! Mom!” Salazar remembers shouting, trying to rouse her.

Karen Salazar holds a picture of her mother, Felipa Medellín, outside of her mother’s home in Houston on Tuesday.Fred Agho / for NBC News

With the dispatcher on speakerphone, Salazar attempted CPR, repeatedly pressing her hands down on her mother’s chest, silently praying for her to startle back to life. But by the time Houston paramedics arrived at her home in northwest Houston, Medellín was dead.

Days later, an autopsy revealed the primary cause: COVID-19.

“We never thought it was COVID,” Salazar said. “We didn’t even realize she had it.”

Medellín’s death is part of a troubling trend in Houston.

As coronavirus cases surge, inundating hospitals and leading to testing shortages, a rapidly growing number of Houston area residents are dying at home, according to an NBC News and ProPublica review of Houston Fire Department data. An increasing number of these at-home deaths have been confirmed to be the result of COVID-19, Harris County medical examiner data shows.

The previously unreported jump in people dying at home is the latest indicator of a mounting crisis in a region beset by one of the nation’s worst and fastest-growing coronavirus outbreaks. On Tuesday, a record 3,851 people were hospitalized for the coronavirus in the Houston region, exceeding normal intensive care capacity and sending some hospitals scrambling to find additional staff and space.

The uptick in the number of people dying before they can even reach a hospital in Houston draws parallels to what happened in New York City in March and April, when there was a spike in the number of times firefighters responded to medical calls, only to discover that the person in need of help had already died. These increases also echo those reported during outbreaks in Detroit and Boston, when the number of people dying at home jumped as coronavirus cases surged.

While far more people died of COVID-19 in those cities than have died so far in Houston, researchers and paramedics say that the trend of sudden at-home deaths in Texas’ largest city is concerning because it shows that the virus’s toll may be deeper than what appears in official death tallies and daily hospitalization reports.

As coronavirus surges, Houston confronts its hidden toll: People dying at home

Changing the Way We Deliver Care -

The daily routine of medical practice has changed.  For several months patients deferred visits to their physicians for fear of contracting Covid-19 and the idea that most clinics would be overwhelmed with Covid-19 patients.  While the volume of clinic visits declined significantly due to those fears, most diagnoses of Covid-19 are made in the outpatient setting of physician offices. (Study)

The pandemic has rocked the financial bedrock of healthcare for small or solo practice. During this pandemic, many patients have chosen to defer or forgo medical visits at a high cost for reimbursement to these practices.  Many physicians had to furlough long time employees from their administrative staff. In some cases even employed physicians were furloughed or terminated. Some of these medical clinics were eligible for the CARES act, which will supplement payroll expenses.  However ongoing expenses, leases, malpractice insurance, health insurance premiums, operating expenses rapidly drained cash reserves.

Some of the changes that have occurred rapidly are the use of telehealth, remote monitoring, and new procedures for patient visits that use online appointments, preregistration, and even messaging systems that instruct waiting patients in their car as to when they can enter the office. This improves efficiency and perhaps will remain a standard for patient-centered medical care.

Gradually as social distancing decreases when the pandemic becomes more controlled new protocols will remain in place.

The lack of personal protective equipment is not quite as acute as several months ago. Both patients and providers have better access to masks.

Biological Age Testing: How old am I ?

Biological Age vs. Chronological Age

There are many ways of determining biological age as compared to determining chronological age. The image above graphically illustrates the difference.  A number of metrics have been used to determine the biological age. This relates to the health of the liver, kidneys, immune status, genetic markers such as length of telomeres on chromosomes.  Some of these tests are readily available and at a low cost.  Most can be obtained with a  blood sample for about eighty dollars.

Metrics:

Standard Complete Blood Count (CBC) Red blood cell count, white blood cell count.

Standard Chemistry Panel. Liver profile, Renal Profile, 

C Reactive Protein: Inflammatory measure.

Telomere length.

White House blocks CDC from testifying on reopening schools next week

(CNN)"The White House is blocking US Centers for Disease Control and Prevention Director Dr. Robert Redfield and other officials from the agency from testifying before a House Education and Labor Committee hearing on reopening schools next week, just as the debate over sending children back to classrooms has flared up across the US.

White House officials informed the committee of its decision in an email, a staff member on the House panel told CNN.

"Dr. Redfield has testified on the Hill at least four times over the last three months. We need our doctors focused on the pandemic response," a White House official said, confirming the decision to block the CDC's participation in the hearing.

But a spokesman for the House Education and Labor Committee said the panel had requested testimony from any CDC official, not necessarily Redfield.

"We asked for anyone at CDC who could testify at the hearing. The invite was not for Dr. Redfield or no one," the official said.

House Education and Labor Chairman Bobby Scott said the testimony from CDC officials is critical to understanding how scientists would manage the reopening of US schools.

"It is alarming that the Trump administration is preventing the CDC from appearing before the Committee at a time when its expertise and guidance is so critical to the health and safety of students, parents, and educators," the Virginia Democrat said in a statement.

CDC officials have delayed the release of new recommendations for sending children back to classrooms.

Earlier this week, Redfield stressed the wearing of masks as a key component to any strategy for reopening schools.

"Because to me, face coverings are the key. If you really look at it, the data is really clear -- they work," Redfield said."

Is this all fake news, or poor communications.  How many layers of desks do these communications go through?

Coincidences?

White House orders hospitals to bypass CDC and send covid-19 reports directly to the White House

White House instructs CDC to not testify at House Committee.

Other information was discovered in regard to Robert Redfield

Perhaps the White House has lost confidence in Dr. Redfield as director of the CDC. While there is considerable frustration at the White House they continue to have considerable faith in Anthony Fauci M.D.  Dr. Fauci is head of the National Institute of Allergy and Infectious Diseases, a department in the NIH. Rather than depending on the head of the CDC.  Dr. Fauci was called upon to direct and consult the approach to Covid-19. Dr. Fauci remains a stellar example for scientific research and also immune to political pressures.

As the coronavirus death toll  in the US  tops 107,000, questions have intensified over what could have been done to avoid such a catastrophic loss of life.  Beyond criticism of President Donald Trump himself, scrutiny has fallen particularly hard on the US Centers for Disease Control and Prevention and its embattled director, Dr. Robert Redfield, whom Trump appointed to the job in 2018.

In interviews with numerous public health experts, including eight current CDC officials, many said they are disillusioned by Redfield, telling CNN he's failed to push back against White House efforts to sideline the CDC and politicize its science.

While sources consistently described Redfield as a respected doctor, they also view him as a relatively ineffectual public health leader at a time of the pandemic, and a pawn of the President's political agenda.

"A major problem for our agency is lack of leadership," said one CDC official who spoke about Redfield on the condition of anonymity for fear of reprisal. "He's a very nice guy, but I think he was put in place to serve a political purpose, not to lead an agency."

Inside the CDC, confidence in Redfield has deteriorated amid the rising death toll. CDC sources who spoke to CNN said they are deeply frustrated over what they say has been an effort to freeze out the agency from decision-making, and cut it off from directly addressing the public. Tensions have risen between the White House and the Atlanta-based public health agency, with some CDC officials blaming Redfield for not doing more to advocate for the agency's own authority.

This is not the first time Redfield has been at the heart of a controversy over the government's response to a virus epidemic. In the early 1990s, Redfield, then one of the Army's top AIDS researchers, was at the center of a scandal over a purported HIV vaccine. Allegations that Redfield oversold data and cherry-picked results sparked an internal Army investigation into his work. 

The Army ultimately did not charge Redfield with scientific misconduct. But interviews with former colleagues with direct knowledge of the investigation, and a review of internal documents suggest Redfield knew he was misrepresenting the data behind the vaccine, even as he publicly touted its results— an effort that ultimately helped garner millions in federal funds for further testing.

Redfield was also found to be in violation of Army code over his relationship with a conservative AIDS nonprofit run by a prominent evangelical activist who has promoted abstinence-only solutions to the disease.

In the end, the vaccine treatment did not pan out. Redfield has previously said that he stands by his work.

Manu Raju contributed to this story.

https://tinyurl.com/yx979obk

Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians | Global Health | JAMA Health Forum | JAMA Network

Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians

To mask, or not to mask, that is the question.   Americans obsess about their freedoms, the constitution was written to protect them.  It was originally intended to prevent despots from suppressing the possibility of overthrowing a government by allowing contrary views.  Since 1776 many have taken the liberty of using it for other purposes. Historically many individuals and groups have repurposed the amendment II to validate their argument. This is also true for many. constitutional amendments. 

What are the risks of not masking? It depends on where you are and how many other individuals are close to you.  That begs the questions, how close, and what locations?

In an article by The Journal of the American Medical Association  Doron Dorfman,LLB, JSD; Mical Raz, MD, Ph.D., MSHP write about exemptions for disability under the definition of the Americans with Disability Act (ADA).  This further confounds the answer. Dorfman and Raz make a rational if not more complex about wearing masks during a pandemic.

Masking or face covering amid the global coronavirus disease 2019 (COVID-19) pandemic has emerged as a highly polarizing practice, with surprising partisan divisions. While masking remains contentious, there is bipartisan agreement among policymakers that medical exemptions for masking are necessary and appropriate. Yet there is a dearth of guidance for clinicians on how to approach a request for an exemption. We analyze the medical and legal standards to guide this debate.

Medical Exemptions

Few guidelines exist regarding medical exemptions. Beyond the CDC’s recommended exemptions—children younger than 2 years, people with difficulty breathing, and anyone unable to place or remove the mask—there are certain categories of disability that undoubtedly warrant medical exemptions. In this evidence-free zone, clinicians must make individual determinations as to whether a patient should be exempt from mask-wearing. Some individuals, particularly children, with sensory processing disorders may be unable to tolerate masks. Facial deformities that are incompatible with masking are an additional category of exemption. Other situations, such as chronic pulmonary illnesses without an active exacerbation, are less clear. An individual with a chronic pulmonary illness is at higher risk for severe disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Conversely, if that same individual were infected with SARS-CoV-2, he or she would likely also be at higher risk for spreading viral illness because many pulmonary illnesses are associated with a chronic cough. There is a risk-benefit ratio that must be carefully considered. Professional societies would provide a valuable service to clinicians if they could provide clear guidelines that include objective measures, such as a decrease in pulse oximetry results, to guide determinations. It is likely that chronic pulmonary disease in itself is a compelling reason for masking, rather than a category of exemption.

Legal Grounds for Exemption

A medically necessary exemption from masking is considered a disability modification under the Americans With Disabilities Act (ADA). Individuals with disabilities have clearly defined legal protections under both federal and state law. Title II of the ADA prohibits disability discrimination in “programs and activities of state and local government entities.” Title III prohibits disability discrimination “in the full and equal enjoyment of…services” at places of “public accommodation.” These are privately owned establishments and include restaurants, hotels, and grocery stores, which may require customers to mask. The “full and equal enjoyment” standard can be fulfilled via the use of “reasonable modifications in policies, practices, or procedures.” A reasonable disability modification might be a masking exemption, but this is not the sole remedy. Amid a global pandemic, reasonable accommodations for masking intolerance can and should include avoidance measures, such as curbside services and delivery.3

Employers can legally require masking at their workplace, and workers may be asked to provide medical documentation for an exemption. This presents a unique challenge to clinicians who understand the necessity for individuals with disabilities to maintain job security. Yet few medical conditions are truly incompatible with all forms of mask-wearing, and the same guiding principles of preserving public health and reducing individual risk remain relevant. As other workers cannot reasonably exempt themselves from the presence of an unmasked coworker, workplace accommodations should be conceptualized in a broader framework than a simple mask exemption. These accommodations might include remote work, placement in non–public-facing positions, or, under certain conditions, leave. These may all be considered reasonable accommodations under title I of the ADA, which regulates employment.⁴

Employers restaurants and other public gathering places may utilize methods to ensure distancing.

The solutions beg creativity

Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians | Global Health | JAMA Health Forum | JAMA Network

Former CDC directors: Trump has politicized science more than any past president. - The Washington Post

         

      The administration is undermining public health

                      

It fouls the mind when a politician makes decisions that are contrary to educated people. Even giving the President the benefit of the doubt he should delegate decisions such as public health decisions to those who know and have the experience to make rational decisions.

                                         

                

Public health authorities throughout the United States already have legal authority locally and at state, levels to make decisions without consulting the Executive branch.  It is the Executive Branches duty to support the states in their decisions.

In addition to those in authority, there are many qualified experts who have served previously in the CDC. such as Tom Frieden, MD, Jeffrey Koplan M.D., and David Satcher, M.D. all who served as Director of the CDC.  

Former CDC Directors Richard Besser, Tom Frieden, Jeffrey Koplan, and David Satcher explain why the agency's guidance on reopening schools must be based on sound science, not political pressure—and centered on safety and health equity.

As America begins the formidable task of getting our kids back to school and all of us back to work safely amid a pandemic that is only getting worse, public health experts face two opponents: COVID-19, but also political leaders and others attempting to undermine the Centers for Disease Control and Prevention. As the debate, last week around reopening schools more safely showed these repeated efforts to subvert sound public health guidelines introduce chaos and uncertainty while unnecessarily putting lives at risk.

As of this date, the CDC guidelines, which were designed to protect children, teachers, school staffers, and their families — no matter the state and no matter the politics — have not been altered. It is not unusual for CDC guidelines to be changed or amended during a clearance process that moves through multiple agencies and the White House. But it is extraordinary for guidelines to be undermined after their release. Through last week, and into Monday, the administration continued to cast public doubt on the agency’s recommendations and role in informing and guiding the nation’s pandemic response. On Sunday, Education Secretary Betsy DeVos characterized the CDC guidelines as an impediment to reopening schools quickly rather than what they are: the path to doing so safely. 

CDC updates expands list of people at risk of severe COVID-19 illness only valid reason to change released guidelines is new information and new science — not politics.

Older Adults.                         People of any age with these conditions

The latest from the CDC (video)

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

The CDC is home to thousands of experts who for decades have fought deadly pathogens such as HIV, Zika, and Ebola. Despite the inevitable challenges of evolving science and the public’s expectation of certainty, these are the people best positioned to help our country emerge from this crisis as safely as possible. Unfortunately, their sound science is being challenged with partisan potshots, sowing confusion and mistrust at a time when the American people need leadership, expertise, and clarity. These efforts have even fueled a backlash against public health officials across the country: Public servants have been harassed, threatened, and forced to resign when we need them most. This is unconscionable and dangerous.

We’re seeing the terrible effect of undermining the CDC play out in our population. Willful disregard for public health guidelines is, unsurprisingly, leading to a sharp rise in infections and deaths. America now stands as a global outlier in the coronavirus pandemic. This tragic indictment of our efforts is even more egregious in light of the disproportionate impact we’ve witnessed on communities of color and lower-income essential workers. China, using the same mitigation tools available to us and with a far larger population, has had just a tiny fraction of the 3.1 million cases reported here. The United States now has more cases and deaths than any other country and the sixth-highest rate of any large country in the world — and we are gaining on the other five. The United States is home to a quarter of the world’s reported coronavirus infections and deaths, despite being home to only 4.4 percent of the global population.

Perhaps when tragedy strikes a sense of humor can confound the true gravity of a situtation. 

 

Comedy and Cartoons

Former CDC directors: Trump has politicized science more than any past president. - The Washington Post

How Coronavirus Kills Some People But Not Others - I'm a Lung Doctor (ME...

If you want to learn much more about how Covid-19 makes people so ill and how they die. Its complicated and has similar methods as other lethal diseases. Besides causing pulmonary insufficiency it causes increased coagulation in other organs such as the heart, lungs, kidneys, and brain. 









Dr. Mike Hanson is an outstanding clinician and an outstanding communicator. I highly recommend this video as a credible source.



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Telehealth and the Future

2020 witnessed amazing explosive growth in telehealth.  Although an infrastructure for telehealth developed in the prior five years by visionary entrepreneurs there was slow to non-existent adoption by providers, hospitals, and allied health providers.  Much of the reticence was due to poor reimbursement by health plans.  

During January 2020 to current times telehealth became an established and at times preferred method for outpatient visits.  This was due to an existing crisis fueled by a viral epidemic (pandemic) by a novel coronavirus (COVID-19). Social and physical distancing was mandated by public health officials globally.  This served to radically alter the health care setting. Physician office visits plummeted, even for the normal population. Elective surgical procedures were canceled and postponed. 

How COVID-19 is affecting internet performance

According to Fastly, to understand how the internet is performing with the changes in internet use brought on by the COVID-19 pandemic, we investigated two key metrics during February and March in some of the countries and states that were hit hardest by the virus: changes in the traffic volume served to those regions as a reflection of changes in internet use, and changes in download speed measured at our servers as a reflection of internet quality. In almost all regions, the largest increases in traffic volume occurred immediately after public policy announcements, such as school closures or stay-at-home orders. Similarly, the most dramatic decreases in download speed followed the official starts of those policies — presumably when populations made the shift to staying home.

Table 1 reveals the sharp uptick in internet traffic by country and state and the effect on broadband speed.  The findings reveal metropolitan areas suffered the least, most likely due to penetration and redundancy of the internet in cities.  Italy suffered the most increase in usage and the decrease in broadband speed. In the U.S.A. rural states such as Michigan saw a marked decrease in internet speed. Michigan is a rural state and the penetration and less redundancy in infrastructure caused network speeds to decrease by almost 40%.

Definition of High-speed internet

Perhaps the best modern measurement of whether an Internet connection is “high speed” is in what services are supported at that speed. Virtually any broadband, or non-dialup, connection can support a home user’s standard browsing habits. Streaming of standard-definition video, with a pixel width of 480, requires a minimum 1Mbps connection. Low-end high-definition video, with a pixel width of 720, requires at least 2.5Mbps. Streaming high-definition 1080p video needs at least a 9Mbps pipeline to avoid buffering delays. And these numbers only take into account a single device — if five users in your office network simultaneously stream separate 1080p videos, your 10Mbps will not seem “high speed.”   

If one lives in a rural area there may be severe limitations on live streaming used by telehealth.

The. Brookings Institute published a breakdown of what type of internet customers can access.  There are some surprising results

The lack of internet broadband access in the mid-south has created a need for cellular coverage.  While 4G/LTE is widely available there are some areas that only provide 3G. 4G/LTE may be adequate for video streaming when signal strength is strong. As 5G cell coverage becomes ubiquitous it becomes mainstream.   A recent test on T-mobile cell coverage in Southern California revealed a 60-75 MPs download and 40 MPs upload speed. That is adequate for live streaming as indicated by calls on Zoom and other video conferencing apps such as GoToMeeting, Google Meet, Webex, or Cisco.

Webinar: What is the future for telehealth?  REGISTER

There are some indications that some payor and Medicare are planning to re-institute restrictions on telehealth reimbursement once the acute pandemic ends.  However, that is a big contingency since the ongoing pandemic is still evolving.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

There have been conflicting comments and opinions on the efficacy of Hydroxychloroquine for the treatment of Covid-19 patients. Many have opined on the failure of HCQ to reduce morbidity and death in patients with Covid-19.

The patients studied at HFH Systems were treated early in their disease. 

In a large-scale retrospective analysis of 2,541 patients hospitalized between March 10 and May 2, 2020 across the system’s six hospitals, the study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine. None of the patients had documented serious heart abnormalities; however, patients were monitored for a heart condition routinely pointed to as a reason to avoid the drug as a treatment for COVID-19.

                                      


Patients treated with hydroxychloroquine at Henry Ford met specific protocol criteria as outlined by the hospital system’s Division of Infectious Diseases. The vast majority received the drug soon after admission; 82% within 24 hours and 91% within 48 hours of admission. All patients in the study were 18 or over with a median age of 64 years; 51% were men and 56% African American.

“The findings have been highly analyzed and peer-reviewed,” said Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, who co-authored the study with Henry Ford epidemiologist Samia Arshad. “We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring. Our dosing also differed from other studies not showing the benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”

Dr. Zervos also pointed out, as does the paper, that the study results should be interpreted with some caution, should not be applied to patients treated outside of hospital settings and require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety and efficacy of hydroxychloroquine therapy for COVID-19.

“Currently, the drug is "off label" and should be used only in hospitalized patients with appropriate monitoring, and as part of study protocols, in accordance with all relevant federal regulations,” Dr. Zervos said.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

FDA MedWatch - Hand Sanitizers with Methanol

In a rush to manufacture and distribute hand sanitizers some companies took shortcuts and had defective alcohol production methods resulting in the production of methanol.  This was also a problem during the era of prohibition in the 1920s.  Methanol is toxic to the optic nerve and will cause blindness.   A MedWatch Safety Alert was added to the FDA Drug Safety and Availability webpage.  TOPIC: Hand Sanitizers with Methanol: FDA Updates  AUDIENCE: Consumer, Health Professional  ISSUE: FDA is warning consumers and health care providers that the agency has seen a sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination. The agency is aware of adults and children ingesting hand sanitizer products contaminated with methanol that has led to recent adverse events including blindness, hospitalizations, and death. Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects. FDA’s investigation of methanol in certain hand sanitizers is ongoing. The agency will provide additional information as it becomes available. Recent recalls include:  All Clean Hand Sanitizer, Moisturizer and Disinfectant by ITECH 361 Mystic Shield Protection Topical Solution by Transliquid Technologies BACKGROUND: Substantial methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death. Although all persons using these products on their hands are at risk, young children who accidently ingest these products and adolescents and adults who drink these products as an alcohol (ethanol) substitute, are most at risk for methanol poisoning.

RECOMMENDATION: FDA reminds consumers to wash their hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. If soap and water are not readily available, the Centers for Disease Control and Prevention (CDC) recommend consumers use an alcohol-based hand sanitizer that contains at least 60 percent ethanol. This chart outlines the information on hand sanitizer labels for consumers to use to identify a product that has been tested by FDA and found to contain methanol, that is being recalled by the manufacturer or distributor, or that is purportedly made at the same facility as products that have been tested by FDA and found to contain methanol. FDA advises consumers not to use hand sanitizers from these companies, or products with these names or NDC numbers. Consumers and health professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: Complete and submit the report online. Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178.

FDA MedWatch - Hand Sanitizers with Methanol

How can the Coronavirus pandemic end?

As we struggle to re-open our economic and social fabric in the United States we wonder how will the pandemic end?

There are two ways it can end.

1. Herd Immunity (also called herd effect, community immunity, population immunity, or social immunity)



In our present setting, the coronavirus only affects a very small percentage of the world population.  Even so, it is causing major disruption to the economy and to social functions.

A mathematical model for the unrestricted spread of infectious diseases, such as smallpox,  pertussis, measles, or coronavirus has been developed.  The model has been tested and proven by previous pandemics.  The variables in the equation are R (the number of infections transmitted by a single host) and S ( the proportion of the population who are susceptible to infection and setting this product to be equal to 1.

Viral entity                                R0                                   HIT       

Measles Airborne                    12–18                              92–95%

Pertussis Airborne droplet 12–17[51]                      92–94%

Diphtheria Saliva                       6–7                              83–86%

Rubella Airborne droplet          6                                       83–86%

Smallpox                                       5–7                                       80–86%

Polio Fecal-oral route

Mumps Airborne droplet           4–7                                 75–86%

COVID-19

(COVID-19 pandemic)              2–6                                50–83%

SARS

(2002–2004 SARS outbreak)               2–5                    50–80%

Ebola

(Ebola virus epidemic Bodily fluids      1.5–2.5               33–60%

Influenza

(influenza pandemics) Airborne      1.5–1.8                    33-40%

These are the facts, numbers do not lie.  

Prevention at the moment (summer 2020) may reduce the numbers, or flatten the curve but has the disadvantage of population variables, such as political motivation, willingness to comply with distance, wearing PPE, following CDC and WHO guidelines.  As we have experienced as soon as PPE, social distancing are removed the infectious rate quickly returns to a high level since the vast majority of the population is naive to coronavirus.


2  An effective vaccine.

Belgian virologist Guido Vanham, the former head of virology at the Institute for Tropical Medicine in Antwerp, Belgium, and asked him: how will this pandemic end? And on which factors might that depend?

Guido Vanham (GV): It will probably never end, in the sense that this virus is clearly here to stay unless we eradicate it. And the only way to eradicate such a virus would be with a very effective vaccine that is delivered to every human being. We have done that with smallpox, but that's the only example - and that has taken many years.

So it will most probably stay. It belongs to a family of viruses that we know - the coronaviruses - and one of the questions now is whether it will behave like those other viruses.

It may reappear seasonally - more in the winter, spring and autumn and less in the early summer. So we will see whether that will have an impact.

But at some point in this epidemic - and certainly in the countries that are most affected, like Italy and Spain - there will be saturation, because according to predictions, up to 40% percent of the Spanish and 26% of the Italian population are or have been infected already. And, of course, when you go over 50% or so, even without doing anything else, the virus just has fewer people to infect - and so the epidemic will come down naturally. And that's what happened in all the previous epidemics when we didn't have any [treatments]. The rate of infection and the number of those susceptible will determine when that happens.

This natural course, prior to vaccines places a demand on health services, significant morbidity, and mortality.  The cost of a natural process would exceed the cost of quickly developing an effective vaccine. Despite media exaggerating the mortality rate coronavirus kills few that it effects, mainly older and the chronically ill. Examining the R0 and HIT covid-19 is far less infectious than Pertussis and Measles.

Measles have been a chronic illness of children and when a vaccine developed it was eliminated very quickly.

The charts above display the rapid diminution of viral epidemics once vaccination begins. Normally the development of a safe and effective vaccine may take several years using previous technology.  Vaccines are now manufactured using RNA technology rather than growing batches of viral particles to be injected.  If the proper RNA is developed it can be injected directly into humans and the normal biochemistry of cells will develop the protein segment of the virus to be used as a vaccine. This means an entire viral particle is not necessary to produce immunity.

Several other factors could take place.  Covid-19 has exhibited some mutations in serotype already which are minor thus far.  A mutation could evolve spontaneously that would alter it immunologically and also it's pathophysiology.

Today pharmacology allows a pipeline to be developed to manufacture like products without having to reinvent the entire process.