Tag Archives: Straight No Chaser

When Stay at Home is the Wrong Choice

April 21, 2020Public Health, Health PreventionBehind the Curtain, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, COVID, Stay at HomeJeffrey Sterling, MD

Introduction

This Straight No Chaser addresses when stay at home shouldn’t be governing your decisions in the midst of the COVID-19 pandemic.

When Time is Tissue

Let’s not get mixed messages about “Stay at Home.” COVID-19 is all the rage, but other diseases such as heart attacks, strokes and asthma will still end up killing more of us this year than the novel Coronavirus. When we ask you to stay at home, none of that should be interpreted as staying away when you have concerns about what could be an acute life-threatening emergency.

It’s great that people are becoming comfortable using telehealth and telemedicine to get minor concerns addressed and to obtain information and advice. Continue to do so. However, there are diseases for which “time is tissue,” meaning delays in diagnosis and treatment will likely be devastating. Below are a few links to Straight, No Chaser posts that help you appreciate when your first action needs to be getting to the emergency room instead of getting on the phone on the computer. Stay safe.

Straight, No Chaser Links for Critical Disease Recognition

When to Visit and Not Visit the ER

Stroke Recognition

Heart Attack Recognition

Asthma Exacerbations

Suicide Risk Recognition

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being filled (without shipping delays!) at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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Questions and Answers about Masks for COVID-19

April 20, 2020Infectious Disease, Public Health, Health PreventionBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, N95, Facial Masks, Surgical mask, Surgical masksJeffrey Sterling, MD

Introduction

This Straight, No Chaser offers five questions and answers about masks to be used against COVID-19.

Wasn’t it first recommended that we not wear masks?

Yes, but that wasn’t based on science. It was based on prioritizing the scarce supplies of masks to the public. The supply sufficiently changed so that the recommendation changed. It was unreasonable to leave the public exposed with so many new cases and deaths occurring.

Why did the CDC recommend use of homemade masks?

The recommendation to wear scarves and homemade masks is also done in deference to healthcare and other essential workers, not because they work. The ideal public mask, inclusive of available supply, not exhausting needed supplies for hospitals and other essential workers, and effectiveness is a surgical mask. It is fair to assume that any next set of recommendations from national public health professionals will be along those lines. Don’t just take my word for it. Here’s Dr. Fauci’s comments: “When we get in a situation where we have enough masks, I believe there will be some very serious consideration about more broadening this recommendation of using masks…One of the best ways Americans can avoid infecting others — even if they aren’t showing any coronavirus symptoms — is to wear a surgical mask when they’re out in public.”

Aren’t N-95 masks better?

Yes, but you don’t need N-95 masks. The level of protection these masks offers is way above the concentration of virus to which you’re likely to be exposed. The extra percentages of protection come in handy in hospital and other treatment settings. Surgical masks hit the sweet spot for the public.

Are homemade masks effective?

They don’t offer the same level of protection as surgical and other types of masks. There are several studies that have found cotton mass only work about half as well as surgical masks. According to the CDC they are to be considered a last resort. The issue is homemade face masks don’t block some very fine particles in the air that may be transmitted by coughs or sneezes, so it’s not best for preventing someone who’s wearing one from contracting the airborne coronavirus. On the other hand, they do help to block larger respiratory droplets, they can keep you from spreading it to someone else. If you’re going to wear a homemade mask, ensure it’s made of thick cloth and creates a tight seal around the face.

How do you clean your cloth masks?

You’re best off handling them like a package. Consider them contaminated. Wash them in hot soapy water and occasionally sanitize them in bleach. This means if you’re using them, you should have quite a few that you use while you are washing the others.

It would be a fair prediction that everyone may soon be recommended to wear masks when out in public. The science for this is based on the ongoing ability to transmit the disease some 14 days after infection. Make sure you and your family are ready.

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Reopening America During a Pandemic: Phase One

April 17, 2020Public HealthBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19Jeffrey Sterling, MD

Introduction

This Straight, No Chaser reviews the proposal criteria set by the Trump administration for phased reopening America and restarting the economy. This post reviews gating criteria for the states and Phase One of reopening.

Proposed State or Regional Gating Criteria

These are the criteria needing to be satisfied before proceeding to the phased opening.

Symptoms

Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
Downward trajectory of COVID-like syndromic cases reported within a 14-day period

Cases

Downward trajectory of documented cases within a 14-day period
Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)

Hospitals

Treat all patients without crisis care
Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

Guidelines for All Phases: Individuals

Continue to Practice Good Hygiene

Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used items or surfaces.
Avoid touching your face.
Sneeze or cough into a tissue, or the inside of your elbow.
Disinfect frequently used items and surfaces as much as possible.
Strongly consider using face coverings while in public, and particularly when using mass transit.

People Who Feel Sick Should Stay Home

Do not go to work or school.
Contact and follow the advice of your medical provider.

Phase One for States and Regions that Meet the Gating Criteria

Phase One: Individuals

All vulnerable individuals should continue to shelter in place. Vulnerable individuals are the elderly and individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy.
Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents.
All individuals, when in public (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others.
Social settings of more than 10 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed.
Avoid socializing in groups of more than 10 people in circumstances that do not readily allow for appropriate physical distancing (e.g., receptions, trade shows)
Minimize non-essential travel and adhere to CDC guidelines regarding isolation following travel.

Phase One: Employers

Continue to encourage telework, whenever possible and feasible with business operations.
If possible, return to work in phases.
Close common areas where personnel are likely to congregate and interact or enforce strict social distancing protocols.
Minimize non-essential travel and adhere to CDC guidelines regarding isolation following travel.
Strongly consider special accommodations for personnel who are members of a vulnerable population.

Phase One: Specific Types of Employers

Schools and organized youth activities (e.g., daycare, camp) that are currently closed should remain closed.
Visits to senior living facilities and hospitals should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene.
Large venues (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate under strict physical distancing protocols.
Elective surgeries can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines.
Gyms can open if they adhere to strict physical distancing and sanitation protocols.
Bars should remain closed.

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The Other Upcoming Pandemic

April 16, 2020Mental Health, Public Health, Health PreventionCoronavirus, Depression, mental-health, Post-Traumatic Stress Disorder, PTSD, Sterling Medical Advice, Straight No Chaser, asksterlingmd, Covid-19Jeffrey Sterling, MD

Introduction

This Straight, No Chaser looks at mental health as an equivalent of an upcoming pandemic.

The general American population (and perhaps the world in differing amounts) is about to get a up close look at what is known as social determinants of health. With another 5.2 million Americans filing for unemployment (raising the number to over 22 million over the last four weeks), we are reaching a critical mass of economic hardship. As a result, someone (everyone) needs to prepare for the mental health ramifications of this.

Mental Health Challenges

Here are some predictable scenarios, each with mental health consequences:

• Depressions (and even suicide rates) will explode.
• Individuals prone to post-traumatic stress will have flare ups. Also, others will develop an equivalent of it.
• Americans will be forced to choose between food and medicine. Unfortunately, others won’t have either as an option and will become ill (and die) as a result.
• We will become angry. Anger will be expressed; in some cases rightfully so, and it will be displaced inappropriately. Predictably, we have already begun to see demonstrations.
• In some instances, there will be violence. This will range from domestic violence to outward expressions. Sadly, everyone’s fuse is shortening.

How Will You Cope?

There’s so much more, but you should get the point. The question, of course, is how will you cope with the upcoming pandemic of mental health issues? Do you have the means, inclination and access to get help? Let’s start with self-help measures you can take. From there, just being mindful that these issues will be arising may convince you to get help when you need it. Also take the time to look after those you care for. Actually engage people in conversations about their mental health. For years, I’ve told patients that when I asked them how they were doing, it wasn’t a pleasantry but an actual inquiry. Care enough to do the same. We’re all in this together. When things “return to normal,” maybe show a little empathy for those for whom this has always been their normal.

Straight, No Chaser Posts on Mental Health

Stress Management

Developing a Stress Management Plan

Post-Traumatic Stress Syndrome in Communities

Depression: How to Avoid it and When to Get Help

Suicide Risks and Prevention

How to Escape a Domestic Violence Situation

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Lingering COVID-19 Questions, from Reinfection to Reopening

April 15, 2020Infectious Disease, Public HealthBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, Dr. FauciJeffrey Sterling, MD

Introduction

This Straight, No Chaser looks at some lingering COVID-19 questions. Many of these have been prompted by a recent study. According to Reuters, S. Korea has reported that at least 116 people who were thought to have recovered from COVID-19 have tested positive for it again. This is an introduction to the reality that there still remains much that we don’t know about this virus.

Consider These Distinct Possibilities

The virus could be mutating in real time. Patients are getting reinfected.
Instead of patients getting reinfected, the virus is reactivating. In effect, it finds a way to “come back to life.”
These events are simply a result of testing errors. Some percentage of false positive tests will occur. Over millions of tests, the expression of false positives become realized as these cases. Furthermore, if a patient’s treatment is stopped too soon as a result of a false positive test, the reemergence of symptoms will appear to be a reinfection.

Lingering COVID-19 Questions

These events throw what we know and believe into uncertainty. Here are a few questions that now come to mind that are the focus of upcoming research efforts.

Does positive antibody testing mean we’re immune? That is understood to be the case. However, if the novel coronavirus actually has the ability to rapidly mutate, if additional strains develop, or if a reactivation mechanism exists, this may not be so. In other words, whereas we would be immune to “what was,” we might not be immune to a changed virus.
Is there a possibility that even in the presence of a positive antibody test, the virus could exist in a latent state and could still be transmitted to others, creating an infection, a la chicken pox/shingles? This is truly a worst-case scenario but is extremely unlikely. Unfortunately, based on the nature of the novel coronavirus, it has to be considered.
When will a vaccine will be ready? An effective vaccine would be a game changer. A vaccine that only works against the current strain in the presence of a virus that is able to mutate and/or develop additional strains would not be as effective.
When will preventive and curative medicines will be made available? There are current emergency provisions in place for certain medicines in the face of seeming life-threatening progression of the disease. Last minute use of experimental medicines can’t be the standard or sole recourse we have. The process of clinical research must continue.
Are we seeing a curve or a wave? Believe it or not, this is yet to be determined. If the exercise of removing the stay at home orders too soon isn’t precisely timed, the number of infections and deaths will go back up. We have seen this occur in other countries around the world. This is why it’s key to engage in community testing, contact tracing and antibody testing – still.

Until these lingering COVID-19 questions are answered, our understanding will be limited at best. Until we know these things, our ability to reopen the country for business and life approximating “normal” will be limited. We cannot currently say that we can answer these questions with certainty.

Perhaps you’ll take comfort in knowing where the standard lies. Generally, those that have recovered from COVID-19 will likely be immune if a second wave hits. According to Dr. Anthony Fauci of the White House coronavirus task force, “Generally we know with infections like this, that at least for a reasonable period of time, you’re going to have antibodies that are going to be protective…If we get infected in February and March and recover, next September, October, that person who’s infected –– I believe –– is going to be protected.” Stay tuned.

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Specific Reasons for Overrepresentation of COVID-19 in African Americans

April 14, 2020Public HealthAfrican American, Behind the Curtain, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, Covid-19, SI Medical SupplyJeffrey Sterling, MD

Introduction

We’ve previously quantified the overrepresentation of COVID-19 in African Americans. This Straight, No Chaser offers a few specific reasons for those disparities. We hope policy makers and public health professionals continue to identify and address these root causes of medical and social determinants of health. These are among the main reasons for the vicious health care disparities now being revealed.

Individual Reasons for the Overrepresentation of COVID-19 in African Americans

Clustering in America’s most populous cities
Disproportionately poor
Disproportionately represented in front line “essential” jobs (janitors, cashiers, bus drivers, etc.)
Greater presence of preexisting conditions
Inadequate housing and higher representation in homeless population
Increased neighborhood risks (exposure to pollutants and toxins, less green spaces, less healthy food options, less safety), many of which lead to lowered immunity
Less access to care (health facilities are less available in African American communities)
Less access to testing (testing facilities are less available in African American communities)
Need to utilize public transportation (representing 25% of users)
Overrepresentation in the incarcerated population
Unequal levels of care received due to an “empathy gap” by physicians caring for African Americans
Perceived criminalization (yes, the perception of Blacks wearing masks actually is inhibitive to the use of personal protective equipment in the community)

These conditions don’t excuse the presence of disease or absolve individuals from exerting their best efforts toward health self-empowerment. However, it helps to appreciate factors that stack the deck for or against specific groups of individuals. Furthermore, doing so allows health professionals to create and adjust plans accordingly. Stay safe.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being filled at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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We’re Helping Those In Need. You Can Too.

April 11, 2020Infectious Disease, Health PreventionStraight No Chaser, asksterlingmd, Covid-19, Protective MasksJeffrey Sterling, MD

Introduction

At Straight, No Chaser, we’re into helping those in need. As we’ve discussed, certain communities are especially disadvantaged when it comes to having access to equipment that defends against COVID-19.

Our efforts are not simply to make a buck here. Your support of our efforts to place masks in the hands of the public has additional benefits. Your purchase allows us to contribute to communities that can’t afford or otherwise can’t access masks. Also, there’s no worries about the masks we’re offering. These are the masks the CDC recommends for the public. These masks defend the amount of exposure (viral load) typically seen by the general public.

Please leave the N95 masks for medical personnel because the shortage is real. We don’t need those on the front lines exposed. When physicians, nurses, first responders and other essential workers are interacting with so many others, if they are infected, they can spread the disease much quickly. Let’s not have further shortages be the reason for that happening.

Help us help others. We’re all in this together. If you represent a community that needs access to masks, feel free to contact us.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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The Rationale for Not Using Hydroxychloroquine and Azithromycin to Treat COVID-19

April 9, 2020Infectious Disease, Medical Treatment, Public Health, Toxicology/DrugsBehind the Curtain, CDC, Centers for Disease Control and Prevention, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, Covid-19, hydrochloroquine, azithromycin, zinc, Dr. Fauci, Dr. ZelenkoJeffrey Sterling, MD

Introduction

Before looking at the rationale against the use of hydroxychloroquine and azithromycin to treat COVID-19, think about what’s being asked here. There are two option. The first is you’re potentially asking for a patient requiring critical care to benefit from a miracle cure. The second is you’re asking for an antiparasitic medication with a dangerous side effect profile to work in preventing the spread of an especially virulent virus in patients who mostly recover on their own. It’s as if the cards were stacked at the beginning of the conversation. In case you haven’t done so, review the previous post on the rationale for using hydroxychloroquine and azithromycin.

There’s a difference between hope and false hope. To quote Dr. Fauci’s comments on physicians and persons endorsing this combination without evidence, “We don’t operate on how you feel. We operate on what evidence is, and data is…we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug.”

Meanwhile, President Donald Trump, in his self-described capacity as a cheerleader, has notably encouraged using these drugs, saying “What do you have to lose?” Well, physician don’t operate that cavalierly with your lives. We operate under the mantra “Do No Harm.” Let use these opposing premises as the starting point for a review of the arguments against the proposed uses of hydroxychloroquine in treating COVID-19.

The Research

There really are four topics that constitute the arguments (“evidence” if you will) for use of hydroxychloroquine in treating COVID-19. Let’s review them.

Small studies performed on laboratory cell cultures

A Chinese study demonstrated that hydroxychloroquine prevented proliferation of the COVID-19 in a lab setting. Anyone who has ever taken a high school science course should recall the difference between in vitro and in vivo. What happens in a petri dish is a long way away from having the same effect on and having benefits in living beings. Furthermore, efforts specifically meant to replicate the lab (in vitro) success have not been successful. Per the academic journal Antiviral Research: “Chloroquine has been proposed several times for the treatment of acute viral diseases in humans without success.” Simply put, the drug has shown no benefit when tested on any animal in clinical studies.

Comments of Chinese Health Officials

Chinese health officials assert “chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome.” That sounds good, but this Chinese consensus statement provided no data to support the assertion. For example, one such paper was titled “Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies.” It cites as its primary source an audio recording of a news briefing from the State Council of China. That’s propaganda, not science.

The French Study

A single French study that suggested the combination of hydroxychloroquine and azithromycin was effective against COVID-19. (This is the study Trump references in his tweets.) The study’s conclusion states “hydroxychloroquine is efficient in clearing viral nasopharyngeal carriage of [the novel coronavirus] in COVID-19 patients in only three to six days, in most patients.”

This paper has been criticized widely. Here are some of the cited concerns.

The study contained 20 people, thus lacking the statistic power to make extrapolations of the data that supporters have made. Also, this study was published without underground the peer review process that subjects these things to medical scrutiny.

This was not a double-blinded study. The doctors and the patients were aware of patients’ group status within the study. This is a failure by itself. Also, only a quarter of the placebo patients actually had their viral load measured! So how was the conclusion of reducing nasopharyngeal COVID-19 quantified? By the way, even if “clearing of the virus” occurred, that doesn’t necessary equate to “better clinical outcomes.” There is no suggestion one set of individuals fared better than the other.

Furthermore, six (a pretty substantial proportion) of the patients from the group who had been receiving the drug quit the trial. Three of them ended up in intensive care. One died. These likely were failures of the drug to work against the virus, but this data wasn’t considered or reported as such in the results.

Dr. Vladamir Zelenko’s 699 Patients

Many are enamored with Dr. Vladamir Zelenko’s claims that he has treated 699 patients successfully with hydroxychloroquine and azithromycin (with zinc). Here’s all you need to know to analyze his efforts. Zelenko’s claims are exactly that: claims. He has published no data. He has described no study design. There has been no analysis reported. His anecdotes are not close to being scientific proof.

Pushback

In fact, there has been an actual controlled clinical trial from China that showed no statistical differences in health outcomes between a control group and patients who received hydroxychloroquine after seven days. However, because of its small size, it also can not be deemed conclusive.

Still, and in case you didn’t know, the preponderance of evidence (or lack thereof) has compelled the Centers for Disease Control and Prevention to pull back its guidance for hydroxychloroquine usage for COVID-19. It no longer offers recommendations for its dosage. Also, the CDC has also deleted all information on those aforementioned early studies of the drug from its website. Its “off-label” use for emergencies is left to the discretion of individual physicians. It is of note that multiple prominent institutions, such as Northwestern Memorial Hospital in Chicago, have declined to offer it.

Summary

What this all means is, at best, “the absence of evidence isn’t evidence of absence.” It is indisputable that the research thus far is below the medical and scientific standard. However, because of some of the theoretically plausible benefits and the actual absence of any meaningful data, the drugs are worthy of undergoing the scrutiny of the scientific method of research. And thus, legitimate clinical studies have begun.

It is unfortunate that the attention paid to hydroxychloroquine and azithromycin (and their unfounded positioning as miracle drugs) could be distracting from other possible solutions. It certainly is a distraction from the need to focus on wider testing and preventive strategies. What has also been lost in the fervor is the combination of hydroxychloroquine and azithromycin could be dangerous for individuals, particularly those with some heart conditions. However, you will note that looking at side effects wasn’t even necessary to demonstrate the use of these medicines is premature at best. In the spirit of “do no harm,” let’s finish back with Dr. Fauci, who was asked if he would take the drug if he were stricken with the virus. His response? “Only if it were part of a clinical trial.”

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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The Rationale for Using Hydroxychloroquine and Azithromycin to Treat COVID-19

April 8, 2020Infectious Disease, Public Health, Respiratory/Lungs, Toxicology/DrugsBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, WHO, asksterlingmd, Covid-19, chloroquine, hydrochloroquine, plaquenilJeffrey Sterling, MD

Introduction

This is the first of a two-part Straight, No Chaser view at the rationales for and against using hydroxychloroquine and azithromycin to treat COVID-19.

Perhaps the distraction of the US President trumpeting (no pun intended) this combination has turned some away from the possibility that these medicines could be helpful. Maybe the well-publicized deaths of individuals taking the medicine has caused concern. Perhaps the robust criticism of the most-commonly cited study used as evidence has led many in the medical and scientific communities to be dismissive. Still, there has to be scientific reasons for putting forth the medications and the combination, right? In fact, there are.

Hydroxychloroquine and Azithromycin

Let’s review the ways the drugs work and the scientific rationale for their use against COVID-19.

Hydroxychloroquine

Hydroxychloroquine (HC) is a derivative of an older drug (chloroquine). Both drugs are best known as drugs used to treat malaria, which is a disease caused by a parasite spread by mosquitos. HC has the following properties as a drug:

It disrupts the ability of parasites to reproduce and proliferate by blocking a chemical needed to digest proteins. It’s basically starving the parasites. This mechanism doesn’t appear to have applicability in viruses.
Even though HC is not an anti-viral medication, it has effects that could combat the way viruses in general replicate, thus slowing its spread.
There is evidence that HC inhibits cells’ ability to secrete substances known as cytokines. This is relevant because one of the most devastating effects of COVID-19 isn’t found in the activity of the virus itself. It’s the immune system’s response to the virus. In severe cases, there’s an overreaction by the immune system within the lungs by these cytokines. This by itself can cause fatal damage. This concept should be familiar to those with autoimmune diseases. Sometimes the body is just so exuberant in attacking foreign agents within us that damage occurs to us in that fight. Therefore, if HC activity blocked that cytokine release process, it conceivably would be helpful.
COVID-19 appears to bind to hemoglobin, the molecule that transports oxygen. COVID-19 seems to force hemoglobin to release its oxygen molecule. This reduces oxygen-carrying capacity, which ultimately contributes to feelings of shortness of breath. Most importantly, the lack of oxygen within the body’s cells contributes to their death. Furthermore, that unbound iron is a free radical and oxidant. In this state, it causes damage to lung cells (wanting to avoid this process is why so many of you take “anti-oxidants”). Hydroxychloroquine appears to inhibit the binding of COVID-19 to hemoglobin, theoretically reducing much of this.

Azithromycin

Azithromycin is an antibiotic, meaning it is used against bacteria. You likely have taken it and know it as a “Z-pack.” It does not work against viruses. However, there are many situations in which a viral infection lowers the body’s immunity, and bacterial infections take advantage of the situation and “jump” on you. These are called secondary bacterial infections or co-infections. In these situations, azithromycin could be of use because it’s treating the secondary infection.

The Combination

There is actual case history for the use of hydroxychloroquine with and without azithromycin. It is used in China, South Korea and a few other countries. In fact China asserts that chloroquine might improve the overall treatment’s success rate and subsequent outcome, along with shortening hospital stays. Also, there are scattered physicians in the US who have (in)famously cited miraculous success using these drugs.

Summary

Many of those in the pro-camp for the use of these drugs also cite various studies that have shown promise for the use of these medicines. However, as we’ll discuss in the next Straight, No Chaser, those studies actually are support against the current use of these medicines. However, one recalls that penicillin was discovered on a mold that was stopping bacteria from growing on a petri dish.

Even with the theoretical benefits of these drugs having nothing to do with direct anti-viral properties, the indirect efforts are sufficient to suggest that robust research should be conducted within the medical tradition to establish if and how these medicines may be used in patients with COVID-19. It is not inappropriately hopeful to think hydrochloroquine could have a role in the more severe patients. Its indirect effects may prove to be a means of slowing down the march of COVID-19. It is most correct to say that there is insufficient evidence to advance its use, either as prophylaxis or treatment. It is equally important to note that all such evidence is either theoretical or anecdotal.

To that end, in late March, the WHO announced that hydroxychloroquine was among four treatments being analyzed as possible tools in this fight. There is a lot more to come and to be said.

The next post reviews the case against the use of hydrochloroquine and azithromycin in patients with COVID-19.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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The New COVID-19 Normal – Three Steps to Safety

April 7, 2020Infectious Disease, Public Health, Health PreventionBehind the Curtain, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, antibody testingJeffrey Sterling, MD

Introduction

This Straight No Chaser offers you a “Three Steps to Safety” approach for what will become the new normal.

Think about the next COVID-19 Outbreak.

I’ve been wondering what next year looks like. Consider this a thought exercise, based around three questions.

How long can we endure the current way of life?
Under what conditions would we be comfortable going back to work, back to church, back to the beaches, back to what once was “normal?”
What will we do next year when next year’s outbreak begins?

These questions take me back to influenza. How is it that we’ve become comfortable with allowing an infectious disease to kill 35,000 Americans a year? Would you be comfortable with COVID-19 killing year after year?

The thing with COVID-19 is it imparts a level of horror that influenza doesn’t. It has required social distancing and self-quarantine activities. Could our nation do this for 3-6 months every year?

Even if we could, we wouldn’t want to. So how do we get there?

Three Steps to Safety

I propose these “three steps to safety.”

What we’ve learned about masks, handwashing and social distancing will and should become the new normal. There are several countries in which it is considered an insult to be in public without a face mask. That’s actually a fairly prudent standard. I doubt that we’d get to the extreme of banning public gatherings, but risk minimalization by social distancing is a strategy to be used whenever possible.
Presumably, there will be a vaccine available sometime within the middle to end of the next respiratory season (say at the turn of the year). Will you get it? Hopefully we’ll do a better job with this than we do using the influenza vaccine. Of course this will need to be coupled with testing that’s at least as available and the influenza vaccine currently is.
The problem with the current influenza strategy is people get the vaccine, and we then make assumptions about its effectiveness. In other words, the vaccine by itself isn’t enough. That isn’t good enough for influenza, and it certainly won’t be good enough for COVID-19. I call for routine antibody testing to become part of the medical evaluation process. Antibody testing allows individuals to know that they are immune from the disease, and it can be done from the convenience of home. That’s the level of confidence needed to reengage the workplace and normal activities.

This isn’t that complicated. As is often the case, the devil is in the implementation. Stay safe.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being accepted at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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African American COVID-19 Outcomes are Disproportionately Bad

April 6, 2020Infectious Disease, Public HealthAfrican American, Behind the Curtain, CDC, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19Jeffrey Sterling, MD

Introduction

Very few states have been collecting COVID-19 demographic data based on race. When you look at the data, it’s apparent why some may not wish to be confronted with that information. We’ve already discussed how African Americans are set up for horrific outcomes due to this pandemic. African Americans fit the high-risk profile in numbers disproportionate to the greater population. They have increased incidences of diabetes, chronic heart disease, chronic lung disease and HIV. As you may be aware, along with being elderly and having other causes of lower immunity, these conditions constitute the most significant risk factors for poorer outcomes with COVID-19 infection.

African Americans are also subject to poorer outcomes due to social determinants of disease. In each of the major considerations: impediments in accessing care, having equal quality of care, and baseline economic status allowing the navigation of costs of care, African Americans are less well off than the general population.

African American COVID-19 Outcomes in Selected Locations

Here are a few data points that show just how dangerously and disproportionately COVID-19 is affecting the afro-descendent community.

In Chicago’s Cook County, African American residents make up 23% of the population. Unfortunately, they account for 58% of the COVID-19 deaths. According to data from the Cook County Medical Examiner’s office, half of the deceased lived in Chicago. Furthermore, the majority of African American COVID-19 patients who died had underlying health conditions, including respiratory problems and diabetes. Eighty-one percent had hypertension (high blood pressure), diabetes or both.
However, it’s not just an issue in Chicago. Statewide, the number of African American residents throughout with COVID-19 is also disproportionately high. African Americans account for 38 percent of the confirmed cases in Illinois while only being 14% of the population. The state has not released a racial breakdown for deaths, although Illinois is one of the few states that keeps COVID-19 data with a racial breakdown.
As of April 2nd, African Americans were almost half of Milwaukee County’s 945 cases. They were 81% of its 27 deaths. Milwaukee County’s population is 26% black.
According to the Michigan Department of Health and Human Services, as of April 2^nd, African Americans made up 35% of the state’s overall confirmed cases. They accounted for 40% of Michigan’s 417 deaths related to COVID-19. In Michigan, the state’s population is 14% black.
Louisiana has not published case breakdowns by race, but 40% of the state’s deaths have happened in Orleans Parish, where the majority of residents are black. New Orleans has emerged as one of the nation’s hotspots for COVID-19.

Other Examples of Disparities

Other concerns have been expressed without the data to precisely quantify them. Disproportionality in African American having access to tests with the same systems have been reported. Temporary COVID-19 treatment facilities have tended not to go up in areas accessible to African American communities. The $2 trillion stimuli bill was passed after stripping affirmative action guidelines promoting fairing in the business procurement process, making it less able for Black businesses to get opportunities to fund and fashion culturally specific solutions. The explosion in unemployment also disproportionately affected African Americans. These social determinants of health matter.

The concept of a perfect storm ignores the fact that there’s nothing perfect about it to its recipients. A certain degree of willness ignorance about public health challenges tends to exist at the onset of major catastrophes. Let’s not allow that to define the experience of African Americans during this already devastating pandemic. It’s long been said that when White Americans catch a cold, Black American get pneumonia. Given the devastation occurring across America, let’s be mindful of the still disproportionate effects that occur in this demographic.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being accepted at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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The CDC Recommends Facial Masks for the Public

April 5, 2020Public Health, Health PreventionBehind the Curtain, CDC, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Facial Masks, SI Medical SupplyJeffrey Sterling, MD

Need Facial Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Orders are now being accepted at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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Wear a Mask: The New Normal

April 2, 2020General Health and Wellness, Infectious Disease, Health PreventionBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, asksterlingmd, Covid-19, N95, defense production actJeffrey Sterling, MD

The answer really has been in front of our faces all along (no pun intended). I’ve long appreciated the wisdom of foreigners at airports walking around with their masks. It’s really a pretty simple proposition: no garbage out, then no garbage in. I’ve been saying for a while now that I wear a mask to protect you from me. It’s easy to combine that with the notion that everyone should act as if they’re infected and not trying to give it to anyone else. A great way to lower the chances of spreading COVID-19 is to put a mask on potentially infected people. In this case, that means everyone.

The name of the game here is risk reduction. As I mentioned in yesterday’s Straight, No Chaser blog, you should consider one of your essential to-dos wearing a mask or any available covering on your face upon leaving your house (yes, I’m assuming you’re not entertaining inside of your homes). Anything provides some measure of protection, even if it’s not an N95 mask.

This simple maneuver covers your sneezes and coughs. It eliminates your needless debate on whether COVID-19 is airborne. Wearing a mask avoids your potentially transporting COVID-19 around on your sleeve or elbow. It is what Sweden credits with bending the curve in their country.

Of course, this is where I remind you that all that’s really necessary to accomplish this in the US is further (how about full) enactment of the Defense Production Act. We need enough masks as not to not take away from medical personnel. We need those masks made in America to further assist with the economy.

Message to everyone involved: wear a mask! Just do it. Masks aren’t just for Halloween anymore.

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Ten Simple Steps to Lower Your Risk of Acquiring COVID-19

April 1, 2020Infectious Disease, Public Health, Health PreventionBehind the Curtain, Coronavirus, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, COVIDJeffrey Sterling, MD

Introduction

It’s time for health self-empowerment in the fight to lower your risk of acquiring COVID-19. Here are ten specific recommendations to give you and yours the best chance to get through these next few months. Adjust your lifestyle.

Do These!

If you have a medical concern, call your physician or any accessible nurse line, telehealth or telemedicine outlet.
If you have moderate to severe medical symptoms, find your local urgent care or emergency room. Newsflash: call around first to see how busy the ER is. There actually are quite a few small community hospitals around that aren’t as busy as you’d think.
If you leave the house, put on a mask. Any mask. Any covering.
If you are going to be in contact with anyone. Put on a mask. Any mask. Any covering. Stay away from anyone sick.
When you return to your house, wash your hands first thing.

Here are Five More!

If you are touching objects, sanitize them first and wash your hands after. If you are wearing gloves, replace them after you’ve contacted an object.
Do not touch your face without having washed your hands first.
Do not spew (cough, sneezing, yell, sing) outdoors or in the presence of anyone. Use your elbows. Do it while wearing a mask.
Find your inspiration and happiness wherever you can without violating the other considerations. Your mental health matters. Keep living your lives as best you can. Just be smart.
Focus on your overall health. Eat healthy. Stay active. Keep your immune system strong. The healthier you are, the better your body’s defenses will be.

We started by saying take steps to avoid catching the disease. We amended that to say act as if you have the disease and don’t want to spread it to others. You should now behave as if you are a part of a national lottery of death (yes, I know, but it’s true), and you don’t want to end up being mourned. Own your lives and your health.

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Coping with COVID-19

March 30, 2020Uncategorized, Infectious Disease, Mental Health, Public HealthBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, Stress, Stress Management, There are 72 Hours in a Day, asksterlingmd, Covid-19Jeffrey Sterling, MD

Introduction

How are you coping with COVID-19? This disease has produced and is producing more cases in the U.S. than any other country in the world. Therefore, it’s time to appreciate that we all can and in some way likely will be touched by it. Sadly, for some that means dying from the disease. For others, that means contracting the disease and recovering. Perhaps, we’ll watch someone we love become ill, not knowing if or that we were the cause of transmitting it. For others, our employment may be terminated or our relationships will be strained. For others still, we watch and wait.

Are You Coping?

However, for all of us, there is a measure of uncertainly. Every day, we have to either choose to socially isolate or not. We have to actually pay attention to when and how to wash and touch our faces. We have to be measured in how we show greetings and affection. Did you ever imagine the day would come that we’d question whether or not hand shaking was still appropriate? Can you imagine the anguish in needing to adjust the way we conduct funeral services?

Whether or not you’ve realized it yet, everything has changed – including us. However, the issue of how we come out of this pandemic is not yet the issue. How we cope with the stress and uncertainty currently before us is something we each should take a moment to reflect upon.

Tools for Coping with COVID-19

Let’s refer you to these two Straight, No Chaser posts that address stress management and how to develop a stress management plan.

Things To Do!

Now let’s acknowledge that the stress we’re enduring is a different kind and level of mental trauma than most of us have previously had to endure. Please consider the following suggestions about keeping focused and even productive during this time.

Break

COVID-19 has consumed our lives. Give yourself a break from news and social media engagement around the topic. It’s stressful!

Virtual

We are social creatures. If used correctly, social media can be quite the uplift. Engage in a virtual happy hour, class reunion, dance party or book club. Phone a friend. Often.

Activity

Yes, binge watching those television shows and movies you’ve always wanted to catch up on are options. Engage them! However, take advantage of this time to meditate, get in shape, learn a new language or develop a new hobby. I hear some of you have taken to sewing face masks!

Take Care of You and Yours

Make sure you’re getting sleep. Find things that make you smile. Learn to appreciate your time away. Create your own home vacation world. Get creative! And don’t forget about the kids!

Medical Information and Advice

Your health is a big source of stress right now. You should take comfort in knowing that nurse advice lines, telehealth and telemedicine are a phone call away. These vehicles can and should be your first steps in addressing any developing health concerns (assuming that your primary physician can’t be reached of course).

Whatever your level of stress, you’ll do better by not facing it alone, literally and figuratively. Remember, an idle mind is the devil’s workshop. Stay active and engaged so the stress created by coping with COVID-19 is left behind.

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Why Isn’t There a Coronavirus Vaccine?

March 29, 2020Infectious Disease, Public HealthCoronavirus, FDA, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, SARS-CoV-2Jeffrey Sterling, MD

Introduction

Creating a coronavirus vaccine seems like such a simple thing, doesn’t it? However, creating any vaccine is among the most complicated and arduous endeavors in medicine. As opposed to most medicines, a successful vaccine will be distributed to billions of people worldwide. In this Straight, No Chaser, we’ll look at the general process of vaccine creation as a means of understanding what has to happen prior to having a safe and effective coronavirus vaccine.

The Decision to Make Any Vaccine

The decision and process of making a vaccine is quite involved. I’ll summarize several of the considerations here.

Rationale and Target Immunization Rates

First, there has to be a public health rationale for a vaccine. There has to be an infectious disease present that’s severe and frequent enough to pursue a vaccine beyond other preventive strategies. That’s why there’s no vaccine for the common cold. Although everyone gets it, the body handles it just fine.
The ability to achieve target immunization rates has to seem reasonable. The World Health Organization has a target of 90% coverage for all vaccines by 2020. That level of coverage ensures protection for the others in the population who can’t receive the vaccines due to allergies or other reasons. If this goal can’t be approximated by the verbalized support of target populations around the world, the effectiveness of the vaccine may not be enough to justify the process of developing it.

Efficacy and Side Effects

Efficacy of the vaccine in preventing the disease sounds like a given, but it’s not. First, a vaccine needs to stimulate an immune system response that doesn’t under react or overreact. Either scenario could be deadly, so a level of precision is a must. This also involves discovering if a live vaccine or inactivated particle proteins from the virus can be used to stimulate that response. Furthermore, good efficacy takes into consideration that viruses are quite adept at mutating. The art of vaccines involves adjusting to keep current with the different viral strains and the viruses’ efforts to stay alive. We can expect this coronavirus to be an adaptor and/or mutator because it’s an animal virus. It’s already proven able to adapt from the environment of bats to humans.
The frequency and severity of vaccine side effects and adverse reactions are equally as important as efficacy. Can you imagine the consequences of giving a deadly vaccine to billions of people without having fully tested it? In a world prone to medical skepticism anyway, it’s a must that at least the medical, public health and regulatory communities are in agreement about safety considerations based on science, even if the public is not. Typically, each stage of studies (including pre-clinical, animal and human trials) will need to be replicated at multiple medical institutions in multiple different types of populations to ensure the results of one anecdotal case or study weren’t a dangerous random event.

Remembering that a pharmaceutical company is pursuing the development, testing and distribution of a vaccine, there has to be a business case for one. Vaccines don’t get made just because a new disease shows up. The costs of development ultimately will need to be recouped. However, the public will be equally insistent that the vaccine be cost-effective. There’s a lot to consider. There certainly appears to be justification for creating a coronavirus vaccine.

The Incentives to Make Any Vaccine

Here’s where I remind you that it’s not a governmental endeavor to make vaccines. These are decisions made by pharmaceutical companies. Potential vaccines are subject to approval by the equivalent of FDAs (Food and Drug Administrations) countries around the world. There are many regulatory hurdles to be cleared by the FDA before a coronavirus vaccine could be given widely to the US population.

This process is so arduous that it historically has taken between two and fifteen years to develop a vaccine. In fact, the most recent vaccine with which you may be familiar (the varicella vaccine, for prevention of chicken pox) took about 11 years to be licensed by the US FDA.

Considering all of that, think of the investment that must be made into making a coronavirus vaccine. There’s the study of a new virus, with the need to learn its genetic code, the means of causing disease and how it reacts to different threats. Mutation and other modes of adaptation need to be considered. There is a ton of work to be done before the process of creating a vaccine can even begin. Then the process has to go through animal models and rounds of human clinical trials prior to approval. As noted, the “chickenpox vaccine” took about an 11-year investment that needed to be paid for by the pharmaceutical manufacturer. That’s a long time and a big financial risk to take. Even while the public is demanding cost-effectiveness, somehow the manufacturer has to recoup its investment and make a profit.

The Prospects of a Coronavirus Vaccine

Now having discussed these things, consider where we are with a vaccine for the virus causing COVID-19. It’s named SARS-CoV-2, by the way. As a reminder, the world outside of China first gained access to the RNA sequence of the virus in January – just two months ago. There are now facilities in the US, Europe, Australia and possibly China already beginning the arduous process of learning enough about the virus that a vaccine may be proposed, developed, tested and approved.

Honestly, there is no way to predict when a SARS-CoV-2 vaccine will be available because there are multiple substantial steps to be taken. Each of these steps come with challenges, potential obstacles and potential setbacks. It would be irresponsible to even present a best-case scenario (but a target of 12-18 months has been placed as a challenge). However, you can rest assured that multiple entities across the world are putting forth their best efforts. In the meantime, prevention and early detection remain our best defenses while efforts continue on a coronavirus vaccine and effective treatment.

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COVID-19 Update, Actions and Next Steps

March 25, 2020Infectious Disease, Public HealthBehind the Curtain, CDC, Coronavirus, Straight No Chaser, There are 72 Hours in a Day, WHO, asksterlingmd, Covid-19, Flatten the curveJeffrey Sterling, MD

Introduction

This Straight, No Chaser addresses the latest on COVID-19 and discusses actions and next steps.

Number of Cases

The United States is now contracting 40% of the new cases of COVID-19 worldwide. As of this morning, there have been 428,220 cases and 19,101 deaths around the world. In the US, there have now been 55,330 confirmed cases and 804 deaths. That is more American than have died in the Afghanistan war in the last 8 years. Even if that was a hard stop, it would be horrific. But it’s only the end of the beginning.

You should reflect on the fact that we’ve only been dealing with this a short time. The next three weeks will be horrific. #PrayForNY #CaliforniaYoureNext #IllinoisKeepFighting

The Trajectory

Look at this chart of the disease trajectory. It’s not a curve. It’s a straight line. The curve has not yet bent. Cases are doubling every three days. This is not a game or a casual happenstance. This is science and medicine. Any individual’s (even the President’s) exhortations about their opinions or wishes about when and how this will end means next to nothing. Even if you’ve never heard of it, epidemiology is a branch of medicine addressing the incidence, distribution, and possible control of diseases and other factors relating to health. In other words, this is foreseeable and predictable. It could have been controllable much sooner. It is yet to be determined when it will be controlled.

Now look at this chart. Most US states are actually on the same trajectory. It’s not just New York. If anything, NY is the canary in the coal mine. Forewarned should be forearmed.

What’s Next: Actions and Next Steps

The next three weeks are going to be scary to many and deadly for a lot of Americans. The state of New York’s health care system is about to become overrun as if hit by a tsunami. As much as can be illustrated, the depictions of the numbers of people about to die will be shocking. However, it was still foreseeable. Predictable. Controllable.

And still, it can get worst. There are two sides to #FlattenTheCurve. You must still continue with the need to #StayAtHome. You must engage in vigorous, frequent hand washing. Cough or sneeze into your elbow. Keep your hands away from your eyes, nose and mouth. Sanitize items before and after you touch them. Stay six feet away from others. Avoid gathering of any size, and certainly more than ten people.

Regarding the other side of #FlattenTheCurve, it is not politics to ask the government to engage in public health best practices. We need widespread testing of symptomatic and high risk patients to identify the infected instead of just the seriously sick. #WhereAreTheTests We need to quarantine the infected. We need enforced isolation and treatment of the sick. #WhereAreTheSupplies We need to implement the Defense Protection Act today.

Ongoing half measures, stops and starts and variations from the standard continue to propel the disease forward. It pains me to opine that we have neither seen quick nor decisive action, often due to efforts to weigh other national considerations, including the economy. Pandemics don’t work that way. The best chance for these peripheral considerations to be addressed as soon as possible is to fully address the disease as soon as possible.

Thank you to my colleagues across health care and other essential services for continuing to put your lives on the line to combat this disease. Now, more than ever, health empowerment needs to be your mantra. When our system falls short (or even when it doesn’t), ultimately the responsibility for your health falls in your hands. Please take the actions and next steps recommended. Act as if you already have the disease and don’t want to transmit it.

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Actual Criteria for Coronavirus Testing

March 22, 2020Infectious Disease, Public HealthBehind the Curtain, CDC, Centers for Disease Control and Prevention, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19Jeffrey Sterling, MD

Introduction

Do you have any idea about the actual criteria for coronavirus testing? Even if you don’t want to know, if you’re talking or visiting a physician, you should be aware of what’s being used to determine (under current recommendations) your eligibility. This Straight, No Chaser presents an active set of criteria for your review.

Meanwhile, the need to expand coronavirus testing criteria and to expand the availability of tests continues. Let your voices be heard. #WhereAreTheTests

Whom Should Physicians Test for COVID-19?

Physicians may test any patient with symptoms consistent with COVID-19. Examples of these typically include fever, cough and shortness of breath. As commercial testing becomes even more increasingly accessible, expect criteria to expand.

However, the following patients should be prioritized for testing:

Critically ill patients receiving ICU-level care with unexplained viral pneumonia or respiratory failure. This is regardless of travel history or close contact with suspected or confirmed COVD-19 patients. This is meant to inform decisions about infection control and investigational therapeutics.
Any persons with fever (subjective or confirmed) and/or symptoms of a lower respiratory tract illness and a history of close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset. This includes all residents of a long-term care facility that have had a laboratory-confirmed COVID-19 case.
1. “Close contact” is defined as being within approximately six feet of a COVID-19 case for a prolonged period. A prolonged period equals more than about 10 minutes per current public health contact-tracing practice. It also includes those having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).
2. Here’s when physicians and other health care personnel (e.g., nurses and administrative staff) should be tested. Testing may be considered if there has been exposure to a person with suspected COVID-19 even without laboratory confirmation. Even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed health care personnel. This is warranted given their extensive and close contact with vulnerable patients in health care settings.

Any symptomatic individuals with a history of travel within 14 days of symptom onset to geographic regions where sustained community transmission has been identified.
Any symptomatic individuals who may be at higher risk of poor outcomes. These include those who are ≥ 65 years of age, immunosuppressed, or have high-risk chronic medical conditions (e.g., diabetes, heart disease, chronic lung disease, chronic kidney disease).
Individuals with fever and/or symptoms of a lower respiratory tract illness who are critical to pandemic response. These include health care personnel, public health officials, and other essential leaders.

Whom should physicians NOT test for COVID-19?

Asymptomatic individuals are not recommended to be tested for COVID-19, regardless of exposure history.
If an alternative diagnosis can be determined (e.g., rapid strep, rapid flu, BioFire viral panel), a clinical determination can be made that a COVID-19 test is not necessary. This is especially true if there is not yet community transmission of the disease in your area.
CDC recommends that mildly ill patients should be encouraged to stay home. You should contact your physician by phone for guidance about clinical management. If telemedicine is available and determines that symptoms are mild, patient’s should be referred to a mobile testing site if available. Otherwise, your doctor may elect to test you at the end of the day in the office away from other patients. This can protect staff and other patients and preserves the use of personal protective equipment.

You would do well to print this out. Use it as a guide to determine if your symptoms meet criteria for coronavirus testing under current guidelines. Use it to insist on testing if you meet criteria. #KnowledgeIsPower #KnowledgeIsHealth

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The Coronavirus Good News Post

March 21, 2020Uncategorized, Infectious Disease, Public HealthBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, Covid-19Jeffrey Sterling, MD

Introduction

Would you believe me if told you there was Coronavirus good news? Even in the first of what is likely to be weeks of a shutdown of activity for many places across the nation, it’s my professional inclination to look at things from multiple angles. I want to make a good faith effort to point out where we are from about as optimistic of a point of view as possible. Consider this an academic exercise as much as a reflection of any reality.

This has been a conversation about style, preferences and metrics. We’d do well to be reminded that the current process of combating the disease is based on a different philosophy (for better or worse) than has presently been used. This philosophy is based on less reliance on the federal government, with outsourcing of solutions to the states and the private sector. This is still America, and even with a slow start and what appears to be half measures when compared to best practices, we have seen a relatively low amount of deaths and the abilities of American innovation begin to come to bear on our behalf.

Coronavirus Good News

Here are five particularly positive developments and innovations of note from America and around the world.

Cleveland Clinic developed a COVID-19 test that gives results in hours. (Source: News 5 Cleveland)
South Korea has not only “flattened the curve,” but recoveries from documented cases now outnumber new cases. These occurred after implementation of mass testing. (Source: NBC News)
Isreali scientists are poised to announce the development of a coronavirus vaccine. (Source: The Economic Times)
The first three Maryland residents to test positive for coronavirus have completed treatment and are now doing well. (Source: WBAL)
The Japanese drugmaker Takeda Pharmaceutical Co. said it was developing a new coronavirus drug derived from the blood plasma of people who have recovered from Covid-19. Its approach is based on the idea that antibodies developed by recovered patients might strengthen the immune system of new patients. This is the type of effort that led to dramatic improvements during the pandemic of 1918.

Stay Calm and Do Your Part

Furthermore, the response from the most at-risk States and citizens across the country has been quite admirable (with a few notable exceptions). The ongoing enforcement of CDC recommendations, which are now mostly being endorsed (if not enforced) by the federal government will substantially improve the outcomes of Americans and people around the world.

Of course, all of this is to be balanced against other information. The situation will get worse before it gets better. However, in total, circumstances speak to the need to maintain diligence and determination instead of panic and feelings of helplessness. We can come out on the other side of this better and more self-empowered in our health.

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Coronavirus Myths, Part I

March 19, 2020Infectious Disease, Public HealthBehind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, asksterlingmd, Covid-19, SARS-CoV-2Jeffrey Sterling, MD

Introduction

Yes, Coronavirus myths are a thing. Coronavirus is not an all-powerful entity that spells the end of mankind. We just have to be diligent in attacking this pandemic. There’s so much information and misinformation out there that Straight, No Chaser needs to clarify some of the more important facts to know and egregious myths to avoid.

Myth: The virus is a variant of the common cold

No, it’s not, but it is part of the Coronavirus family of viruses. Different Coronaviruses cause different disease, and in fact four different members of that family cause common colds. However, SARS-CoV-2, the specific virus that causes COVID-19 is not one of them. So if you have the cold, don’t worry. The world isn’t about to end!

Myth: The virus was made in a lab

This particular Coronavirus myth/conspiracy theory is easy to combat (no pun intended) if you believe in science. All evidence suggests that SARS-CoV-2 (the virus that causes the disease of COVID-19) seems to have originated in bats. Also, there is no evidence that the virus was man-made. Furthermore, there are other viruses that have originated in animals that migrated to humans. This particular virus’ characteristics and activity fall in line with that of those other examples.

Myth: Any face mask protects you from Coronavirus

The problems with regular surgical masks is those viral particles aren’t blocked from penetration. However, the masks do have value in potentially blocking large respiratory droplets that you expel when coughing or sneezing. The most effective masks are the N95 respirators that medical staffs use. However, these need to be fitted to prevent air from escaping around the edges. Also, they must be checked for ongoing effectiveness after each use. Truthfully, it’s a matter of risks. Use the best option you have, and focus on prevention.

Myth: Getting COVID-19 is guaranteed to kill you

Here’s the data. Just over 2% of people infected with COVID-19 are killed by it. About 14% contract a severe illiness (significant shortness of breath), and just under 5% are critical (respiratory or multi-organ failure or septic shock). Over 80% of the infect have mild infections that may not include symptoms. The elderly and those otherwise immunocompromised are those most at risk, but there is some level of risk of severe disease and death for every individual contracting the disease.

Myth: The worst has passed in the US

We’ve continued to tell you (and most experts are agreeing) that the worst of COVID-19 has yet to come. We have seen incremental steps toward full quarantine and isolation in the US, seemingly in hopes that it won’t become necessary. However, as testing reveals the full extent of the disease, expect more of the school closures, athletic arena fan bans, city curfews, airport screening of the need to fly and other once-thought draconian measures to take hold, complete with military enforcement of the new rules. You probably didn’t know this, but state and federal laws are already in place for these considerations in the face of a public health emergency.

There are a lot more Coronavirus myths out there for us to beat down. If you have some you’d like us to address, leave them in the comments section. Stay tuned!

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