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Category Archives: Public Health
Notes from your Doctor: Good News on 2019-nCoV
In tracking the numbers of the epidemic, there is some good news flying under the radar. While the number of infections is increasing, and could potentially increase exponentially in the next couple weeks, the number of recovered patients, and the rate of increase of recovery is much quicker than the increase in the number of patient deaths.
These numbers are order of magnitude, since they change at least hourly. But in a broad stroke, the number of worldwide infections went up from about 15,000 on Sunday to about 20,000 on Tuesday (ET, China is a day ahead) with 13% in serious condition. Deaths over the same period increased from about 360 to 425 (20% increase), while recoveries increased from about 450 to about 725 (60% increase).
This, combined with the number of infections outside of China that are mild or asymptomatic lead to two conclusions: yes, it’s spreading and community based transmission is likely, BUT it’s likely that it will end up with a mortality rate of under 0.5%. In simple terms, this means while the probability of infection is increasing, the chances of the disease being survivable and potentially mild is also increasing.
Also posted in 2019-nCoV
Tagged Coronavirus
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Notes from your Doctor: nCoV Update 2_2_20
There are now more than 100,000 suspected cases of nCoV worldwide, the majority in China, but the number of confirmed cases is less than 20,000. The count of confirmed cases, deaths and recoveries is updated hourly by the folks at Johns Hopkins at this link.
There are a lot of medical and public health concerns, but there are also political and economic affects that will impact all of us whether or not we ever come in contact with 2019-nCoV.
But first…since my first post on this a week ago, I’ve heard from people who are starting to panic. Now is NOT time to panic. It’s time to be smart, to ignore the falsehoods about this illness, and to follow standard infection controls that you should be following anyway….when it’s time to panic, I’ll let you know. So, NO this is not a bioweapon, and NO you can’t get it from drinking Corona beer, and NO there is no specific treatment made from saline solutions. You can check the list of all the fake news on 2019-nCov here.
Also posted in 2019-nCoV, Notes from Your Doctor, Uncategorized
Tagged Coronavirus, epidemic, nCoV, pandemic, public health
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Notes From Your Doctor: 2019-nCoV Update
As of 29 January, the number of infections in mainland China has now surpassed the total number of SARS infections, albeit with a death rate two-thirds lower. There are signs that this will soon be a pandemic, as the R0 number appears to be increasing.
The most disturbing thing I’ve seen comes from a study in The Lancet indicating some issues with the initial information from the Chinese government. Whereas China had said that all the initial infections were tied to the Wet Market in Wuhan, the Lancet article indicates that only 66% had visited the market, and that the onset of symptoms in the first patient was earlier than reported. With a two-week incubation, this sets onset back to November.
As an aside, I had never heard the term “wet market” until a few days ago. It turns out that it refers to any market that sells animals, dead animals or produce, as opposed to a “dry market” which sells only durable goods like clothing and electronics. Learning is life-long.
Also posted in Healthcare, Notes from Your Doctor
Tagged 2019-nCoV, Coronavirus, Wuhan
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Notes from your Doctor: The Wuhan Coronavirus
W.H.O. is determining whether to designate the outbreak of 2019-nCoV as an international public health emergency. Sadly, W.H.O. has put this determination off for at least 10 days, the same sort of cowardly “watch and see” that allowed other diseases to fester and spread. W.H.O. never seems to learn. We know that there is airborne human to human transmission, and that there is a true risk of a pandemic, so let’s look at what you can do to protect yourself, as there’s no doubt that the first American patient won’t be the last.
On the upside, this coronavirus is less virulent than SARS or MERS, meaning that there is a lower probability of death. However, it is still mutating, so we don’t know how it will end up.
As I wrote back when SARS, MERS, Zika, Swine Flu, Bird Flu and other viruses started spreading: fingers, nails, fingers, fingers, fingers. Which means wash your hands. And not just your palms – but your fingers, your nails and then your fingers over and over. You should wash your hands for a minimum of 20 seconds. You should do this every chance you get, it will decrease your probability of all sorts of illnesses. In fact, per an internal paper from the CDC, if every American washed his/her hands properly a minimum of 10 times a day, the incidence of non-venereal communicable disease would decrease by 90% over 30 days nationwide. Believe it or not, washing your hands is even more important than wearing one of those paper masks.
Tagged Coronavirus, pandemic
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Healthcare: Next Steps
We had our day of glee over the abject failure of the GOP. And let’s recap: they had SEVEN YEARS to come up with a replacement and chose not to. It’s critical to understand why they didn’t, because it affects what we do moving forward. The Republicans never developed a replacement because they don’t want government to have any part of healthcare (or social services of any sort). Their goal is to dismantle not just the ACA, but Medicaid, Medicare and then Social Security. As a side dish – public education, environmental protection, etc. That’s their goal. And when your goal is death, you’re never looking to develop a treatment plan.
The AHCA bill was a tax bill, plain and simple. Its thrust was to create a trillion dollars in savings so that Ryan and crew could enact the tax cut bill they want: without the savings, it will be harder to decrease monies paid by individuals making over a million a year. They’ll likely make some progress, however, on corporate tax dismantling. More on that below.
It went down in flames for several reasons: yes, the protests certainly gave cover to Republican in moderate districts, especially those that Hillary Clinton carried last year. Don’t underestimate that, and DON’T STOP!!! But the overarching reasons are all on the Republican side: they have to do with the Freedom Caucus which stood en bloc in the face of direct threats from the White House. They couldn’t care less what their party thinks of them, they’re not afraid of Trump and Bannon, they don’t even care that much about their constituents. They are ideologues with no understanding of how government functions, only how to stop it. Their goal is NO government, and they’re too stupid to understand that “NO government” is synonymous with “Failed State” and “Anarchy”. In our planning, we need to consider the best ways to leverage them. Remember, this was never going to pass the Senate, and we suspected that when the first draft was published in early March. (See paragraph six in this link.)
Also posted in Healthcare
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The Week in Review
There is an old saying that a week is a lifetime in politics. In most weeks, there is a lot happening either behind the scenes or at lower levels (e.g., committee hearings and markups on bills that nobody is watching). It is the rare week, however, that so much is taking place front and center competing for the attention of the American public.
The big story of the week was the non-vote on and the collapse of the Republican effort at major health care reform — the so-called Affordable Health Care Act (a name that in itself was an attack on the bill that it was trying to “repeal and replace,” the Affordable Care Act. There are several significant aspects to this non-event.
First, despite their efforts, Donald Trump and Paul Ryan could not get the sizable Republican majority in the House to pass a bill (forget the exact details of the last version of the bill, they could not get a majority behind any version) on one of the top Republican priorities of the past seven years. While Trump may have been a great negotiator, it is very easy to reach a two-sided deal. (Of course, it’s possible that Trump’s belief in his negotiating skill may be one of his great delusions. He may have just been offering the right deal at the right time and actually have been taken to the cleaners in his business negotiations.)When you have three or more sides to a deal, however, it becomes very difficult to keep everybody on board. This problem is particularly true in politics — when one faction thinks that a bill is too conservative and the other faction thinks that the bill is too liberal, there really isn’t any change that could make both sides happy. At that point, it’s not really about negotiating but selling.
Also posted in Donald Trump, GOP, House of Representatives, Judicial, Politics, Russia
Tagged Affordable Care Act, Affordable Health Care Act, Donald Trump, Health Care, Neal Gorsuch, Paul Ryan, Russia, Supreme Court
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Protecting Democracy
Every day, more nominees. I never thought I’d actually be rooting for Mittens so there will be at least one adult in the room.
If you’d told me that “President of these United States” was an entry-level elected position, I would have laughed.
Who could have predicted that the Weekly World News would have gotten more right over its years of publication than what is shown on most news stations. (At the very end of this post is the best story EVER about the Weekly World News.)
Also posted in Disaster, Donald Trump, Elections, House of Representatives, Politics, Senate
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A Note from your Doctor: Zika and Dengue
While we’re less than a hundred days out from the election of our lifetimes, Rio will open on Friday night, and one of the considerations there will be Zika. OK, in addition to the crime, pollution, corruption and other dangers. But what about other places? Do we have a problem with mosquito-borne illnesses? Yes we do, and we need to protect ourselves and our kids.
Because I like you and try to avoid making your eyes glaze over, I’m going to skip the virology involving words like serotype, macrophages, Fc receptors and antibody-dependent enhancement. Bottom line: there are a number of different types of mosquitoes and many of them carry multiple diseases. Sometimes an infection with one disease makes infection from a second disease more pronounced. This is likely the case with Dengue intensifying the effects of Zika. And don’t think Zika problems are limited to fetuses: Guilliane-Barre is another potential complication.
Remember that when you’re bitten by a mosquito, they take some blood from you while laying down potential infections. If a mosquito bites an infected person (Dengue, Zika, West Nile, Chikungunya, etc.) they will pass it on to the next victim she bites. (Only females suck blood.)
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