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Covid Saliva Testing - Cheaper is Better

Saliva testing for Covid-19 may just be better than nasal swabs and cheaper too.  It's preliminary, but Yale University has published a letter in The New England Journal of Medicine that showed saliva testing from the mouth picked up more positive Covid-19 patients than nasopharyngeal swab testing.  The patients they studied were already hospitalized and had tested positive for Covid-19.  They re-tested them with nasal and saliva tests and found at 1 to 5 days after diagnosis  81% of saliva samples were positive compared to 71% of the nasal swabs.  And at 6-10 days after diagnosis, 76% of the saliva samples were positive, compared with 65% of the nasopharyngeal swab specimens.This is important because of the shortage of medical supplies, inability to self test nasal swabs, and the ability of using common and available reagents in the saliva test.  If one reagent is out of stock (or price gouging is going on), another can be used.  Yale is sharing their protocol so others can repli…

Covid-19 and Convalescent Plasma

This week, President Donald Trump announced the emergency use authorization (EUA) for convalescent plasma to be used to treat Covid-19.  The "groundbreaking therapy" was announced at the White House after he accused the deep state at the FDA of delaying approval of therapeutics to hurt his re-election campaign.  Folks, this is politics getting mixed up again with science.  The real question is: Is convalescent plasma effective in treating Covid-19?Health experts are saying the early results are promising but we don't yet know if it works.  Convalescent plasma is taken from the blood of people who have recovered from Covid-19 infection and have developed antibodies.  If it works, those transfused antibodies will help the recipient of the plasma fight off the infection.Currently there are fifteen randomized controlled clinical trials (and 54 other studies) looking at the effectiveness and one has shown preliminary success when given to patients under 80 who aren't on a…

Your Blood Type Doesn't Affect Covid-19

We are at least eight months into the Covid-19 new pandemic and we are quickly learning about this virus and how it affects our bodies.  A few weeks ago there were reports that a person's blood type might protect them from getting the infection. We now know this is not true.  But first, a quick tutorial on human blood type.Each of us inherits our blood type that is carried by an antigen on our red blood cells (RBC).  The RBC is the largest quantity of blood cells in our body and is mainly designed to carry oxygen to our tissues.  Each of us is either Type A, Type B, Type AB or Type O with a protein that is either positive or negative and is called Rh factor.  We know that these types are critical in blood transfusions and receiving the wrong type of blood will cause a severe reaction.  Every time a person is administered blood they get a "type and cross" that checks the blood type and makes sure the proper transfusion is given.  People with Type O blood have no antigens …

Don't Believe Mr. Pillow Guy

I'm rather disappointed that I even need to write this blog.  But this is the age of "Anti-Science" and it seems there are a lot of impressionable people - people who would believe a Mr. Pillow huckster- about how to deal with the Covid-19 pandemic.  So let me spare you reading and give you the cliff notes to this blog:DO NOT TAKE OLEANDRIN TO PREVENT OR CURE COVID-19.Nerium Oleander is a highly toxic plant.  I grew up with Oleander bushes as yardscapes because they produced lovely flowers, could be trimmed into hedges and grew like weeds.  But even I knew, as a child, that they were poisonous and all parts of the plant are dangerous if ingested by animals or humans.This should not even be a story, except that The My Pillow Guy, Mike Lindell, inventor, businessman, entrepreneur and friend of Donald Trump, claims he is inspired by the Bible to promote Oleandrin as a preventative and a cure for Covid-19. He has invoked Dr. Ben Carson, Secretary of HUD as a proponent also t…

Five Conditions That Are Risky for Covid-19

Why do some people get severe illness and even death with Covid infection, and others develop a mild illness or no symptoms at all?  One of the answers to that question is the five associated conditions that we now know lead to severe Covid -19 infections. These five underlying conditions increase the risk for severe Covid-19 and they are highest in counties in the Southeastern United States and in more rural counties and urban areas.

People with one or more of these conditions had hospitalizations that were six times higher, ICU admissions that were 5 times higher and deaths 12 times higher that people without the conditions.

High risk conditions for severe Covid-19:

Chronic kidney disease (CKD)Chronic obstructive pulmonary disease (COPD or Emphysema)DiabetesHeart DiseaseObesity, defined as having a body mass index (BMI) 30 or greater Now get this! In the United States the median prevalence of any of these 5 health conditions is 40.7%.  Some Counties were over 50% prevalence. Obesity -…

I Have Gout - Now What?

Any Doctor will tell you that in medicine, things come in threes.  As expected, I diagnosed three cases of gout this week.  If you have been told you have gout you may wonder "Now what?"
Gout can affect anyone and it usually occurs quite suddenly, often at night.  It is caused by uric acid crystals that deposit suddenly in a joint, most commonly the big toe, but any joint can be affected.  Patients describe deep throbbing pain that is very intense and sometimes even a sheet touching the joint can cause exquisite pain.  The pain is worse within the first 12 hours.
Uric acid is present in our blood and gout occurs when the urate levels are too high and deposit crystals in the joint.  Uric acid is made from purines that are broken down from certain foods such as steak, seafood and organ meats.  Alcohol and juices sweetened with fructose are also causes of excess purines.  Usually uric acid is excreted in the kidneys but if there is an excess in the blood or if the kidneys can'…

Why I Don't Check Covid Antibodies in Patients

We are (at a minimum) 5 months into the worldwide Covid-19  pandemic that has upended all of our lives.  We have been told "testing, testing, testing" is needed and will be our way out to get back to normal.  There is still massive confusion about testing so let's try and make some sense out of it.
First some definitions:

The Covid-19 nasal or throat swab test-  This is the test that we are promised "Anyone can get" and most of the time it will reliably diagnose Covid infection.  These tests are now provided in labs, drug stores, drive through testing and some specialized medical offices.  Because they deal with patients who might be infected, the front line testers have to have full PPE to protect against the virus.  Depending upon the test, the results are ready between 24 hours and up to a week.  This test has up to a 20% false negative rate, meaning it will say there is no infection, even if a person is infected.  The test has to capture the virus when it i…

Burn Care. What You Should do at Home

Approximately 500,000 patients In the United States seek medical care for burns each year and 92% are treated as out-patients, according to the American Family Physician.  Burns are classified by depth.

Superficial burns are called first degree. They are localized to the outer (epidermal) layer and are painful, red and dry.  These burns do not blister and they take about 3 days to heal. A bad sunburn or quick stove burn is a first degree burn.
Partial thickness burns are called second degree. The epidermal layer is destroyed and they are very painful and usually blister.  Most will heal within three weeks or sooner.
Deep partial thickness burns involve the reticular dermis underneath the epidermal layer and they are usually dry. These are third degree burns. They take more than three weeks to heal and often cause loss of skin and scarring.  Deep partial thickness burns should receive immediate medical attention and sometimes even need skin grafting.
Full thickness burns extend through t…

Hydroxychloroquine for Covid-19 is Dead

Physicians and Scientists everywhere, led by Anthony Fauci, have been saying "Lets wait for the data on Hydroxychloroquine as a treatment for Covid-19".  Well, we now have that data and it is irrefutable that Hydroxycholorquine and Cloroquine, with or without a macrolide antibiotic (Azithromycin), does not work for Covid-19 and, in fact, causes increased death.

In case you are wondering about the guy who says "Hey, my uncle has been taking it and he got better in six hours", or "Hey, I know lots of people who take it every day and they are just fine", let me explain this Lancent study for you.

The researchers studied 671 hospitals on six continents involving 92,036 patients.  They looked at hospitalizations from Dec 20, 2019 through April 14, 2020.  Patients who were given Remdesivir were excluded.  The mean patient age was 53.8.

They formed two groups, a control group given standard treatment and a Hydroxychloroquine or Chloroquine group with and witho…

Covid Fatigue...the Good and the Bad

We have entered a new phase of the global Covid-19 pandemic.  After 9 weeks of shut-down in some areas, twenty-four hour a day news, and our lives completely disrupted, many are entering into a phase of Covid Fatigue.

The adrenaline rush that has sustained front-line caregivers is starting to wane and the grind of wearing uncomfortable PPE and seeing the virus described as a hoax makes crawling out of bed an effort.  Essential service people like food supply chain (farmers, pickers, packagers, processors, transporters, stockers and grocery clerks) have been doing double duty, caring for children, managing their own lives as well as going to work every day with fear.  And this includes police, firefighters, sanitation workers, food prep, cleaners, your local cable guy and everyone working from home too.  Covid Fatigue is part depression, part anxiety, part fear with a hint of hopelessness thrown in.
 "Will this ever end? Will I have a job? Will I be homeless? Should I close my bu…

Antibody Testing for Covid- Not So Fast

Image from The Verge - Vox
I wrote a couple of weeks ago about the importance of having antibody testing for Corona Covid-19 as a pathway forward for resuming activity and work. Antibody tests are now being offered at urgent care clinics, private doctor offices, Labcorp labs and by the time you read this, there may be home antibody tests offered from ads online.

 I'm getting many requests a day from patients who think they had Covid if they had any illness from December onward.  "I want to know if it is Covid and if I am immune."   It is vitally important for us to know who has had the virus, who is immune from future exposure and who is safe for asymptomatic passing of the virus.  But...and this is a big BUT...antibody testing today is NOT READY FOR PRIME TIME.

Let's break this down.  Why?

The FDA has relaxed its usual standards and has permitted emergency use authorization for antibody testing.  This means Neighbor Joe can get some funding, throw some reagents toge…

The Hype About Coconut Oil Benefit Is False

The benefits of using coconut oil has been hyped online, in the press and in diets with stories of its benefits for health. If you google coconut oil you will see it being touted for weight loss, antimicrobial effects, calorie burning, improving good cholesterol, reducing seizures, and boosting brain function in Alzheimers.

This shows just how misled the public can be with fads and brilliant marketing by the industry.  The coconut oil and related industries have been very successful in calling coconut oil a natural, healthful product.  Their marketing worked!  The New York Times commissioned a survey in 2016 that showed 72% of the public said coconut oil is a healthful food.  Actually studies from as far back as 1955 show coconut oil is not a heart healthy oil.  And here is more evidence based truth:

Clinical trials (Reported in JAMA, April 8, 2020)  showed that coconut oil, compared to other vegetable oils, increases low density lipoprotein cholesterol.  Low density lipoproteins (LD…

The Nine Symptoms that Go with Covid-19

The Centers for Disease Control and Prevention (CDC) have added to the list of symptoms that reliably go along with Corona Covid-19 infections.  The nine symptoms are:
ChillsShortness of breathFeverCoughRigors (shaking chills often followed by sweating)HeadacheMuscle painSore throatNew loss of taste or smell One or more of these symptoms are reliably present in documented Covid infections and can be a guide for patients to watch out and isolate early if any of them occur.  A patient doesn't have to have all of the symptoms, but as the infection progresses more may occur.  Fatigue is also often what patients report and we are also seeing blood clots, chest pain and and pressure. 
I've answered a number of questions from patients who have GI symptoms like diarrhea, abdominal cramping and nausea and wonder if it is Covid-19.  Those symptoms alone are not likely to be Corona Covid-19.  The Corona virus is specific for the respiratory tract and symptoms always involve the lungs. 
I …

Loss of Taste and Smell common with Covid-19

Over the past month doctors and researchers are gaining more information as we make our way through the novel Corona Covid-19 virus.  We now know that a high number of patients diagnosed with Covid-19 have a sudden loss of smell (anosmia) and/or taste as a presenting symptom.  Some of these patients have no other symptoms and remain otherwise well, yet testing shows they do, in fact, have the virus.

The American Academy of Otolaryngology-Head and Neck Surgery CEO, Dr. James C. Denneny, believes the symptoms could be an early warning signal and patients with acute onset loss of smell or taste should have a high index of suspicion for Covid-19 (also known as SARS-CoV-2) infection.

Since Covid-19 is extremely contagious, any early hints that someone could be carrying the virus would be a clue to get tested and go into quarantine.

The CDC puts out a weekly report called Morbidity and Mortality Weekly and in a study of 5000 healthcare workers who reported symptoms, 750 (16%)s wrote loss o…

Leaving WHO is a Huge Mistake

Donald Trump's declaration that the United States would stop funding the World Health Organization in the middle of a global pandemic sent shock-waves through the medical world.

Less than twelve hours later, the American College of Physicians (the largest medical specialty organization in the United States with members in 145 countries worldwide) declared grave concern that this decision will undermine the effort to make progress on the Covid-19 pandemic. The ACP stated, "We urge the President to immediately restore U.S. funding to WHO, and for Congress to take appropriate action to ensure the continued funding."

In case you wondered, the United States pays about 1/5 of the budget ($400-500 million according to Trump), which sounds like a terrific deal to me. 

What does the WHO do?  Why does it matter if we participate?

The World Health Organization consists of more than 7000 people from 150 countries that work together promote health, keep the world safe and serve the …

Most Covid-19 Hospital Admissions Have Underlying Conditions

Corona Covid-19 Virus is scary.  We remain concerned that the hospital admissions and death rate in the United States continues to rise, even though we are seeing some "flattening of the curve" in some areas that put in early stay-at-home measures.
But the great majority of people will not be hospitalized and will recover from this infection.  Let me emphasize that.  
The great majority of people will not require hospitalization and will recover from this infection.
We have information from the Centers for Disease Control and Prevention (CDC) that helps us understand what is happening.  The hospitalization rate is 4.6 per 100,000 population and almost 90% of those hospitalized have some type of underlying condition; hypertension, obesity, chronic lung disease, diabetes or cardiovascular disease.
As reported before, patients age 65 and over are most likely to have one or more underlying condition (94.4%) but even younger individuals between ages 18-44 had co-morbidities (85.4…

Antibody Testing Is Our Path Back to Work

The world has been sheltering in place for over a month now and everyone wants it to end.  There is much speculation about when cities in the US could start functioning again.  I've had a number of patients and friends ask about antibody tests to see if one has actually had Covid.  Most everyone can remember a "cold" or "sore throat" that they had since December and now wonder "Did I really have Covid-19?"

The answer to that will be provided with a serologic (blood) antibody test.  By taking a few drops of blood (not nasal swabs) we will be able to see if a person has built up antibodies to the virus.  That would mean they were at one time infected. We still don't know what level of antibody provides protection against catching it again, but if Covid-19 follows other viruses, it should be one-and-done, at least for a couple of years, which gives us time to develop a vaccine.

A number of studies are ongoing in humans to answer the question of who …

Covid Virus Challenges of Sub Clinical Infections

The New England Journal of Medicine (NEJM) reported a letter to the editor today (April 6, 2020) from scientists in South Korea describing the challenges of dealing with early infection in patients who do not show symptoms.

Remember that South Korea started testing patients very early and tracking patients they tested. The first confirmed case of Corona Covid-19 was on January 20, 2020.  They started testing people who had traveled and by Feb 10 there were 28 cases of laboratory confirmed Covid Virus ranging in age from 21 to 73.  Only twenty of the patients developed early symptoms and only 8 of the 20 started with a fever.  Some patients reported severe sore throat and some had only a mild cough.

They were able to track all of these patients who had recently traveled and see how they transmitted the virus.  Patient 3, who had no symptoms, transmitted the virus infection to Patient 6, who in turn transmitted it to patients, 10,11 and 21. Patient 12 contracted the virus during a stay…

Will Telemedicine Be The New Normal

The technology for telemedicine (video visits with your doctor) has been around for decades. Sutter Health was the first hospital system in the West to install the electronic ICU (eICU) where critical care physicians and nurses could do remote video monitoring of all patients in ICU beds and jump on problems before they became serious (drop in blood pressure, restless patients, changes on oxygen, or other critical markers).  We have wearable technology for patients to transmit their blood glucose levels, EKGs and even sonograms but despite the technology and hype, none of this has been adopted on a wide scale.

So why has it taken so long for patients and doctors to adopt this technology and use it every day instead of relying on last century visits to the doctors office?  Why does a patient in a rural community need to drive for hours and wait months to see a specialist in a big city?

The Corona Covid-19 Virus will revolutionize telemedicine and I don't see us ever going back.

We…

Ventilators and Corona Covid-19

We are hearing about the need for ventilators during this Corona Covid-19 surge time so thought I’d explain how ventilators work in this crisis and why there is such a demand. It’s important to remember that the Covid-19 virus has no treatment. When a patient is admitted to the hospital we provide supportive care. That means we help the patient stay alive long enough for their own immune system to mount a defense and eradicate the virus.

Supportive care is provided by intense nursing with IV fluids, oxygen, anti-fever drugs, blood pressure support, anti-blood clot drugs and close monitoring for decompensation. Covid patients decompensate (get worse) very quickly and can develop a condition called ARDS (acute respiratory distress syndrome). This is a life-threatening pneumonia where fluid leaks into the lungs and does not allow the alveoli (pulmonary cells) to exchange air.

When patients go downhill and their blood oxygen saturation (O2 sat) falls, they will need mechanical ventilatio…

PPE Is A Massive Problem

I was shocked to receive an email from a friend today with a story that sent chills down my spine.
Everyone knows there has been a shortage of PPE (personal protective equipment) that puts health providers at risk of contracting the contagious Corona Covid-19 virus.  Yesterday (April 2) at the White House briefing it was reported that 200,000 N-95 masks were sent to New York and millions of masks and other PPE will be sent across the nation.   When I received this email, I realized that response is totally inadequate.  The doctor referred to in this email is being kept completely anonymous because he fears his position as a resident would be impacted if the hospital or identifying information were known.

Considering the recent firing of U.S Navy Captain Crozier after he asked for help for his stricken men, this doctor is not being paranoid to want anonymity.

Read this plea and then ask yourself if we are doing enough.

"Dear Toni,
My brother is on the front line in _____________…

Covid Test Negative? Not So Fast

Now that we are expanding testing for Corona Covid-19 Virus, many patients are confused when they feel sick but get a negative test result.  They have all the signs of Covid infection with fever, cough and malaise but the test came back negative.  The Washington Post reported on a woman who was hospitalized with presumed Covid pneumonia but her test was repeatedly negative.  What is going on?
Every clinical test we use in science and medicine has a sensitivity and a specificity.  This tells us how good the test is in diagnosing who has the disease (true positive) and how many people with the disease we missed (false negative).  Doctors know that tests with high sensitivity are pretty good at giving us accurate results for Covid-19 to show us the patients who have the virus. 
With the Covid Virus we have many many tests that are being used and each of them, depending upon how they are testing and how they were developed in the Petri dish, have different values.  None of these tests we…

Life In The Hot Zone

This Cartoon was created by Alex Thomas, MD for the Annals of Internal Medicine.  It shows what many physicians are experiencing as the CDC and hospital organizations change the protocols on a daily basis to deal with the Corona Covid-19 Virus pandemic.  Doctors feel like they are human fodder.  (click on the image to see it larger)



Hydroxychloroquine and Covid-19

Thanks to a shout out by President Trump that Hydroxychloroquine would be a "game changer", this drug is all over TV and web as the possible treatment for Corona Covid-19.  Because this virus HAS NO KNOWN TREATMENT,  the FDA is fast-tracking pharmaceuticals and vaccines.  There are at least 22 known studies ongoing to test the effectiveness in humans and Corona Covid-19.  Here's what we know (today, March 28, 2020) about Hydroxychloroquine:


As a drug used to treat rheumatoid arthritis and lupus, Hydroxychloroquine works in a complex manner on cells and proteins to down regulate the immune response.It is also used to treat uncomplicated plasmodium malaria but is not effective against all malaria strains.The brand name for rheumatology use is Plaquenil and it can be found in the urine three months after taking.  It has a very long half life.The Journal of Antimicrobial Agents reported astudy of 26 patients receiving Hydroxychloroquine. Six patients were lost to follow up, …

What Patients Get Wrong About Covid-19 Virus

There is so much information, pop-ups, social media and gossip about Corona Covid-19 Virus, it is not a surprise that patients have some erroneous beliefs.  It is an evolving situation and we are learning new things every day.  Here are a few beliefs that people have wrong:  

                                  1. Only older people ( Old Boomers) get serious illness 
Wrong. As of March 16, the CDC reported the cases of hospitalized patients in the U.S. were:
Over age 85 -  9%
Age 65-84.  - 36%
Age 55-64   - 17%
Age 45-54   - 18%
Age 20-44   - 20%
< Age 19     -<1%

Until March 16, 80% of all deaths were in people over age 65.  Note these numbers are rapidly changing as the incidence grows.

    2.Any Symptom could be Corona Covid Virus
Wrong.  Covid Virus is always respiratory and its main action is in the lungs and bronchioles. The virus contains glycoprotein spikes that attach to receptors and enter cells in the lower respiratory tract of humans.  The symptoms include cough, fever,…

Home Made Cloth Masks For Corona Covid-19 Crisis

Everyone is aware of the shortage of Personal Protective Equipment (PPE) and the sorry state our health care workers are in without the basic infection protection.  Many industries use PPE but the current shortage with the Covid-19 Virus pandemic is a true crisis for health care.  The types of PPE are face shields, gloves, goggles and glasses, gowns, head covers, masks, respirators and shoe covers.

Healthcare organizations are asking for PPE donations from other industry and the federal government has promised to deploy equipment from the National Stockpile. Americans want to help and many have taken to their sewing machines to create homemade masks and gowns to supply medical professionals.

The British Medical Journal (BMJ) studied cloth masks ( two layer, made of cotton) vs.   medical masks (3 layer made of non-woven material)  in 2015 and compared the infection efficacy of the two. Participants used the mask on every shift for four consecutive weeks. They were asked to wash the cloth…

Beware of Scams with Corona Covid-19 Pandemic

Whenever there is fear, chaos and uncertainty, there are people who will take advantage of others.  Unfortunately the Corona Covid-19 virus creates a ripe environment for scammers and way too many people will fall for it. Here are some things to watch out for:

1. Pfishing emails - pfishing emails are cyber attacks that use fake emails as a weapon.  The goal is to trick the recipient into thinking it is real and have them click on a link or download an attachment.  The fact that people are hungry for real information makes them susceptible to any email that "looks official" and promises goods or information. These emails can place malware on your computer, get private personal information or even get the recipient to divulge passwords and financial information.

Remember, pfishing emails use popular brands to trick consumers.  The most popular are PayPal, Facebook, Microsoft, Netflix, Whats App, BofA, Apple, Chase....you get the picture.  They can be quite real appearing with…