The infodemic from the pandemic Covid-19 untruths!

Misinformation and half truths are very dangerous in our current situation. It is really important that you arm yourself with the truth so you can make informed choices. Time is of the essence.

The pandemic will be over in 2 weeks: This is totally untrue. In fact it will be a lot worse in 2 weeks especially if people don't start to take the instructions of Public Health specialists including the CDC seriously. Your family and your community needs your help to stop this from going into the summer.

Viruses are like bacteria, you can kill them with antibiotics: Not true viruses are organisms with no cell walls, they have a core of nuclear material surrounded by a protein capsule. The capsule of this virus looks like a crown, that is why it is called corona.  They release the nuclear material into your cells when they infect you causing a reaction. Their structure is completely different from bacteria and that it why antibiotics don't work on them. Just like they don't work on fungal infections.

There is medication that can cure the virus: Once again untrue. There is no medication that can prevent or cure the virus! It is possible that there is medication that can mitigate the symptoms, the associated co-morbidities (i.e the other things that happen like respiratory failure and cytokine storm) and the viral load (the amount of virus in someone's system). None are proven effective and are certainly not appropriate for prevention. The one 'study' in France on hydroxychloroquine actually showed that more patients on hydroxychloroquine ended up being transferred to the ICU than the group without. There is no conspiracy to deprive people of life-saving medication that works!
We often use azithromycin (Z-pak) for the secondary lung infections that people get sometimes when they get the flu and so this is also used sometimes in Covid-19 patients in the same way. If this antibiotic is overused however, as with all antibiotics, infections will become resistant and they don't work anymore.

The main way you get the virus is someone coughing in your face: You can get it that way but that is not the main method of transmission. You are far more likely to introduce it to your respiratory tract with your hands. Wash them all the time, wear gloves and keep your hands off your face! Every time you are handed back your credit card use hand sanitizer and again when pushing elevator buttons or turning doorknobs. It is obvious when someone coughs in your space besides you are supposed to be keeping a 6 foot distance from others anyway.

The virus will be gone when it gets warmer: This is not the flu, this is a novel virus. We don't know if it has seasonal prevalence or not. There are countries that are way hotter than ours which are battling the virus right now, don't bank on the heat taking care of it! Having said that, if you have a home sauna feel free to use it frequently. The sauna heats up your core temperature and makes you sweat which detoxifies and makes your body unfriendly to the virus. This is why we generate a fever when we are sick the body is trying to kill the virus.

It is not as bad as they say: No, it is WORSE!

Some people are immune: Not true, unless you are from Wuhan, China. No one is immune because it is a novel virus. Everyone is equally likely to get infected if they don't take precautions. Doesn't matter if you are a prince or a pauper, white collar or blue collar, big or small, black or white.

Black people don't get the corona virus: read above.

Don't use aspirin or Ibuprofen if you have the virus: This is true, it can make the condition worse.

Men are more likely to get infected and die from the virus:  True, reasons are unclear currently but all over the globe this has been the case. However this is a relatively useless piece of information because everyone still needs to do all the things I have advised but......if it makes men sit up and take notice so much the better.

Everyone who wants to get tested for corona virus 19 can: False! Because of lack of foresight from our leadership there are very few tests available. The number of tests are totally insufficient for everyone in Maryland let alone the rest of the country. Most testing stations will test a maximum of 500 people a day and only people who have symptoms or are medical staff or first responders. Forget about getting tested for now and act as if you have the virus. Prevention is better than cure and this has never been truer.

You should go to the ER if you feel sick: False. Only go to the ER or Urgent care if you have difficulty breathing with a high fever. Why?  Many reasons. Because the resources are very meager right now and beds are scarce. You may not have Covid on the way in but could come out with it on the way out! You expose the hospital staff to unnecessary risk.
The correct protocol is to call first, even if you are going to the ER (if you are not that ill do not clog up their lines).

Dr. Tuakli's pledge: True! As always, I will serve my patients to the best of my ability during this crisis. I will stay open and available as long as I can. My goal is to keep you adequately informed and dispel misinformation. Last but not least I will try my hardest to keep my patients from having to access acute care institutions like hospitals and urgent care. Remember you can always call me, we can help you on the phone, do video calls and in-office consults. Do not wait until you are gravely ill to contact me. I am here for you. Let's work together, be transparent and disseminate truthful information.

COVID-19 Someone in my house has Covid-19! What to do?

What should you do? Isolate anyone who is visibly ill. Open the windows regularly and dilute the indoor air. You can put an air purifier in the room where the person is. Viruses survive longer at low humidity  so a humidifier may be helpful.  Change your dressing gown and shoes when going in and out of the room if practical, leave them at the door each time. Clean and disinfect commonly touched surfaces with dilute bleach ( 5 tablespoons per gallon or 4 teaspoons per quart) or alcohol. These surfaces include things like doorknobs, light switches, hand rails, counters, vanities and tap handles. Computer keyboards and phones.

Close the toilet lid before flushing and run the exhaust fan in the bathroom. If you have a mask available it is more useful to give it to the person with the Corona virus to prevent them from spreading it. The virus is highly contagious. Make sure the person is being followed by a doctor even if you don’t go into the office. A lot can be done to help mitigate their symptoms on the phone or with telemed.

Prevention

I have been stressing these measures in my last 6 blogs so you are probably tired of hearing about them but here are the most efficient methods: Hand washing, social distancing, sanitizing (more about that later), stay home, cover your cough or sneeze. Get expert advice if you are sick.

Stress is affecting everyone, even those sitting at home. There is worry about personal health and safety, job security, loved ones especially the frail and children.

Everyone is looking at everyone else and wondering if they have the virus. Well, they may have , since estimates are that 80% of us will have had it by the time everything is said and done. For many of us the worry is not so much that we might catch it but that the healthcare system is woefully inadequate for those who get very sick from it. In addition to that so many people still do not have healthcare.  If not for John McCain's vote Obamacare would have been a thing of the past and things would have been even worse!

The effects of long-term stress include anxiety, depression, weight gain or loss, insomnia, irritability, sexual dysfunction.

Supplements that help anxiety and depression include St John’s wort, Lithium (YES, over-the-counter!), Valerian root, 5-HTP and Kava.

Get outside daily. Exercise. Call friends you’ve been meaning to catch up with. Take an on line course. If all else fails call me J

Don’t fall for it!

If the country was completely shut down for 5 weeks the virus would be defeated. Since this is unlikely to happen we must conduct ourselves sensibly and not succumb to fake news and fake medicines  and snake oil. 

Taking medications that may help once you are sick are not going to prevent the virus from attacking you. Do you want to take medications for 5 weeks and then when you get the  actual virus they don’t work? Work on boosting your immune system so the virus can’t take you down. A good combo is: Pregnenolone 50 mg, Vitamin C 2000mg, DHEA 25 mg, Vitamin D, E 400 and Zinc 25mg and probiotics.

If you want to get fancy you can do an IV infusion of vitamins to boost your system (costs about $175 for basic). You can also get a shot of B complex or take our Granules with B Complex if you don’t like swallowing pills (last check we had about 6 left).

 If nothing else basic Vitamin D supplementation reduces the risk of respiratory infection, regulates cytokine production and can limit the risk of other viruses such as influenza. Most Covid deaths are from acute respiratory failure due to cytokine storms – a vicious cycle in which our inflammatory cells damage organs throughout the body. Adequate Vitamin D, may potentially provide some modest protection for vulnerable populations.

Watch that take out!

I know sitting home is boring and you have time to cook but the hassle of the grocery store and fear of the outside is making people eat a lot of take out. Be careful, there’s take out and then there’s junk! You might look up when all this is over and wonder where that extra 15 pounds sprung from. Let’s not clog up our arteries AND get corona.

Last but not least Testing :

Earlier this week, Secretary Neall (Maryland state health department) issued a Directive and Order stating that health care providers shall prioritize COVID-19 test orders to the following groups:

A. Hospitalized patients, who should be tested by the most expeditious means available

(either a hospital lab, private lab, or the State Laboratory);

B. Symptomatic Emergency Medical Service Personnel, healthcare workers, and law

enforcement personnel;

C. Symptomatic patients in nursing homes, long-term care facilities, or in congregate living

facilities housing individuals who are medically fragile; OR

D. Symptomatic high-risk unstable patients whose care would be altered by a diagnosis of COVID-19.

MDH cannot accept lower priority specimens for testing at this time.

We did get notification today from a private lab that with process ‘self pay’ patients’ labs through. The corona virus test is about $180 a kit. Not cheap!

There are also several testing locations in Howard county and if you call the office we can give you their contact information. They however will be following the secretary’s directives and require a consultation before they will do the test.

More next time!

Covid 19 Are you in good company? Stay calm and carry on

Prince Charles has been found to have been infected with the virus and so has the President of my Alma Mater Harvard University, Dr.  Lawrence S. Bacow and his family. There are a slew of celebrities, new ones every day, and politicians who have also contracted the virus.

Not to say this is good company or vice versa but the fact is that many many of us have this virus and don’t know it because we haven’t been tested.

Which brings me to my 'pet peeve’ about this whole Covid virus pandemic here in this country. As someone who has a Master’s degree in Public Health (MPH) I can tell you that Epidemiology 101 requires us to screen everyone when there is a pandemic. This is a basic first step. That is the only way to stop it. We knew this was going to happen 3 months ago and yet we did not get the tests in place or the equipment that we needed ahead of time to handle it and limit the damage. A community needs to screen both symptomatic and asymptomatic people to determine who needs to be quarantined so they don’t infect the rest of society.

Now we have no choice but to shut down social gatherings and schools to limit people’s contact with each other but what happens when we lift the bans? People will still be spreading the virus without knowing it. Hopefully at some point we will have enough ‘herd immunity’ as it is called, to reverse the rates of infection and therefore deaths. Things are going to get much worse before it gets better.

There are still parts of the USA that haven’t been so badly hit yet. Still no one seems to learn from areas that precede them in this tragedy. People are still thinking it won’t affect them or it won’t be as bad. Be warned: no one is special and because it is a novel virus, no one is immune!

We all saw what China was going through but somehow didn’t get the message. Spain looked over and saw the disaster in Italy but still didn’t accelerate their response. Russia looks at Europe and pretends it’s not a Russian problem. Louisiana doesn’t want to shut down yet because its ‘not as bad as New York’ . The Governor of Alabama says “this isn’t China!”

Next stop Africa and India please get ready you don’t have sufficient sophisticated medical care, thousands will die. I heard today that India was so busy exporting masks and ventilators they didn’t keep enough for themselves.

Well now that I got that off my chest….. let’s try and control what we can!

Howard county is about to start a drive through testing center in Columbia (MVA Emissions testing center) but you will still need a doctor’s note to get tested. I understand the personnel are currently being trained. It should be open soon, hopefully. There is another one scheduled to open at Fedex field. It is being held up by a lack of testing kits!

 It is important that you understand everyone cannot request a test (despite Epidemiology 101) because the US has insufficient tests nationwide. Therefore we have to prioritize who can get tested, please be patient and community minded.

In the meantime if you have these symptoms CALL your doctor:

·      Fever

·      Cough

·      Difficulty breathing

·      Loss of taste or smell

·      ?Red eyes (not validated)

Do NOT got to the office without calling first.  We can arrange for you to get the prescription for testing (when the centers open) if it is appropriate.

If you have mild symptoms:

·      Do not rush to the ER!

·      Self isolate

·      Maintain hydration. Drink only warm liquids

·      Inhale steam

·      Take  Acetaminophen (Tylenol) NOT Ibuprofen (Advil, Motrin or Aleve) and not aspirin for fever and aches

·      Cough syrup or lozenges to ease the cough (your doctor may also call something in for you)

·      Take Echinacea, Goldenseal or our Viral Mix

·      Rest, rest and more rest

·      Monitor your temperature to see if it is responding to treatment

For severe symptoms such as difficulty breathing call the doctor or 911.

Last but not least notify appropriate contacts to be cautious.

 To be continued! Stay well.

Dr. N. Tuakli MD, MPH

FYI Our office is open for in-person and telemedicine visits.

Isolated but not lonely

Every day there are more and more limitations being put on our activities. Rightly so in my opinion. A little too late, but that is a different blog. This one is about what to do if you are shut in or self quarantined.
We have to work with this new reality but isolation does not necessarily mean loneliness. In this situation it is important to be mindful of your mental health while avoiding the virus. We don't have a lot of choices at this point so let's make the best of it.
Gratitude is a great cure for despair, so let's look at what we can be grateful for. First, consider the alternative: we are alive. Not only that, it could be you on a ventilator or sleeping on the floor of an emergency room. That alone is reason for thankfulness as well as compassion for the sick.
Spring has sprung, throw open the windows and get the fresh air inside. Take deep breaths, we all need them. Do some form of exercise: Go for a walk daily, if possible in a natural setting so you can receive some 'ecotherapy'. Not into walking? get a You Tube yoga video on your computer and do at least 10 to 20 minutes daily.
Look in the mirror and feel good about how you are helping the community. You are not making anyone else sick. Doing the right thing is not always easy but knowing you are doing it should make you feel proud. Your good neighborliness will pay off eventually and we will all get through this that much sooner.
Maintain your social media connections but don't binge too much on screen time.
And last but not least, think about people for whom what you are experiencing is a normal way of life, like the disabled. Walk in their shoes for a minute and then be grateful because for you there is an end date and so many more options. Stay well both mentally and physically. Yours truly

Dr. Tuakli

Covid 19 the real deal!

I am writing to share facts about this pandemic. Real information is the best way to understand what is happening and avoid panic. This is a large subject that cannot be completed in one blog so it is to be continued as the week progresses.

Covid-19 stands for corona virus 2019.
The Covid 19 is a novel virus discovered in December 2019 in China. Novel means it is completely new and so any predictions that are made are purely speculative and based on what we know about the Corona virus family. There have been other Corona viruses like SARS and MERS which gives us an idea of how this one might behave but there are no definite answers. Because it started in China 3 months ago we can also look at how it behaved over there and what techniques were used to reduce it. It still hasn't been conquered there however and we don't know if it will recur.

So let's look at known facts. It is transmitted by large droplets in the air mostly, these droplets can fall on surfaces and people can touch these surfaces and spread them with their hands. These droplets contain the virus which has to get into your airways in order to make you sick. Airways means nose and mouth mainly. Apart from inhaling the droplets the second commonest cause is introducing them to your face and airways with your hands. The virus is not generally transmitted by food.

•  Stay at least 6 feet way from other people so that if they introduce droplets into the air, they are too far away for you to directly breathe them in.
• Wash your hands religiously with soap and water
• Use hand sanitizer after touching public surfaces
• Avoid touching your face, mouth, eyes with unwashed hands
• Clean and disinfect high touch surfaces with disinfectant or bleach (4 teaspoons per quart of water)

The incubation period based on other corona viruses from the time you get exposed to the time you get sick is thought to be from 5 to 14 days. This however is a guess based on history, it could be longer. The people who have been asked to self quarantine are asked to do so for 14 days based on this assumption. Remember people do not have to be sick to carry the virus. This is why large groups have been canceled to reduce exposure to people in general since anyone can be a carrier.

You are more likely to die if you are over 60, male and have chronic health problems. That tells us that people's general state of health is critical as to whether the virus will kill them or not.

There is no vaccine and there will not be one (non-experimental) for at least a year. Maximize your health now.

• Take your vitamins. Good ones to take are B complex, Zinc, Vitamin C (2000mg)
• Supplements Echinacea, Elderberry, Acidophilus
• Take our viral mix at the FIRST sign of respiratory illness
• Control your diabetes
• Stay hydrated
• Do regular exercise
• Manage your mental health

I believe that this pandemic is going to get worse before it gets better so hang in there for the long haul. Focus on your general health as well, don't run out of your medicine and eat well. Fast food quite frankly should be out!

• My office is open, we have protocols in place to prevent any exposures in the office. 
• Everyone will use hand sanitizer before signing in. 
• If you prefer to wait in your car until it is your turn to be seen we will call you. 
• Many issues like follow ups can be handled by telemedicine such as phone, Skype, FaceTime and other video platforms 
• I don't want anyone to neglect their health because of fear. 
• If in spite of our precautions you are still afraid to come to the office then call and we will accommodate your needs. 
• I want to make sure no one has to access an urgent care or emergency room with any extra risk of exposure.  
• Plus we need to allow the acute care facilities to care for those who really need it.

A lot of information to digest for now, more next time. Be healthy.

Dr. Tuakli

Self Care: What can you do to prevent Covid 19?

To maximize your wellbeing during this crisis here are some steps you can take:

·      Familiarize yourself with what Covid 19 is and stay up to date with national, state and local guidance on closures and advisories. The CDC website has citizen information about preventive measures and symptoms and when to call your Primary Care Physician.

·      Handshaking: avoid shaking hands with anyone. You can still convey friendliness and caring.

·      Supplies: maintain the supplies you need without overstocking and creating

panic buying and artificial shortages. Many grocery stores now have hours in the morning for seniors to be able to get their groceries without mingling with the general population.

·      Handwash: with soap and water at random times throughout the day. The suggestion is you wash as long as it takes to say your favorite nursery rhyme.

·      Immune Boosters: Vitamin C, Vitamin D, Zinc and Echinacea are all good for your immune system. As well as fresh fruits and vegetables (uncooked preferably).

·      Sleep: Adequate sleep is good for the immune system as well. If you are having difficulty you could try melatonin, valerian root or chamomile tea.

·      Mental Health: This is a stressful time for everyone. Be attuned to your mood and if you find you are becoming over anxious or depressed, seek help.

·      Exercise: Maintain regular exercise even if you are self-quarantined.

·      Stay Hydrated: The average adult should drink at least 64 fluid ounces a day (coffee is dehydrating).

 Read my blog regularly. Tomorrow I hope to explain more about the virus itself and how it is transmitted. Stay well.

Dr. Nadu Tuakli

We are here for you! Supporting the community during Covid 19 pandemic

We are here for you!  Supporting our community during COVID 19

Dear valued patient,

Nothing matters more to me than the health of my patients. The safety and well-being of my patients and employees has always been my top priority.

Trust and excellent care are the core guiding principles of my practice. I would like to give you guidance to continue to protect and care for you in our changing reality.

The Covid 19 pandemic is an evolving situation and I am staying on top of the guidance from the CDC, state health department and other authorities to protect my patients. As new and relevant information becomes available I will keep you updated. In addition to my MD I have a Master’s in Public Health from the Harvard School of Public Health this give me unique access to the best minds in Public Health and their recommendations at any given time.

We are open for business and well positioned to navigate this new challenge and will continue to provide the services you have come to count on from us. You can remain confident that we will care for you through this challenging time.

Our staff is working diligently to maintain a safe environment and for now our office hours remain the same.

I returned early from my vacation to be available in whatever form is needed. I can do video consults (especially for the elderly) phone consults, prescription refills as well as regular in person consultations.

As always, we continue to practice universal precautions such as hand washing, disinfecting equipment and surfaces that contact patients and staff, and using personal protective equipment when necessary. We will continue to be diligent with these practices in light of COVID - 19. These are unprecedented times. It is our intention to continue to meet all of our patient’s needs while doing our part to keep each patient, and our staff, safe. With thoughtful, evidence-based decisions, patience, and grace, we will work through this challenge as a community. We all need to work together to contain/mitigate the spread of COVID-19. As such, we ask that you please adhere to the following guidelines: If you are feeling ILL… please CALL TO SCHEDULE; short-notice fees will not apply. You will be asked if you have a cough, respiratory issues, fever or recent travel. Depending on the answers we will triage you accordingly. No walk-ins are allowed, if you have acute issues you must call first. If you have traveled internationally within the last 30 days… please CALL TO RESCHEDULE; short-notice fees will not apply. SOCIAL DISTANCING … please work to keep distance from other patients when entering and exiting our office.  After check-in, you’re also welcome to wait in your car and we will call you when your exam room is ready for your appointment so that you can come inside. Please limit, as best you can, the number of people you bring with you. We will closely monitor the health of our team, and no one will be allowed to come to work if they are sick.  Telemedicine  is available for patients, so that we can support our patients remotely. You will need to call for details. Patients who are OVER 70 should avoid coming to the office and should take advantage of skype/zoom or telephone calling. Charges apply just as they would in office. You can email us at Tuaklihealth2020@gmail.com On the bright side if you are out of work this may be a good time to catch up on routine care like physicals, paps and blood pressure checks. As you can see we are deliberately keeping sick patients from mingling with well ones. I would strongly recommend if you need blood drawn you get it done in my office and not go and be exposed at the lab It is always my privilege to provide your primary healthcare with attention to excellence. We appreciate your understanding, patience and partnership. If you have an upcoming appointment, we look forward to seeing you and want to reassure you that we are doing everything we can to provide a safe visit. If you need to change or cancel an appointment, please contact us. There will be no cancellation fees. We will continue to help you and your family, together we can meet this challenge. All the best, Dr. Nadu Tuakli MD, MPH