The 7 Best Things about Covid-19

“When something bad happens, something good will follow”. That’s one of those old sayings that isn’t particularly useful like “good medicine has to taste bad”. We’ve had a lot of bad this year so I’m sure everyone is ready for some good to follow, so I decided to look for the silver lining. It is after all, a good strategy in life to always try to see some positives even in a bad situation.

So here goes:

1. I think the best thing about Covid-19 is that it is preventable.

We know what causes Covid-19 and we know how to prevent it. Having the will to do what is necessary is a personal decision however.

Imagine how bad things would be if one had no options.

Fortunately this isn’t the plague where you are just a sitting duck. It is not rocket science either. There was a spike in cases and hospitalizations after July 4^th  as expected. At this point, everyone knows what to do. We have no choice but to put life on hold until they do it.

2. The seniors got the memo! The death rate in the elderly is decreasing because they are being more careful. Maybe we should all take a leaf out of their book.

3. You never have to get the flu ever again! As a scientist I am thrilled to see that people finally understand how viruses are spread. Now people are careful about what they touch and are very generous with their use of hand sanitizer. This winter should be like no other. People are already asking me for the flu vaccine. No more chasing folks. I love hearing lay people using all the old epidemiological terms like ‘co-morbidities’, risk factors and infection rates. They sound like pros now.

4. People now understand why organizations like the CDC exist and why disbanding or defunding public health is a bad idea.

People also understand how the health in one country can affect people on the other side of the globe. Yes, the World Health Organization is an important component of a stable planet and the world economy.

5. The racial and socioeconomic disparities in health care are as obvious as a sore on your face. Not just that, people finally realize that we are all interconnected and that it is in everyone’s best interest for even poor people to be healthy.

Disease can spread from the bottom up, even when the rich people hide in the Hamptons they still need ‘essential’ (aka menial) workers.

Maybe universal healthcare for all isn’t such a bad idea after all! Imagine how much money we would have SAVED this year alone not to talk of lives and productivity.

We can no longer pretend healthcare is not political. We hear nothing from our current administration about their plans for providing healthcare to the underserved, only scare tactics about people losing their health insurance. Of course having health insurance requires you to be healthy enough to have a job!

6. Many people have enjoyed working from home. Less gas, less traffic, less pollution, less wear and tear on their bodies. Fewer outfits, less dry cleaning etc! I think that genie is out of the bottle. It behoves us to accommodate this new reality. (By the way have you tried digital medicine yet?)

7. I believe Covid-19 has been a wake up call for a lot of people.

Hopefully we are now more appreciative of what we had and what we are now missing.

These are just some of my thoughts.

Please, at least take the uptick in cases seriously or we could continue this pandemic until the end of the year. It is predicted that at the current rate of increase America will lose another 30,000 people in the next 2 months. A very sobering thought, positives not withstanding.

The Phantom of the Mask, the Myths!

THE SWEDISH MODEL OF 'PREVENTION' :THE RECENT INCREASE IN COVID CASES Do masks work? In a word Yes! But before we get into the myths surrounding the wearing of masks let’s talk about preventive measures in general. Yes, the same ones I have been harping on for 4 months now. The good old social distancing, hand washing, hands off the face and hand sanitizer stuff. How do we know they work? Well, first let’s look at Sweden. Sweden has captured international attention by conducting an unorthodox, open-air experiment. It has allowed the world toexamine what happens in a pandemic when a government does not institute rules. Sweden was the only Scandinavian country that decided not to lockdown or quarantine when the corona virus hit Europe. This is what has happened: Not only have thousands more people died than in neighboring countries, thatimposed lockdowns, but Sweden’s economy did not fare better. Per million people, Sweden has suffered 40 percent more deaths than the United States. Sweden who chose not to lockdown, has 358 deaths per million compared to Norway 44, Finland 53 and Denmark 93 (The US is 267 per million and rising). But Sweden’s grim result showed that a failure to impose social distancing, costs lives, jobs and does not stop the economic consequences of Covid. This disaster is now playing out in the United States, there are states particularly in the South that decided to follow the ‘Swedish model’. Florida for instance currently has 7,000 people in the hospital and has had 4241 deaths and the numbers are rising daily, exponentially. Texas is another state with complete disregard for social distancing. Maryland on the other hand, where masks and social distancing is mandated, continues to have a decline in hospitalizations (Current total 410, ICU 143). Please do not quit while you are ahead! Here we are 4 months in and we are still on high alert, with numbers rising in areas were people insist on being in denial. Who would have thought that because of such lack of political leadership this would still be going on? Even China were it began has pretty much gone back to normal. My neighbor told me a joke the other day: The patient asks the doctor : “Hey Doc how long is this Covid  problem going to last?”  The doctor says:  “I don’t know, I’m not that much into politics!” THE MYTHS OF THE MASK: "Wearing a mask is accepting defeat" : False, it is a sign that you are a responsible citizen. "Wearing a mask implies you are a ‘Liberal’":False, last I checked anyone, of any political persuasion can be infected (and die). Carbon dioxide from exhaling gets trapped under the cloth and can make you sick.  False: this is not true, false science. "Cloth face masks are not effective." False: they create a barrier between your mouth and nose and those around you. This makes it more difficult for the droplets that spread coronavirus through coughs, sneezes and talking to reach other people. Cloth masks are highly effective for the general public. According to the CDC, a cloth face mask needs to have the following in order to be fully effective: ·      Cover both your nose and mouth ·      Fit snugly but comfortably against the sides of the face ·      Be secured with ties or ear loops ·      Have multiple layers of fabric ·      Allow for unrestricted breathing ·      Able to be laundered and machine dried without damage or shape changes "If you've had coronavirus, you don't need a mask". False: If you've had coronavirus before or had an antibody test come up positive, you may believe that you don't need to wear a mask. Unfortunately, at this time, there is no way to know whether having coronavirus once provides immunity from the virus infection again or how long that your immunity might last. This means that you could potentially catch the disease again and spread it to others. Everyone should wear a cloth mask when in public unless they have breathing problems, are under age two, or can't remove the mask without assistance. "You don't need to wear a mask outside". False: At this time, being outside is generally considered safer than being inside. When taking a stroll or participating in other outdoor activities by yourself or with people you live with, a mask isn't required. However, when you find it difficult to maintain at least six feet of distance from people you don't live with – such as passing someone on a sidewalk or eating out at a restaurant – it's important to have your mask on. You should always have your mask on hand when you leave your home. Everyday health in extraordinary times: We are staying open so you can stay healthy! We have special protocols in place in the office to keep you safe and minimal waiting. No walk-ins. Anyone who doesn’t have a mask waits in their car until their appointment. Extra sanitation procedures daily and hand sanitizer for everyone! Come on in! It’s a great time to lose weight especially with our 10% off sale on the Weight Reduction Program. You have plenty of time to focus on your goal (and quit snacking). Other reasons why this is a good time to visit the doctor: Make self care a priority so you can be there for your family and handle your responsibilities better. Schedule that physical exam and pap smear you can never get around to when you are working. Keep your medications up to date and current prescriptions refilled. Pick up your Vitamin C, D and zinc, Echinacea Take off that mole you have been worried about. Get your shots updated. Get a cosmetic consultation. Balance your hormones so you can handle stress. Last but not least manage those co-morbidities that put you at higher risk of Covid-19

"Give me Liberty or Give me Covid!"

People should be careful what they ask for, Covid is no laughing matter. Our numbers in Maryland continue to go down. Todays numbers: 447 in hospital, 160 in ICU and 127 deaths across the state. Unfortunately that is not the situation in most other states. The cavalier attitude that has been rampant is now catching up with them. Even Mike Pence is now seen wearing a mask. Remember when he said “I’m the Vice president I get tested daily so I don’t need a mask!” Things are bad in the South and West and getting worse by the day. I read about a family that got together for a big birthday party and 18 family members got Covid. 9 hospitalized, grandpa fighting for his life on the ventilator. I don’t understand why people cannot learn from what others have experienced as opposed to actually needing to feel the burn themselves. It is truly frustrating that people continue to die needlessly from mishandling and disinformation. The good news is that these will not be my patients. I know you are all wiser than that and will not go crazy just because it is July 4th. There will be many July 4ths to come, missing out on one could keep you alive! Please, it is up to you to make sure that our area does not back track making another compulsory lock down inevitable. I really look forward to the day when I can write about other healthcare issues besides Covid but for now we must all be patient. For those who are interested I made a video on Vitamin D: https://youtu.be/PANxger2_nM And for those who have forgotten what they should be taking at a minimum, here it is again: Vitamin D 4000 units daily Zinc 50 mg daily Elderberry or Echinacea Vitamin C 2000mg We have all these items in stock in the office if you can’t find them. For those at high risk we can give you a short course of antibiotic to keep at home in case you develop the characteristic cough. I am so pleased none of my patients have died. Let’s keep it that way!

Maryland hospitalizations continue their downward trend!

Corona Virus Testing If you are interested in being tested for the corona virus in my office, either by the blood antibody test or the nasal swab please give us a call.

Update on Covid-19

Testing is available in our office

For anyone who is interested in getting tested for the corona virus, testing is available in our office as well as in the labs: Quest and Labcorp, if you don’t want to go to the testing stations.

It is highly recommended that those who took part in the totally justified demonstrations last week get tested this week, just to err on the side of caution.

Healthcare workers suffer major losses

In the US about 600 frontline healthcare workers died from the corona virus. According to the Kaiser Foundation and The Guardian most of the workers identified as African American or Asian/Pacific Islander. The CDC notes 375 deaths among Healthcare “Professionals” but acknowledges that this is probably an undercount.

Worldwide, according to the International Association of Nurses more than 600 nurses lost their lives to Covid-19 as of June 3rd.

Its not over yet!

Its been a rough 3 months so far and we are almost there. Don’t lose patience.

We in Maryland are lucky to have a Governor who relies on science and commonsense to lead, he has saved many lives with his precise directions.

Please don’t quit while we are ahead.

Our hospitalization numbers and deaths are down even though in 19 states the number of cases are still increasing. Currently Maryland has 902 people in hospital of which 358 are in ICU. Nationally there have now been in excess of 112,000 deaths.

Even though things are ‘opening up’ please be cautious and don’t go overboard. Just because you can sit inside in restaurants now doesn’t mean you need to.

Buyer beware! Your nails can wait another two weeks

Taste and Smell in Covid, not an old wives' tale!

Not an old wives' tale after all!

I had previously mentioned that loss of taste and smell were symptoms of Covid-19 based on clinical observations but a report in the Harvard Gazette this week confirms that these are significant predictors of the disease.

A recent collaborative study between Boston and London in which 2.6 million people used a smartphone app to log their symptoms daily showed that these odd symptoms — loss of smell and taste — was one of the best predictors, and one that scientists said should be including in screening guidelines.

They found that loss of taste and smell were reported by most of those tested, about 65 percent, and that the most predictive group of symptoms was loss of smell and taste, fatigue, persistent cough, and loss of appetite.

Also interesting is that this can occur up to 5 days before the onset of other Covid symptoms like fever.

Show seniors some love. Let's protect them from Covid-19

People in their 80's are 10 times more likely to die from Covid-19 than people in their 50's. Why? No its not just because 'they are old'. They do have a weakened immune system because of age but it can be strengthened by simple measures. Here is my "Senior Script". please follow it for any seniors that you care about. P.S Remember they need quality sleep.
This video discusses my recommendations. Please share with those who take care of and care for the elderly. Please do your part.

https://youtu.be/72YOFkzDeaM

Talking Numbers and Preventing Deaths

Let’s talk numbers

There is an infodemic going on and it is easy to get lost in the numbers. Let’s try and keep it basic. What two numbers do we really care about?

The number of cases in hospital and the number of deaths. If you follow these two numbers you will be able to appreciate trends which will give you a better sense of safety especially those numbers close to where you live.

Quite frankly the “number of cases” is a worthless number. Why? Because it depends on how many sick people got tested. If everyone doesn’t get tested that  number tells you nothing. When there is more testing there will be more ‘cases’ and when fewer people get tested there will be less.

On Saturday there were 1500 people in hospital, today 1460. A nice trend but not huge.

The number of deaths is a grim reminder of the seriousness of this condition. Isn’t it incredible that we now measure success by how many people died?

Sometimes you have to go back to basics to make sense of it all.

It sounds easy for people to say what should have been done and what should be done now. But believe me it’s the basic measures and simply following epidemiological guidelines that will get us through this.

Watch this clip from the BBC News.

Is it not amazing what people with little or no resources were able to achieve yet we, the ‘most powerful, richest’ country on earth have left 92,000  and counting dead bodies in our wake?

Now I want to talk about ventilators vs testing. 

Do you remember when there was all the brouhaha about who had enough ventilators and why New York didn’t need 30,000?

It costs $20,000 to $50,000 to make a ventilator and that doesn’t take into account the oxygen and all the pieces of equipment and highly trained personnel that go into making them actually work. Third world countries know they cannot afford ventilators. If you dropped off a 100 in the Navajo Nation health clinic they wouldn’t know how to use them. It would have to come with staff and PPE’s and so on.

It took a presidential decree to convert car manufacturer factories into ventilator producing plants so the country could get 'enough' ventilators.

It cost $1 to $5 (worst case scenario) to make a corona virus test kit. You do the math! The only life a ventilator saves is the one person on it at the time and then it needs to be disinfected and recalibrated, you get the idea.

The first day in an ICU bed in the United States costs $10,794 and tapers to $3968 per day by Day 3.

The average stay in the ICU with Covid-19 is between 8 and 14 days.

A regular bed hospital stay costs  $1488.

I know, its enough to make your head spin!

Do we get it yet?

Please follow the prevention measures I have been discussing in these emails. Believe me: Money and time spent on prevention is 100s of times more valuable than chasing cures.

Are we there yet? (AKA: Stop in the name of love!) Can you get Covid twice? Why do seniors die at higher rates with Covid?

Here are three VERY short videos about important topics.

The title may sound a little jovial but it is only an attempt to brighten the dark cloud we are under. Nothing can lift it as fast as taking this whole thing seriously and doing your part. Right now that includes staying home.

54 more Marylanders lost their lives yesterday (RIP). The worst hit counties are Montgomery, PG and Baltimore. Still it doesn't matter where, we are we are all connected, the sooner we realize that the better.

Please take a moment to watch the videos and let me know if you have any suggestions or questions. We can get through this but we are not quite there yet.

Here is the link to one. It is called "Are we there yet?"

. 

This video is about Covid-19 infection rates and whether we are ready to 'open up yet'. The real yardstick to determine that would be aggressive testing. Since we don't have that we have to go by the current numbers.

Are we there yet? Nope!

https://youtu.be/K4yFGMWZr5M

Here is a second link about the elderly and Covid

https://youtu.be/1GhHxMxO5eM

As people get older their immune systems weaken but there are lots of other factors that explain why a person in their 80's is 10 times more likely to die from Covid than someone in their 50's.

So why do the elderly die from Covid and how can we change that? Unfortunately, right now many are like sitting ducks.

Can you get infected twice?

Understand how immunity, whether to a vaccine or an infection works and why you can't be too complacent if you have already been diagnosed with Covid-19

Here's the third link
https://youtu.be/sHY6ZORabDs 

If you prefer to just click on the videos they are below.

Look forward to hearing from you

Love,

Dr. Tuakli

HOW TO GET BACK TO SCHOOL AFTER A PANDEMIC: SOME IDEAS

GETTING BACK TO SCHOOL: IDEAS It seems everything about this pandemic has caught us off guard but now we have an opportunity to plan ahead for a change. One must understand that things are never going to be ideal, corona viruses will not disappear from human existence now they are here. The best we can hope for is containment, something that a vaccine could help with, but which can still occur without one. The vaccine is a year or more away and we cannot wait another year for our kids to go back to school. We all need to be clear that there is no such thing as ‘zero risk’. So we should work with what we have and plan ahead. Here are some ideas on how to reduce the risk for students. I hope if you know someone in education, you will forward this to them. First, I truly believe kids could return to school in September. That gives us 4.5 months to get ready, ample time. Kids should be encouraged to bring the minimum amount of extra stuff to school. Show and tell maybe a thing of the past! School bus/ transport: Parents who can, and who want to, can take their kids to school themselves. They should be encouraged to do so. This reduces the crowding on the buses or there can be alternating days when some parents drive and some bus. The bus drivers should wear gloves and masks and squirt hand sanitizer (first grade and up) onto the kids hands before they get on the bus. (This will require prior consent from the parents stating they allow hand sanitizer to be administered to their child for the common good). On the bus the seats should be marked to allow for social distancing maybe 2 or 3 seats apart. The windows of the school bus should remain 3 inches open to significantly decrease the concentrations of airborne contaminants. Each bus can be sanitized at the end of the day. At the school: On arrival all kids should pass through the contactless temperature scanner. Any child with an elevated temperature should not be allowed in. No temperature, then next stop would be the bathroom for hand washing. On the way into each class a little hand sanitizer. I took these building suggestions from the Harvard Gazette (4/24/20): Engineering for healthy building strategies like: Optimize the building ventilation, filtration and purification. Increase the flow of outside air, install portable air purifiers and swap out existing filters in air circulating systems for ones that can capture smaller particles. Rearrange the desks so that they are staged and children are not sitting directly opposite or in front of each other. Gym should be held outside where possible, when not maybe shorten the day? Teachers should wear masks because they have to speak loudly and therefore aerosolize droplets. Public Health Education: (This is key!) Educate the school nurses, teachers, parents, students and staff about virus infections and how they spread. Train the custodial staff on sanitization protocols. It sounds like a lot but most of these measures actually don’t cost a lot. The fact of the matter is the world has changed forever and we must adapt to it. I would love to hear your comments on these ideas and please forward them to the educators. Let’s at least start the conversation. Everyday health in extraordinary times: We are staying open so you can stay healthy! We have special protocols in place in the office to keep you safe and minimal waiting. No walk-ins. Anyone who doesn’t have a mask waits in their car until their appointment. Extra sanitation procedures daily and hand sanitizer for everyone!

The way out of lockdown.....the truth may set us free!

Why is testing such a big deal? A lot of people (including politicians) don’t really understand why testing for Covid-19 is such a big deal. I am going to try and break it down and make it easier to understand. If people are tested for the corona virus whether they have symptoms or not, we can stop the spread of the disease. Let’s say we put thousands of people who have lost their employment to work testing everyone. One of two things would happen the person tested would either be positive or negative. The positive people would be quarantined for two weeks and their contacts would be traced and managed likewise and everyone else could go back to work. The sick would be taken care of, the positives would be managed and the whole thing would be over within a month. Sounds easy doesn’t it? But of course there are some problems. Two that spring immediately to mind: One: lying politicians and two: there are not enough tests oh, and three: politicians that lie about one and two. On February 28th 2020 the president said the virus would probably disappear “like a miracle”. On March 6th 2020, he said that “anybody who wants a test can have one” A bold faced and deliberate lie. Yesterday it was cranked up a notch. The president suggested we could be “getting close” to doing 5 million tests a day. A Harvard study published last week said the country needs to be able to do 5 million tests a day by June and 20 million a day by late July, for the country to safely open up. Meanwhile, Admiral Brett Giroir, assistant secretary of health in charge of the government’s testing response (AKA the testing Czar) said yesterday and I quote “there is absolutely no way on earth or any other planet” that we can do 5 million tests a day. In fact the total number of tests that have been done in the US this year is only 5.7 million. He said by next month we might be able to do 8 million tests per month. He says the Harvard figure is an “Ivory Tower unreasonable benchmark” that could "not be supported by current technology". So far, the maximum number of tests conducted in a single day is 314,182 but when Donald Trump said yesterday the US was getting close to the 5 million mark he did not explain how the1500% increase per day was going to happen!  It is clear that testing is a crucial element in any plan for people to return to their normal lives. Shouldn’t that be where we are focusing most of our energy? Besides the truth, that is. Only 2% of the population has been tested so far. Perhaps you can be reassured by Mike Pence bragging that as vice president he gets tested for corona virus almost daily so he doesn’t need to wear a mask. The president has refused to compel companies to make tests here in the US instead the car companies are making ventilators. More about that in a later blog. The swabs for the tests so far have come from China and Italy but we do our best to tick them both off. For now, please be clear, smart testing which means targeted screening and contact tracing is the only way we are going to avoid yet another long and painful lockdown. By the way, US deaths from corona have now exceeded 60,000. Sad to think maybe we will actually hit 100,000 after all. The truth could set us free!

Video on Testing www.youtube.com/watch?v=7WciMmfwavY&t=161s Here is the link to my video on testing. Discussing the kinds of tests and the difficulties with interpretation