How long do these syndromes last? The answer is unclear but it certainly can persist for months and they can range from a mildly annoying to literal incapacitation.

What are the symptoms? They are protean and include fatigue, “brain fog,” other cognitive difficulties, shortness of breath, sleep disorders, fevers, anxiety and depression, a persistent loss of taste and smell or headaches. Some symptoms that were initially thought to be very uncommon include tremors which now appear to occur in about 40% of affected people and a sense of vibrations in about 30%. Some develop symptoms of circulatory imbalances and various cardiovascular dysfunctions (See my following article.)

Emotional health has been affected among Long Covid sufferers with increases in anxiety, increased frequency of depression, and many sleep disturbances. In many individuals, perhaps especially in older people, there is mild but real brain damage. This causes pervasive yet subtle cognitive, behavioral and psychological problems.

What is most common? Chronic fatigue is perhaps the most common symptom. Its degree varies from person to person but certainly can be truly debilitating. Individuals report feeling “rundown” and tired. They find they can’t exercise or do even simple tasks without feeling truly exhausted. This can persist for weeks, months or over a year.

What exacerbates symptoms? Some people have symptoms that get worse after physical or even mental exertion. This was initially unrecognized as related to Long Covid but now it’s appreciated to be common and is termed “post-exertional malaise.”

Do individuals with Long Covid have the same symptoms as they did with their initial infection? Not necessarily. Symptoms can be a continuation of the original ones but often are entirely different or can be some combination. Symptoms don’t necessarily persist unchanged. They can wax and wane, disappear and reappear. Patients can feel better for a while and then relapse with symptoms and this can be repeated ad infinitum.

Who is at risk? Just about anyone but women seem to be a bit more affected than men, as are older than younger adults, as are those with more symptoms at the time of initial infection. One study suggests that those with an unhealthy microbiome, meaning a loss of bacterial diversity in the GI tract, compared to the typical healthy microbiology, adds to the risk of developing Long Covid.

Another report suggested those more likely to develop Long Covid had a lower level of immunoglobulins in the blood tested after initial infection but before Long Covid developed, those with low levels of autoimmune antibodies (low enough not to have caused an autoimmune disease,) those with Coronavirus particles in the bloodstream, or those with reactivation of the Epstein-Barr virus. Just what all of this means is unclear and it is important to remember that these are all correlations and correlation does not necessarily equal causation.

How frequent is Long Covid? The answer is unclear but certainly, 10 to 30% of people with mild Covid develop Long Covid, quite possibly it’s more. It’s suspected that those with asymptomatic Covid-19 can also develop Long Covid.

What about kids? It’s probably less common among children, perhaps 4 to 10% but one report found a much higher incidence. Whatever the incidence, it is stressful, to say the least, for the child who is affected.

Does vaccination prevent Long Covid? Unvaccinated people have the highest incidence of Long Covid. Those who are vaccinated and get a breakthrough infection can definitely develop Long Covid although the incidence is lower. Those who are vaccinated and boosted and then get a breakthrough infection have the lowest incidence. But for the individual who develops Long Covid, it’s a problem of significance no matter their vaccination status as Arthur found with his fatigue and brain fog syndromes.

How long does Long Covid last? It can vary extensively — from weeks to months to over a year. In one international survey of some 3762 participants with Long Covid, 91% had symptoms that persisted for greater than 35 weeks (seven months, the length of observation.) Among these individuals, 86% had relapses that were triggered by physical exercise, mental exercise or just stress. At the time of the survey, 46% required a reduced workload compared to their pre-infection employment status. Twenty-three percent had not worked since developing Long Covid. The survey concluded that “by seven months, many had not yet recovered, had not returned to previous levels of work, and continued to experience significant symptom burden.”

Bottom line — Just one more reason why you want to avoid becoming infected. And it definitely tells us that getting infected to build immunity is not at all-wise.

In the next article in this multi-part series, I will do a deep dive into Long Covid heart damage following mild Covid. Please join me.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of Longevity Decoded — The 7 Keys to Healthy Aging and his co-authored book with Dr. Harry Oken BOOM — Boost Our Own Metabolism.

The post Long Covid is Common After Mild Covid-19 Infection appeared first on Medika Life.

The Houston Methodist Hospital System is now the first US hospital to require all staff to be vaccinated against Covid-19. The bold move toward mandatory vaccination comes on the heels of a new CDC report showing the messenger RNA vaccines are 90 percent effective at preventing COVID-19 infections in healthcare workers and first responders.

Bloomberg reported Chief Executive Officer Dr. Marc Boom notified the staff via email of the new vaccine policy. The Methodist system currently requires all new staff to be fully vaccinated. The new mandate will require all staff to receive their first vaccine dose by the middle of April.

The Houston Methodist system employs 26,000 people. Currently, 83% have started the vaccination process. Dr. Bloom encourages hospital staff to demonstrate leadership through vaccination to help create a safe environment for patient care. He stated, “When we choose to be vaccinated against COVID-19, we are prioritizing safety by helping stop the spread of this deadly virus and keeping our patients, visitors, and colleagues safe,”

The Houston Methodist system is now the first hospital in the US to mandate employee Covid-19 vaccination. This company decision by a private company is likely to be a driving force to encourage widespread vaccine adoption. Recent data from the Center for Disease Control (CDC) show this controversial decision is back-up by clinical evidence.

The CDC published updated information on vaccination’s safety and efficacy in healthcare workers in the March 29th Morbidity and Mortality Weekly Report. This update analyzed Covid-19 vaccines in a real-world setting. The findings showed the Pfizer-BioNTech and Moderna were 90 percent effective at preventing COVID-19 infections among healthcare personnel, first responders, and other essential frontline workers.

Improving the number of vaccinated workers reduces the risk of spreading the infection from health providers to patients.

Many people still report uncertainty regarding Covid-19 vaccinations. There are three FDA-approved vaccines for Covid-19. The two messenger RNA vaccines from Moderna and Pfizer offer 95% protection against Covid-19. The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA). A single strand of mRNA delivers instructions to human cells to produce an antibody against the SARS-CoV-2 spike protein.

The Johnson and Johnson’s Janssen vaccine offers 72% protection against infection and 86% against severe disease. The Janssen vaccine uses Adenovirus 26 (AD26) as the vector to deliver DNA material into our cells to provoke an immune response.

The Moderna and Janssen vaccines are approved for those 18 years old and up. The Pfizer vaccine is approved starting at age 16.

All three vaccines are highly effective in preventing death

Many vaccine-hesitant individuals express fears over the vaccine approval process. The Food and Drug Administration (FDA) has a strict protocol for vaccine approval. Enough data to qualify for emergency use authorization of the Covid-19 vaccines was made possible because of the substantial $10 billion financial investment combined with the virus’s high prevalence worldwide. The FDA did not rush the vaccine approval. It was well-funded, and there were a massive number of trial candidates.

An effective vaccine is only useful if people get it

Public support for vaccination is already changing. Many workers prefer an employee vaccination mandate. This CNBC poll shows the rapidly changing public perceptions.

Recent Equal Employment Opportunity Commission guidance indicates employers may mandate vaccination. The Houston Methodist system may be the first hospital to require vaccination, but other industry employers may be motivated to encourage vaccine compliance to avoid lost workdays, reduce remote working, and prevent increases in health insurance premiums.

Other companies outside of healthcare are exploring options.

In an article in Forbes, Qantas Airways CEO Alan Joyce reported his plans to restrict airline travel to those who have been vaccinated or have documented immunity. During a CNBC interview, Live Nation CEO hinted at the potential for immunity documentation before issuing tickets to concerts and sporting events. Ticketmaster released a vague but clarifying statement on their website, stating, “We are exploring a number of safety features for event organizers to utilize as they look to welcome fans back to events.”

During a Yale Chief Executive Leadership Institute poll at a virtual summit, 72% of current and recent CEOs of major companies signaled an openness to vaccine mandates. Companies participating in the Yale summit include Walmart, Goldman Sachs, and eBay.

The post Houston Hospital First In Nation to Require Staff Covid-19 Vaccinations appeared first on Medika Life.

We’re approaching the holidays in the middle of a pandemic, and flu season is right around the corner. We must take note of the doctors and scientists sounding the alarms.

Public health messages abound are begging the public to avoid Thanksgiving family gatherings, but many still plan to travel and enjoy turkey and stuffing as though 2020 was a typical year.

States are reaching hospital surge capacity all over the country as the dark winter approaches. Reports from Salt Lake City, El Paso, Wisconsin, and the Dakotas offer dire news as hospitals run out of beds. Texas and all of the Midwest are seeing exponential growth in new cases.

At the start of the pandemic, flattening the curve was the goal. The idea was to prevent illnesses from happening all at the same time. We wanted to flatten the curve to avoid surpassing our health system’s capacity to accommodate the needs of the acutely ill. We failed. Miserably.

We are way past the point of flattening the curve. As you see below, Covid-19 patients are filling up the available hospital beds. To make it worse, influenza cases have not yet hit most cities.

As testing capacity continues to improve across the country, the number of diagnosed cases will increase. While an asymptomatic exposure warrants testing at local facilities, large lab companies are running out of testing supplies, reagents, and technicians to meet the demand.

As community spread continues, it will be tempting for mildly symptomatic patients to go to a hospital or urgent care facility for testing. For the vast majority of patients, an ER visit may lead to unintended and tragic consequences.

Only those experiencing severe symptoms, such as difficulty breathing, need in-person medical evaluation. Most Covid-19 patients will experience a flu-like illness without respiratory distress. Those with respiratory symptoms should call a health care provider for guidance. Expanded telehealth services offer quick and easy solutions for medical advice.

Each patient who presents to an ER, urgent care center or physician’s office exposes other patients and, importantly, medical providers to the infection.Over 1,700 health care workers have tragically lost their lives to Covid-19. Health care infections limit the number of available providers to treat others. If doctors, nurses, and other hospital staff are sick, who will care for the patients?

Remember, the hospital capacity problem is not only about caring for Covid-19. People will still have heart attacks, strokes, appendicitis, gallstones, and other medical ailments. If the hospitals are full, there is no way to care for these patients. In my OB-GYN specialty, the coronavirus does not stop pregnancy. Pandemic or not, babies are being born — and each new birth represents hope for humanity.

The Covid vaccine will not help us this winter

Even if a safe and effective Covid-19 vaccine were to be approved tomorrow, the timeline shows there is zero chance a vaccine plays a meaningful role in the next three months.

The leading vaccine candidates require two doses one month apart with a three-week window to develop immunity inducing antibodies. This necessary dosing protocol extends the timeline from receipt of the vaccine until one can reliably count on immunity.

Once the Food and Drug Administration (FDA) approves a vaccine, the challenging process of distributing vaccines to 328.2 million Americans begins.

Lets put politics aside and care for each other

Social isolation. Loneliness. We are all tired and restless. Everyone wants to get back to normal life. There is a pathway forward. Our world requires a collective effort to navigate through the pandemic. Each of us must make sacrifices to squelch the viral scourge.

But not all Americans agree on how society or our government should handle the pandemic. While we celebrate the American diversity of opinions, in this present moment, we each must make decisions about how we live our day-to-day life.

We are living in Pascal’s Wager.

Any of us may be asymptomatic carriers of SARS-CoV-2. Each of us may spread the virus before symptoms began and inadvertently pass the infection to another person.

What can I do at home if I get sick?

The Centers for Disease Control and Prevention (CDC) recommends those who think they may have Covid-19 and are not having severe symptoms to:

1. Stay home except to get medical care.

2. Monitor your symptoms carefully. If your symptoms get worse, call your health care provider immediately.

3. Get rest and stay hydrated. Take over-the-counter medicines, such as acetaminophen, to help you feel better.

4. If you have a medical appointment, notify your health care provider ahead of time that you have or may have Covid-19.

5. Stay in a specific room and away from other people in your home. If possible, use a separate bathroom. If you must be around others, wear a mask.

The CDC recommends prompt medical treatment if you have:

1. Difficulty breathing
2. Chest pain
3. Confusion
4. Inability to wake or stay awake
5. Bluish lips or face

Covid-19 is spread through person-to-person contact via respiratory particles. Breathing, talking, sneezing, and coughing spread large droplets. When we gather in groups, each of us is only as safe as the least compliant person around us.

Each American must follow the mitigation strategies to protect themself and others. Stay at home. Wash your hands. Practice social distancing. Get your flu shot.

And remember: Wearing a mask is the easiest thing we can do to slow the spread of coronavirus and save lives.

The post Doctors Sound the Alarm on Covid-19 Cases. Is Anyone Listening? appeared first on Medika Life.

What is COVID-19?

COVID-19 is a newly discovered virus caused by a type of coronavirus called SARS-CoV-2. It affects many areas of the body, especially the lungs and breathing.

Common symptoms include fever, cough, and trouble breathing. Many have gastrointestinal symptoms like nausea and diarrhea. An odd but common problem is the loss of your sense of smell or taste.

The most common symptoms may appear 2 to 14 days after you are exposed to the virus. Many patients with Covid-19 are asymptomatic carries meaning they have no symptoms or only mild symptoms.

Does COVID-19 affect pregnant women?

Researchers around the world are working to answer the question. Here are the highlights from a CDC report released in June.

Pregnant women who contract COVID-19 may be more likely to need care in an intensive care unit (ICU) or need a ventilator (for breathing support).

Pregnant women of color may have a higher risk of severe illness or need ICU care. This is likely caused by social and economic inequity, not biological differences.

The risk of death is not higher for pregnant women with COVID-19 than for non-pregnant women with COVID-19.

How does COVID-19 affect my baby?

There are many unanswered questions about pregnancy and Covid-19. Researchers study these issues around the world. Here’s what we know so far:

1. Preterm birth has been linked to other similar respiratory virus infections such as SARS and MERS. With COVID-19, some women have had preterm births. We do not yet know if COVID-19 was the cause.

2. Only a few cases of vertical transmission (mom passing the infection to baby) have been identified worldwide.

3. Babies can catch Covid-19 from a mom after delivery through the transmission of respiratory droplets.

How can pregnant women reduce the risk of coronavirus?

The key steps to mitigate the risk of catching the virus are to:

1. Limiting contact with other people as much as possible
2. Washing hands often with soap and water for at least 20 seconds
3. Wear a mask or cloth face-covering in public and any other needed protection while at work
4. Staying home as much as possible
5. Use hand sanitizer that contains at least 60 percent alcohol
6. Avoid touching your eyes, nose, and mouth

Pregnant women should take additional steps to stay healthy. Keeping your live or virtual prenatal care appointments are essential. Prenatal care may look and feel differently during the pandemic. OB-GYNs and midwives are reinventing prenatal care to provide safe care for all pregnant women, to limit the potential for exposure, and to reduce the risk for babies.

Expect changes. Be flexible with your providers, and please be kind to office employees and symptoms screeners working hard to keep you and your baby safe.

Do pregnant women need a mask or face covering?

As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to slow the spread of COVID-19. Studies have shown people spread the virus before showing any symptoms.

Wearing a mask protects others.

Face covers also protect the person wearing it.

Can pregnant women travel?

Covid-19 travel recommendations are updated frequently on the CDC’s Coronavirus Disease 2019 Information for Travel page.

What should a pregnant woman do if she thinks she has COVID-19?

If you think you may have been exposed to the coronavirus and have a fever or cough, call your ob-gyn or other healthcare professional for advice.

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

1. Difficulty breathing or shortness of breath (more than what has been normal for you during pregnancy)
2. Ongoing pain or pressure in the chest
3. Sudden confusion
4. Unable to respond to others
5. Blue lips or face

Call ahead before going to the hospital or office. If you have other concerning symptoms, call your ob-gyn or 911.

What should I do if I am pregnant and diagnosed with COVID-19?

The CDC provides guidelines for those diagnosed with COVID-19. Your Obgyn will help guide you through the process. The current CDC advice for all people with COVID-19 includes the following:

1. Stay home except to get medical care. Avoid public transportation.
2. Speak with your health care team over the phone before going to their office. Get medical care right away if you feel worse or think it’s an emergency.
3. Separate yourself from other people in your home.
4. Wear a face mask when you are around other people and when you go to get medical care

Will my labor and delivery plans change?

Talk with your ob-gyn or midwife about your birth plan. Hospital policies and procedures may change to help keep you and your baby safe.

Most hospitals have limited the number of allowed visitors and require face covers. Check with your hospital and ob-gyn or other health care professional about your birth plan.

What will happen during labor and delivery if I have COVID-19?

We have found labor and delivery to be the oasis in the hospital. The staff will be taking extra precautions to keep patients safe and reduce the risk of infection. We try to celebrate the joy of delivery each day.

Will I be separated from my baby if I have COVID-19?

Updated recommendations from the American Academy of Pediatrics recommend keeping baby with a mother who has Covid-19 but with certain precautions.

Can COVID-19 moms still breastfeed?

Researchers have not yet determined if COVID-19 can pass through breast milk and cause infection in the baby. The most recent data indicates it is Most safe to feed breast milk to your baby when you have COVID-19.

Breast milk is the best source of nutrition for most babies helping to protect babies against infections and boosting the immune system.

If you plan to breastfeed, talk with your ob-gyn or other health care professional to help teach techniques to reduce the risk of Covid-19 transmission.

This article was contributed by MacArthur Medical Center’s Dr. Rebecca Gray and will be featured in our newsletter the MacArthur Minute.

The post Pregnancy FAQs for the Covid-19 Pandemic appeared first on Medika Life.

Nutritional science, aging, and the laws of physics inhibit my ability to get what I want.

Science is very inconvenient.

Everyone has opinions about science these days. Our social media feeds are full of vitriolic opinions. I miss the days of puppy dogs, nostalgic high school photos, and our children’s latest achievement pics. Now we have neighbors screaming at each other about masks and school re-openings.

When it comes to COVID-19, everyone has an opinion.

But here is the deal.

COVID-19 does not care about our opinions. It is a virus.

Specifically, SARS-CoV-2 is an 80 nanometer enveloped, non-segmented, RNA virus containing single strands of RNA with crown-like spikes on the outer surface.

SARS-CoV-2 has no brain or thoughts. It does not think about anything at all. The virus is a random bit of fragmented RNA that attaches itself to a respiratory droplet and spreads from one person to another… and kills people.

The virus has no motivations. It is programmed to replicate. That is it. SARS-CoV-2 has no desires, intentions, or strategies. The only purpose of this small bit of genetic code is to reproduce itself as efficiently as possible.

We are entitled to our opinions

Everyone has a right to their own opinions. Adults may choose to believe anything they want.

Many Americans do not agree on the value of facemasks…except for scientists, epidemiologists, hospitals, The Center for Disease Control, The World Health Organization, The Joint Commission,The American Medical Association, and The National Institute of Health.

Some endorse the idea masks do not work, the virus is a hoax, and COVID-19 is no worse than the flu.

The thing is, science does not care what we think.

When we read a coronavirus story and react with emotions and feelings, SARS-CoV-2 pays no attention. The viral proliferation pathway is unswayed by our well-thought-out responses.

I have many personal feelings about the pandemic.

• I wish COVID-19 would magically disappear.
• I would like the simple act of coming home from work to stop being a potential threat to my family.
• I want my kids to go back to school and to live a normal life.
• I would like teachers to be safe to return to the classroom.
• I want to eat inside a restaurant, hop on a plane, and enjoy a weekend in Las Vegas.
• I do not enjoy wearing a grimy, sweaty mask all day at work.
• I wish everyone would wear a mask and stop the spread of the virus.
• I desperately do not want any of my pregnant patients to catch COVID-19, get sick, or die.

My wants, desires, and preferences do nothing to change the scientific reality. Astrophysicist Neil deGrasse Tyson once said, “The thing about science is that it’s true whether or not you believe in it.”

We can not be dismissive of scientific evidence

The tension between opinions and science are on full display in the #reopenschools debate. There is a bipartisan agreement to find a way to get kids back in the classroom. The open question is how to do it safely.

White House Press Secretary Kayleigh McEnany said, “The science should not stand in the way” of reopening schools.

But if science is not going to guide decision making regarding the US Education system, how will we decide? Gut-instinct, coin toss, fortune tellers, or tarot cards? Or should we reopen schools based on intuition, faith, polling data, or political party?

Bending the science to match our desires will not work. The virus does not care whether we open schools or not. SARS-CoV-2 has no opinion.

The virus is not liberal or conservative. It is not a Republican or a Democrat. SARS-CoV-2 does not watch Sean Hannity or Rachel Maddow.

The virus will simply hop on board a respiratory particle and pass indiscriminately from one person to another. The virus’s spike proteins attach to cell surface ACE2 receptors, hijack the cell, and reproduce thousands of copies of itself.

Our political beliefs have no impact on viral function.

Scientists do not decide what we want the truth to be and then search for evidence to support our beliefs. Instead, we use the scientific method to answer the unknown. We generate a hypothesis, runs tests, and then prove or disprove the theory

Science is a search for the truth, not an effort to bolster our belief system.

SARS-CoV-2 is a bipartisan killer

Planet Earth has been exposed to a novel virus. No human is immune to COVID-19. Until a vaccine or an effective treatment is available, the safest course of action is for every American to live as though we are all asymptomatic carriers.

The current scientific evidence demonstrates the coronavirus pandemic is not a hoax or a left-wing conspiracy.

COVID-19 is a bipartisan killer.

Our Fox News, CNN, and MSNBC friends, families, and coworkers are catching COVID-19. Many will be hospitalized. Others will die. Each day the chances are increasing; each of us will be exposed to or know someone with coronavirus.

The evidence-based data shows the best way to fight the pandemic is to cover our face, respect social distancing, and wash our hands.

My strong opinions wanting the virus to go away will not change reality.

In the meantime, perhaps my life-saving mask will deter me from eating another Tiff’s Treat cookie.

The post SARS CoV-2: A Virus That Does Not Care About Your Opinion appeared first on Medika Life.

We need to talk about what to do if you’ve been in contact with someone with COVID-19 or begin to experience symptoms. Our gut instinct is to run off and get tested. But for the majority of those with viral symptoms, this is the wrong thing to do.

Testing may verify Covid-19, but a positive test for Covid-19 does not change the management. A negative does not change the recommendations either.

When a nonelderly patient without underlying medical conditions or respiratory distress has COVID-19 or has been exposed, the recommendations are home quarantine. Regardless of the test results, the management is two weeks of home isolation and supportive measures such as fluids, rest, and acetaminophen.

Unfortunately, Covid-19 is a new virus for which we don’t have a vaccine, effective medication, or baseline immunity.

What counts as exposure?

You have been exposed after any close contact with anyone who tested positive for COVID-19 or anyone who has symptoms of the disease. According to the CDC close contact means:

• You were within 6 feet of someone who has COVID-19 for at least 15 minutes
• You provided care at home to someone who is sick with COVID-19
• You had direct physical contact with the person (touched, hugged, or kissed them)
• You shared eating or drinking utensils
• They sneezed, coughed, or somehow got respiratory droplets on you

What do you do after an exposure?

Stay home and monitor your health.

• Stay home for 14 days after your last contact with a person who has COVID-19
• You do not need to get tested automatically. You and your doctor should make testing decisions together. After exposure or if you have symptoms, you will be placed on a 14-day quarantine regardless of the test results. Going to get a test exposes you and others to more potential spread. Contact a medical provider to determine if testing is warranted and to make arrangements for testing according to local availability and capacity.
• Watch for fever (100.4◦F), cough, shortness of breath, or other symptoms of COVID-19
• If possible, self-isolate away others, especially people who are at higher risk for getting very sick from COVID-19
• Look for emergency COVID-19 warning signs and seek immediate emergency medical care.
• Communicate with your doctor to evaluate any new onset of symptoms
• Avoid public transportation, ride-sharing, or taxis
• If you become sick, wear a face cover over your nose and mouth if you must be around other people. Masks should not be placed on young children under the age of two.

What are emergency warning signs indicating the need for immediate care?

The CDC provides guidance on when to seek emergency medical attention. If someone shows any of these signs, seek emergency medical care immediately after first calling ahead to let the office or hospital know you are coming.

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Bluish lips or face

What do I do if my child has been exposed or has symptoms?

Having a sick child is terrifying for parents. Parents’ first instincts may be to take your child to an Emergency Department to get tested, but management at home is safe in most pediatric cases. The treatment is isolation, fluids, and rest. The concept that testing does not change management is especially challenging when parents are faced with a sick child.

Emergency care is needed if the child shows severe illness symptoms such as high fever or very low body temperature, shortness of breath, fainting, or confusion. If a trip to the emergency department is required, remember to call ahead and let the staff know you are coming.

Otherwise, the child should receive supportive treatment at home. Parents should contact their doctor or pediatrician for advice and continued monitoring of symptoms.

What are the symptoms of COVID-19?

Many patients have no symptoms at all. The safest course of action is for every American to live as though we are asymptomatic carriers. The sad truth is any one of us may be shedding the virus and putting others at risk.

About 80% of COVID-19 cases show mild symptoms or are asymptomatic. Symptoms include typical viral problems such as fever, body aches, dry cough, fatigue, chills, congestion, runny nose, and sore throat.

Many develop gastrointestinal symptoms such as loss of appetite, nausea, vomiting, and diarrhea.

Others develop neurological symptoms such as loss of smell, loss of taste, muscle weakness, numbness, tinglingly in the hands and feet, dizziness, confusion, delirium, seizures, and stroke.

Approximately 20% of COVID-19 patients develop severe symptoms requiring hospitalization. Severe symptoms include high fever, severe cough, shortness of breath, pneumonia, and low blood pressure. Those over age 60 and people with underlying medical conditions such as diabetes, heart disease, respiratory disease, or hypertension are at higher risk of developing severe illness.

The case fatality rate is decreasing, indicating we are getting better at treating those who get sick. But as testing increases around the country, we must remember the positivity rate is also rising. The increase in cases is not due to the increased testing capacity. A higher percentage of people getting tested have the virus.

Recent data from UT Southwestern Medical Center in Dallas shows an increase in admissions of young patients without risk factors. This shift towards the younger and healthier is an important reminder to all of us to continue handwashing, social distancing, and wearing a mask.This Is the Single Easiest Way to Help During the Pandemic.

How do you get tested to know if you have COVID-19 right now?

To detect the virus, a test must be performed to identify viral genetic material. A PCR test, from saliva or a nasal swab, is used to detect the virus’s active presence. There are multiple technologies available in the US, and each has varying degrees of accuracy.

The key thing to know is a positive test is reliable. If a test result comes back positive, it is almost certain that the person has COVID-19. If a test returns a negative result, then you are not off the hook.A negative test does mean you do not have COVID-19.

Regardless of your test results, if you have COVID-like symptoms self-isolate at home, rest, hydrate, and wear a mask when interacting with family members.

If your symptoms do worsen, contact your doctor for further guidance.

How do you get tested to know if you had COVID-19 in the past?

Our bodies develop antibodies after we are exposed to a virus. Antibodies are special proteins our immune system uses to fight infection. We are hopeful that our immense systems will develop neutralizing antibodies to provide long term protection against coronavirus. We have not proven if this is true with COVID-19, but many studies are in progress.

Blood tests can be done to try and detect Coronavirus specific antibodies. Unlike nasal swabs and saliva tests, blood tests are not used to detect active infection. The antibodies do not appear until at least 5–10 days after infection. Antibody testing detects a past infection.

People who have neutralizing antibodies may donate plasma. Antibodies from plasma can be used to treat some patients sick with COVID-19. We are hopeful these antibodies will prove to provide long term immunity.

Each day scientists learn more about this virus. Until we develop a vaccine, effective medication, or a cure, we all must do our part. Social distancing, hand hygiene, and face coverings are our most effective tools to protect ourselves and each other.

These steps may be a small inconvenience, but these minor alterations may potentially save someone else’s life.

We all must do our part.

The post You and Your Child Were Exposed to COVID-19; Now What? appeared first on Medika Life.

Will our country invest the financial resources to keep our teachers safe? Judging from how the US is handling healthcare workers, it appears the answer is a resounding no.

European countries, such as Germany and Sweden, have successfully opened schools. But they are averaging 100 cases a day, while we are finding 70,000. To make it worse, the CDC Director Robert Redfield reports we are only catching 1/10 cases due to our inadequate testing capacity.

The American Academy of Pediatrics released guidelines supporting school reopening “with a goal of having students physically present in school.”

Studies indicate children are approximately 50% less likely than adults to become infected after exposure to COVID-19. But what about the adults working in the schools? Teachers, custodial staff, cafeteria workers, bus drivers, and other essential employees need to be kept safe.

We have two choices. We can follow risk mitigation guidelines to create the safest possible environment or pretend the problem does not exist. Right now, the US is choosing the path of denial.

The CDC’s K-12 Schools Readiness and Planning Tool outlines a plan to reopen schools and get kids back in the classroom safely, but the White House categorizes the evidence-based plan as too restrictive.

I see a different problem certain to doom the implementation.

The CDC’s plan is nine pages.

We are Americans, and we don’t like to read. The guideline, filled with checklists and action items, calls for leadership and accountability. These are not America’s current strengths.

Page 1 of the plan is listed here

Be honest. How many readers studied each step listed above? The CDC’s plan includes eight more pages just like it. Do we all need to read the fine print and study the details? Probably not. But our political leaders do.

They must.

Or we are all in trouble.

Implementing the CDC’s plan would be extraordinarily difficult and expensive. Americans should be willing to pay the price to do the right thing. We must do what it takes to keep our children and teachers safe.

But we probably won’t.

It is easier to look the other way.

It’s more convenient to pretend COVID-19 is a hoax, a mild infection like the flu, or a leftist conspiracy plot. Besides, social distancing is a hassle, and those freedom-killing masks are just so uncomfortable.

Comfort is what we seek. We are tired of bad news, case counts, and death rates. We want to stop feeling scared.

Every parent wants children back in the classroom. Teachers long to see the children’s smiling faces. Grandparents count down the days until they can cheer from the football stands, band concert, or choir performance.

We have a moment of bipartisan agreement. We all want the same thing.

But, the pandemic is not under control. Reopening without a plan will be disastrous.

Disaster avoidance is possible if we learn from our past mistakes. When the pandemic hit, healthcare workers were left out. Our country did not invest in PPE (personal protective equipment, and healthcare workers are still paying the price.

We are months into the pandemic, and healthcare Facebook groups still report a lack of PPE (personal protective equipment). Nurses wore trash bags to keep themselves safe.

My mother’s friends knitted masks to send to workers in need. Our medical practice started a community organization to help get cloth, washable, reusable face covers to our patients. To help, we recruited local sewing groups on Facebook.

While seeing the community unite demonstrates kindness is more contagious than the pandemic, the truth is doctors and nurses should not have to find their own protective equipment.

Bandanas, knitted face masks, and Facebook groups can not be how The United States of America manages a global pandemic. We need a national plan to fight COVID-19.

In some ways, things have improved. Our hospitals now have masks. Each week, we write our last name with a black sharpie on a brown paper lunch sack where we store our weekly allotment of N95 masks.

Trash bags. Sharpies. Brown lunch sacks. Bandanas.

Without national action, these are the items to bring to “Meet the Teacher Night” when schools open this fall.

The federal, state, and local governments CAN prevent what happened in healthcare from reaching our education professionals. But it will be hard and expensive.

Money and effort are required to implement mitigation steps to achieve success. Investment in ventilation systems, handwashing stations, hospital-grade cleaning protocols, and scaled up testing capacity are the first steps. Full implementation requires community support.

What happens if we do not create safe schools?

Teacher infections will follow a predictable pattern. About 80% will be asymptomatic or have a mild infection. Approximately 20% will get sick enough to require hospitalization. Unless we discover more effective treatments, some will die.

We must face this reality now.

We can not ignore science. Our teachers deserve better than an October surprise. By then, it will be too late. All we will have left is reactive platitudes.

How will we handle the tragic news stories of hospitalized teachers?

Will we fill Facebook feeds with posts featuring our “classroom heroes?” Let’s tweet memes thanking them for their service. Starbucks will offer free coffee to teachers on their way to work. Students will film touching and hilarious Tik Tok videos celebrating our educators.

We can draw spectacular and inspirational chalk art in front of the schools. Some artists will even pull the mask up over their nose to keep the chalk dust out. But only for a second, those masks make it so hard to breathe.

We will do these things to make ourselves feel better for not committing to preventing the inevitable.

There is another way…

We do not have to wait until it is too late. We can learn from the mistakes we made in healthcare. Use the bipartisan support for reopening schools to generate the funding and resources required to keep our classroom heroes safe.

The post Will We Call Teachers “Heroes” on Facebook When COVID-19 Strikes? appeared first on Medika Life.

An expert, Dr. Bruce Aylward, from the World Health Organization, is of a similar mind. But there is hope for stemming the spread now.

Patients who have “recovered” from the virus produce antibodies in their blood plasma. These antibodies may protect them from further infection and can be used as a treatment for other current patients. But this, also, is questionable.

If the antibodies provide any protection, they might be a stop-gap measure before the availability of a vaccine. How long will that protection last before a viable treatment is devised?

Vaccines currently in clinical trials around the world may be one response to stave off contracting the virus, but not everyone will be vaccinated. The lack of total world immunization will result in clusters of either asymptomatic or symptomatic individuals spreading the disease in unprotected areas. Then, too, no one knows if the vaccines will work or how long their effectiveness will last.

To extinguish an ongoing epidemic and obviate the need for any other measures (e.g., social distancing), the vaccine has to have an efficacy of at least 80% with a 75% vaccine coverage.

As vaccines become available and are introduced into world populations, those who have had COVID19 may not benefit from them. Cleared and identified as recovered, these patients are now exhibiting a wide-ranging array of previously unknown symptoms. Could a vaccine negate these symptoms in a patient now recovered? Are the symptoms permanent?

Unusual, long-lasting or transient symptoms

The lungs were thought to be the primary area of attack of the virus, but it soon became apparent that there were other, unusual and unnoticed, manifestations of the disease. Only now is the medical community coming to grips with a virus that appears to come in more than one form and with new symptoms.

COVID19 attacks the entire body in its process that affects all the organs in the body in its mechanism causing blood clotting.

Scientists think these clotting complications may stem from the virus’s attack on cells that line the blood vessels. When the virus attacks blood vessel cells, inflammation increases, and blood begins to form clots, big and small. These blood clots can travel all over the body and wreak havoc on organs, perpetuating a vicious cycle of thromboinflammation.

Skin Changes

In Spain, a study of patients found “…skin manifestations in 18 patients in Italy with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, or coronavirus disease 2019 (COVID-19), describing “erythematous rash,” “widespread urticaria,” and “chickenpox-like vesicles.”

Rashes, known as COVID toes, presented as discolorations of pink or purple, developed toward the ends of patients’ toes. As they began to appear, they were a further sign of the virus’ encroachment on parts of the body unassociated with the lungs.

Dr. Sarah Young of The Cleveland Clinic noted, “The symptoms of COVID-19 are evolving, but do not yet include rash. At this point, when we see rashes in patients, we should still follow the standard protocol to determine — based on symptoms, risk factors and exposures — if screening for COVID-19 is appropriate.”

Hair Loss Is Noted

The link between hair loss and COVID is just starting to be reported and recognized in research. Sara Hogan, MD, a health sciences clinical instructor at the David Geffen School of Medicine at UCLA, says this timeline makes sense because hair loss often happens to patients 3 to 5 months after a stressful illness or experience.

Heart Damage

The circulatory system and the heart show damage caused by COVID19. In the heart, one study found “our findings reveal that significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation, with no significant trend toward reduction of imaging or serological findings during the recovery period.”

Initial symptoms of COVID19 may not include lung issues but “evidence of myocardial injury in 20–40% of hospitalized cases manifesting as cardiac chest pain, fulminant heart failure, cardiac arrhythmias, and cardiac death. Indeed, symptoms of cardiac chest pain and palpitations are the presenting features in some patients.”

Abnormal blood clotting was also noted. The clots can cause stroke, psychosis, and a dementia-like condition. Usually occurring elsewhere in the body, the clots travel to the lung, causing death. In covid19, this wasn’t the case.

So it’s not the pulmonary embolism which is the major cause of severe illness but the inflammation of the blood vessels and a change in the clotting system of the blood.

The Long-Term Effects Now Known

The litany of symptoms associated with COVID19 may still require additions, but we do know that damage is in the whole body. The lungs may be cratered and require transplants, but other symptoms may not be as apparent at this time.

COVID19 also perpetuated its damage via neurologic and psychiatric syndromes. “Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients.” Symptoms included psychosis, delirium, visual hallucinations, and peripheral nerve damage.

An additional concern has now cropped us, known as the “post-COVID19 syndrome,” concern has been expressed by Dr. Fauci. The symptoms in many of these unrecovered patients are “highly suggestive” of myalgic encephalomyelitis, the disabling illness also commonly called chronic fatigue syndrome or ME/CFS. “This is something we really need to seriously look at,” said Fauci.

The appearance of some of these symptoms as a result of COVID19 isn’t new. After the 1918 influenza pandemic, approximately one million people were diagnosed with a brain disorder called encephalitis lethargica or “sleepy sickness.” It was seen again in the 20s and 30s.

The cohort of worldwide patients recovering or being reinfected with the virus is growing, and new symptoms will crop up. The task now is to recognize neurologic and psychiatric disorders related to COVID19 and take appropriate measures. But the question of what are “appropriate measures” remains to be answered with trial-and-error efforts against a quickly morphing disease.

The post The Long Arm of COVID19 appeared first on Medika Life.

Before them, I had multiple members of one family in my ICU who were also sick with Covid-19. The outbreak started in the patriarch, a man in his 70s. He gave it to his wife. His sons — who cared for their parents— caught the virus and got sick themselves. They gave it to their families. It was such a tragedy.

The parents both died. Of the multiple children who got sick, some recovered after several days in the hospital. Others, however, got very, very sick, and had to be transferred to another hospital for a heart-lung machine (ECMO). They ultimately survived, but with significant disability. One is still on ECMO as I write this.

This is what has been so maddening about Covid-19. It is the same virus, but it causes vastly different diseases in every person it afflicts. Sure, some people have underlying conditions — like high blood pressure, heart disease, and (especially) diabetes — that can cause the disease to be worse in that specific person.

At the same time, as we took care of patient after patient after patient with Covid-19, what drove us crazy is that the same treatments would work for one person but not the next. For some patients, steroids worked. For others, they didn’t. For some patients, blood thinners worked. For others, they didn’t. For some patients, Remdesivir seemed to work. For many others, it didn’t make any difference.

Why is this so? Why does this disease act so differently in different people? We are used to diseases behaving relatively the same in different patients. With occasional variations, sepsis looks like sepsis. Pneumonia looks like pneumonia. Heart attacks look like heart attacks. Of course, some patients have very bad manifestations of these diseases.

With COVID, however, it is a brand new disease in every single person. It is so confounding — and maddening — and it is something we have never seen before in critical care.

It has also been very humbling.

It is very easy to become arrogant in medicine, especially critical care medicine. When someone comes to you trying to die from respiratory failure, you put them on a ventilator, and they live. If someone comes in in shock trying to die, you give them fluids and blood, and they live. When someone comes in trying to die from an infection, you give them antibiotics, and they live.

Of course, we are not successful 100% of the time. At the same time, when the treatments you provide are successful most of the time, it is easy to think that you are invincible, that nothing can stop you. COVID-19 has upended all of that. It has been a very humbling experience, and it definitely has kept me honest as a critical care physician.

When this is all over, I know that I will be a better physician. This pandemic has taught me many things, and I know that I will become better as a result. But that day — the day when it is “all over” — is a long way off.

I look at the spikes in COVID-19 cases in Texas, California, and Arizona — places where I have friends in the ICU taking care of COVID patients — and my heart aches for them. I know they are going through hell right now, trying so hard to care for super sick patients trying to die from this terrible, maddening, confounding, and humbling disease.

May the Lord keep their patients as well as keep them and their families safe from harm.

The post What’s Been So Maddening (and Humbling) About Covid-19 appeared first on Medika Life.

I realize I may be in the minority here, but I wanted to share some thoughts on those “healthcare heroes” signs outside our hospitals.

First, thank you to everyone for what you are doing during this global pandemic. The work you are doing is truly amazing, even heroic. That goes without question.

However, I ultimately believe that labeling ourselves “heroes” does more damage than good. I’ve read pieces from healthcare colleagues across the nation who argue that the “hero label” can be used as a subtle form of (often unintentional) gaslighting.

No one calling us heroes is trying to gaslight us, or put us in an uncomfortable situation, but here are some examples of some of the unintended consequences:

1 — Don’t have enough PPE or safe working conditions? Well, you’re a “hero” to work under those circumstances and heroes don’t complain or demand safe working conditions, they just get the job done. While my current hospital system is fortunate not to be in this situation as they have prioritized securing adequate PPE for all of us, this is a serious issue faced by colleagues in other areas of the country. Some of these “heroes” were fired for speaking out against dangerous working conditions. “You signed up for this” they were told as if the Hippocratic Oath had a section about always agreeing to work in dangerous work environments with suboptimal protective gear.

Nurses and Doctors Speaking Out on Safety Now Risk Their Job. Hospitals have warned, disciplined and even fired staff members who went public with workplace concerns about…www.nytimes.com

2 — As the first wave of COVID-19 was reaching its peak in Italy and New York City I saw several stories of clinicians becoming infected (and some dying) from infections they contracted because they ran into a code blue without proper PPE. There were several clinicians pleading for their colleagues to make sure to don adequate PPE and not just run in unprotected to a code blue. Protecting yourself first is the right thing to do, even in a code situation, as you will be little help to other patients if you are dead, but stopping to don PPE while someone is pulseless certainly doesn’t fit the traditional “hero” ethos.

California nurse treating ‘code blue’ coronavirus patient dies after lack of proper PPE: A nurse in California died weeks after she treated a “code blue” coronavirus patient without wearing proper personal…www.foxnews.com

3 —Clinicians’ burn-out levels were definitely high prior to COVID-19 but have continued to increase. And the New York City medical community was recently rocked when an EMT and an emergency medicine physician, both of whom had been on the front lines combating COVID-19, committed suicide recently. Do “heroes” seek counseling or talk to colleagues when they’re depressed (they should, but I’m talking about the stereotypical portrayal of a hero, here — there are no Marvel movies about Avengers going in for some cognitive behavior therapy)?

Calling health care workers ‘heroes’ harms all of us – STAT. Here’s an unjust fact: Some of the frontline health care workers we’ve been celebrating with social media likes…www.statnews.com

4 — Many of our colleagues, whether it be due to age or medical comorbidities, are at higher risk for developing COVID-19 and worse outcomes, and have been appropriately reassigned to lower risk roles. “Heroes” don’t turn down a rescue mission because their personal risk is too high. The “hero” label does little but cause guilt in many of our colleagues who can’t serve on the front lines due to these conditions.

Anna Wexler, Assistant Professor of Medical Ethics at the University of Pennsylvania Perelman School of Medicine put it this way:

“More perniciously, the hero narrative perpetuates the false notion of health care workers as inherently altruistic, as individuals who will accept the unbridled personal risk, no matter the cost. But in the face of hazardous conditions, there may come a point at which they may not be willing to endanger their own health, nor that of their partners, children, and parents. In the absence of adequate PPE, how much risk can we reasonably ask health care workers to take on?”

“Within the health-care-worker-as-hero narrative, the decision not to work — or to work less, to work in a different hospital, or even in an alternate capacity, such as telemedicine — is nothing short of taboo. It is antithetical to the selfless health care worker stereotype.”

But some people argue that they interpret signs lauding healthcare “heroes” using the nuanced, real-world definition of “heroes”, not the cartoonish superhero version. And I respect that if that’s your interpretation. But that nuance is lost in what has essentially become a public congratulatory campaign. Also “Heroes (but in the real-life sense of the word that allows for all the faults and traits of normal human beings) work here” doesn’t fit nicely on a bumper sticker or a banner.

Reiterating what I said before, I am proud of all of my healthcare colleagues and the tremendous work that we are doing during this international pandemic. If you have no issue with the label of “hero” then I respect that. For me, personally, and I don’t think I’m alone, it feels too self-congratulatory and risks putting superhuman expectations on normal human beings.

It’s one thing for others to call us heroes, it’s another thing to call ourselves heroes. After all, I don’t see firemen (whose actions I often view as heroic) marching into Firehouse Subs wearing shirts that say “community hero.”

The post Stop Calling Us “Heroes” appeared first on Medika Life.