I had two new Covid patients in the last 24 hrs. One fairly symptomatic but not needing to go the ER – yet. Neither was eligible for Paxlovid because of the other medications they were taking. As both were at significant risk for Covid complications, both received IV anti-Covid meds
I agree with the expert quoted in the NYT article on mask use: for those at risk (e.g. myself as a 71 year old). Sample good recommendations: Some experts estimate that you can use a mask for a total of about 40 hours before it’s time to replace it. If you notice fraying, creases, new holes or dirt on your mask, you should replace it before then, Dr. Marr said. If your mask is uncomfortable, or if you feel like it’s moving too much across your face, Dr. Marr recommends trying different brands to find the best fit… If you get the dreaded text that someone you recently spent time with has tested positive for Covid, the C.D.C. recommends putting on a high-quality mask as soon as possible, and keeping it on for 10 full days when you’re around other people…Even if you’re the only person wearing one on the subway or in your office, a high-quality mask can still meaningfully reduce your risk of getting infected… While many people are exhausted by this long pandemic, Dr. Maldonado stressed it’s important to remember that we have tools to reduce our risk. “Masks work, period,” she said. “Whether you choose to use them or not is a different matter. But they definitely work.”
Having cleaner air in schools would be a step forward. Most available funds are unspent.
Nursing homes performed abysmally during the Covid pandemic. As the NYT reported: Only a quarter of infected residents received antivirals, even during the last six weeks of the study — by which time Paxlovid was widely available and free. Nursing homes continue to be short-staffed.
A profile of Mandy Cohen – the new head of the CDC and former North Carolina Director of Public Health. Very worth reading and the following quote from the County Commissioner highlights her and our challenge for the next pandemic: Even as Cohen “became a trusted community voice,” he said, “there was a disconnect between the discussion of equity and the application of equity.” He worries that the painful lessons of those early pandemic months seem forgotten, saying, “We don’t even hear this conversation now.”
Biden is making a bet that the new drug price negotiations will help people and help his re-election. While the structure of the program guarantees a modest impact, just the regulation alone mandating $35 max for insulin for all Medicare diabetics (Republicans were opposed to having the rule cover all diabetics) can be a vote getter. For now, some of my patients use Mark Cuban.
Nicholas Kristof recently specified fixes that could address differences in mortality between the U.S. and other industrialized countries: “three … that would make a huge difference: expanding access to medical care; more aggressively addressing behaviors like smoking, overeating and drug abuse; and making larger society-wide steps to boost education and reduce child poverty…we can do better on health care outcomes … much of the rest of the world already does. Or to put it differently, in a recently published in the Journal of the American Medical Association: poverty should be considered a major risk factor for death in the US.
An excellent Economist article on one of the afflictions of our time: chronic pain. The ranks of people who experience chronic pain are growing all the time. Many diseases that would once have been fatal can now be treated, sometimes leaving patients who are alive but in pain. One in three cancer survivors, for example, live with chronic pain. Interesting new theories.
This Brookings Report highlights new approaches to domestic violence.
Around 3 in 10 Americans still believe ivermectin is an effective treatment for covid. According to polls, nurses, physicians and pharmacists are the most trusted professionals in the country, and we should take advantage of that trust to uphold standards. So far no mainstream health professional organization has stood up and championed rampant misinformation or pandemic preparedness in general. These points and ideas about how health professionals should respond and, for example, encourage Covid vaccination with the forthcoming booster form the premise of my forthcoming (end of September) book Public Health, Public Trust and American Fragility in a Pandemic Era: The Critical Role of Health Care Professionals (Routledge). I am looking for venues to present and discuss the ideas in the book. All suggestions welcome!
With respect to AND’s other activities we are largely focused on building our networks in anticipation of electoral activities. We are looking for health professionals in Arizona, California, Florida, Michigan, New York, North Carolina, Ohio and Pennsylvania. Please feel free to email me if you have one hour a month available and are a health professional from one of these states.
Norbert Goldfield, M.D.