CV🦠News, Week of September 21, 2020 – The Village Doctor

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CV🦠News, Week of September 21, 2020

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Zoom-y greetings, Friends of TVD!

HIPAA-compliant Zoom, that is. As most of you know, The Village Doctor has been “Zooming” you for Telehealth since the beginning of these Pandemic days. In March went the extra mile and worked with Zoom to be sure our platform is HIPAA-compliant for your health information security.

We, along with our partner ElationEMR, are now taking this to another level, and introducing Integrated Zoom Video. This allows us to provide you with our video Telehealth services from within your digital health record AND take advantage of the patient communication tools offered by ElationEMR. Effective immediately you can expect to see automatic patient appointment reminders sent to your email or phone, with the link for your upcoming Zoom Telehealth visits already embedded in the message.

Note that like all new medical technologies, we need your permission to use them, so for your first integrated Telehealth visit you will also see a concurrent “Telehealth Consent” visit scheduled. This will allow us to automatically send you a Telehealth Consent form which you can easily read and complete online (and upon completion gets uploaded right into your chart). Boom. Done.

As always, please give us a call if you have any questions or concerns.

(Eric Weiss, MD, September 21, 2020)

NOTE: CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.

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COVID AT SIX MONTHS: UCSF UPDATE FROM DR. BOB WACHTER

Bob Wachter, Chair of the Department of Medicine at UCSF and the man who coined the term “hospitalist” in 1996, is often considered to be the father of the hospitalist medicine field, and also simply a very reasonable and caring guy. I often find my way to his Twitter feed for a breath of fresh air – grounded in good science and common sense – during these crazy times. Of particular interest recently was his September 14th post, marking a half-year of COVID, in which he walks us through his decision-making in regard to visiting his ailing father in Florida, attempting to answer the question, “how to make sound decisions about risk in the face of uncertainty, longing, frustration & fear.” It’s worth a full read, but a few highlights to intrigue you:

3/ I’m sure I’m not alone – all of us are having to make nuanced risk-benefit decisions re: Covid, nearly constantly. Do I see friends? Inside or outside? Visit family? Send my kids to school? Wear masks? It’s exhausting. And, for 99% of us, this isn’t what we do for a living.

4/ The muzzling of the @CDCgov means there is precious little trusted guidance coming from what would otherwise be the usual source. Which leaves all of us even more on our own as we make dozens of daily decisions that are at once small and monumental.

5/ Not only do we lack trustworthy data from national sources, but one’s assessment of risk (e.g., of your kids going to school) & of the benefits of various interventions (e.g., masks) are colored by which political team you root for – another cost of today’s political insanity.

Getting more philosophical, he continues, “While the March-April full lockdown was emotionally hard, it was cognitively easy – there were few decisions to make. In the face of fear and uncertainty, most of us sought zero risk.” But, he explains, as we learn more about COVID (outside is better than inside, masks work quite well, fomites aren’t so bad) and are given more leeway as things open back up, the cognitive risk analysis underlying each daily action weighs heavily on our minds and can be overwhelming. In fact, he reviews evidence suggesting that humans “stink at weighing risk.” “How do we quiet the primitive part of our brains that overweighs shark attacks & underweighs the risk of driving?” he asks. “And how do we give proper weight to pleasurable activities?” He explains his view that, “We simply have too many months of COVID ahead of us to stick with a notion that zero risk is the only acceptable – and moral – target,” likening our situation to dieting and exercise: “…to succeed long-term, you need to find a regimen you can live with, not a quick but unsustainable win.”

He provides a helpful resource he used when analyzing whether to fly to Florida to visit his parents – “The microCOVID Project, which has an awesome online calculator that takes in key inputs (including constantly updated local prevalence stats) & produces a risk estimate for various activities (including flying, eating out, etc).” He also highly recommends this hour-long conversation between @ezraklein @voxdotcom and Harvard epidemiologist @JuliaLMarcus as a superb overview of a framework for making key life decisions while also managing pandemic risk.

He ends by coming back to how he made his decision –

I plugged in my Florida visit & microCOVID came up with the calculations below – my estimated risk of getting Covid was 40 in a million (or 1 in 25,000). Though not zero, it seemed worth it to see my folks. Check out the site – it’ll help you make more rational choices.

(Jennifer Abrams, MD, September 23, 2020)

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WHEN WILL WE BE ABLE TO STOP WEARING FACE MASKS?

 Many experts, including Dr. Kathryn Anderson from Upstate Medical University in Syracuse, New York, believe that we will need to wear masks for another 1-2 years. She talks about it here in more detail. She, like other public health officials, explains there is no exact end in the near term to wearing masks. The only way communities can safely take off their masks is when we have significant herd immunity, either by infection or vaccine.

We know from all the models that this will take at least 18 months even with a robust vaccine. Consequently, mask wearing is here to stay. You might be wondering as we head into winter, will people be asked to wear masks indoors the majority of the time. Experts in the UK argue yes, in order to curb the transmission of the virus, wearing masks whenever we share a space with those outside of our family will be necessary. 

Mask wearing will become like wearing a seatbelt, it will be automatic. We hope by the Spring of 2021 that the data on the virus numbers will give a better direction on what to expect. For now, invest in a few comfortable cloth masks and plan to keep them. 

(Prerana Sangani, MD, September 23, 2020)

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SHOULD I SWAP MY CONTACT LENSES FOR GLASSES DURING COVID?

 We have long known that viruses and other germs can enter the body through mucous membranes on the face including those in the eyes, nose and mouth. This is the reason that the recommendations to prevent the spread of coronavirus have always been “wash your hands and don’t touch your face.” For coronavirus, the main point of entry does seem to be through the nose, hence it is important to keep your nose covered by your mask. That said, a small percentage of patients do have eye symptoms ranging from excessive tearing or itchy eyes, to conjunctival discharge or conjunctivitis (pink eye), but that does not necessarily mean the virus entered through their eyes. 

 Given what we know, eye protection and face shields have been recommended for people in certain high-risk occupations or positions, which led a team of researchers in China to question whether simply wearing glasses was protecting individuals from disease. The small observational study did indeed find that people who wear glasses regularly were less likely to be hospitalized with COVID-19. By determining the percentage of hospitalized patients who wore glasses, 5.8% of the 276, and comparing that to the 31.5% of the nearby population in that area, they calculated that hospital admissions were five times lower than might be expected in the bespectacled population. Unfortunately, since this was a small observational study, it’s important to remember that correlation does not necessarily mean causation. There are many other factors that could have contributed to the results and in order to prove causation, a controlled trial would need to be done that looked at variables including age, socioeconomic status, and living situations.

 So while it seems that wearing glasses may make you less susceptible to COVID-19, the authors themselves did not even conclude that more protective gear should be recommended, but rather simply that “the eye may be an important infection route for COVID-19, and more attention should be paid to preventive measures such as frequent hand washing and avoiding touching the eyes.” Of note, this study did NOT include individuals that wore contacts, but if you are choosing between contacts and glasses and plan to be around other people, it’s probably not a bad idea to opt for glasses as long as you are comfortable wearing them and won’t be more tempted to touch your face to adjust them. You can read more about this topic in a recent article in The New York Times here.

 (Jackie Phillips, MD, September 23, 2020)

HOPE AND GRACE

If you have made it this far, time for a reward, something to lighten your day, and acknowledge the human spirit. Find some escape, or perhaps even inspiration, in this ever growing collection of works and perspectives gathered from around the world. Please contact me directly if you have come across something that has lifted your heart today.  Dr. Eric Weiss

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One Voice.  In keeping with the uplifting and MUSICAL theme, this is simply lovely: the official Maroon 5 – Memories Cover by One Voice Children’s Choir. The video was made during the quarantine period of Covid-19 2020. Again, turn it up. And smile.

One Voice Children’s Choir is a non-profit organization and an internationally renowned performing artist with vision to use music to: inspire, uplift, enrich; serve our global community; build youth; all with one voice.

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Feel like DANCING instead of SINGING (or maybe simply BOTH), then this is pretty terrific, too!

Again, CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.

*****

Yours, in health and resilience,

Eric and the TVD MD team…