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Covid-19 update
april 8, 2020
Right now, it can be very difficult to determine what information about COVID-19 is true! It’s a new virus, so the science surrounding it is constantly developing, information comes out every day from sources with varying degrees of reliability, and public health interventions are intertwined with political concerns.
The public has been told all sorts of things—“don’t wear a mask,” “do wear a mask,” and more. New travel restrictions and advisories appear every day. It can feel impossible to keep up with. One major point that should not be missed is that ultimately, each of us is responsible for guarding our own health. While Public Health officials can make far-reaching decisions and should have the expertise to make wise decisions, they can also make wrong decisions.
There is no doubt that thousands of people have died from COVID-19. Let’s contextualize the numbers. As of April 7, 2020:
· USA population 333,000,000
· Daily USA deaths 7,500
· Total COVID-19 infections 375,000
· Total USA COVID-19 deaths 12,000
· 2019-20 Seasonal flu infections 39,000,000
· 2019 Seasonal flu deaths 24,000
Testing
There are two categories of tests that are necessary to get a handle on the extent of the infection that will allow each of us to make informed decisions. Polymerase chain reaction (PCR) tests can identify small quantities of organisms. The results can tell you if you are actively infected. One particular test, developed by Abbott Laboratories, can give reliable results within 15 minutes.
Enzyme-linked immunosorbent assay (ELISA) tests identify those persons likely to be immune because they have developed antibodies to the virus. Widespread ELISA testing would allow those who are immune to return to meaningful engagement with job, family and friends. Testing would also inform of us of the severity of the effect on public health.
Although we have done more PCR testing than any other country, the true extent of the disease cannot be measured until we start testing a representative sample which includes persons with minimal or no symptoms. ELISA testing is only recently being developed.
Symptoms
The CDC (Centers for Disease Control) lists fever, cough, shortness of breath as suspicious symptoms. Of course, those symptoms can overlap with pre-existing conditions (asthma) and other infections (influenza and other viruses).
There are a few distinctive things about COVID-19, one of which is that symptomatic shortness of breath does not respond to typical asthma/COPD medications. There are a couple of assessment methods. The ability take a deep breath and hold it for 10 seconds is reassuring. If one has an O2 saturation monitor, the reading should be higher than 95%. If it is less than 90%, that is highly suspicious. Infected persons frequently report loss of smell and/or taste. This is highly significant and suggestive of COVID-19 in this setting.
Unfortunately, even today, the CDC online tool recommends isolation and not medical evaluation if one has mild symptoms. Many health centers recommend patients stay home rather than come in for professional evaluation. The danger is that one’s condition can get worse in short order. Furthermore, the recommendation to stay home is based on protecting others, including the medical staff, but does not take into account the need for full-scale assessment of underlying medical condition and the fact that doctors can detect things that patients overlook. If there is effective treatment, treatment of relatively mild symptoms may be warranted!
Politics
Politics enters the picture in an ugly way when several state governors, notably Nevada and Michigan, took medical decision-making into their own hands prohibiting doctors from prescribing hydroxychloroquine for this infection.
The desire for “top down” medical treatment is a threat to health and to innovation. When one goes to a doctor for a second opinion, one is going for a second opinion, not a second fact. Health officials are offering their opinions even when they use high-minded terms such as “best practices.” While each doctor has different skills, training, and judgment, it is also true that each patient has different communication, symptoms, and body. Proper medical care is personal. This is the invaluable benefit of having a doctor that knows you personally.
My current recommendations:
As an Internist, I have a deep interest in the scientific background of the pandemic. However, I have a deeper interest in what each of us as individuals can do to optimize our health, even in this setting.
Prime your own immune system to reject infections.
1. Stop habits which impair your immune system: smoking (all), illicit drug use, excess alcohol, excess carbohydrates (sugars and starches) in the diet.
2. Drink plenty of water to keep mucus membranes moist.
3. Exercise for 20 minutes at least 4 times per week.
4. Get good quality sleep.
5. Consider regular supplementation with vitamins A, C, D, and E.
6. Until more is known (i.e. your own immune status re COVID-19), continue proper hand washing and relative social isolation. Yes, wearing a mask in public is helpful. If you have a cloth mask, ironing with steam should serve to kill any organisms that may accumulate day to day. (This is a practical rather than scientific recommendation.)
7. If you have the misfortune to get seriously ill with this virus, I would insist upon treatment with the combination of hydroxychloroquine (Plaquenil) and azithromycin (ZPak). Although this combination is not yet FDA-approved for this purpose, there are a plethora of reports around the world attesting to its effectiveness. Off-label use of medications is common.
IMPORTANT
Off-label use of medications is common and is not illegal, unethical, nor immoral. Medical professionals know that antibiotics treat bacterial infections, not viral infections. However, some antibiotics have anti-inflammatory properties, including azithromycin and doxycycline. Hydroxychloroquine also has anti-inflammatory action. Much of the damage from COVID-19 is due to inflammation in the form of a cytokine storm.
Once things settle in Massachusetts, I am looking forward to opening new patient registration later this spring! As a patient, you will have the ability to text or call me between office visits whenever you have a health concern. We don’t want you to have to climb barriers for high-quality care.
Once my office is up and running, infection prevention will be at a premium. Part of the disinfection process will utilize ultraviolet-C lanterns for surface and air decontamination. The chances of you being infected by viruses left by previous patients is greatly reduced.
Please use the official sites to keep track of the latest recommendations.
https://www.cdc.gov/coronavirus/2019-nCoV/index.html
This blog will be periodically updated.
EDUCATION: how covid-19 affects the lungs
march 27, 2020
Good day,
I have some fascinating images for you to review today. This “fly through,” created by a specialized CT scan at George Washington University Hospital in Washington DC, shows some important characteristics about the COVID-19 virus. It was released by Dr. Keith Mortman. There is no sound, so please read the following explanation before viewing the video.
Watch video HERE.
What you see on the link is an image of the lungs of real patient. The ribs are a peachy color. The white filmy shapes are the left and right lungs, inside the ribs. The blue branching structures are the airways. The yellow blobs show places where the virus has infected the lungs. Most pneumonias attack one specific segment or lobe of the lungs. Most often, the lung regains full function when the infection resolves.
In the case of COVID-19, you can see that the infection and lung involvement is diffuse, affecting both sides, upper and lower segments of the lung. The virus tends to destroy lung tissue. As a consequence, lung function is frequently permanently impaired.
Normal gas exchange does not occur in the airway (bronchioles) but in the spongy part of the lungs where the alveoli are located. That is where the virus and the body’s over-reaction (inflammation) occur. Hence, without proper gas exchange, the patient becomes short of breath, sometimes to the degree that they exhaust themselves. They need respirators to do the work of breathing and higher-than-normal concentrations of oxygen to feed the body properly. When the patient recovers, the infection and inflammation resolve. In the severely ill, lung tissue destruction can cause permanent breathing impairment.
As mentioned previously, with viruses, prevention is better than cure.
John Diggs MD
Coronavirus (COVID-19) update
march 24, 2020
Good day.
There are many sources of information regarding the spread of coronavirus aka COVID-19 aka SARS-COV-2. The most reliable fact-based sources are at www.cdc.gov and https://www.coronavirus.gov/. Several government sources are providing daily briefings and updates.
Today, I will address the questions that have been brought to my attention.
Is it that bad?
Yes and no. Yes: the disease can cause death and permanent lung damage even if one recovers. No: the fatality rate, probably less than 1%, is much lower than Ebola (70%) and fewer people are dying from COVID-19, so far, than die every year from the seasonal flu. This particular infection is getting a lot of attention because it spreads rapidly and easily. On a daily basis, many more people in the world are dying from alcoholism, malaria, heart disease and the seasonal flu.
Is social distancing necessary?
Prevention is better than cure when dealing with viruses. The reason that “social distancing” is such a vital tool is because many infected people have no symptoms. Furthermore, among those that get ill, viruses are known to replicate and contaminate before symptoms begin. The key concept is that the virus can be spread by a person who is unaware that he is infected. While screening is useful, it is far from foolproof. For example, 80% have mild or no symptoms. These findings are based on widespread testing performed in South Korea.
While the issue should be taken seriously, only with the passage of time will we have an idea of whether our current personal and governmental interventions are necessary, helpful, or harmful. On one hand, social distancing seems an obvious solution. On the other hand, it does not come without costs. Financial downturns and worsened mood disorders from isolation can have negative effects. Loss of jobs can cause loss of medical insurance, depression, suicide, and substance abuse. Tele-medicine is not a panacea: physicians are less likely to make correct assessments without full histories and actual physical exams; this can lead to a higher rate of incorrect diagnoses.
Who is at high risk?
The elderly, and folks with pre-existing conditions are at highest risk. In Italy, the average age of death is 80 years old. Of 1000 deaths, 938 were over 60 years old. Most deaths in Italy were in people with 3 pre-existing significant conditions, most commonly hypertension, heart disease and diabetes mellitus. Generally speaking, optimizing your immune system will help you resist infection.
Stop smoking
Get sufficient sleep
Get adequate amounts of vitamins A, C, and D
Get sufficient exercise to maintain proper weight and muscle tone
What now?
There may be an effective treatment on the horizon. There are reports of improvements that have been associated with using a malaria drug and a common antibiotic – azithromycin, aka Z-Pak. The analysis remains incomplete. I do NOT recommend that patients treat themselves. Both medications can have significant side effects and drug interactions. There is reason to doubt preliminary reports. Stay tuned to ongoing news from the websites listed above.
I encourage people to maintain their optimal health at all times, not just during pandemics and crises. Like the parable of the “Grasshopper and the Ant”, the time to do so is before the problem arises. I fully support the recommendations of public health officials. Stay informed, exercise, stay vigilant, and get serious about your health.
If you are struggling with suicidal thoughts or impulses, please contact the National Suicide Prevention Lifeline at 1-800-273-8255.
construction is in full swing!
Here’s a sneak peek behind the scenes of the office construction. No walls yet, but the timeline is quick—we’ll be taking new patients by summer, latest. Sign up for the mailing list to be notified when we begin new patient registration.
Located in Wilbraham, MA, the new office is full of light, and is being built out according to our custom specifications to make your visits a comfortable and special experience. We’ve picked out some gorgeous details—wait til you see the floors!—and we’re installing exclusive UV-C technology to sanitize the very air you breathe in the office. Check out our last post to learn more about UV-C technology.
In the Office: Exclusive Sanitization Technology
Our office will employ non-toxic infection-prevention technology that not only cleans surfaces, but will clear the air around you so that patients don’t catch organisms left behind by the previous patient! We’ll be using UV-C technology—the same sanitizing technology used in operating rooms—to keep you safe and healthy. This technique is almost never used in an office setting—we’re ahead of the curve!
Our goal is to get, and keep, you healthy. We will offer remote tele-medicine visits for no extra charge, and combine traditional Western medicine (allopathic) with complementary medicine techniques. Additionally, we will offer regular educational information on our website exclusively for members, as well as periodic seminars.
If you haven’t already, sign up for our mailing list to be notified of new patient registration and other updates!
Corona Virus (COVID-19): What You Need to Know
Corona virus: it’s all over the news, and all over the world. Let’s go through some facts about it.
Information is still unfolding on an international scale, and it’s changing all the time. The full scope of the viral infection remains to be determined. Many people are afraid to see their doctors these days, worrying that an office visit will get them sick. Caution is merited; fear is counter-productive.
On to the facts.
It is a virus. Therefore, it is not cured with antibiotics.
The "attack rate" is very high, meaning, exposure frequently leads to infection.
The mortality rate is low, probably less than 1%. The overwhelming majority of generally healthy people who are infected recover, some without ever knowing they were infected. As with many viruses, many people who are infected have symptoms so mild that they are not aware of the infection. For example, South Korea tested over 200,000 people and found 6,000 who were infected. So far, 40 deaths were reported. The death rate is calculated to be 0.66%
The number of deaths and the mortality of the newly identified infection is less than that of the common seasonal flu (influenza).
The currently available 'flu shot' is not effective prevention for COVID-19. In selected cases, I recommend high-dose vitamin D-3 to boost one's immune system. This is not an intervention for everyone. In certain people it can trigger kidney stone formation.
Do you need to avoid groups? Time will tell. At this stage, I would say that going to a basketball arena is reasonably safe. Being on airplanes and cruise ships, or other enclosed spaces is riskier. However, the risks have always been there.
Hand washing and secretion control are key. Cough into your sleeve rather than your hand. Don't leave used tissues around your office or home. Avoid hand-to-mouth/nose contact.
Those with compromised immune systems (diabetes, asthma, COPD, cancer and cancer treatment, immunological disorders, for example) should avoid crowds and those who are ill.
If you have any recognizable viral symptoms, stay home, stay away from hospitals, do not share telephones, keyboards, or smooches!
information accurate as of March 8, 2020
Working Together for Your Health
Welcome to John Diggs, MD LLC!
Our new, solo, primary care, exclusive office is under construction in Wilbraham. Keep an eye out for photos—we can’t wait to show you!
Whether you’re a longtime patient of Dr. Diggs, or a new patient who is ready to take charge of your health, we pledge to continue our commitment to thoroughness, education, written instructions, and personal care. Every body is unique. So all treatment is personal. One-size-fits-all care fits no one. The principal of "Uniformity," cherished in corporate medicine, is not good for you.
As an independent practice, we will improve on previous patterns of communication (no call centers), availability (sometimes on the same day), and timeliness (minimal in-office waiting). Decisions will be made by Dr. Diggs in your best interest rather than by unreachable administrators beholden to a Corporation.
Be empowered! We want you to understand your healthcare. In the increasingly complex, jargon-laden field of medicine, we believe that it is important for patients to know what’s going on in their own bodies.
After all, it’s your health!
