The Greatest Enemies of Freedom

Posted Posted in Brain Science, Continuing Education, Elder Care, Pain, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Election Day.  Veteran’s Day.  Pearl Harbor Day.  Do these days have anything in common?  They do — more than most of us might think.  The catastrophic attack on Pearl Harbor on December 7, 1941, shocked the nation into unprecedented action.  Millions of people who had ignored the war in Europe and Asia could no longer remain unaware or uninvolved.  Massive numbers of people rushed to enlist or pitch in on the home front to defend freedom itself.  People willingly sacrificed everything from gasoline, to meat and sugar, to fabrics and metals for the sake of the war effort.  Discipline and sacrifice were a given.

Veteran’s Day (originally called Armistice Day) honors the end of World War I. Few of us can even begin to fathom the anguish, misery, and suffering endured by the troops in Europe.  The horrors of trench warfare, malnutrition, hideous infectious disease, nerve gas, and deprivation of every sort took a terrible toll.  Nearly half of U.S. troops who died succumbed to complications of the Spanish Flu.  A hundred years ago, there were no antiviral drugs and no antibiotics to treat secondary bacterial pneumonia or meningitis.  Curiously, President Wilson never even gave a speech about the flu pandemic.

In World War I and World War II, the hardships of sacrifices endured by so many millions of people were intense.  But how does that relate to Election Day 2020?  It’s not that strange or complex.  The two greatest enemies of freedom are apathy and cowardice.  It’s been that way for thousands of years.  We are in a time of great conflict and uncertainty.  Angry, jealous, controlling people are everywhere.  Remember, if someone is trying to frighten you, he or she is trying to control you.  Don’t be intimidated.  Don’t be demoralized.  Observe, think, and vote.  Apathy and cowardice have dreadful consequences.

This Too Shall Pass

Posted Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Raging wildfires, hurricanes, flooding, tornadoes, riots, arson, violence, lockdowns, pandemic fears, economic upheaval, and political turmoil.  If you’re not stressed out at this point you may be in a medically-induced coma.

Nearly everyone is dealing with some degree of anxiety, sleeplessness, weight gain, tension, irritability, frustration, and/or depression.  There are some constructive strategies we all know and have even advised patients to follow.  But we’re in “Physician, heal thyself” mode these days, so here are a few reminders:

  • Avoid people who are chronically angry and, if possible, don’t be one of them.
  •  Don’t obsess about things you cannot control, including the behavior of other people.
  • Re-invent some aspect of yourself — invest in a new hobby or resurrect an old one that used to give you joy.
  • Freshen up your work space or home. A pleasant, cheerful, clean, de-cluttered environment can really boost morale.
  • Move more.  Sitting at a computer or in front of a TV for hours on end is not healthy physically or emotionally
  • Take a good look at yourself and your appearance.  It may be time to kick it up a notch, if only for your own mental health.
  • Limit your exposure to negative, nasty, snide, snarky people on TV — that means 95% of the “news.”
  • Let yourself have 30 minutes of total silence every day.  It might feel like withdrawal if you’re addicted to noise and devices.
  • Make an effort to compliment someone — about anything.  It may turn around your entire day and theirs.
  • Go out of your way to be kind to a patient, colleague, neighbor, stranger, or — this is shocking — relative.  Acts of kindness boost levels of endorphins, serotonin, and Immunoglobulin A in everyone involved.
  • Get your minimum daily dose of uplifting inspirational reading, prayer, and meditation.  Human beings are more than bodies.
  • Don’t be difficult.  Being pleasant and cooperative is a gift to the people around you.  As we read in the Book of Proverbs, “A merry heart doeth good like a medicine.”

Cheer up.  Do some good for others.  This too shall pass.

COVID-19: Independent Thought

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars

By Mary O’Brien, M.D.

Are you running on fumes these days?  You’re not alone.  For seven months, we have been bombarded by endless, awful news about the pandemic.  Riots, vandalism, looting, arson, and horrifying murder rates continue to plague cities across the nation.  Economic and financial stresses have taken their toll on nearly everyone outside the political class.  Somehow the elites of the ruling class never suffer the consequences of their own policies.

News alert:  Our rights are not granted by governors.  Our rights are not granted by health care officials or supercilious people on some city council.  Our unalienable rights of life, liberty, and the pursuit of happiness come from our Creator. Many people seem to have forgotten this. Cowardice, perhaps born of fatigue and fear, has overtaken too much of our society.  “Stay home or put on your mask and be a good little lemming.”  Tens of millions mindlessly comply.  Power corrupts and absolute power corrupts absolutely.  This has been true since the beginning of time.  At some point, however, a critical mass of people needs to say, “Enough!”

“Freedom is never more than one generation away from extinction.”  Ronald Reagan said that over 50 years ago.  He was right.  There will always be people who lust for power and control over others.  They will invent reasons to keep people fearful, uncertain, and angry.  The one thing they cannot abide is independent thought.

They say, “We know what’s best for you.”

No.  You know what’s best for you.  You know what’s best for your family, your business, your patients.  Over the past seven months, the “experts” have been spectacularly wrong.  They have fostered a level of panic that is out of proportion to reality.  Unless you live in a nursing home, you are at greater risk from getting into a car than you are from COVID-19.

Fear and sadness deplete energy.  Courage and good humor replenish it.  People adapt.  We can proceed with life, work, school, and business by combining prudence with creativity.  We can focus on facts, not on someone’s fearful narrative intended to control others.

If we actually value freedom, we need to stop cowering in a corner.  Fear is the enemy of freedom.  It’s time to show some spine.

COVID-19: It’s Time

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Are you caught up in the back-to-school debate?  It’s stunning that anyone is arguing about this.  There was never a medically valid reason for closing schools and colleges in the first place.  As far back as February, we know who the vulnerable people have been.  They were older individuals with multiple, significant underlying illnesses.  This pattern was observed everywhere from China to the European countries.

The panic-stricken rush to close schools and colleges was precisely that — a panic.  Experience over the centuries should have taught us that quarantining a healthy population is ineffective.  The sound, medically sensible approach is to isolate and protect the vulnerable people as quickly as possible.

Consider a few facts:

  • In the U.S. since February 2020, approximately 40,000 deaths attributed to COVID-19 have occurred in people age 85 and older.  Approximately 32,000 COVID-related deaths occurred in people aged 75 to 84.
  • Between the ages of 5 to 14, there have been 14 COVID-19 deaths.  Over 120 children have died from the flu.
  • Children are not vectors for COVID-19.  This illness does not mimic transmission patterns seen with cold and flu viruses in kids.  Young children do not bring COVID-19 home to grandma and grandpa.  There are several medically documented cases of adults transmitting the virus to children (out of millions of cases), but not the other way around.
  • The main reason for this curious fact appears to involve receptor sites in the nasal passages. ACE2 receptors (angiotensin-converting enzyme) in the nose seem to function like docking stations for COVID-19. (Most people are familiar with a class of blood-pressure medications called ACE inhibitors.) Children under the age of 10 have very low levels of ACE2 receptors.  Children between the ages of 10 and 17 have slightly higher levels of these receptors.  Adults gradually develop greater concentrations of these receptor sites as they age.

What does this mean?  It means that there is no medically valid reason for normal, healthy children to wear masks.  Masks can trap bacteria, spores, allergens, pollen, particulate matter, and even increase carbon dioxide retention in certain patients.  Socially and psychologically, there may be a price to pay one day.

Children should go back to school.  Colleges should reopen.  Teachers will be exposed to colds and flu as they are each year.  But COVID-19 is not a massive threat to faculty unless they are already old and sick.

According to the CDC website on “COVID-19 and Children” updated, July 23, 2020:

The best available evidence indicates that COVID-19 poses relatively low risks to school-aged children.  Children appear to be at lower risk for contracting COVID-19 compared to adults.  To put this in perspective, according to the Centers for Disease Control and Prevention (CDC), as of July 17, 2020, the United States reported that children and adolescents under 18 years old account for under 7 percent of COVID-19 cases and less than 0.1 percent of COVID-19-related deaths.[5]  Although relatively rare, flu-related deaths in children occur every year. From 2004-2005 to 2018-2019, flu-related deaths in children reported to CDC during regular flu seasons ranged from 37 to 187 deaths.  During the H1N1pandemic (April 15, 2009 to October 2, 2010), 358 pediatric deaths were reported to CDC. So far in this pandemic, deaths of children are less than in each of the last five flu seasons, with only 64. Additionally, some children with certain underlying medical conditions, however, are at increased risk of severe illness from COVID-19.*

Scientific studies suggest that COVID-19 transmission among children in schools may be low.  International studies that have assessed how readily COVID-19 spreads in schools also reveal low rates of transmission when community transmission is low.  Based on current data, the rate of infection among younger school children, and from students to teachers, has been low, especially if proper precautions are followed.  There have also been few reports of children being the primary source of COVID-19 transmission among family members.[6],[7],[8]  This is consistent with data from both virus and antibody testing, suggesting that children are not the primary drivers of COVID-19 spread in schools or in the community.[9],[10],[11]  No studies are conclusive, but the available evidence provides reason to believe that in-person schooling is in the best interest of students, particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces.

Wash your hands.  Don’t touch your face.  Stay home if you feel poorly.  Keep surfaces clean.  Avoid crowds.

It’s time for kids to go back to school and for adults to go back to work.

COVID-19: Reasons for Optimism

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Are you demoralized by “spikes” and “surges” in COVID-19 “cases”?  Are you afraid to go to the grocery store without a gallon of hand sanitizer and a hazmat suit?  That’s how you’re supposed to feel.  Don’t fall for it.  There are reasons to be encouraged, and they won’t be reported by most people in the media.

Consider the following:

  • Mortality rates continue to fall across the country. The highest number of deaths or maximum mortality in the U.S. occurred on April 10th, 2020.
  • Clinical experience with COVID-19 in hospital and ICU settings over the past five months has improved diagnosis, care, and outcomes dramatically.
  • Hospital length of stay (LOS) for COVID-19 patients is half of what it was in March and April of 2020.
  • Media reports of ICUs being near capacity are misleading. For example, in Texas, on July 6th, COVID-19 patients filled 15% of ICU beds; 85% of ICU beds were filled by non-COVID patients.  Remember, for months, many people who should have been hospitalized with other conditions simply stayed home. Furthermore, most clinicians with significant experience have seen multiple episodes of packed ERs and ICUs at nearly any time of year.  It happens.
  • Protocols using Remdesivir, Dexamethasone, convalescent plasma, and other therapies are improving survival here and in other countries.
  • The current mortality rate for people under the age of 50 is 0.05% or half that of the flu. The mortality rate for people in their 20s is 0.007%.  So far, despite initial concerns, there are no well-documented cases of children transmitting COVID-19 to adults.  Schools in Germany, Norway, Denmark, the Netherlands, and Australia have opened without problems.  The schools in the U.S. can reopen without panic and paranoia.  There is a sensible way to do this.
  • Confirmed cases of COVID-19 are substantially lower than reported cases. An actual case of COVID-19 must be confirmed with additional testing.  False positives seem to outnumber false negatives at present.  A positive “case” or test result does not automatically translate into a sick patient.
  • There is a difference between dying with COVID-19 and dying from COVID-19. Heart disease, COPD, bacterial pneumonias, diabetes, renal failure, strokes, dementia, and cancer have not disappeared.
  • Rapid progress is being made by numerous companies working on vaccines and therapeutics. This would not have been possible without unprecedented public-private partnerships and the easing of burdensome red tape.

It’s easier to scare people than it is to “un-scare” them.  The simplest way to control people is to silence independent thinkers and keep everyone else afraid and uncertain.  Uncertainty promotes fear, and fear is contagious.

The vast majority of people in the med0ia and far too many “officials” and politicians are trying to make this situation sound as bad as possible for as long as possible.  They are teaching people to be afraid of everything including one another.  This is insane.  It borders on sinister.

We are making for more progress than most people realize.  Fear not.  There are plenty of reasons for optimism.

COVID-19: Scary Graphics

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

Quick.  What’s the clinical definition of a “spike”?  You’re not sure, are you.  Don’t feel bad.  No one knows what the clinical definition of a “spike” is.  But the all-knowing bureaucrats and media types toss the word around with abandon.  It serves their purpose, which is to keep as many people as possible afraid and, therefore, controlled, especially in the age of COVID-19.

If you were fortunate enough to have had a good education and some training in critical thinking, you know you must define your terms. It’s the essential starting point for any serious discussion or debate.  You cannot make up terms or definitions on a whim.  This, of course, is distressing to those who worship their notions and emotions. Today, that means millions of people. Reality (or a “spike,”) is whatever people say it is.

Announcing that “the country is seeing a worrisome spike in COVID-19 cases” is misleading.  Defining the terms is not only critical for any measure of professional or intellectual integrity, it is essential for a prudent response.  Sadly, in far too many cases, a lack of intellectual integrity can be easily used to promote paranoia.  Today, nearly anyone can create scary graphics splashed with “worrywart red” ink.  This is done routinely to exaggerate the threat of anything from a virus to a thunderstorm.  Be afraid. Be very, very afraid.

No. Do not be afraid.  Understand what is happening:

  • There is exponentially more testing being done now compared with six weeks ago (as of late June 2020).
  • The criteria for COVID-19 testing have evolved tremendously over the past three months.In March, elderly people with obvious respiratory symptoms were told to stay at home and avoid the emergency room.  They were advised they did not need to be tested.  Today, in much of the country, many people can be tested on demand.
  • Greater numbers of young people are being tested.Naturally, more positive tests will be reported.  Most of these individuals are asymptomatic and will remain so.  Consider this — no one could walk into a clinic or makeshift roadside testing site and simply demand a test for flu, strep, hepatitis, or mono because he or she felt like it.  Medically speaking, what’s going on now is odd.
  • Deaths from COVID-19 have declined by 40% across the U.S. over the last two weeks.This is crucial for understanding what is really happening.  The mortality rate for COVID-19 here is around 0.05% (and probably lower).  Contrast this with what we were told initially.  Italy had a mortality rate around 10-11% and in the U.S. we expected a mortality rate between 3-4%.  That’s quite a difference.
  • Our focus should not be on the number of positive tests, but on hospitalization and mortality rates.There will be regional fluctuations in both.

COVID-19 is new.  Patterns of transmission, virulence, and regional penetrance will change gradually.  Our understanding of the best ways to treat seriously ill patients will change.  This has happened throughout history.  For now, don’t overreact to “worrywart red” on TV graphics.  Steady as she goes, America.  Steady as she goes.

 

Errors in Judgement

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, MD

I’m confused.   It’s too dangerous to go to school.   It could spread COVID-19.   It’s too dangerous to go to work.  It could spread COVID-19.   It’s too dangerous to eat out, get a haircut, go to a concert, a clinic graduation, wedding, or funeral.  It could spread COVID-19.   But riots, vandalism, looting, and arson are somehow First Amendment rights, and they override concerns about spreading COVID-19.  Has everyone gone insane, or is it just I?

The reality is, going to school, work, or other everyday activities was never really problematic.   Riding on filthy, overcrowded subway cars or living in a nursing home has been really problematic.   So far, there is no statistical correlation between the economic shutdown and COVID-19 case rates, hospitalization rates, or mortality rates.   Sadly, there are devastating correlations between riots, anarchy, and the protracted decline of cities.

Some of us are old enough to remember the spring of 1968.   It was horrible.   Shortly after the assassinations of Martin Luther King, Jr. and Robert F. Kennedy, appalling levels of violence broke out at the Democratic National Convention in Chicago.   Cities across the country burned and many neighborhoods never recovered.   Areas of Los Angeles, Detroit, Chicago, Baltimore, Atlanta, and New York City are still scarred today.

Three months of lockdowns from COVID-19 have shown many educated people they can earn a living from the comfort of home.   The violence and destruction of the past two weeks will give many people pause about remaining in big cities.   The exodus has already begun.

Unfortunately, for those left behind, taxes of every type will increase, but the quality of life will decrease even more.   Economic decline leads to declines in education and public health.   And the people who suffer the most are those least able to cope.

The chief duty of any public official is to protect the citizens, not to lock them in their homes.   We have witnessed a series of dreadful errors in judgment on the part of many mayors and governors — over the past few months (in March 2020 and beyond).   It has devolved into gross incompetence and cowardice over the past two weeks of late May and early June 2020.   People in the media love it.   Suddenly, they have a topic to replace COVID-19.

Politics has a massive impact on education and health care.  We cannot pretend otherwise.   In light of that, I’d like to offer a few thoughts:

1.      Ignore 95 percent of the people in the media.  They live for conflict, anger, and fear.

2.      Realize that anyone promoting conflict, anger, or fear is a big part of the problem — in any situation.

3.      Understand that most people are not inherently racist, sexist, xenophobic, or homophobic, but identity politics lives on.  It’s cheap and it’s easy.

4.      Recognize that businesses, large and small, are a good thing for individuals, neighborhoods, and society at large.  Punishing business owners with violence, absurd taxes, or excessive regulations is spiteful and wrong.

5.      Know that people typically get the kind of behavior they tolerate.  If you tolerate violence and chaos, you’ll get more of both.   A famous passage from the Talmud sums it up, “When you’re nice to the cruel, you’re cruel to the nice.”

The year 1968 was awful.  Let’s not make the same mistakes again.

COVID-19: Complications

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

We knew this was coming, or at least we should have known. Several subsets of patients with complex reactions to COVID-19 (the disease from the coronavirus infection) are being recognized.  The very young, the very old, and the very sick may be predisposed to rare and intense immune responses to infection with this coronavirus.  Here is what we know so far:

  • “Cytokine Storm” can be a dire consequence of COVID-19 especially in older patients with several underlying illnesses.  Cytokines are polypeptides or proteins secreted by immune cells coming into contact with bacterial or viral antigens and/or endotoxins.  Cytokines can also be synthesized by adipose cells (one of the reasons overweight patients are at serious risk).  Cytokines include chemokines, interleukins, interferons, and tumor necrosis factors among others.  Simply put, cytokines influence the magnitude of an inflammatory immune response.  Multiple genetic factors seem to play a role.  Clinically, an older, chronically-ill patient with COVID-19 (or other infections, such as influenza) can deteriorate dramatically over 6-12 hours. Vital signs become unstable, O2 saturation drops, respiratory distress intensifies, and inflammatory markers like C-reactive protein rise.  Cardiac function is seriously compromised and liver, kidney, and neurologic function decline rapidly.  Severe clotting disorders may develop.

The outcome is poor, but aggressive efforts to suppress the massive autoimmune inflammatory response may help if initiated at the earliest stages.

  • Toxic Shock Syndrome:  This is an acute, serious, systemic illness triggered by a response to exotoxins produced by staph or strep bacteria. It was first noted in young women in the early 1980s and was linked to tampons, diaphragms, or contraceptive sponges left in the vagina.  It can occur after childbirth, abortion, or surgery.  Symptoms include a high fever, diffuse red rash resembling scalded or burned skin, hypotension and multi-organ system failure leading to shock.  Prompt and aggressive treatment involves removal of foreign bodies, debridement of incisions or wounds, IV fluids, and IV antibiotics (clindamycin and vancomycin).  IV immunoglobulin can be used.

Several patients in the New York area, who tested positive for COVID-19, have presented with symptoms similar to Toxic Shock Syndrome.

  • Kawasaki Disease:  This is a childhood illness with a dramatic presentation and complications related to vasculitis, probably of an autoimmune nature.  Each year in the U.S. there are between 3,000 to 5,000 cases, mostly in children under the age of five years.  Rare cases occur in young infants, teens, or young adults.  Occasional community clusters occur, especially in late winter and spring, without clear evidence of person-to-person transmission.  Diagnosis requires the presence of four out of five clinical findings after fever lasting five or more days.
    • Bilateral conjunctivitis — injection or intense redness without exudate, drainage, or crusting.
    • Mucocutaneous injection of the lips, tongue, and oral mucosa. Lips are red, raw, dry, cracked, and fissured.  The tongue is enlarged, red, and possibly tender.  The classic description is “strawberry tongue.”
    • Skin changes involving the hands and feet.  There is pronounced edema and erythema especially on the palms, soles, and nail beds.  Full-thickness desquamation or sloughing off of skin on the fingers, palms, soles, and toes leaves the underlying denuded skin red, raw, and tender. These changes typically begin around Day 10.
    • Polymorphous rash over the trunk may resemble measles, scarlet fever, hives, or erythema multiform.  The perineal area is often involved.
    • Cervical lymphadenopathy with at least one lymph node in the neck ≥ 1.5 cm in diameter.

The cardiac complications of Kawasaki Disease include coronary artery aneurysms, myocarditis, pericarditis, and valvular disease.  EKG and echocardiogram are indicated at the time of diagnosis and in regular follow-up visits for at least a year.  Treatment involves high-dose aspirin and IV immune globulin.  Approximately 85 children in the New York area who are COVID-19 positive are being evaluated for this condition, now called “Pediatric Multisystem Inflammatory Syndrome.”

Cytokine storm, Toxic Shock Syndrome, and Kawasaki Disease are rare in their original forms or as complications of COVID-19.  The overwhelming majority (over 82 percent) of patients testing positive for COVID-19 remain asymptomatic or mildly ill.  The survival rate in the U.S. (rarely mentioned) is over 99.5%.

Those of us in health care must always be aware of unusual or rare complications of any illness.  But perspective is crucial, a concept lost on many in the realms of media and politics.  After all, the best way to control people is to keep them afraid.

Knowledge, perspective, and prudence:  not fun, but essential.

homestudy

Coronavirus (COVID-19): We’ll Learn To Cope

Posted Posted in Continuing Education, Elder Care, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Enough.  Enough with the panic, paranoia, and power grabs.  Enough with the hysteria, hoarding, and hyperbole.  Enough with the melodramatic funeral music between commercial breaks on TV.  Fear, malaise, and resignation cannot become a permanent feature of life. This is not the end of the world, and this must not be tolerated as the “new normal.”

One of the most effective antidotes to fear is perspective.  Many of us had loved ones who endured far worse situations during the Spanish Influenza of 1918.  In those days, there were no ventilators or even the ability to deliver nasal oxygen.  There were no ICUs, cardiac monitors, or even TVs.  Antibiotics, antivirals, bronchodilators, anti-inflammatory medications, and corticosteroids did not exist.  There was no such thing as a Respiratory Therapist.  It was bleak.

Ten years later, during the beginning of the Great Depression, socio-economic conditions were equally bleak.  There were no social safety nets.  Social Security, unemployment Insurance, Medicare, Medicaid, welfare, food assistance, personal and small business rescue programs were nonexistent.  Soup kitchens and bread lines were the measures of last resort.

There is another major difference between the present day and 1918, and it revolves around the media.  In 1918, people had newspapers.  Radio was in its infancy.  There were no narcissistic TV “personalities” promoting an agenda 24 hours a day.  Enough is enough.  We don’t need any more people in the media selling panic for profit.  We need facts.  We need reason.  We need sensible, constructive solutions to a serious, infectious disease.  But we cannot sit on our hands for 18 months when a vaccine may or may not save the day.

Anyone telling us we have no choice but to lock down everything is misguided.  We always have choices.  Life constantly presents us with potential risks and benefits.  People can learn how to function with reasonable safety once they have the facts.  We are not helpless, clueless children who must be grounded “for our own good.”

Death is a certainty at some point — for each of us.  It always has been.  What matters is living a life that is good, honorable, and uplifting to others.  We are told no one should determine who lives and who dies.  Yet politicians and bureaucrats proclaim which “workers” (a Marxist term) are essential and which ones are not.  That reflects a stunning level of arrogance.  The only “non-essential” job or business is the one you didn’t pour your heart and soul into.  A handful of officials (where jobs, paychecks, and pensions are secure) is destroying the lives and futures of tens of millions of other people.

We’ve learned how to cope with tuberculosis and terrorism, the Great Dust Bowl and diphtheria, threats of nuclear war, and natural disasters.  We’ll learn how to cope with COVID-19, not through fear, not through paralysis, but through prudent, innovative, courageous action.  Enough with the panic.

Let’s get on with it.

COVID-19: Clinical Observations

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Every new illness brings new knowledge. Global experience with COVID-19 is revealing patterns of clinical illness which will guide our approach to treatment. Here are some of those important observations:

  • The illness in 80% of people causes mild symptoms. Many people remain completely asymptomatic. Moderate and severe illness often has two phases. Days 1‒7 are characterized by fever (above 101° F), headache, significant cough, profound fatigue, myalgias, and malaise. Between days 4‒8 some patients have nausea, vomiting, abdominal pain, and/or diarrhea. Some patients lose their sense of taste and smell. Days 8‒21 are characterized (in 15‒20% of patients) by increasingly severe symptoms, including shortness of breath, dyspnea or difficulty breathing, chest pain or tightness, tachycardia and weakness.
  • The mean interval between onset of symptoms and hospitalization is 9.1‒12.5 days. This delay in the progression to serious illness may give us a window of opportunity for treatment.
  • Clinical findings typically include a low oxygen saturation level (O2 sat) on room air. This is a key finding and levels as low as 75‒90% are being seen (95‒100% is normal).
  • Laboratory results also show patterns similar to what was observed with SARS and MERS:

o   ↓ WBC or leukopenia

o   ↓ Platelet count or thrombocytopenia

o   ↑ Liver enzymes, especially LDH around hospital days 5‒8

o   CXR typically shows streaky opacities in both lungs consistent with an atypical pneumonia.

  • Serious complications of COVID-19 include severe viral pneumonia, ARDS (Adult Respiratory Distress Syndrome) respiratory failure, cardiac injury including arrhythmias and CHF. Poor perfusion can lead to hepato-renal syndrome. Neurologic symptoms, delirium, and coma may occur.
  • There is evidence that intubation and mechanical ventilation may be causing more harm than good in some patients. One component of ventilator function, the PEEP setting (positive end-expiratory pressure) may be delivering pressures that are too high for the alveoli or air sacs in the lungs. It appears that some COVID-19 patients in respiratory distress actually need lower levels of PEEP (15‒20) as opposed to levels around 25. Some patients seem to need higher O2 concentrations delivered by face mask, CPAP or BiPAP, and not intubation and mechanical ventilation.
  • According to the CDC, two thirds of the patients who have died from COVID-19 (as of mid-April) had documented serious underlying conditions (heart disease, diabetes, asthma, renal disease, malignancy, immuno-compromise). Obesity has been a significant factor contributing to mortality. 1.9% of patients who have died had no known underlying condition.

We have only scratched the surface here. The next few weeks will reveal new insights about the illness itself and the best treatment protocols. In the meantime, do what is prudent to protect yourself and others. It may not be obvious to everyone, but tremendous progress is being made.

Blessings to all through Passover and Easter.