On Leadership, Science, and Happiness

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

By Mary O’Brien, M.D.

It’s safe to say we’ll all be happy to see this year come to an end.  Fifty years from now people will still be studying the pandemic of 2020, catastrophic hurricanes, tornadoes, wildfires, riots, a controversial election, and the Nashville bombing.  We have reasons to be exhausted.

Despite all these dreadful events, or perhaps because of them, there is much to be learned.  It could easily fill a book, but for now, a few thoughts will suffice:

On Leadership

  • The people who are trying to frighten you are trying to control you.  Ignore them. Good leaders inspire confidence and optimism, not despair.
  • There is never a place for panic in leadership. There is never a place for panic in public policy.
  • Good leaders actually do what they ask others to do. They do not exempt themselves from difficult, inconvenient, or unpleasant tasks.
  • True leaders respect others.  They do not harbor disdain for others.
  • Tyrants (false leaders) often succeed because cowardice is so common.  Show some spine when bullies arise, and remember, no politician or bureaucrat has missed a paycheck in 2020.
  • When in the course of human events, it becomes clear that what you’re doing isn’t working, it’s time to change what you’re doing — especially in a crisis.

On Science

  • Genuine science requires brutal honesty, discipline, openness, acceptance of uncertainty, and humility.  Real science always has been and always will be a work in progress.  When people scream, “Follow the science,” all too often they mean, “Do as I say.”
  • The main point of science is to help us overcome problems and adapt to difficult circumstances. Creative people in every domain have learned to adapt to massive challenges over the years. The Year 2020 was no exception.  In a crisis people need practical advice and suggestions, not domination and suppression.

On Happiness

  • Most of us still have much for which to be grateful, and there is no happiness without gratitude. Take nothing for granted. Many of us now miss things as simple as family, friends, hugs, and handshakes.
  • There are plenty of unkind people in the world. Don’t be one of them.  Kindness and happiness go hand in hand.
  • Don’t believe anyone who insists our darkest days lie ahead.  Such people do not understand the wonders of the human spirit.  It is never time to give up, despair, or cower in a corner.

Fear not.  We’ve learned a great deal in 2020, and we will build on that knowledge.  Be focused.  Be engaged.  Stay informed (not indoctrinated).  No matter what happens in 2021, do not relinquish your right to engage in independent thought and speech.  The future depends on it.

Happy New Year to All.

Exactly What We Need

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

By Mary O’Brien, M.D.

The holidays have gotten off to an odd start.  Thanksgiving was different, to say the least.  Most family gatherings were small and lots of people were alone.  Now the focus has shifted to shopping and decorating. At least it’s a pleasant distraction.

Hanukkah begins on December 10th and Advent started this week.  Who knows what will happen by Christmas.  Given the depressing and stressful nature of this entire year, it might be uplifting to embrace some time-tested traditions of a spiritual nature. For centuries the Christmas tradition of Advent was a time of fasting, prayer, and alms giving.  Many of us were taught to “give up” something like candy or soda as a spiritual discipline in preparation for Christmas.  Nothing wrong with that, especially since many of us have gained a few pounds during the pandemic.  But giving up candy doesn’t help someone feel better.  And right now, nearly everyone needs a little something to feel better.  So here’s an old idea that might help us all feel uplifted.

Cut 25 strips of paper and write an activity for the day on each one.  Fold the strips of paper and place them in a jar or bowl.  Each morning, pick one, and commit to performing the activity.  By Christmas, you will be a better person (and a happier one) for the ripple effect you will have set in motion.

Here are some examples:

  • Send a Christmas card with a personal note of gratitude and encouragement to an active service member or veteran.
  • Leave a little treat (not homemade this year) on the doorstep of a neighbor you haven’t met.
  • Stop by your church or synagogue for a few minutes of quiet prayer or reflection.
  • Give up fancy coffee drinks or alcohol for a month and donate the money you save to a shelter.
  • Offer to do a grocery store run for an elderly neighbor.
  • Say something pleasant or kind to someone you don’t like, perhaps a grumpy patient.
  • Send a small floral arrangement anonymously to someone in a nursing home.
  • Order take out or delivery and give an unexpectedly generous tip.
  • Apologize to someone you may have hurt or offended. It may be more difficult than giving up candy.
  • Place a treat in the mailbox for your mail carrier just because.
  • Try to get through the entire day without criticizing anyone.  There’s some spiritual discipline!

You can make up your own list. It’s well worth the effort.  The next four weeks will pass regardless of our actions.  This year the true spirit of Advent could be exactly what we need.

homestudy

Deconstructing Anxiety: Finding the True Source of Fear for Profound Healing

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Pain, Psychology

By Todd E. Pressman, Ph.D.

Fear and fulfillment. These are the prime movers of our life, the two great forces that drive the human experience.

Fear is a constant companion. It whispers in our ears of lurking dangers and impending catastrophes. Fulfillment is our high purpose, that which calls us from our most secret places and compels us to discover a freedom and wholeness far beyond what we had thought possible.

These two forces engage in a constant battle. If we forgo our fulfillment and succumb to fear, we are never fully satisfied. But, fear warns us, if we venture forth, we risk the unknown; we are sure to encounter all sorts of perils and should, instead, “play it safe”.

A STRANGE PHENOMENON

Our solution, as a humanity, is to try to satisfy both drives. This results in a strange phenomenon: we convince ourselves that fear is the best strategy for finding and securing fulfillment. We have an impulse for fulfillment—a desire to connect with someone or an urge for creative expression—and immediately consult our fear to negotiate the terms. Fear becomes our provocateur, rooting out from dark corners anything that might signal danger. It becomes our warning device for taking the actions that will protect our fulfillment.

Unfortunately, the strategy backfires; it is impossible to be fulfilled while we are in fear. Not only does fear keep our attention on danger, but we know we can never truly prevent all potential threats. Our response to this is to dig in more deeply, devoting ourselves to an even greater control over danger. We fool ourselves into believing we are working toward the day when we will finally achieve the safety we seek, free to get about the business of fulfillment.  Of course, that day never comes. As the Chinese proverb states, “We are always preparing to live.”

This is the human drama that has been playing out in every culture of every age. Our first and greatest drive is for fulfillment—we know this experience whenever we watch a child filled with the joy of being—and we will not be satisfied until we reach it. Our soul rattles its cage not just for relief from anxiety but to actively create our good.

But the seduction of fear is powerful. We can’t really afford to dwell in the joy of the moment, it tells us. We must keep our eye on looming dangers or the possibility of a sneak attack. So we make the decision to take care of fear first, somehow hoping to get things under control in a complete and permanent way.

When we look around at our current state of affairs, the tragic effects of this strategy are all too evident. Security is the overwhelming goal for most of us, with fulfillment often postponed to the point of being forgotten. It has us live in ever-more-constricted ways, squeezing our once expansive, exuberant selves into a very narrow psychic territory.

We learn to delay gratification, taking care of responsibilities and handling problems, before we can get around to what makes life really worthwhile. There seems to be always one more thing to handle, and then one more and one more. Again and again we tolerate the frustration of postponing our fulfillment until we become rigidified in a posture of waiting. When this goes on long enough, we can indeed forget our original goal.

The great irony of our approach to fulfillment, using fear as our guide, is that it is precisely the approach that will keep us from it. Over a lifetime of such practice, we see our opportunity for fulfillment slipping by. We become stunned by how hard life can be, how much we’ve lost, how far we have fallen from the dreams and high expectations of our early ideals. Because we have sought to get control over a fulfillment that never comes, the futility of the effort catches up with us and we find either that we never did have control or that it wasn’t truly fulfilling after all.

WHAT’S MISSING?

What makes fear so compelling? Why have we become so entrenched in its strategy to secure fulfillment, even when we see that it isn’t working and can make us miserable? If we consider clinical anxiety as simply an exaggerated form of the fear we all struggle with*, the problem can truly be said to be epidemic, the need universal.  How does anxiety co-opt the brain to become so maddeningly fixed and unyielding? What are we missing in our understanding?

The problem, I propose, is that we have not yet fully deconstructed anxiety. We have not yet achieved a successful analysis of precisely how it works—the exact mechanisms that create it, maintain it, give it its power, and make it so intractable. Our paradigms have been incomplete. We need a comprehensive model for understanding and working with the fear at the root of our difficulties, a Rosetta Stone for cracking its code.

Such a model would not only unravel the mystery of anxiety but would illuminate its secret gift. For, as we have said in a previous article**, finding fear’s cure reveals the path to transcending suffering in general, providing a map to deep fulfillment, healthy relationships, and a more functional world.

And why has this been so elusive? Why are we only sometimes successful in our treatments for anxiety? Simply put, whenever a therapeutic intervention fails to produce the desired results, it is because it has not yet fully deconstructed fear in these ways. Fear’s trickery depends upon its ability to convince us not to look at it deeply.  In clinical language, we say fear is hallmarked by avoidance behaviors. We seem to be reflexively wired to respond to fear with these avoidance behaviors.

THE FEAR OF LOOKING AT FEAR

Since the beginnings of psychotherapy, we have understood the importance of reversing this avoidance response, whether through insight into the unconscious, cognitive transformations, various types of exposure therapy, etc. Yet this wiring is powerful, our defenses are resistant, and we still have not explored the nature of fear in a complete enough way. Even if we think we are intimately familiar with it, many of the fast and fleeting thoughts behind the scenes will slip by unexamined. In truth, this is because we are subtly afraid to look at them and discover all they have to teach us. We don’t want to look at them because we know they will require a complete paradigmatic shift in our understanding of who we are and how we deal with life.

We have become so invested in our fear-based ways of negotiating the world that we will not easily give them up. Most of us resist looking at fear as much as possible. But even those who pursue a deeper exploration of the psyche can get lost in its meandering catacombs, missing the ways in which fear is distorting their compass. The fear of looking at fear is the first obstacle to overcome in our search for freedom and fulfillment. It is the source of our human predicament and that which preserves it as well.

Our existing strategies for dealing with fear fall short of real change in direct proportion to the extent that they do not look at and deconstruct the fear fully.  We need an approach that reliably digs up the fear at the bedrock of our suffering with insight into what gives rise to the suffering in the first place.

Those who have sought out this answer, intrepid explorers of consciousness, have demonstrated enormous courage to bring back maps of the terrain they traveled. Freud at one point thought he was going crazy as he conducted his own self-analysis. Jung had to acknowledge his “shadow” in order to deal with it effectively. The Buddha determined he would sit under the Bodhi tree until he either reached enlightenment or died trying. Their courage, and that of others, has paved a way for the rest of us, showing that we must look at and examine fear, digging it up fully, if we are to become free. The hero’s journey, the dark night of the soul, and the death-rebirth archetype all describe the same path: we must confront and move through fear all the way in order to find our higher good.

Facing fear fully, in safe and manageable ways but wholly without reservation, then, becomes the key to finding the true source of suffering and opening a path to freedom. And resolving the fear of facing fear is the first essential step in this process.  We must be willing to follow fear to its most subterranean hideout. But when finally there, standing resolutely in the face of that from which we have been running our entire life, we may at last come to know our true “enemy,” shake hands with it, and even befriend it. With this, we reveal the gift it held, discovering what it was calling for all along and satisfying its need in a new and more fulfilling way.

In traveling this path, we will come to see that the whole of humanity has been engaged in an endless cycle of fear built upon a faulty strategy for securing fulfillment. But seeing the problem clearly like this makes transformation possible.  No longer are we merely a figure caught in a play. When we take hold of the fear that has been directing from behind the scenes, we can rewrite the script in more fulfilling ways. Finding the anxiety at the root of things gives us a sort of X-ray vision where we see through our automatic assumptions about life and reveal the truth they were hiding. Like discovering the “man behind the curtain” in The Wizard of Oz, we lose our fear when we understand its source.

Our task, then, is to fully deconstruct anxiety, learning how to navigate through the subterfuges of fear and, ultimately, how to design a life lived from free choice. Rather than being twisted and distorted by the ways of fear, such a life reaches for a transcendent truth, one that has the potential for resolving suffering at its source and restoring us to our original fulfillment.

In future blog posts, we will begin to lay out exactly how the Deconstructing Anxiety model takes up this task.

————————————————————————-
*In these blog posts, the word “fear” is considered as synonymous with “anxiety”, as per the Buddhist concept that the anxiety created by anticipating a future event has the same effect in the mind as the fear experienced by an imminent threat.

**See Deconstructing Anxiety: The Journey from Fear to Fulfillment
_______________________________________________________________________

This is an edited excerpt adapted from Todd Pressman’s Deconstructing Anxiety: The Journey from Fear to Fulfillment (2019), published with permission from Rowman and Littlefield Publishing.  All rights reserved.

Copyright 2020 by Todd Pressman

COVID-19: The Whole Goal

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

By Mary O’Brien, M.D.

What is guiding your life right now?  Is it notions and emotions fueled by the media?  Is it political correctness and group-think?  Is it fear of ridicule, criticism, or worse?  What we do, what we avoid, and what we fear speak volumes.  Malevolent forces are at work in our culture, and the whole goal is control.

Sadly, far too many people in health care have become passive, dutiful sheep.  “I’m just doing what they tell me to do” has become a veritable mantra.  Nurses, doctors, dentists, and pharmacists who should be capable of independent thought and logic now lower their gaze and comply with idiocy.  It’s embarrassing.

This week (in August 2020), the CDC (Center for Disease Control), in usual fashion, issued a statement contradicting previous communications:  Patients without symptoms do not need to be tested.  Anyone with modest medical knowledge and a three-digit IQ should realize that.  Asymptomatic people, with rare exceptions, are not the problem.

Once again, we don’t have people line up in cars to be tested for flu, strep throat, tuberculosis, mono, or hepatitis because they feel like it.  We have wasted an obscene amount of money, time, and effort on unnecessary and often unreliable testing.  Ah, but it makes us feel as if we’re doing something, and it fuels the fear and paranoia.  Clearly, fear and paranoia make control so much easier.  What could be better?  Put on your mask and spray some Lysol — if you can find any.

There is no clear evidence anywhere in the world that lockdowns mitigate anything.  Viral epidemics run their course regardless of the interventions.  Many people in politics, education, and even health care have trouble with that reality.

We didn’t shut down the country during World War I and the Spanish Flu epidemic. We didn’t shut down business, travel, and education because of tuberculosis, yellow fever, whooping cough, polio, or the Hong Kong flu of 1969.  But back then, we didn’t have ignorant, malicious people pushing an agenda on cable TV and the internet.  We weren’t suffocated by pretentious bureaucrats issuing irrational edicts.  Sensible people would have laughed at such nonsense.

When a brand new illness develops, there are no “experts.” Guidelines will never take the place of facts, logic, and common sense.  Notions and emotions will never solve problems or save lives.  Group think and political correctness will never spark creativity or innovation.

We need to stop the passive, dutiful sheep routine.  The choices we make out of fear are almost always wrong.  Remember, the whole goal is control.  Just say no to the nonsense.

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.

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