COVID and Total Deaths

by timryanmd

Skeptical

We read accounts of people dying from diseases or accidents that have nothing to do with COVID, yet because they “tested positive” they are being registered as a COVID death. If mistakes or fraud like this happened frequently then obviously the data on COVID deaths would be misleading. A lot of us are becoming skeptical of the data.

Back in May the Gateway Pundit even wrote an article essentially saying that the overall death rate during the first four months of 2020 were not significantly higher than what we should expect. They concluded that the COVID pandemic was a lie.

A Real Epidemic

The Gateway Pundit was wrong. CDC data confirms that a significant and historic epidemic did started in the middle of March 2020 and is now ending. This epidemic caused over 200,000 deaths in the United States from a respiratory illness. A large majority of deaths were in those over 70 years old.

There are two graphs from the CDC that accurately show the impact of the epidemic. The first graph (below) shows pretty clearly that toward the end of March deaths from all causes started to rise far beyond what was expected based on historical averages.

The second graph correlates with the first and shows that those increased deaths were almost all caused by a respiratory infection.

The not-so-flat rise in the percentage of all deaths from Pneumonia, Influenza or COVID-19 (PIC) peaked in mid-April (week 16). In that week alone 22,207 people died of PIC* which represented 27.7% of all deaths in the United States.

These two graphs taken together are strong evidence that we had a unique and deadly epidemic caused by an increase in deaths from a respiratory infection. This should silence those who claim that the number of deaths from COVID is in error because of erroneous or fraudulent death certifications.

*A discussion about PIC is a long one, and for the purpose of this article I will be assuming that PIC deaths in 2020 are synonymous with COVID deaths.

Is It Safe Out There?

by timryanmd

I am getting a lot of questions about how to get back to a normal life. Patients are asking me if its safe for their children to return to school. Others ask if it’s safe to return to church or work or shop or go on a vacation. Some patients are asking me to write a letters saying that it is “unsafe” for them to work because they have a medical condition.

These questions are difficult to answer. In fact, they are almost impossible to answer because because everybody has different ideas about safety. Safety is subjective. Only you can ultimately decide what is safe. The best I can do is inform people about risk and offer my advise.

Marketing Fear

One piece of advice I often give is to stop watching the news so much. For the last six months the mainstream media has been carpet-bombing us with non-stop messaging of fear. It seems like all we hear about are COVID deaths, COVID cases, flattening curves, opening too soon, overwhelmed hospitals, second waves, shut downs, social distancing and masks, masks, masks.

Constant fear coupled with universal germophobic solutions have carried the day. It is time to get a level-headed perspective. The best way to make good decisions is to look at the facts and assess your own risk so you can take reasonable actions to prevent getting sick and help others.

Risk

We need to recognize that dying of COVID is pretty rare. On August 1, Worldometer reported that over the last six months there have been almost 158,000 deaths in the USA from COVID. This means that 99.95% of the 330,000,000 Americans have not died of Coronavirus.

If you catch COVID, your chance of dying is very low. The CDC now estimates that the overall infection fatality ratio is about 0.65%. Yes, this is much worse than the typical influenza (0.1%), but those are still good odds. COVID is more deadly for the elderly. Those over 65 have about a 1.3% risk of death and the risk for those over 75 is higher than that. But the risk of death for healthy people under 65 is low between 0.05 to 0.2%. The risk of death in those under 50 without chronic medical conditions is less than 0.05 and the risk to school-age children and young adults is as close to zero as you can get.

The GA DPH website has good information, so I go there a lot. You can download the spread sheet of all deaths and do your own analysis. In Georgia, there have so far been 3,826 COVID deaths among our 10,600,000 residents. Half of those who died were over the age of 76 and two thirds were over 70. Only sixteen percent (16%) of all deaths were under the age of 60 and a significant majority of them had other chronic medical conditions. There were five deaths under the age of 22.

Closer to home, Bartow County has a population of over 100,000 people and 59 of them have unfortunately died of COVID. Half of those deaths were in people over 80. Only 10 of the 59 deaths were under the age of 70 and all but one of them had other chronic medical conditions. The youngest was 52.

Advice

I think healthy people under 60 can safely get back to a reasonably normal life. Their risk of dying is very low, on par with the risk of dying during Flu season.

Normal Life

I’m assuming we “flattened the curve” already, so a very reasonable way forward is for lots of young people to catch COVID and get over it. Their collective immunity to COVID is what will eventually slow the spread. These young people should be very cautious about getting near those who are over 65 or who have medical problems.

I think students can safely get back to school and college and lead a normal social life without masks. They are safe. But they should also be very cautious and socially distance themselves from those who are vulnerable and at risk.

People who have chronic medical conditions like diabetes, cardiovascular disease, obesity and kidney disease are at a much higher risk of dying, especially if they are over 60. All people over 70 are high risk. If you are one of these people, you should still strictly follow social-distancing rules. You should stay away from sick people and crowds as much as possible. Avoid (for now) the young people I described above. I know it is a very lonely and difficult time, but be patient and hang in there. This will end.

The best way to make your own rational and logical decisions about how you will get back to normal is to look at the data yourself. Some of the sites I use are Worldometer, Our World in Data, GA DPH and the CDC.

COVID Masks

by timryanmd

Fauci maskedWearing masks in public has become a hot topic and it’s not just because we have different opinions.  The media messaging has become very intense and Governors are mandating it.   Trying to decide whether you ought to be wearing a mask in public is becoming somewhat of a dilemma.

On the one hand, wearing a mask seems like a good idea because masks provide a barrier that could block SARS-Cov-2 or other viruses from entering or exiting your nose and mouth.   And if you block viruses then you won’t contract or spread a disease, so wearing a mask seems harmless and potentially helpful.

On the other hand, masks are uncomfortable, and they stink and wearing one makes it harder to breathe and more difficult to communicate.  The masks might not even help much when you consider that the COVID virus is only 0.125 microns in size which is much smaller than the pores in an N95 mask (0.3 microns)  or a surgical mask (2-10 microns), so the mask shouldn’t stop the virus very much at all.  Then again, the virus is carried on a respiratory droplet which is about 5 microns, so the mask fibers might stop something that size, so maybe they do help.  But if your soggy mask traps all those virus/droplets and you keep wearing it, then wouldn’t you inhale and exhale a lot of the viruses?  What if you touch your annoying mask and then touch something or someone else and spread your COVID germs?  There are obviously a lot of factors to consider.

In deciding about whether you should wear a mask, the most logical first step is to look at the science to help determine how effectively masks prevent the spread of disease caused by a contagious respiratory virus.  Fortunately,  we can turn to science because the efficacy of masks has been studied extensively.  Influenza and Corona viruses are spread in a similar way and when the CDC looked at studies on Influenza, this is what they concluded:

“In our systematic review, we identified 10 RCTs that reported estimates of the effectiveness of face masks in reducing laboratory-confirmed influenza virus infections in the community from literature published during 1946–July 27, 2018. In pooled analysis, we found no significant reduction in influenza transmission with the use of face masks ….  Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.”

If you have Linkedin, go here because James Lyone-Weiler has a good summary of other studies, all of them concluding that masks don’t slow the spread of Influenza or other respiratory viruses.  The World Health Organization also recommended that we not wear masks in public to prevent the spread of COVID.

The one study I am aware of that actually looked at the effect of wearing cloth masks was done in Vietnam on 1600 Health Care Workers in 14 different hospitals during Influenza season.  The results were published in the British Medical Journal in 2015 showing that wearing a cloth mask actually INCREASED your risk of catching a Flu-like illness.

The scientific evidence indicates that wearing a mask in public does not prevent the spread of Influenza or other respiratory viruses, but the CDC, the media and scientists like Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases are repeatedly telling us that we should wear them (even cloth ones) in public.  What is going on?

For one thing, we should admit that there are reasons to wear a mask that don’t have anything to do with science or with preventing the spread of a virus.  Dr. Fauci likes the non-scientific and symbolic reasons.  He says that masks let people know that we are doing the kinds of things that seem helpful.  He also thinks that the leaders in government should mandate mask wearing and he wants to be sure that we send a unified message about them, and not a mixed message showing that we have different opinions.  One opinion piece in the NEJM also points out that masks are ineffective, but useful because they provide psychological comfort.

So, the evidence from scientific studies does not support the idea that masking will protect us or slow the spread of the virus, so I think we should stop emphasizing it so much.  We should spend our energies on more common- sense behaviors that have been shown to help:

    1. Stay home if you are sick
    2. Keep your hands clean and away from your mouth
    3. Respect social distancing

And please remember that COVID is particularly deadly to the elderly and they should be protected.

Heartburn

by timryanmd

If you are taking a Proton Pump Inhibitor (PPI) like Prilosec or Nexium for heartburn or GERD, you should do what you can to get off it.   The long-term effects may not be good for your health.

PPIs are very effective at reducing the amount of acid in our stomachs. While there are some rare medical conditions that cause increased acid production and require chronic PPIs, most people are not taking these medications because they have too much acid. They are taking them because they have GERD (Gastroesophageal Reflux Disease).

GERD is a condition where acid from the stomach is getting into the esophagus where it doesn’t belong. With GERD the “trap door” or sphincter between the esophagus and stomach is not functioning properly and is causing reflux.  PPIs help because reducing the amount of acid in your stomach will also reduce the amount of acid that gets into your esophagus.

You might ask, “Isn’t just reducing the acid in your stomach avoiding the real problem which really has to do with that sphincter”?  And you might also ask, “Don’t we need acid in our stomachs for proper digestion?” Yes, we make hydrochloric acid for a reason. It helps digest food and is necessary for optimal absorption of a lot of nutrients. It also helps kill germs that enter our GI tract.

In fact, studies now are showing that PPIs contribute to certain deficiencies like Vitamin B12 and Magnesium. PPIs can also increase your risk of infections with germs like H.Pylori and C.difficile. They increase your risk of pneumonia. Some studies are even correlating chronic PPI with heart conditions and possibly kidney disease.

Stopping PPIs is not easy because of what is called “PPI rebound acid hypersecretion”. This is when the stomach cells generate (temporarily) MORE acid when the medication is stopped, thus more symptoms and so people resume their medications and end up dependent on the PPI.

What can you do? First, talk to your doctor about your symptoms and tell them about your medication use. Ask your doctor if it is safe for you to try and stop your medication. You may need other tests to establish a proper diagnosis.

If you have GERD, there are things you can do to improve the function of your “trap-door” LES:

  1. If you are overweight you must lose weight. Go here for advice on that, or make an appointment here.
  2. Don’t skip #1. Be sure and do that first!
  3. Eat smaller portions.
  4. Avoid foods that are known to contribute to reflux like alcohol, peppermint, citrus, tomato based foods, chocolate and caffeine.
  5. Elevate the head of your bed 6-8 inches

If you decide to stop your PPI, you need to be patient and do it slowly. There are no established recommendations on how to do this, but basically you would wean slowly over the course of weeks or months. You may make the transition with the use of other medicines like Zantac or Tums. Your doctor could probably give you advice.

Concierge and Direct Pay

by timryanmd

I’m occasionally asked, “Do you have a Concierge practice?”  My answer is, “Yes and no” because it depends on how you define “concierge”.  If you define “concierge” as the type of practice that provides individualized care, great service and the attention you deserve when you see a doctor then yes, I have a concierge practice.

But most people who ask about a “concierge” practice (now often called “Direct Pay”) are probably asking about a kind of practice where patients become members by paying a fee of usually about $1,500/year.

This membership fee promises service for patients beyond what they might otherwise receive.  Better service is possible because the Direct Pay doctor keeps his panel of patients very small, maybe 500, so he therefore has more time to spend with each patient.  This arrangement is very good for the doctor because he has few patients and a lucrative income.  It is pretty good for the patient because they get more time with the doctor and improved access if they can afford it.  I don’t have this new type of “Concierge Practice”.

The main reason I don’t have this type of practice is because I don’t think paying all that money provides nearly as much value for patients as a straight fee-for-service model like what I offer at my office.

It is also often the case that people who need the most medical care do not have the resources to pay for entry to a Concierge Practice.  Who is going to see them?  I think my system can do it best.  My prices are reasonable and a good value for everybody.

Concierge, or Direct Pay, is an interesting alternative style of practice and I’m confident it will grow.  I hope the future of medicine allows good doctors to establish their own unique practices so patients can find the individualized care that suits them best.

Allergy Season is Here!

by timryanmd

Spring allergy season has hit early this year.  I’ve already seen a lot of patients with symptoms from pollen.  They have what is called Seasonal Allergic Rhinitis.

If you have lived in Georgia for any length of time you probably know what this is: runny nose, sneezing, sore throat, congestion, itching eyes, cough and sometimes fatigue and irritability.

Seasonal allergies are prevalent in Georgia mainly because the pollen counts are so high from hardwoods in the Spring and grasses and weeds in the Summer and Fall.

If you struggle with seasonal allergies, there are a few things you can try before you go to the doctor.

  • Dust and vacuum frequently so that you remove sources of pollen in your home.
  • Use a vacuum with a HEPA filter.
  • Keep your AC ducts and filters clean.
  • Keep your windows and doors closed.
  • When you come in from outdoor activity, change your clothes and take a shower.

If you need medications, you can purchase many of them over-the-counter (OTC).  The best is probably a glucocorticoid nasal spray like Flonase or Rhinocort.  These work very well for most people and if used consistently throughout allergy season they may be all you need.  If the nasal sprays don’t help enough, add a once daily non-sedating antihistamine which you can also buy OTC like Zyrtec, Claritin or Allegra.  Saline nasal sprays or gentle use of a Neti Pot can also help.

If these remedies don’t give you relief then a visit to your doctor can help because something else may be causing your symptoms like an infection or other non-allergic causes.

If you don’t have a doctor, contact us and we’ll be glad to help!

Private information hacked

by timryanmd

Community Health Systems owns or operates over 200 hospitals in the United States.  Almost half of their hospitals are recognized as “Top Performers in Quality Measures by the Joint Commission”.  They are also participants in a Patient Safety Organization (PSO). According to Community Health Systems,

“PSOs were authorized under the Patient Safety Act of 2005 and are designed to improve the quality and safety of U.S. healthcare delivery. By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health systems can collect, aggregate and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care.”

Oops.  Bloomberg that tells us that their data is not secure. The data was hacked. The article points out how

“Medical records are extraordinarily valuable for identity theft, as they contain all manner of personal information needed to take out credit and receive services in victims’ names. They’re most valuable, ironically, for the non-medical information they contain.”

Doesn’t it seem inevitable that despite the efforts of HIPAA more data will be compromised?  Unfortunately, our current healthcare system is obsessed with collecting a lot of data on every patient and sending it to out to several entities like the large corporate headquarter of the hospital or to an insurance company or CMS.  The data includes not only your name, birthday, social security number, address, phone number and insurance number.  It may include your credit card number.  It certainly includes many diagnostic and procedural codes that now define you to the payers and planners. Many of the codes are inaccurate.

The collection of this data is dangerous not only because it is inaccurate and can be compromised.  It is also dangerous because it takes a lot of time and effort to collect it.  Filling out the Electronic Medical Record with these codes is a high priority to your doctor and hospital and it detracts from the real work of caring for patients.

 

Irrational pricing

by timryanmd

The Washington Post has an article today describing how the price for a cholesterol panel can range from $10 to $10,000 (the average was $220.  I charge $30).  Yes, the exact same test can cost 1,000x as much at a different hospital.

The authors have no firm conclusion about why there is such a range.  One obvious conclusion is that their pricing (like the pricing in most US healthcare) is not based on the cost of providing the service or the value.  Pricing  is arbitrary and the number only means something when the hospitals misleadingly claim “charity” if it is not paid.

Distortions like this would not exist if healthcare was more like a free market.