Coronavirus Doctors

US coronavirus: As doctors worry about an ‘apocalyptic fall,’ the CDC retracts Covid-19 info – msnNOW

(CNN)As most US states head in the wrong direction with coronavirus, the Centers for Disease Control and Prevention has retracted key information about how the virus spreads.

The US is on the brink of 200,000 coronavirus deaths, with the number of new cases rising in 28 states, according to data from Johns Hopkins University.
“We may be in for a very apocalyptic fall, I’m sorry to say,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
“And it’s happening because we’re forcing schools to reopen in areas of high transmission. We’re forcing colleges to reopen, and we don’t have the leadership nationally, telling people to wear masks and to social distance and do all the things we need to do.”
Dr. Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama at Birmingham, said she agrees this fall “could be apocalyptic” after recent spikes.
“Why are we going back up? I think there are a few reasons,” Marrazzo said,
“One is that there is general fatigue. People are really tired of this,” she said. “And then the second thing is … the completely contradictory messages that we’re getting — not just the misinformation, but also the confusion about how things are spread.”
She cited a recent update from the CDC that said you can get Covid-19 just by inhaling tiny particles from an infected person’s breath that linger or travel in the air.
“There is growing evidence that droplets and airborne particles can remain suspended in the air and be breathed in by others, and travel distances beyond 6 feet,” the CDC’s website said in an update Friday. “In general, indoor environments without good ventilation increase this risk.”
Many doctors have known that for months — hence their pleas for the public to wear masks.
“The updated guidance would have been fine if it came out last May,” Hotez said. “We knew all of these things months ago.”
But by Monday afternoon, the CDC’s update was removed.
“The fact that they retracted this, even though this is common scientific knowledge at this point, one has to wonder what’s behind it,” said Dr. Leana Wen, a CNN medical analyst and an emergency physician at George Washington University.
“Was there political pressure? Political interference that’s driving this rather than science?”
The removal was not the result of political pressure, according to a federal official familiar with the situation.
“This was totally the CDC’s doing,” the official said. “It was posted by mistake. It wasn’t ready to be posted.”
The official said the guideline change was published without first being thoroughly reviewed by CDC experts.
“Somebody hit the button and shouldn’t have,” the official said.
The official added that the guidance is “getting revised,” but didn’t say when the revision would be posted to the CDC’s website.
Both the heads of the CDC and the Food and Drug Administration were appointed by President Donald Trump. And while Trump said he gives himself an “A+” on his handling of the pandemic, he has also said he “wanted to always play it down.”
When asked why the CDC retracted its update on aerosolized spread, a spokesman for the agency said it was posted in error.
“A draft version of proposed changes to these recommendations was posted in error to the agency’s official website,” CDC spokesman Jason McDonald said in an email to CNN.
“CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2 (the virus that causes COVID-19). Once this process has been completed, the update language will be posted.”

Where Covid-19 cases are rising and falling

As of Monday, 28 states had more new cases this past week compared to the previous week, according to Johns Hopkins data.
Sixteen states are holding steady, and only six states are showing declines in new cases: Delaware, Hawaii, Louisiana, Michigan, South Carolina and Vermont.
But it’s not just the raw numbers of new cases that the public should pay attention to. It’s also the test positivity rates — the percentage of tests taken that turn out to be positive.
The World Health Organization (WHO) has advised governments maintain test positivity rates at or below 5% for at least two weeks before businesses reopen.
As of Monday morning, 27 states and Puerto Rico had test positivity rates higher than that 5% threshold, according Johns Hopkins University.
On the other end of the spectrum, five states have test positivity rates lower than 1% — Maine, Vermont, Massachusetts, New Hampshire and New York.

The race for a (safe and effective) vaccine

CDC Director Dr. Robert Redfield has said a vaccine might not be available to most Americans until mid-2021.
But Moncef Slaoui, chief adviser to Operation Warp Speed, told CNBC Monday that “we are pretty close” to having a vaccine for Covid-19.
Operation Warp Speed is the federal government’s effort to speed development of drugs, vaccines and other measures to fight the coronavirus pandemic.
At least three vaccines are in Phase 3 clinical trials in the US. Slaoui said it’s possible vaccine efficacy could be determined between October and January.
“The longer we wait, the more likely,” Slaoui said.
If approval or authorization is granted by November or December, “we may be able, for instance, to immunize the most susceptible populations in the US by December of 2020,” Slaoui said.
“Most of the elderly population and first-line workers in January of 2021, and the rest of the US population progressively in the month of February, March and April,” Slaoui said.

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Doctors Russian

Russian doctors claim to have saved Kremlin critic Navalny’s life – Al Jazeera English

The doctors denied they had come under pressure from authorities while treating Navalny [Alexey Malgavko/Reuters]

The doctors denied they had come under pressure from authorities while treating Navalny [Alexey Malgavko/Reuters]

Doctors at the Siberian hospital that first treated Russian opposition politician Alexei Navalny said on Monday that they had saved his life but that they had not found traces of poison in his system.

Navalny, a longtime opponent of President Vladimir Putin, fell gravely ill on Thursday after what his allies believe was a poisoning and was airlifted to Germany for treatment on Saturday.

“We saved his life with great effort and work,” head doctor Alexander Murakhovsky told reporters at a news conference in the Siberian city of Omsk.

“If we had found some kind of poison that was somehow confirmed then it would have been a lot easier for us. It would have been a clear diagnosis, a clear condition and a well-known course of treatment,” said Anatoly Kalinichenko, a senior doctor at the hospital.

The Russian doctors did not say on Monday what specifically they had done to save Navalny’s life or what they had treated him for.

Last week, they said they had diagnosed him with a metabolic disease possibly brought on by low blood sugar.

Russian opposition politician Alexei Navalny, his wife Yulia and opposition figure Lyubov Sobol take part in a rally to mark the 5th anniversary of opposition politician Boris Nemtsov's murder

Navalny is a longtime opponent of President Vladimir Putin [File: Shamil Zhumatov/Reuters]

The doctors denied they had come under pressure from authorities while treating Navalny.

Navalny’s allies had accused doctors of holding up his medical evacuation to Germany. The doctors initially said Navalny was not in a fit state to be transported for treatment.

Jaka Bizilj, founder of Germany’s Cinema for Peace Foundation, told mass tabloid Bild over the weekend that Navalny, who is being treated in a German hospital, would survive.

He said: “Navalny will survive poison attack, but be incapacitated for months as a politician.”

But Kira Yarmysh, Navalny’s spokeswoman, said there were no new details about the politician’s condition and that only she or the doctors treating him would be able to provide reliable information.

News agencies

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Doctors Televisits

Televisits may be here to stay for doctors, patients – San Antonio Express-News

The terms telehealth, telemedicine and e-health have nuances when used legally, but for consumers, they are usually used interchangeably and refer to health care provided by a professional in a non-face-to-face manner, says Mei Wa Kwang, executive director of the Public Health Institute’s Center for Connected Health Policy in Sacramento. Options can include a phone call, email, text, video visit or even a video email.

Before mid-March, Jay Mazel, a cardiac electrophysiologist at MedStar Washington Hospital Center in Northwest Washington, never gave much thought to telemedicine. His specialty involves the treatment of heart rhythm problems. While he’s still doing emergency procedures, with enhanced safety protocols, two days a week, maintenance visits are largely by video.

“Even though it’s brand new for my patients — who tend to be older — and their doctor, they love it and so do I,” says Mazel, who does a lot of the televisits from home.

Mazel says he does think the first visit with a new patient should be in person if possible, “to help us establish rapport.” But for now, both he and his patients are happy with the information they are able to exchange during virtual appointments for uncomplicated routine follow-ups.

Nationally, telehealth visits, including for symptoms of covid-19, the disease caused by the coronavirus, are projected to climb to 1 billion by the end of 2020, according to Forrester Research. The uptick started in mid-March when state stay-at-home orders began. Partners Healthcare, for example, a Massachusetts-based health-care system that includes Massachusetts General and Brigham and Women’s hospitals, had 1,600 televisits for outpatient care in February, 89,000 in March and 242,000 in April. Jefferson Health, a health-care system in Pennsylvania and New Jersey, saw a 11-fold jump from February to end April.

Telemedicine was largely ready for the influx.

The past decade or so has been full of telehealth demonstration projects, including video visits with specialists, for people living far from academic medical centers. Several dedicated telehealth companies have sprung up, often catering to people with no insurance or high deductibles. Each telehealth company has different offerings — but a common visit such as checking symptoms for flu, generally costs under $100 per visit. The limiting factor, Kwang says, had been that most people have little or no health insurance coverage for video visits and doctors often have not been able to be reimbursed for telehealth services.

Amid the covid-19 outbreak, that has changed.

The increase in telehealth visits has been bolstered by decisions to cover them by Medicare, Medicaid and many private insurers, some of whom have even waived co-pays and deductibles for some visits, especially for ones related to covid-19 symptoms, according to information from the industry’s association, America’s Health Insurance Plans. Aetna, for example, is “offering zero co-pay telemedicine visits for any reason,” and Humana is “waiving member cost share for all telehealth services delivered by participating/in-network providers.”

Emily Shevitz, 30, of Kendall, Fla., was grateful for her first televisit in mid-March when she couldn’t get a headache under control, a chronic condition since a near-fatal car accident in 2012.

“Because of a weak immune system, I didn’t want to go to urgent care or my primary-care clinic, out of concern I could contract the virus,” she said. Shevitz accessed a telehealth visit through Baptist Hospital in Miami. “I was able to talk to an ER doctor who asked me about my medical history and prescribed . . . medication until I could see my neurologist. It was reassuring that I was able to be seen from the comfort of my own house.”

Joe Kvedar, vice president of Connected Health at Partners HealthCare and president-elect of the American Telemedicine Association, which represents the industry, recommends calling insurers to determine telehealth coverage and options. If a doctor does not offer televisits, the insurer may be able to connect the patient to a firm that does, often at no charge or a small co-pay.

Other tips include checking whether any information or forms must be signed, having an ID number or password ready if a practice requires them to connect to the visit, finding a quiet and private place for the visit, and charging the device the patient is using.

In March, the Department of Health and Human Services issued a notice that because of the covid-19 emergency, Medicare would pay doctors and hospitals for a broad range of telehealth services, including those delivered by nurse practitioners, clinical psychologists and social workers at the same rate as in-person visits.

The guidance also allows doctors to use any technology they choose to deliver care and treat patients via telehealth even if it’s not related to the virus outbreak.

For Medicaid, run by each state individually, waivers can be submitted to change to telehealth delivery. In Colorado, the state has added telephone and live chat visits to video visits that were already allowed.

“If Medicaid continues to allow these visits, as we hope, after the emergency is over, many of my patients can access care without the need to travel or take time from work,” said Kyle Knierim, a family physician in Colorado and associate director of Practice Transformation in the Department of Family Medicine at the University of Colorado School of Medicine.

Telehealth, however, hasn’t been, and can’t be, a replacement for every health visit.

An April 23 study, published by the Commonwealth Fund, analyzed data on changes in visit volume for more than 50,000 health-care providers and found that the number of visits to physician offices declined nearly 60 percent in mid-March from Feb. 1 and has remained low through mid-April. Telehealth accounted for only 30 percent of visits that were still happening, but it did not make up for the much larger decline in visits.

For the week of April 5, for example, ophthalmology saw the biggest drop in in-person visits, a loss of 79 percent. Behavioral health was least affected, but still saw a drop of 30 percent. Alarmingly, pediatric in-person visits saw a drop of more than 60 percent.

“Telemedicine volume has grown too modestly to make up for lost in-person visits,” said Eric Schneider, senior vice president for policy and research at the Commonwealth Fund. He says that in-person visits will still be needed for diagnosis and testing of some complex conditions.

“It really is important to be very aware of the limitations,” says Anthony E. Magit, a pediatric otolaryngologist and chief of physician integration at Rady Children’s Hospital in San Diego, where telehealth visits have jumped from just a few before the pandemic to as many as 800 per day recently.

Those limitations include brief visits that focus on a single issue and may not include questions that lead to other health concerns as often happens during in-person visits, lack of privacy for some patients and lack of certain tools sometimes used in visits, such as smartphone cameras that allow doctors to see throats and ears, and pulse oximeters or blood pressure monitors that give doctors critical patient data.

“We don’t want to create a solution that makes the situation for underserved individuals worse,” Magit said. “It’s our responsibility to advocate through legislators and payers to make sure that the divide doesn’t get wider because of telemedicine.”

In a report published May 11, researchers at the Kaiser Family Foundation said that “service parity and payment parity for telehealth across all insurers would help increase access for patients.”

Once the Centers for Medicare and Medicaid Services released the new rules on telemedicine visits in March, the American Medical Association and other medical societies such as the American Academy of Pediatrics and the American College of Obstetrics and Gynecologists kicked into high gear to advise their members on the rules and telehealth best practices. Wide use of telemedicine is so new that the AMA released a primer in March.

The AAP, for example, has posted clinical suggestions on its website including “consider[ing] . . . adjustments to . . . clinical operations [such as] only conduct[ing] well [in person] visits for newborns, and for infants and younger children who require immunizations and to reschedule well visits for those in middle childhood and adolescence to a later date.”

The same is true for patients who need urgent follow-up testing. But if recent screening exams, such as a mammogram, were normal, physicians are likely to wait for the outbreak to abate in their communities before recommending additional testing, said Mark B. Woodland, OB/GYN chair at Reading Hospital/Tower Health and Drexel University College of Medicine and the chair of the Council on Resident Education for the American College of Obstetrics and Gynecologists.

Analysts and doctors do not expect the “genie of telemedicine to be put back into the bottle” once the crisis ends, Woodland said.

“The silver lining is that we will learn how to do it well, and our patients will help us learn how to do it even better.”

Schneider said he expects that even once the pandemic ends, physicians will probably create “hybrid practices” that mix telemedicine and office visits.

Therapydia DC, a physical therapy practice in Northwest Washington, had offered only telehealth visits since mid-March but expects to offer both televisits and office visits — once the city begins to allow offices to reopen.

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Doctors parents

Doctors warn parents to look out for symptoms of rare, mystery illness in kids that could be linked to coronavirus – KPRC Click2Houston

So far, about 85 children around the country are believed to have this illness

HOUSTON – Some children in the US are getting sick from a mysterious illness believed to be related to COVID-19 and officials want parents around the country to be aware. While Pediatric Multi-System Inflammatory Syndrome is rare, doctors and researchers are on an urgent search for answers.

“It’s possible that these cases were coming in and not diagnosed as related to COVID because they don’t appear as COVID-19,” said New York Governor Andrew Cuomo in a press conference.

Cuomo announced the state is investigating two more deaths after three children were already confirmed to have died from the rare sickness.

Symptoms of this rare illness

Doctors are alerting the public to a range of symptoms to look out for.

“If they have a child with a fever for more than three days and have these abdominal symptoms of vomiting, diarrhea, severe belly pain, that would be the time to call your pediatrician,” said Dr. James Schneider, Chief of Pediatric Critical Care at Cohen Children’s Medical Center.

The symptoms are mirroring more commonly-known inflammatory illnesses like Kawasaki Disease and toxic shock syndrome. Other states have reported similar illnesses.

Other cases of this rare illness include four patients at Boston Children’s Hospital, an estimated five to 10 at Children’s Hospital of Philadelphia, three at Children’s Hospital Los Angeles, three at Nemours Children’s Health System in Delaware, three at Ochsner Medical Center in Louisiana and one at Seattle Children’s Hospital, according to a report by NBC News.

Children’s National Hospital in Washington, D.C., has also reported two patients, but it has 15 more children in intensive care with some kind of massive inflammatory response to COVID-19. It’s unclear whether all of those patients indeed have the pediatric multisystem inflammatory syndrome.

“It may be possible and it may be probable that this is a problem that exists in other states and we want to make sure that they are aware of it,” Cuomo said.

Illness might develop later

The newly identified syndrome appears to be the result of a child’s immune system going into overdrive after a COVID-19 infection. Experts know this can develop up to six weeks after the coronavirus infection even if children who did not know they had COVID-19. We learned last week that some COVID-19 patients were left with heart damage, including some kids.

It’s important to remember, this is very rare and most kids do recover. Doctors say there is no way to know which kids are at risk.

Copyright 2020 by KPRC Click2Houston – All rights reserved.

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