I spent the entire month of February 2020 in a state of silent panic.
Watching Europe + US outbreaks play out, I knew something terrible was coming. But few of my colleagues shared the depth of my fear.
It feels like this again. And I think the public still has no idea.
Just. look. at. this. graph.
Did late March feel terrible and apocalyptic? We are FAR past that point right now.
And guess what? We have not yet reached the BUSIEST HOLIDAY TRAVEL WEEK OF THE YEAR
My patients are asking me about travel plans. They have no idea what is coming https://t.co/klskKjmP49
The problems of post-COVID-19 syndrome are not getting enough attention. I am seeing patients every single session with persistent fatigue, generalized weakness and other weird symptoms like partial anosmia.
There's nothing to offer them, even the barest thread of information
This is really, really, really, really bad. Tell your loved ones, your patients. STAY HOME. Be the MOST cautious you have ever been in 2020.
If you follow me you know that I am not prone to hyperbole. I hope I'm wrong and being alarmist. But I don't think so.
/fin (for now)
@HarvardChanSPH Because there is no clear guidance, I am confident that at least tens of millions of Americans will travel for Thanksgiving. During the worst peak of COVID-19 in history. With many states' hospital systems already overwhelmed.
December will be a very dark time.
@HarvardChanSPH A vaccine distributed in April or May will not help us now. We need UNCEASING and CONSISTENT messaging for people to STAY HOME and wear masks or else nothing will change.
Some say that high COVID-19 case counts are from testing. But this does not explain what is happening.
Hospitalization counts are at or approaching their highest level EVER in the US across many states and we have just entered the exponential growth part of the infection curve.
This is not a drill. This is a profound crisis approaching.
And the most vulnerable will suffer most https://t.co/qFqPzc3YK5
@HarvardChanSPH Of the many many failures of US govt in the pandemic, total lack of consistent public messaging might be the worst
The CDC, White House, local public health depts. issue conflicting, changing and confusing messages daily.
People simply do not know what behavior change to follow
There are reports in Boston that pharmacies are seeing a spike of hydroxychloroquine prescriptions by physicians for themselves or their families 😬
Just a reminder that this is not only deeply unethical and but also quite harmful if it doesn't work twitter.com/JeffreyLowMD/s…..
VERY big telehealth news
Medicare is now covering telehealth:
1) For any patient (not just rural)
2) Equal payment to standard office visits
3) In any setting (mobile phone, home etc)
4) No requirement to have seen patient in-person first
And how can I blame them? Even *I* am uncertain about how to best counsel them.
Honestly guys ... as a PCP my best source of COVID-19 guidance is #epitwitter and #medtwitter.
If this is how I feel, as a PCP and a professor at @HarvardChanSPH then I fear for our country.
Remember nursing homes? The where 5% of the population has been decimated by COVID-19? Things have never gotten better there. And they are about to enter the most perilous threat of their existence.
A very grim milestone: the US has reached 100,000 deaths in nursing homes from COVID-19
That is **7.7%** of all nursing home residents nationally. 1 in 13
Things have never really gotten better. Testing is a struggle, PPE and staff are daily challenges.
I didn't think this was allowed guys https://t.co/mlJFH07l1k
@JAMA_current If even a small fraction of the millions of cases in the US result in a chronic fatigue-like syndrome, that's hundreds of thousands of Americans with a new, miserable chronic illness.
Who knows how this will shake out - data is thin and I am extrapolating a lot. But I'm worried.
This is a wild correction.
The authors discovered that the treatment and control groups were flipped during the analysis so what looked like an effective intervention for COPD transitions of care actually harmed patients
kudos to the authors for finding and owning this twitter.com/JAMA_current/s…..
It's not often that I can publish a very positive policy story but I think I have one to share with you all
New research out this week @Health_Affairs
We looked at what happened after NPs and PAs became eligible to apply for buprenorphine waivers in 2017 https://t.co/JyVl9WUWAO
I will say one thing about that recent editorial medtwitter is buzzing about
If you are going to scoff at primary care and “population health” as emblematic of what’s wrong in medicine, you are saying that you only care about patients who can make it to your office.
🚨 New in @JAMA_current 🚨
"Secret shopper" survey of 368 residential addiction programs for opioid use
Fewer than 1/3rd offered maintenance treatment with buprenorphine while over 1 in 5 actively discouraged buprenorphine use
Brief primary care rant.
It's 2021. We have developed an effective vaccine for a novel virus in months and we can land a probe on a comet.
There is major cognitive dissonance with our potential as a society vs. the every day struggle to provide basic care for common conditions
Let's combine this with an extremely optimistic interpretation of the report on persistent COVID-19 symptoms from Italy in @JAMA_current
At a mean follow up of 60 days (n = 179), 53% of patients still had fatigue and 44% still had worse quality of life.
The implications of a prolonged post-COVID-19 syndrome are really staggering.
There are 3.9 million confirmed Covid cases in the US - and we know that is only a fraction of total cases. Let's say we have 6 million total cases.
I propose that toddlers get Covid-19 serology tests first. Then we have Covid IgG+ preschools while we sort everything else out. Please.
CMS continues to slash regulations at a breakneck pace with a new announcement
1) telemedicine visits can be AUDIO ONLY
2) telemedicine will count as “face to face” for ordering home health, etc
3) “virtual check ins” for new or established patients
Something I don’t hear enough about for outpatient docs:
I just finished a conference call with a psychiatrist, gastroenterologist, hematologist and social worker for the same complex patient of mine.
I coordinated the call.