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Illness Prevention

COVID-19 Emerging Data & Treatments

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Our politicians and scientists rely on models that predict a surge in patient volumes in our region in the third or fourth week of April. Despite news reports about reaching the so-called “plateau” in New York City, in Florida, we likely lag by a couple of weeks. We must not be lulled into complacency by a premature sense of security. This is the calm before the hurricane heading towards us. Many of us have experienced that sense of calm, during which we prepare, get supplies, fortify our homes, and hope that instead of making landfall, the storm redirects sparing us the brunt of overwhelming our healthcare system. How much that storm redirects results from the steps we are taking now to protect ourselves and to ensure our healthcare system’s ability to care for those who need it the most. We are hopeful that the anticipated surge in Florida will be lower than what was previously predicted.

STATISTICS (according to Johns Hopkins, CDC and Fl Dept of Health as of 4/10/20 8am)

  • Total confirmed cases (worldwide): 1,612,646
  • Total worldwide deaths: 96,786
  • Total confirmed cases (US): 466,299
  • Total deaths (U.S.): 16,676
  • Total confirmed cases (Florida): 16,323
  • Total deaths (Florida residents): 371
  • Total cases Sarasota/Manatee counties: 380
  • Total deaths Sarasota/Manatee counties: 21

As Dr. Caballero has pointed out, we need a validated point-of-care to expedite engaging and socializing once again. For now, continue social distancing. Just when we need each more in America, we are forced apart. Former U.S. Surgeon General Dr. Vivek Murthy states “we find ourselves with a silent but common challenge of loneliness that people are struggling with all over the country.” Take at least 15 minutes daily to talk with or write a loved one. Helping others may be as simple as a phone call. Allow others to help you as well, mindful of the social distance constraints to keep them and yourselves safe.

COVID-19 Emerging Treatments

There is hope for multiple emerging treatment possibilities for COVID-19 patients. There has been much discussion regarding hydroxychloroquine and azithromycin. Baycare health systems in the Tampa Bay area are participating in studies on remdesivir and sarilumab. Sarasota Memorial Hospital has joined studies using plasma as well as remdesivir. Dr. Caballero and I review these options daily, relying on each of our over 25 years of experience as internists as we evaluate guidelines from CDC, FDA, our professional associations and journals to remain abreast of the latest developments. We seek to treat based on science that supports proven benefits.

We are engaged in your health. Stay safe.
Jose R Santana Jr MD MPH FACP

COVID-19 Projections

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It’s my hope that this blog finds you restful.

We are familiar with projection models in Florida. We’ve all been glued to the Weather Channel starring at “spaghetti” strands representing hurricane projection models. A lot of science goes into generating those models, including measurements from the eye of the hurricane. Rarely are they right. That’s typical of projection models, whether for COVID-19 or hurricanes.

The best data right now has the mortality of COVID-19 around 1%. This puts it somewhere between the 1957 influenza pandemic 0.6% and the Pandemic of 1918 at 2%. This is about ten-fold the rate for seasonal influenza which accounts for approximately 50,000 US deaths per year; so, it’s tracking to kill 500,000 Americans. Another projection, and we know about projections.

A fundamental problem with COVID is how easily it spreads. The average infected person spreads it to 2.2 others. Mildly symptomatic and even asymptomatic people can spread this virus adding to the challenge of containment.

Fortunately, the vast majority of infected patients overcome this virus without the need for hospital-based care. There are millions of Americans who have had this and gotten over it. As antibody testing expands, we will be able to identify naturally immunized people and let them out of isolation, returning to the community and economy.

Following guidelines and stay-at-home orders is what you do for your fellow man. “Bending the curve” doesn’t reduce the area under the curve. In other words, it doesn’t reduce the number of deaths that COVID-19 will cause; effective therapy and vaccines reduce mortality. What isolation orders do is protect our community resources from being overwhelmed. When you stay at home, you’re helping Sarasota Memorial and all health care workers.

Because SMH is not overwhelmed I was able to admit a patient for non-COVID-19 reasons Saturday night, using ER resources and available hospital beds. This is the capacity that is under threat and the one we are trying to prevent in the collective.

It’s the same thing homemade masks do. THEY DO NOT PROTECT YOU. But they help reduce viral spread from asymptomatic shedding in our community. That, in turn, modulates the stress on our health-care resources.

Dr. Birx and Admiral Polowczk presented data tracking cases at the county level. Admiral Polowczk said he was using this information to move supplies to areas of need. After hearing that vendors were holding up supplies, Admiral Polowczk said vendors would be delivering to the front door based on his order. Public hospitals like ours receive top priority, then VA hospitals, then nursing homes. An agile and prudent use of supplies saves lives in pandemics and this was great news.

It is also good that vaccines studies are currently in animal safety trials. Scientists were able to sequence the entire genome of this virus and develop vaccine prospects. Factory construction has received Federal approval and funding for mass production the moment a vaccine proves safe and successful. A vaccine stops the spread of the virus and allows broad relief of public health restrictions.

Anti-viral medications are undergoing clinical trials. Anti-viral medications transformed the treatment of HIV and today millions can expect to live full lives despite infection. Several drugs are in effectiveness trials for COVID-19. They may become available within months decreasing mortality among the infected.

At long last, the President of the AMA has answered the President’s question: What you have to lose is your life unnecessarily. I exchanged e-mails with Thomas File MD MACP over the weekend. He is the President of the Infectious Disease Society of America (IDSA). He said he understood how I felt about the lack of leadership and guidance by the IDSA and said I’d be happy to know that the Society would be putting out evidence-based guidelines next week and asked that I follow up with him after they are issued. If they’re evidence-based, they will not endorse the use of hydroxychloroquine and azithromycin.

I just finished exchanging e-mails with Lindsey Baden MD. He’s leading COVID for The New England Journal of Medicine along with Dr. Eric Rubin, the editor. Lindsey was one of my professors. I pointed out my concern that no “Position Statements” had been written against the use of dangerous, unproven medications without informed consent. I drew attention to a nationally well-known hospital’s behavior.  This was not a Florida hospital.

This hospital has actually instituted a protocol for hydroxychloroquine and azithromycin to be used outside of clinical trials. In what will live as one of the most regrettable statements in the history of the institution, they report a favorable risk/benefit analysis and worse yet a good cost:benefit analysis too. They have no evidence of benefit to make an analysis. Success in the lab leads to clinical promise. Clinical promise presupposes that benefit is still to be determined. You can’t use clinical promise in a benefit analysis- by definition. This hospital’s protocol is indefensible.

Lindsey says he appreciated my points and assured me ‘comments addressing these issues are underway.’ We should see something in the NEJM shortly.

American organized medicine has been slow and stumbling, while the rank and file medical personnel are in their “finest hour” and in greatest need of leadership. Toni Morrison said times of dread are “precisely the time when artists go to work. There is no time for despair, no place for self-pity, no need for silence, no room for fear..” That’s good advice for artists, but it’s also good advice for medical leaders and frankly, all Americans.

The coming week will be hard to experience. An exponential rise in deaths will begin sweeping across the country. Please know that we need kindness now, more than ever. Help yourself, help your community, help your hospital and its workers by staying home and using up your supply of compassion and empathy. If you go out wear a mask and be kind.

Exercise caution and kindness,

Carlos

In The Midst of Coronavirus, We Thank You!

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Many of you have reached out offering different ways to help. You have provided us with personal protective equipment (PPE) which we, our families and our community appreciate immensely. Your assistance helps Carlos and Jose to continue to care for our hospitalized patients, provide home visits when necessary and perform testing in our own parking lot. Our office staff is committed to remaining as always available for you whenever you need us.

On Wednesday this week, there were 10 positive patients at Sarasota Memorial Hospital, half of those were severe enough to require intensive care. Let me repeat, 50% were critically ill. There were over 70 “persons under investigation or PUI” at the hospital as well. The number of positive cases continues to increase exponentially locally and nationally.

STATISTICS (according to Johns Hopkins and Fl Dept of Health as of 3/27/20 10 am)
• Total confirmed cases (worldwide): 553,244
• Total confirmed cases (US): 85,906
• Total deaths (U.S.): 1,307
• Total confirmed cases (Florida): 2,484
• Total deaths (Florida): 29

We continue to ask our patients to “stay home safely.” These orders have already been issued in neighboring counties including Tampa. You should connect with family and friends using technology. Leave home only for essential needs, such as groceries or medications.

We encourage you to remain active even at home. Be safe but get creative. Try to get your 30 minutes of daily exercise, which may be as simple as walking in your living room or lifting a 5 lb. bag of rice. Create safe activities adjusted for your own abilities.

In the event you do become ill, call us at Private Physician Services right away. Obtain your medical advice from us or from sources we select for you. Be wary of the many options being touted online, even those that may seem to come from health professionals. We remain up to date on any current therapeutic developments as they present on a constant basis.

Jose R. Santana Jr MD MPH FACP

Social Distancing… Avoiding Coronavirus

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Many of you have called us for guidance to protect yourselves from the virus causing COVID-19. Our nation is a week or two behind what has happened in Europe, particularly Italy. We now see the drastic steps several countries have taken. Sadly, the explosion in deaths seen demonstrates that pandemic management requires significant social distancing. While this may be uncomfortable and inconvenient, it must be widespread in order to flatten the curve so that our health care system is not overwhelmed. As physicians, we fear that any of our patients may succumb to this disease not just because of COVID-19, but due to a lack of access to proper services such as ventilators. If the healthcare system is overwhelmed because of COVID-19, there is still a need for patients who have any other medical condition, such as heart attacks, strokes, and so on.

Five states, (California, Ohio, Illinois, Massachusetts, and Washington) are reported to have closed bars and restaurants. New York City is closing movie theaters, gyms, small theater houses, restaurants, and concert venues.

We suggest that you cancel social public gatherings. Even if Florida has not closed restaurants, theaters, etc., now is the time for you to be Commander in Chief of your own health and take extreme steps by avoiding those venues. Of course, do your grocery shopping, but keep your distance. Even if one friend comes over for dinner, you are creating new opportunities for transmission. Avoid the gym. COVID-19 symptoms may take several days to manifest. A dinner guest, or someone sitting next to you at a theater or walking by you at a restaurant who looks extremely well if perfectly capable of transmitting the virus.

Take care of yourself and your loved ones. Sarasota is blessed right now with excellent weather. You can still exercise, go for a walk if able to do so, sit outside, but when possible, stay physically away from those, outside of your household. Avoid visiting nursing homes, to avoid exposing other elderly people who are the most vulnerable to complications and death from this virus. Stay in contact with loved ones via your phone and video chat.

Finally, again a reminder to frequently wash your hands for 20 seconds each time, particularly if you have gone out such as for groceries.
In the event you do become ill, call us at Private Physician Services right away, as Dr. Caballero, Dr. Santana, and our staff remains always available to guide you and provide care when you need us.

STATISTICS (according to Johns Hopkins, as of 5pm on 3/15/20}

  • Total confirmed cases (worldwide): 162,687
  • Total confirmed cases (US): 3,244
  • Total deaths (U.S.): 62
  • Total confirmed cases (Florida): 115

COVID-19 Update

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Two days ago, March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). Prior pandemics have been due to influenza, but there has never been a pandemic by a new coronavirus. There is little or no immunity in Sarasota to this disease which spreads easily from person to person. Testing has been limited so we likely only know the tip of the iceberg as far as how many people are carrying this virus. There are likely hundreds of thousands of Floridians carrying the virus. Many have mild or no symptoms. However, the elderly and those with chronic health conditions are far more likely to develop severe symptoms (fever, shortness of breath, lung damage) and even death.
Both Dr. Caballero and Dr. Santana, want every single one of our patients to take steps to protect themselves and avoid contact with this virus. We believe now is the time to avoid gatherings whenever possible. Cancel optional activities, not only of large, but even small gatherings. We realize this may not always be possible but recommend it as an effort to avoid unnecessary contacts.

Many may not even be aware of having the virus, since the symptoms may not show even if the person is contagious. Shopping for your food is necessary, but shopping for non-essential items at stores should be avoided. Other public gatherings, such as movie theaters, shows, are also of concern and may put you at risk for exposure. Absolutely avoid getting on a cruise, not only is there risk of exposure, but the additional risk of confinement to the ship.

Frequently wash your hands with soap and water for at least 20 seconds.
For your protection, we are happy to provide a phone call for routine visits instead of an office visit.

As always, call us for symptoms and we will be happy to guide you.

The Centers for Disease Control has excellent guidelines www.cdc.gov

Coronavirus Preparedness

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Coronavirus disease 2019 (COVID-19) is caused by a virus named SARS-CoV-2 which has now been detected in many locations including right here in Sarasota. The CDC believes that more cases will be identified in the United States as we see more communities spread from person to person. At Private Physician Services we will continue to provide you with excellent care taking measures to ensure your safety.

The majority of coronavirus cases (81%) are mild, but there is a serious risk of complications particularly in the elderly and those with underlying medical issues. 

Those affected may have symptoms ranging from mild to severe, resulting in death in the more severe cases.  Symptoms of fever, cough, chest congestion and shortness of breath may appear 2-14 days after exposure in someone with COVID-19. The common cold, on the other hand, often includes sneezing, stuffy and/or runny nose, sore throat, watery eyes.  If you have these symptoms, please call us so that we may guide you properly.  We can help you distinguish between the causes of these symptoms. When necessary, we can arrange for further testing such as to determine if you have the flu and need treatment.

The most important step right now is taking preventive measures for yourself and other members of your household.

  1.  Avoid close contact with people who are sick.
  2. Stay home when you are sick, except to get medical care.
  3. Cover your coughs and sneezes with a tissue.  If you do not have a tissue, use your elbow, not your hand when able to do so to cover the mouth.
  4. Frequently washing your hands with soap and water for at least 20 seconds, particularly before eating.
  5. Avoid public gatherings that are optional when possible.

High Blood Pressure, the Silent Killer… or Maybe Not-So-Silent

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So why is high blood pressure called the silent killer?

In some ways, high blood pressure has earned its’ nickname well as a “silent killer.” After all thousands of unsuspecting people become disabled or die from its consequences every year. By the time most people get symptoms of high blood pressure, such as headaches or nosebleeds just to name a couple, the blood pressure is dangerously high.  On its way there, that pressure has been damaging our kidneys, heart, brain, and other organs. Having high blood pressure puts you at risk for heart disease and stroke. The killer may be silent, but the damage caused and the lives impacted are far from that.

How does high blood pressure affect us?

According to the CDC, about 75 million United States adults (32%) have high blood pressure and just slightly over half of those (54%) have it under control.  It takes a daily toll killing what averages out to 1,100 Americans dying each day.

So what can we do about high blood pressure?

Fortunately, there is much we can each do:

  1. Lower your sodium intake (no more than 1500 mg daily)
  2. Avoid smoking and using tobacco products.
  3. Be physically active daily
  4. Eat a heart-healthy diet
  5. Keep a healthy weight
  6. Limit alcohol consumption

A good start is looking at our sodium intake.  The American Heart Association (AHA) recommends up to 1500mg of sodium for ideal cardiovascular health. 90% of Americans consume more than 1500mg (average consumption is 3400mg) and about 90% of Americans are expected to develop high blood pressure in their lifetimes. According to the AHA less sodium in the diet can help to blunt the rise in blood pressure that occurs as we age.

Most of our dietary sodium comes not from the salt-shaker, but from processed foods.  Always try to consume lower-sodium versions of any of your foods, in particular, bread, soups, and cold cuts. Select fresh or frozen poultry that hasn’t been injected with sodium (i.e. broth).

A good source for information on sodium is at www.heart.org/sodium

Resources: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm

Jose R Santana Jr MD MPH FACP

How to Protect Yourself from the Flu

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The flu once again is upon us.  Many will become ill, some will die from it.

As an internist, I have cared for flu patients every single year for over 25 years. I witnessed first-hand the weakness, aches, fever, headache and other symptoms knock so many I care about off their feet, causing them to miss work, school, family events and more. Too often loved ones are then exposed and become ill as well. According to the CDC, during 2017-18, just over a year ago, the flu broke records for deaths and illnesses, killing nearly 80,000 people. That would be a Jumbo 747 jet with 500 passengers going down every day for nearly 6 months!

Who is at highest risk of flu complications?

Pregnant women and those over the age of 65, as well as those with chronic conditions such as diabetes, asthma, and other conditions are at the highest risk of more severe flu complications. Our immune systems weaken as we age.  In the United States, people over 65 account for 70-85% of flu-related deaths. But keep in mind that over 10,000 adults aged 18-64 died last season in the United States from flu complications, along with nearly 180 children. We are all at risk, so we must take steps to protect ourselves.

How to protect ourselves and our loved ones from the flu.

Annual flu vaccination is recommended for all people ages 6 months and older unless you have a contraindication to influenza vaccine. Even if you had the flu this season, you should still get vaccinated since the vaccine contains 3-4 different influenza strains. Rarely people who get the vaccine may have mild flu-like symptoms, but they will not get the flu from the vaccine. It takes 1-2 weeks to develop immunity after the vaccine, so there are some people who may be exposed to the flu before they have immunity and become ill with the flu, but this did not come from the vaccine.

The flu vaccine is the best way to prevent the flu.  Speak to one of our physicians on how to best avoid this all too common illness.

For more information go to www.cdc.gov/flu

https://www.immunize.org/vis/flu_inactive.pdf

Author: Jose R Santana Jr MD MPH FACP

Dr Santana is a Board-Certified Internist with Private Physician Services, PLLC in Sarasota Florida.