Hello everyone!
I’d like to thank you all for so many appreciations and positive responses to the letters I’ve been sending out since the Covid-19 virus, the Coronavirus, came into and changed our world.
The feedback has been very positive which I really appreciate, because I’ve been trying to present some realistic perspective, in the midst of so much created bone-chilling fear.
This is now a very difficult time we live in, and for so many different and multi-layered reasons, much of which is also now political!
Some of what I’d like to say may be somewhat politically incorrect, but I would like to try to continue with a realistic and personal perspective.
I’m a doctor and a cardiologist, and this is how I see it:
I checked the CDC website, and asked what the death rate is in the United States over the past 10 years. You can all check it out. The range is about 2,800,000 people dying per year in the United States. (Always less than 3 million.) I’ve mentioned this before in a previous letter, but the number one cause of death is cardiovascular disease at about 850,000, followed by strokes, (which is also mostly an atherosclerotic, arterial disease). Then, followed by cancer, unexpected deaths, (usually tragedies: murder, car accidents, other accidents, suicides, drug deaths) pneumonia, infectious disease, flu, and “others”!
I’ve also previously presented some information on annual flu season, with the millions of people who get it (DESPITE THE FLU VACCINE!), get hospitalized, and the range of 30,000 to 65,000 who die annually from this viral contagion! Viruses continue to mutate so every flu season is a mutation of a previous influenza virus.
Despite this, no one has previously ceased flying in airplanes (whereby we inevitably get sick from all the sneezing and coughing of those next to us and behind us), and no countermeasures have ever been put in place, EVER, to mitigate behavior during flu season.
This has now been described as a Pandemic, something that we have not apparently faced before, but why? We had the Spanish flu in 1918, with 60 to 80 million further deaths added upon the ravages of WW1, the Asian flu in the 1950’s, Polio, all of which were quite vicious, and obviously over the years, other viral illnesses that have caused great degrees of suffering.
This virus, was possibly leaked out from a lab in Wuhan, China (you should all know the stories around this), and then manipulated by the Chinese government to keep it hidden, to “lockdown“ travel in China, and to allow up to 500,000 people to travel world- wide.
It appears to be highly contagious, but with quite a low level of high degree illness and death, despite the fear and terror brought upon us by the media.
Yes, many older people have died, in nursing homes, and as well, with chronic morbid illness: over the age of 65, (I’m older than that!) having obesity, diabetes, hypertension, cardiovascular disease, pulmonary disease, and other organ system diseases.
This is indeed a calamity, with so many getting sick and dying, and certainly with so many dying, the sadness is overwhelming to family and friends. Almost always!...
But here’s the hurtful thing: Dying is where we all end up!
We’re only here for a small moment of time, for many it’s never enough, but it is what it is. Many die too young, some die maybe at the right time, (which is never the right time), and some live too long!
I’m sorry to say this, but it’s true!
And yes, there are the outliers, the young, the otherwise healthy, who get stricken and succumb in the most sad and unexplainable ways. (You still have to wake up every morning being lucky, because it’s the random chance of life!)
I’m going to try and address some perspective here based on a personal story:
My Mother, Henrietta died last year. She was 96 years old and she had a wonderful, complete, and fulfilling life. She was loved and admired by many, and she was a leader in her community. She was self-sufficient and terrific up to 94. She then had a stroke, she survived, but she then spent the next year and a half diminishing, waking up every morning regretting that she was waking up. She lost her thought processing, (I could no longer speak to her on the phone), she became bed ridden, and she required 24/7 care. If she had a catastrophic event, such as a cardiac arrest, a pneumonia, another stroke, anything that would have taken her, she and the family all agreed that she would die naturally: No Code, no heroic measures, no ventilator, no prolonging her life. Thus, if she got the flu, or if she got the Covid Virus, and if she died from that, then that would have been ok. Most certainly for her! There comes a time for all of us when your time is up! And more often than not, it’s nothing that any of us are in control of.
Certainly sensitivity, correct behavior, well thought out protocols, decency, practicing good medicine and nursing, should always be present...But when a vicious virus is attacking our biological selves, and the death rates are higher in the elderly and the ill, then perhaps there’s something to be said about the “natural way of things”.
I previously wrote that our experience of “modern medicine” is about 75 years old! Consider the invention of insulin in the 1920’s, and antibiotics (Penicillin) around World War 2). With the unfolding of “modern medicine” there is so much that we can address, take care of, manage, and sometimes cure, so there is a perception that everything must be done, and when the outcome is unsuccessful, and leads to death, all too often, it is someone’s fault! Sometimes that’s true, but way more often, it is the natural end of a life despite everyone’s very good efforts.
A word about public health: I’ve been very impressed by the Presidential Task Force, and the people on it. They were all dealing with an unknown situation! Look how easy it is to be the arm chair quarterback on Monday morning and find endless criticism as to when and how this was all done wrong. They, including the President, and the Vice-President, and all those participating, have been utterly tireless, not sleeping, presenting information and trying to soothe the public spirit the best they can, and in the face of endless rudeness, criticism and rancor from so many in the media. This was a new thing, and no one even now really knows where it’s going!
All the doctors I know went through medical school, further training, specialization in the medical and surgical fields, and we all take care of people with many, many health problems. Most are practitioners, and many also went into academic medicine, doing basic, and clinical research, writing papers, teaching, etc.
Then there are those who went into public health from various clinical backgrounds, and I must say it’s a different discipline!
Dr. Fauci is getting a lot of heat now, particularly as things are moving so slowly to get back to an acceptable “Normal” I do think he tends to Speculate and Prognosticate more than he should. The job in public health is to create models and trajectories of disease infiltration. The job is to create the “worst case scenario” particularly when you’re working for the President of the United States: because the worst case scenario is a possible outcome, And the Administration needs to plan for that... and no one knows what will really happen until it’s happened!
This is an intellectual discipline about public health policies, behavior, population control, bureaucratic rules, and the input of control and authority: so we’re seeing it blend into various forms of political authoritarianism!
The longer it goes on, the worse it gets, and we are suffering through a huge collapse of our and the world economies. Two months ago, we had the best employment and the best economy in our country’s history, and now we have the worst since and including the Great Depression of the 1930’s.
I think that our leaders, our writers, our pundits and commentators are lacking the imagination to really articulate how horrible and tragic this is. This circumstance may lead to human destruction and death perhaps more that the virus! The Depression created utter human misery: People starving, the breakdown of law and respect for our institutions (already going on), families being torn apart: parents had to give their children away (go watch the excellent movie, Seabiscuit again!)
Which leads to this:
This is a war with an invisible enemy, which has been the analogy already articulated by the President.
It may not be a geo-political war yet, but this has been a viral attack which has changed our world, with loss of work, identity, health, life, money, school, sports, culture, and everything that we accepted as being normal in our lives
The media and certain politicians are continuing to foment fear. Yet the original advisements still hold: allow for appropriate social separation, stay home if you’re sick with a fever, a cough, a cold, etc. Wear an appropriate mask in the appropriate situations! Wash your hands over and over! And be respectful to others!
We must not cave in to fear, and paralysis. We must look the monster in the eye, and fight back with our good common sense, our need to Make A Living, Support Our Families, Nurture Our Children, and Help Our Elders!
The three-phase opening brought forth by the Task Force is rational and well thought out, and some politicians are proceeding with it, while others are holding back and continuing with rules to continue to control human behavior. There must be a process of moving forward! Europe is doing it, some states are doing it, some regions in some states are doing it. WE MUST PROCEED! We must not let our economy, our culture, our world, our well- being collapse because of this. We must be brave and have the commitment that we will not be defeated; WE MUST AND WE WILL PREVAIL!
Because at the end of the day, we will come to an end! And what we take with us, is hopefully the realization that we did our best!
I wanted to say something about Dr. Fauci’s comments yesterday. Yes he is a brilliant scientist and as well a great infectious disease epidemiologist.
His words yesterday were jarring: that we would see millions of cases of patients with Coronavirus and the surge would see between 100,000 to 275,000 deaths!
REALLY!!
Some of you may know that after my cardiology fellowship training at the University of Toronto, I became a Lown Fellow at Harvard School of Public Health. My mentor was Dr. Bernard Lown, who was also renowned as a great scientist, and also a great clinician. If some of you think that I do a good job as a clinician and in “taking care of people”, I learned most of those skills from him.
He said something once that got my attention:
“WATCH OUT FOR THE GREAT PROGNOSTICATOR!”
That means, watch out what you say to patients about their future!
You can heal and you can hurt, and the words, though often based on experience, are nonetheless, “SPECULATIVE”.
In Cardiology, we’re really good at it:
“You’re next heart beat may be your last one!”
“You’re a walking time bomb!”
“You have the ‘widow maker’!”
“Most of your heart is dead!”
“Your heart virtually exploded!”
I’ve heard it all!
There are times I have said the wrong thing to a patient and I kick myself afterwards!
From my teaching I have always tried to teach patients about their problems, and to try and create optimism and educational choice making.
In Medicine, words can “hex” and damage, or they can be used as tools for healing!
The old adage stands true:
“Hope for the best”, “Plan for the worst”.
I’d like to say, as a humble clinical cardiologist who does his best to “take care of people”, that perhaps Dr. Fauci was planning for the worst! We don’t yet know how many millions of people will get this contagious virus, and currently we know that the mortality in the US is less than 1.5 %, but to state on an interview with CNN that there could be between 100,000 to 275,000 deaths is a speculative statement that only sows more fear.
Again, try to hold on to “PERSPECTIVE”!
Subject: Virus
We wanted to keep people up to date the best we can.
Vicky and I attended a virtual “Town Hall” meeting on Thursday evening for the medical staff of Hoag Hospital, with our chief infection control physician giving us the following information:
As of Wednesday, March 18th, there were 42 cases of Coronavirus in Orange County.
There were 2 patients at Hoag Irvine, and 2 patients at Hoag Newport.
It is a droplet disease, not an airborne disease. Thus, it can be transmitted in close proximity with coughing, and sneezing and picked up through the mouth, the nose, and the eyes. Though it is not an airborne disease, it could be if nebulizers are used.
It is actually a “delicate virus” and the “Crowned cap” can be disrupted with soap and water, and liquid sanitizers.
If a person is completely asymptomatic it is unlikely to spread , again, because it is not an airborne virus. You have to have symptoms of coughing, sneezing, and runny nose to propel the droplets.
The incubation period is about 5 days with a range from 2 to 14 days.
85% of people contacting the virus will have minimal to mild illness like the common cold, or perhaps a mild “Flu”.
Those who are at higher risk, are older people, (They say older than 65, which seems too young to me!). Others at increased risk are those with diabetes, smokers, COPD, bronchitis, (and other lung diseases), and heart disease. (In this case, this does not necessarily imply those who have coronary disease with successful stenting or bypass surgery with normal heart function. It implies more, those with weak hearts, congestive heart failure, serious valve issues.) Also at risk are people who are immunosuppressed , either with autoimmune disease, cancer, transplants , and the presence of immunosuppressive medication; increase in various co-morbidities, which includes the above, as well as significant obesity and poor physical conditioning.
The usual scenario is that if you start getting symptoms and feeling sick, it will last up to a week with a cold like illness, possibly a fever, sore throat, muscle aches, a non productive cough, like the flu. As mentioned, for 85% of people it will resolve at that point.
Sicker people will go on to get shortness of breath, particularly with activity such as walking and stair climbing. Further cough! More weakness. A CBC ( complete blood count) will show a low white count. A chest X-ray may show infiltrates in both lungs, with the development of pneumonia.
If you’re well enough to stay at home and self treat, then STAY HOME! BUT do not be alone. If you are in distress go the the nearest hospital ER.
If you feel you need testing, it needs to be authorized by your physician. In fact there is a specific form that needs to be filled out. No one gets tested if there are no symptoms. If you are to be tested do not go to the hospital. The hospitals will be quickly overwhelmed in that case. For the local folks, go to Hoag Urgent Care in Tustin Ranch or Sand Canyon, or any of the other recommended locations. (You’ll need to find out your own locations if you are part of another hospital system).
Once again, IT IS NOT RECOMMENDED TO STOP your blood pressure meds, specifically the ACE inhibitors (prinivil, lisinopril, ramipril, enalapril, etc.) and the ARB’s (losartan, valsartan, olmesartan, telmisartan, irbesartan, etc.)
There are several old and new therapies that are being assessed, which many of you have seen in social media.
Don’t forget, this phenomenon is only 3 months old!
You can go to the CDC website, or “Coronavirus.gov”
These are unprecedented times and we are all in this together and we all have to continue daily living as “normally” as we can. Please try to avoid the media outlets. They just add fuel to the fire and so much is “false fuel”!
Sent from my iPad
CORONAVIRUS.GOV
Coronavirus Disease 2019 (COVID-19)
Subject: Virus
We wanted to keep people up to date the best we can.
Vicky and I attended a virtual “Town Hall” meeting on Thursday evening for the medical staff of Hoag Hospital, with our chief infection control physician giving us the following information:
As of Wednesday, March 18th, there were 42 cases of Coronavirus in Orange County.
There were 2 patients at Hoag Irvine, and 2 patients at Hoag Newport.
It is a droplet disease, not an airborne disease. Thus, it can be transmitted in close proximity with coughing, and sneezing and picked up through the mouth, the nose, and the eyes. Though it is not an airborne disease, it could be if nebulizers are used.
It is actually a “delicate virus” and the “Crowned cap” can be disrupted with soap and water, and liquid sanitizers.
If a person is completely asymptomatic it is unlikely to spread , again, because it is not an airborne virus. You have to have symptoms of coughing, sneezing, and runny nose to propel the droplets.
The incubation period is about 5 days with a range from 2 to 14 days.
85% of people contacting the virus will have minimal to mild illness like the common cold, or perhaps a mild “Flu”.
Those who are at higher risk, are older people, (They say older than 65, which seems too young to me!). Others at increased risk are those with diabetes, smokers, COPD, bronchitis, (and other lung diseases), and heart disease. (In this case, this does not necessarily imply those who have coronary disease with successful stenting or bypass surgery with normal heart function. It implies more, those with weak hearts, congestive heart failure, serious valve issues.) Also at risk are people who are immunosuppressed , either with autoimmune disease, cancer, transplants , and the presence of immunosuppressive medication; increase in various co-morbidities, which includes the above, as well as significant obesity and poor physical conditioning.
The usual scenario is that if you start getting symptoms and feeling sick, it will last up to a week with a cold like illness, possibly a fever, sore throat, muscle aches, a non productive cough, like the flu. As mentioned, for 85% of people it will resolve at that point.
Sicker people will go on to get shortness of breath, particularly with activity such as walking and stair climbing. Further cough! More weakness. A CBC ( complete blood count) will show a low white count. A chest X-ray may show infiltrates in both lungs, with the development of pneumonia.
If you’re well enough to stay at home and self treat, then STAY HOME! BUT do not be alone. If you are in distress go the the nearest hospital ER.
If you feel you need testing, it needs to be authorized by your physician. In fact there is a specific form that needs to be filled out. No one gets tested if there are no symptoms. If you are to be tested do not go to the hospital. The hospitals will be quickly overwhelmed in that case. For the local folks, go to Hoag Urgent Care in Tustin Ranch or Sand Canyon, or any of the other recommended locations. (You’ll need to find out your own locations if you are part of another hospital system).
Once again, IT IS NOT RECOMMENDED TO STOP your blood pressure meds, specifically the ACE inhibitors (prinivil, lisinopril, ramipril, enalapril, etc.) and the ARB’s (losartan, valsartan, olmesartan, telmisartan, irbesartan, etc.)
There are several old and new therapies that are being assessed, which many of you have seen in social media.
Don’t forget, this phenomenon is only 3 months old!
You can go to the CDC website, or “Coronavirus.gov”
These are unprecedented times and we are all in this together and we all have to continue daily living as “normally” as we can. Please try to avoid the media outlets. They just add fuel to the fire and so much is “false fuel”!
Sent from my iPad
CORONAVIRUS.GOV
Coronavirus Disease 2019 (COVID-19)
I’m finding it distressing that the media outlets are showing the “daily counts” every moment of the day!
Worldwide and US daily numbers of new cases of Coronavirus and daily death counts! ...And, the percentage increases daily!
THIS CREATES NOTHING BUT FEAR!
If only they would post next to this information the US year to date influenza rates, the total number of cases (greater than 20,000,000),the number of hospitalizations, (greater than 500,000), the number of deaths (greater than 20,000).
Perhaps this would help create perspective.
To try and help create further perspective, the 2019 death rate in the US from all of heart disease was about 840,000. Of these, about 366,000 were from Sudden Cardiac Death. There were about 750,000 myocardial infarctions (heart attacks) in the US last year. Of these, about 400,000 die from the heart attack and from heart failure. There were also over 140,000 deaths from stroke.
We are biological and we’re on the planet for only a limited period of time.
I just spoke with a close friend who is a physician and both he and his wife tested positive for the Coronavirus and they have been quarantined at home the past 2 weeks. They both had a sore throat, fever, mild flu-like illness, and they are getting better.
We should all be respectful of this illness, and I hope that this information provides some perspective and helps lessen “The Fear Count!”
By popular demand, we have added and extended our office hours to better accommodate our patients! Check www.chesniehearthealth.com for new schedule!
