Posted in economy, Health, news, Politics

Did COVID Flip? More Young People Reporting Severe COVID Symptoms

The SARS-CoV-2 virus has not gone away as hoped and is now ravaging young adult communities.

What once was considered a “65 and older” disease, more and more young adults are reporting symptoms of severe COVID.

These include shortness of breath, fever, chest pain, body aches, cough, headache and fatigue.

Additional symptoms include nasal congestion, sore throat, loss of taste and smell, nausea, vomiting, diarrhea and rash.

As businesses struggle to remain open during the pandemic due to social distancing guidelines, employee call-outs due to illness add to the strain of staffing these businesses, thus heightening risk of closure.

In Arizona, Governor Doug Ducey ordered the closure of bars and nightclubs for 30 days as their state has seen the highest uptick in cases in the 20-44 year old age group.

In Nevada, the Department of Health and Human Services show younger individual age groups to be more affected than those over 60 years old.

In the last 7 days, those in the 20-44 year age group saw the most prominent spikes.

Image from Southern Nevada Health District

Why are younger adults more affected?

  1. Firstly, many older individuals might have been exposed and infected during the first wave such that the proportions have changed now that more younger people are testing.

2. More testing is being required by employers, hence non-retired workers, who may comprise the younger population, are coming forward to get tested.

3. The virus might have mutated. Some believe it weakened, but in a sense it might have strengthened to overcome a younger, more healthy immune system.

4. Younger individuals who engaged in vaping, tobacco or marijuana use might have become a more susceptible population for a new strain of COVID.

5. Younger adults might have been more social during reopenings or taken part in mass gatherings, protests and demonstrations thereby exposing themselves more than the older, stay at home, population.

The moral: This virus is unpredictable, may mutate, and will infect various population groups leaving younger individuals just as vulnerable as older ones. Don’t let your guard down, wash your hands, keep safe distances away from others, keep up good nutrition and sleep, and seek medical care and/or testing if you feel ill.

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in Health, news, Politics

Should We Be Rethinking Our Hand Sanitizer Use?

Last decade, we were warned by health experts that our obsession with hand sanitizer could threaten our existence as our use of antimicrobial gels could spur the growth of “superbugs”. Now our use appears to have jumped exponentially as a result of COVID and reopening guidelines urging “hand sanitizing” stations to be readily available.

3 Die, More Injured Due To Hand Sanitizer Methanol Poisoning in New Mexico

Although proper hand washing has been urged by most health officials to help fight the spread of disease, hand sanitizers provide a convenient and quick way to “wash up” and appear to be more popular than the tedious trip to the bathroom. Hand sanitizer may have anywhere from 60-95% alcohol base, which is toxic to many pathogens. Ethanol can be an effective toxin to viruses and isopropyl alcohol is also very effective at killing bacteria. But are they the safest, wisest choice in hand hygiene?

Although hand sanitizers may be considered heroes to some, others have criticized them for the following:

They can give rise to “superbugs”

A superbug is a pathogen, most commonly bacteria, that can survive antibiotics that most species would buckle under.  Its resistance could be caused by a variety of factors.  Maybe it has a mutation that makes it stronger.  Maybe its genetic material shields it from the toxic medicine.  Maybe it’s luck.  So shortly after it celebrates surviving the antibiotic assault, it divides to reproduce, making more bacteria.  If this progeny bacteria maintain the same genetic material as its parent, or if included, mutation, they can be now be resistant to the antibiotics as well.

_68481070_c0131441-e._coli_bacterium,_tem-spl.jpg
DRUG RESISTANT E. COLI – IMAGE FROM BBC

A study published in Science Tranlsational Medicine in 2018 found a multi-drug resistant strain of the bacteria, Enterococcus faecium, to be resistant to hospital grade hand sanitizers as as well.

The same can hold true with viral pathogens and fungi.

According to the CDC: Each year in the United States, at least 2.8 million people become infected with bacteria that are resistant to antibiotics and at least 35,000 people die each year as a direct result of these infections.

Some brands may cause methanol poisoning

The FDA released a warning to consumers to avoid the following brands of hand sanitizer manufactured by Eskbiochem SA de CV in Mexico, as they may contain methanol instead of ethanol and can therefore cause methanol poisoning. These include:

  • All-Clean Hand Sanitizer (NDC: 74589-002-01)
  • Esk Biochem Hand Sanitizer (NDC: 74589-007-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-008-04)
  • Lavar 70 Gel Hand Sanitizer (NDC: 74589-006-01)
  • The Good Gel Antibacterial Gel Hand Sanitizer (NDC: 74589-010-10)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-005-03)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-009-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-003-01)
  • Saniderm Advanced Hand Sanitizer (NDC: 74589-001-01)

Signs of methanol poisoning may include:

  • headache
  • blurred vision
  • nausea
  • vomiting
  • dizziness
  • drowsiness
  • confusion
  • seizures
  • nerve damage
  • coma
  • death

The bottles of “sanitizer” one comes across may have contaminants or undisclosed products

When the COVID pandemic began, consumers flocked to stores to purchase hand sanitizer and supplies ran out almost immediately. The WHO offered instructions on DIY hand sanitizer. Slowly supply is coming back but at a steep price for businesses trying to reopen.

So for those businesses eager to open up and needing ample supply of sanitizer, they may be utilizing DIY recipes.

Many business establishments have generic containers offering “hand sanitizer” that reportedly leave a smell of vodka or tequila once applied.

Reports on social media are fueling speculation that some large businesses are using alcohol to create enough supply to meet the sanitizing demands of their customers.

Name brand bottles could also be reused as many companies create their own. Hence if there is no regulation of the product and its efficacy, concerns rise as to how protective the product is.

Frequent hand sanitizer use may cause severe skin conditions

Alcohol is a desiccant, which means it dehydrates, or dries. For those of us with delicate skin or conditions such as eczema, judicious hand sanitizer use can cause painful flare ups.

Dry, cracked skin can cause a breakdown in the barrier that the skin provides, hence infection can ensue. Yep hand sanitizer designed to prevent infection can put dry skin at risk for infection.

Chemicals within some hand sanitizers could pose health risks

Fragrances or products within hand sanitizers could cause allergies or disruption in one’s metabolism. Triclosan, for example, although not used in most products today, has been known to affect thyroid hormone levels.

Many apply hand sanitizer incorrectly

For those who choose to swap hand swashing with soap and water for a couple quick pumps of hand sanitizer, they may be missing out on some good cleansing.

The World Health Organization recommends the following steps to be taken when using hand sanitizer:

  1. Fill entire palm with hand sanitizer
  2. Rub both palms together
  3. Put right hand over left and interlace fingers
  4. Put left hand over right and interlace fingers
  5. Interlock fingers to get under the nails
  6. Rotation rubbing to clean the thumb
  7. Hands are clean once alcohol has dried
fig02

The process takes about 30 seconds.  However, in a study released last year, researchers from the University Hospital Basel found that if all steps were taken but performed in 15 seconds, the same results will be obtained.  However, if fewer steps were taken, more bacteria/viruses/pathogens would remain on the hands.

Hence if someone avoided an effective means to clean one’s hands such as hand-washing with soap and water for slip shot sanitizing they could be doing themselves and others a disservice.

There’s no doubt it’s going to take some heavy weapons to fight COVID-19….we just need to make sure the treatment is not worse than the disease itself.

Great Gift!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is a Board Certified Family Physician

Posted in coronavirus, Covid-19, Health, news

Shoes Can Spread Coronavirus, and May Move 13 Feet Through Air

A recent study in Emerging Infectious Diseases, found SARS-CoV-2 to be easily spread by the shoes of health care workers.  Moreover they found the virus to travel up to 4 meters/13.1 feet between patients.

HERO_coronavirus

Study authors collected samples from floors, computer mice, trash cans, and sickbed handrails, and found evidence of contamination, moreso in ICU wards than general wards (GW).  50% of the shoes tested positive for the virus, and authors state, “the highest rates were for computer mice (ICU 6/8, 75%; GW 1/5, 20%), followed by trash cans (ICU 3/5, 60%; GW 0/8), sickbed handrails (ICU 6/14, 42.9%; GW 0/12), and doorknobs (GW 1/12, 8.3%). Sporadic positive results were obtained from sleeve cuffs and gloves of medical staff.”

They continue, “these results suggest that medical staff should perform hand hygiene practices immediately after patient contact.”

Looking at aerosol transmission of the virus they found, based on airvent measurements, the ability of the virus to travel downstream and upstream despite air currents.  They write, “Sampling sites were located near the air outlets (site 1), in patients’ rooms (site 2), and (site 3). SARS-CoV-2 aerosol was detected at all 3 sampling sites; rates of positivity were 35.7% (5/14) near air outlets, 44.4% (8/18) in patients’ rooms, and 12.5% (1/8) in the doctors’ office area. These findings indicate that virus-laden aerosols were mainly concentrated near and downstream from the patients. However, exposure risk was also present in the upstream area; on the basis of the positive detection result from site 3, the maximum transmission distance of SARS-CoV-2 aerosol might be 4 m.”

This implies current social distancing of 6 feet between others may not be adequate.

It also implies that shoes and clothing could bring the virus home and those who are around others who may have COVID-19 need to wash their shoes and clothes thoroughly to prevent cross-contamination.

Or shoe covers may need to be warn by those who work in medical centers and thrown out prior to leaving work.

non-woven-shoe-cover-500x500.jpg

The CDC recommends washing linen shoes in the “warmest possible temperature setting”, if using a washing machine, and letting them dry completely.

Leather shoes may pose a challenge, due to their destruction in water and chemicals.  Other shoes, such a clogs, can be cleaned with soap, water, or diluted bleach solutions as advised by the CDC here.

 

ultimate book cover final

Great Gift!!!

The Ultimate Medical Student HandBook

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in coronavirus, Covid-19, disease, Health, news

Coronavirus: Your Questions Answered

What is coronavirus?

Coronaviruses come in multiple types and can cause an array of illnesses from the common cold to SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The latter two causing severe illness, as SARS killed over 700 people and sickened over 8000 in the 2002-2003 outbreak.

Hence a coronavirus can be unpredictable, mutate to more virulent forms, or cause mild upper respiratory illness.

How is Coronavirus spread?

The virus can be spread from human contact with animals, and human to human contact. Scientists believe the strain of 2019-nCoV may be transmitted by saliva and respiratory secretions but are still investigating its ability to be spread by this “droplet transmission.”

What are the symptoms of the Coronavirus strain 2019-nCoV?

As with most viruses, this strain can cause any of the following symptoms:

  • Fever
  • Cough – dry early on and then in later stages may be productive
  • Runny nose
  • Headache
  • Fatigue/malaise
  • Sore throat
  • Wheezing
  • Difficulty breathing
  • Nausea
  • Vomiting
  • Diarrhea
  • Red/irritated eyes
  • Loss of taste
  • Loss of smell
  • Lack of appetite

How long after exposure can one become sick?

The incubation period can range anywhere from 2-14 days.

How long can Coronavirus live on surfaces?

Various studies have reported ranges from 3-17 days, with average of 9 days.

How does one die from Coronavirus?

If the illness persists or becomes severe, one could potentially suffer from pneumonia, respiratory difficulty and even secondary infections.

How does one tell if they have a mild Coronavirus strain or a deadly one?

The early onset of disease could mimic a cold or flu, hence it may be difficult to tell. However, severe or persistent symptoms could suggest a more aggressive strain of the virus and will warrant immediate evaluation.  Medical providers have been urged to ask patients about their travel habits and exposure to others who may have been exposed and to notify local health departments to facilitate testing of those who demonstrate symptoms of the 2019-nCoV strain.

Is there a vaccine for 2019-nCoV?

No, however, we have heard a vaccine for 2019-nCoV is being researched and may be in its early development.

What is the treatment for this strain of Coronavirus?

At this time there is no specific treatment for this strain. However, supportive measures can be instilled such as rest, fluids and maintaining oxygenation in severe cases.

How can we prevent a 2019-nCoV infection?

Experts urge avoiding sick contacts and washing hands thoroughly. Cover your nose and mouth when sneezing and coughing to avoid spreading illness if you are sick.  And if you do have a family member with 2019-nCoV, the CDC suggests the following:

PREVENTION STEPS FOR PEOPLE CONFIRMED TO HAVE, OR BEING EVALUATED FOR 2019-NCOV INFECTION WHO RECEIVE CARE AT HOME
YOUR DOCTORS AND PUBLIC HEALTH STAFF WILL EVALUATE WHETHER YOU CAN BE CARED FOR AT HOME. IF IT IS DETERMINED THAT YOU CAN BE ISOLATED AT HOME, YOU WILL BE MONITORED BY STAFF FROM YOUR LOCAL OR STATE HEALTH DEPARTMENT. YOU SHOULD FOLLOW THE PREVENTION STEPS BELOW UNTIL A HEALTHCARE PROVIDER OR LOCAL OR STATE HEALTH DEPARTMENT SAYS YOU CAN RETURN TO YOUR NORMAL ACTIVITIES.
STAY HOME EXCEPT TO GET MEDICAL CARE
YOU SHOULD RESTRICT ACTIVITIES OUTSIDE YOUR HOME, EXCEPT FOR GETTING MEDICAL CARE. DO NOT GO TO WORK, SCHOOL, OR PUBLIC AREAS, AND DO NOT USE PUBLIC TRANSPORTATION OR TAXIS.
SEPARATE YOURSELF FROM OTHER PEOPLE IN YOUR HOME
AS MUCH AS POSSIBLE, YOU SHOULD STAY IN A DIFFERENT ROOM FROM OTHER PEOPLE IN YOUR HOME. ALSO, YOU SHOULD USE A SEPARATE BATHROOM, IF AVAILABLE.
CALL AHEAD BEFORE VISITING YOUR DOCTOR
BEFORE YOUR MEDICAL APPOINTMENT, CALL THE HEALTHCARE PROVIDER AND TELL THEM THAT YOU HAVE, OR ARE BEING EVALUATED FOR, 2019-NCOV INFECTION. THIS WILL HELP THE HEALTHCARE PROVIDER’S OFFICE TAKE STEPS TO KEEP OTHER PEOPLE FROM GETTING INFECTED.
WEAR A FACEMASK
YOU SHOULD WEAR A FACEMASK WHEN YOU ARE IN THE SAME ROOM WITH OTHER PEOPLE AND WHEN YOU VISIT A HEALTHCARE PROVIDER. IF YOU CANNOT WEAR A FACEMASK, THE PEOPLE WHO LIVE WITH YOU SHOULD WEAR ONE WHILE THEY ARE IN THE SAME ROOM WITH YOU.
COVER YOUR COUGHS AND SNEEZES
COVER YOUR MOUTH AND NOSE WITH A TISSUE WHEN YOU COUGH OR SNEEZE, OR YOU CAN COUGH OR SNEEZE INTO YOUR SLEEVE. THROW USED TISSUES IN A LINED TRASH CAN, AND IMMEDIATELY WASH YOUR HANDS WITH SOAP AND WATER FOR AT LEAST 20 SECONDS.
WASH YOUR HANDS
WASH YOUR HANDS OFTEN AND THOROUGHLY WITH SOAP AND WATER FOR AT LEAST 20 SECONDS. YOU CAN USE AN ALCOHOL-BASED HAND SANITIZER IF SOAP AND WATER ARE NOT AVAILABLE AND IF YOUR HANDS ARE NOT VISIBLY DIRTY. AVOID TOUCHING YOUR EYES, NOSE, AND MOUTH WITH UNWASHED HANDS.
AVOID SHARING HOUSEHOLD ITEMS
YOU SHOULD NOT SHARE DISHES, DRINKING GLASSES, CUPS, EATING UTENSILS, TOWELS, BEDDING, OR OTHER ITEMS WITH OTHER PEOPLE IN YOUR HOME. AFTER USING THESE ITEMS, YOU SHOULD WASH THEM THOROUGHLY WITH SOAP AND WATER.
MONITOR YOUR SYMPTOMS
SEEK PROMPT MEDICAL ATTENTION IF YOUR ILLNESS IS WORSENING (E.G., DIFFICULTY BREATHING). BEFORE GOING TO YOUR MEDICAL APPOINTMENT, CALL THE HEALTHCARE PROVIDER AND TELL THEM THAT YOU HAVE, OR ARE BEING EVALUATED FOR, 2019-NCOV INFECTION. THIS WILL HELP THE HEALTHCARE PROVIDER’S OFFICE TAKE STEPS TO KEEP OTHER PEOPLE FROM GETTING INFECTED. ASK YOUR HEALTHCARE PROVIDER TO CALL THE LOCAL OR STATE HEALTH DEPARTMENT.
PREVENTION STEPS FOR CAREGIVERS AND HOUSEHOLD MEMBERS
IF YOU LIVE WITH, OR PROVIDE CARE AT HOME FOR, A PERSON CONFIRMED TO HAVE, OR BEING EVALUATED FOR, 2019-NCOV INFECTION, YOU SHOULD:
  • MAKE SURE THAT YOU UNDERSTAND AND CAN HELP THE PERSON FOLLOW THE HEALTHCARE PROVIDER’S INSTRUCTIONS FOR MEDICATION AND CARE. YOU SHOULD HELP THE PERSON WITH BASIC NEEDS IN THE HOME AND PROVIDE SUPPORT FOR GETTING GROCERIES, PRESCRIPTIONS, AND OTHER PERSONAL NEEDS.
  • HAVE ONLY PEOPLE IN THE HOME WHO ARE ESSENTIAL FOR PROVIDING CARE FOR THE PERSON.
    • OTHER HOUSEHOLD MEMBERS SHOULD STAY IN ANOTHER HOME OR PLACE OF RESIDENCE. IF THIS IS NOT POSSIBLE, THEY SHOULD STAY IN ANOTHER ROOM, OR BE SEPARATED FROM THE PERSON AS MUCH AS POSSIBLE. USE A SEPARATE BATHROOM, IF AVAILABLE.
    • RESTRICT VISITORS WHO DO NOT HAVE AN ESSENTIAL NEED TO BE IN THE HOME.
    • KEEP ELDERLY PEOPLE AND THOSE WHO HAVE COMPROMISED IMMUNE SYSTEMS OR CHRONIC HEALTH CONDITIONS AWAY FROM THE PERSON. THIS INCLUDES PEOPLE WITH CHRONIC HEART, LUNG OR KIDNEY CONDITIONS, AND DIABETES.
  • MAKE SURE THAT SHARED SPACES IN THE HOME HAVE GOOD AIR FLOW, SUCH AS BY AN AIR CONDITIONER OR AN OPENED WINDOW, WEATHER PERMITTING.
  • WASH YOUR HANDS OFTEN AND THOROUGHLY WITH SOAP AND WATER FOR AT LEAST 20 SECONDS. YOU CAN USE AN ALCOHOL-BASED HAND SANITIZER IF SOAP AND WATER ARE NOT AVAILABLE AND IF YOUR HANDS ARE NOT VISIBLY DIRTY. AVOID TOUCHING YOUR EYES, NOSE, AND MOUTH WITH UNWASHED HANDS.
  • WEAR A DISPOSABLE FACEMASK, GOWN, AND GLOVES WHEN YOU TOUCH OR HAVE CONTACT WITH THE PERSON’S BLOOD, BODY FLUIDS AND/OR SECRETIONS, SUCH AS SWEAT, SALIVA, SPUTUM, NASAL MUCUS, VOMIT, URINE, OR DIARRHEA.
    • THROW OUT DISPOSABLE FACEMASKS, GOWNS, AND GLOVES AFTER USING THEM. DO NOT REUSE.
    • WASH YOUR HANDS IMMEDIATELY AFTER REMOVING YOUR FACEMASK, GOWN, AND GLOVES.
  • AVOID SHARING HOUSEHOLD ITEMS. YOU SHOULD NOT SHARE DISHES, DRINKING GLASSES, CUPS, EATING UTENSILS, TOWELS, BEDDING, OR OTHER ITEMS WITH A PERSON WHO IS CONFIRMED TO HAVE, OR BEING EVALUATED FOR, 2019-NCOV INFECTION. AFTER THE PERSON USES THESE ITEMS, YOU SHOULD WASH THEM THOROUGHLY (SEE BELOW “WASH LAUNDRY THOROUGHLY”).
  • CLEAN ALL “HIGH-TOUCH” SURFACES, SUCH AS COUNTERS, TABLETOPS, DOORKNOBS, BATHROOM FIXTURES, TOILETS, PHONES, KEYBOARDS, TABLETS, AND BEDSIDE TABLES, EVERY DAY. ALSO, CLEAN ANY SURFACES THAT MAY HAVE BLOOD, BODY FLUIDS AND/OR SECRETIONS OR EXCRETIONS ON THEM.
    • READ LABEL OF CLEANING PRODUCTS AND FOLLOW RECOMMENDATIONS PROVIDED ON PRODUCT LABELS. LABELS CONTAIN INSTRUCTIONS FOR SAFE AND EFFECTIVE USE OF THE CLEANING PRODUCT INCLUDING PRECAUTIONS YOU SHOULD TAKE WHEN APPLYING THE PRODUCT, SUCH AS WEARING GLOVES OR APRONS AND MAKING SURE YOU HAVE GOOD VENTILATION DURING USE OF THE PRODUCT.
    • USE A DILUTED BLEACH SOLUTION OR A HOUSEHOLD DISINFECTANT WITH A LABEL THAT SAYS “EPA-APPROVED.” TO MAKE A BLEACH SOLUTION AT HOME, ADD 1 TABLESPOON OF BLEACH TO 1 QUART (4 CUPS) OF WATER. FOR A LARGER SUPPLY, ADD ¼ CUP OF BLEACH TO 1 GALLON (16 CUPS) OF WATER.
  • WASH LAUNDRY THOROUGHLY.
    • IMMEDIATELY REMOVE AND WASH CLOTHES OR BEDDING THAT HAVE BLOOD, BODY FLUIDS AND/OR SECRETIONS OR EXCRETIONS ON THEM.
    • WEAR DISPOSABLE GLOVES WHILE HANDLING SOILED ITEMS. WASH YOUR HANDS IMMEDIATELY AFTER REMOVING YOUR GLOVES.
    • READ AND FOLLOW DIRECTIONS ON LABELS OF LAUNDRY OR CLOTHING ITEMS AND DETERGENT. IN GENERAL, WASH AND DRY WITH THE WARMEST TEMPERATURES RECOMMENDED ON THE CLOTHING LABEL.
  • PLACE ALL USED DISPOSABLE GLOVES, GOWNS, FACEMASKS, AND OTHER CONTAMINATED ITEMS IN A LINED CONTAINER BEFORE DISPOSING THEM WITH OTHER HOUSEHOLD WASTE. WASH YOUR HANDS IMMEDIATELY AFTER HANDLING THESE ITEMS.
  • MONITOR THE PERSON’S SYMPTOMS. IF THEY ARE GETTING SICKER, CALL HIS OR HER MEDICAL PROVIDER AND TELL THEM THAT THE PERSON HAS, OR IS BEING EVALUATED FOR, 2019-NCOV INFECTION. THIS WILL HELP THE HEALTHCARE PROVIDER’S OFFICE TAKE STEPS TO KEEP OTHER PEOPLE FROM GETTING INFECTED. ASK THE HEALTHCARE PROVIDER TO CALL THE LOCAL OR STATE HEALTH DEPARTMENT.
  • CAREGIVERS AND HOUSEHOLD MEMBERS WHO DO NOT FOLLOW PRECAUTIONS WHEN IN CLOSE CONTACT WITH A PERSON WHO IS CONFIRMED TO HAVE, OR BEING EVALUATED FOR, 2019-NCOV INFECTION, ARE CONSIDERED “CLOSE CONTACTS” AND SHOULD MONITOR THEIR HEALTH. FOLLOW THE PREVENTION STEPS FOR CLOSE CONTACTS BELOW.
  • DISCUSS ANY ADDITIONAL QUESTIONS WITH YOU STATE OR LOCAL HEALTH DEPARTMENT
PREVENTION STEPS FOR CLOSE CONTACTS
IF YOU HAVE HAD CLOSE CONTACT WITH SOMEONE WHO IS CONFIRMED TO HAVE, OR BEING EVALUATED FOR, 2019-NCOV INFECTION, YOU SHOULD:
  • MONITOR YOUR HEALTH STARTING FROM THE DAY YOU FIRST HAD CLOSE CONTACT WITH THE PERSON AND CONTINUE FOR 14 DAYS AFTER YOU LAST HAD CLOSE CONTACT WITH THE PERSON. WATCH FOR THESE SIGNS AND SYMPTOMS:
    • FEVER. TAKE YOUR TEMPERATURE TWICE A DAY.
    • COUGHING.
    • SHORTNESS OF BREATH OR DIFFICULTY BREATHING.
    • OTHER EARLY SYMPTOMS TO WATCH FOR ARE CHILLS, BODY ACHES, SORE THROAT, HEADACHE, DIARRHEA, NAUSEA/VOMITING, AND RUNNY NOSE.
  • IF YOU DEVELOP FEVER OR ANY OF THESE SYMPTOMS, CALL YOUR HEALTHCARE PROVIDER RIGHT AWAY.
  • BEFORE GOING TO YOUR MEDICAL APPOINTMENT, BE SURE TO TELL YOUR HEALTHCARE PROVIDER ABOUT YOUR CLOSE CONTACT WITH SOMEONE WHO IS CONFIRMED TO HAVE, OR BEING EVALUATED FOR, 2019-NCOV INFECTION. THIS WILL HELP THE HEALTHCARE PROVIDER’S OFFICE TAKE STEPS TO KEEP OTHER PEOPLE FROM GETTING INFECTED. ASK YOUR HEALTHCARE PROVIDER TO CALL THE LOCAL OR STATE HEALTH DEPARTMENT.
  • IF YOU DO NOT HAVE ANY SYMPTOMS, YOU CAN CONTINUE WITH YOUR DAILY ACTIVITIES, SUCH AS GOING TO WORK, SCHOOL, OR OTHER PUBLIC AREAS.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is Board Certified Family Physician

Posted in coronavirus, disease, Health, news, pets

“Low Level’ of Coronavirus Found in Pet Pooch

Image above from Unilad

A report released this week from the Hong Kong Agriculture, Fisheries and Conservation Department (AFCD) states a pet pomeranian of a patient infected with COVID-19, the novel coronavirus, has tested weakly positive for the virus as well.

The dog had no symptoms of COVID-19 (fever, cough, respiratory distress), however oral and nasal cavity samples tested “weakly positive” for the virus.

Although we have not heard of a previous case of COVID transferring from a human to their pet, the dog has been quarantined at a facility at the Hong Kong Port of Hong Kong-Zhuhai-Macao Bridge.

The AFCD is also considering this may be an environmental contamination causing the weakly positive test.  Repeated testing on the dog will be conducted and once proven negative after the 14 day quarantine period, may be released back to his owner.

Pet owners are urged not to kiss their pets and wash their hands thoroughly after handling them, whether they have coronavirus or not.  If a pet does appear to show symptoms of being ill, they should be put under quarantine by appropriate authorities.

Currently over 83,000 people in multiple countries have been affected by the virus. The death toll is over 2,850, the majority of whom have been from China. In the US, 60 cases have been confirmed.

This is a developing story.

What is coronavirus?

 

HERO_coronavirus

Coronaviruses come in multiple types and can cause an array of illnesses from the common cold to SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The latter two causing severe illness, as SARS killed over 700 people and sickened over 8000 in the 2002-2003 outbreak.

Hence a coronavirus can be unpredictable, mutate to more virulent forms, or cause mild upper respiratory illness.

How is Coronavirus spread?

The virus can be spread from human contact with animals, and human to human contact. Scientists believe COVID-19 may be transmitted by saliva and respiratory secretions but are still investigating its ability to be spread by this “droplet transmission.”

What are the symptoms of the Coronavirus strain COVID-19?

As with most viruses, this strain can cause any of the following symptoms:

  • Fever
  • Cough – dry early on and then in later stages may be productive
  • Runny nose
  • Headache
  • Fatigue/malaise
  • Sore throat
  • Wheezing
  • Difficulty breathing
  • Nausea
  • Vomiting
  • Diarrhea
  • Lack of appetite

How long after exposure can one become sick?

The incubation period can range anywhere from 2-14 days.

How does one die from Coronavirus?

If the illness persists or becomes severe, one could potentially suffer from pneumonia, respiratory difficulty and even secondary infections.

How does one tell if they have a mild Coronavirus strain or a deadly one?

The early onset of disease could mimic a cold or flu, hence it may be difficult to tell. However, severe or persistent symptoms could suggest a more aggressive strain of the virus and will warrant immediate evaluation.  Medical providers have been urged to ask patients about their travel habits and exposure to others who may have been exposed and to notify local health departments to facilitate testing of those who demonstrate symptoms of the COVID-19 strain.

Is there a vaccine for COVID-19?

No, however, we have heard a vaccine for COVID-19 is being researched and may be in its early development.

What is the treatment for this strain of Coronavirus?

At this time there is no specific treatment for this strain. However, supportive measures can be instilled such as rest, fluids and maintaining oxygenation in severe cases.

How can we prevent a COVID-19 infection?

Experts urge avoiding sick contacts and washing hands thoroughly. Cover your nose and mouth when sneezing and coughing to avoid spreading illness if you are sick.  And if you do have a family member with COVID-19, the CDC suggests the following:

The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask.
    • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
    • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to  others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, iHeart Radio and is Board Certified Family Physician

Posted in children, Health, news

US Braces for New Wave of Polio-Like Illness

As August approaches, the CDC is asking health care professionals to be on the lookout and report any suspected cases of AFM (Acute Flaccid Myelitis), a paralyzing illness resembling polio, as cases may peak during this time.

Last year a total of 233 cases were confirmed in 41 states.  This year 11 have been reported and an additional 57 cases are being investigated.  Cases have been reported in California, Maryland, Nebraska, North Carolina, Pennsylvania, Texas, Utah and West Virginia this year.

 

afm-state-map.png

Image above from CDC

Last year, California, Colorado and Texas appeared to be the worst hit with 15, 16 and 31  cases respectively.  Experts are urging states to report any cases of suspected AFM as the above map could be an under-representation of true numbers.

On their website, the CDC reports the following:

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all the stool specimens from AFM patients that we received tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 570 confirmed cases of AFM since 2014, which points to the cause of those patients’ AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 48 states and DC.

 

The “48 states” refers to cases since 2014.   90% of the cases occurred in children under the age of 4.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.

In 2018 parents of two children who died from AFM accused the CDC of hiding their deaths.

Although the exact cause of AFM is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) cocksackieviruses and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 570 cases have been confirmed since the outbreak began in August 2014.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.  Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume it’s a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Health, news

Nerve “Transfer” May Help Those Paralyzed by Polio-like Illness, AFM

An 8 year-old boy who was paralyzed when he developed Acute Flaccid Myelitis (AFM) is now able to walk again due to a new surgery that “transfers” healthy nerves to limbs who lost their neurological function.

Brandon Noblitt of Greenville, South Carolina, lost use of his lower extremities in 2016, a week into him having cold like symptoms.

Amy Moore, MD, plastic and reconstructive surgeon Washington University in St. Louis was able to perform a nerve transplant, taken from his arm, and one year later, Brandon can walk again.

 

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He uses a wheelchair to play basketball but can play football and play with his friends.

The surgery has better success if done within 9 months of the illness.

This rare polio-like illness is startling health officials as cases of AFM are popping up throughout the US.

Since August 2014, the CDC has received reports on 404 cases, 72 of which were from this year alone.

Multiple states who have reported cases of children diagnosed with AFM, which may manifest initially with cold type symptoms but then progress to sudden muscle weakness, stiffness, slurred speech and facial droop.

The age range of children affected appear to be 3-14.  A 6-year-old boy in Washington State died in 2016 and was the first death to be linked to this mysterious illness.  His parents reported he had felt ill, became dizzy and within hours suffered swelling in the brain and paralysis.  Despite medical efforts, he passed.  Although the exact cause is unknown, health experts are considering a variety of possibilities. They have actually been investigating this since 2014 when reports of AFM began to surface across the United States.

What is AFM?

AFM stands for Acute Flaccid Myelitis.  It’s a condition that occurs suddenly, causing inflammation of the brain and spinal cord, causing loss of muscle tone and reflexes.  Although limb weakness is the primary symptom, patients could also exhibit slurred speech, facial drooping, and in serious cases inability to breath due to paralysis of the respiratory muscles.  Mild cases appear to resolve but serious cases can cause residual paralysis or death. Children appear to be more affected than adults.

What causes AFM?

Although health officials do not know for certain, due to its rapid onset, a pathogen such as a virus seems highly likely.  With the 2013-2014 outbreak, some of the cases tested positive for enterovirus (EV-D68), but it is not conclusive whether this was the exact cause or just coincidentally found in the patients tested.

Some postulate a combination of viruses may be a factor or an autoimmune disease.  Although Guillain-Barre syndrome causes acute limb weakness and paralysis when the immune system begins attacking the nervous system, the report that many individuals feel feverish or ill prior, seem to point to a pathogen as the primary cause although the latter is not being ruled out.  Virus families such as enterovirus (including polio and nonpolio enterovirus), adenovirus (causing respiratory and GI illness) and flaviviruses (including West Nile) have been suspected.

How common is AFM?

Per the CDC, acute flaccid myelitis is rare (less than 1 in a million cases) however currently they report 362 people affected in currently 16 states (down from 39 states in 2016). CNN reports, however, as of mid October “most” states are affected.

How is it diagnosed?

Medical professionals look at a variety of factors.

History: how the paralysis/loss of muscle tone began and which limbs did it affect first

Laboratory tests and CSF (cerebrospinal fluid) testing: to look for signs of infection

MRI of the brain: which may show gray matter involvement in a case of AFM.

Is there a treatment?

There is no standard treatment that has been proven effective, however depending on the severity of the symptoms, health professionals can consider a variety of options including steroids, IVIG, interferon, antivirals and supportive measures.  Some physicians are using “nerve transfers”, similar to a transplant, to help children regain control of their limbs.

Is there a vaccine?

No.  Until they can identify the exact cause, or causes, health officials cannot create a vaccine.

How does one avoid getting AFM?

If we assume its a pathogen causing the illness, avoiding contact with sick individuals, being up-to-date on one’s vaccines and good hand-washing are imperative.  Although we do not know if AFM is caused by a mosquito-born illness, avoiding mosquitoes would be wise as well.   More therefore needs to be researched to determine why and how those individuals with AFM were infected.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

Posted in Health, news

Case of PrEP Failure Reported in California Man

A man from San Francisco is apparently the 6th reported case of HIV (Human Immunodeficiency Virus) acquired while taking Truvada, the pre-exposure prophylactic agent.

He’s the third man in the United States who acquired the sexually transmitted virus while taking Truvada as directed.

 

What is PrEP?

PrEP stands for Pre-Exposure Prophylaxis, meaning a treatment taken prior to becoming exposed.  Truvada is PrEP providing protection for those who may become exposed to HIV.

It is composed of two medications:  200 mg emtricitabine and 300 mg tenofovir disoproxil fumarate.

It is taken once daily in pill form.

 

How does PrEP protect against getting HIV?

HIV infects T-cells, or T-Lymphocytes which help fight infection in the human body.

448523-b40db4493269414ce8806eaa4b89bc0e.png

Once it infects a healthy T-cell, the virus hijack’s the host’s “machinery” to produce more HIV infected cells using an enzyme called reverse transcriptase.

Truvada’s two medications interfere with this enzyme, preventing HIV from infecting more cells and using their DNA to expand.

 

How effective is PrEP?

Per the CDC, Truvada can provide at least 90% protection and more if combined with condoms and other prevention methods.

 

How does PrEP fail?

If one does not take their prescription regularly it may not provide its full protection.  Moreover PrEP can fail if a strain of HIV shows resistance to the medication.

Those who take PrEP cannot currently have HIV or severe renal disease.  Moreover we screen for liver disease and active hepatitis prior to starting the medication.

PrEP has been groudbreaking in HIV prevention and “failure” cases such as this are extremely rare.  However it does remind us that HIV can develop resistance, hence no medication is 100% effective all of the time.

For more on this story read here.

For more on PrEP read here.

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

 

 

Posted in Health, news

Close the Toilet Lid When you Flush

Back in microbiology class we learned to “flush and run” after using the toilet.

Sneeze-Effect-300x212

Now its starting to catch on.  Media outlets have reported on studies that have shown how aerosolized microbes can contaminate surfaces nearby. And for those of us who leave our toothbrush on the counter….gross.

Fox News reports pathogens including Shigella, Salmonella, and norovirus can be in high concentrations in feces and vomit, transmitted to users when the “plume” is formed during flushing.  They write:

According to a 2013 review of studies published by the American Journal of Infection Control, it’s clear that flushing your toilet with the lid wide open can pose potential risks. The specific act is called “toilet plume aerosols,” which occurs during flushing. When the toilet contains feces or vomit, the flush can produce potentially infectious aerosols that will live in your bathroom for hours.

Li et al last summer investigated toilet flushing systems and their effect on spewing microbes. They reported:

..in all flushing conditions the emission strength of S. epidermidis was greatest, followed by E. coli and then P. alcaligenes.
This paper also highlights the need for greater concern over the transmission via toilet flushing of aerosols containing pathogenic organisms, which poses particular for the immunocompromised, children and the elderly. Finally, our findings also imply that a cistern tank design is preferable to a flushometer design with respect to aerosol generation.

Pathogens can live on inanimate objects such as surface counters for extended periods of time.  The following is a list of bacteria and viruses and their documented survival time outside of a host.

 

3042980_Table-1-Pathogen-survival-times-on-dry-surfaces

Closing the lid can protect bathroom goers and storing dental utensils in closed cabinets will lessen exposure.

toothbrush

Moreover how many times have we dropped things into the open toilet?  And I wouldn’t trust the 5 second rule on that one if your sandwich gets submerged….

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada

 

 

 

 

Posted in Health, Hepatitis, news

Ohio Joins Multiple States in Declaring Hepatitis A Outbreak

Since 2017 multiple states have declared outbreaks of the Hepatitis A Virus and now the Department of Heath in Ohio (ODH) has declared one as well.

Since the start of 2018, cases in Ohio have risen to 79, double the total number recorded for 2017 in the Buckeye state.

hepatitis A

Image from Cleveland.com

 

WTOL reports: Ohio’s hepatitis A outbreak cases appear to be primarily among people who use illegal drugs, those who have been incarcerated, people who have had contact with known cases, those also infected with hepatitis C, men who have sex with men, and people experiencing homelessness.

Per the CDC, the below states have reported the following number of cases:

  • California 704  (as of April 11, 2018)
  • Indiana 148  (as of June 21, 2018)
  • Kentucky 760
  • Michigan 846
  • Missouri 125
  • Utah 109 (2018) and 147 (2017)
  • West Virginia  248
  • Arkansas 40 since February, 2018

Last year Colorado reported a doubling of Hepatitis A cases since the previous year.

What is Hepatitis A?

Hepatitis A is a disease that affects the liver.  Its caused by a virus (Hepatitis A virus) that is most commonly ingested. Poor hand washing and/or contaminated food are likely culprits.  It’s transmitted by the fecal-oral route, where food or drink contaminated by fecal matter enters another person’s GI tract.  Sexual transmission of Hepatitis A has been reported during activities involving oral-anal sex.

Hepatitis A can live outside the body for months, so unclean dining areas can be contaminated and transfer to food.

Those who are immunosuppressed run the risk of dying from the infection.

 

What are the symptoms of Hepatitis A?

Symptoms of Hepatitis A include:

Jaundice – yellowing of the skin and eyes

Fever

Abdominal Pain

Fatigue

Dark Urine

Joint Pain

Clay – looking stools

Diarrhea

Nausea

Vomiting

Loss of appetite

Hepatitis-A.jpg

 

What is the treatment for Hepatitis A?

There is no specific treatment for hepatitis A.  Most hepatitis A infections resolve on their own.

We usually recommend rest, fluids, and offer medications to help with nausea and vomiting.

For liver injury we avoid medications and alcohol that can worsen liver damage. The liver will usually recover within months after hepatitis A infection.

There are vaccines for Hepatitis A included in the childhood vaccination schedule.  Those older who weren’t vaccinated as a child can get the vaccine from their local provider or health department.  Many states require all health care and food workers to be vaccinated.

The best form of prevention however is good hand washing, dining area hygiene, and cooking food thoroughly.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician