Holiday recommendations

Dear Member,

Increase in COVID-19 cases: In the short two weeks since we last wrote, we have seen a large increase in COVID-19 cases. The uptick is quite dramatic. It is usually a similar story - I went for drinks with a friend, dinner with a friend, saw my cousin, my child had a case in his class. The small private gatherings are the main source of the case increases. COVID-19 loves the indoors. The weather is now colder and we are spending more time inside.

Holiday recommendations: We can't stress enough that now is not the time to let down your guard. Double up your efforts with safe protocols. Spend the holidays with only those who live with you. We are very concerned for the upcoming holidays. There is a very strong possibility of a steep increase in cases that can overwhelm the medical system once again. We do not want to get there again. Please rethink any holiday plans you may have, including any travel plans. It has become clearer that the virus stays airborne for longer than originally thought. If you do have holidays with those who currently don’t live with you, then we suggest you try to be outside as much as possible and wear masks. Consider not having the meal together where you take off your mask and convene in a smaller area. Redefine the holiday this year. Other tips are preparing the food in advance to limit time congregating together in the kitchen. Keep a few windows cracked open. Keep social distance and wash your hands often. But Megan McArdle from The Wall Street Journal said it best: “Next year’s turkey will taste a lot better if everyone is around to eat it”. We are near the finish line - a vaccine is coming soon and with that a downtrend in rates of infections. Keep the faith and stay safe!

Home video telemedicine: We had a huge response to the possible option of a Telehealth kit. Before we make a final decision next week please let us know if you are interested in purchasing an at home Telehealth kit for $400. It enables us to listen to your heart, lungs, throat, ears, skin as if you were in the office with us. All while being in the comfort of your home or office. We feel it will be of immense use during this time and beyond. It is the future of telehealth. Please contact us at info@flatironfamily.com if you have any questions or interest in owning one. Again if we get enough interest, we hope to move forward quickly.

Study shows benefit of high dose vitamin D3 in early COVID-19: This study shows that early vitamin D3 supplementation at a high dose (20,000 IU daily) significantly reduced the incidence of admission into the intensive care unit and the severity of disease in hospitalized patients. This studied only hospitalized patients who were also given azithromycin and hydroxychloroquine as well. We do think that it is important to make sure your vitamin D levels are sufficient, especially in the wintertime when they tend to decrease in most of us. Please do not start taking this high dose of vitamin D without consulting your physician. Vitamin D is fat soluble and there can be a toxic level.

Gastrointestinal issues as the presenting symptoms of COVID-19: A new review of previous COVID-19 cases stated that 18% of patients presenting with gastrointestinal symptoms; nausea, vomiting, diarrhea, abdominal pain as the first sign of COVID-19. There is growing literature that abdominal symptoms are the initial or sometimes (16% of cases) the only signs of COVID-19.

Blood type and COVID-19: There has been some “talk” that certain blood types follow a worse course of illness if infected with COVID-19. A new observational study out of the journal ,Nature, evaluated how patients from New York Presbyterian Hospital (NYP) fared with infection, need for intubation and death when infected with COVID-19. They received data on over 14,000 patients. In this study they found evidence for associations between blood type and Rh blood groups and COVID-19. Using data from NYP they found moderately increased infection prevalence among non-O blood types and among Rh-positive individuals. Intubation risk was increased among AB and B types, and decreased among A and Rh-negative types. Risk of death was slightly increased among type AB individuals and was decreased among types A, B, and Rh-negative types. The blood type differences were modest but there was a greater difference in Rh types. These results add further evidence to the previously discovered associations between blood types and COVID-19.

The Cherokee nation: While the cases in the US rise, one nation within our borders is doing much better. The Cherokee nation had a mask mandate since spring, has free drive through testing, and hospitals fully stocked with PPE. They have been able to curtail their cases and deaths due to COVID-19 despite the surge in the surrounding areas in Oklahoma. This tribe has 140,000 citizens with 4000 cases and only 33 deaths due to COVID-19. They have started to manufacture their own PPE, protected the elderly by having strict guidelines surrounding them, and have given out stipends to help with food and resources for those who aren’t working. If the US followed the same protocols, we would have seen tens of thousands of less deaths. “It’s very impressive. It’s a reminder of how much leadership matters and how even under difficult circumstances, with limited resources, you can make a huge difference,” said Ashish Jha, dean of the Brown University School of Public Health. “It fits with what I’ve seen in the world. You see countries like Vietnam. They’re not a wealthy country, but they’ve been following the science and doing a great job.

Rapid testing: We now have rapid molecular tests available on site with results available in 15 minutes. If someone is symptomatic this is a very accurate test. In a few weeks, we should have rapid PCR testing on site. PCR testing is the gold standard of testing. The nasal pharyngeal swabs sent to the labs are PCR testing. Our new testing will have results within 40 minutes. PCR testing is better at picking up asymptomatic and very early cases (COVID-19 prior to having symptoms). It also has less false positives and negatives. No test is 100%.

COVID-19 Vaccine: Two vaccines are showing promise to help end the COVID-19 pandemic: One by Pfizer showing preliminary results of being 95% effective at preventing infection and one by Moderna being 94.5% effective. Both vaccines and their potential effectiveness are very welcome news. The effectiveness was shown in important populations - the elderly and persons of color. The Moderna vaccine has also shown that subjects who did get COVID-19 despite the vaccine had very mild symptoms. We don’t yet know the durability of the vaccines. Some vaccines, such as measles, lasts up to 10 years. However, we do believe it will be game changing even if only active for the short term. We do think they will last longer due to recent report on Tuesday that immunity from the virus is presumed to last years. The Pfizer vaccine can be made in larger quantities but requires an ultra-cold freezer for storage which is not readily available for many places. Moderna does not require this freezer but is not able to make as many vaccines currently. The first round of vaccines reportedly will be for front line health care workers and the elderly or those who are very high risk. Most people (those with no underlying high-risk issue) will likely be able to obtain the vaccine sometime in the spring. These vaccines are pending FDA approval for Emergency Use Authorization. But vaccines don’t save lives, vaccinations do. We feel confident these vaccines will be approved and will be recommending them for everyone when available. We have signed up with the New York State Department of Health to be a distributor and are waiting to hear if that occurs. The vaccines won’t end the pandemic immediately. But after time the infections will become so rare that life will return to normal. And that is something we are ALL looking forward to!

Stay Safe!