Dear Patients and Newsletter Followers:

This week my office has been getting a lot of calls and questions about the reported rising COVID-19 cases being reported across the globe. I wanted to give everyone my direct feedback so we can keep our calm and reassess the situation. For time's sake I am sending this as a lengthy email update. I apologize for the length and it really should be a blog piece for The Doctor's Report. Click the colored font to see more details.

In my past newsletters on this subject I have forecasted that this virus is going to become the 5th seasonal coronavirus. This family of viruses are highly contagious (they spread easily and run a seasonal pattern through the fall and winter months). COVID-19 or SARS-CoV-2 has clearly become a human-to-human respiratory spread virus. Since we have a highly sensitive test for it and since we are highly testing the population at large we are seeing more positive cases. As cough and cold season starts we are now observing what I believe will be a recurring annual trend. More cases in the winter and northern climates will see it earlier in the season. The good news is mortality from the virus remains on an improved stance.

Looking at Florida's cases the graph for incidence is not rising at the rates the United States overall is. Latest Florida case data is less than 1/2 of the July peak. This is likely partly due to us having our high peak (so far) this July/August. More Floridians likely have gained immunity and further we had our crisis in July. Granted as more folks return from the north we likely will see a later repeaking of cases, similar to how Florida sees Flu peak later in the winter than the north. Now the states who claimed no cases in the summer are being inundated with infection as this virus finds its way into more of the population that is susceptible. The US infection rate graph looks much like Florida's did in July.

Earlier in October I informed my patients that I saw a cluster of Entero Rhinovirus confirmed cases. These folks look very much the same clinically as COVID-19. There are over 200 infectious pathogens (mostly viruses) that can mimic COVID-19 clinically Historically we have documented these cases as a collective grouping under "Flu-lIke respiratory illnesses and hospitalizations".

These various pathogens in the susceptible host can give the same acute respiratory distress syndrome we have identified in many of the terminal COVID-19 cases. COVID-19 mortality is presently estimated 2-3 deaths per 1,000 infected persons. Population antibody testing supports the math of 10-12 times incidence of immunity by antibody over clinical confirmed cases.

I did just go up to the global database and confirmed that death rates are highest in the United States of all countries. One can speculate that the reason for this fact is that we are documenting things more honestly or perhaps we are documenting the data less honestly. I know many are aware of the perverted incentives the US healthcare system has to document COVID-19 admissions and mortality.

Another possibility that we are documenting the highest mortality rates is that there is groupthink that starts with the CDC and FDA where only in-hospital treatment is available.For me it is important to note that these advisors are not seeing patients, they are administrative physicians.

Based upon the CDC and FDA recommendations, presently in our hospital there are three things offered to COVID-19 cases. One is decadron, a steroid- this has good mortality benefit data and global science agreement. Second is convalescent plasma infusion therapy and the third is intravenous remdesivir. A recent review of these options from UpToDate (an electronic medical textbook) summaries the various option and none of these can demonstrate survival benefit, except steroids. Recall early on the CDC advised against steroids based upon theoretic concerns.

In August I notified patients and followers that there was an excellent Covid- 19 outpatient assessment and management review- it apparently hasn't been read by my peers here in town. I personally have communicated with more than one Lee Health Hospitalist Physician (and administration physicians) who continually discount the use of hydroxychloroquine for either outpatient or inpatient management. Perhaps this is a factor in our world leading COVID-19 mortality statistics.

I will grant all readers and my peers, the data for Hydroxychloroquine is sketchy but there are more favorable outcomes than null conclusion. Additionally there is no mortality benefit yet there remains the consistent and fevered recommendation to keep using plasma infusions and remdesivir. I would recommend readers check on this website which is tabulating reports on therapeutics that are worldwide and include more than just the options I discussed in this alert.

At the end of the day, physicians seeing patients in real time have to make the call on who gets tested and diagnosed and how best to manage and treat these persons. Bosses, businesses and laypersons should not be driving the testing bus. Your private health is not for the public to triage. I find this particular part of the groupthink the most troublesome.

There continues to be continued improved mortality statistics despite more confirmed cases and admissions. Either the things we are doing are helping and we just lack the statistical proof the high bar of science is requesting or the virus has become more tame.

As a final note- I am planning a trip to Montana to hang out with some of the men hunting kin from November 22nd-28th. I hope no state shuts down travel and ruins this opportunity. My staff will be here attending the office and procedures for care. I will wear a N95 mask when on the plane (that is a real source of germ spread). I will follow good hygiene and be vigilant to avoid sick people (until I return to my office). I hope my patients use common sense and not over react to the media and political hype surrounding the respiratory infection season. Sooner or later we need to return to normal life. The statistics on surviving Covid-19 are markedly improved and reassuring. We also know a vaccine is likely soon to be announced.

Internal Medicine Lipid & Wellness