Reaching horizons soon! Corona will set soon!

Source: Richard Price/Unsplash

We are in the middle of an unprecedented, unbelievable and unheard scenario. Who knew, just a few months ago, that a virus, a bug will change our lives, to this extent! A lot of us had plans to go to cruises or Disney or Universal or some quite getaways. Unfortunately, we had to cancel everything. A lot of scheduled appointments had to be postponed till further notice. A lot of patients had to postpone their surgeries or treatments.

Millions and millions of people around the world have lost jobs! The governments are doing their part in the form of stimulus packages and other relief measures to ease out financial burdens on their citizens.

The questions that come to everyone’s mind everyday are: when is this going to end? When is life coming back to normal? When will corona set? Where is the horizon?

History is the evidence

Zika, H1N1, SARS, Spanish Flu, etc etc. All of these have come and gone! Yes COVID-19 is probably the strongest one and is causing greater harm and is lasting longer than its predecessors but nothing is permanent, nothing is invincible.

Just like the cycle of life and death, parasites have their cycles of survival (till it’s unknown) and death (once it’s known). Scientifically speaking, once herd immunity starts, this virus will also start to disappear like all of the previous ones. Like any other human parasite, it can only survive till it finds humans that it can infect. Once the human species finds immunity against it, it can’t infect humans anymore!

Vaccines- herd immunity

The best way to generate herd immunity is immunization! There is a lot of fuss going around in the process of re-opening that let people infect others and acquire immunity. Technically speaking, yes, but it’s too dangerous to acquire immunity like this.

Dozens of institutions are working towards making a vaccine. Some of them are progressing towards third phase of testing. If everything goes right, a few companies will come up with a working vaccine by as early as October-December!

Hang on till vaccines are being invented! Science has the answers but we need to be patient. It needs only a microbe to cause a pandemic but it needs a lot of time, resources and most importantly, patience. So readers, please spread your positivity amongst your friends and relatives. We all understand the difficult times that a lot of us are going through, but believe me, “there is always light at the end of the tunnel”.

Source: Tim Foster/Unsplash

Rise of cancer related deaths during the pandemic

It was expected! Patients appointments are cancelled and postponed because the clinics are closed. A lot of clinicians were made to work from home. This resulted in patients’ lack of medical access, delay of the early diagnosis, delay of treatments like chemo or radiation of known diagnoses and delay of decision making on behalf of patients and clinicians.

Source: National Cancer Institute/Unsplash

Here are the most important stories that Medscape Oncology’s editors picked for you to read today:

Excess Cancer Deaths Predicted After COVID-19 

One year from now, there will be 33,890 excess deaths among patients with cancer in the United States, and 6270 excess deaths in England, predicts a first of its kind report.

The prediction is based on data showing that the majority of patients who have cancer and individuals suspected of having cancer are not accessing healthcare services because of the COVID-19 pandemic. The report found a 60% decrease in chemotherapy attendance and a 76% decrease in urgent cancer referrals for early diagnosis compared with prepandemic levels.

“It is universally accepted that early diagnosis and treatment and adherence to treatment regimens saves lives,” pointed out a commentator. “Therefore, these COVID-19–related impacts will cost lives.”

Heading towards new normals

I hope that going forward, these patients don’t die because of lack of access of medical care. When humans have been struck with such a pandemic, we have blessed with growth in technology. Why can’t tele-health become the future of healthcare? This is already been in practice these days. So why can’t our cancer patients reach out their physicians online and get their check ups online? This will be the new normal and should be the new normal!

Tele-health is not a new concept. Companies like Genoa Health care have been thriving on this concept for their tele-psychiatry program. They have millions of patients seeking treatment and consultations via tele health. It’s amazing to see how COVID-19 pandemic taught us to accept tele-health as our future of clinical consultations! Imagine the benefits of this! No cancer patient will stay deprived of medical care and get their early diagnosis and treatments. No patient will have to wait for months to get appointments. Outpatient centers won’t get overcrowded for unnecessary patient visits. Less traffic in roads, less consumption of gas, more productive use of time for both patients and doctors, cost effective- some of the other fringe benefits of tele-health.

Source: Marek Levak/Unsplash

Diabetes and COVID-19

“Diabetes is generally a major risk factor for the development of severe pneumonia and sepsis due to virus infections, and data from several sources suggest the risk for death from COVID-19 is up to 50% higher in people with diabetes than those without, they say” – Miriam E Tucker, Medscape, April 28, 2020, More guidance on “vulnerable subgroup” with Diabetes and COVID-19.

Source: https://diatribe.org/what-you-need-know-about-diabetes-and-coronavirus

An article from Medscape lists what can be safely used, what medicines be dropped and what medications be used with caution:

https://www.medscape.com/viewarticle/929558?src=iphone&ref=message

Patients who have diabetes must seek professional consultation and get education regarding COVID-19 symptoms, dos and donts and most importantly, know what medications they shouldn’t be taking in case they become positive to the virus.

Free consultation from Glucocious

Source: Glucocious

Feel free to consult at:

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Post Corona: What would it be like!

Source: Laura Chouette/ Unsplash

It’s fair to say that Corona virus has set “new normals” for the world. At this moment, the entire world is trying to control the spread and working hard to invent treatments and vaccines. “What would it be like” is not exactly the priority for the moment!

As it has been said by scientists around the world that this unprecedented pandemic is not a one time thing like the West Nile virus or the mad cow’s disease or the H1N1 or even the SARS. This one will be around for a while or may be even seasonal, like Influenza. So, unless, vaccines are good enough, it’s gonna be social distancing throughout!

Once cases are suppressed, it may allow some measures to be lifted for a while – until cases rise and another round of restrictions are needed. Doing this could, unintentionally, lead to herd immunity as more and more people were to be infected.

Fun and entertainment

Imagine Disney world admits only one-tenth Of the number of people in the park and increase the entrance charge multiple fold. Imagine people for rides are 6 feet apart. Imagine the carts for rides are so far from each other and no two people can sit together!

Imagine a movie theater! 5 vacant seats between 2 people! Movie tickets might be so unaffordable! Only the rich might go to movie theaters.

And what about beaches! Probably banned for public. What about cruises and flights! And the list goes on and on!

Home might be our real and virtual world! Amazon prime and Netflix might be our only entertainment sources. Our backyards and swimming pools might be our only getaways and resorts. I hope sports be played the same way except the spectators separated on the stands or may be no spectators! Hopefully, none of the above imaginations come true. We would love to have our “normals” back and not to deal with “new normals”.

Nature’s reset

Everything has a limit and must be realized! Like in calculus, limit of a function is still determined even if “x tends to infinity”. Some religious beliefs and philosophies say that nature decided to limit our ever multiplying desires and unfriendliness towards our own earth. This pandemic might just be an indication that whenever we try to abuse mother nature’s liberties, we will have to pay some consequences.

So much consumption of everything in terms of food, clothes, travel, gadgets, etc., so much greed for money, so much materialism, so much self- centered interests, so much lack of love and respect for each other. These are only some of the vices of the modern society that nature might want to reset!

Here is a section from an article relating to overconsumption of meat and epidemics:

https://www.vox.com/platform/amp/future-perfect/2020/4/22/21228158/coronavirus-pandemic-risk-factory-farming-meat

“Some experts have hypothesized that the novel coronavirus made the jump from animals to humans in China’s wet markets, just like SARS before it. Unsurprisingly, many people are furious that the markets, which were closed in the immediate wake of the outbreak in China, are already reopening. It’s easy to point the finger at these “foreign” places and blame them for generating pandemics. But doing that ignores one crucial fact: The way people eat all around the world — including in the US — is a major risk factor for pandemics, too.”

“That’s because we eat a ton of meat, and the vast majority of it comes from factory farms. In these huge industrialized facilities that supply more than 90 percent of meat globally — and around 99 percent of America’s meat — animals are tightly packed together and live under harsh and unsanitary conditions.”

Thousands of lives are lost, millions of people are having difficult times! But there is a light at the end of the tunnel. Lives will not return but some losses will be reversed. A lesson learnt hopefully will be remembered so more lives will not be lost in future!

Ending on a positive note

Yes, our lives are stressed out thinking about the pandemic. The virus is scaring almost everyone. Fears are leading to mental problems. Financial problems are mounting day by day. Arranging food has become a challenge. Maintaining enough cleaning supplies at home has become a daily task.

But to wrap it up, think about the little positives. Enjoy those little family moments. We have all the time to play with our kids, talk to them, give them the time for their activities, build that rapport with our teenagers, grow relationships with our loved ones.

Together, we will fight this out! Let’s all be one in this battle against the CoVID-19!

Source: Phillip Goldsberry/Unsplash

Corona- Test of leadership

Source: Jehyun Sung/Unsplash

Wow! A small bug can turn the world upside down. There is a popular Bollywood movie dialogue, “ek machhar admi ko hijda bana deta hai”. It’s been pretty much like that. Right from shops, departmental stores, factories, offices, sports arenas and guess what….IPL is shut down too! Although I am sounding a bit disappointing but believe there is light at the end of the tunnel. And to get to that light, social distancing is the only way! We need to work together as teams, societies and nations to protect against this darkness. I am sure, eventually, we will win.

Companies to nations

A lot of companies have helped their employees stay safe by enforcing social distancing measures and providing PPEs at work. People with likely exposures or positive symptoms are allowed to stay home with getting full pays. Governments are pouring in money to accomplish this. America gave us stimulus money to their citizens to help them stay home and not be deprived of basic necessities.

All of the above is fine, but the situation is so tensed and it’s definitely testing the leadership across the globe. Leaders around the world have been working their strategies to fight out Corona. Some nations are criticized for not implementing strict lock downs. People were still gathering on beaches, parks and other public places. Some leaders were criticized for implement it too far and so much that people from different states got stuck in remote places and can’t even go back home. A lot of people have lost jobs and even though governments are providing them some relief, they are still not able to make ends meet.

Some leaders decided to keep their businesses open in the name of essentials where as some essential businesses decided to reduce their hours. We, as humans, are critical about everything and that’s normal! But at the end of the day, we must look at the bigger picture, hold on with a lot of patience and follow guidance from our leaders. Some things might make sense, some might not. But, to put a fight against an unknown enemy, isn’t it critical to stand together and be unified! As we read news, we do realize that the entire world is united!

India shows her resilience!

https://www.tribuneindia.com/news/comment/applauding-modis-leadership-in-time-of-corona-62542

Modi has not only brought India together, except a couple of mishaps, but has influenced other nations by his resilience against COVID-19!

Source: https://gulfnews.com/photos/news/covid-19-india-lights-candles-in-a-show-of-solidarity-against-coronavirus-1.1586105797656?slide=2

All of the SAARC nations (except Pakistan), Japan, Israel, Australia, Germany supported India’s call to show solidarity and one-ness! This was, to me, a pinnacle of leadership!

Continue social distancing, stay safe and stay united!

Your comments and feedbacks are truly appreciated!

Comorbidities- Most COVID-19 Patients!

www.medscape.com/viewarticle/928531

As per the above Medscape Article, almost 90% of hospital admissions involve comorbidities. Some of the most prevalent comorbidities cited are hypertension, obesity in different age groups.

Source: Annie Spratt/ Unsplash

Sure enough that diabetes, even though not the most prevalent as per this article, but it must also be one of the comorbidities in a lot of patients admitted due to COVID-19. Obesity is a risk factor for diabetes and hypertension is also connected with diabetes patients. Also, a lot of other immuno compromised patients are at risk of COVID-19. People with chronic inflammatory and auto-immune diseases like Cancer, Rheumatoid Arthritis, Psoriasis, Multiple Sclerosis, etc are also at risk because of the anti-inflammatory and immuno modulatory treatments that compromise their immunity.

In a lot of these patients, doctors have advised them or patients have themselves decided not to continue their treatments for fear of contracting Corona virus. These are the patients who must be carefully monitored for any exacerbations in their conditions.

Once again, we can’t emphasize more on how important it is to maintain social distancing, coughing-sneezing etiquette, wearing face masks and yes, hand-washing. Continue to keep the distance, stay home and be safe!

Virus- a secret satan!

Source: H Shaw/Unsplash

Watch the following video clip in which leading scientists tell CNN that it’s possible that Corona virus has not just come to humans months ago from bats but it might have come decades ago!

apple.news/A1hvVvN5rRbe19bSlR-Qi8A

https://apple.news/A1hvVvN5rRbe19bSlR-Qi8A

Amazing, isn’t it! Viruses are so dynamic and notorious. They have been in humans trying to adapt, mutate to replicate, become more infectious and eventually become lethal….the way it’s showing up these days!

But on the positive note, they are not invincible either! Now that we know CoVID-19 better, we will definitely get after it and invent treatments and vaccines. For now, we can follow the guidelines of social distancing, basic hygiene and most importantly, hand washing measures to keep it away from us.

COVID-19- Do we have treatments: evidence-based vs randomized trials?

(STOP HOARDING MEDICINES)

Source: Unsplash/ Fusion medical animation

Lately, there has been a lot of excitement about Lopinavir-Ritonavir, Hydroxychloroquine and other treatments. Surprisingly, people are starting to hoard these medicines, especially HCQ (Hydroxychloroquine) since it’s so cheaply available in pharmacies with a prescription. I do not understand why are doctors freely writing HCQ prescriptions for their known friends, families and VIP patients just so that they can have them.

As per guidelines set by health systems with directions from CDC, there are several stages of COVID-19 cases like mild, moderate, severe and critical. These stages are based on severity of symptoms and intubation status. So HCQ is not even needed in most mild cases. In cases of moderate and higher severities, you would rather go to the hospital to fix the respiratory depression, clear the airway, suppress the secretions and prevent emergencies instead of carelessly taking HCQ at home. This is dangerous because patients can actually die if respiratory complications are not controlled which can only be done in a hospital setting. Then what’s the point in hoarding medicines at home when they should be reserved for patients who actually need them!

And if symptoms are relieved but the virus is not eliminated, they might be under the illusion that they are cured and will not practice social distancing and other measures as seriously as they should be. This would make them even more contagious.

Here is a very thought provoking and interesting article from Medscape by Dr F Perry Wilson:

https://www.medscape.com/viewarticle/927342?nlid=134727_3901&src=wnl_newsalrt_200328_MSCPEDIT&uac=70399SX&impID=2327297&faf=1

Click the link above for the detailed article but I urge you to read the part I liked the most:

“Now let’s look at the study. Thirty-six patients in France with COVID-19 were examined. Twenty of them got hydroxychloroquine and 16 were controls. But this was not randomized; treated patients were different from those not receiving treatment. The researchers looked at viral carriage over time in the two groups and found what you see here:



This appears to be a dramatic reduction in coronavirus carriage in those treated with hydroxychloroquine. Awesome, right? Sure, it’s not randomized, but when we need to make decisions fast, “perfect” may be the enemy of “good.” Does this study increase my 50/50 prediction that hydroxychloroquine could help?

Well, with data coming at us so fast, we have to be careful. There is a huge fly in the ointment in this study that seems to have been broadly overlooked, or at least underplayed. There was differential loss to follow-up in the two arms of the study; viral positivity was not available for six patients in the treatment group, none in the control group. Why unavailable? I made this table to show you:

Three patients were transferred to the ICU, one died, and the other two stopped their treatment. By the way, none of the patients in the control group died or went to the ICU. Had these six patients not been dropped, the story we might have is that hydroxychloroquine increases the rate of death and ICU transfer in COVID-19.”

Bottom-line: Please stop hoarding medicines. When dealing with COVID-19, an unknown enemy with a drug which has created an excitement with unknown clinical outcomes (based on the above article), it would be foolish to self-medicate with HCQ. The right approach would be to go to hospital if your symptoms are moderate to higher severity.

Even more, please focus on prevention than cure. Stay away from everyone, practice social distancing, wash hands, take showers after work, keep your homes clean, get educated on symptoms on CDC website and stop doing things just because others are doing them. Only follow advice from your healthcare providers.

COVID-19!

Life is on hold!

Source: CDC/Unsplash

First of all, please do not panic. Don’t think that Corona virus will kill everyone like the pandemic Plague did! Remember, epidemics like COVID-19 or SARS or EBOLA can be dangerous or even life threatening if we don’t take precautions and try to contain it. But if we follow the guidelines and basic rules, then we can definitely steady this ship. People start reacting to news or WhatsApp messages as if the world will come to an end soon! There are lines as long as a mile in department stores, people going crazy for masks or hand sanitizers. Thank god, they are not boarding their homes with hurricane shutters….lol! FYI, there are more than 1000 fatalities per week from preventable diseases like FLU/pneumonia! So numerically, this is not even comparable.

Having said that, we must make sure that we are following all the recommendations suggested from CDC and health organizations. One of the most important suggestion is to AVOID unnecessary travels. Avoid going to vacations, cruises, theme parks, etc to make sure we are not risking ourselves to getting exposed to the virus. This virus can come from individuals who may not seem sick (incubation period) but can easily spread it by coughing, sneezing or simply from their breaths. This virus can survive on surfaces for up to 3 days. So someone who sat on a bench can infect others who may sit on the same bench, touch it and then somehow get it into their lungs (touching nose, mouth). That’s why, it’s so important to keep ourselves away from mobs till this epidemic is contained.

Stay home, practice good hygiene, keep your homes clean, not have too many parties or visitors and enjoy your time at home with your families. Yes, it might feel like house arrest but it’s better to be safe than sorry. Hand sanitizers are good to prevent bacteria but not viruses. So avoid excessive use of hand sanitizers since they are not good for skin if used excessively. Washing hands is the best thing you can do to get rid of any dirt including viruses. Any time you touch any surface like door knobs, public benches, shopping carts, car doors, make sure hands are washed. Avoid contacts. May be change to Indian way of greeting “Namaste” 🙏 instead of hugs, kisses or even hand shakes. It might sound weird but believe me, lesser the body contacts, fewer the exposures to virus or any germs, in general.

Be aware of the symptoms of infection in case you get exposed to it. Here are some of them:

  • Runny nose
  • Sore throat
  • Cough
  • Fever
  • Difficulty breathing (severe cases)

Also know you local health centers that test for Corona virus. Here is a link for people in US to keep handy just in case:

https://findahealthcenter.hrsa.gov

If tested positive, follow the recommendations by the healthcare team and seek treatment. As of now, there is no known specific treatment. Some antivirals are being tried and have shown some promise. There is a lot of research underway for treatments and vaccines.

Normal healthy adults have recovered well from this infection. Just like any other infection, older people or people with comorbidities may take longer to recover or in extreme cases, some have not recovered and lost their lives.

Good luck to all of us! Be informed, cautious but calm ! We will all get through this battle against corona virus and be successful if proper precautions and guidelines are followed.

Financial hardship:one of the causes of non-adherence

Source: http://www.glucocious.com

Being financially healthy keeps you healthy! It may sound mean but analyzing the health care of our country really proves the point. Working as a pharmacists, we know how many people chose not to buy their medications just because they couldn’t afford their copays. In most cases, the copays are around $5 to $100. But there a lot of people who cannot afford these copays. This is a sad situation! Here is an article from medscape that demonstrates this:

https://www.medscape.com/viewarticle/925845?src=iphone&ref=message

“Americans with diabetes are experiencing more financial hardship from medical bills than those without diabetes, even when they have health insurance, new research shows.

Results from an analysis of data on medical bills among adults aged 18-64 years from the National Health Interview Survey in 2013-2017 were published online February 6 in Circulation: Cardiovascular Quality and Outcomes by Cesar Caraballo, MD, of the Center for Outcomes Research and Evaluation, Yale New Haven Health, Connecticut, and colleagues.

Nearly two in five of the 8967 adults with diabetes surveyed reported financial hardship from medical bills, including medical debt or the inability to afford needed medical care. This hardship, in turn, was associated with high financial distress, food insecurity, cost-related nonadherence, and foregone or delayed medical care.

“Our study findings illuminate the health- and nonhealth-related consequences as a potential side effect of burdensome medical bills from diabetes mellitus management…These findings underscore

the need for price transparency and clear communication with patients and their families on costs of care,” say Caraballo and colleagues.

“Great consideration should be taken on presenting less expensive but still effective treatment options, as well as a need to comprehend patient’s insurance coverage and financial obligations in our management decision-making processes,” they add.

And the older Medicare population isn’t immune either.

Another study — this one on costs affecting the insulin-requiring Medicare population aged 65 and older — found that provisions in the Affordable Care Act intended to reduce the impact of the Medicare Part D “doughnut hole” were counteracted by rising insulin prices.

Those findings were published online February 10 in Diabetes Care by Chien-Wen Tseng, MD, of the Department of Family Medicine and Community Health, University of Hawaii, Honolulu, and colleagues.

“Lower insulin prices and other solutions are necessary to improve access to treatment for Medicare beneficiaries with diabetes,” Tseng and colleagues assert.

Medical-Related Financial Hardship Brings Other Issues 

The 8967 adults aged 18-64 with diabetes included in the National Health Interview Survey study by Caraballo and colleagues would extrapolate to represent about 13.1 million individuals across the United States.

They were a mean age of 51.6 years and 49.1% were women.

Annually during the survey, 41.1%, corresponding to 5.4 million nationally, were part of families reporting financial hardship from medical bills, including 15.6% (corresponding to 2 million) reporting that they were unable to pay their medical bills at all.

Inability to pay bills at all was most prevalent among those who were low-income and uninsured (39.1%) and least common among middle- or high-income and insured (8.5%) individuals.

However, of the 3613 adults reporting financial hardship because of medical bills, 83.2% were, in fact, insured.

In turn, among individuals with diabetes, those in families with versus without financial hardship because of medical bills had higher financial distress (52.1% vs 25.4%), food insecurity (30.0% vs 12.8%), cost-related nonadherence (34.7% vs 9.1%), and foregone/delayed medical care (55.5% vs 21.6%) (all P<.001).  

These associations remained significant after adjustment for sociodemographic, economic, and clinical confounders.

All of these adverse factors were significantly greater among those with versus without diabetes in the survey.

In summary, after adjustment for known confounders, individuals with versus without diabetes were at greater risk for overall financial hardship (odds ratio [OR], 1.27), high financial distress (OR, 1.14), food insecurity (OR, 1.27), cost-related nonadherence (OR, 1.43), and foregone/delayed medical care (OR, 1.30).

Stuck in the Doughnut Hole: Rising Insulin Prices

Meanwhile, the study by Tseng and colleagues examined Medicare Part D coverage, which applies to the 3.1 million beneficiaries who require insulin (type 1 and type 2 diabetes).

In the Part D coverage gap (also referred to as the “doughnut hole”) — which dates back to the Medicare Modernization Act of 2003 — beneficiaries pay a percentage of the drug’s price until they reach the point of catastrophic coverage.

To minimize that burden, the Affordable Care Act incrementally reduced beneficiaries’ cost-sharing during the gap, from 100% of the drug price in 2010 to 25% in 2019. At the same time, manufacturers were required to provide greater discounts during the gap, reaching 70% by 2019.

Tseng and colleagues analyzed nine insulins, including the top five by 2017 Part D spending ($8.2 billion or 62% of Part D insulin expenditures), averaging monthly and out-of-pocket cost requirements across plans nationwide, with cost projections based on 50 units/day and no other medications.

From 2014 to 2019, the average annual insulin price rose 55%, from $3819 to $5917.

Monthly out-of-pocket cost for insulin in the covered (predoughnut) phase rose 18%, from $49 to $58. Accounting for all Part D phases, the projected yearly out-of-pocket cost for insulin increased 11% from $1199 to $1329.

In contrast, if insulin prices hadn’t risen and instead remained at 2014 levels, annual out-of-pocket cost would have dropped 19% to $967 because of lower coinsurance in the gap.

This wasn’t uniform, though. Lantus pens had the lowest price increase (19%), and for that the annual out-of-pocket costs dropped by $167. However, if the price hadn’t risen patients would actually have saved $292.

With Levemir, which had the greatest price increase (165%), annual out-of-pocket costs increased by $992 instead of falling by $297 had the price remained unchanged.

In 2019, eight of nine insulin prices exceeded $4800 annually, with patients’ projected out-of-pocket costs surpassing $1000 under a standard Part D plan.

Of concern, Tseng and colleagues say, “Insulin list prices continue to rise, driven by multiple complex factors including manufacturers competing by offering greater proprietary rebates to pharmacy benefit managers for formulary placement.”

“Since measures to close the Part D gap were fully implemented in 2019, future price increases will not be counteracted unless new policies are enacted to reduce patients’ cost-sharing,” they conclude.

US prices for insulin have come under intense scrutiny in recent years. Around a quarter of patients with diabetes are said to ration use of this medication ― which, for those with type 1 diabetes, is essential for life ― because of high costs.

Patients and parents of children with diabetes have long protested, and some states have started to cap prices ― most recently, Illinois, which has said that no person covered by state-regulated commercial health insurance plans should pay more than $100 per month for insulin.”

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