7 Vital Medical Items You Need BEFORE a Pandemic to Prevent Hospitalization for COVID-19

Louis Pasteur (1822-1895), French Microbiologist, Chemist, Pioneer of ‘Germ Theory,’ Inventor of Pasteurization. Quote attributed to Louis Pasteur In the fields of observation chance favors only the prepared mind.’

‘Hi doctor, I was exposed to Coronavirus 19 and now feel fever, chills, cough, and/or difficulty breathing. Do I have COVID-19 & when should I go to the hospital?’

Written by Natan Schleider, M.D. March 25th, 2020 10 PM 3 MINUTE READ

NOTE TO ALL MY PATIENTS: INFORMATION PROVIDED BELOW IS BASED ON CURRENT CDC GUIDELINES LAST REVIEWED MARCH 25TH, 2020 AND THEREFORE LIKELY TO CHANGE GIVEN THE DYNAMIC NATURE OF A PANDEMIC; HOWEVER, SINCE STARTING MEDICAL PRACTICE IN NEW YORK CITY IN 2005, MY GOAL REMAINS KEEPING YOU OUT OF THE HOSPITAL AND LOWERING YOUR RISK OF HOSPITAL-ACQUIRED INFECTION.

TO KEEP YOU SAFE AND THINKING RATIONALLY, REDUCE YOUR RISK OF STRESS, ANXIETY, WORSENING MOOD DISORDER, AND/OR MOOD INSTABILITY, STAY IN CONTACT WITH ME AND MY OFFICE. DO NOT WAIT UNTIL YOUR MEDICINE BOTTLE IS EMPTY BEFORE SCHEDULING A CONSULT. THERE IS NO SHORTAGE OF PRESCRIPTION MEDICINES (ALTHOUGH SOMEMEDICINES NOT NORMALLY MASS PRODUCED LIKE CHLOROQUINE ARE BACK-ORDERED). IT IS NORMAL TO GET ANXIOUS WHEN RUNNING LOW ON MEDICINE SO PREVENT THAT ANXIETY BY SCHEDULING DOCTOR CONSULTS WELL IN ADVANCE.

PLEASE OWN A PULSE OXIMETER AND KNOW HOW TO USE IT. THEY COST AROUND 50 DOLLARS, CAN BE BOUGHT ONLINE, & MAY SAVE YOU A TRIP TO THE EMERGENCY ROOM. IF YOU KNOW HOW TO USE A LARGE PAPER CLIP AND HOW TO INSTALL BATTERIES INTO THE BACK OF A REMOTE CONTROL, YOU KNOW HOW TO USE A PULSE OXIMETER (A MEDICAL DEVICE ABOUT 2 INCHES LONG AND 1 INCH HIGH THAT RUNS ON 2 AAA BATTERIES THAT GIVES AN INSTANT DIGITAL DISPLAY OF YOUR PULSE / HEART RATE AND YOUR BLOOD’S OXYGEN SATURATION)

PLEASE HAVE AN ADVANCED DIRECTIVE OR LIVING WILL PREPARED. THIS IS SOMETHING EVERY RESPONSIBLE GROWN UP ADULT SHOULD HAVE LIKE HEALTH INSURANCE OR CAR INSURANCE. PLUS IT IS FREE. SHOULD YOU VISIT AN EMERGENCY ROOM THE DOCTORS AND NURSES WILL WANT TO KNOW WHO YOUR HEALTH PROXY IS (A HEALTH PROXY IS A PERSON TO CONTACT IF YOU GET SICK NEED, SO SICK OR CONFUSED THAT YOU CANNOT ACCURATELY ANSWER QUESTIONS). YOU DO NOT NEED AN ATTORNEY TO COMPLETE AN ADVANCED DIRECTIVE / LIVING WILL. IN NEW YORK STATE AND THEY CAN BE FOUND FOR FREE ONLINE AND ALL YOU WILL NEED ARE 2 COMPETENT ADULTS WHO ARE NOT YOUR DOCTOR NOR WORK IN THE HEALTHCARE FACILITY YOU MAY OCCUPY: https://ag.ny.gov/sites/default/files/advancedirectives.pdf OR https://livingwillforms.org/wp-content/uploads/new-york-living-will-form.pdf

PLEASE HAVE AT LEAST 3 PAPER COPIES OF THE MEDICINES YOU TAKE AND ONE COPY ON YOUR SMART PHONE. HELPFUL HINT: LINE UP ALL YOUR MEDICINE BOTTLES INCLUDING OVER THE COUNTER MEDICINES AND TAKE A GOOD CRISP PICTURE OF THEM WITH ALL PARTS OF LABELS READABLE.

Before calling your physician worried with any coronavirus 19 COVID-19 questions, please be ready to answer your doctor’s questions and follow these instructions (because this is what I will ask you):

Doctor Question 1: ‘When did you last check Center of Disease Control (CDC) recommendations about coronavirus COVID-19 Website?’

Intelligent Prepared Patient Answer 1: ‘I visited the CDC website before calling you.’

Doctor Question 2: ‘Have you checked your vital signs including Temperature, Respiratory Rate, Pulse, and Oxygen Level?’

Intelligent Prepared Patient Answer 2: ‘Yes because I own a thermometer and pulse oximeter and know how to use them.’

Doctor Question 3: ‘What is your temperature over the last 12-24 hours and does it go down if you take a fever reducing medication like acetaminophen (Tylenol) or an NSAID like ibuprofen (Advil) or Naproxen (Alleve)?’

Intelligent Prepared Patient Answer 3: ‘My thermometer reads 100.4 degrees Farenheit [38 degrees Celcius] AFTER the maximum recommended dose of acetaminophen (or ibuprofen or naproxen).

Doctor Question 4: ‘What does your pulse oximeter read?’

Intelligent Prepared Patient Answer 4: ‘My pulse oximeter which I put on my fingertip is reading BELOW 95%-98% oxygen saturation. My pulse is reading on average ABOVE 100 beats per minute.’

Doctor Question 5: ‘What is your respiratory rate?’

Intelligent Prepared Patient Answer 5: ‘I counted the number of times I took a breath over 60 seconds at least twice before I called you and the rate was above 20 and yes, I used my inhaler and took an anti anxiety medicine you prescribed’

Doctor Question 6: ‘Do you have a bag packed for a log emergency room or hospital stay as advised?’

Intelligent Prepared Patient Answer 6: ‘Yes including my medicines and my phone charger.’

Doctor Final Question 7: ‘How are you getting to the hospital because all the vital signs you are giving me are approaching the red zone?’

Intelligent Prepared Patient Answer 7: ‘ I am on my way to the hospital already because I knew what you would ask and yes, I am wearing a facemask to protect others from getting infected.’

Coronavirus 19 STILL News March 2020 and 3 Ways to Combat Fear Generated by The Media

BY Natan Schleider, M.D. March 13th, 2020 THREE MINUTE READ

‘POLIO: POINTERS for 1951’ emphasizes washing hands; watching for signs and symptoms of fever; trouble breathing; flu-like symptoms; avoiding contact with the potentially ill

So what do you think of this coronavirus 19 thing? Because I’m scared…’

This is a common question I am getting regularly, especially from patients. Assaulted with news, updates, national guard movement, and political responses I have 3 suggestions:

  1. Educate yourself about Human Coronaviruses (there are a bunch of them) from a reputable source.
  2. Make emergency preparations within your budget and mindset and expect help from the government to come along the timeline and quality of Hurricane Katrina
  3. Study American History of viral epidemics and realize that when neither the ‘government’ nor ‘experts’ know that to advise, hand washing, isolation of the ill, and avoiding / cleaning of fomites ( objects or materials which are likely to carry infection, such as clothes, utensils, and furniture) will be advised.

Knowledge safeguards against fear so before you turn on the news or you smart phone latest feed, learn about the 7 strains of human coronaviruses currently known and ask yourself which of them CURRENTLY scare you?

Seven strains of human coronaviruses are known:

  1. Human coronavirus 229E (HCoV-229E)
  2. Human coronavirus OC43 (HCoV-OC43)
  3. Severe acute respiratory syndrome coronavirus (SARS-CoV)
  4. Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus)
  5. Human coronavirus HKU1
  6. Middle East respiratory syndrome-related coronavirus (MERS-CoV), previously known as novel coronavirus 2012 and HCoV-EMC
  7. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019-nCoV or “novel coronavirus 2019”

You will learn that after rhinovirus (the most common cause of the cold), coronaviruses are the second most common cause of the common cold (at about 15%).

Emergency preparation, especially in an urban environment, is extremely nuanced and from a medical perspective, is changing very quickly. If a patient with metastatic cancer on hospice is in a quarantine zone, will they be provided a large supply of opiod pain killers in the setting of an opiod epidemic AND viral pandemic?

For example, the following New York State Department of Health has new guidance which seems only applicable to Medicaid and remains active only until the ‘Declared Disaster Emergency in the State of New York COVID-19 has ended’ https://mcms.org/resources/Documents/Practice%20Manager%20Resources/Medicaid%20Pharmacy%20Guidance%20Disaster%20Emergency%20in%20the%20State%20of%20New%20York.pdf

This allows for early refills of controlled and non-controlled substances for Medicaid members due to quarantine or outbreak. Does this mean physicians can prescribe larger quantities of pain killers to the cancer patients on hospice in quarantine zones? I asked the New York DEA this past in January 16th, 2020 and they replied promptly and politely referring my to the state medical board. The New York State Bureau of Narcotic Enforcement has not yet replied to my questions.

A Review of American Response to Infectious Pandemics is quite interesting with hygiene and quarantine staple go to initiatives by the CDC or historic equivalents.

Soap advertisement for fighting Polio circa mid 1900s [with later data showing soad does NOT kill Polio virus, chlorine does]

As a result of Polio in the early to mid 1900s, soap sales went way up (like hand sanitizer is currently) despite later evidence showing that soap did not kill Polio virus, rather chlorine did.

Hope the above provided a bit of insight, knowledge and comfort.

sincerely,

Natan Schleider, M.D.

Coronavirus COVID 19 remains in the News causing ‘Turmoil’ and ‘Panic’ March 6th 2020: ‘When It Bleeds it Reads’

By Natan Schleider, M.D. March 6th, 2020 9:20 am

Information and news regarding coronavirus 19 changes as quickly as the name of the virus (1st called ‘2019 novel coronavirus’, then ‘2019 nCoV’ and now Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This leads to a misinformed public and more confusion AND MORE CLICKS AND USE OF MEDIA NEWS WHICH IS OBVIOUSLY A STRONG FINANCIAL MOTIVE.

Example: February 12th, 2020, Article by Healthcare Purchasing News Title reads WHO renames novel coronavirus Covid-19 BUT writes in very 1st paragraph The World Health Organization (WHO) head, Tedros Adhanom Ghebreyesus, said the group has come up with an official name, Covid-19, for the disease caused by the new coronavirus. If media editors and journalists cannot accurately report simple definitions like a name change, how can we trust ANY information they provide moving forward. These semantics are important. Maybe it is done on purpose (making it disinformation)

Information about SARS-CoV-2, again aka COVID19 aka coronavirus 19 causes changes, misinforms, and misleads. Moreover, by the time I finish typing half of what is written may be dated BUT media use of words crisis, turmoil, panic I can guarantee will remain in use for a long time as they have in the past.

Cultivating more anxiety creates more: readership, followers, and newspaper sales. ‘When it Bleeds It Reads’ remains tried and true.

Simply saying the truth about coronavirus 19 like We Don’t Know Much about What We Don’t Know probably would not sound good for the CDC, WHO, politicians MIGHT leave them more street credibility?

News information / updates from this morning rea something like: coronavirus 19 causes 3000 people dead worldwide and 87,000 infected.

Let me rephrase: a strain of coronavirus has caused no symptoms or cold symptoms in 96.6% of people tested with the remaining 3.3% (many with underlying serious health conditions) hospitalized or killed by either the coronavirus OR a bacterial pneumonia that easily set in when the patient’s immune system was weak.

I have to head to work so please contact me with any specific questions and I can tell you whatever crappy data and information is or is not available.

BY THE WAY, 7,000 AMERICANS DIED LAST WEEK FROM ATHEROSCLEROSIS, A DISEASE LARGELY PREVENTABLE AND HAVE BEEN DYING AT A RATE OF ABOUT 1000 DAILY IN THE USA FOR SOME TIME. THAT IS 4000 DEAD IN 1 WEEK IN 1 COUNTRY THAN CORONAVIRUS HAS KILLED WORLDWIDE. WHY IS THAT NOT NEWSWORTH?

Thanks for reading,

Natan Schleider, M.D.