Tag Archives: 2021

Covid-19: The Unwanted Thanksgiving Day Guest

The risk of Covid starts with the level of infection in your community. If high or rising,of course, you have to be more careful. If low or dropping, you can be less worried. The whole adventure revolves around your personal tolerance for risk.

If you are healthy, young and fully immunized, especially with a booster, you can take more risk. If you have actually had test-positive  Covid, that counts as one injection.

Remember that your immunity begins to wane after 3 to 6 months.
If you have an immune deficiency, such as age more than 60, obesity, or a variety of immune associated illnesses, you should be more careful.

If you have decided to go to one or more holiday venues, you might consider reducing your exposure for a week before, or possibly take a rapid test the day before you go, as a courtesy to the other guests. At the party, you can choose to be as close to a window, or fan, as possible, or prefer those groups who are outside. Wearing a mask might also be helpful, and at least will tell the other guess that you are worried.

The catch 22 is that if you are really worried you might consider not attending the gathering. Distancing to more than six or 9 feet is still a good idea, but makes you seem like a Grinch, and is difficult at a party. Do remember that the greater the density of people the greater your risk. If you are a host, especially in an area where Covid is rampant, your guests should be vaccinated. You might consider asking your guests to get a rapid test the day before they come. 

If you have children who are unvaccinated, you might ask them to wear a mask, and keep their distance from the guests. You could open the window a crack to improve the ventilation in the room, and hold as much as possible of the gathering outside your house. You could ask the guests to wear masks when they are not eating. The N-95, KN-95, and KF-94 masks are all excellent, and will protect the people who wear them to some degree, and be very protective against their spreading the Covid virus.

After the gathering, especially if good protocol has not been followed, you might be alert to the possibility of an infection within a week to 10 days following the party. If you develop symptoms, a prompt rapid test is advisable. If positive, you can check with your doctor about the possibility of IVIG, or other medications. If negative, and the symptoms persist, the test should be repeated, since they are not 100% reliable.

There are a couple of oral  tablets that are on the verge of being approved. You might ask your doctor about fluvoxamine, an already approved medication.

Immunization is not a ironclad guarantee against getting the infection, or spreading it. Unfortunately, Covid is still lurking in the background, and gatherings for the holidays should be evaluated on a risk-reward basis.

For an interesting discussion of this topic, I would recommend the Sunday, November 21, 2021 edition of the New York Times, where three knowledgeable people discuss individual situations.

—Dr. C

Telemdicine: Growth Rate Peaked During April 2020, Then Stabilized In 2021

A year ago, we estimated that up to $250 billion of US healthcare spend could potentially be shifted to virtual or virtually enabled care. Approaching this potential level of virtual health is not a foregone conclusion. It would likely require sustained consumer and clinician adoption and accelerated redesign of care pathways to incorporate virtual modalities.

  • Telehealth utilization has stabilized at levels 38X higher than before the pandemic. After an initial spike to more than 32 percent of office and outpatient visits occurring via telehealth in April 2020, utilization levels have largely stabilized, ranging from 13 to 17 percent across all specialties.2 This utilization reflects more than two-thirds of what we anticipated as visits that could be virtualized.3
  • Similarly, consumer and provider attitudes toward telehealth have improved since the pre-COVID-19 era. Perceptions and usage have dropped slightly since the peak in spring 2020. Some barriers—such as perceptions of technology security—remain to be addressed to sustain consumer and provider virtual health adoption, and models are likely to evolve to optimize hybrid virtual and in-person care delivery.
  • Some regulatory changes that facilitated expanded use of telehealth have been made permanent, for example, the Centers for Medicare & Medicaid Services’ expansion of reimbursable telehealth codes for the 2021 physician fee schedule. But uncertainty still exists as to the fate of other services that may lose their waiver status when the public health emergency ends.
  • Investment in virtual care and digital health more broadly has skyrocketed, fueling further innovation, with 3X the level of venture capitalist digital health investment in 2020 than it had in 2017.4
  • Virtual healthcare models and business models are evolving and proliferating, moving from purely “virtual urgent care” to a range of services enabling longitudinal virtual care, integration of telehealth with other virtual health solutions, and hybrid virtual/in-person care models, with the potential to improve consumer experience/convenience, access, outcomes, and affordability.

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