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Thursday, September 3, 2020

Hello COVID Fall

Summer Friends,

  Summer is ending. School is back on, in various forms. September first, a whole lot of people realized they had to do all of the things they have put off since March. WHAM! 
  Jenny, a School Librarian and go-to person for online work-arounds, recovering from spinal surgery (instead of trekking Machu Picchu) has been hammered hard, and is getting farther behind as she works 12 hour days. She sees that none of the parents, teachers, librarians, tech people, school board or principals has been able to keep up with their in-boxes all summer. Everybody is flailing, changing edicts and protocols weekly, and most are asking her to fix/get something for them now, while they are here... It's not possible. See the email from last week.
  As a Family Practice Doc, I have had a summer of testing for COVID, treating a few folks who were not better by the time results came in, then a lull for most of August, as people in Austin got tired of getting tested for nothing, and heard about the 2 week turnaround times for results in July.
Now, with very limited number of in-patient visits and limited number of "telemedicine visits" (a phone call visit that the clinic gets paid for, instead of not paid for, like usual), there is a deluge of urgent and recurrent needs which are revealed through long, irate, and recurrent phone messages on the Nurse lines. There are hospital records and patients needing follow up that can't be arranged, and they are often months old records. 
  Everything is piling up, and getting frantic, because it can't be put off and it can't be done. I have been spending hours after paid-work, still at the clinic, going through reams of information, ordering tests and medicines, calling people after hours for unreimbursed consultations and interventions, spending clinic resources, and getting farther behind, as problems worsen. Many of these people were last seen in late winter, and things change. They can't be assumed to be on the same trajectory. 
We had half a year of doing things half-assed and putting them off. Didn't you? I think it was the mandate.
I stayed 3.5 hours late last night and I'm going in early today, expecting the same. 
I reviewed about 120 pages of medical records on my brother's friend this morning. He has broken down somehow in the last half year. He's losing weight and wandering around the house. What to do?
I feel the need for a change; don't you?

Our clinic will get a rapid testing machine and kits next month, October.
I intend to test and treat and test and treat and test and treat. I have been advocating and giving away vitamin-D since January.
People in Austin, at least at our clinic, have really lost interest in getting tested unless sick, then testing fell further in the last week or 2, as percent positives also dropped. The peak of illness load in Austin was in July. In Texas it was July/August. By all measures Texas is over the summer hump, wearing masks, starting to die less, a month after getting fewer infections, and with about 21 diagnosed cases per thousand Texans. 
  Is it just masking? More cases are younger people and middle aged people, among the sick, which implies a whole lot more that we are not seeing. 
A good rule-of-thumb that I have been tracking, which held true through early May in Oregon, is that population exposure, as monitored by antibody screening, is about 10 times the number of confirmed cases. 
That means I am just calling cases-per-thousand as approximately the percent of the population who has been infected already. It's close...
  So new infections, percent positive-tests, total tests and deaths have all been falling in Texas, with something like 20% of the population having had COVID, mostly very mild, like a cold, like what my daughter is getting over.
My brother,  the Respiratory Therapist, working in a hospital, says they are seeing more of their admissions being younger and middle aged, and less severe than what they saw in spring and early summer. Fewer need ventilators. They mostly have co-morbidities.
  It may just be masking. The Governor mandated masks in public buildings and businesses just before July 4, and things peaked by late July. People gradually increased actual masking in smaller towns as rural cases picked up in July and August. Now everybody masks in grocery stores, even in Yoakum.
  What if it's not masking? How would we know? I don't want to do the experiment. The Japanese do fine wearing masks on the trains and in crowds and stores. It allows things to be mostly-normal. 
Bars and strip clubs are still closed, which tells me the Governor is still serious about this.

  From my point of view, Texas needs to keep masking, and do massive testing and treating, first with rapid testing equipment, but better with home tests, as soon as they are available. 
  Population vitamin-D levels are probably at peak, which may be a good part of the improvement, and they are about to start falling soon. I really don't want an unmanaged COVID winter. I really do not.

Fall And Can't Get Up

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