Medicine

COVID-19/SARS-CoV2 Update 2-23-2020 — When the “New Versailles Class” Meets Reality Without Privilege

by

The themes of this update will be on issues of COVID-19 spread, testing, public health institutional credibility, some e-mails evaluating the CDC and our elites, and my personal analysis of same after the top line infection numbers and headlines.

The SARS-CoV2 virus and it’s COVID-19 virgin fields infection seems to have a top line R(0) of between three and 6.7 — that is one person infects near seven people on average — because there are repeated “super spreader” events where one person slimed an institution with a lot of close contact and then the fomite contamination of that institutional setting causes everyone present to get the disease. Examples thus far include the Diamond Princess Cruise ship, a pair of prisons in China, and multiple hospitals in China and now South Korea. The rate of growth of the COVID-19 pandemic is such that we will be fighting it on a very large scale in a few weeks (no more than 10) in every nation world wide with the public and private medical institutions, societal resources, and people we have right now, with all their flaws. And not what we wish they were, but will never have. There simply isn’t going to be time and energy for blame games when issues of daily survival break upon us all.

Top line, there are currently 78,986 confirmed COVID-19 cases worldwide, including 2,468 fatalities as of 23 February 2020 at 11:52 a.m. ET on the BNO News corona virus traking site (https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/) China, Taiwan Hong Kong, Japan, Thailand, Singapore, Italy, and Iran all appear to have local, or endemic, spread of the disease. See multiple charts attached and headline summary

Bar Chart of World COVID-19 Infections as of 23 Feb 2020
Bar Chart of World COVID-19 Infections as of 23 Feb 2020
Bar Chart of World Qide COVID-19 Infections Without China and the Diamond Princess Cruise Liner
Bar Chart of World Wide COVID-19 Infections Without China and the Diamond Princess Cruise Liner

World Headline Summary:

o Italy confirms 3rd death and cancels last 2 days of carnivale in Venice as cases soar above 100
o 4 more cases confirmed in UK
o 200 Israelis quarantined
o Japan confirms more cases
o Japanese Emperor expresses hope for Tokyo Games (fat chance)
o ROK Gov’t total cases above 600
o Trump says US has everything ‘under control’ as he asks Congress for more money (I call B.S. below)
o EU’s Gentiloni says he has ‘full confidence’ In Italian health officials
o Turkey, Pakistan close borders with Iran as confirmed cases soar
o Global Times (Chinese Gov’t news source) says virus may not have originated at Hunan seafood market
o Axios reports shortages of 150 essential drugs likely. (Most source in China)

Read more

COVID-19 Update Morning 2-14-2020

by
There are currently 65,213 confirmed COVID-19 cases worldwide, including 1,486 fatalities. Of which 4,823 new cases and 116 new deaths were reported in Hubei province, China.
.
There are several trends in this update, as well as the headline summary. First Community spreading of COVID-19 is now established in Hong Kong (attached graphic), Japan and Singapore.
COVID-19 in Hong Kong
COVID-19 in Hong Kong
.
Second, the shut down of China as an economic power seems near complete. See the JP Morgan coal for electricity usage and the Goldman Sachs economic projection charts attached to this post. The JP Morgan chart shows that while traditionally daily coal consumption – the primary commodity used to keep China electrified – rebounds in the days following the Lunar New Year collapse when China hibernates for one week. This is not the case this now. There hasn’t been even a modest increase, indicating that so far there hasn’t been a return to work.
.
2020 Chinese Coal/Electrical Consumption
2020 Chinese Coal/Electrical Consumption
.
Short Form — Lack of Chinese coal use/electric power generation indicates the scale of Chinese industries that are shut down…AKA near total.
.
And the “Just-In-Time/Sole-Source in China” world-wide, Multi-national corporation, economic shut down virus is gathering a huge economic momentum. Nissan has shut down auto production in addition to South Korea’s Hyundai for lack of Chinese parts. Rumor has it that Ford has the same issue — as their heater coils in their autos are sole sourced in China — and will soon shut down auto production.   Anything cheap or disposable in the world economy is sourced in China, and the Chinese economy is now off-line for the foreseeable future.
Near Term Economic Projections for China
Near Term Economic Projections for China
.
Third, China is again playing games with COVID-19 numbers and particularly the announced deaths to keep the death rate at 2.1%, saying deaths were “double counted”?!? (See JP Morgan graphic).
.
Dodgy Chinese COVID-19 Infection Numbers
Dodgy Chinese COVID-19 Infection Numbers
.
 This has been ‘officially noticed’ by the White House.
.
See:
White House does not have ‘high confidence’ in China’s coronavirus information, official says
.
.
Fourth, American COVID-19 are now officially 15 with a case in San Antonio, Texas from a Wuhan evacuation flight and no deaths. I say “officially” as there possible COVID-19 death in Boise, ID. See:
.
.
The possible COVID-19 victim was a 71-year-old man found dead on Feb 9 in an advanced state of decomposition. He returned from China Feb 5. The initial testing came up negative, but additional tests are being run. The cause of death has not been released.
.
An idea of what “Community spreading” in Singapore means can be seen in the following report:
.
“Singapore Casino employee confirmed with COVID-19; symptomatic Feb 5, hospitalized Feb 9
On February 13, 2020, the Central Epidemic Command Center (CECC) pointed out that the confirmed case of coronavirus disease 2019 (COVID-19) in Singapore announced on February 11 is an employee at the casino in Resorts World Sentosa Casino. The employee developed symptoms on February 5 and was hospitalized in isolation on February 9. Travelers who visited the casino during the communicable period (February 4-9) are advised to call 1922, put on a face mask and seek immediate medical attention as instructed if suspected symptoms develop within 2 weeks. Moreover, such travelers should inform the physician of any relevant travel history when seeking medical attention.”
.

.

World Headline Summary:
.
o China says 1,716 medical workers have been infected
o Singapore reports largest daily jump in cases amid increased human-to-human transmission
o Hong Kong reports 3 new cases
o Hubei’s new party boss orders quarantine tightened
o President Xi touts new “biosecurity law”
o Hong Kong Disney land offers space for quarantine
o Chinese company says blood plasma of recovered patients useful in combating the virus
o US mulling new travel restrictions

-end-

A Modest Proposal

by

New ‘Medicare for All’ Bill Would Kick 181 Million Off Private Insurance

Now might be a good time for new federal legislation requiring all members of Congress to use only Medicaid for their own non-emergency medical care. The plan’s features could include:

-Doctors assigned randomly from a list of the Medicaid providers in each member’s district.

-Penalties (fines? misdemeanor/felony? the posting of the member’s name in an online ledger?) for going outside of this system for treatment without prior approval.

-Prior approval to require a unanimous vote by a panel of citizens selected randomly from a list of the registered voters in each member’s district.

Of course this legislation would have no chance of passage. Its purpose would be to make Congressional single-payer advocates explain why they should be exempt from it, and then why the rest of us should be be subjected to their hare-brained socialized-medicine schemes.

Make them live by their own rules, as a great man once said.

Some thoughts on what health care reform could look like.

by

I have previously posted some articles on the French healthcare system, which is the best in Europe.

Here is an article on the French system.

The French citizen or resident joins Caisse Nationale d’Assurance Maladie deTravailleurs Salariés (CNAMTS)—health insurance organisation for salaried workers. That covers about 80% of the population now and it pays 80% (often more like 70%) of a fee schedule for the doctor visit although specialists are allowed to charge more. French doctors are divided for payment and fee schedule purposes into three “sectors” after 1980. Sector 1 doctors agreed to abide by the fee schedule established in 1960, modified for inflation and technological changes. They are mostly primary care doctors although some had waivers from the fee schedule prior to 1971 because they were more experienced or had great reputations. Few are still practicing. Sector 2 doctors could set their own fees but reimbursement was still determined by the fee schedule. These two categories correspond roughly to Medicare assignment in the US. If you accept assignment, you agree to accept Medicare payment as the full payment (or 80% of it plus the Medi-Gap payment).

The French have private insurance that acts like US “Medi-Gap” polices but for all.

It seems unlikely to me that Democrats would accept a health plan that allowed balance billing, which is the only way to control costs, short of pure rationing. The French basically provide a fee schedule that is the same for everyone but which allows doctors to charge more if the patient is willing to pay. For example, I called the office of a new internist last week to schedule an appointment. The clerk required that I submit all my insurance information, not my health status, and the doctor would decide if he would see me. If he is that busy, perhaps he could justify charging more.

Here is another article from that series explaining the French system.

French primary care physicians are paid less than American but medical school in France does not require a college degree and is free. I suspect that system might be more attractive in the US than many realize.

Unfortunately, such a radical reform is unlikely. There are other options under consideration.

Read more

Russia to healthcare in one day. What now ?

by

Last Friday, the Mueller report was submitted to the DOJ. Monday, left wing media saw ratings collapse.

What next ? Why Healthcare, of course.

Obamacare, which is a form of expanded Medicaid, costs too much and provides too little care (high deductibles) unless you are a Medicaid recipient. It was designed to shift costs to the insured from the poor. It also was a gift to certain sectors of the healthcare industry. Ted Kennedy criticized healthcare as a “cottage industry” with lots of independent doctors doing their own thing as small businesspeople. That is why doctors have traditionally been conservative. Obamacare changed that. Healthcare is now an industry with doctors mostly on salary and controlled by administrators.

I talked to a young ophthalmologist last week, who had treated a mild eye disorder. He told me he moved to Tucson to work at U of Arizona medical center, which used to be called “UMC” by everybody in Arizona. He explained that the UMC administrators had gotten deeply into debt installing a new “Electronic Health Record” system and sold the UMC to Banner Health. This is a chain that runs the former UMC and has seen an exodus of university faculty physicians. Even my barber noticed. He told me several weeks ago that his surgeon, who had operated on him, got tired of constantly being told he only had 15 minutes to see each patient and left for the VA. The ophthalmologist was disappointed as he had looked forward to working at the academic center.

Traditionally, administrators hated doctors. We made their lives more difficult by advocating for patients. I once told an administrator that if the hospital did not reduce the markup on pacemakers, I would testify for the patient if they sued him for the balance of the bill. They didn’t like it but knew I could go elsewhere,and take my patients there. If I had been an employee, I would not have that choice. Several years ago, I explained how we started a trauma center in our hospital. Since then, the hospital has been sold to a non-profit run by nuns. The surgical group that ran the trauma center for 35 years was fired two years ago. They had declined to sell the group to the hospital. They were replaced by six female surgeons no one had ever heard of and who had never applied for privileges at the hospital or been evaluated by the Surgery Department. No one knew anything about them except one member of this new group had applied for a job at the trauma group and been turned down.

There were a few comments about some less satisfactory results on trauma cases but that has quickly gotten quiet.

Read more