The Aesthetic Center

LETS NOT DO THIS AGAIN! Seven weeks ago (July 13th), California shut down again after relaxing restrictions and the Memorial Day/July 4th holidays. Here we sit again about to go into another holiday weekend and things are looking better. Here's the latest Kaweah Delta: 36 inpatients and 8 people in the ICU. That is way down from where it had been.... Tulare County: rates of new cases are falling with a 7-day average of 99 cases. Still too many but the trend is better. CA: rates also falling but over 5000 people per day are being diagnosed US: interestingly, rates have gone from falling to flat. This is seen with increasing rates in the northern tier states, many states in the center of the country and case rates are rising again in the East Coast. Only 9 states show falling rates of infection. California has made some progress. Let's not blow this! Relax with family and friends but not too many and with masks. The Governor is relaxing restrictions AFTER the Labor Day Weekend, but that doesn't mean we stop wearing masks or being socially distant. Hang in there! We can do this! Have a safe weekend.

Pandemic Lessons Learned The old lesson about learning from history and avoiding the mistakes of the past seem really important as we navigate 2020. What can we learn from worldwide infections of the past? Jessica Pearce Rotondi highlighted 5 things in an article for the History Channel. The full text is here: https://www.history.com/news/pandemics-lessons. ... 1-Quanantine: derived from the Italian word for '40', it was the number of days people from plague ridden cities needed to wait before entering clean areas. Naval soldiers returning from World War 1 were quarantined to try and stop the spread of the Spanish Flu. 2-Social Distant Food and Drink Pick Up: During the Italian Plague of the early 1600's, citizens used wine windows (burchette del vino) to sell wine to others without having to go into the streets. Who knew drive up windows would become so popular? 3-Mask Wearing: I actually saw one of these suits at a Vinegar tasting in Germany. During the plague, Doctors wore masks with long beaks packed with herbs to help with distancing and the herbs were thought to keep the wearer safe. During the Spanish Flu, some cities required masks and threatened those who refused with fines, jail time and having their names printed in newspapers as "Mask Slackers". 4-Washing Hands and Surfaces: self explanatory 5-Fresh Air and Adaptive Schooling: Over 130 American cities had outside classrooms to decrease the spread of Tuberculosis. Just a quick update: Tulare County, California and the US as a whole are seeing their new case rate decreasing. This is really good news but as the Labor Day Holiday approaches, all of this can be undone. Stay safe. Don't be a Mask Slacker!

Some Good News Here at Home I have mentioned Kaweah Delta Medical Center numbers before and how to access them. I thought I'd take this opportunity to reexamine the numbers put out each day by our local hospital; especially since they have shown some improving trends. US and state wide, our numbers seem to be flattening. Tulare County actually has some recent increases which is concerning. Some of those numbers are from the recent data snafu with California, but this shoul...d be sorted out by now. Here are the most recent Kaweah numbers and you can access them yourselves just by searching Kaweah Delta Covid. As of 11 am yesterday: -49 inpatients with COVID-19 -6 patients are on a ventilator -Test Positivity Rate is 14% (I believe that's a 7 day average) If you click below that, there is a link to the full report. -14 day average positivity rate is 16% and dropping -221 patients tested positive in the last week and the trend is also down. While Tulare County seems to be increasing, here in Visalia, we are doing better. Congratulate yourselves on the hard work and sacrifice we all have been doing to help ourselves and those around us. We've seen this virus come back so no letting up now. See you next week.

WHAT KINDS OF MASKS WORK BEST? So this thing has been going on for weeks and nearly every post talks about wearing masks. We all have a job to do if we want to get back to some sort of normal. So which mask is best? GREAT QUESTION and someone finally tested a bunch. In a paper published August 7th, 2020, a group of researchers from Duke University took very inexpensive materials and put together a testing box looking at droplet production with normal speaking and then rete...sted that with various mask materials. The link is at the bottom for those interested in the specifics. The important thing to know is these tests are done so that assumptions of what might work can be shown to be correct. More importantly, they sometimes show that assumptions are not good enough. Not surprisingly, professionally fitted N95 masks and surgical masks worn in the operating room and hospitals work best. Most masks work better than nothing. Even a bandana was better than nothing but was getting close to the droplet transmission of no mask at all. What was surprising were the fleece gaiters worn around the neck and put up over the nose when around people. The droplet transmission was actually greater than not wearing a mask. How does that work? Well the authors saw that larger, heavier droplets produced when speaking were actually being broken up by the fleece, resulting in increased number of droplets. The concerning thing is that more droplets and smaller droplets stay in the air longer, potentially increasing infectious risk. Stay safe. Wear Your Mask. Don't use a Gaiter! https://advances.sciencemag.org//2020/08/07/sciadv.abd3083

Maybe some good news? I know, hard to imagine but I think there is reason for some optimism. However, this is not a sign things return to normal. OK, the good news. Overall new case rates for the US and California have been flat. This means that some places are going up, some are going down and some are holding steady. ... GREAT NEWS TULARE COUNTY! We are actually seeing something of a decrease county wide. You've been wearing your masks so new cases are heading down. But remember, I said back on June 2nd (2 months ago), that perhaps we were heading back to normal. Clearly that didn't happen. Between Mother's Day, Memorial Day and July 4th, we didn't heed the recommendations, a new spike happened and we're worse off than before. Now, some bad news. Death numbers have increased as those exposed, then infected, have now succumbed. The CDC reports that people die, on average, 11 days after diagnosis. Some quick math says that if those infected over the July 4th weekend take two weeks to show symptoms and then another 2 weeks to perish, that's one month and that is where we are now. Our next major holiday is Labor Day and that is on September 7th. Schools also come back into play but for the most part are online. Take this next month as an opportunity to get ahead. Hold on to your hats, because an easy slide this Labor Day means months of additional closures, shuttered businesses and bankruptcies; none of which we need. Wear Your Mask and Stay Safe!

NOT JUST FEVERS, COUGH AND SHORTNESS OF BREATH! We've all heard the "typical" symptoms of this virus. "Call your Doctor if you have fevers, cough or shortness of breath". And according to a CDC study published last Thursday, 96% of the patients studied had one of those symptoms and 45% had all three. Not surprisingly, hospitalized patients had more complaints of shortness of breath compared to non-hospitalized patients. However, this study also found that of those with s...ymptoms, 50% of patients had symptoms from their intestines with diarrhea being the most common. UCSF is finding this as well. Here is a link to the full article that discusses the other ways the virus attacks the body and very interestingly, how the immune response may do more damage in some people than the virus itself: https://www.ucsf.edu/magazine/covid-body They published their findings of testing done in the Mission District in San Francisco. Of those testing positive, 53% HAD NO SYMPTOMS! Of those with symptoms, most people start with a fever, dry cough and a loss of sense of taste and smell. From there, the conditions can progress. Diarrhea, heart damage and heart failure, blood clots, COVID toes and rashes are just some of the concerns. It also seems capable of attacking our children with a pediatric inflammatory syndrome. It's not all doom and gloom but the important take aways from this are the following: -Most patients with the virus don't have symptoms making it easy to spread and not know it. -Most people with symptoms don't describe this as their typical cold or allergy with fever and cough being common. -We are still getting to know this virus and how it behaves and recommendations will change as our knowledge improves. Wear your mask! Continue Social Distancing! Stay Safe!

Mixed Messages (but not at the end of this post) With all of the news of COVID numbers, it's hard to know where we are. Doctors are trained not just to look at the numbers, but in many circumstances, focus on the trend. It's like losing weight. Different scales may show you different numbers, but if you pick a scale and you see the trend is down, then you know you're doing well. So what are the trends? US: Trending up in cases with a 7 day rolling average of new cases at ...nearly 67,000 but about 58,000 reported yesterday CA: Curve is flattening with a 7 day rolling average of about 9000 cases but yesterday was about 12,000. Tulare County: trending flat with 136 cases per day over the 7 day average but 213 cases yesterday Locally, how is Kaweah doing? Not great. They show a dramatic increase of 439 patients last week up from 326 cases the week before. They point out that these are all new cases and NO DUPLICATES. Also, yesterday there were 65 inpatients testing COVID + (trending up) and 9 patients on a ventilator with COVID (also trending up). In addition, they show that 40% of all the patients who have tested positive since they started testing were between the ages of 20 and 40, nearly double the percentage of cases from 50-70. When the trends are mixed, you hunker down and wait for the dust to settle. So keep wearing your masks, and avoid large gatherings if you can. Lastly, I want to send a personal note to all of you that have read and shared these posts. Originally, I felt compelled to try and give people a better sense of what I saw given my connection to so much of the healthcare in our little corner of the world. I was amazed and grateful to the overwhelmingly positive response. Last week, my post reached over 10,000 people. So many of you shared it! I am humbled beyond words and so appreciative. Please stay safe and we'll get through this together. Have a great week!

Shut Down Again, but Let's Talk Numbers! I spent the weekend thinking about aspects of this pandemic I really hadn't talked about before. And then, this morning, our Governor essentially shut us down again because of the surging numbers in our state. So let's talk about those numbers. Our CDC's estimates of Flu cases and deaths from October 1, 2019 to April 4, 2020 was 39 Million and 24,000 respectively (and that was the LOW estimate). That's a death rate of 0.06% or 6 dea...ths per 10,000 cases.(Again, LOW estimate). Current US cases from this Corona Virus are 3,352,696 with 135,512 deaths. That's a death rate of 4.02% or 4 deaths per 100 cases (That is 67 times MORE deaths than the flu). How about California? 327,735 cases and 7056 deaths for a death rate of 2.2% (That's 37 times more deaths than the flu). Tulare County is 5942 cases with 152 deaths for a death rate of 2.6% (Better than the US as a whole but worse than California). Some folks might say the numbers are wrong or misleading. Nobody's perfect. So, for the sake of argument, let's say that the number of US deaths is wrong by 50%. That would mean that there were only 67,756 deaths for a death rate of only 2%. That is still 33 times more deadly than the flu. This thing is no joke. Someone who should know about numbers is Robert Kaplan, President of the Federal Reserve Bank of Dallas and former Professor of Management Practice at Harvard Business School. He was quoted on July 10th with this; "If we all wore a mask, it would substantially mute the transmission of this disease and we would grow faster," he added. "We would have a lower unemployment rate ... and we would be less likely to slow more of our reopenings." Slow transmission, less shut downs, better economy, lower unemployment rate. I think we can all agree on this. Have a better Tuesday.

Surge or No Surge-That is the Question It's not news that cases are increasing. Tulare County had 382 cases reported yesterday. That's a new record by far. It does however represent the weekend as well so it's not quite fair, but the seven day trend is devastating. We as a community must slow this down. Kaweah Delta is nearly full. Again, the reality isn't quite what it seems. The COVID numbers are fairly stable. However, the hospital doesn't just take care of COVID ...patients. It takes care of all comers. As we as a community have returned to some of our other activities, other injuries, accidents, heart attacks, strokes, etc. have increased. So Why Does Any of this Matter? All one has to do is remember what China, Spain, Italy, and New York went through with hospitals overrun. Deceased patients were placed in cargo containers because the funeral homes were full. Now we're seeing the same things in Texas and Arizona. We do not want to go back to stay at home orders. For all these reasons and what I've said before about protecting the most vulnerable, please wear your masks. I know I sound like a broken record but the truth bears repeating. Care for yourselves and your loved ones. Please don't be the reason they are no longer with us. Stay safe.

Surge 2? Wow, what a difference a week makes! You've all seen the news with increases essentially across the board. Florida, Arizona, New Jersey and Texas are seeing such increases in numbers that they are closing bars. California has seen a similar increase and our bars are closed now too. Tulare County's numbers, while high seem to have flattened over the last few days. Kaweah Delta is updating their reporting site so the last numbers we have are from last Friday (4 day...s ago). COVID + patients total and those on ventilators were stable. Interestingly, their number of available ventilators had decreased from about 68 to 55. Are these patients who have other issues, such as post Cardiac or other surgery? Are they COVID patients who are awaiting testing results? We'll have to wait and see. It appears that our Governor is focusing on high risk, high transmission activities (such as drinking in a bar) for now. If we can continue to socially distance and wear our masks, keep the rate of infection stable or lower, we may be able to continue going out. No one wants a return to where we were but if our hospitals get overwhelmed, people will suffer needlessly. Wear your mask! See you next week. Enjoy your fun but socially distant Fourth of July!

Antibody Testing is Available! Late last week Kaweah Delta made antibody testing available to all providers in the community. If you have an interest in knowing if you have been exposed to COVID-19, please see your primary provider to order the test. Here are the locations currently available in Visalia to go once you have the order: 100 Willow Plaza... Kaweah Admissions and Testing Services (KATS) Kaweah Delta Imaging Center Kaweah Delta Exeter Health Clinic Sequoia Prompt Care Kaweah Delta Medical Foundation (Visalia Medical Clinic) It is a blood test so be prepared for a sample to be taken. As I presented last week, cases are going up. California yesterday had 6541 new cases in ONE DAY! and had it's highest day by over 2000 cases. But more importantly, Kaweah Delta's patient numbers are stable. Please take care of yourself and others by wearing a mask when you are out. Stay safe and healthy!

Increased Exposures = Increased Infections! It's pretty clear that as we return to our more normal activities our infection rates will increase. Mother's Day and especially Memorial Day saw lots of gatherings. The #BLM movement and protests also saw huge groups of people in close quarters. Many were still wearing masks but many weren't. Here are the numbers:... Tulare County, while higher than before, the rate of new cases seems flat California had a brief slowdown but now continues to head up US, which had been decreasing is now trending up Between the increased exposures and the increased testing (up 50% from mid April), it would be expected that the numbers increase. That number isn't as critical. Even Dr. Fauci has said that increased infection numbers don't necessarily mean an second surge. What does matter is increased hospitalizations. Here are Kaweah Delta Numbers from yesterday: 38 Inpatients + for COVID19 (nearly 50% increase from prior days when it trended in the mid 20's), Ventilator patients at 6 (had been trending 4 to 5) and a Positive testing rate of 9.2% since the beginning (these are just Kaweah numbers, not Tulare County as a whole) Here's the harsh reality: Without a vaccine (remember, we don't have a vaccine for the common cold), the virus remains in our communities. Like the flu, it will continue to spread. Those that are exposed that will die, will die. Those that are exposed that will live, will live. Those that are exposed that get really sick will die IF the hospitals are overwhelmed. Our job is to slow the virus enough so the hospitals aren't overwhelmed. That's where our wearing masks comes in. If you are infected and don't know it, you minimize exposing other people by wearing a mask. Please help your Doctors, Nurses, Medical Professionals and all of the essential workers that are helping us get through this by wearing a mask when out in public. It can't be said too many times. I hope all of you have a wonderful week and Happy Father's Day (this Sunday) to all the Dad's out there.

I just got my antibody test done. So what does that mean? All good questions deserve good answers. Kaweah Delta now has the ability to test for the antibodies. Be careful of antibody tests done in your doctor's office. Many tests are out there under a temporary FDA approval that is now being re-looked at. Kaweah Delta's has been approved and rigorously tested. If it's positive, it means I've been exposed to the virus with enough time to develop an antibody response. The... CDC says that takes about two weeks. If it's negative, it means either that it's too soon to develop the response or that you haven't been exposed. So, what does that mean? Unfortunately, right now, not a lot. We don't know that the presence of antibodies makes you immune to new infections. It likely does, but we just don't know. A positive result is not a Get Out of Jail Free Card! You should still wear a mask and practice social distancing while the science catches up. Right now, the data is better from a population health standpoint so we know the numbers of people in a given area that may have been exposed and infected but never developed symptoms. One bright spot is that if you do have antibodies, you may be able to help those with severe infections. The hospital can take your blood, specially treat it and then provide those antibodies to people who need extra help. Donate if you can! Please stay safe! Please remember we're all in this together and the more we do for each other, the more we do for ourselves! Oh, and for those of you who read all the way to the bottom, I tested negative. Have a great week.