This is the Covid-19 blog page of Dr. Mark Thornton, who has been blogging faithfully about Covid-19 since the beginning of the crisis. Dr. Thornton provides accurate and reliable information about the current crisis, based on his knowledge and his research.
ReMarks Spring Newsletter Well, we made it through another winter season of Flu, RSV and Covid with some norovirus thrown in for good measure. Fortunately, measles is not an epidemic and is unlikely to be one due to our herd…
“Is something going around?” is a question I am often asked. In previous holiday seasons, I have often responded, “The Christmas Crud.” Now with the improvement in multipathogen respiratory panels, I can give a more nuanced response. Before I do…
PLEASE NOTE: THE OFFICE WILL BE CLOSED NOVEMBER 27-29TH TO ALLOW US TO TRAVEL TO AND FROM THANKSGIVING GATHERINGS. AS ALWAYS, DRS. THORNTON AND WALLACE WILL BE AVAILABLE BY EMAIL, TEXT OR CELL FOR URGENT ISSUES. We are about…
Here is the latest on it from JAMA, Journal of the American Medical Association. Bottom line: If you are older and have underlying health conditions, it may help prevent you from being hospitalized or dying. Will it make you get…
My advice to take precautions against mosquitoes was timely. America’s most famous infectious disease specialist, Dr. Anthony Fauci, was hospitalized with West Nile Virus. I believe he has been released from the hospital. As expected, the FDA approved two new…
HOT WEATHER POSTS COVID FATIGUE FALL VACCINE UPDATE RSV VACCINE GUIDELINES FLU VACCINE MEDICARE ADVANTAGE Kids may have gone back to school, but summer is by no means over. I have posted some usual summer topics on my blog which…
My phone has been ringing again and that’s a sign that lots of people have Covid 19. It seems like it is worse than last summer, but according to this report , it sounds like it’s about the same as…
It is Summertime and as in previous summer there is a surge in Covid cases. Here are a trio of articles on the subject. Happy 4th of July! Above is a photo taken in the Douro River valley of Portugal. …
Two new things: There is a new monoclonal antibody that can be used every three months in immunocompromised patients to prevent infection. This will only be helpful to a small number of our patients. Also, there will be a new…
Every day or two a new case. No recent hospitalizations. What will the summer bring? Here is an article on the topic followed by news on ending vaccine coverage for the uninsured and possible combination vaccines. A new Covid variant…
Sorry, but there is still plenty of Covid going around. One would always like to avail themselves of anything that will help speed recovery. Will you get better faster if you take Paxlovid for Covid 19? Maybe not. Here is…
ISOLATION FOR RESPIRATORY VIRUSES UPDATE CDC RECOMMENDATIONS ON COVID 19 VACCINATION WEIGHT LOSS DRUGS CANCER DETECTION BLOOD TESTS INSURANCE UPDATE OFFICE CLOSURE FOR THE SOLAR ECLIPSE Spring is in the air along with oak and many other pollens. The…
Stay home until you feel better and use caution when you resume normal activities. This summarizes the new recommendations from the CDC. Covid 19 is just as infectious as ever, but deaths have dropped from 21,000 deaths a week to…
“Is something going around?”, is a question that I am often asked. “Yes”, is invariably the answer. We have been seeing colds, flu, RSV and Covid 19. They vary from day to day. It’s hard to come up with a…
Flu. Covid19. Flu. Covid 19. It seems like the cases alternate, but they are daily. Lots of Flu A circulating. Being vaccinated reduces the risk but doesn’t eliminate it. Same thing with Covid 19. A recent article suggests that…
Some people who have infectious illnesses have a rebound of symptoms following clinical improvement. There has been some debate as to whether taking Paxlovid increases the risk of rebound in Covid 19 patients who are treated with it. This is…
I estimate that 90% of the flu cases that I have seen this year have been in people who didn’t get a flu vaccine. When asked, they often sheepishly admit that they just didn’t get around to it. Others are…
One of my longstanding rules of travel is that I must read all of my journals on the plane before I can read anything for pleasure. Journals have a way of piling up and this is a good method of…
As you may have noticed, there are still a lot of people getting sick out there. RSV is supposed to be declining, but Covid 19 and flu are not. Fortunately, things are not as scary as they were two years…
Christmas may be over, but the aftermath is not. It happens every year. Respiratory infections ramp up during the holiday season. It started around Thanksgiving as families gathered together and shared more than just food. It has been worse this…
I haven’t posted much lately. There is plenty of Covid 19 still out there, but vaccine rates continue to be low. People are tired of vaccines, apparently. Still, it’s a good way to avoid getting sick or severely sick. Unlike…
As we head into our fourth year with Covid 19, this is a reasonable question to pose. This is an interesting editorial from this week’s New England Journal of Medicine on the subject. Perspective Do Pandemics Ever End? List of…
I got my updated Covid 19 vaccine at the pharmacy today. I scheduled it online. Here is why I didn’t want to wait. San Antonio COVID cases continue to rise; 5 deaths reported in the past week Texas Public Radio…
As predicted the FDA approved the new Covid 19 vaccines from Pfizer and Moderna. Today the CDC’s advisory committee, the ACIP, recommended the vaccine be given to patients 6 months of age and up. I wish Covid would go away,…
Here is an interesting Q+A from The Washington Post with infectious disease and vaccine specialists about how they are dealing with the rise in cases of Covid 19. Do they mask? Are they eating out? How covid experts are living…
As Covid 19 cases have risen, I checked under my sink, which is where I have kept my supply of Covid 19 tests, to see if any were expired. Many of them were and I haven’t found any useful advice…
Fall Vaccine Update “Fall”, I like the sound of that. It may not be here for a while, but already the temperatures have begun to moderate from the hottest summer on record. Now if we could just get some…
People are concerned about the rise in Covid 19 infections and would like to know if the new vaccine will be recommended for them. Unfortunately, I can’t tell them. Although we have information that the vaccine will be released in…
As previously reported, there is a lot of Covid 19 going around. Chances are, it won’t kill you if you get it. Not so, the other virus circulating. West Nile virus can be a real killer. It’s not spread from…
Covid 19 cases are increasing. COVID-19 Hospitalizations Continuing To Increase In US, CDC Says ABC News (8/15, Benadjaoud, Kekatos) reports, “COVID-19 hospitalizations are continuing to increase in the United States, according to the” CDC. Data show that “for the week…
We had been led to believe that the new Covid 19 vaccine would be available in late September. Apparently, that is correct. However, we don’t know anything new as far as who should receive it. New COVID-19 Vaccines To Be…
Let’s hope that you have better things than discuss the latest variants with your friends over wine. The XBB.1.5, our dominant variant for months has now been replaced by it’s cousins. However, they are closely related enough that this fall’s…
Unfortunately, numbers continue to climb. Hospitalizations for Covid 10 are on the increase as well. I ran across this article and thought it had some good practical advice. It is all something that you should have heard before. but a…
We should know later this month about a new Covid 19 vaccine. We don’t know yet for whom it will be recommended. Here is an update from today’s US News and World Report. When the report comes out we will…
It’s true, unfortunately. There is a rise in Covid 19 infections. Fortunately, numbers are still low, but it is something that we need to be aware of and we don’t have the monitoring systems in place that we had before. …
One of the greatest challenges of the pandemic was combating widespread information some of which came from physicians. I was shocked to see the recommendation recently from a patient’s family member that she take two widely discredited drugs for her…
Every year 6,000 to 10,000 older adults die of Respiratory Syncytial Virus.https://www.cdc.gov/rsv/high-risk/older-adults.html Most people associate this with a disease of children, but it also affects adults. When you get RSV you usually cough for 3 weeks. One of my patients…
Since the beginning of the pandemic, we (the medical community) have wondered why some people get very sick from the virus and others do not. W assumed that there must be subtle genetic differences that account for this. Now there…
Update on Office Policies Telemedicine New Receptionist/ Physician’s Assistant Sunscreens Insect Repellents Travel Medicine Avoiding Heat Stroke Summer is officially here. I wanted to update you on some practice developments as well as give you some advice…
Here is a news summary on the FDA’s recommendation for the composition and administration of a new Covid 19 vaccine. The recommendation is that it be based on the most prevalent strain circulating. MRNA vaccines can be tailored more…
Most people think of RSV as a childhood disease, but it affects a lot of adults each year and is responsible for 6,000 to 10,000 deaths annually. One of my patients had the misfortune of having both in December and…
As anticipated, the FDA approved a second dose of the Bivalent Covid 19 booster (the only one available now) for adults 65 and older and those people who are immunocompromised. The next article is one about vaccine developments that are…
Even though only 17% of eligible Americans have gotten Bivalent boosters, many patients ask me if they can get another, Here is some recent information on this. F.D.A. Plans to Allow a Second Updated Covid Booster for Vulnerable Americans…
Covid cases are down and we are relaxing our office policies to reflect the decreased risk of transmission. But it is still with us. I had two more cases last week. While it is often “just another cold’ in symptoms,…
After three years if Covid 19 we have a lot better idea about what works and what doesn’t. This is an article from The Medical Letter which is a nonprofit organization that publishes medical reviews which are not subject to…
We are almost at the anniversary of San Antonio’s shutdown three years ago. We are still seeing Covid cases almost daily. Since most people have some immunity by being vaccinated, being sick or both, we don’t see many seriously ill…
I haven’t been blogging much recently. Call it Covid fatigue. Influenza and RSV seem to have peaked and gone away, but Covid remains. Not a day goes by that I don’t get a call from a patient who has Covid…
As I have said previously, bivalent boosters have been a tough sell. They do work, however, as this report of a study done by the CDC shows. They compared positivity rates on tests done in a pharmacy and compared it…
Here is one of the articles that may have inspired patients to ask me about all the people dropping dead from Covid 19 vaccines. As it turns out, it was a post on the website Expose misinterpreting or intentionally misrepresenting…
Here is an update on tripledemic numbers followed by news on the FDA’s recommendation for an annual Covid 19 vaccine. I’m still looking forward to information of nasal vaccines which may have the effect of reducing the risk of any…
Here is some information on where we are on the perfect storm of flu, RSV and Covid 19, AKA ” the Tripledemic” from the Texas Medical Association followed by an article which addresses some recent concerns about “safety signals” in…
I don’t know if it is just Americans who love conspiracy theories or whether it is a worldwide phenomenon. What is the first conspiracy theory that you heard of? JFK’s assassination? The moon landing? The advent of the internet has…
“I thought it was just my cedar allergy”. People call with their respiratory symptoms, and I ask if they have done a home Covid test. Often, they reply something like, “Oh, I’ve had Covid, and this doesn’t feel like that.” …
The latest Covid 19 variant has been given this ominous moniker. Here is some current information on XBB.1.5 aka “the Kraken”. Bloomberg What We Know About the ‘Kraken’ Covid Variant XBB.1.5 and Why It’s Causing Concern A healthcare worker prepares…
ILI= Influenza Like Illness. The holidays have contributed to the rise in the number of respiratory infections, RSV, flu and Covid 19. Plus, there are the other rhinoviruses and adenoviruses that circulate this time of year. While flu and RSV…
No, it’s not vodka. We usually don’t make toddies. There are not cures for most respiratory infections, so we treat the symptoms and outlast them. This was an interesting article from the Wallstreet Journal. I think that most physicians shy…
The painting is called Arrangement in Grey and Black Number One,but is commonly referred to as Whistler’s Mother and hangs in the Musee D’ Orsay. Someone sent this to me right before Thanksgiving and I didn’t have time to post…
“Don’t travel” won’t cut it. One of my patients asked why I hadn’t posted lately. I said that I didn’t have any new news and that things were getting worse. The “Tripledemic” is a reality. People don’t want to hear…
Tripledemic is the term that has been coined to describe a surge in cases of three viruses this fall, Covid 19, Respiratory Syncytial Virus and Influenza. My phone has been ringing again. Not a good sign. There are new flu…
Bivalent vaccines have been a tough sell, but with new variants BX 1 and BX 1.1 increasing, getting one of the new boosters before the holidays is a reasonable thing to do. Studies have shown the neutralizing antibody levels…
Often times in people with Covid 19 it is not clear whether they should be treated with medication if their symptoms are mild. This article, which has not yet been peer reviewed, suggests that treatment with Nirmatrelvir (Paxlovid) may prevent…
The Flu season is off to an early start this year. Respiratory Syncytial Virus is also on the rise and while it usually affects children it also causes disease in adults and kills about 14,000 people a year. Covid 19…
Will there be a Covid wave this winter? Time will tell, but this is an interesting article from The Washington Post that tells us what might happen and why. Following that is an article from The New York Times which…
People’s minds are pretty well made up when it comes to boosters for Covid 19. It’s hard to change anyone’s opinion regarding their safety or effectiveness. Sad. Here is a summary of some modelling about the number of lives and…
It’s nice to give good news. First of all, the new vaccines are better than the old ones. Of course, if someone is not predisposed to take vaccines, this will fall on deaf ears. This is the abstract of a…
Some people are fond of telling me the number of people that they know who have been vaccinated and gotten Covid 19. I remind them that the vaccines were designed to keep people out of the hospital and out of…
I wanted to cover briefly, my views on 4 viral issues in the news. Influenza vaccine: It’s available now Covid 19 Bivalent vaccine: It’s available now Monkeypox: I wouldn’t lose sleep over this one Polio: Ditto INFLUENZA VACCINE We have…
Here is the FDA’s News Release from today. It includes data that shows that the antibody levels in patients who received the bivalent booster (containing components against the original virus and BA 4+5) and the original booster. After one month…
Here are a couple of new articles on the new vaccines followed by ordering information. One has to do with whether one should get a second booster vaccine before the new ones are out from the New York Times. There…
It’s not just cost containment, but cost shifting. More of the cost of vaccines and medication will be covered by individuals and third-party payors. Here is an article from today’s Wall Street Journal covering the government’s plan. Biden Administration Plans…
This is a photo of mothers lined up with their children to get an experimental polio vaccine in the 1950s. First Covid 19, then Monkey Pox, now polio? Do I need to worry? No. Not at this point. Most of…
Here’s an article for todays’ New York Times regarding the Center for Disease Control’s update released today on quarantine and isolation in patients who have, or are exposed to, Covid 19. C.D.C. Eases Covid Guidelines, Noting Virus Is ‘Here to…
A bivalent Covid 19 vaccine is coming sooner than expected. It was forecast for the fall. I thought it would be middle to late fall, but now it is said to be coming next month! The new vaccine would be…
As I mentioned in a previous post, small molecule treatments for viral illnesses, those that can be put in a pill, take years to develop. Large molecule treatments like monoclonal antibodies are easier to develop quickly, but less convenient to…
This is a practical advice on what do and what to expect when recovering from Covid 19. Everyone is different, which makes it hard to make recommendations. I thought this article from The Wall Street Journal had some reasonable advice.…
Here is an interesting article from the New York Times from a virologist who sheds insight on variants, vaccines and what virologists think about what the future holds. Did you know that hippos can get Covid 19? I knew that…
Here is an article from this morning’s New York Times which is a nice summary of where we are. If you have not had a second booster, get one. Don’t wait until the mid-fall when a newer vaccine is supposed…
Here are several recent articles from the Wall Street Journal on the treatment and prevention of Covid 19. Bottom Line: We will run out of monoclonal antibody treatment in late August. If the government doesn’t pay for it, will you…
Sicilians, along with other Italians continue to emphasize outdoor dining to limit the spread of Covid 19. Above is a street in Noto, Sicily. I’m not home but my phone is still ringing. Never a good sign. Now things continue…
Here is an article from the New York Times about yesterday’s meeting of the FDA vaccine committee. It looks like the concensus was to develop a vaccine that targets Omicron variants, BA 4 and 5, not just Omicron. That is…
Paxlovid has been shown to be effective in reducing death and hospitalization in unvaccinated patients at risk for severe Covid. Now there is a study which shows that it is effective in vaccinated patients as well. The caveat is that…
Here is something from this morning’s WSJ on the problems associated with being abroad and testing positive for Covid 19. Now, if I am getting on an airplane for an 8-10 hour flight, I would like to know that the…
I would like to say that things are better, but they aren’t as far as numbers go. People act like it is over, but it isn’t. We have better treatments, but cases are up so it makes sense to do…
Here is an interesting editorial from last week’s Journal of the AMA, JAMA, which summarizes where we are in the pandemic. May 27, 2022 COVID-19 in 2022—The Beginning of the End or the End of the Beginning? Carlos del Rio, MD1,2; Preeti N. Malani, MD, MSJ3,4 Author…
COVID-19 Rebound After Paxlovid Treatment Distributed via the CDC Health Alert Network May 24, 2022, 9:00 AM ET CDCHAN-00467 Summary The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to update healthcare…
People have felt cooped up for a long time and are anxious to travel. Many are traveling internationally. Is it safe? Well, there is a lot of Covid 19 circulating in Europe, but there is a lot circulating here as…
I often tell patients that medication doesn’t help the bottle in which it is contained. It will only help you if it is taken. Likewise, vaccines will only help you if they are taken. If you haven’t gotten a first…
As mentioned previously, newer variants are able to evade the immune response due to previous infections and to a certain extent, immunizations. Here is an interesting article on the subject from the New York Times. One of the interesting points…
My phone is ringing again, never a good sign. Cases are rising as the graph shows and these are under reported since most of the cases are diagnosed from home tests. 50% of Americans got Omicron earlier in the year. …
People ask if they should get a Covid 19 booster if they have already had Covid. I advise them to if they are over 50, because the antibody response to recent variants is not as robust compared to those vaccinated…
First of all, masks are still recommended in clinical settings such as hospitals and doctor’s offices. I will continue to wear an N95 mask on airlines. If I upgrade to first class and am sitting next to my wife, I…
Here’s a view of what’s happening in the Northeast followed by a local update. Courtesy of the New York Times and the San Antonio Report. A Covid uptick Covid outbreaks in elite circles in Washington, D.C., and on Broadway…
After two plus years we know a lot about Covid 19. We certainly don’t know it all, but we know a lot more about what works and what doesn’t than we did a few years ago. In spite of many…
24 states report a rise in Covid 19 cases. It looks inevitable that eventually Texas will as well. Here is an interesting article from the Wall Street Journal that covers what numbers to watch and how to be prepared. Following…
My phone hasn’t been ringing as much in the last week. That’s good. We are still seeing sporadic cases but so far the surge of Omicron BA2 cases has not emerged. Most cases that I see are are diagnosed by…
I have a feeling of deja vu. The debate over whether a second booster shot is needed sounds like the debate last year about whether a first booster shot is necessary. The problem is that there is not a lot…
As expected, yesterday the FDA approved a second covid 19 booster for people age 50 and over. Here is the FDA news bulletin. FDA NEWS RELEASE Coronavirus (COVID-19) Update: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Older…
My phone is ringing again, not as much as in January, but things seem to be heating up again. I’ve had a flurry of cases in the past week. Cases are still low but, are rising in certain parts of…
Pfizer has applied for emergency use authorization for a fourth dose for adults of it’s Covid 19 vaccine. Just because they are applying for it doesn’t mean that you have to run out and get one. Independent experts need to…
Here is an article from the TMA published today on the latest recommendations. CDC: Masks Still Recommended for Everyone in Health Care Setting By Sean Price Does the Centers for Disease Control and Prevention (CDC) recommend masking for physicians and…
Two new articles regarding Covid 19 vaccine. The first is from Bloomberg News on Pfizer’s vaccine. The second is from today’s New England of Journal which shows the efficacy of Covid 19 vaccine boosters in preventing Omicron. Boosters were more…
Painting by Taylor Thornton While Covid 19 cases are low and it recedes to the back of our collective brains, it is important to remember some of the long-term effects may be. Patients and friends would question whether it…
TWO YEARS OF COVID 19 It was in early March 2020 that I saw my first patient with Covid 19. We didn’t know it at the time, but that’s what he brought back from a ski trip in Colorado. According…
Masks remain unpopular in some areas and locally, it seems like few people are wearing them. Local numbers are declining , but the CDC still considers us in the HIGH LEVEL due to the hospital data. https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=Texas&data-type=Risk&list_select_county=48029 Here is an article…
First, some news about the outpatient treatment of Covid 19 with Remdesivir followed by some new guidelines on the timing of the second dose of Covid 19 vaccines. Following that is an article from today’s WSJ on BA2, the new…
It is gratifying to see numbers continue to fall, but Covid 19 is still out there and I still hear reports of patients receiving prescriptions for Ivermectin. here is the latest from the Journal of the American Medical Association. Here…
There were 1,752 cases reported yesterday. Slightly up from the previous day. The 7 days average dropped to 2,822, but the positivity rate is about 30%. Before the surge we were running a daily rate of around 200 with a…
From the graph above, it appears that Covid 19 infections have peaked. It remains to be seen how quickly they will drop and what the daily rate will become. One of the most nefarious internet myths about Covid 19 vaccines…
The map, though hard to read, is of the antiviral medications available in this area. The two tiny purple dots are the locations for the only Paxlovid in the San Antonio area. It’s the most effective oral anti-viral medication for…
As the pandemic rages on and there is no sign that it is peaking locally, here is an interesting article on what the future holds from the Wall Street Journal. The Covid Race to Watch: Vaccines vs. Variants Omicron…
The most effective masks for preventing Covid 19 are the N95 masks. As you may have read, they may be hard to find and there are reports of counterfeiting. I saw this guide from the New York Times that had…
For people who are immunocompromised, their primary series is 3 vaccinations. 5 months after the last dose they should get a booster dose per the CDC. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html Additional Primary Shot and Booster Shot for Some Immunocompromised People After completing the…
When it comes to nasal swabs, it is better to give than to receive. The hundreds of patients that I have swabbed should be grateful that I have been on both ends of the swab. It does change your perspective. …
By my calendar it looks like the local Omicron surge started the week of December 20th. It has not peaked yet that I can tell. The good news is that most of the cases that I have seen in boosted…
The National Institutes of Health (NIH) COVID-19 Treatment Panel has released recommendations that include an order of preference for which therapeutics to use to treat nonhospitalized patients with mild to moderate COVID-19 who are at high risk of severe disease…
No. At least not directly. As we have learned, we have to immunize the world to keep ourselves safe from new variants. The mRNA vaccines are not good candidates given their storage and transportation requirements. A couple of Texas researchers…
This is a very timely article for the Wall Street Journal. The last sentence is the critical one. click on the link to see the graphics displayed better.https://www.wsj.com/articles/cloth-face-mask-omicron-11640984082?st=d1mx7yt67b3pdzp&reflink=desktopwebshare_permalink Why Cloth Masks Might Not Be Enough as Omicron Spreads With the…
Despite information from the Texas Department Health Services that certain San Antonio pharmacies were to be given the new anti-Covid medications Paxlovid and Molnupirivir calls to them today revealed that they were clueless about when they would receive them. Later,…
FROM THE TEXAS MEDICAL ASSOCIATION: As COVID-19 cases surge across the country, five regional infusion centers in Texas have exhausted their supply of sotrovimab, the only monoclonal antibody treatment effective against the omicron variant, the Texas Department of State Health Services (DSHS) announced Monday. But…
Much has been said about Omicron being less severe that the Delta variant. One of the ways to tell that is when the local numbers go up, but hospitalizations do not. Mitigating factors can be local immunization rates and the…
Isolate if you are infected. Quarantine if you are exposed. Here is the latest: CDC Updates and Shortens Recommended Isolation and Quarantine Period for General Population Media Statement For Immediate Release: Monday, December 27, 2021 Contact: Media Relations (404) 639-3286 Given…
As this surge heats up, the demand for treatment has increased. The lead time on getting monoclonal antibodies has increased from a day to 5 days. It is important to get tested early if you are at high risk of…
My phone has been ringing again. That’s not a good sign when the number of calls, texts and emails surge with questions from people reporting symptoms or exposure to Covid 19. Officially, Bexar County reported 376 new cases yesterday with…
As I mentioned on my post of November 29th, I felt the Omicron variant of Covid 19 was already here. This was confirmed yesterday when it was found on two patients. One test was taken on November 27th and the…
Today the CDC released new guidelines on home testing for Covid 19. Due to the low sensitivity of the tests in asymptomatic individuals they had previously recommended limiting their use to symptomatic individuals. Now with the surge of the Delta…
Here are three things about the outpatient treatment of Covid 19. The first is the latest from this week’s New England Journal of Medicine about the efficacy of treating Covid 19 with the monoclonal antibody combination, Regen-Cov. The second is…
The photo above is of mothers and children lined up for a polio vaccine trial in 1954. A vaccine was approved in 1961. People lined up to get their children vaccinated. Everyone knew someone who had been affected by this…
Omicron is breaking news, but it really shouldn’t come as a surprise and it is probably already here. I think that South Africa is probably doing a better job of genetic sequencing than we are to identify variants. The first…
As predicted, Covid 19 Booster Update – Mark Thornton (personalphysicianmd.com) , the FDA and CDC have broadened the recommendation for who may receive a booster. CDC Recommends Booster Dose for All Adults Who Receive Pfizer-BioNTech or Moderna COVID-19 Vaccines The…
Here is some interesting news on the effectiveness of Covid 19 vaccine based on Texas Department of Health Services data. Texas physicians have strongly encouraged patients to get vaccinated against COVID-19, and a new report from the Texas Department of State Health Services (DSHS)…
Here are some handy facts from the Texas Medical Association on Covid 19 boosters. The recommendations for who qualifies for a booster are as of today. It is my belief that the FDA/CDC/ACIP will open this up soon to all…
Numbers are down and that’s a good thing. Bexar County is ahead of the Texas average vaccination rates. Judging by people’s behavior, they think the pandemic is over. Every time we have thought that in the past, numbers have surged.…
During the pandemic, people deferred medical care. We’ve all heard about how the number of patients hospitalized for heart attacks plummeted. The rates of people having heart attacks didn’t decline, just those hospitalized. Many people died of Covid-19 indirectly by…
This probably won’t convince anyone who hasn’t been vaccinated, but is useful information when someone says that they had Covid 19 and don’t need to be vaccinated. Since this virus is new, it’s been hard to make predictions about it. …
I am sometimes asked by patients if they should have their antibody levels against Covid 19 checked. The answer is usually “No” as there is no level of antibodies that confers protection. Immunity to Covid 19 is not just about…
Over the counter testing for Covid 19 is becoming increasingly popular. I am frequently asked how accurate they are. It’s a tough question, but here is a recent table from The Medical Letter which helps answer the question. The sensitivity…
Here are two summaries of the recent recommendations to the FDA by advisory committees regarding Moderna and J=J Covid 19 vaccines. Don’t run to the pharmacy asking for it as it still requires the CDC’s advisory committee, the ACIP to…
Often I encounter someone who says that they take a low dose aspirin daily. When I inquire why they invariably respond that they thought it was a good idea. It isn’t. Aspirin is a double edged sword and can increase…
Cases of Covid 19 are trending downward. That makes me feel better. It remains to be seen whether it will reach about 100 cases a day that it was before the most recent surge started this summer, but I’m ready…
Today’s New England Journal was chock full of articles on Covid 10 vaccines. Take home message. You are 18 times more likely to be hospitalized with Covid 19 if you are unvaccinated. Here’s the abstract of the first article: Effectiveness…
There was a lot of hoopla about a new oral anti viral drug for Covid 19 last week. I like to wait for independent analyses like that provided by the nonprofit, The Medical Letter. To date there are only three…
At this point it’s hard to know what will motivate people to get vaccinated. One couple I know got vaccinated when their baby sitter gave them an ultimatum. The first summary has to do with the risk of Covid 19…
Covid 19 cases are declining, but not rapidly. The speed at which the slope declines depends on how much virus is circulating. Hopefully, by Halloween, there will be approval for children to be vaccinated. In the meantime, mask wearing reduces…
“It’s a mess, aint it Sheriff? If it aint it’ll do till a mess gets here.” ― Cormac McCarthy, No Country for Old Men This is my favorite line from that movie. It applies to the recent guidelines on Covid 19 boosters.…
There is widespread confusion on the need for Covid 19 vaccine boosters, who will need them, who will qualify for them and when they will be available. Now physicians are being told that if they prescribe these vaccines off label,…
Today was supposed to be the day that everyone could start getting boosters. As usual, the devil was in the details. An advisory committee met Friday and came up with some well publicized recommendations which are summarized in the following…
First of all, remember that getting more people vaccinated is more important than getting people with more vaccines. Unless we get the world vaccinated there is going to be more virus mutating into potentially worse things. Having said that, immunity…
As I wrote in January, https://personalphysicianmd.com/hurricane-ike-and-covid-19/, Galveston has been at the forefront of research in neutralizing antibodies which are different than the ones that some people are ordering from reference labs. Even with these antibodies there is no consensus on what…
I can tell you from personal experience that masks work, but this is the largest study of it’s kind ever done which shows that wearing masks reduce the risk of Covid 19 transmission by a third in adults 60 and…
One of the most disheartening aspects on the pandemic is the amount of time physicians have to spend responding to the disinformation that is constantly being fed to patients. That some people benefit financially from spreading this bilge is especially…
The debate over whether boosters are needed continues as outlined in yesterday’s New York Times article. Don’t assume that you will be lining up for a booster on September 20th. It is still more important to get more people vaccinated…
I believe it was Mark Twain who said, “There are lies, damn lies and statistics”. From Monday’s New York Times: THE BOOSTER INDUSTRIAL COMPLEX By David Leonhardt Late last month, researchers in Israel released some alarming new Covid-19 data.…
Immunity to Covid 19 involves more than just antibodies. Antibodies are more easily measured than other aspects of immunity. There are no commercially available blood tests that will let you know if you have immunity to Covid 19. That’s one…
There have been multiple reports of animals, especially cats (big and small) getting Covid 19. You may remember 8 tigers at the Bronx Zoo got Covid 19 from their keeper. https://personalphysicianmd.com/viral-developments/ Here is the latest that the San Antonio Zoo is…
In spite of lack of proof of the efficacy in randomized controlled trials, Ivermectin has proven to be popular in some circles for the prevention and treatment of Covid 19. It is approved for use in humans in the US…
I am hoping the trend on the graph continues. Fall Newsletter 2021 Flu vaccine Third Dose or Booster of Covid 19 Vaccine Quarantine and Isolation: Updated Guidelines What to do if You Test Positive for Covid 19 We…
One quibble. I don’t know how pharmaceutical come up with names. Comirnaty. Now with the imprimatur of FDA approval maybe more people will get it. Not sure when Moderna’s will come. FDA NEWS RELEASE FDA Approves First COVID-19 Vaccine Approval…
By now you probably know of someone who has has Covid 19 in spite of being fully vaccinated. While increasingly common, they still don’t amount to a large percentage of total cases. This is one reason we are still wearing…
If you are immunocompromised, have had a transplant or have a cancer and are undergoing treatment, you should have a third dose of Covid 19 vaccine. The same as the previous one. If you had the J+J vaccine, they…
Briefly: It’s not a booster, it’s a third dose for people who weren’t likely to respond to the first two. Boosters are still being hotly debated, but probably will be given to nursing home residents and health care professionals in…
First of all it sounds like the FDA will weigh in on boosters for the immunocompromised tomorrow. We don’t know who all will be included in this group but it will most likely be those groups that have shown poor…
Here is an interesting article on the subject from today’s WSJ. WSJ NEWS EXCLUSIVE HEALTH FDA Covid-19 Vaccine Booster Plan Could Be Ready Within Weeks Extra shots are being weighed as a way to extend protection against the coronavirus as…
I just finished swabbing 15 people. Not a record, but an indication that people are being exposed to Covid 19. If the test is positive and they meet the criteria for Regen-Cov, we can send them for an infusion of…
Things are going to get better, but they are going to get worse before then. Hospitals are full and aren’t accepting transfers from within the city or outlying areas. A friend told me that a rural hospital outside of Bexar…
One of the reasons that people who are reluctant to be vaccinated for Covid 19 often mention is that the vaccines aren’t FDA approved. That is correct. Why? The short answer is PAPERWORK. This is an article in a prestigious…
The big news of the day is the change in masking guidelines for vaccinated people to resume wearing masks indoors in areas where the virus is spreading widely. Unvaccinated people were supposed to wear them, but few did. No big…
The numbers continue to rise, but the average daily rate increased by only about 100 cases a day from 265 to 363. What I hope this means is that vaccinations are preventing a precipitous rise that we saw with previous…
An estimated 2-4 % of Americans are immunocompromised by virtue of a medical condition or a medication they take to treat a medical condition. Many of them don’t show an adequate response to Covid 19 vaccines. There has been a…
Unfortunately, Covid 19 cases continue to rise. Only time will tell whether this is a bump or a surge. Here are the latest numbers as reported in TPR. Latest COVID-19 Updates For Bexar County On Wednesday, the City of San…
First of all, I in no way meant to imply that the Texas Cavaliers were responsible for the bump in Covid 19 cases. That would be a stretch. I think that the people of San Antonio were anxious to celebrate…
Great King! Phil Bakke. My phone is starting to ring again. Not a good sign. People have stories of exposure to people who have tested positive for Covid-19. We were worried if throngs gathering together would bring a rise in…
I haven’t had much to blog about recently. This is a good thing. Things seem more normal. I worked taking tickets at the Texas Cavalier’s River Parade. Downtown San Antonio was bustling. Few masks were in sight. Those that I…
One of the positive effects of trying to avoid Covid 19 is those measures (mask wearing, social distancing and hand washing in case you’ve forgotten) helped to reduce all respiratory infections. As an example, I never treated a case of…
“9 out of 10 doctors recommend…..” Sounds like an old sixties commercial. This post by infectious disease specialist, Dr. Paul Sax, summarizes a number of conversations I’ve had with different physicians across multiple specialties about their experiences with the different…
Here are some recent articles on Covid 19 that you may have missed. How long does protection from coronavirus infection last? It’s most durable in those who have been infected AND who are immunized. Coronavirus immunity lasts at least a year,…
The current masking guidelines are based on the latest medical knowledge. The problem with them is that people who are unlikely to get vaccinated are also unlikely to wear masks. People who are immunocompromised by their illnesses or medications that…
Some people Texans are grateful that the legislature only meets every other year. When you read proposed bills it reinforces that opinion. From the Texas Medical Association: Senate Bill 1669 by Sen. Bob Hall (R-Edgewood) would make every single…
I am reminded of early December when the vaccines were first to be released. I predicted that 1/3 of patients would trip over themselves to get the vaccine for Covid 19. The next 1/3 would adopt a “wait and see”…
New Covid 19 cases are low in San Antonio, but they are still out there. I was reminded of that this weekend when a patient emailed me that he and other family members had tested positive. His symptoms were mild…
I have written previously about repurposed drugs being used for Covid 19. The most recent candidates where colchicine and fluvoxamine. According to the NIH, there is not enough information to recommend using them. This is not surprising as the studies…
I have to admit, I seldom wear a mask outdoors except when I am at the nursery. I’m not close to other people when I am walking my dog. Of course, walking the streets of San Antonio is different than…
This isn’t the hot news of the day. That is CDC’s latest guidance on wearing masks outdoors, but I’ll address that tomorrow. I have frequently quoted or reposted the blogs of Dr. Paul E. Sax, a noted infectious disease specialist. …
Here’s what doesn’t work. Sorry Ivermectin fans. March 4, 2021 Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19A Randomized Clinical Trial Eduardo López-Medina, MD, MSc1,2,3; Pío López, MD1,2; Isabel C. Hurtado, MD2,4; et alDiana M Dávalos, MD, MPH, DrPH5; Oscar Ramirez, MD, MPhil3,6,7; Ernesto Martínez, MD8,9; Jesus A. Díazgranados, MD10; José M. Oñate, MD3,8,11; Hector Chavarriaga, MD, MS12; Sócrates Herrera, MD13; Beatriz Parra, PhD14; Gerardo Libreros, PhD14; Roberto Jaramillo, MD15; Ana C. Avendaño, MD15; Dilian F. Toro, MD16; Miyerlandi Torres, DrPH12; Maria…
This is the vaccine locator on the Texas Department of Health Services website. bit.ly/2Jvpru3. It is a useful tool for locating vaccine. Vaccine is available at more locations. University Health, located at Wonderland Mall, is now open to walk-ins Monday…
Even though the Texas Department of Health Services hasn’t seen fit to give me any vaccine, they still consider me a vaccine provider and what follows is the official notification of the pause in the administration of Johnson and Johnson’s…
Once again, we received no vaccine. Here is where it went. It also appears that Costco is now offering the vaccine. Someone was able to book it online with only a few days notice. https://www.dshs.texas.gov/news/updates/COVIDVaccineAllocation-Week18.pdf Yesterday morning, as part of…
I was watching a lecture on YouTube, another adaptation to the pandemic. I am a member and past president of the Texas Club of Internists, an almost 100 year old organization dedicated to continuing medical education for Texas internists. https://www.texasclubofinternists.org/.…
First of all, TDHS did not give us any vaccine for next week. Here’s where it went: https://dshs.texas.gov/news/updates/COVIDVaccineAllocation-Week17.pdf In addition to going to the usual places, a lot is going to HEB and Walgreens pharmacies. If you have not been…
Local cases are low, but seemed to have plateaued. Fortunately, vaccines remain effective for months and the ones used in the US are effective against the South African variant. Here are some succinct summaries from Physician’s First Watch: Pfizer-BioNTech efficacy…
When we read about the effectiveness of Covid 19 vaccines it has to do with clinical trials used to get their approval. What is the real world experience? The short answer is they were even more effective in health care…
The TDHS decided again this week not to give us any vaccine. Here is where it went. https://dshs.texas.gov/news/updates/COVIDVaccineAllocation-Week15.pdf Interestingly, this doesn’t include large pharmacy chains who must be getting it directly for the government. As you can see the vaccine…
Here is some recent information on vaccines as well as information on availability. I haven’t included an online article from yesterdays’ New England Journal of Medicine indicating the dismal track record of Astra Zeneca’s vaccine in South Africa. That’s not…
A patient walked into the office the other day, masked per our protocol and said that he had read a new report from the CDC that showed that masks were ineffective at preventing the transmission of Covid-19. “Poppycock and balderdash!”,…
It was a year ago that I took care of my first Covid patient. I didn’t know that at the time. He had been skiing in Colorado and developed a fever and a sore throat. He didn’t improve upon his…
I was going to tackle the subject of restaurant dining, but then the governor ended the mask mandate which required me to rethink that subject and the CDC finally came out with their recommendations of what people who are fully…
The Texas Department of Health Services did not approve our request for Johnson and Johnson’s new Covid 19 vaccine. Here is the summary from the Medical Letter, a nonprofit which reviews and comments on new medications and treatments free of…
Ivermectin is an antiparasitic drug that has been touted for the use of Covid 19 in people who aren’t sick enough to warrant hospitalization (see January 6th blogpost). Unfortunately, this study does not show a benefit to taking it. Here…
” Is it safe?” This is the question that Laurence Olivier asks Dustin Hoffman repeatedly in Marathon Man as he tortures him using dental instruments. It made trips to the dentists more difficult after seeing the 1976 film which was…
The storm that hit two weeks ago disrupted our lives in many ways. I can say it is easier to enjoy snow when you have power. When the office was closed it was still possible to do telemedicine visits with…
AVAILABILITY: Text updates: The City of San Antonio announced Wednesday that they’ve partnered with some of the Bexar County vaccine distribution sites to create a vaccine availability text alert system to keep the community informed about the release of more COVID-19 vaccines.…
The lion’s share of Covid 19 vaccine this week went to University Health whose 10,000 appointments were scheduled this evening within an hour. The curious thing was that in the Week 11 vaccine allocation report it was listed as destined…
The CDC now says that people who’ve received either authorized COVID-19 vaccine do not need to quarantine after exposure to a person with COVID-19, provided they meet all of the following criteria: They’ve received both vaccine doses, and at least…
To Our Patients, We understand that trying to get Covid-19 vaccination has been very stressful for our patients. We are still waiting to see if the Texas Department of Health Services will give us any vaccine. The push has been to…
First of all, vaccine update: If you are eligible for a vaccine and have been unable to book an appointment to get inoculated, WellMed announced it would be reopening its reservation hotline on Tuesday morning, beginning at 8 a.m. Call 833-968-1745 to…
Before you ask your physician for a prescription and start hoarding colchicine, realize that the study has not been through the peer review process where experts scrutinize it’s methodology and conclusions. Many drugs have been studied to see whether they…
Having Covid 19 reduces the likelihood of getting it again for months. How many months depends upon how severe the infection was and whether or not this is a new strain. Antibody response is said to be directly proportional to…
There is a new vaccine against Covid 19 that is very effective against the virus. On face value it may not seem as effective as the other two vaccines, but that’s not the whole story. Remember, in a good year,…
To say that this has been a stressful year is a gross understatement. It has been challenging to keep patients well while taking care of those who are sick. Keeping my staff protected and having a safe practice setting has…
Bottom line: The risk is less with the Moderna vaccine than with Pfizer. Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as peanuts or bee…
Some of you are familiar with the expression “The University of Texas stops for no storm” – the Chairman of the Board of Regents’ telegraphed response to a suggestion that UTMB close after the 1900 hurricane. “We Stop for No Storm”…
I keep a list of the benefits of Covid 19. So far, I only have two. The first is the widespread adoption of telemedicine. This helps to keep physicians and patients connected without them having to be in the same…
This week’s New England Journal of Medicine has several articles on monoclonal antibodies, synthetic antibodies against Covid 19, that show their efficacy in the treatment of early to moderate disease. The problem is, we have them and they are not…
I frequently repost Dr. Paul Sax’s blog. He is a noted infectious disease expert. This one was sent to me by Dr. Wallace. This is the best Frequently Asked Question’s I have seen on the Covid-19 vaccines. It’s geared toward…
As promised, the state continues to allocate vaccine to large providers. Here’s who is receiving it in Bexar County this week. Sorry for the quality of the photo, but the University Health System and the City of San Antonio received…
I had an 86 year old patient show up at Wonderland Mall yesterday at 6:30 PM and get vaccinated for Covid 19. She did NOT have an appointment. At the end of the day, literally, they are not going to…
Here is some advice from the CDC about mask wearing after Covid 19 vaccination followed by an article from the New York Times on a more effective way to wear masks. DO I NEED TO WEAR A MASK AND AVOID…
18,000 does are coming to San Antonio. 9,000 to the Alamodome and 9,000 to the WellMed locations. Here’s more info from MySA.com: WellMed’s COVID-19 vaccination hotline reopening, more doses coming to San Antonio Madalyn Mendoza Jan. 15, 2021Updated: Jan. 15,…
Previous studies had shown equivocal results for treating severely ill patients with Covid 19 with the plasma of patients who had recovered. the studies were hampered by a lack of uniformity of the dosing of plasma. http://personalphysicianmd.com/plasma-for-covid-an-infectious-disease-specialist-weighs-in/ All plasma does not…
I don’t have any new tips on getting the vaccine, but one positive development is that those patients who received their vaccinations today at the Alamodome received follow up appointments for their second dose. Patients who did receive them Monday…
A friend told me that he is volunteering at the vaccine clinic at the Alamodome and that one of the perks of volunteering is that they vaccinate you. It’s called the Alamo Area Medical Reserve Corps. https://www.signupgenius.com/go/30e0e4ba9ae22aaf49-covid191 I just received…
Here’s where the week 5 vaccine allocation was sent: Some patients have had luck calling the WellMed number (833-968-1745) to schedule and appointment. Others have given up in frustration. I am told the best chance is just before the official…
First of all, the Alamodome vaccination center filled all 9,000 appointment slots in 6 minutes. Starting Monday, WellMed will offer 1,500 free Moderna vaccinations per day, 6 days a week. They will be offered at two different locations : The…
As mentioned previously, Texas Department of Vaccine Services will begin allocating vaccine to providers who can vaccinate at least 100,000 people. Here is the map of vaccine providers: https://txdshs.maps.arcgis.com/apps/webappviewer/index.html?id=91ac7fb5e5fd47e7ada4acfe4a05920a Locally, the City of San Antonio will turn the Alamodome into…
Quite a few patients have been able to get immunized based on what they have told me and reports that I have received. Many received theirs from UT Health and Christus Santa Rosa who had received relatively large quantities of…
Short version: I don’t know if ivermectin, an anti-parasitic drug, is effective against Covid-19. Studies are in progress. If they show it to be effective I will use it. Background: There has been a lot of research into using drugs…
Here it is. Get on the phone! Kyle Communicare Health Center 2810 Dacy Ln Kyle BEXAR 500 15RX Pharmacy-2 11212 State Hwy 151, Plaza-2 San Antonio BEXAR 100 Arthur S Hernandez Md 88 Briggs St San Antonio BEXAR 100 Christus…
That image was taken from this link. https://txdshs.maps.arcgis.com/apps/webappviewer/index.html?id=91ac7fb5e5fd47e7ada4acfe4a05920a These providers received the vaccine, but their presence on the map doesn’t mean they are providing it to the public. Last week was chaotic. Late Sunday night I received word that HEB…
To Our Patients, We still don’t have vaccine, and don’t know when (or if) we will have vaccine to administer at the office any time soon. It looks like it’s going to be provided to large institutions like hospitals and…
I don’t have any vaccine, yet. We are doing more training online tomorrow afternoon to be prepared when the State of Texas decides to give us some. We will send out an email notifying patients when we get it. In…
When hospital workers and physicians first started being immunized with the Pfizer vaccine two weeks ago, many posted photos on Facebook and Instagram. I thought that was good to show that they believed in the safety and efficacy of the…
The Vaccine Before Christmas By Kevin A. Wilson (with apologies to Clement Clarke Moore) ‘Twas some days before Christmas—how many I’m not sure (The days ran together; everything was a blur). All the houses were locked down from…
Here are the new guidelines about who should receive vaccine from the CDC, followed by those from the State of Texas. They are not the same. CDC advises, but states make up their own rules. Then I will comment on…
There is a new strain of Covid-19 being reported in Britain. There have been thousands documented. We don’t know if this is more dangerous and more infectious. It will probably respond to the vaccine. Here is some information on the…
I was going to send this out as a newsletter, but I have been busy with the surge in virus cases and now Christmas is around the corner. First of all, I don’t have any vaccine. This will be determined…
As I mentioned in the December 7th post, bamlanivimab, a monoclonal antibody (A type of protein made in the laboratory that can bind to substances in the body, including cancer cells. There are many kinds of monoclonal antibodies. A monoclonal antibody is…
The US has an ongoing system to monitor vaccine safety which has been in place for years. It’s called the Vaccine Adverse Event Reporting System. There is a new component to it that I learned of today for the new…
This is exciting news. Dr. Wallace and I have taken the first steps to getting the vaccine from the Methodist Healthcare System. I’m not sure when that will be. There are additional logistical hurdles for administering the vaccine beyond the…
There are no approved medications that speed the recovery from Covid 19 in people who are not sick enough to be hospitalized. Now there is one that is available under emergency use authorization EAU. Bamlanivimab is a synthetic monoclonal antibody…
CME= Continuing Medical Education. One of the most daunting challenges of being a physician is staying current. You have to commit to a lifetime of learning. We do this in a variety of ways, reading journals, searching the literature and…
CME= Continuing Medical Education. One of the most daunting challenges of being a physician is staying current. You have to commit to a lifetime of learning. We do this in a variety of ways, reading journals, searching the literature and…
How will we determine whether a vaccine is safe and effective? In part by reviewing evaluations by independent organizations like The Medical Letter. Here is their analysis of two of the vaccines which are most likely to be approved in…
Quarantining for 14 days after exposure to someone with Covid-19 to prevent spreading it often imposes hardships. People are often not able to comply. Since the likelihood of transmitting it decreases with time, the CDC has come up with a…
The federal government supplies the vaccine and makes recommendations for the distribution, but the final say is up to the states. For our part, we have completed the TDHS application to be able to administer the vaccine and been approved.…
A patient sent me this article. It is a great overview of the vaccines for Covid-19 in the pipeline. It gives the type of vaccine, the manufacturer, the target supply, the funding and the development timeline followed by a few…
Dr. Paul Sax is a well regarded infectious disease (ID) specialist. It was interesting to read in Physician’s First Watch what he was grateful for on Thanksgiving Day. November 24th, 2020 Some ID Things to Be Grateful for This Holiday…
This is the C.DC’s newsletter. You might think that it just says, “Don’t go anywhere”, but there is practical advice for those that chose or need to travel. Much of this has been covered in previous posts. Holiday Highlight More…
A friend pointed out this article in the New York Times which highlights the limitations of having a negative test for Covid-19. No, a Negative Coronavirus Test Does Not Mean You Can Safely Socialize A negative test is helpful, scientists…
This is how the vaccine will be distributed and given. We don’t know where in this our practice will fit in. We don’t know at what point it will be given to us to administer. Because of that, WE ARE…
Here’s an interesting article from The New York Times about the impact of the pandemic on physician’s and their practices. Doctors Are Calling It Quits Under Stress of the Pandemic By Reed Abelson November 15, 2020 Original article Stay ‘in the know’…
While our attention is focused on Covid-19, another virus lurks out there. West Nile Virus. This mosquito borne illness has recently been reported in Bexar County. https://www.ksat.com/news/local/2020/11/12/west-nile-virus-detected-in-bexar-county-mosquito-pool-metro-health-says/ The weather is unseasonably warm and we will be spending more time outside over…
Here is a cool risk calculator for determining the risk of acquiring Covid-19 over Thanksgiving. Put in the size, ascertainment bias (I would use 5) and go on the map to Bexar County. Hint: it has San Antonio in it.…
Months ago I wrote about the latest study on chloroquine and and said, “Put a fork in it, it’s done.” Apparently not. I had a patient go to a private mobile Covid-19 testing unit and tested positive. They were asymptomatic. …
Regarding the vaccines which are being approved. We don’t know which ones will be approved, whether we will be able to administer them and the groups to which we can administer them. So, it is a little too early for…
Quick antigen tests are popular for Covid-19 testing. The results come back in 15 minutes and can be helpful in making decisions that involve treatment and quarantine. The trade off is they are less accurate than PCR tests that may…
Bottom line: Maybe. It’s an association, not proof of cause and effect. Probably not any downside to hedging your bets and taking some. Vitamin D deficiency is associated with a wide variety of diseases. There is no proof that supplementing…
Patients ask me if they come down with Covid-19, what am I going to give them? I point out that 80% of patients have mild disease and require no treatment. They also ask if there is something that they can…
My phone is starting to ring again. It always rings, but it rings more right before Covid-19 cases begin to escalate. The calls have to do with exposure scenarios. Frequently, these do not fit into the guidelines so Dr. Wallace…
As was predicted, Covid-19 cases are on the rise. It’s a combination of college students, kids going back to school and fatigue. It has been estimated that 100,000 fewer people would die if mask wearing went from 50% to 90%.…
I had previously posted about the ability of dogs, cats and lions to get coronavirus from sick people. Here is the latest. It’s a summary with commentary from Journal Watch about an article for the Proceedings of the National Academy…
I’ve given my recommendations for flying apparel, but here is another physician’s. Dr. David Aranoff, director of the division of infectious disease at Vanderbilt University Medical Center gave this advice in a recent article in the Wall Street Journal. Flying…
The numbers go down. We become complacent, socialize with more people without masks and social distancing. Then the numbers go up. This is being repeated across the country and in Europe. We are on track for 300,000 deaths in this…
Yes, chloroquine is still around. It’s still being studied. The last I reported on it was a study that it didn’t work for post exposure prophylaxis. That is, it didn’t prevent Covid-19 when taken after exposure to the virus. Some…
Someone used the expression “Quarantine 15” to refer to weight gain associated with being isolated at home. I haven’t read any studies which indicate what change in weight has been associated with dealing with the pandemic. There has been a…
As outlined in this article in the New York Times, Covid-19 infections hit the young this summer, but that’s not where they stayed. Virus Cases Surged in Young Adults. The Elderly Were Hit Next. Infections among young adults eventually may…
Much had been made of the CDC’s waffling on testing asymptomatic individuals. The problem is testing supplies are still very limited and we have to figure out which asymptomatic individuals to test to prevent asymptomatic individuals from spreading the disease. …
As SARS-CoV-2 continues its global spread, it’s possible that one of the pillars of Covid-19 pandemic control — universal facial masking — might help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic.…
We knew that college students were going to get sick. What we didn’t know is what the universities would do with them when they were. The following article is from today’s Wall Street Journal. Colleges Send Students Home as Outbreaks…
The only person I swabbed in the last two weeks for Covid-19 was a patient who needed proof for his employer that he is now testing negative after having Covid. That is not recommended by the way. That is not…
I mentioned yesterday my continued unease at the influence of politics on medicine during this pandemic. Dr. Paul Sax, an infectious disease specialist at Harvard, weighs in on the controversy. August 24th, 2020 FDA’s Emergency Use Authorization for Convalescent Plasma…
Bottom line: maybe I meant to post last week about the lackluster data that convalescent plasma from patients recovered from Covid-19 was effective for hospitalized patients with the virus. Here is the summary from Journal Watch dated August 19th: Plasma…
YOU CAN’T MAKE GOOD DECISIONS WITH BAD INFORMATION I said this a lot several months ago when counselling patients who had friends or family members test positive for Covid-19 with inaccurate antibody tests from China performed by a local doctor.…
So you think you want to go somewhere that’s too far to drive and you might consider flying again? Here’s what I would do: I would pick an airline that is blocking the middle seat or better yet, if you…
Before I get to the judge, local numbers are encouraging. Hospitalizations are down. Percent positivity is still high, but fewer patients are opting to be tested. That may mean that fewer people are sick or they are just frustrated by…
If you come down with Covid-19, will you have a cold or end up on a ventilator? The answer is probably the former, but some people will end up with the latter. How do we predict who will get very…
Here is the latest study on masks. No surprises here. It confirms what previous studies have shown. The only surprise is that the county judge continues to wear a bandana. The first is a summary from Journal Watch. Following is…
The Texas Medical Board oversees the licensing and disciplining physicians in the state of Texas. It’s mission is as follows: Our mission is to protect and enhance the public’s health, safety and welfare by establishing and maintaining standards of excellence…
Here are the latest updates on ending quarantine from the CDC. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
One of my patients groused, “Why don’t you ever have anything good to say about chloroquine?” Well, that’s because there is not much good to say. There was an observational study (A type of study in which individuals are observed…
It is. Here is a graphic of risk of certain behaviors. Who is Wearing Masks in the US? San Antonio Mask Wearing Mask Wearing by Country
A number of well-meaning people sent me a 31 minute you tube video of an interview with a Texas physician who claimed to have a cure for Covid-19. They wanted to know my opinion. I aspired to be dismissive, but…
July 14, 2020 Studies Show Importance of Face Coverings in Limiting Spread of COVID-19 By Kelly Young Edited by David G. Fairchild, MD, MPH A trio of studies takes a closer look at face mask use in the U.S. Use of…
There was some encouraging news regarding the development of a vaccine for Covid-19 from the New England Journal of Medicine. It is mentioned by it’s other name, SARS-CoV-2. I am including a summary from Journal Watch followed by a link…
Baking. That is a Covid skill that many have been perfecting while they have been spending more time at home. Here is Dr. Jennifer Wallace’s No Knead Bread from a recipe in the New York Times: https://cooking.nytimes.com/recipes/11376-no-knead-bread Next is Carolyn Thornton’s…
Ennio Morricone died this week. What does that have to do with Nexium and other proton pump inhibitors? Stay with me. Ennio Morricone was a composer probably best known for his haunting score of The Mission. Here is a synopsis of his…
Want to know your blood type? Curious if you have antibodies against Covid-19 (even though we aren’t sure what those results might mean)? Donate blood. The hospitals are full up and need blood for critically ill patients that require transfusion. …
Whenever I have occasion to pass a flower arrangement, it’s my habit to smell the flowers. Unfortunately, roses are grown now for show and not for fragrance. I can’t always smell them and since Covid-19 has become a presence in…
When I was a kid, I would walk down the street to my grandmothers house to visit. She subscribed to Reader’s Digest and I would flip through them at articles like ” I am Joe’s Kidney”. But my favorite section…
Here are three new things on Covid-19. Congratulations to Jim Berg! Jim was found to have positive antibodies to Covid -19 several months after getting sick while skiing in Colorado in early March. Jim has been donating plasma which is…
Here is an article from the NY Times that shows how a bar is the perfect environment for the spread of Covid-19. A Virus Walks Into a Bar … As communities open up, it’s becoming increasingly clear that the indoor…
Hot on the heels of “What blood type am I?”, “Should I be tested?”, we have “Do I need an MMR?”. That stands for Measles, Mumps and Rubella, a live viral vaccine given during childhood. This is the latest darling…
This summer marks the 45th anniversary of the movie Jaws. What does that have to do with Covid-19? A month ago I told patients that if they avoided jails, meat packing plants and nursing homes that they stood a pretty…
Here is a scenario with which I have been presented four or five times today and every day for the last 10 days. I ( we) were with some friends last weekend and they had been with some other friends …
As the number of cases of Covid-19 increase in San Antonio and hospitals become more crowded, hospitals restrict their visitors to reduce the risk of transmission, This is difficult on patients and families. It’s bad enough to be sick, but…
Long before Covid-19 I avoided touch points. There is scant evidence that we catch the novel corona virus from surfaces, but why tempt fate? The above picture is an example. It shows how you push the elevator at the hospital…
4 New Things About Covid-19: 1. There is more of it. What follows is a report from the Methodist Health Care System which confirms what I knew from the phone calls that I have been getting for the last 10…
My sister, Felice, has a description of a good hug that she would always tell my kids. “You need to use both arms and make noises.” Hugs are one of the many tactile exchanges that people miss during this time.…
Catchy title. Yesterday I posted the CDC’s advice on going out. It omitted any advice on sex. The New York Times supplied it’s own advice. Masks, No Kissing and ‘a Little Kinky’: Dating and Sex in a Pandemic New York…
The CDC issued guidance on Friday for people who are deciding to go out with some sensible advice on decision making. It includes topics like going to the bank, gym, restaurants, travel and yes, going to nail salons. Coronavirus Disease…
novel [ˈnävəl] ADJECTIVE novel (adjective) new or unusual in an interesting way. “he hit on a novel idea to solve his financial problems” synonyms: new · original · unusual · unfamiliar · unconventional · off-center · unorthodox · different · fresh · imaginative · creative · innovative · innovatory · innovational · inventive · modern · ultramodern · state-of-the-art · advanced · avant-garde · futuristic · pioneering · groundbreaking · trailblazing · revolutionary · rare · unique · singular · unprecedented · uncommon · experimental · untested · untried · unknown · surprising · strange · exotic · out of the ordinary · newfangled · left-field · new-fashioned · neoteric antonyms: old · traditional Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[2][3] is the strain of coronavirus that causes coronavirus disease 2019 (COVID-19), a respiratory…
I have been pondering this for months. What percentage of patients infected with Covid-19 have no symptoms? The bottom line is that we don’t really know. This became controversial in a statement from the WHO yesterday suggesting that disease transmission…
Studies retracted: Two studies in the New England Journal of Medicine and the Lancet have been retracted because they relied on a Surgisphere database, which has come under scrutiny. The NEJM study examined the relationship between hypertension drugs and mortality in COVID-19 patients, while the Lancet study looked at…
It is not officially summer, but it feels like it outdoors. People are tired of staying at home and when political turmoil subsides they would like to go somewhere. Here is some practical advice from the CDC. It’s just their…
On May 23rd, I wrote of an article in the journal Lancet on chloroquine, “Put a Fork in Chloroquine, It’s Done”. Since then a large group of scientists have criticized some of the methods involved in the study. This is…
Wear a Mask, Please Recently, I’ve been surprised by the number of patients who come to our office and aren’t wearing a mask. This won’t work. Studies have shown that we can reduce the risk of transmitting the virus by…
Here are a couple of news summaries from different news releases from the Center for Disease Control plus a statement by the Methodist Healthcare System on Covid-19 antibody testing. The first is good news. It’s tough to get the coronavirus…
The latest and most comprehensive assessment on the use of chloroquine in treatment of Covid-19 was published yesterday in The Lancet. Here is an article in the Washington Post (it was on Fox News too) followed by a link to…
There are actually five. I have bolded them in the article. I am envious of physician authors. It’s tough enough to be a good doctor, but to be able to write too? Dr. Gawande is a neurosurgeon who has authored…
There is a popular theory that the Covid-19 virus will disappear in the summer months. This is because the other corona viruses which are some of the viruses which cause the common cold tend to disappear in the warmer months. …
Texas continues to open up, though with some trepidation. The following is some interesting polling data provided by Taylor West. Regardless of how quickly Texas opens up, the prevention of further cases boils down to personal hygiene, covering our faces…
Here is a very good article from The NY Times on that question. The only part that I take issue is the percentage of people who infected who are asymptomatic. It seems to be particularly high in nursing home residents,…
Many Covid-19 antibody tests have been produced, but few are FDA approved. Many are unreliable. This study compares two that are FDA approved. The first part is a summary of the study from Clinical Chemistry (not one that I subscribe…
Many people are not aware of it, but San Antonio has a world renowned biomedical research institute, Texas Biomed.https://www.txbiomed.org/ It was founded in 1941by Tom Slick and specializes in the study of infectious diseases, is on the forefront of coronavirus…
One picture…. Some people like to read the journal articles themselves to see what they look like even though they may not understand all the terms. This editorial from this week’s JAMA gives a lot of details about the different…
It has been a record 22 hours since anyone has asked me about antibody testing for Covid-19, but before the day is done someone will. For those who haven’t kept up with recent posts, this is a nice summary article…
The title was a little dry so I had to include this photo: The CDC revised their guidelines for how long a person should isolate themselves after being diagnosed with Covid-19 or with assuming that they have it based…
The wild west of antibody test manufacturing may be coming to an end finally, as this article from The New York Times details. Manufacturers are being asked to show proof that their products actually work. Shocking! F.D.A. Orders Companies to…
The following article that Dr. Wallace sent me from the Washington Post does a great job of explaining the seemingly esoteric Bayes Theorem, named for an 18th century Presbyterian minister, how false positives and negatives are calculated and why they…
Many people who are older and/or have medical conditions which put them at higher risk from complications of Covid-19 have taken the stay at home orders seriously. Many have isolated themselves at home, at their ranches, lake or beach houses. …
Linda Nealon’s masks Office visits are what we call them. Insurance companies refer to them as “patient encounters”. These are the same people who changed me from a “physician” to a “provider”. I prefer visit. It’s much more descriptive of…
I’ve spent hours counselling relatives, friends and neighbors of patients who received positive antibody tests administered by a physician in town. The erratic results have caused panic in many healthy people. It is a cautionary tale of employing unproven technology…
In San Antonio, Covid 19 cases appear to have plateaued. It’s a little scary to say. I don’t want to jinx it. I would feel better if the numbers were falling, but they have to plateau before they can fall.…
If you have an emergency, go to the emergency room. They are empty. People are avoiding emergency rooms and hospitals for fear of getting Covid-19. The precautions that are being taken in those places make that possibility remote. Patients with…
In the late 60’s there was a TV show called The Wild, Wild West. It was sort of a western James Bond which starred Robert Conrad. I am reminded of that because he died a few months ago at age…
As mentioned in previous posts there is no good evidence of efficacy of hydroxychloroquine/chloroquine in the treatment of Covid-19. There is also risk of cardiac toxicity, especially when used with azithromycin. Here is an excerpt from the FDA’s bulletin followed…
I just couldn’t do another Covid-19 update. Everyone wants to know how long Covid-19 has been in the United States and how prevalent it is, but, first two important developments. First, how safe are your cats? As you recall, the…
There is some positive news about the drug, Remdesivir. It is being studied and there are anecdotal reports of it’s efficacy. From the Medical Letter: Remdesivir: A Possible Treatment for 2019 Novel Coronavirus March 12, 2020 by Mark Abramowicz, M.D.…
To say that this is a hot topic in some circles is an understatement. I certainly don’t believe everything that I read in the New York Times, but before you let someone poke a hole in your finger, you may…
People have been suggesting for some time now that we don’t know how long this virus has been around and if it is more prevalent then the mortality rate would be lower. That is small consolation to the 40,000 people…
This is an interesting article from the Wall Street Journal. A hot topic. Pun intended. Will the rise in temperature have an effect on the virus or is it an effect on the virus’s hosts that may cause a…
I am fortunate to have smart physician friends, very smart physician friends and then there is Dr. Robert Haley who is in a league of his own. Robert W. Haley, M.D., is Professor of Internal Medicine and Director of…
Covid -19 is often more serious in older people. In an effort to help minimize infection risk for seniors, HEB and Favor have partnered to provide safe delivery of groceries for them at a minimal additional cost. https://favordelivery.com/seniors I’ve previously…
HOW NOT TO WEAR A MASK We updated our website over the weekend and our old blog posts are being reloaded. I hope. Here is a useful article from the New York Times on how not to wear a mask.…
We keep reading/hearing news that testing capability for COVID-19 is increasing, more tests are being run, and now Abbot labs has launched a test with a turnaround time of <15 minutes. Abbot says they will be distributing on the order…
This is a follow up to yesterday’s post. It discusses the process for approving new tests. https://www.mdlinx.com/internal-medicine/top-medical-news/article/2020/03/31/7636008/?utm_source=alert&utm_medium=email&utm_campaign=ajm_49718&uic=ZZ3A66E5401E924D13BF3A6961747578A2
The Medical Letter is published by a nonprofit foundation. It does not take money from the pharmaceutical industry. It is considered a highly reputable source of unbiased medical information. This is the type of information that physicians rely upon, rather than…
First, a definition: antigen [ˈan(t)əjən] NOUN a toxin or other foreign substance which induces an immune response in the body, especially the production of antibodies. The tests that we are doing to detect the presence of the virus are antigen…
Several patients have expressed concern about getting Covid-19 from inanimate objects. The following article was sent to me by a patient and it has what I like, good practical advice. https://www.washingtonpost.com/opinions/2020/03/26/dont-panic-about-shopping-getting-delivery-or-accepting-packages/
I’m not sure what the day will bring. That is energizing and a challenge. That is true for all my days, but especially true now. Today, the first thing that I received were texts from several patients who were concerned…
When I wrote the post on staying home, my long-standing German receptionist, Sieglinde, asked why we are to keep away from other household members and pets. ” Why pets?”, she asked. Can our pets transmit corona virus and vice versa?…
1. Dr. Wallace gave a great summary of our meeting yesterday with the physicians and staff of Metropolitan Methodist Hospital. One additional point that I would add is the caution from Dr. Luis Cisneros, a well regarded infectious disease specialist.…
Today Dr. Thornton and I attended a medical department teleconference for Metropolitan Methodist Hospital to discuss what’s going on in that hospital system with Covid-19. It’s encouraging to hear how hard Methodist system is working to adapt quickly to respond…
The following is a summary from Journal Watch, a publication which provides summaries of important medical studies from AUTHORITATIVE medical journals around the world. The reason authoritative was in CAPS is that a lot of the articles that patients send…
So you have a respiratory infection and feel crummy. You decide to isolate at home. What do you do? These are the guidelines from UpToDate: Home care — Home management is appropriate for patients with mild infection who can be adequately…
I’ve written a number of notes today for worried individuals who are concerned that the caregivers for their loved ones will be pulled over by the police on their way to work and prevented from getting to their jobs. Home…
In this morning’s Wall Street Journal (which has a lot of good medical articles BTW), there was mention of the possibility of a lot of people being asymptomatic carriers of Covid-19. Dr. Anthony Fauci cautioned about taking our eyes of…
This is the equipment which includes mask, gloves, gown and eye shields that health professionals use to keep safe. The problem is, there is a shortage of it. We have gloves and masks, but are waiting on shipments of gowns…
Even before President Trump made his statements about hydroxychloroquine people have been asking for prescriptions. That and azithromycin which were used in some of the tiny studies that are widely circulated as supporting their use. Yesterday, the Texas State Board…
First of all here is the link that didn’t attach to yesterday’s post to the Washington Post article that tells what the FDA really said about chloroquine: https://www.washingtonpost.com/business/2020/03/19/trump-calls-anti-malarial-drug-game-changer-coronavirus-fda-says-it-needs-study/ We are expecting the first Covid test kits early next week. We…
There you have it. Actually, the FDA is not anymore sure today than yesterday.
Not everything that you read on the internet is true, especially these days. Most of this is well meaning, but some of it is not. Case number one: I was exercising and got a text at 17:58 from a patient…
The bottom line is we don’t know, but I’ve been asked this question 5( a sixth time while writing this) times today, including from a neurologist who takes it for other reasons. This stems mainly from a jerry-rigged article that…
We are exposed to a lot of viruses we don’t catch. Ever wondered why? Our immunity helps to prevent that. What can we do to boost our immunity? Rest, proper diet and exercise. There are a lot of supplements out…
Here is the latest on corona virus testing in SA. We will see how smoothly that goes. Not for the “worried well”. It will require a negative flu screen which we can do. The more elaborate viral panels done in…
Dear Patients, As I know you are all aware, we are preparing as the Coronavirus (COVID-19) pandemic extends its geographic area and number of cases. The most accurate and up to date information can be found on the CDC website.…
03/16/2020 Dear Patients: As I know you are all aware, we are preparing as the Coronavirus (COVID-19) pandemic extends its geographic area and number of cases. The most accurate and up to date information can be found on the CDC…
Catchy title, but it has little to do with Covid-19. There was a photo on the front page of today’s Express-News which showed a mobile testing unit in the Medical Center. That is just for first responders and healthcare personnel…
Here’s the latest on testing. Governor Greg Abbott announced that San Antonio would have the first drive through testing, but we don’t know when that will happen. It will still involve having the test sent to a lab. The results…
The current recommended protocol which may change is: if the patient has flu like symptoms and exposed to a patient who has tested positive or traveled from endemic country they will likely be asked to go home and self-quarantine x…
I use the CDC for advice on Covid-19. https://www.cdc.gov/coronavirus/2019-nCoV/index.html Of course, these are the folks who screwed up the testing. By the way, the test is only done via the Metropolitan Health District and they will only do it on…
Coronavirus Disease 2019 Travel: Because of the novel (new) coronavirus outbreak, CDC recommends that travelers avoid travel to mainland China, South Korea, and reconsider cruise ship travel to or within Asia. The recommendation to avoid travel to China applies only to mainland China and does not…
Travel: Because of the novel (new) coronavirus outbreak, CDC recommends that travelers avoid travel to mainland China, South Korea, and reconsider cruise ship travel to or within Asia. The recommendation to avoid travel to China applies only to mainland China and does not include Hong Kong,…
