Tag Archives: WHO

An Open Letter to the African American Community about the Upcoming COVID-19 Vaccine

July 10, 2020Public Health, Health PreventionCDC, Coronavirus, Straight No Chaser, There are 72 Hours in a Day, Vaccination, WHO, asksterlingmd, Covid-19, AMA, APHA, Behind the Curtain, NMAJeffrey Sterling, MD

Introduction

This Straight, No Chaser looks at the African American community and the upcoming COVID-19 vaccine.

Indeed, the African American community specifically has decisions to make as we approach the possibility of a vaccine for Covid-19 being available. Here’s the thing. This community continues to be disproportionately affected by COVID-19 for reasons that have been previously discussed in this blog. As such, there is a significant amount of righteous angst about the social determinants of health and the institutional racism that play into why this has become yet another healthcare disparity.

However, the issues about the upcoming COVID-19 vaccine point to another issue begging to be addressed. I’ll support anyone who analyzes data and recommendations and after doing so, makes an educated decision not to accept the immunization. However, you can not think it’s rational to reject a potential lifeboat out of hand before even seeing the data. We fear the unknown and mock what we don’t understand. However, this is still America. We can still perform great feats in the face of crisis.

Are We Governed By Fear or By Facts?

More importantly, think about what’s being said here.

The Black community is being overrepresented by Covid-19 cases and deaths.
The upcoming COVID-19 vaccine is the single most important component of the solution for all populations to avoid cases and deaths.
However, many of you are saying there are no circumstances for which you’ll take the vaccine.

So if you opt out, will you still complain about the health care disparities confronting our community on this issue? Also, how and when do our lesser choices become our failures of responsibilities? I understand distrust of the government. I’ve lectured on the Tuskegee experiments and healthcare disparities for years. Additionally, I’ve counseled and disciplined physicians discriminating against patients. That should not be our primary concern at this moment.

Furthermore, I also understand that education and empowerment are the way out, not over-reliance on the government.

Let’s Wait and Not Hurry Up

How about this: can we reserve judgement until we at least see the data and hear the recommendations from the CDC, WHO, the American Public Health Association and the American Medical Association? Would the views of the National Medical Association, our oldest, largest and most esteemed organization of Black physicians move you? How about if Dr. Kizzmekia S. Corbett (pictured above) and her team develops or supports the vaccine?

Remember this: there’s shared sacrifice required here. An effective vaccine requires about 70% of the population to take it to sufficiently create herd immunity. More importantly, as long as herd immunity doesn’t exist, it is the African American community that will be most severely and disproportionately affected by the ravages of COVID-19.

Choices have consequences. Let’s choose wisely.

Need Personal Protective Equipment (PPE)?

Are you a first responder? Does your job make you one of the first exposed? Courtesy of SI Medical Supply, you have an option to provide masks, gloves, hand sanitizer, disinfectant wipes and no-touch thermometers for your family and loved ones. Importantly, getting these product does not deplete the supply needed by first responders and medical personnel. Orders are now being filled (without shipping delays!) at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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Feel free to #asksterlingmd any questions you may have on this topic. Take the #72HoursChallenge, and join the community. As a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share! Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders! Thanks for liking and following Straight, No Chaser! This public service provides a sample what you can get from http://www.docadviceline.com. Please share our page with your friends on WordPress! Like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

When a Virus Becomes Politics

June 9, 2020Infectious Disease, Public Health, Health PreventionStraight No Chaser, There are 72 Hours in a Day, WHO, asksterlingmd, Covid-19, PPE, hydroxychloroquine, Behind the Cur, 72 Hours Life, CDC, CoronavirusJeffrey Sterling, MD

Introduction

This Straight, No Chaser addresses the notion of when a virus becomes politics, aka you’re too close to the source.

I can’t recall a situation (even including HIV), in which scientific information was being researched, discovered, information released and information politicized in plain view on a daily basis. I would suggest this level of transparency (subjecting research to the hourly news cycle) is not a good thing.

The Scientific Discovery Process

Scientific and medical consensus are rarely based on an individual research study, regardless of the quality of the study. Each study builds upon that which came before it, forming a medical consensus. Subsequent to forming consensus, recommendations and policies are announced to the medical and public health communities, which undergo additional analyses. It is usually at this point that information is released to the public in a mass fashion.

What you’re seeing with COVID-19 is both how the sausage is made and what happens when a virus becomes politics. Scientists aren’t close to being perfect. Studies are flawed, and interpretations are constantly (and sometimes successfully) challenged. This isn’t occurring any more or less frequently with COVID-19 than it ever has. It’s just occurring in a far more public manner that it has been previously, and it’s being done in a more premature manner than it should.

The scientific method is not well suited for public consumption. The public wants certainty. You correlate certainty with competence. That’s not what we’re seeing. Episodes ranging from hydroxychloroquine, to both the CDC and WHO’s statement on masks, and to the evolving evidence or case fatality rates are being interpreted as confusing by the public, and they are. However, this is closer to the norm than you’d imagine. You just haven’t been excessively exposed to this.

Health Empowerment is the Key

Overall, in the spirit of engaging, educating and empowering the public, this isn’t a bad thing. You need facts to help you determine your own best course of action. However, perhaps the biggest challenge is to avoid misinformation. Yes, there are those presenting information through a political slant, and there are those are imposing a political spin on every piece of new information. I want you to appreciate that facts themselves don’t come with a political bend. It is what it is. Perhaps you’re reading this information through a political filter. That’s on you.

Science follows the facts. Individuals decide what to do with the information. Hopefully, you’ll prioritize matters of health and not live your lives subjecting your health to the priority of adhering to a political ideology. When a virus becomes politics, everyone loses.

Stay safe. Make good choices. Ask good questions. Lives are in the balance.

Need Personal Protective Equipment (PPE)?

Are you a first responder? Does your job make you one of the first exposed? Courtesy of SI Medical Supply, you have an option to provide masks, gloves, hand sanitizer, disinfectant wipes and no-touch thermometers for your family and loved ones. Importantly, getting these product does not deplete the supply needed by first responders and medical personnel. Orders are now being filled (without shipping delays!) for masks at www.jeffreysterlingmd.com or 844-724-7754. Other items are preorders with an expected delivery date of May 8th. Get yours now. Supplies are limited.

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The Rationale for Using Hydroxychloroquine and Azithromycin to Treat COVID-19

April 8, 2020Infectious Disease, Public Health, Respiratory/Lungs, Toxicology/DrugsCovid-19, chloroquine, hydrochloroquine, plaquenil, Behind the Curtain, Coronavirus, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a Day, WHO, asksterlingmdJeffrey Sterling, MD

Introduction

This is the first of a two-part Straight, No Chaser view at the rationales for and against using hydroxychloroquine and azithromycin to treat COVID-19.

Perhaps the distraction of the US President trumpeting (no pun intended) this combination has turned some away from the possibility that these medicines could be helpful. Maybe the well-publicized deaths of individuals taking the medicine has caused concern. Perhaps the robust criticism of the most-commonly cited study used as evidence has led many in the medical and scientific communities to be dismissive. Still, there has to be scientific reasons for putting forth the medications and the combination, right? In fact, there are.

Hydroxychloroquine and Azithromycin

Let’s review the ways the drugs work and the scientific rationale for their use against COVID-19.

Hydroxychloroquine

Hydroxychloroquine (HC) is a derivative of an older drug (chloroquine). Both drugs are best known as drugs used to treat malaria, which is a disease caused by a parasite spread by mosquitos. HC has the following properties as a drug:

It disrupts the ability of parasites to reproduce and proliferate by blocking a chemical needed to digest proteins. It’s basically starving the parasites. This mechanism doesn’t appear to have applicability in viruses.
Even though HC is not an anti-viral medication, it has effects that could combat the way viruses in general replicate, thus slowing its spread.
There is evidence that HC inhibits cells’ ability to secrete substances known as cytokines. This is relevant because one of the most devastating effects of COVID-19 isn’t found in the activity of the virus itself. It’s the immune system’s response to the virus. In severe cases, there’s an overreaction by the immune system within the lungs by these cytokines. This by itself can cause fatal damage. This concept should be familiar to those with autoimmune diseases. Sometimes the body is just so exuberant in attacking foreign agents within us that damage occurs to us in that fight. Therefore, if HC activity blocked that cytokine release process, it conceivably would be helpful.
COVID-19 appears to bind to hemoglobin, the molecule that transports oxygen. COVID-19 seems to force hemoglobin to release its oxygen molecule. This reduces oxygen-carrying capacity, which ultimately contributes to feelings of shortness of breath. Most importantly, the lack of oxygen within the body’s cells contributes to their death. Furthermore, that unbound iron is a free radical and oxidant. In this state, it causes damage to lung cells (wanting to avoid this process is why so many of you take “anti-oxidants”). Hydroxychloroquine appears to inhibit the binding of COVID-19 to hemoglobin, theoretically reducing much of this.

Azithromycin

Azithromycin is an antibiotic, meaning it is used against bacteria. You likely have taken it and know it as a “Z-pack.” It does not work against viruses. However, there are many situations in which a viral infection lowers the body’s immunity, and bacterial infections take advantage of the situation and “jump” on you. These are called secondary bacterial infections or co-infections. In these situations, azithromycin could be of use because it’s treating the secondary infection.

The Combination

There is actual case history for the use of hydroxychloroquine with and without azithromycin. It is used in China, South Korea and a few other countries. In fact China asserts that chloroquine might improve the overall treatment’s success rate and subsequent outcome, along with shortening hospital stays. Also, there are scattered physicians in the US who have (in)famously cited miraculous success using these drugs.

Summary

Many of those in the pro-camp for the use of these drugs also cite various studies that have shown promise for the use of these medicines. However, as we’ll discuss in the next Straight, No Chaser, those studies actually are support against the current use of these medicines. However, one recalls that penicillin was discovered on a mold that was stopping bacteria from growing on a petri dish.

Even with the theoretical benefits of these drugs having nothing to do with direct anti-viral properties, the indirect efforts are sufficient to suggest that robust research should be conducted within the medical tradition to establish if and how these medicines may be used in patients with COVID-19. It is not inappropriately hopeful to think hydrochloroquine could have a role in the more severe patients. Its indirect effects may prove to be a means of slowing down the march of COVID-19. It is most correct to say that there is insufficient evidence to advance its use, either as prophylaxis or treatment. It is equally important to note that all such evidence is either theoretical or anecdotal.

To that end, in late March, the WHO announced that hydroxychloroquine was among four treatments being analyzed as possible tools in this fight. There is a lot more to come and to be said.

The next post reviews the case against the use of hydrochloroquine and azithromycin in patients with COVID-19.

Need Masks?

The CDC now recommends everyone wear masks. Courtesy of SI Medical Supply, you have an option to provide 3-layer facial masks for your family and loved ones. You can now obtain a pack of 15 for $35, including shipping and handling. These are the recommended masks. Importantly, getting this product does not deplete the supply needed by first responders and medical personnel. Order are now at www.jeffreysterlingmd.com or 844-724-7754. Get yours now. Supplies are limited.

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Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Receive introductory pricing with orders!

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COVID-19 Update, Actions and Next Steps

March 25, 2020Infectious Disease, Public HealthBehind the Curtain, CDC, Coronavirus, Straight No Chaser, There are 72 Hours in a Day, WHO, asksterlingmd, Covid-19, Flatten the curveJeffrey Sterling, MD

Introduction

This Straight, No Chaser addresses the latest on COVID-19 and discusses actions and next steps.

Number of Cases

The United States is now contracting 40% of the new cases of COVID-19 worldwide. As of this morning, there have been 428,220 cases and 19,101 deaths around the world. In the US, there have now been 55,330 confirmed cases and 804 deaths. That is more American than have died in the Afghanistan war in the last 8 years. Even if that was a hard stop, it would be horrific. But it’s only the end of the beginning.

You should reflect on the fact that we’ve only been dealing with this a short time. The next three weeks will be horrific. #PrayForNY #CaliforniaYoureNext #IllinoisKeepFighting

The Trajectory

Look at this chart of the disease trajectory. It’s not a curve. It’s a straight line. The curve has not yet bent. Cases are doubling every three days. This is not a game or a casual happenstance. This is science and medicine. Any individual’s (even the President’s) exhortations about their opinions or wishes about when and how this will end means next to nothing. Even if you’ve never heard of it, epidemiology is a branch of medicine addressing the incidence, distribution, and possible control of diseases and other factors relating to health. In other words, this is foreseeable and predictable. It could have been controllable much sooner. It is yet to be determined when it will be controlled.

Now look at this chart. Most US states are actually on the same trajectory. It’s not just New York. If anything, NY is the canary in the coal mine. Forewarned should be forearmed.

What’s Next: Actions and Next Steps

The next three weeks are going to be scary to many and deadly for a lot of Americans. The state of New York’s health care system is about to become overrun as if hit by a tsunami. As much as can be illustrated, the depictions of the numbers of people about to die will be shocking. However, it was still foreseeable. Predictable. Controllable.

And still, it can get worst. There are two sides to #FlattenTheCurve. You must still continue with the need to #StayAtHome. You must engage in vigorous, frequent hand washing. Cough or sneeze into your elbow. Keep your hands away from your eyes, nose and mouth. Sanitize items before and after you touch them. Stay six feet away from others. Avoid gathering of any size, and certainly more than ten people.

Regarding the other side of #FlattenTheCurve, it is not politics to ask the government to engage in public health best practices. We need widespread testing of symptomatic and high risk patients to identify the infected instead of just the seriously sick. #WhereAreTheTests We need to quarantine the infected. We need enforced isolation and treatment of the sick. #WhereAreTheSupplies We need to implement the Defense Protection Act today.

Ongoing half measures, stops and starts and variations from the standard continue to propel the disease forward. It pains me to opine that we have neither seen quick nor decisive action, often due to efforts to weigh other national considerations, including the economy. Pandemics don’t work that way. The best chance for these peripheral considerations to be addressed as soon as possible is to fully address the disease as soon as possible.

Thank you to my colleagues across health care and other essential services for continuing to put your lives on the line to combat this disease. Now, more than ever, health empowerment needs to be your mantra. When our system falls short (or even when it doesn’t), ultimately the responsibility for your health falls in your hands. Please take the actions and next steps recommended. Act as if you already have the disease and don’t want to transmit it.

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Straight, No Chaser: Hoping for Health, Happiness and Healthcare Reform that isn't Sexist On Mother's Day

May 14, 2017Obstetrics and Gynecology, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, CDC, maternal mortality, Mother's Day, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a Day, WHOJeffrey Sterling, MD

Apologies in advance for this not being the Mother’s Day post you might have expected, but in the current environment, it’s perhaps a more valuable gift than your typical set of platitudes…
There’s something about being a Mother that men clearly don’t get. Even as a physician, I’ve always been fascinated at how seemingly oblivious to their own health women are in pursuit of the care of their children. I’m not just talking about all the infection risks that come from caring for the snotty noses, strep throats, flu and pneumonia that kids get (moms, you do know that stuff is contagious, right?). I’m talking about risks of death. Mother’s Day is as good of a time as any to remind the thirteen men in the US Senate drafting a bill to repeal and replace the Affordable Care Act (aka Obamacare) why this matters.
Did you know that the U.S. has the absolute worst maternal mortality rate (death during childbirth) in the developed world? That’s right (or wrong), we’re #1 in the worst possible way here. According to the World Health Organization, the U.S. was one of a very few countries in which the rates of death for pregnant and new mothers increased in the years between 1990 and 2015. Meanwhile, in the rest of the world, that rate dropped by 44% – nearly half. In 2014 alone, the estimated US maternal mortality rate increased by 26.6%. The sum total here is about three mothers die every single day. In case you were wondering, according to this same data, African-American women are three times as likely to die from pregnancy complications than white women.

Of course, nothing compares to an actual death, but our ongoing national tragedy is compounded by analysis from the CDC Foundation suggesting that approximately 60% of maternal deaths are preventable. In other words, this isn’t just attributable to say, women choosing to have children at more advanced ages, which independently increases the risk of death.

Incredibly, it is against this backdrop that steps are in place to worsen the situation. Remember, death is an absolute and not a factor of your political inclinations. In the American Health Care Act bill just passed in the House of Representatives, here’s a three-pack of considerations that will predictably further increase the maternal mortality rate:

Labeling pregnancy as a pre-existing condition
Reducing or eliminating coverage for contraception and abortion
Removal of funding for Planned Parenthood and other sources of reproductive health

Medicaid pays for approximately one-half of the childbirths in the United States.
This post probably isn’t what you think it is. Given everything happening in the political arena regarding proposed changes in this nation’s provision of health, Mother’s Day is as good of a time as any to remind the 13 men in the US Senate why this matters.
Happy Mother’s Day to everyone. Here’s hoping it’s a healthy one. Let’s all give the additional give of fighting for adequate health care.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser In The News: Ebola Virus – Likely Not Coming Soon To a City Near You

August 1, 2014Infectious Disease, Public HealthCDC, Center For Disease Control and Prevention, Ebola virus, WHO, World Health OrganizationJeffrey Sterling, MD

We must be doing something right when so many of you are asking about Ebola virus. I say that because of the incredibly high probability that neither you nor I will ever see a case of Ebola. In the news is an outbreak of the Ebola virus in West Africa. In this Straight, No Chaser, we will discuss the threat and spread of Ebola, and in a subsequent post, we will review the disease itself.
The basis of concern of diseases such as Ebola is we have become a global community. Worldwide travel now imports and exports diseases in a way not previously common, exposing far-flung populations to seemingly esoteric and rare conditions. The concept that a deadly disease such as Ebola virus is simply a plane ride away is a scary one.

According to the Center for Disease Control and Prevention (CDC), Ebola has infected 1,323 people and killed 729 people in the current outbreak, which includes Liberia, Guinea and Sierra Leone. The Director of the CDC has described this outbreak as follows: “This is a tragic, painful, dreadful, merciless virus. It is the largest, most complex outbreak that we know of in history.” Notably, as the World Health Organization (WHO) has mobilized medical attention and support to those in need, some of those providing care have become infected. As such…
Your concerns are straightforward:

Is Ebola “coming” to my country?
Can I become infected by the Ebola virus?

Focusing on the United States, the answers to both questions are yes, but the risk of your becoming infected are so remote that you should simply understand how to avoid the threat. Furthermore it is important to understand that bringing an infected American home for treatment (as is occurring in Atlanta) is not the same as exposing the population to the disease.

And so, here are some quick facts for your consideration:

Ebola virus is not transmitted like the cold or flu. It requires significant exposure to blood or bodily fluids.
Prior to that contact, you’d be most likely be aware of its presence. Those infected with Ebola are so ill so quick that it’s obvious.
The chances of an infected and unrecognized person infected with Ebola making it to the U.S. through commercial air travel are infinitesimal.
Over $100 million in medical support is being provided by the WHO and CDC to combat this outbreak.
Medical management of Ebola is not especially complicated once identified.
It is estimated the current outbreak will be defeated within 3-6 months.

What should you do? Continue the same diligence you should be applying to your health everyday.

Engage in healthy habits, including hand washing and maintaining a level of health to support a vibrant immune system.
Avoid risky behaviors involving transfer of blood and other bodily fluids.
Get prompt medical attention for those appearing sick, particularly after recent travel to areas affected by disease outbreaks.

We end this post with another two thoughts from the Director of the CDC:

“Although it will not be quick and it will not be easy, we do know how to stop Ebola.”
“Ebola poses little risk to the U.S. general population.”

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook atSterlingMedicalAdvice.com and Twitter at @asksterlingmd.