Thursday, June 25, 2020

UNION OF SCHOLARS FORMULATE COVID TREATMENT PROTOCOL



With a confirmed global count of 9.27+ Million cases and 470,000+ deaths,  the world continues its desperate search for a treatment that will save the lives of COVID-19 patients who come into the ER or hospital with low oxygen levels or struggling to breathe.  Where the more popular treatment for patients in ICU is the use of ventilators, a reported 80-85% of Covid-19 patients on ventilators in New York end up dying (Associated Press and state and city officials).

A founding union of experts discuss the MATH+
protocol in this widely shared video: SEE LINK
M.A.T.H.+ ESSENTIALS:
Recently, a group of scholars specializing in critical care developed what appears to be an effective treatment protocol using a combination of medicines that is having remarkable success in hospitals that have adopted its use. According to the critical care physicians applying this formula, MATH+ manages multiple facets of the illness, such as sepsis, inflammation, severe clotting, and acute respiratory distress syndrome (ARDS), all complications known to arise from CoronaVirus infection. This protocol is designed to counter the body’s overwhelming inflammatory response to the virus as it is this hyper‐inflammation, not the virus itself, that damages the lungs and other organs, and ultimately leads to multi-organ failure and death. (To view the complete video of the founding union of experts discuss the MATH+ protocol, visit: www.covid19criticalcare.com)

The corticosteroid Methylprednisolone is a key component, based on large studies that have proven its effectiveness in prior viral pandemics‐ and whose potency is significantly increased when administered intravenously with high doses of the antioxidant Ascorbic acid (Vitamin C). Thiamine (Vitamin B1) is given to optimize cellular oxygen utilization and energy consumption, protecting the heart, brain, and immune system and the anticoagulant Heparin prevents (or breaks up) blood clots that increasingly appear as illness worsens. The + represents other supportive treatments by the administering doctor for patients who present other pre‐existing conditions (as needed). The group also plans to add or change components and dosing as published  medical  literature evolves.


PROVEN SUCCESS FROM THE FRONT LINES
This segment is based on a recent interview with Dr. Joseph Varon, Chief of Clinical Care at the United Memorial Medical Center in Houston, TX.  Dr. Varon introduces the MATH+ treatment solution from the Covid Unit of one of America's latest CoronaVirus epicenters.




THE JUNE SPIKE OF HOUSTON
According to the Texas Medical Center data, COVID-19 cases escalated from 267 in week 10 (5/31) to 962 in week 13 (6/21). "I've had the worst 48 hours of the last 84 days. I have received more patients over the last two weeks than in the last 10 weeks [totalled]. As the state opened up, people get crazy‐‐ this includes Memorial day weekend and last week's protest and mass gatherings. Out of all this, my ward is getting a flood of patients. I have tested more than 55,000 people for Covid in the Houston metropolitan area‐‐ and out of those 55,000, 10.5% are Covid positive. And these numbers in Texas are still going up."

Dr. Varon attributes the current increase in case numbers to the lack of social distancing among the general public as the state's lock‐down is released. "I'm seeing more cases now than I have ever seen. So I have to trust our data based on all that work that we have done as a group. The problem is that (at least) in Texas, when people got told that they can go out to restaurants, they act as if CoronaVirus is over! There is no social distancing, no masks... nothing. The virus is very unique and what we're seeing now, the severity of illness for us is increasing from all these mass gatherings... but also the people‐‐ they don't give too much attention to the virus. By the time they come to us, it's often too late. MATH+ works beautifully when you start early. So the sooner I can start you off, the better off you are!"

REPLACING THE VENTILATOR
Medical data from UMMC Covid Patients
Treated with MATH+: Click to Enlarge
Countless news reports and researchers are now showing a significant percentage (75‐85%) of ventilated patients are ending in death. Interviews with medical experts state that patients who are ventilated typically have critical or dire conditions‐ whereby ventilators are not the cause of death.

According to the Journal of American Medical Assoc., "In (a) case series that included 5700 patients hospitalized with COVID‐19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died (n = 2634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died."

"When the pandemic started, my partner who owns a hospital was going crazy, trying to get ventilators. When we started working with MATH+, we actually changed the whole concept of treatment. Out of the last 70 patients that I've had with severe Covid, only two have required ventilators.  Why? Because I can manage most of the patients with high flow nasal cannula (HFNC), which are special devices that can provide large amount of oxygen comfortably to patients without having to put them on it on a respirator. Now this is not what's happening across the U.S. a lot of people are still using ventilators. A lot of people don't believe that when we tell them, once you put a patient on a mechanical ventilator, we're pretty much giving them more than 80% chance of dying. Information changes every day. In early March, I was probably thinking about ventilating a lot of people, but when I saw that MATH+ was working fabulously, that changed everything. And when we started to give them all these corticosteroids, ascorbic acid and the Heperin... they get well!"


"MATH+ Saved My Life" - In March, 2020, Jeffrey Boney of Houston, TX had fallen critically ill from the CoronaVirus and checked into critical care at United Memorial Medical Center.  Dr. Joseph Varon, frontline physician saved Mr. Boney through the use of FLCCC’s MATH+ protocol. (see Mr. Boney's video)





PAVING THE WAY TO GLOBAL ACCEPTANCE- ONE PATIENT AT A TIME
By: Dr. Joseph Varon

Dr. Paul Marik and I have been working together for close to 30 years. Since the middle of 2017, we've been working very closely on the H.A.T. protocol, (Hydrocortisone, Ascorbic Acid and Thiamine) and we enrolled more than 1500 patients together. By the time the pandemic came around, that's when I met with Dr. Umberto Meduri (the world's Guru on corticosteroids) and educated us all on Methylprednisone as a better choice. Then other specialists and researchers came aboard like Dr. Jose Iglesias and Dr. Pierre Kory‐‐ the group just came together, all from video conferencing.

Like anything else in life, every time a new therapeutic intervention comes in, it's usually met with a lot of resistance. Oddly enough, I'm getting a lot of international acceptance. Domestically, acceptance is not there yet. We are still having issues of people here who are just afraid‐ of giving steroids because they think that patients are going to get worse. They're stuck on the idea of intubating everybody. Now, in all fairness, when I am in my regular ICU, if you sneeze, I will intubate you. I'll put you on a respirator. But if I am on the Covid unit, I will do whatever it takes to prevent you from getting ventilated.

Covid‐19 is a very liquid illness because of its ability to keep changing. What I'm doing today is not what I was doing 10 weeks ago. We're in June now, and we are in the process of (still) learning more about the disease... and (with concepts like MATH+), we are trying to implement things that are easy to adopt by everybody. As of today, in my hospital, we have a 96.7 percent success rate with MATH+ . When you look at the data from Dr. Marik’s hospital and some of the other members of FLCCC, we're talking about a 95%, success rate among everybody. That's by far the best therapeutic intervention that is out there for coronavirus.

(End of Part 1)
For complete information about the MATH+ treatment protocol, visit: www.covid19criticalcare.com

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VIEWPOINTS


"The incredible work that has emerged from the group of scholars working on the MATH+ formula for patient care reminds me of the importance of collaboration in medicine.  This treatment formula was designed with patient care in mind, during an unprecedented time in our history.  The formula has clearly been shown to be an effective treatment to combat the virus.  The combination of corticosteroids, ascorbic acid and the Heperin has effectively been shown to reduce severity of patient symptoms and greatly reduce the need for the ventilator.  This is certainly a step forward in treatment options for COVID19 patients."   Dr. Noelle Cutter (Molloy College | Associate Professor of Biology and Chemistry) 


"I find the M.A.T.H.+ protocol to be a very intelligent approach to combining known proven treatments of COVID-19 into one complete protocol. From the experience of over 12.7 million worldwide cases and over 566,000 deaths, we learned COVID-19 can lead to an overwhelming inflammatory response to the virus which can lead to severe morbidityy. M.A.T.H.+ hits different points in the body’s over-reactive immune response; Methylprednisolone (a corticosteroid) decreases the body’s inflammatory response. Ascorbic acid (vitamin C) and Thiamine (vitamin B1) optimizes cellular oxygenation protecting the vital organs and optimizes the immune system. Finally Heparin (anticoagulant) stops the known hypercoagulation which leads to strokes and organ failure as the organs lose their vital blood supply. I am truly very impressed with the combined scholarship to create this M.A.T.H.+ protocol. It will surely help physicians save lives." - Stephen A. Chagares, MD, FACS

"In global pandemics with changing guidelines such scholarly articles based on facts and effective treatment options provide useful insights. While  world awaits for vaccine and effective treatment for Covid, existing proven treatment regime like "MATH+"  provides evidence based guidance to fight the current  pandemic to majority of world deprived of  access to cutting edge medicines and vaccines immediately." - Smita Dhumal, MD, MS, CCRC / Clinical Trial Manager at Amgen

"A group of scholars, specializing in critical care has developed MATH+ protocol, which reveals to be a fantastic treatment combating the virus Covid19 until a vaccine has been found. This, by fighting the hyper-inflammation that damages the lungs, with a less expensive treatment, and thus, affordable to everybody. This group of scholars have demonstrated how important is team work between scholars and teachers, and Dr. Varon reported that MATH+ protocol has provided until 96.7 percent success rate in his hospital."  - Sergio Marcucci, DO, MSc, DHSc / Private Practice of osteopathic medicine (Luxembourg), A. T. Still University College of Graduate Health Studies


"As a health coach one of my goals is to help my clients reduce inflammation in their body. Chronic Inflammation causes the body’s inflammation response to eventually damage the body’s healthy cells, tissues and organs.  Ventilators being used are only enabling COVID-19 patients to breathe however a protocol such as MATH plus that uses a combination of medicines such as Ascorbic Acid (Vitamin C) and Thiamine to protect the heart, brain and immune system is battling the chronic inflammation that leads to failure of organs. It’s a functional approach and provides a chance of survival as well as a possibility of counteracting future disease."  - Sonia Bhatia, MBA, INHC (www.beinghealthylivingwell.com)

"To unite like minds toward a powerful goal (like saving lives) has always been a global effort worth pursuing.  This article about MATH+ was tremendous... it raised the bar of awareness as far as bringing out information that most people may not have heard about. It captivated me to read more about Dr. Varon, Dr. Marik and the entire group of doctors involved! As we are all quarantined and locked into the watching grim news, this is the BEST news I've read in months!"  - Carmen Regallo-Dewitt, PhD / Medical research/columnist for www.AwarenessforaCure.org | 
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THE "COVID WAR"- FOUGHT BY A GLOBAL ALLIANCE OF SCIENTISTS
By: Cheri Ambrose & Adrian Barrios

June 24, 2020- Months into the CoronaVirus pandemic, the tally of efforts expended by government health agencies and professionals worldwide has been noted to significantly exceed any global campaign in history.  Economists tend to use war terms to help put the pandemic's containment efforts and collateral damage in perspective.  IMF's chief economist Gita Gopinath,  (in an April 15 news conference) stated that "the best case scenario, the world is likely to lose a cumulative $9 trillion in output over two years"- making this a global war 3x the fiscal size of World War II.

As with past wars, alliances were formed, industries were committed to task and scientists worldwide have united by sharing information toward this single directive. The Department of Global Communications (U.N.) announced their drive to mobilize global cooperation in science-based COVID-19 responses, "The United Nations is mobilizing international cooperation to harness the power of science to tackle the coronavirus pandemic, while also working with partners to explore innovative crisis response tools."

Epidemiology
Unlike the early months of the year, the second quarter showed the front lines to finally "catching up to the war efforts" with installments of these comprehensive containment measures:
  • a dedicated testing strategy & global data tracking
  • ample access to Covid tests and antibody testing
  • policy enforced education about preventive and safety guidelines
  • ample manufacturing of medical equipment and medicines
  • consistent PPE supply & distribution chains
  • trained critical care response personnel
  • lab research for therapeutics and vaccines

GLOBAL SOLIDARITY AGAINST THE PANDEMIC
"The COVID-19 pandemic has demonstrated the interconnected nature of our world – and that no one is safe until everyone is safe.  Only by acting in solidarity can communities save lives and overcome the devastating socio-economic impacts of the virus.  In partnership with the United Nations, people around the world are showing acts of humanity, inspiring hope for a better future." - United Nations

World medical conferences and international forums unite
multidisciplinary experts to continue global info-sharing
This pandemic has clearly illustrated that "Scientists by nature do not see borders or politics - only solutions", states Dr. Robert Bard, cancer diagnostics expert (NYC). "The spirit of teamwork is alive and well with this community- especially in a crisis. Historically, medical and scientific people have always raced to the front lines - always at the ready to pool resources and collaborate.  Like the domestic and international health associations, we continue to see some of the sharpest clinical minds in the world- including American teams that are now coming out with promising protocols to help end this pandemic.  To contain and eliminate this human threat means UNITING WITH SCIENCE AND WORKING TOGETHER ON A COORDINATED GOAL."

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Other articles recently published in Prevention101.org

"The Power of Prevention of Covid-19 is in YOUR HANDS"
Source: MD Anderson Cancer Center
Watch how a blacklight reveals what improper hand washing can leave behind. According to Dr. Christina Le-Short of MD Anderson Cancer Center, "Cancer patients are at greater risk of developing complications from respiratory viruses... Effective hand-washing is your best defense against germs that cause the flu or Covid-19". 
Possible Health Hazards Behind the Mask
Source: NIOSH SCIENCE BLOG
Reports about Prolonged PPE Use by healthcare workers are aligned with health issues from abnormally elevated carbon dioxide (CO2) levels in the blood causing increased pressure inside the skull, nervous system changes, cardiovascular effects and reduced tolerance to lighter workloads that may lead to possible dizziness, hyperventilation and dehydration. View the report by the CDC about the many physiological effects of breathing increased concentrations of CO2 and the effects of failing overused respirator masks: See complete article
Suggested Safety Measures for Covid Prevention in Medical Offices  From respirators to hand sanitizers to regular use of hospital-grade disinfectants, the medical community is trusted to apply and set standards when it comes to safety measures, risk prevention strategies and sanitizing efforts. This new article offers a collective set of smart and sensible safety ideas from a group of doctors in your area. Promoting SAFETY GUIDELINES in any health practice is everyone's duty in our community.  See complete article




References:
1) Some doctors moving away from ventilators for virus patients: https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d

2) Global economy to be worst hit since Great Depression: Gita Gopinath, Chief Economist, IMF

https://www.youtube.com/watch?v=rpiZ0DkHeGE

3) W.H.O. CASE COUNT: https://covid19.who.int/?gclid=CjwKCAjw88v3BRBFEiwApwLevVNWB8VzRXQYzS6KGVe1QkdIdQ7P5G4SoXNIeYnTSKcIooGXKqbIzBoCnIkQAvD_BwE


4) UChicago Medicine doctors see 'truly remarkable' success using ventilator alternatives to treat COVID-19 https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/uchicago-medicine-doctors-see-truly-remarkable-success-using-ventilator-alternatives-to-treat-covid19


5) Ventilators: Helping or Harming COVID-19 Patients https://www.webmd.com/lung/news/20200415/ventilators-helping-or-harming-covid-19-patients#1


6) Study: 88% of coronavirus patients on ventilators died in NY

https://www.syracuse.com/coronavirus/2020/04/study-88-of-coronavirus-patients-on-ventilators-died-in-ny.html

7) Coronavirus patients on ventilators are unusually likely to die, causing some doctors to change strategy

https://www.independent.co.uk/news/coronavirus-ventilators-nhs-death-rates-china-wuhan-us-cases-a9458541.html

8) Texas Medical Center Data: https://www.tmc.edu/

9) Nearly 9 in 10 COVID-19 patients who are put on a ventilator die, New York hospital data suggests
https://www.livescience.com/coronavirus-ventilator-deaths-new-york.html

10) Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area
https://jamanetwork.com/journals/jama/fullarticle/2765184

11) Center for American Progress: Removing Barriers for Immigrant Medical Professionals Is Critical To Help Fight Coronavirus  https://www.americanprogress.org/issues/immigration/news/2020/04/02/482574/removing-barriers-immigrant-medical-professionals-critical-help-fight-coronavirus/

12) UN Foundation: HOW THE WORLD’S SCIENTISTS, DOCTORS, AND NURSES ARE UNITING TO FIGHT COVID-19  https://unfoundation.org/blog/post/how-worlds-scientists-doctors-and-nurses-uniting-fight-covid-19/



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Monday, June 15, 2020

POTENTIAL HEALTH RISKS BEHIND THE MASK

Introduction By: R. Christenson, MD (From: "Holding the Front Line with Zero"- an essay by a covid health responder)

During the worst 2 months of the pandemic in New York, I spent countless double-shifts in a constantly slammed Long Island Covid Unit, tending to what seemed like a never-ending avalanche of critical cases.  The vast majority of our medical team was stretched to the very max of their professional tolerance, where each traumatic situation bred severe anxiety, PTSD and a rising count of suicide.

Exhaustion came in many forms; the drain on our mental composure ate away at our physical endurance as did the absence of sleep, zero nutrition plus the eminent fear and threat of death allaround us all. Add all that to the much reduced air supply from expired respirator use plus hedging on a number of serious complications from excessive CO2 intake - and you've got yourself the makings of some serious health conditions that may easily answer for what we simply call "burnout".


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The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts

Source: NIOSH SCIENCE BLOG/ CDCOriginal post on by Jon Williams, PhD; Jaclyn Krah Cichowicz, MA; Adam Hornbeck, MSN, APRN, FNP-BC, FNP-C; Jonisha Pollard, MS, CPE; and Jeffrey Snyder, MSN, CRNP.

Healthcare workers (HCW) and first responders often work long, physically and mentally exhausting shifts and are also required to wear personal protective equipment (PPE), which may include N95 filtering facepiece respirators (FFRs) elastomeric half-mask respirators, or powered air-supplied respirators (PAPRs). Particular features of PPE can impose a physiological (how the body normally functions) burden on the HCW which can be exacerbated by long work hours without adequate breaks for eating, hydration and self-care. HCWs should be provided regular opportunities to take breaks and a supportive environment to report symptoms related to their PPE use. For example, using an FFR for an extended period may cause dizziness (as well as other symptoms), which could compromise the worker, workplace, and patient safety. Dizziness is an important warning sign, as it can be caused by dehydration, hyperventilation (gasping for breath), elevated carbon dioxide [CO2] levels in the blood, low blood sugar, and anxiety, among other things.
When HCWs are working longer hours without a break while continuously wearing an N95 FFR, CO2 may accumulate in the breathing space inside of the respirator and continuously increase past the 1-hour mark, which could have a significant physiological effect on the wearer (Lim et al., 2006). Some of the known physiological effects of breathing increased concentrations of CO2 include:
  1. Headache;
  2. Increased pressure inside the skull;
  3. Nervous system changes (e.g., increased pain threshold, reduction in cognition – altered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels);
  4. Increased breathing frequency;
  5. Increased “work of breathing”, which is result of breathing through a filter medium;
  6. Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels);
  7. Reduced tolerance to lighter workloads.


Disclaimer: All content from "the above article (The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts" ) is republished in this associated blogsite / newsletter from its original source (NIOSH/CDC Science Blogand is done so with express permission from NIOSH/CDC and is in compliance with the source's agency regulations. Whereas use of any and all materials, information and links to the materials on the CDC [Centers for Disease Control and Prevention], ATSDR or HHS [Health and Human Services] websites, does not imply endorsement by CDC, ATSDR, HHS or the United States Government of this publication, the NY Cancer Resource Alliance, IntermediaWorx Educational Publications and other producers/publishers herein. 


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UV-C Light is used to disinfect & extend PPE life for reuse
UVC and the Coronavirus
By: Dr. Robert L. Bard & Lennard Gettz

A rising trend in hospital disinfecting (as well as in commercial areas and public institutions) is the installation and use of UV-C disinfecting technology. From small 8" x 10" boxes that extend the life of face masks in the healthcare field, to 8-foot transportable setups that fully sanitize hospital recovery and surgical rooms to (lately) subway trains covering a daily chemical-free sanitizing program.  Controlling infections with UV-C is fast earning public acceptance as a low-risk, non-chemical solution with significantly proven effectiveness.

Hospitals that use UV-light disinfection typically applies this technology as a 2nd step to cleaning and disinfecting measures.  This process is recognized by clinical infection control professionals and agencies to significantly mitigate infection risks associated with environmentally mediated transmission routes. (see complete article)


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RESOURCE 1: REPORTING BOGUS RESPIRATORS (part 1)
By: Stephanie Stevens (CDC / NIOSH / OD)


AD: Review on Counterfeit PPE for Health Responders-
sponsored by: The Advocacy for Professional Safety
According to Megan Casey, MPH, a nurse epidemiologist in NIOSH’s Personal Protective Technology Laboratory: Coronavirus is thought to spread through respiratory droplets produced when an infected person coughs or sneezes, but some medical procedures could potentially suspend virus particles in the air that healthcare providers are breathing. Wearing appropriate respiratory protection is a vital line of defense during these procedures. Counterfeit respirators can compromise the safety of anyone who uses them, including healthcare providers.

NIOSH receives reports of possible counterfeit respirators through a number of channels.This includes reports from manufacturers who are trying to protect the integrity of their own NIOSH approval. We may also be contacted by purchasers and users who have concerns about product or marketing materials. NIOSH staff may also identify instances of counterfeits or misleading information, including through web searches or from reports from stakeholders.  

When NIOSH becomes aware of counterfeit respirators or those misrepresenting NIOSH approval on the market, these respirators are posted online to alert users, purchasers, and manufacturers. As per our regulation, NIOSH only has authority over companies that hold a NIOSH approval. If the devices are not approved by NIOSH, we have no authority over them. We can only report these issues on our Trusted Source webpage for Counterfeit Respirators/Misrepresentation of NIOSH-Approval.


Resources to help identify counterfeit respirators:


Also see our expanded feature: The "Wild West" PPE Industry + A special feature on COUNTERFEIT RESPIRATORS


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SUGGESTED SAFETY GUIDELINES FOR MEDICAL OFFICES

Copyright © 2020- IntermediaWorx Inc. Educational Publications & NY Cancer Resource Alliance


As essential health and medical service providers, our community looks to us to set the standards when it comes to implementing safety measures, risk prevention strategies and sanitizing efforts.  We are all in the same fight to control the spread of pathogens and to preserve the health of our patients and our staff.  These same priorities align with our commitment to share these top recommended protocols for HEALTH & SAFETY which we assembled from a wide survey of safety‐minded colleagues. We urge you to review and consider these safety measures for your office.  Only together can we continue 'flattening the curve' and win this global health crisis- one office at a time!


1) BY APPOINTMENT ONLY:    As private practices are now beginning to re-open on a cautiously limited and adjusted schedule, communicate with your patients that you are officially open for in-person patient care and your new office hours. Adjusted scheduling allows you to better spread out all appointments for better crowd control and allows your staff time to disinfect and clean between patients. Also, emphasize NO WALK-INS.

2) TEMPERATURE CHECKS AT THE DOOR: More and more businesses and professional practices are now requiring temporal temperature checks at the door as an essential public safety measure.  The doorway is a major point of contact with the public at large- and one of your first lines of defense, starting with temperature screenings. Also, you can suggest all patients to check their temperature prior to traveling to your office - and stay home if they have above 101 degree reading.

3) PATIENTS ANNOUNCE THEMSELVES UPON ARRIVAL: When the patient reaches your facility for their appointment, request that they announce themselves via phone from outside. This gives your staff a chance to adjust in case the office is backed up- or if you can see them earlier. If possible, encourage patients to wait outside the building until their time is ready.

4) THE "NEW" WAITING ROOM: More and more doctors’ offices are now reducing the number of seats, and others are even eliminating their waiting rooms altogether.  Waiting rooms have been recognized as a potential ground for sharing bacteria and viral pathogens.  Reducing the wait capacity to the least number of patients (ONE or TWO max) is crowd-control and supports social distancing. 



Brought to you in part by the NY Cancer Resource Alliance and the Advocacy for Professional Safety, publishers of Prevention101.org







REFERENCES-
2) Visual Detection of Bacteria and Microbes;  https://aabme.asme.org/posts/device-quickly-detects-live-bacteria-for-life-saving-diagnosis

3) Acute Oxygen Therapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113909/

4) Healthcare suggers from PTSD... https://ohsonline.com/Articles/2020/05/19/Healthcare-Workers-Suffer-from-PTSD-and-Burnout-During-COVID19.aspx?Page=3

5) The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts  https://blogs.cdc.gov/niosh-science-blog/2020/06/10/ppe-burden/

6) Compliance Safety and Health Officers (CSHOs) for enforcing the Respiratory Protection standard: https://www.osha.gov/memos/2020-04-24/enforcement-guidance-decontamination-filtering-facepiece-respirators-healthcare

7) Study: Think Twice About Reusing KN95 or Surgical Masks- https://www.medpagetoday.com/infectiousdisease/infectioncontrol/87077?xid=nl_popmed_2020-06-16&eun=g1405490d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyUpdate_061620&utm_term=NL_Daily_Breaking_News_Active

Tuesday, June 9, 2020

SUGGESTED SAFETY GUIDELINES FOR MEDICAL OFFICES

Copyright © 2020- IntermediaWorx Inc. Educational Publications & NY Cancer Resource Alliance


As essential health and medical service providers, our community looks to us to set the standards when it comes to implementing safety measures, risk prevention strategies and sanitizing efforts.  We are all in the same fight to control the spread of pathogens and to preserve the health of our patients and our staff.  These same priorities align with our commitment to share these top recommended protocols for HEALTH & SAFETY which we assembled from a wide survey of safety‐minded colleagues. We urge you to review and consider these safety measures for your office.  Only together can we continue 'flattening the curve' and win this global health crisis- one office at a time!


1) BY APPOINTMENT ONLY:    As private practices are now beginning to re-open on a cautiously limited and adjusted schedule, communicate with your patients that you are officially open for in-person patient care and your new office hours. Adjusted scheduling allows you to better spread out all appointments for better crowd control and allows your staff time to disinfect and clean between patients. Also, emphasize NO WALK-INS.

2) TEMPERATURE CHECKS AT THE DOOR: More and more businesses and professional practices are now requiring temporal temperature checks at the door as an essential public safety measure.  The doorway is a major point of contact with the public at large- and one of your first lines of defense, starting with temperature screenings. Also, you can suggest all patients to check their temperature prior to traveling to your office - and stay home if they have above 100 degree reading (recommendation by the CDC). 

3) PATIENTS ANNOUNCE THEMSELVES UPON ARRIVAL: When the patient reaches your facility for their appointment, request that they announce themselves via phone from outside. This gives your staff a chance to adjust in case the office is backed up- or if you can see them earlier. If possible, encourage patients to wait outside the building until their time is ready.

4) THE "NEW" WAITING ROOM: More and more doctors’ offices are now reducing the number of seats, and others are even eliminating their waiting rooms altogether.  Waiting rooms have been recognized as a potential ground for sharing bacteria and viral pathogens.  Reducing the wait capacity to the least number of patients (ONE or TWO max) is crowd-control and supports social distancing. 

5) (NEW) REMOVE MAGAZINES & NEWSPAPERS: Take away any materials in the waiting room that may land on a patient's hands.  Reading material is a potential breeding ground for traveled viruses from others.

6) MASKS & OTHER PPE: The current law of “NO MASK = NO SERVICE” applies to all indoor professional or commercial settings where masks (nose & mouth covering) are required AT ALL TIMES. And when working with patients under treatment, make sure to wear clinical-grade protective gear such as gloves, protective gowns and face shields as standard precaution. 

7) HAND SANITIZING: Regular hand-washing 
(20 seconds) is highly advised for reducing contamination from pathogens both for the public and your staff. In addition, your office should have visible & easy access to hand sanitizers in every room especially for all office occupants. 

8) REDUCE IN-PERSON TALKING: As viruses are widely recognized to be transported by one’s BREATH and atomized saliva, a major part of Prevention means limiting verbal exchange between patients and medical staff to the absolute essential minimum. A safe alternative is discussing anything administrative BY PHONE prior to the appointment.   

9)  PAPERLESS OFFICE:  Another means of reducing person-to-person contact and minimizing physical engagement with patients. Transmitting and receiving patient forms and payment processing via email before the visit is a proven and safe office solution (PAPERLESS OFFICE) that streamlines workflow and reduces patient time spent in the office. 

10) TELEMEDICINE: A sustainable tech option that is spiking in popularity, TeleMedicine is a nationally billable alternative to the (now risky) face-to-face consultation and post-procedure doctors’ visit.  Digital and video communication with patients is an intelligent use of our existing web & video technology.  Telemedicne supports the elimination of the patient's travel time and is a completely SAFE preventive measure from any possible exposure from a waiting room or public contact.



11) OFFICE DISINFECTING REGIMEN: Stock up on disinfectant wipes and sprays for your staff’s daily maintenance.  Upgrade your office cleaning routine to include a regular hospital-grade sanitizing regimen.  This includes use of industrial rated anti-microbial products. Offices and hospitals can hire outside disinfecting companies to come in and conduct disinfecting services. Research the many available products and sanitizing vendors in your area. Also, explore the many new disinfecting technologies (their efficacy and pros and cons) - including liquid sprays, electrostatic applications, UV-C (Ultraviolet) Lamps and Negative Air Ionizing Filters.  [CDC also recommends increasing the frequency of disinfecting surfaces.]


12) (NEW) QUESTIONNAIRE / PATIENT'S CURRENT CONDITION
Sometimes, clerical measures can be a preventive tool.  Many doctors offices are requiring patients to fill out and sign a form asking about the patient's health condition and history with Covid-19. By their signature, they are attesting legally to the validity of their responses, committing them on record as to their level of risk to others and to themselves.

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CORONAVIRUS UPDATES FROM NIOSH/CDC





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TALK ABOUT SAFETY... See what other docs are saying

NO-TOUCH TECHNIQUE
“Without a doubt, this pandemic has awakened much change in the way we do just about anything, and thinking SAFETY is a big part of that! Our patients appreciate our converting to an ONLINE platform for all patient registration forms... once we went completely digital,  you have a true “no touch” and "no talking"  technique where patients walk directly in to an exam room and no stopping at the front desk and no MA’s or techs needed.  It’s a direct walk into treatment then out the door.”  
– Dr. Stephen Chagares, Breast Cancer Surgeon- NJ (drchagares.com)


A TIMELY REVOLUTION IN METHODS
“- I’ve always felt that there are many areas in patient care that could use an upgrade... this  pandemic made us re-evaluate every part of our work process for better safety and cost efficiency. This  includes our current resources like TeleMedicine- where remote consults and digital file have become such a blessing as it saves patients travel time and $$ while keeping everyone safe from unnecessary risk and exposure." 
Dr.Robert  L. Bard, Cancer Diagnostic Imaging- NYC (Cancerscan.com | TelemedScans.com)



LEADING BY EXAMPLE
"It is imperative to institute good safety measures in medical office settings as we begin to navigate this COVID-19 pandemic and help guide the country through the reopening phases.  As healthcare professionals- it is our duty to set the example for others to follow.  We can provide a framework and high standards of health and safety ideas that can be mirrored in all office settings, stores, schools , banks and other industries." 
- Juanita Mora, MD, Volunteer National Spokesperson, American Lung Association


PREVENTIVE ADJUSTMENTS
“The landscape for treatment has changed…Patient visits are spaced so that no one is in the waiting room. Patients  must wear a mask upon entrance and throughout the course of the visit and so does the caregiver or attendant. After each visit, the room is wiped down with appropriate sanitizers; careful to not overdo it which might cause respiratory problems. Common surfaces (doorknobs etc) are also wiped” 
– Dr. Richard Kushner, Podiatrist - NYC


PATIENT CONFIDENCE
"It is critical that every patient “touch point” is educational and science based. Examples include; the first email sent out announcing your practice re-opening, the screening questions that are asked prior to the patient’s first visit,  the patient’s greeting/screening at your entrance, the handwashing station, the waiting and patient areas. Take the time to make sure your staff is comfortable with the procedures implemented."
Dr. Carol Stillman Physical Therapist and owner of Sutton Place Physical and Aquatic Therapy.


SMART SYSTEM UPGRADE
"Promoting SAFETY GUIDELINES in any health practice (especially during this Pandemic) is everyone's duty in our community-- where we all need to do our part to help minimize the risk of contamination. Policies like checking temperatures at the door and having maintaining sanitizers and PPE's for the staff gives the patients peace of mind knowing they are walking into a safety conscious office.  It's an opportunity for providers to lead by example!" 
 Jessica GlynnLicensed clinical social worker/psychotherapist- NYC (jagtheracoach.com)  

For  the  latest  CDC updates,  additional  information  and  safety  recommendations  for  your  medical  office,  visit:  PREVENTION101.ORG and review our CDC SAFETY LINKS.  This list of suggested Safety Guidelines for healthcare offices  is published by The Advocacy for Professional Safety‐ a branch of the NY Cancer Resource Alliance and IntermediaWorx  Educational Publishing. (c) Copyright, 2020‐ All Rights Reserved. 
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VIDEO EXTRA:
"The Power of Prevention of Covid-19 is in YOUR HANDS"
Source: MD Anderson Cancer Center

You have the power to reduce your risk of infection by washing your hands often. Watch how a blacklight reveals what improper hand washing can leave behind. According to Dr. Christina Le-Short of MD Anderson Cancer Center, "Cancer patients are at greater risk of developing complications from respiratory viruses... Effective hand-washing is your best defense against germs that cause the flu or Covid-19".

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A WORD FROM THE TOP
As the country aims at opening more and more areas of business, the concern for safety is at its highest.  Commercial business and health centers alike are following the many safety protocols recommended by city, state and federal leaders with the hopes of quelling the threat of a Covid recurrence, bringing us all back to another shut-down.

In a NY State press conference on 5/12, Governor Andrew Cuomo presented his goals for reopening lower New York with safety conditions, starting with a push to maintain social distancing and valuing the importance of continued face covering.  "Out of respect to you," he started, "I wear this mask.  The mask says I respect the nurses and the doctors who killed themselves through this virus to save other people- all essential workers who get up every day to do their job so I can stay safe... it's not about ME-- it's about WE!" ( see complete video LINK)

A recent CDC report about Screening Patients for COVID-19 at Intake stated, "If there is widespread community transmission of COVID-19, facilities can consider instituting active temperature monitoring by having a staff member check the patient’s temperature immediately upon arrival at the door and when the patient is first asked about symptoms".  (ref. link: CDC Screening PatientsIn addition,  masks, social distancing and disinfecting work areas are part of this new critical infrastructure.  (See complete CDC Interim Guidance)

In addition, the NYS Dept of Health also published Covid-19 Guidance for Medical Providers about infection control.   "...When engaging a client (patient), staff should use alcohol-based sanitizer with at least 60% alcohol prior to entering the home and should wear a face mask, if available.  Staff should attempt to keep at least six (6) feet away-- [and] should also remind everyone to practice appropriate hand hygiene and to avoid touching their face".  From a May 2020 update, the DOH also encourages Telemedicine and TeleHealth technologies whenever possible. (link).- Also see Managed Care Organization Contracting and Surveillance Relief.  (DOH link

Also see: Senator Biaggi’s 6/4 COVID-19 Update: NYC has Zero Confirmed COVID-19 Deaths for first time since March 11




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