When is it time to stop whining and be grateful?

In a word….NOW! Yes, I mean now. Emotions are running hot and the stress level is high, but, it is still time to stop complaining and be grateful. Please. If you or a family member are not on a ventilator or have lost someone you love to COVID-19, please think before you speak about how this virus is inconveniencing you. It’s really boils down to that big of a picture. People are facing death with this thing. In comparison, the cancellation of activities is pretty minor. I get that the economic stress is significant as well. My husband and I just finished a somewhat grueling loan application process to try to keep our businesses and our employees afloat during this time. The whole thing just re-bubbled all my pent up anxiety to the surface again. I couldn’t help it. But, I had to take a step back and regain some perspective and be glad that this option is possibly available to us in the first place. There are no guarantees even if we are able to get the loan. I am hoping against hope that my own cleverness combined with opportunity and a good deal of altruism will carry me through somehow. I am working hard every day, even though I am supposed to be on vacation, researching ways to get through this thing. I am trying to figure out how to remind people through advertising that I intend to stick around without seeming tacky. I am begging lenders and trying to build bridges just like the rest of the world, while trying to keep my family’s spirits up, home cook every night and ration the toilet paper the best that I can. I know how hard it is. I understand what is going on. I am just asking that you take a second before posting your latest Covid complaint post and put things into perspective again. Tomorrow is never guaranteed, let’s try to enjoy today if we can. Have a great day everybody.

Dr. Katz

How’re we doin?

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Hi everybody! Shelter in place day 1. How’re we doin? I am feelin the panic from everyone. I even felt a little creeped out last night when I went for my walk and suddenly my phone was overtaken by a reminder of the executive order…complete with a notice about unnecessary travel being prohibited. It literally gave me the chills for a second, like I was in one of those weird future dystopia movies or something. Then, I shook it off. You know why? Because it is not really any different than what we were supposed to be doing anyway! I know what you’re going to say. Hey! Before we could still get take out and go to the mall, etc. Hey! This is even a bigger crush on small business. Yes. Yes. All that is true. My business is being severely affected too. I can’t do any surgery, unless it’s an absolute emergency. I can’t see any people that are sick who actually need me. They have to go through the ER or stay at home. I can basically only see well patients or OB patients, if I can even get them to come in. I am not immune to this process. The scary flipside is, that I also have to risk exposure to COVID everyday. If a COVID positive OB patient comes in, we still have to figure out how to deliver them safely with the least exposure to the least amount of people and keep their newborns safe as well.

However, if you think about it, we were already supposed to be restricting unnecessary trips and travel. We really should have been following our social distancing, not going to restaurants, not going to the movies, not going to the mall anyway. There was no dire need to get our nails done or go to the tanning salon. These are not basic life needs. Before you get all ruffly, let me explain what I mean about basic life needs. They are things that are life or death dependent. Your life or death does not depend on how brown you are or how good your nails look or if you got that extra candle or how gray your hair is ( Trust me, I am battling that one as we speak). It just doesn’t, if we are being honest. I am of the opinion that if we were truly following instructions in the first place, there would have been no need to issue an executive order. (Having said that, I also get that a politician’s need to appear like they are actively doing something in a crisis may, in fact, supersede the actual need for action.) If we hadn’t panicked and hoarded all paper products, in reaction to a virus whose main symptoms are NOT GI symptoms, except for a small percentage, those of us that have been working like crazy might have had an option to wipe our asses besides the wipe with the left, eat and shake hands with the right method. C’mon people! I am looking at all the fear-mongering, crazy Facebook posts. They are unnecessary. They are not helpful. They are not helping anyone get through this thing.

I took it upon myself to break down the governor’s executive order announcement into a less than five minute summary. I will do the same right now for you. Here are the main bullet points. Stay at home whenever possible. If you have an essential job (defined on the Michigan.gov website), you can go to and from work. Essential businesses are still open. You can go to get gas for your car. You can go to the pharmacy or grocery store. You can still get money. You can still go to the doctor or to the hospital if you need to. You can still go outside. You can still go for a walk. Maintain your social distance of 6 feet at all times. No crowds. Have meetings remotely. All your basic needs can still be met. Amazon is not shutting down like rumors have said.(JK, she didn’t really address that…lol..but it is true.) Don’t panic. Don’t hoard. That is it in nutshell…in two minutes or less. Let’s just all screw our heads back on properly and dig into our common sense reserves and we will get through this together! Have a fantastic day everyone!

Dr. Katz

COVID-19 and Pregnancy

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Hi everybody! We have been doing so many updates about all aspects of this virus and it’s effects lately. It seems to be all we can talk about. However, I feel like we have forgotten about the preggies. It’s time to review a little bit about what we know about COVID and pregnancy. Please keep in mind that whatever I explain right now this minute could still change tomorrow. The following is a break down of the recent commentary about COVID and pregnancy in the journal Obstetrics and Gynecology.

First, let’s keep in mind that the WHO only declared a global pandemic as of March 11th, so there hasn’t been a ton of time or pregnant women to study since then. Let’s go over what we do know and what we have seen. Keep in mind that this situation is changing rapidly. As of March 17th, more than 189,000 people have been diagnosed with COVID globally with more than 7,500 deaths and more than 150 countries involved. Realistically, this is probably just the tip of the iceberg because of the limitations of testing so far. We know the common symptoms of dry cough, fever, and fatigue. We know that the incubation period is up to two weeks. We know some of the findings on chest x-ray and in lab tests that can occur with COVID and we are working on a serum test instead of the nasal swab. We also know that there are multiple very similar coronaviruses that have been around since the 1980s! Hmm. How new is this thing really? I am asking for purely academic interest only I promise. Has it really been around all this time in bats like the other viruses and somebody just finally ate the right/wrong bat in a soup so it could make the jump to humans?

Ok. I am getting distracted. I was supposed to talk about COVID and pregnancy. So, what do we know about the preggies anyway? So far, there have been three case series for a total of 31 pregnancies affected by COVID that have been published. We also have a WHO report from China with some limited information on 147 pregnancies. We also have reviews looking at features of other coronaviruses like SARS(Severe Acute Respiratory Syndrome-Associated Coronavirus) and MERS( Middle East Respiratory Syndrome-Related Coronavirus) in pregnancy. The American College of Obgyn has already published guidelines for pregnancy and the CDC has posted answers to frequently asked questions about COVID and pregnancy, but there is still a lot we do not know for sure right now.

So, what are the answers and what are the questions? One of the biggest questions is the case-related fatality of the disease in pregnancy. It is hard to sort through the data on the fatalities because the fatality rate really depends on the co-morbidities of the patients, the quality of the health care provided and the age and health of the patients affected. It’s not just straight numbers. So far, rates around the world have been reported in a range from .9% to 9%. But remember, these rates are overall rates, not adjusted for the variables mentioned above. Plus, mild or asymptomatic cases can be missed so the fatality numbers can actually be overestimated. We don’t fully know the fatality rate in the United States yet and as of yesterday, we do not have any fatalities reported in pregnant women that I am aware of.

We still have questions about all the routes of transmission of COVID as well. We are still looking at how long the virus survives on surfaces. So far, 9 days is the magic number, depending on the surface and the particular coronavirus. We are still looking at whether asymptomatic people can transmit the virus. For a pregnant woman, the biggest question if there is vertical transmission of the virus. Vertical transmission refers to transmission of the virus from a pregnant woman to her fetus. We really haven’t had enough pregnant women yet to compare to nonpregnant women of similar age. There was a small study comparing SARS in similar aged pregnant and non-pregnant women that suggested that pregnant women may have a greater incidence of severe disease and death, but we are not seeing that so far with COVID.

As far as vertical transmission, we really don’t know the answer yet. SO FAR, we have not seen it yet in the small number of COVID pregnancies reported up until this point. This sounds great, but I don’t think we can count on this just yet. I am going to hang on to this bit of potential good news anyway for now. I will say that the in the group of pregnancies studied so far, the vast majority of women were infected in the third trimester and most of them had delivery by c section. We don’t really have any pregnancies to refer to at this point where the women were infected in the first or second trimester.

There is a question about pregnant health care workers and COVID. Should they be given special consideration? In the past, the CDC has recommend different guidelines for different viruses. For H1N1, they recommended that pregnant workers follow the same precautions as other workers, but maybe avoid any procedures that could generate aerosols( infected respiratory droplets). A different systemic review of 1862 publications rated the following as the aerosol-inducing procedures with the highest risk of infection transmission of SARS: tracheal intubation, tracheotomy care, airway care, and cardiac resuscitation, non-invasive ventilation and manual ventilation before intubation. Results were mixed as far as nebulizer treatments. With Ebola, the CDC recommended that pregnant workers not even care for those patients. We just don’t have enough data yet to make specific recommendations for pregnant workers and COVID.

Currently, hospitals are recommending immediate separation of newborns from COVID positive mothers postpartum. At our hospital currently, COVID positive mothers will remain in negative airborne isolation throughout their stay. Immediately after birth, the neonate is put into an isolette, separated from the mother and moved into the nursery under negative airborne isolation. Those mothers that choose to have their infants remain in the room for bonding must wear PPE( personal protective equipment) and the infant must stay in the mother’s room throughout the entire stay. Remember that so far, we have not seen vertical transmission (mother to fetus in the womb), but the neonate could still get infected after exposure to the mother after birth. Luckily, so far, it looks like children in general are mildly affected by COVID, but we really don’t know about neonates.

So, where does that leave breastfeeding? We have a very small amount of data that suggests that SARS is not transmitted through breastmilk, but we really don’t know about COVID. Even the SARS data is too limited to apply on a broad scale.

I get it. I just basically said that we really don’t know anything solid about COVID and pregnancy. The situation is just evolving too fast. We do have some possibly good news about the lack of vertical transmission but we need to keep watching. At this point, the best thing to do regarding pregnancy and COVID is to keep using the same methods that we already are to prevent the spread of other viruses like the flu. Tell patients to not go around known ill persons. Tell them to wash their hands frequently and not touch their face. Tell them to cover their coughs and sneezes and not just blast into the open air. Screen pregnant patients for upper respiratory symptoms, travel, cough and fever and triage accordingly. Separate ill patients from well patients. Limit visitors to labor and delivery and postpartum. Cancel mass gatherings and concerts. Maintain social distance. The reality is that pregnancy care does not truly lend itself to telehealth as a rule. These patients need regular visits. We need to take every universal precaution, like we should anyway. Give patients copies of their records frequently in case their care gets disrupted.

Basically, this situation is going to keep changing until it runs it’s course. This is the best info we have available right now. Until we have more data on more pregnant women, this is all I have to offer you right now. I think the key for now is to use common sense and universal precautions and to stay tuned for more updates as they arise. Hang in there and try to have a great day.

Dr. Katz

Just when I thought I could stop being anxious

I saw the news today celebrating no new corona virus cases in Wuhan. Whoohoo! That means there is an end to this thing at some point, right? It sounds good doesn’t it? Now take a quick step back and remember that this cycle took several months….that we know of. Also consider that China was months ahead of us. This means we are not done with this for awhile folks. This means it is more important than ever to listen to the EXPERTS like the CDC…not google…not your friends( unless they are healthcare workers on the front lines maybe)…not your chiropractor or the kid at the grocery store. Pay attention to Dr. Anthony Fauci! Who is Dr. Anthony Fauci? He is the director of the National Institute of Allergy and Infectious Diseases. If he starts talking, be quiet and listen for a minute. He says think twice before you get on a plane. He says we have to take this seriously. He says that there are no PROVEN safe and effective therapies for the Corona Virus yet. That does not mean that possible treatments are not being looked at. He doesn’t say to panic, but he does say that we all need to do our part to stay at home when possible, not to make unnecessary trips and to stay away from crowds to decrease the chances of spread. Every time I see the latest beach vacation pic lately with hundreds of people in sunny Florida, defiantly partying, I just scratch my head in bewilderment and disgust. What the heck do people think they are doing? Have we become so egocentric that we think that nothing can permeate our own little bubbles? Do we think our actions have no consequences? Newsflash! There are no bubbles right now! Every single unnecessary exposure just puts more people at risk like gigantic ripples on the ocean. I can’t help looking at those pictures with some resentment as I am going straight home from work and then straight back to work the following day. I think about the vacations that are now cancelled and everything my kids are missing. But guess what? All those things are survivable and worth it! I realize that the government is not just trying to ” control” me or “mess with me.” They are trying to take what steps they can to stop the spread of this thing. Believe it or not, the same folks that are defying the guidelines while complaining about being controlled are the same folks that are taking the one element that we can control( social distancing) and throwing it to the wayside, unilaterally deciding for all of us how the course of this virus will go. I had to go to the store today for the first time in awhile. I was standing in line and these two people stumbled up next to me, obviously under the influence of something and were making out in line. Then they decided to plunk their items down almost on top of mine and then snatch them back, run back to the aisle and pick out something else and then plunk that down on top of my purchases. They were also both coughing with no attempt to cover whatsoever. I looked at the guy and said,” What are you doing? Now is not the time for that.” They just stared at me, shocked, as if it completely escaped them that I would not want to be coughed on, bumped against, watch them slobber over each other, or have our purchases hang out together like some kind of slumber party in the middle of a pandemic! Imagine that! To be honest, I wouldn’t enjoy any of those behaviors even if there were no pandemic, but who’s counting..lol) It is just this kind of ignorant and belligerent behavior that is going to get us all into trouble, make this pandemic last longer and completely close the small window of opportunity for us to get back to our normal lives a little sooner. Please people. We have to do better. It won’t kill us to stay in our houses more, cook at home, stop making unnecessary trips or avoid crowds. Life will go on temporarily without trips, festivals and concerts, but if we don’t try a little harder to follow these temporary guidelines, we will end up having to forcibly surrender all of the autonomy that we thought we were fighting for in the first place.

Dr. Katz