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Health Care Policy

Calculating the Risk of Asymptomatic But Infectious Person in a Group

By Commentary, Covid-19 Epidemic, General Science, Health Care Policy, Preventive Medicine, Primary Care 4 Comments

We use available state Covid-19 infection rates and other published data together with the binomial distribution to calculate the risk of unsuspected infections in small group gatherings. With our current high level of infections (20 times higher than summer) the risk is 5-10% for groups of 10 or 20. You DON’T want to gather indoors with other than household members this winter.

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How We Protect You and Us From Covid-19

By Commentary, Covid-19 Epidemic, Health Care Policy, Men's Health, Preventive Medicine, Primary Care, Women's Health 3 Comments

A brief review of the multiple ways we work to protect you and our staff in our clinical environment, including improvements in HVAC, aggressive cleaning and PPE, and SARS-CoV-2 antigen testing for patients and staff. These efforts all serve to reduce the risk of passing or acquiring Covid-19 in the OHC clinical office.

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C19: Updated Self-Care and Risk Advice

By Commentary, Covid-19 Epidemic, Health Care Policy, Men's Health, Preventive Medicine, Primary Care, Women's Health 2 Comments

We are still in the midst of a pandemic that has subsided in Massachusetts but is still very much with us and could easily rebound. We need to remain vigilant in our self care. No real good news. US infections and deaths are at high levels and increasing. An effective and proven vaccine is not realistic until next year and then will take many months to distribute. Keep up your careful self care. This is depressing but real.

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C19: Checkup Visits Beginning, Carefully

By Covid-19 Epidemic, Health Care Policy, Men's Health, Preventive Medicine, Primary Care, Women's Health No Comments

We have started scheduling comprehensive visits (“checkups”) for members in the office. Checkups will be divided into two parts, with video discussion one day and in-office physical exam and completion the subsequent day. This will allow thorough and effective comprehensive exams that will be safer by restricting in time spent in closed exam rooms. In addition we have detailed phone prescreening for Covid-19 and active virus point-of-care testing on arrival at the office to protect all of us.

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Staying Safe Out of Quarantine, Clarified

By Commentary, Covid-19 Epidemic, Health Care Policy, Preventive Medicine, Primary Care 2 Comments

We are beginning to leave quarantine. Covid-19 risks are much lower, but still present. We have to keep up our self protection appropriate to the risk, where greater intensity and duration of exposure increase risk. Use of handwashing, appropriate masks, social distancing, avoiding lingering in groups indoors, and home sanitization are all self-protection techniques. It is summer. Enjoy the outdoors, which is overwhelmingly safe.

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Understanding Covid-19 Test Uncertainty and Managing Your Personal Risk

By Commentary, Covid-19 Epidemic, General Science, Health Care Policy, Preventive Medicine, Primary Care 22 Comments

I explain multiple and sometimes complex issues with the Covid-19 epidemic, starting with where we are in the infection epidemiology (new infections in Mass. are leveling off but are still high, deaths are growing). Then I explore the types and efficacy of biological tests (PCR and antibody), and why different people have different personal Covid risks and may make appropriately different responses in behavior and personal protective equipment. I tried to keep it short, but ultimately chose clarity over brevity.

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Covid-19: Perhaps Some Progress, Worse Coming, Many Unknowns

By Commentary, Covid-19 Epidemic, Health Care Policy, Preventive Medicine, Primary Care 10 Comments

Today is Day 2 of Week 6 of the epidemic. We need to maintain rigorous self-quarantines and personal protection when outside, but there is hope and some data that the rate of new cases in Massachusetts is slowing. What we need most to get ourselves out of quarantine is an effective drug treatment, so that an infection does not carry high risk of hospitalization and ICU care or death. PPEs are still problematic and testing is not yet up to the need. The real bulge of cases here certainly seems likely to extend through May. Happy birthday, Happy birthday is still the key song.

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Covid-19: Day 6 of Week 4: Where Are We Heading? Understanding the Numbers

By Commentary, Covid-19 Epidemic, General Science, Health Care Policy, Preventive Medicine, Primary Care 14 Comments

The next six weeks will be risky for all of us as the Covid-19 epidemic continues to extend its reach. Nevertheless, I am convinced we can all stay safe with a high degree of probability during this time, whether by keeping in our circles of safety, or by careful use of personal protective gear, providing we are rigorous in our self-protection. I present and explain a graphical model of how and why the number of active cases will likely increase and by how much over April and May.

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Covid-19: Day 7 of Week 3: Worst Yet to Come, Likely Soon

By Commentary, Covid-19 Epidemic, Health Care Policy, Preventive Medicine, Primary Care 12 Comments

Covid-19 cases in Massachusetts are expanding exponentially, which will continue through this month. Later in April we pass a peak, or just reach a high plateau. Which is not known. Hospitals, physicians and nurses are struggling still without fully adequate equipment. We have no proven drug treatments nor vaccine. Almost all of our members are safe in their circles of safety, which work. Stay in yours. Do not see others in person regardless of the holidays upcoming.

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Covid-19: Day 1 of Week 3: Safer, But at Least a Month to Go

By Commentary, Covid-19 Epidemic, General Science, Health Care Policy, Preventive Medicine, Primary Care 9 Comments

Today marked beginning of the third week of our collective quarantines. Our practice has had just several possible or likely cases of Covid-19. We will be in “lockdown” certainly through April and most likely through May. We are not providing any off label treatments at this time. Much more testing of active and past disease is needed to enable us to eventually come out of quarantine safely, as well as face masks for all. These of course are not available as yet. But a good card game to try is.

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