Coronavirus Update

There has been some widespread misinformation about COVID-19.  I am encouraging anyone who follows my blog, podcast, TV show, or social media to please pay attention to the sources from which you receive information.  I have found a few very credible sources that I have recommended to people asking about the virus.  As always, the Centers for Disease Control and Prevention (CDC) is a great place to turn. The National Institute of Allergy and Infectious Diseases is the home of Dr. Anthony Fauci whom you’ve probably seen on television lately. The federal government has set up a coronavirus website and for those of you wanting to know about ongoing research go to the NIH Coronavirus page. National news sources such as the New York Times, Wall Street Journal, and CBS News have had excellent coverage.  I especially like the common sense of CBS’s Dr. John LaPookJohns Hopkins University is widely known as the top public health school and a top medical school.  Information from Johns Hopkins is relevant and high quality, though sometimes a little academic.  In West Virignia, a few my friends and colleagues have been disseminating information that I know to be credible.  Dr. Kathy Moffatt (pediatric infectious disease expert at WVU Medicine), Dr. Cathy Slemp (WV State Health Officer), Dr. Sherri Young (Kanawha Charleston Health Officer, and Dr. Clay Marsh (Dean of Health Sciences at WVU) have all been credible experts giving what is great advice to West Virginians. 

Misinformation can further the spread of the virus and can give a false sense of security to vulnerable populations that should be staying at home and not receiving visitors.  If you have a neighbor or relative that is in a vulnerable population, give them a call and check on them.  Now is a good time to call all of the old friends you haven’t seen in a while.  As I write this post, worldwide, there are 392,780 cases confirmed of COVID-19 in the world.  17,159 people have died as a result.  102,980 people have recovered.  These numbers tell me that we should be paying attention to the experts, not spreading misinformation, social distancing, and checking on others.

The Governor of West Virginia has issued a Stay at Home order.  Please don’t take this lightly.  Everyone realizes it is impossible for all of us to stay at home all the time.  We need food and supplies.  If you are out of something, go to the grocer and pick them up.  Go quickly, stay 6 feet away from everyone as much as you can.  If the parking lot is full, go back home and come another time or use the delivery and pickup services many grocers and pharmacies are offering.  The same goes with restaurants.  Go and use the curbside most of these local businesses are offering.  Please know that there are people working to make certain you have what you need.  Keep that distance from the cashier, people bagging your groceries, pharmacist, delivery person or anyone else you have to come near for basic necessities.  

A cropped shot of a young woman washing her hands in her bathroom

If you haven’t heard it enough, please wash your hands.  I realize that people have stocked up on hand sanitizer, but your best bet, is just to use the one major supply few seem to be running out of, good old fashioned soap and water.  Washing your hands with soap and water while counting backwards from 20 slowly will greatly help you keep the virus spread down.  Not just when you use the restroom, do it often.  

Legislature Goes Sine Die at Midnight

The 84th legislature will adjourn shortly. As I write this, I am listening to the Senate as members work toward finishing the day’s calendar and concluding legislative business. This legislature had many debates on healthcare issues during its 60 day session.

The Mountain State has one of the highest per capita rates of tobacco use in the country. Tobacco is always a big topic of discussion among policy makers and interest groups. There were no efforts to change clean indoor air regulations that are typically done at the local level in West Virginia. Though unsuccessful, Senate Leadership made a valiant effort to increase the tobacco tax and give tax parity to vaping products. The legislature was prepared to discuss raising the purchasing age for tobacco products to 21, but the Trump administration did so right before the session.

Vaccine policy is always a heated discussion, where West Virginia is a national leader. Our level of school-age immunizations has kept diseases like measles outside our borders. There were multiple bills that attempted to water down the vaccine policy in West Virginia, all of which were unsuccessful.

Medicaid is the 900 pound gorilla in the room. In his State of the State address, the Governor asked for the creation of a Medicaid trust fund and for removal of the wait list for the I/DD waiver. The legislature delivered both which sets West Virginia up with a healthy savings account for Medicaid and helps many West Virginians get the help they so need. A provider tax on MCOs will generate revenue that will provide adult dental coverage for Medicaid recipients up to $1,000.

The legislature passed one bill discussing telemedicine that begins to put West Virginia health providers in the 21st century to deliver healthcare to their patients using technological means.

John Law helped in drafting this post.

Some Facts About Coronavirus

The news media is covering COVID-19 or coronavirus as much as the 2020 US Presidential campaign and a number of my friends and colleagues have asked me about the disease.  Here is a little of what I know about it.  

Coronavirus is a respiratory illness that is spread much like influenza.  This strain was first identified in China, but has made its way across the world.  Italy has quarantined 50,000 people near Milan.  New York City discovered its first case of a woman who had recently traveled to Iran.  

While there are cases in the United States, coronavirus is not currently spreading rapidly in this country.  Experts are not entirely certain about how contagious COVID-19 is compared to other diseases that spread from person to person.  For example, measles is very contagious.  Organizations are putting out guidance about limiting or cancelling business travel and in larger population instances, are asking people to use technology like Skype or FaceTime to meet.

There are many ways to protect yourself from this disease.  Interestingly enough, they are similar to the ways you should protect yourself during flu season.    According to the Centers for Disease Control and Prevention (CDC) if you are feeling sick, stay home and rest.  Cover your cough or sneeze and frequently clean and disinfect any objects or surfaces you come in contact with.  The best ways one can limit exposure are by: 

  • Avoiding people who are sick
  • Avoiding touching your eyes, nose, and mouth with unwashed hands
  • Washing your hands often with soap and water for at least 20 seconds
  • Using an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available   

There is no vaccine for coronavirus, but the federal government is working with pharmaceutical manufacturers to create one.  Vaccine development for COVID-19 is moving at a rapid pace, but it may be a year before we see a working vaccine.  There is no specific antiviral treatment for COVID-19.  If you are feeling flu like symptoms, you should visit your primary care physician.  If you live in West Virginia, it’s probably not COVID-19, but you could have the flu.  The quicker you get started on treatment, the better off you’ll be.  

For full disclosure, I am not a clinician, much less an infectious disease specialist or an epidemiologist.  I recommend everyone use reliable sources, such as the CDC or your primary care physician for further information and to prepare yourself.  Much of the information I used for this blog post is from the CDC’s Coronavirus Disease 2019 What you should know site and can be found here: https://www.cdc.gov/coronavirus/2019-ncov/about/index.html

Vaccines are Safe, Effective, & Save Lives

The state of West Virginia works to stay above other states like Alabama and Mississippi in the bottom of most health rankings. Unfortunately, we have a lot of issues where the state ranks 50th out of 50 states. One of our bright spots is childhood immunizations. It is an area we rank number one. In fact, strong immunization laws have kept measles out of the Mountain State.

The year 2019 saw measles making a comeback tour across the United States. West Virginia was lucky in missing that comeback tour, or was it great planning? The West Virginia legislature decided many years ago to ensure children in school—public and private—were up-to-date on “their shots.” The exception to that law allows children with valid medical reasons, such as those in treatment for certain cancers or with allergies to vaccine ingredients, to be granted a medical exemption.

Photo courtesy of the WV Legislature

Every year, a vocal minority advocates for what they misguidedly call healthcare freedom. Usually offering pseudo or debunked science as a reason, they don’t want to vaccinate their children before they go to school. A well-known, now infamous, United Kingdom physician, Andrew Wakefield, lost his license to practice medicine for falsely reporting injuries from vaccines. Well-meaning parents receive bad information. In today’s social-media-filled environment, they run with whatever they have.

With certain exceptions, vaccines are safe for the person taking them. Vaccines work with “herd immunity,” which keeps the incidence of disease to a minimum. Vaccines are effective when the herd immunity is in effect. Vaccines prevent diseases like measles mumps and rubella along with certain types of cancer.

cdc.gov

The best advice someone can get when looking for information is from the Centers For Disease Control and Prevention (CDC). The CDC gives patients and providers information about what vaccines to take and when. The information on the CDC website is scientific.

Helmet Laws Protect Life

Nearly every public health or medical association has shown support for universal helmet laws. I understand the arguments legislators make for freedom, but we live in a society with laws meant to protect the public. As someone who has laid a motorcycle down while riding, I can share with you a small scar on my arm and leg that still show, but I didn’t taste asphalt or even have any long term headache due to a proper DOT approved helmet with a full face shield.

Photo courtesy of Chris Yarzab via Flickr

Last week, two pieces of legislation were introduced that are meant to seem innocuous and tourism friendly. Senate Bills 153 & 154 are aimed at repealing laws that require motorcycle riders wear helmets. SB153 will permit riders in West Virignia that have held a motorcycle endorsement on their driver’s license to ride or be a passenger on a motorcycle without wearing a helmet. SB154 permits riders from other states that permit them to ride without a helmet to do so in the Mountain State. It will be called the “Motorcycle Tourism Act of 2020”.

To understand the consequences of such legislation, one shouldn’t look much further than a state a little to our north, Michigan.  The University of Michigan Injury Center has studied the repeal of a helmet law and its consequences.  The Great Lake State’s legislature introduced a bill in 2012 that partially repealed its universal helmet law for motorcycle riders.  The stipulations were for riders over the age of 21 that carried $20,000 in medical insurance and had their motorcycle endorsement for 2 years.  Before the repeal, Michiganders’ statewide helmet use was a near perfect 99.4%.  Shortly after, it noticeably dropped to 75%.  The lowest rates of helmet use (45%) were those who were found to be intoxicated.

Motorcycle related head injuries increased following the repeal and affected 50% of crash-involved riders seeking trauma care, including a greater percentage with skull fractures. The need for neurosurgical procedures almost doubled. According to the UofM Injury Center, riding without a helmet doubled the odds of a head injury and fatality. They also studied the financial implications. Roughly 1/3 of riders involved in crashes have public insurance such as Medicaid , are self payers, or are uninsured. The cost for accident related health care for non-helmeted riders is about 35% more than those riding with a helmet. This means that taxpayers will be paying the unnecessary burden in a time when we cannot afford to pay it.

I am advising the members of the West Virignia Legislature to not support this bill.  Will you contact your legislator to tell them to keep motorcycle riders safe?

Happy New Year

I remember as a child, my first grade teacher had the door of our class room at Chelyan Elementary decorated with cartoon like pictures of an old man standing next to a baby.  The imagery was to show the comparison between the old and new years.  1982 wasn’t a particularly good year for me as I had lost my grandfather in December, so the idea of a new start hit me even as a 6 year old. 

Every year, we celebrate the seemingly arbitrary beginning of the Julian calendar, which is a relic of the Roman Empire and Julius Caesar.   January 1st or New Year’s Day for some is just another day.  For many, it can be a new beginning in so many things.  People everywhere resolve to be wealthier, healthier, happier, and better for the new year.  Far too often, those resolutions go by the wayside within weeks of the new year.  People give up on the budget, the new diet, fall into traps that get in the way of their happiness and feel lesser because of it.    This year I have a few goals of my own. While trying to be healthier and happier, I hope to just realize how blessed I am each day. 

Thank you to those of you who read these posts, listen to the Appalachian Health Podcast, or watch Live Healthy, Live Well, West Virginia.  I hope the material I cover with friends, colleagues, and guests will enrich someone this year.  With a little divine intervention, everyone reading this will be a little richer, a little healthier, a little happier, and a little better.  Here’s to a great 2020.  Happy New Year.

County Health Rankings: What can we do?

In the above diagram, if you look at the left, it shows that policies & programs can influence health factors which will then influence health outcomes.  At the top, health outcomes are basically half and half length of life and quality of life.  We all want to have longer more fulfilling lives.  The thing thats missing from this is that there should be another arrow atop health outcomes.  It should say cost, because better outcomes can mean lower costs to healthcare.

The factors portion is what’s interesting.  Only about 10% of factors comes from the physical environment. In West Virignia we really get beat up on rankings of housing and transportation because we are a rural community and have a lot of poverty.  

The next section is social & economic factors.  This is 40% of the factor scores.  Educated citizens make better choices.  We should all make certain physical education & health classes are taught at a young age and continued throughout the K-12 education for our youth. It might not hurt to bring home economics back either.  Family & social support and community safety make up the rest of this.  There is nothing you can substitute for family & social support or for community safety.  Any investment in these will eventually lead to better outcomes.  And remember, better outcomes means lower costs.

Clinical care is only 20%.  Access to care is driven a great deal by employers providing health insurance and other benefits like sick leave.  Quality of care is up to providers.  We are fortunate in West Virginia to have some truly high quality providers in such a small rural state.

The last block you see going up is health behaviors.  It is 30%.  If you use tobacco, investment in a cessation program will pay you back.  Diet and exercise are also big drivers.  Having a limited use of alcohol and limiting drug use can help tremendously.  If you are sexually active, and not in a monogamous relationship there are risks that you may be taking.  Talking with your healthcare provider about the risks and how to mitigate them may save you from certain sexually transmitted infections.

More than half of the factors listed above are things you can help your employees with.  This investment in their health will pay dividends.  Keep in mind these are long term investments and they don’t happen over night.

If you’re further interested in how these are calculated or how your community is graded versus the rest of West Virginia or the rest of the county, go to https://www.countyhealthrankings.org and you can see the data in an easy to use format. 

Invest in Your Health

In 1962, economist Selma Mushkin discussed the additions to our economy by investments in health.  She discussed the effect of a reduction in the death rate on the rate of economic growth from advances in healthcare.  Fast forward to today.  The United States spends more than any other developed country on healthcare, however life expectancy at birth is 2 to 3 years lower.  Any other investments that we make, we look at the dividend paid or the final yield and wonder are we better off than where we began. Why don’t we look at our investments in healthcare?

Healthcare further complicates itself as a business. There is a third party in most of the transactions and contracts.  The third party in this transaction is your health insurance.  They negotiate rates with the employer, or more often tell the employer what they’ll pay.  Then the insurance company will negotiate rates with the health care organization that has the supply. 

Being able to change insurance companies every year, means that insurance companies see no high value investments in your health.  In their eyes, they may see an investment they make in your long term health could mean that their competitor will receive the dividend.  As patients regularly change payers, any individual third party payer has less incentive to commit to any expensive, high value treatment, as the result may mean their competition will reap the reward.  I don’t blame them for this. Often Medicaid programs and sometimes small insurers will say that short term budget constraints keep them from paying for high value therapies.  

Hospital costs are up, healthcare administration costs are up, diagnostic costs are up, pharmaceutical costs are up, and insurance companies have less incentive to control long term costs and make you healthy.  Some people have even said this was a large driver of the opioid crisis.  For example, third party payers would pay for an opioid prescription in lieu of physical therapy for an injured patient, because the negotiated rate on the 30 day supply of an opioid was much cheaper than 6 weeks of physical therapy, though PT may have been the answer.  We’ve seen multiple pieces of legislation across the country addressing this very issue.

So, the question I get asked the most about is “Is single payer the right strategy for our country?”.  People have very strong views about healthcare.  I recall working in the Governor’s office when the Affordable Care Act was passed.  We had people calling in droves to the switch board telling us to keep our government hands out of their Medicare.  They didn’t understand that Medicare is government healthcare and the Governor had little control over it.  The bottom line is, no matter what the democrats tend to trot out, I see neither an economic model, nor a political environment where that will work.  Further, we have gone down this road for so long, I can’t imagine the federal government destroying entire companies to replace them with a federalized healthcare system similar to European models.  

The next step in healthcare reforms will be focusing on value based healthcare and perhaps eventually capitation in health plans. Third party payers are going to do everything possible to limit their share of the risk involved in healthcare. The best advice anyone can get from this is to take care of his or her own health. Its the only way you can guarantee some modicum of lower healthcare costs in the near future.