Blog

INTRODUCTION

• Who Am I?
• The Journey
• History of Medicine
• Future Of Medicine
• Medicine in St Kitts/Nevis

Who Am I?

Physician Pilot Athlete Author Entrepreneur

How Did I Get Here?

• New Town Primary School
• Basseterre Junior High School
• Basseterre High School
• Adelphi University
• Howard University College of Medicine
• Michigan State University
• USAF Aerospace Medicine/Military Medicine
• Operation Noble Eagle, Operation Iraqi Freedom
• Hospital / Critical Care Medicine
• Private Practice / Primary Care Medicine
• Business Of Medicine

The History Of Medicine

• Stone Age – 3300BC
• Imhotep – 2600BC
• Hippocrates – 420BC
• Galen – 129-216AD
• Late Medieval Period – 1200-1500
• 1500 – 1799
• 1800 – 1899
• 1900 – 1999
• 2000 – Present

• Bloodless Surgery
• Cryopreservation
• HIV Vaccine
• Ebola Vaccine
• Nano Particle Technology
• Anti Cancer Therapy
• Robotic Surgery Advances
• Biomarkers for disease
• Anti-Ghrelin Therapies
• Xeno Transplantation
• 3D Organ Printing
• Anti Aging Therapy
• Predictive
• Personalized
• Preventative
• Participataory
• Point Of Care
• Precision
• Empowering Bright Brains
• Patient Centered Care

• Gene Therapy / Germ Line Therapy
• Editing Natures Software [CRISPR]
• Old Question: Can It Be Done?

NEW QUESTIONS

Is it Ethical? Who Makes The Decision? How Will We Alter The Shared Environment? What Are The Repercussions of Genetics Intervention? Will We Realize Too Late That Vectors Serve Another Valuable Purpose?

FUTURE OF GLOBAL EPIDEMICS / PANDEMICS

• Step 1 Early Detection
• Step 2 Sound The Alarm
• Step 3 Rapid Response
• Step 4 Strict Isolation/Complete Quarantine
• Step 5 Treat / Repair
• Step 6 Augmentation
• Step 7 Debrief

Medicine in St Kitts, Nevis and the Caribbean

Challenges

• Climate Change
  • Increase Transmission of Vector Born Diseases
  • Air Pollutants
  • Decreased Food Security
  • Affects Drinking Water
  • Affects Nutrition

• Non Communicable Diseases
  • Cancer
  • Obesity
  • HTN
  • DM
  • CKD
  • Heart Disease
  • Asthma

• Gun violence
  • New Public Health Risk

• Access To Technology

SOLUTIONS

• Improved Telecommunications
• Primary, Secondary & Tertiary Centers
• Air Evacuation
• Sustainability Partners
• Economies of Scale with Neighboring Islands
• Diaspora Partnerships
  • Health
  • Academia
  • Financial Institutions
  • Research and Development
  • Government
  • Private Sector

CONCLUSION

• Embrace Your Legacy
• Study The Landscape
• Use The Power Of Innovation and Technology

Questions?

Leonard Richardson M.D.
President/CEO Kingdom Medicine Administrative Services Inc.

Picture Courtesy of NIAID-RML

Timeline

• December 31, 2019 – China CDC and WHO alerted for cluster of pneumonia – ruled out avian influenza, SARS etc
• January 7, 2020 – causative pathogen identified
• January 14, 2020 – First case in the US by date of illness
• January 23, 2020 – Chinese government limited movement Wuhan
• January 30, 2020 WHO declared this outbreak a Public Health Emergency of International Concern

Eastern Mediterranean, Europe, Western Pacific

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200308-sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4

Epidemiology

• Incubation period – 5.6-7.7days travelers, 2-7days subset with known exposure, WHO report 5-6 days
• Severity – WHO report – 80% mild/asymptomatic, 13.8% severe, 6.1% critical
• Reproductive number – @ 2.2 -2.68
• Case fatality rate – China crude fatality rate 3.8% (17.3->0.7%), really 2%, lab confirmed 1.4%,
• Close contact transmission – Symptomatic – 10 pts, 445 close contacts active monitoring for sx 2/54 household contacts (10.5% of household contact), WHO report 3-10% household attack rate, 1-5% contacts, 0/11 HCW unprotected in Hong Kong no transmission
• Asymptomatic transmission – asymptomatic transmission case reports, serial interval 4.0-4.6 based on 20 pairs

Fauci NEJM 2020, Guan NEJM 2020, Nishiura IJID 2020, Backer Eurosurveillance 2020, Wu Lancet 2020, Tong EID 2020 Rothe NEJM  2020
https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

COVID-19 Global Situation Summary

MDH prioritization

At this time, based on current local epidemiology, MDH is using the following criteria to prioritize testing at MDH:

• Person who had close contact with a laboratory-confirmed COVID-19 patient within 14 days of onset AND either fever or signs/symptoms of a lower respiratory illness
• Person with travel to a country with a CDC Level 2 or 3 Travel Health Notice or an area with confirmed ongoing community transmission within 14 days of onset AND has fever and signs/symptoms of a lower respiratory illness AND tested negative for influenza on initial work-up
• Person who resides in a nursing home or long-term care facility AND who has either fever or signs/symptoms of a lower respiratory illness AND who tested negative for influenza on initial work-up AND a respiratory virus panel negative for all pathogens AND no alternative diagnosis

U.S.: COVID-19 Cases

• 186,101 Confirmed Cases
• 1,110 Travel-related cases
• 3,128 Close Contact
• 181,863 “Under Investigation”
• 3,603 total deaths
• 55 jurisdictions

Source: www.cdc.gov, accessed April 2nd

Maryland: COVID-19 Cases

http://health.maryland.gov/coronavirus
Data current as of April 2nd, 2020

Maryland Epidemiology Breakdown

Cases by age range:

• 0-19: 55
• 20-39: 696
• 40-59: 908
• 60+: 672

Hospitalization: 26%

Deaths: 36

http://health.maryland.gov/coronavirus
Data current as of April 2nd, 2020

COVID-19 Testing in LTC

• Approval is NOT required from public health
• 1 Nasopharyngeal swab (NP) swab for COVID-19 testing
• Specimens can be safely collected in LTC using standard, contact, and droplet precautions (with a face mask) with eye protection
• Specimens should not be collected if a resident requires higher level of care
• Specimens should be sent to MDH laboratory to ensure rapid identification of residents with COVID-19

When should you be thinking about it?

Fauci NEJM 2020, Guan NEJM 2020, Nishiura IJID 2020, Backer Euro surveillance 2020, Wu Lancet 2020, Tong EID 2020 Rothe NEJM  2020
https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

Laboratory testing

• RTPCR test
• MDH capacity
• JHH testing
• Commercial laboratory

New MDH Guidance – Preparing for and Responding to COVID-19

• New guidance document includes:
  • Definitions for undiagnosed respiratory illness, suspect COVID-19, COVID-19 outbreak
  • Requirements for reporting to public health
  • Preventive measures against COVID-19
  • Steps for responding to suspect COVID case(s)
  • Steps for responding to positive COVID case(s)

New Universal Masking Recommendations

When COVID-19 cases are in the community, indicating community spread of COVID-19….

Universal masking should be considered

Universal Masking – The practice of wearing a face mask at all times while working within a facility.

How should universal masking be implemented:

• Staffing education – Staff should understand how to apply and remove face masks and when face masks should be changed.
• Ensure that staff understand that this is only ONE part of preventing the spread of COVID in LTC. Hand washing, appropriate use of PPE, not working while sick, and environmental cleaning are still important!

Mitigation vs. No Mitigation

NYT 3/11/2020, adapted CDC/economist

P & I Mortality 1913-1917

Hatchett PNAS 2007

Pandemic planning

-Keep minimally ill covid-19 patients outside hospital

-Reduce minimize elective visits/procedures – telehealth

-Operational capacity – workforce, space, covid-19 and non covid-19 supplies

-Social distancing

-Testing strategies

-Conserve supplies

HCP w/ COVID-19 – Return to work

Non-test-based strategy. Exclude from work until

At least 3 days (72 hrs) have passed since recovery defined as resolution of fever w/o the use of fever-reducing meds AND improvement in respiratory symptoms; AND,

At least 7 days have passed since symptoms first appeared

If HCP results are still pending, HCP may still return to work if criteria for non-test-based strategy are met 

Return to Work

After returning to work, HCP should:

Wear facemask at all times in HC facility until sx fully resolved or until 14d after sx onset, whichever longer

Be restricted from contact w/ immunocompromised pts. until 14d after sx onset

Adhere to hand hygiene, respiratory hygiene, & other aspects of infection prevention and control

Self-monitor for sx and seek re-evaluation from occ health if respiratory symptoms recur or worsen

MDH Novel Coronavirus:
http://health.maryland.gov/coronavirus

MDH Laboratory Coronavirus:
https://health.maryland.gov/laboratories/Pages/Novel-Coronavirus.aspx

COVID-19 People at risk
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

CDC Coronavirus Prevention & Response in Long-term Care
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

CMS Coronavirus/LTC:
https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf

CDC Guidance for Infection Control
https://www.cdc.gov/coronavirus/2019-nCoV/infection-control.html

Resources

Questions?

Email questions to MDH.IPCOVID@Maryland.gov

At Kingdom Medicine we want to make sure that all our clients are taking the necessary precautions to avoid the spread of the Coronavirus Disease 2019 – COVID-19 and are protecting themselves following all the safety measures. To help you get access to accurate information from relevant medical sources we will be sharing content from reliable sources.

Free coronavirus patient education

To help you communicate important COVID-19 information, we’ve published 8 new videos on key topics.

ViewMedica Videos

• Human Coronaviruses
• How COVID-19 Spreads
• Simple Ways to Avoid COVID-19
• Dealing With the Stress of Self-Isolation
• Importance of Hand Washing
• Symptoms of COVID-19 Infection
• Caring for Someone Who Has COVID-19
• Disinfecting Your Home of COVID-19

At Kingdom Medicine we want to make sure that all our clients are taking the necessary precautions to avoid the spread of the Coronavirus Disease 2019 – COVID-19 and are protecting themselves following all the safety measures. To help you get access to accurate information from relevant medical sources we will be sharing content from reliable sources.

“Coronavirus Disease 2019 (COVID-19) has touched everyone, but perhaps no profession has been impacted as profoundly as the healthcare industry. Clinicians are on the front lines caring for COVID-19 patients and those whose infection status remains uncertain. As clinicians navigate through these incredibly difficult times, myCME, Haymarket Medical Education (HME), and the rest of the Haymarket Medical Network offer these resources to further your suddenly essential COVID-19 education. The resources are laid out such that the user may skip directly to a section of interest using the links in the Table of Contents at right.

Our understanding of the pathophysiology of COVID-19 and the landscape of disease management is rapidly evolving. While several vaccine candidates and therapeutic approaches are being developed and tested, the current recommendations from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and all other medical organizations unanimously agree that “distancing”, both on a social and medical level, should be exercised. This will not only limit the spread of infection, but also “flatten the curve” to limit the number of critical patients needing intensive care and overburden the already stretched healthcare system. The emerging deficit of personal protective equipment (PPE) has further demonstrated the need for us to act as a community in supporting the healthcare providers who are at the forefront of this crisis.

From all of us at myCME and HME, we thank all medical professionals for all you do.”

Click here for the full post.