I little tongue and cheek from a local Doc…….<\/p>\n
Dear patient,<\/span><\/p>\n \u00a0<\/span>Wacko<\/span><\/b><\/p>\n We call it \u201cthe seventies,\u201d that economically moribund period from 1974-1982 where, save the occasional vinyl record, people rarely shopped for pleasure, and our world was far more Soviet-style and utilitarian than most care to remember. Nowhere embodied that climate better than Melrose Avenue, the street that ran by my drug-infested high school in Los Angeles. Just east of the school was a long stretch of the kinds of drab, dusty stores that defined shopping back then. Vacuum cleaner sales and service. Electrical supplies. Auto upholstery. A typewriter store with a grimy window display that had not been changed in a decade. These stores sold anything you might need, but nothing you might want.<\/span><\/p>\n \u00a0<\/span>And then, out of nowhere, came Wacko. It was 1984, a year with 7.1% growth in GDP, a record that has still not been bested in the 35 years since. Seemingly overnight, Melrose Avenue was transformed by a blindingly colorful store that sold…junk. Stupid T-shirts, wind up Elvis toys, fast food erasers, and it was wonderful. It was incredible. And it was packed with people. I walked out of Wacko in 1984, stood on Melrose, now riddled with gloriously nonessential shops and neon peach-and-mauve restaurants, and I said, \u201cWow! The country has money again!\u201d<\/span><\/p>\n \u00a0<\/span>We\u2019re in our own short-term 1970s right now. I see it in the crashing economy, the high unemployment, and in my long-haired patients who have not had a trim in months–they look like we all did back then. We just need inflation to complete the picture, and that is probably on its way.<\/span><\/p>\n \u00a0<\/span>I put it in these terms because we\u2019ve now surpassed 5.5 million COVID-19 cases worldwide. After six weeks of various lockdowns, we\u2019re still seeing 100,000 new cases daily. Just here in Washington, it\u2019s about 200 per day, and since only a small percentage of patients get tested, it probably indicates more than 2000 actual new cases each day in our state. Although COVID-19 might disappear this summer, it seems more likely that we\u2019ll be stuck with this infection, together with masks, some degree of social distancing, and a lousy economy, until the vaccines arrive in 2021.<\/span><\/p>\n \u00a0<\/span>But here\u2019s the thing. Back in the seventies, we thought it would always be the seventies. We thought inflation would always be 10%, that men would always have long hair, and that music would always be sold on big round disks of polyvinyl chloride. Then a giant of a man, educated at Princeton, Harvard, and the London School of Economics, serving under Carter and Reagan, brought the economic disaster to a close. Thank you, Paul Volcker. Right on time in 1983, the seventies ended and the eighties began.<\/span><\/p>\n \u00a0<\/span>Running our marathon<\/span><\/b><\/p>\n Although 99.9% of us are not going to die of COVID-19, 100% of my patients need to navigate their lives between today and the moment in 2021 when people walk out of my office with a Band-Aid slapped on their arm and COVID-19 antibodies being mass produced underneath. That navigation involves many things: travel, seeing family, having your nails done, and tending to preventive health care. Over the next couple of months, we\u2019re going to be reaching out to patients regarding annual exams and other preventive items. Our first assumption, which may be wrong, is that we\u2019re entering a minor lull in the action only to face a second wave at the end of the summer. Our second assumption is that an annual exam is more pressing for some patients than others . Those patients who are stable, doing well, and don\u2019t want to come in, might prefer to review things over the phone and otherwise push the in-office annual out another year. We don\u2019t want to drag people in just to drag them in. For others, the benefits of coming to the office might make such a visit worthwhile. If you are overdue or soon due for your annual and you happen to be in the office for any other reason, we\u2019re likely to catch up on all your labs and preventive health care while you\u2019re here. There is not an exact answer in each case, but our overall goal is to ensure that the visits are necessary and worthwhile. Once all my patients have been immunized against COVID-19, we\u2019ll revert to the practice of bringing everyone in just for kicks and to extract some money. Ok, kidding. We don\u2019t do that, ever.<\/span><\/p>\n \u00a0<\/span>Welcome Melissa Schorn, DNP<\/span><\/b><\/p>\n Two months ago, a nurse practitioner joined the office, Melissa Schorn. Melissa walked in at the height of the COVID-19 pandemic, took one look at this disaster, and then promptly quit. Thank goodness, not. Actually, she is doing a super job. Melissa has a doctorate from the University of Washington, which is the highest degree one can achieve in nursing. She was in an academic practice at UW for five years before jumping ship. We\u2019re mostly working side-by-side and often seeing patients together, but if you have an issue that you\u2019d prefer to discuss with a woman, or you want a health care provider who looks uncannily like the singer Sarah McLachlan, then just reach out to Melissa. Similarly, if you have an issue you\u2019d rather just discuss with m e, not a problem at all. Just let us know. Our goal is to have Melissa meet everyone in the practice and get to know your medical history so that there are two clinicians familiar with your needs. In Washington State, Melissa has full prescriptive authority, and she is licensed to do anything that a physician can, except make bad real estate investments or get divorced more than three times.<\/span><\/p>\n \u00a0<\/span>Enter the dragon<\/span><\/b><\/p>\n While Moderna presses forward with its leading-edge technology mRNA vaccine and the Oxford group moves to test their brand-new chimpanzee adenovirus vaccine, at least one company is going about things old school. Sinovac, a Beijing biotechnology company that gets its name because, \u201cWe Sin<\/u>ned, and so here\u2019s the Vac<\/u>cine” is moving to phase I studies of their candidate vaccine PiCoVacc. The vaccine is made by infecting kidney cells from the African green monkey with COVID-19 and collecting the massive number of viral particles that come from that infection. The virus is then dunked in a sterilizing solution of beta-Propiolactone, whic h kills off the virus, and then it is injected into monkeys. (Note to science nerds. Yes, I know viruses are not really \u201calive\u201d and can\u2019t be killed, but give me a break.) You can shoot huge numbers of infectious COVID-19 virus particles directly into the lungs of the vaccinated monkeys and they either get minimally sick or not at all. The advantage of this approach is that it uses a vaccine technology–growing the virus, killing it, then injecting it–that has been in use for 100 years and saved many lives. The disadvantage is that this approach, which is how we make the flu vaccine, might take longer to produce the billions of doses we\u2019re going to need as compared to other methods. This is not your first choice for a vaccine if you happen to be an African green monkey. Another potential disadvantage is that killed or inactivated vaccines sometimes don\u2019t produce as strong an immune response as other approaches.<\/span><\/p>\n \u00a0<\/span>Also coming soon to a phase 3 trial near you<\/span><\/b><\/p>\n Right now, with no vaccine and a pandemic raging so intensely that you can\u2019t even get a good beer on tap, we\u2019ll take any vaccine we can get. We\u2019re like a kid in high school with no date for the prom. It pays to be flexible under the circumstances. However, as more than one vaccine makes its way through the research pipeline, we\u2019re going to become a little more choosy. How many booster doses are needed? How long will immunity last? What about side effects? Cost? Need for refrigeration? Consumers and governments looking for an old-school, battle-tested vaccine technology might go with PiCoVacc if it is proven in clinical trials.<\/span><\/p>\n \u00a0<\/span>The Oxford vaccine, recently renamed AZD1222, is going to be manufactured by AstraZeneca here in the US at a scale large enough to pump out 400 million doses in fairly short order. The Moderna vaccine is going to be mass produced by a Swiss biotechnology company, Lonza. The world is going to drop a billion dollars on mass producing vaccines before they\u2019ve been fully tested and approved. We\u2019ll throw out any that don\u2019t work. Gearing up manufacturing ahead of time, even with the risk of discarding some products, will save money in the long run, especially when you look at the damage being done to the world\u2019s economy with each month that we don\u2019t have a vaccine. For people in high-risk groups who grow impatient with social distancing, it helps to k eep in mind that the fastest vaccine development in history is underway right now. It is highly likely that of all the vaccine candidates, at least one will ship the first doses in late 2020 or in the first half of 2021.<\/span><\/p>\n \u00a0<\/span><\/b>About those curves<\/span><\/b><\/p>\n Because we\u2019re entering the boring phase where we all do our best by wearing masks, avoiding rock concerts, and patiently waiting for a vaccine without burning down the government, I\u2019m going to send these emails as needed instead of weekly. I\u2019ll send them more often if the situation is changing rapidly and less often when it is pretty much the same shucks, different day. For my patients, as always, I encourage you to reach out any time you have a question about COVID-19 or need my help in any way.<\/span><\/p>\n \u00a0<\/span>The seventies are here, but the eighties are coming. I can\u2019t tell you if it will be at Folklife 2021, New Years\u2019 Eve next year at the Space Needle, or just one day when you realize no one at the QFC has masks on anymore, but the eighties are coming. You\u2019ll suddenly say to yourself, \u201cHey, COVID\u2019s gone!\u201d Life won\u2019t be a carbon copy of 2019, but it won\u2019t be too different, either. Let\u2019s shake on it.<\/span><\/p>\n \u00a0<\/span>Daniel S. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":" I little tongue and cheek from a local Doc……. Dear patient, \u00a0Wacko We call it \u201cthe seventies,\u201d that economically moribund period from 1974-1982 where, save the occasional vinyl record, people rarely shopped for pleasure, and our world was far more … Continue reading