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4/2/21

Unfortunately, ATT notified us that our phone lines are down because a "cable has been damaged" and they are trying to repair it but it may not be" until this weekend because of COVID"!!!!  Please contact us through email if you need anything or you have my cell phone for after hours.  The office will be closing at 1 pm today.  Sorry for the inconvenience and have a Happy Easter.  

Doug

2/9/21

I hope you had a wonderful weekend. My patient Susan A. gave me information about United Health Centers having a vaccine appointment waiting list. You can call t(1-800-492-4227). She was trying to get her parents on the list and stated she had to hold a while but when she got through, they were taking 75 and above and was able to get her parents on the list They received a call from United Heath a few days later & are scheduled for their injection this week.   She asked United Health about the wait time, as many cannot wait that long without bathroom access, and she was told United's waits have been nowhere near the six hours that was taking place at Sierra Pacific Orthopedic Center.  I would not have known they were taking names for a waiting list unless someone told me, so I really appreciate the information.

 Fresno Counties site states that new appointment scheduling will begin between 7 am and 8 am on February 10^th, 2021 for those who qualify for the COVID 19 vaccine via MyTurn form the California Department of Public Health. Confirmed first dose appointments will take place on Saturday, Feb 13, 2021 at The Big Fresno Fair.

Starting Friday, February 12, 2021 and each Friday following, new appointments will be posted using MyTurn for those that qualify.  For mor information, please visit https://myturn.ca.gov

 I heard that Gavin Newsome will be listing the Savemart center as a mass vaccination site at the end of the week, so keep you eyes, and ears open for more information.  Lastly CVS stated that they will be taking appointments via their site, but you will need to go online to see what is available.  I know there is a lot of places and uncertainty, but I am trying to get you what I know.  Please thank Kristen Quezada (Receptionist/Office manager/My right hand) 😉for  looking out for the information.  Have a great day.

 

January 28, 2021

I am happy to say we have added a dietician/nutritionist to the practice.  Emily Hellam graduated from Arizona State University with a degree in Dietetics and a Masters in Dietetic Sciences.  She is excited to get established in the community and offer her skills and education to all of those who need some help when it comes to diet. (All of us😊)  She will be specializing in weight loss, diabetic teaching, cardiac diet consulting as well as answering any questions pertaining to your dietary needs or requests.   As part of your annual fee I will be giving all my patients an hour for the initial consultation.  If you elect to continue with Ms. Hellam (Emily) she can set up a fee structure that works for you.  It will be customized to your needs and is quite reasonable considering what is in the community currently.  She works with me and keeps me updated on her plan and recommendations.  I have been extremely happy with what she has done so far and the response has been amazing.  She is energetic and a go getter, so get ready.  She is also working at Madera Community Hospital so her time is limited but she is available.  She has been working with patients here at the office and soon will have her own office soon.  If you are interested in her services please contact her directly via email at emilybrocatord@gmail.com . She will schedule an appointment and soon you will be living a healthier life.  No excuses.  Have a great day and a wonderful weekend.

 

 

January 22, 2021

Happy Friday.  I hope you had a great week. Unfortunately, there was not a lot concerning the vaccine situation this week that was good, other than the county adhering to the vaccination recommendations of only giving it to individuals who are >75.  I also received word today that Fresno county, as of now, is pausing on mass vaccination sites next week with no guarantees of new shipments.  If you noticed no appointments available on the county website, this is why.  As of now, there is nothing scheduled for next week at the fairgrounds, Sierra Pacific Orthopedic Center or United Health Centers.  They currently have enough supply to make sure those who have got their first dose will be able to get their second dose at least for next week.   

 There are some volunteer vaccine sites that Cedric R. brought to my attention (ThankYou!)  http://www.vaccinateca.com/san_joaquin_valley.html and   https://vaccinateca.com/counties/fresno.html .  These have been set up and are being operated by volunteers.  I really think if you focus on the initial timeline that the county put out (Healthcare workers and >75 currently.  Likely >65 and agricultural workers after 2/1/21.  Greater than 55 years of age after 3/1/21).  Will likely be the worst-case scenario.  This is “following the science”.  But I see that educators, incarcerated individuals in prisons and jails, homeless and unhoused will be in February as well, regardless of age.  Also, the president has promised to make the vaccine available regardless of immigration status and has outlined plans to create a Covid-19 Health Equity Task Force to provide “recommendations to tackle inequities in outcomes by race, ethnicity, geography and disability”.  I don’t feel this is “following the science” but it feels fair and I guess we can be selective when it comes to being fair.  Science is not selective. It is what it is.  2+2 =4.  When you throw a rock in the air it will fall down (because of gravity in case you didn’t know).  The sun rises in the east and sets in the west.  Water boils at 212 degrees Fahrenheit or 100 degrees Celsius.  I think your catching my drift, feeling my vibe or sensing my irritation.  If science is selective it is not science and when we do not follow the science lives will be lost.   "The good thing about science is that it is true whether or not you believe in it."-- Neil deGrasse Tyson. If you are fine with this then be fair.  I am still a scientist and will always be a scientist.  I hope you have a wonderful weekend.  Keep up the great job if you haven’t got COVID yet and if you got COVID this week (6 of my patients did), you will be fine.  Stay healthy my friends. Go Bills.  Shouting out to my sister (Shelly Hellam) from another mother (Joan Fino) who has been a Bills fan forever.  Pulling for Josh Allen and the Firebaugh nation.

1/18/21  2:00 PM

It appears that the county has come to their senses again and the vaccine is only available to those of you who are >75 years old.  Again, realize that we are still ahead of schedule at 75 and above was not going to start until February 1st.  Please check with Sierra Pacific Orthopedic Centers website because they have a form you can fill out that may help with some of the wait time in the future.  So far, the Fresno County website has been a reliable source as to where the vaccine is being administered.  I have received emails and texts stating that friends and family have been getting the vaccine through "their doctors" in other counties.  I wish I was able to give it to you but we do not have the vaccine to give.  Hang tight and when your time comes, it iwll be available.  You have waited 10 months so a few more weeks is not asking much.  Have a great day and thank you for the updates.  "One moment of patience may ward off great disaster.  One moment of impatience may ruin a whole life" Chinese Proverb.  There is no reason to ruin someones life, literally,  when all you need to do is wait your turn.  Trust me on this.  Stay healthy my friends.

1/18/21

Good morning.  I hope you all had a great weekend and were able to enjoy the great weather.  I have some updates concerning the vaccination process.  I still would check with the Fresno County website and schedule an appointment at the fairgrounds because they are still giving the vaccinations.  I understand SPOC (Sierra Pacific Orthopedic Center) is not giving them today so we will keep you updated if they start again.  United Healthcare Centers is offering vaccines for qualified groups at Central High School-East Campus today, the 21 st and 22 nd. go to the site https://unitedhealthcenters.org/vaccineappt to see if you are eligible.  Have a great day and I will continue to update you with any information that comes our way. 

1/15/21

TGIF!!!! What a week.  First, no one was getting the vaccine, then everybody was getting the vaccine, then now we can't get the vaccine. I saw multiple sides to multiple individuals. Anger, jealousy, frustration. I witnessed political rants, individuals prior to the election who stated there's no way they would get this vaccine because of the administration it was created under, and the same individuals who were angered by the fact they could not get the vaccine. I saw facilities try to make money from the vaccine when this is supposed to be free and the only thing, you're supposed to be charged for is the administration. This is not a federal problem; it is a state problem. The vaccine has been rolled out in several states without difficulties. Granted we are the 6th largest economy in the world. This is what happens when we don't adhere to structure and “follow the science”.  The one scientific fact and risk factor that we can't argue over is that of age. Individuals greater than 65 are at increased risk, individuals older than 75 are a greater risk and individuals greater than 85 even more of a risk. This is a greater risk than color, race or medical history. I would have liked the administration of the vaccine to have been handled by the military because of the structure that would have been adhered to and it would have taken away any other incentives or politics when it came to the administration.  Since I am a physician, I received my vaccine nearly three weeks ago. I felt guilty getting it before others who are older than me. Did anyone else feel guilty? I hope so. Not adhering to the age guidelines will definitely cost lives. But one thing I did appreciate waiting in line was the pride I had being an American.  The great scientific minds in this country came together regardless of their political affiliation and developed a vaccine in a record amount of time. Many said this could not be done and it was. As a result, thousands of lives will be saved. When I was waiting in line, I did not see Republicans or Democrats, I saw Americans. So, when you get your vaccine, and all of you will, take a moment and think of how great a scientific feat this was. Be proud and use this moment to see the positivity in coming together.  One would hope that we could use this as a steppingstone, or an olive branch to see what working together as Americans can accomplish.  Hard work still pays off.  Please never lose sight of this fact.  Now I will step off of my soapbox and let you know what I know of the vaccination process.

 Sierra Pacific Orthopedic Center ran out of the vaccine today and I do not know if they will have more come Monday.  I would call the number that was posted on a previous post before you drive there. I believe Fresno County is still administering the vaccination at the fairgrounds. If you go on to their website, you can make an appointment. I understand they are adding more appointments so please check regularly. I had a few patients attend the United health centers vaccination clinic at Central Unified High School. I'm not sure if this is still available next week. I have received questions pertaining to individuals who have had COVID-19. They are still recommending receiving the vaccine, but the real question is when. I would say 4 weeks to three months would be an appropriate time to wait. The truth is no one really knows. You may be immune indefinitely, but we don't know. My recommendation would be if you can get it get it when your time is available. Another question I have been getting is “Which vaccine should I get?” My answer to this is whichever one is available. Currently there are both Pfizer and Moderna . Johnson and Johnson will be coming out with one shortly as well. It is important that you complete the two-shot series with the Moderna vaccine and the Pfizer vaccine. You cannot start with one and finish with another and be fully protected. I hope this helps.  Have a great night and a wonderful weekend.  Stay patient and keep doing what you are doing.  It has been working and we will get through this.  If any of you get more information about vaccinations, please let me know and I will post it on this site. 

1/14/21 :11:45 am

Okay, here is the latest. Although the Fresno Fairgrounds site states that there are no remaining appointments, I hear they will be adding more so I recommend that you contnue to check there because, so far, it has been the most reliable source.  I also heard that United Health Clinics will be doing a clinic for those OVER 65 ONLY tomorrow (come on younger patients-PLEASE WAIT YOUR TURN HERE).  If you click on the site: https://unitedhealthcenters.org/  it will give you the instructions and the location.  For those of you calling wanting to talk to me about the situation, I cannot guarantee I will be able to get back to you because there are too many calls. I am doing my best to get you the information while, simultaneously, caring for patients   This is the best place to find the information.  I DO NOT have access to vaccines. I DO NOT have control of this process and I DO NOT know when it will get better.  All I can do is relay the information to you.  With time we will get there.  Please remember, based on the original path >75 were to get it in February, >65 in March and >50 in April to June. Please be patient. Let the elderly go first. I will guarantee lives are being taken away when you don't.  Doug

 

1/14/21

Good morning we are being hammered with calls about whether or not you should get the vaccine. The answer  is YES!!!  Period, end of report.  It does not matter if you have a food allergy, drug allergy, or allergy to a previous vaccination.  There could be reactions and there will likely be reactions that could be severe but not likely.  Just like with any other vaccination.  You have the choice to not get it but I am advising you to get it.  If you do not get it and you get the virus you WILL likely be fine.  There are no absolutes in this world people.  Sometimes you just have to take a chance and this is a chance I recommend you take.  Have a wonderful day.  Doug

P.S.-I ws told there is a four mile car line trying to get the vaccine at SPOC so I am sure they will be running out.  Please remember that the elderly need to go first.  I am a little upset at the individuals less than 55 jumping ahead. 

January 13, 2021 6:00 pm

I swore I would watch my swearing this year but today was officially a shit show.  We private physicians are not being told anything by the county and we are left to ourselves, our patients and our peers to figure out what is going on.  Starting this morning we were told that the Fresno Fairgrounds were administering the vaccine to those 75 and above and 65 and above would start February 1, 2021.  Then we were told that Sierra Pacific Orthopedic Center was giving the vaccine to those older than 75 yo and then after 1 pm they said that they were giving it to the public if you were greater than 65. Then at ~4 pm we got word that Fresno County was going to start giving the vaccine to those 65 or older on 1/18/21 and this was followed by another statement that they may be giving it starting tomorrow.  Regardless, I recommend that you go to the Fresno County site that I posted and schedule an appointment.  Concerning SPOC (Sierra Pacific Orthopedic Center), they ran out of the vaccine but are expecting a shipment tomorrow.  We were told that you can call 256-5200 and see what they tell you.  It is a drive up clinic.  Good luck and I will keep you posted with what I know.  Have a great evening and stay healthy my friends.  Sorry about the cursing but I couldn't think of anything that summed it up as well. Sorry Mom:)

January 13, 2021

 Good morning.  Fresno country has stated that they will begin giving the vaccine to individuals 75 or older and all agricultural related workers at the Fresno Fairgrounds.  This apparently will start on Monday the 18th.  You need to go to Fresno County Health Departments website and register. https://www.co.fresno.ca.us/departments/public-health/health-messages-for-medical-providers/covid-19-vaccine-information

I do not know what will be required to verify that you are an agricultural worker.  I would hope that the younger individuals will be honest with this and not lie just to get the vaccine sooner as you may be taking a life away from someone who has a greater need based on age.  I have also been notified by patients that there are facilities that are giving it if you are a health care provider but they don't ask for verification of this.  This is a Titanic type moment and the term "women and children first" should be" the elderly and high risk first"  Please be honest with yourself.  Your time will come.  Let us know how the process goes so we can realy the information to others. Stay healthy my friends. 

 

January 12, 2021

There still is no word on when the vaccine will be available to the general public here in Fresno county.  The next wave of vaccines will be distributed to the nursing homes and schools-teachers and staff.  (I am not in agreement with the latter for teachers who are less than 50 because they are 4 x more likely to die from the complications of the influenza compared to the COVID 19 infection.  There would be more lives saved if it was available to those greater than 65 but this is the current environment we are living in.  We follow the science when it is convenient. I was told by a patient of mine that he was able to get the vaccine from a vaccination event in Tulare county.  I don't know how he heard about this but it is for individuals >75.  If you fit into that category you may want to go to the website: https://covid19.tularecounty.ca.gov/covid-19-vaccine/  You did not here it from me but it may be worth a try.  It was all done in the car.  Let me know if this works.

January 7, 2021

 I have been receiving questions concerning the Moderna vaccination versus the Pfizer vaccination.  There is a risk for a reaction (swelling) in individuals who have had dermatologic injected facial fillers (lips, cheeks etc…)  the reactions occurred ~2 days after the vaccination and affected 3 individuals in the third phase of the Moderna trial.  I do not believe this was listed as a side effect in the Pfizer vaccination. One of the individuals had had fillers injected 6 months prior and another 2 weeks prior to receiving the vaccination.  Also, one of the individuals has a similar reaction after receiving a flu vaccination years previously.  So, the take home is although it is rare, if you want to avoid this happening, and you have a choice, I would go with the Pfizer vaccination.  The problem is you may not have a choice so I would take the vaccination that is available.  The reaction is easily treatable with antihistamines and prednisone (steroid).  If you want to err on the side of caution because you are going to get the Moderna vaccine I recommend taking an antihistamine, such as Zyrtec (cetirizine) or Benadryl (diphenhydramine) and an anti-inflammatory (Ibuprofen or Naproxen) the day of the vaccination.   I WOULD NOT avoid getting the Moderna vaccine if it is what is the first available one. Have a great day and stay healthy my friends.  Doug

January 5, 2021

HAPPY NEW YEAR

I hope all of you are well.  A lot has gone on since the last post.  I just wanted to briefly touch on a subject that we have received a lot of calls on. THE COVID 19 VACCINE!!!!  You know, the thing that couldn’t happen.  Well, it did and everyone wants it.  It’s like the Cabbage Patch Kids Dolls when I was younger that my mom made me wait in line for because they were going to be worth “a lot of money someday” or the Tickle Me Elmo I waited in line for one of my children or the Sony Play Station 5 of today. All kidding aside, it is a hot commodity and rightfully so.  Both the Moderna and the Pfizer vaccines have been found to be 90-95% effective in preventing the current strain of the virus.  That’s the good news.  The bad news is that it is going to take time to distribute to the entire population and it is determined by the state it is being distributed in.  Fortunately, or unfortunately, we live in California so it depends on what the Governor and his team feels is the hierarchy of distribution.  For now, hospital staff and health care workers will be first.  It will be given through the hospitals and, eventually pharmacies.  WE WILL NOT BE GETTING THE VACCINE TO DISTRIBUTE FROM THE OFFICE.  That is not to say that we won’t for the future but as of now we do not have it, nor do we have the means to order it.  There are multiple reasons for this. First, the Pfizer vaccine has to be stored in -75 degrees  to -112 degrees Fahrenheit.  The hospitals and pharmacies have the capability to store them.   The second reason, and most important, is that the vaccine must be given in a structured fashion.  The elderly are at the greatest risk of dying from the illness if they were to get it. (Everybody wants to be elderly now😊 )  If the vaccination process was open to everyone on a first come first serve basis the vaccine would be wasted on those <50 (who are 4 x more likely to die from complications of the flu compared to COVID 19).  We want to make sure that those who have the greatest need get the vaccine.  So, after healthcare workers the next group of patients will be nursing home patients.  Then individuals greater than 65.  I am not sure if this will be distributed by decades (>80, >70, >60 etc…)  I spoke with an individual at the health department who stated that we hope that we will be able to address these groups (Healthcare, nursing home, >65) by March or April.  I am telling patients that if you are <65 I think it would be realistic to assume you may get it by summer or fall.  Please realize that we physicians cannot order it for you. Another question I have been getting is since I have a high risk disease do I get to go in front of someone else who is older and doesn’t have a high risk disease.  Right now, the answer is NO. The number one risk factor continues to be obesity and if that was the case 40% of the American population would be cutting in line. Also, I am being asked “which one should I get?”.  I recommend go with the one that is available and you will likely get the alternative one later when it is available.  I got my first Pfizer vaccine a week ago.  I didn’t feel the injection.  The next day my arm was quite sore and for the following week I have been a little tired and achy but not bad.  I still felt good enough to mountain bike and walk 18 holes of golf.  The studies have been showing that the second dose is worse but the side effects (muscle aches, fever, fatigue last ~24 hours.  I will keep you posted.  If you have a food allergy you still can get the vaccine.  I have an allergy to shrimp, lobster and crab and I did fine.  So be patient and we will all get through this.  As more information comes around, I will post it for you as soon as I get it.  Be careful because a big wave of exposure is going to hit over the next 2 weeks.  Prior to Thanksgiving I continued to have 1 case since March 2020.  My count now is near 50.  No one has died as a result of COVID 19 in my practice and the age range is from 16-91, so I am thankful for this.  Another oddity is that of my nearly 50 verified patients I only have ~4 who are women and that appears to be the same percentage with my colleagues as well.  You ladies are not only smarter but healthier as well.   Stay healthy my friends. 

 

July 14, 2020

Hot damn!! It been a long time since my last post and I was poked and prodded hard enough yesterday by the recent recommendations by the Governor to say a few things.  It appears that the politicians are beginning to miss their fix of power again as evidenced by Governor Gavin Newsom’s latest power grab.  All based on the “cases going up”.  Over the past two weeks the diagnosed cases in Fresno and the state have increased substantially, yet the deaths from COVID-19 still remain lower than in the beginning of this pandemic.  There were ~6,600 cases diagnosed this past Sunday with 25 deaths statewide.  Yesterday, there were 9,005 diagnosed cases and 46 deaths statewide.  Did we forget that the virus has not gone anywhere but we are just testing more people?  Are we forgetting that Fresno has had 88 deaths since the beginning of the pandemic and is number six in the state counties where as the top five counties of the state have a total of 5,527 deaths with 3,824 deaths in Los Angeles County alone?  If you add up the reported COVID-19 deaths in Fresno, Tulare, Merced, Kings, Kern and Madera counties the total deaths are 398. So, despite deaths remaining on the lower side since the beginning of the pandemic, we are going to close down businesses again, only to see them fail because of a governor thinks he knows more than what the science is showing?  I am tired of being told what to do and how to do it by someone who has no idea what he is doing.  A real leader would realize that this is not a one size fits all ruling. It’s time for us in the valley to take a stand and not be punished at the cost of many more lives lost because of their financial ruin.  This is what we do know.  Of all the deaths in California, 77% of them were >65 years of age and nearly 50% of them resided in nursing homes.  Of those younger than 65, most, if not all, had a risk factor: Obesity, Hypertension, Cardiovascular Disease, Diabetes, Asthma/COPD or an immunocompromised state. So, if you fit this category, keep social distancing, wear your mask when you can’t guarantee 6 feet of distancing and wash your hands frequently. For those of you who are not in this group, do the same but keep working, go to school and we will get through this.  Stay healthy my friends.  Doug

6/15/20

I have had a large response to the MMR vaccination study that I presented with the latest post from 6/11/20.  It is best to get the vaccination from your pharmacy and Costco and Rite Aid has the vaccine in stock.  I do not carry the vaccine in the office because it is primarily a pediatric vaccination.  I would recommend it only for individuals >60.  It appears to be covered by most insurances.  If you are <60 years old, I would recommend getting an MMR titer because you may not need the vaccine if you already have protection against it.  The other benefit of the vaccination will be protection against Measles, Mumps and Rubella, as there are many parents who do not believe in the benefits of vaccinations.  Similar to the outbreaks we have seen with whooping cough, you will begin to see outbreaks with Measles, Mumps and Rubella.  Again, this is based on the ignorance of these parents (yes I said ignorance). Vaccinations should not be a selective decision.  You are either for them or you are not.  I think if these parents were around during the polio outbreaks, and I still have patients with the residual effects of the neurologic disorder that was eradicated with vaccinations, they would have second thoughts about refusing vaccinations that can eradicate diseases that are life altering and deadly.  The anti-vaxxers were saying the same thing about measles until they saw the results of the disease in children who were not vaccinated. As with ANY vaccine there are risks, as far as side effects are concerned.  I would say they are similar to all other vaccines-fever, soreness, rash, fatigue etc... but the benefits exponentially outweigh the risks. The daily counts continue to rise as there were an additional 2300 diagnosed cases in California yesterday and Fresno just surpassed Tualre in number of cases.  Stay healthy my friends.  Doug

 

6/11/20 CORONAVIRUS COUNTS AND CASUALTIES

I hope all is well.  The number of daily new cases continue to slowly climb and is expected to increase more in the next week because of the recent openings and recent protests, particularly in the larger California cities.  I have received several questions pertaining to the potential benefit of MMR (Measles, Mumps and Rubella) vaccinations pertaining to protection from the COVID 19 coronavirus.  At first I could not see why there could be a benefit because none of these viruses are corona-like but the literature from the studies is quite impressive.  As we are all aware, the COVID 19 infections have presented with a very unusual morbidity penetration, where patients younger than 50 showed little morbidity from the disease, with mortality dramatically increasing above age 50. This is a very different presentation from other viral diseases, suggesting that some factor is protective in younger people, and missing in older patients. It was the theory of the study that different exposure to vaccines between younger and older people may account for this different morbidity rate. Widely deployed measles-rubella containing vaccines (MRCV) Including MMR, MR, and MMRV are believed to be why children, teenagers and other young adults often have few symptoms from COVID-19, and few deaths are attributed to COVID-19 in the young. Statistical data also demonstrates that MRCV vaccination rates substantially correlate with the widely varying outcomes from country to country related to COVID-19 mortality. Countries with recent, major MRCV vaccination programs have few if any deaths from COVID-19.  The MMR vaccine was introduced in 1971. It was most commonly given as a single vaccination from 1971 to 1978 then is a set of two vaccinations at least 28 days apart starting in 1979. Based on its year of introduction, most people today age 49 and under would likely have at least one MMR vaccination and those 41 and under would mostly likely have had two MMR vaccinations. This vaccine history may be a possible explanation for a COVID-19 death rate pivot point close to age 50. In countries where “vaccination catch up” programs have been instituted in recent decades there appears to be the lowest incidence of death from COVID-19, an in a few countries no deaths at all. In many of these countries two doses of MRCB were given to older teenagers and in some cases also to young adults in addition to children. 

 Published data demonstrates the following associations: 

Madagascar, a country with 26.26 million people, recently vaccinated 7.2 million of its citizens (over 27.4% of the total population) with MRCV in 2019.  This is in addition to any citizens who may have already been vaccinated. There had been no deaths at all from COVID-19 and Madagascar as of May 4th, 2020. 

Hong Kong in 1997 initiated a mass immunization campaign targeting infants through 19-year old adults. During 2019, Hong Kong instituted a free MMR vaccination program for all adult health care workers, airport staff and foreign domestic helpers, and also made MMR vaccinations available to many other adults seeking them.  Hong Kong continued this program in 2020. Only four people have died from COVID-19 in all of Hong Kong despite its proximity to the epicenter of the pandemic, just 563 miles away in Wuhan, China. Hong Kong is the world's fourth most dense country with a population nearly the size of New York City which recently had large scale protests with over 1 million people at some rallies, continuing well into 2020. Nonetheless, no nude COVID-19 deaths had been reported during the seven-week period ending May 3rd 2020.

On the opposite end of the spectrum, Belgium is the country with the highest COVID-19 death rate in the world. Belgium didn't even offer MMR vaccinations until 1985, and it wasn't until 1995 that it began giving the recommended two doses of MMR vaccinations per person. Even though Belgium has a population just 54% larger than Hong Kong, it has a staggering 7844 deaths from COVID-19, compared to Hong Kong's four.

Another country on the opposite end of the spectrum, Italy, had a large-scale measles outbreak in 2017 affecting over 4000, caused by a much lower than typical MRCV rate in that country. The lack of sufficient MRCV is a possible explanation why there has been a higher death rate in Italy from COVID-19 when compared to most other similarly affected countries. The measles immunization rate in Italy in 2005 was just 85%, one of the lowest in Europe. 

 Further epidemiological evidence possibly supporting MRCV decreasing severity of COVID-19 cases can be obtained from the USS Roosevelt. As of April 30th 2020, 1102 people on board the Roosevelt tested positive for COVID-19 . Although there was one crew member death early on, of the 1102 current COVID-19 positive crew members only seven had been hospitalized over the course of the outbreak, and no cases are currently in an ICU. The data set provided by the USS Roosevelt is unique because unlike the general population which typically receives only MMR vaccinations as young children, the United States military gives all recruits new MMR vaccinations upon entry regardless of prior vaccine history. This means nearly everyone on the USS Roosevelt most likely had updated MMR vaccinations within the last several years period most crew members of the USS Roosevelt likely fall into the 20 to 44 age range which is known to have a typical COVID-19 hospitalization rate of 14.3 to 20.8%. Currently at only a 0.6 hospitalization rate, the hospitalization rate for those on the USS Roosevelt appears to be around 20 times lower than that for the general population that COVID-19 positive people in the same age range.

 The efficacy of MRCV has been shown to go down with age, leaving some of those who received the vaccines and their youth more vulnerable as they age. Most people over age 60 never received any form of MRCV.

 A possible mechanism for the protective effect of the rubella component of MRCV in relation to COVID-19 was recently described by scientists at the University of Cambridge, corroborating from a biological perspective the same conclusion reached herein by principle investigator from an epidemiological perspective. Further evidence supporting the postulated relationship between MRCV and COVID-19 include: a live measles vaccine has previously been considered in studies as a base for other corona vaccines including SARS; novel alphacoronaviruses and paramyxoviruses (the measles family) have been found to cocirculate; and MRCV had previously been shown to generally increase immunity against many unrelated viruses. An excellent discussion was presented noting the homology of amino acid sequences between the COVID virus and the rubella virus possibly explaining crossover reactivity of the vaccines. 

Based on these findings, I would recommend that anyone 60 years or older should receive at least 1 MMR vaccination and possibly boosting after 30 days.  I would be reluctant to tell everyone to be boosted because there will be a huge shortage for the vaccination which should be, first and foremost, reserved for the children and for teenagers who missed their vaccinations as a child and need to catch up.  If you are less than 60 years old, I would recommend checking your antibody levels to see if you have a positive titer.  If you are interested please let us know because I will need to fill out a lab slip for you to check your antibody levels and it will not, typically, be covered by your insurance. Now on to the counts. 

California now has 139,780 cases (+2,723) and 4,854 casualties (+105) for a daily average of 2,862 cases and 67.1 casualties per day.  The highest toll is among seniors where 79 % of the dead were >65 and 2,479 (~50%) were in nursing homes.

 Quote of the Day:

“At the end of the day we must go forward with the hope and not backward by fear and division”-Jesse Jackson

“Those who seek to profit by division don’t stand a chance”-Henry Rollins

I never thought I would ever quote the Reverend Jackson but I feel that it really tells who we should really be.  This should not be a political decision inasmuch as a cause that is driven by nationalism and with the betterment of the country being the greatest priority.  I feel that politics still drive the recent virus debates, race triggers and call for drastic change that many are crying for.  No to police?  No to authority?  No to work and corporations?  No to success and if you are successful it’s not because you worked hard but it was given to you?  No to the American dream because according to many if you feel you can you really can’t because of the color of your skin?  What has changed in the past 3 months that has led to this turmoil.  Besides the virus, NOTHING has changed.  It was the same under Obama, Bush and Clinton but now it is real?  Ferguson was under the watch of Obama.  I can remember when it was said that Mitt Romney was a racist and was “going to put y’all back in chains” according to vice president Biden and now he is considered a saint in the democrats’ eyes.  I remember when George W. Bush was called a racist because of his slow response to hurricane Katrina and now, according to the democrats we should listen to him because he is not for president Trump.  Again, when I feel a political pulse I know it is must be wrong.  They are trying to divide us and they do not stand a chance.  Stay healthy my friends.  Doug

6/6/20 CORONAVIRUS COUNTS AND CASUALTIES

I hope you have something planned that is taking advantage of this excellent weather we are having.  I think it may be our last hoorah before we see high nineties and triple digits consistently torturing us again. I am getting more emails and calls concerning the safety of rescheduling appointments that have been put off because of the virus.  I am recommending that you start rescheduling because we cannot ignore the other medical, dental, eye and, most importantly, hair and nail:) issues that can be irreversible if you do not stay on top of it.  Everyone in these fields are adhering to safety precautions and I would say if you do not feel that they are point it out or maybe it will be time to change to someone else.  There are a few concerning issues based on the numbers we are seeing.  Fresno has had 21 deaths in the past 14 days.  Kings county now has a doubling of the cases every 7.4 days, but the good news is that their deaths are still low at 6 out of the 1,483 cases.  This is likely due to the fact that most of their case surge is from the state prisons in the county and the prisoners are on the younger side of the age range.  The number of Fresno ICU beds that have been used by COVID 19 patients is declining as well but this is a transient decline as more cases are being diagnosed now that more people are out socializing, and the protests have not helped this situation. Santa Clara's ICU bed usage is going up, which is concerning because they were one of the first counties to detect the virus then drop because of the "shelter in place" rules.  There are more people travelling, going out for meals and it is nice to see more people getting together.  We just need to be cognizant of potential exposure to those who have risk factors. For those who are high risk, I leave it up to you if you are willing to take that risk in order to live a quasi-normal life.  I know if I was in your shoes, I would take that chance.  Until the hospitals are overwhelmed and (hopefully they never will be) then you have the right to do what you want.  Just be reasonable and I strongly believe you will be fine.  As I have stated before, I really do not think it is about age as much it is about the diseases we collect as we age and, more importantly, diseases that are not controlled.  If you have high blood pressure and it is controlled, it is not as risky as if it is not. Asthma controlled is better than if it’s not etc… Obesity is a difficult one because the only way to control that is to control your diet and exercise to help you lose weight.  There are healthy obese people. (Those individuals who are exercising and improving their physical fitness but are still classified as obese because they haven’t lost enough weight yet.  We refer to these individuals as an “obesity paradox”.  So, if you are obese there is STILL NO EXCUSE for adhering to the lifestyle that has kept you this way.  You need to pick you’re battles.  I like wine, rocky road, Ben and Jerry’s Chunky Monkey and Coffee toffee.  So, I eat healthier and exercise more in order to reward myself for these vices of mine.  All in moderation of course ;) Intermittent fasting works for me. (My kids call me manorexic :) )  For others it may be frequent smaller meals, others, Weight watchers, low calorie, low carb or low fat or a combination of all of the above.  Whatever it takes, you need to do it. On to the numbers. California now has 126,329 confirmed cases (+3,327) and 4,538 casualties (+84) for a new daily average of 2,761 cases and 64.3 cases per day.

CALIFORNIA COUNTIES COUNTS AND CASUALTIES

1. Los Angeles with 61,074 cases and 2,567 casualties (516 in the past 14d)
2. Riverside with 8,777 cases and 355 casualties
3. San Diego with 8,180 cases and 294 casualties
4. Orange with 7,064 cases and 174 casualties
5. San Bernardino with 5,930 cases and 217 casualties

CENTRAL VALLEY CASES AND CASUALTIES

1. Kern with 2,534 cases and 45 casualties
2. Tulare with 2,116 cases and 92 casualties
3. Fresno with 2,080 cases and 43 casualties (21 in the past 14d)
4. Kings with 1,483 cases and 6 casualties (doubling every 7.4 days)
5. Merced with 334 cases and 7 casualties
6. Madera with 155 cases and 3 casualties

Quote of the Day: 

“Success seems to be largely a matter of hanging on after others have let go.” William Feather

The number of documented cases is starting to increase because the number of exposures is increasing. There are still individuals that continue to hang on but there are too many out there that are letting go.  You will see more cases and deaths in the future because of this. Hopefully we will get enough of a bump to remind them of the importance of hanging on again but not too big or else we will be starting the whole process over again. Stay healthy my friends.  Doug

6/4/20 CORONAVIRUS COVID 19 COUNTS AND CASUALTIES

The practice is starting to get back to normal so I will not be posting as frequently as I did before unless something drastically changes.  This is a good thing, to see my patients wanting to address all of their other issues that should not be ignored in place of the pandemic which is still with us and will be with us for the next 18 months.  Do not let the protests, marches and news media make you think that has changed.  You will see a rise in cases in the next few weeks and there will be another spike in the fall.  It disgusts me to see politicians, who were complaining that people were protesting the lockdown a week ago without masks meaning they didn’t care about the older people who are at risk.  Now these same politicians are walking with the protestors and cheering on the protestors because they say it is for a worthy cause.  This should scare each and everyone of you, to realize as long as the narrative is supported the rules change.  What hasn’t changed is the virus, the individuals who are risk and the way it spreads.  I hope you question the rules like I do.  How does this make sense?  How does the killing of a civilian by a disgusting cop make the virus situation change?  It doesn’t. We are told this is a racist virus and now we are told it is a “woke” virus.  I can’t wait to see what we will be told next.  The total California counts are now 122,167 cases and 4,44 casualties for a daily average of 2,555 cases and 65 casualties per day.  This tells me that more younger people are being diagnosed and once they start socializing with their older family and friends, you should start to see the deaths start to climb again. This will likely start in July.  Hopefully I am wrong.

CALIFORNIA COUTIES COUNTS AND CASUALTIES

1. Los Angeles with 59,692 cases and 2,532 casualties
2. Riverside with 8,303 cases and 345 casualties
3. San Diego with 7,798 cases and 283 casualties
4. Orange with 6,783 cases and 165 casualties
5. San Bernardino with 5,650 cases and 209 casualties

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 2,462 cases and 45 casualties
2. Tulare with 2,083 cases and 92 casualties
3. Fresno with 1,944 cases and 37 casualties *
4. Kings with 1,187 cases and 6 casualties
5. Merced with 310 cases and 7 casualties
6. Madera with 129 cases and 3 casualties

*Fresno will likely surpass 2000 after today

Quotes of the Day:

“Anger is never without a reason, but seldom with a good one.”-Benjamin Franklin

“In a controversy, the instant we feel anger we have already ceased striving for the truth, and have begun striving for ourselves.”-Buddha

There are a lot of angry people out there for multiple reasons but the anger is not helping us get through this pandemic and is only worsening the situation. Striving for our individual selves is selfish and will only make the situation worse. Quit being stupid and for those of you who think you know better.  Good luck.  I am tired of picking up after you.   Stay healthy my friends. Doug

6/2/20 CORONAVIRUS COUNTS AND CASUALTIES

It just feels as if we live in a different country today.  I never thought I would have to send my staff home early because we are near a mall that protesters are meeting at and there may be a riot.  A country where police are told to stand down as rioters and anarchists (of which I will not lump into the term protestors) are allowed to vent and express themselves with destruction, violence and arson because we are afraid stopping them would cause more violence.  They say it is for George Floyd, but the reality is he is just an excuse. We all agree that what happened to that poor man was despicable, disgusting and the individuals involved deserve everything that will happen to them and then some.  No one is arguing that fact and if they are they are disgusting individuals themselves.  We are dealing with mostly unemployed individuals who have been pinned down in their homes for 2 months looking for an excuse to “express themselves” at the cost of others’ lives, dreams and livelihood’s.  The reality of all of this is not that it is a racial issue, inasmuch it is an issue over the haves and have nots.  I was never given a thing other than my mom and my grandmother’s (Nan’s) encouragement and my family and friends emotional support to be who I am today.  It was not easy.  I had many trials, setbacks, mistakes and self-doubt.  I have been in fights, gone to jail.  I have eaten my share of mac and cheese, PB and J’s as well as top ramen. I bought generics most of my life, the cheapest beer and factory seconds.  I have collected cans and bottles for gas money for my father and picked peas to save money for a fishing pole when I was a kid. I have shopped at swap meets and yard sales and continue to do so to remind me of where I came from and who I am. I have ridden the bus with my mom when we did not have a car and ridden my bike when I didn’t have a license.  My mother had me when she was 16, my dad was an abusive alcoholic and we were poor.  There were always others that had more than me and there will always be others that continue to have more than me.  But what I never had was a reason to blame others.  My mother was a poor Mexican and my father was a poor Okie and I was a poor kid who didn’t know that, nor did I care.  I just knew I would do better.  I knew I would make something of myself and I knew that it would take hard work.  I sound like an old man when I say this and, I know my kids will say I am, but this is the result of not letting our children struggle and realize that in order to succeed it takes hard work.  It is the fault of the parents who let their children get a degree in sociology or art history at a private university that costs $80,000 a year only to come out and make $30,000 a year and have a life of debt.  It is the fault of the parents who do not have the courage to parent as opposed to always wanting to be the good guy.  So, I will cast a majority of blame on parenting, or lack thereof. There is no excuse for the actions that are occurring right now.  I know I may be called a “racist” or someone who is not in touch with the “oppression” that others have been through.  I will say that my mother was told to drink out of a different water fountain and use a different restroom because of the color of her skin and she is only 16 years older than me.  This is not about race.  It is about effort, the ability to succeed because of the opportunities that this country offers us.  It is the reason people sacrifice everything they have to get here and there are a group of thugs, hoodlums (white, brown, black yellow and green) who feel that life is too hard.  That life is stacked against them.  That it’s not fair. You know what’s not fair?  The fact that we continue to deal with these pieces of crap with kid gloves.  Telling them that someday it will be alright because all you have to do is wait for life to be fair.  If you want something, you need to make it happen and stop making excuses. And by the way, there still is a freaking pandemic out there.  I love how it is as if the COVID 19 disappeared according to the news.  Here are the numbers.  

California now has 115,643 cases (+3,356) and 4,287 casualties (+114)

CALIFORNIA COUNTIES COUNTS AND CASUALTIES

1. Los Angeles with 55,968 cases and 2,384 casualties (+22)
2. Riverside with 7,982 cases and 344 casualties (+5)
3. San Diego with 7,612 cases and 312 casualties (unchanged)
4. Orange with 6,532 cases and 147 casualties (unchanged)
5. San Bernardino with 5,355 cases and 204 casualties (unchanged)

CENTRAL VALLEY COUNTS AND CASUALTIES:

1. Kern with 2,332 cases (+72) and 38 casualties (unchanged)
2. Tulare with 1,897 cases (+18) and 89 casualties (+5)
3. Fresno with 1,882 cases (+148) and 36 casualties (+1)
4. Kings with 1,122 cases (unchanged) and 5 casualties (unchanged)
5. Merced with 301 cases (+16) and 7 casualties (unchanged)
6. Madera with 114 cases (+8) and 2 casualties (unchanged)

Quote of the Day: “A stumble may prevent a fall”-Thomas Fuller

I hope this latest episode of anarchy is just a stumble because if it is a true fall, this country will never recover.  I know we will not fall.  Stay healthy my friends.  Doug

 

6/1/20 CORONAVIRUS COUNTS AND CASUALTIES

I decided to take a break over the weekend. No news, no television (with the exception of the SpaceX Dragon launch, which continues to be an amazing site to see what we are capable of doing).  What is even more amazing was the ability we had to do this in the 60’s.  Our capabilities are limitless when we put on minds to it. The trends continue at the same pace. There were no major changes with the exception of Kings County making a big jump posting 408 cases since Friday. This is attributable to the outbreak in Avenal state prison.  If anything, there is more good news as the death count appears to be decreasing, but again, I expect this to start to climb 14-21 days since the recent daily counts have increased.  I would also expect to see the cases numbers increase as I see more and more people out and about as the restrictions are being lifted. We need to continue to focus on social distancing.  You can see what happens when individuals are confined to a small area by looking at how rapid it has spread at Avenal State Prison. The total California counts are now 113,114 cases with 4,242 casualties.

1. Los Angeles with 54,996 cases and 2,362 casualties
2. San Diego with 7,544 cases and 312 casualties
3. Riverside with 7,492 cases and 339 casualties
4. Orange with 6,354 cases and 147 casualties
5. San Bernardino with 5,246 cases and 204 casualties

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 2,260 cases (+253) and 38 casualties (+1) *
2. Tulare with 1,879 cases (+44) and 84 casualties (+4) *
3. Fresno with 1,734 cases (+76) and 35 casualties (+3) *
4. Kings with 1,122 cases (+408) and 5 casualties (+5) *
5. Merced with 285 cases (+5) and 7 casualties (unchanged)
6. Madera with 106 cases (+8) and 2 casualties (unchanged)

*Changes based on last counts from Friday 5/29/20

Quote of the Day: “We are only as string as we are united, as weak as we are divided” -J.K. Rowling

 On this Day:  In 1938, Superman appears for the first time in D.C. Comics created by American writer Jerry Siegel and Canadian artist Joe Shuster

 Although I was able to avoid the news this past weekend, there was no avoiding what is going on in our country today.  No one can deny that our country has some injustice, but I think we need to be honest and realize it is not as bad as it is being portrayed, and definitely not bad enough to warrant the blatant crimes that we are witnessing in most cities.  Two wrongs do not make a right and, equally disturbing, is the stoking of the flames by the news media as well as our politicians.  We need to call for calm and let the justice system play out.  I know that it is difficult to sit and wait but I do not see how breaking into a Target store, grabbing a Patagonia vest and a Samsung television, then lighting the place on fire makes the situation better.  This is what happens when you tell people they have to stay indoors for 2 months and then give them an excuse to go crazy.  We are better than this. Just as there are a few bad cops out in the world there are a few bad people as well.  These are the exceptions and not the rule. I don’t know about you, but I could use a Superman right about now.  Enjoy your Monday and stay healthy my friends. Doug

5/28/20 CORONAVIRUS COVID 19 COUNTS AND CASUALTIES

I hope you Thursday has treated you well.  There are no major shifts with the counts.  California’s totals are now over 100,00 with 101,945 cases (+2,048) with 3,918 casualties for an average of daily count of 2,242 cases and 59.6 casualties per day.  It is an unfortunate coincidence that as California surpassed the 100,000 cases the U.S. also surpassed 100,000 casualties

CALIFORNIA COUNTIES COUNTS AND CASUALTIES

1. Los Angeles with 48,778 cases and 2,201 casualties (+56)
2. Riverside with 7,252 cases and 306 casualties (+3)
3. San Diego with 6,983 cases and 255 casualties (+6)
4. Orange with 5,646 cases and 136 casualties (+5)
5. San Bernardino with 4,777 cases and 183 casualties (+7)

CENTRAL VALLEY CASES AND CASUALTIES

1. Kern with 1,941 cases (+65) and 36 casualties (+7)
2. Tulare with 1,796 cases (+25) and 79 casualties (unchanged)
3. Fresno with 1,631 cases (+96) and 30 casualties (+4)
4. Kings with 704 cases (+6) and 3 casualties (unchanged)
5. Merced with 278 cases (+5) and 7 casualties (unchanged)
6. Madera with 94 cases (+4) and 2 casualties (unchanged)

Quote of the Day: “To make our way, we must have firm resolve, persistence, tenacity.  We must gear ourselves to work hard all the way.  We can never let up.”-Ralph Bunche

On this Day: In 1957, the National league owners voted unanimously to allow the New York Giants and the Brooklyn Dodgers to move to San Francisco and Los Angeles.  And so, the rivalry began.

As the quote indicates we need to be persistent and tenacious to get through these difficult times.  Not just concerning the virus but with the racial tension that continues to erupt in this country.  There are bad people in this country but that does not mean everyone is bad.  There are bad cops, bad firemen, bad teachers, bad mechanics, bad lawyers and definitely bad doctors.  We cannot let the actions of a few bad individuals destroy the good that all the others in their profession do and provide.  I wish we didn’t have to pick sides or be told to pick sides.  Your either Democrat or Republican.  You are either pro black or pro white.  You are either for wearing the mask or not wearing the mask.  You are either for the lockdown or for opening up. We need to quit listening to the media and the politicians and stand up for one team. The United States of America.  There is still a word, compromise, that I believe has made this country what it is that will work today.  The tribalism needs to stop in order for us to survive all of this.  But, there is no compromise when it comes to the Dodgers and Giants:) You either bleed blue or orange.  I cut myself shaving today and it was blue:)  Stay healthy my friends. Doug

5/27/20 CORONAVIRUS COVID 19 COUNTS AND CASUALTIES

Happy hump day once again.  Yesterday was the largest daily increase in California cases on record with 3,215 cases but only 58 casualties.  I say only because it is relative to the counts that were consistently over 75 for the past month.  Every life is valuable but death is inevitable for all of us.  Los Angeles county is responsible for 50% of the new cases over the past 14 days and 79% of the casualties are in individuals 65 or older.  The new California totals are 99,809 cases with 3,825 casualties for a daily average of 2,281 cases and 58 casualties.   We will pass 100,00 cases sometime today.

CALIFORNIA COUNTIES COUNTS AND CASUALTIES

1. Los Angeles with 47,875 cases and 2,145 casualties (+29)
2. Riverside with 7,139 cases and 303 casualties (+11)
3. San Diego with 6,882 cases with 249 casualties (unchanged)
4. Orange with 5,578 cases and 131 casualties (unchanged)
5. San Bernardino with 4,467 cases and 176 casualties (unchanged)

CENTRAL VALLEY CASES AND CASUALTIES

1. Kern with 1,876 cases (+5) and 29 casualties (unchanged)
2. Tulare with 1,771 cases (+130) and 79 casualties (+4)
3. Fresno with 1,535 cases (+53) and 26 casualties (+4)
4. Kings with 698 cases (+10) and 3 casualties (+1)
5. Merced with 273 cases (+5) and 7 casualties (unchanged)
6. Madera with 90 cases (+5) and 2 casualties (unchanged)

Quotes of the Day: “Your life is not a simulation; it’s the real game. Play wisely. -Richelle E. Goodrich

“Risk is part of the game” – Victoria Aveyard

On this Day: In 1937-The San Francisco Golden Gate Bridge opened after 5 years of construction and over 200,000 walked across it on that day.

I do view what we have been through, and continue to go through as a game.  A new game.  We are learning moves and skills and techniques. It is filled with trials and errors but with each move, we learn something new.  Some moves will result in dying and others will result in staying alive ultimately resulting in a victory.  This also feels like a bridge; it takes time to build but some day we will complete it and make it to the other side.  I look forward to that day.  Stay cool and healthy my friends.  Doug

 5/26/20 CORONAVIRUS COUNTS AND CASUALTIES

Sorry about the delay in the post today.  Pretty full schedule, which, hopefully is a sign of some normalcy to come.  The total daily diagnosed cases are steady at 2,178 but the daily casualties were the lowest yet with 12 since yesterday.  This brings the total California number to 96,594 cases with 3,767 casualties for a daily average of 2,109 cases and 68.6 casualties a day.

CALIFORNIA COUNTY COUNTS AND CASUALTIES

1. Los Angeles with 46,023 cases and 2,116 casualties (+8)
2. Riverside with 7,004 cases and 292 casualties (+2)
3. San Diego with 6,797 cases and 249 casualties (unchanged)
4. Orange with 5,469 cases and 131 casualties (unchanged)
5. San Bernardino with 4,365 cases and 176 casualties (unchanged)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,871 cases (47) and 29 casualties (unchanged)
2. Tulare with 1, 641 cases and 75 casualties (both unchanged) *
3. Fresno with 1,482 cases and 22 casualties (both unchanged) *
4. Kings with 688 cases (+41) and 2 casualties (unchanged)
5. Merced with 268 cases (+7) and 7 casualties (+1)
6. Madera with 85 cases (+1) and 2 casualties (unchanged)

*Tulare had a third day of no cases or casualties and Fresno was unchanged from yesterday as well.  I think this is a Holiday delay and you will see a large jump tomorrow

 Quote of the Day: “If I cannot do great things, I can do small things in a great way” Martin Luther King Jr.

 On this Day: The “Duke” or our great American cowboy John Wayne was born on this day in 1907 and in 1978 the first legal casino to be operated in the United States outside of Nevada was opened in Atlantic City, New Jersey.

As I stated over the weekend, the tide appears to be changing and hopefully better days are ahead.  We all need to do our part to make sure the tide does not change substantially, again. I say substantially because another surge will occur.  Small things like washing our hands, social distancing, avoiding large groups can enable us to see family and friends who are longing for real socialization.  We are a social animal, for those of us who are not, we are called “loners” or “anti-social" but we all like talking and sharing. Just some of us more than others.  Not all of us can do great things but do these small things greatly. Remember our family and friends who at risk who may be scared.  Call them and talk to them as I find, a majority of my visits now are discussing how they feel, what they are doing and why they are scared.  Please do not treat our older patients as if they are lepers.  I think we are to a point in time where you need to ask them if it would be okay to visit.  I think it would be fine if you have done what you can to avoid being exposed needlessly.  It is something small that you can do so when they ask you if you would like to come over you can say, “I would love to” and feel confident when you do. These higher risk individuals are willing to take a chance if you will take a chance with them.  It will be a gamble for the next 18-24 months, but these patients have the “True Grit” that we can only wish to have as we grow older.  Enjoy the hot weather.  Make sure you are drinking 64 to 100 ounces of water a day in this hot weather and stay inside because there is some bad air.  I apologize because I had to run today.  Wasn’t smart but I took a chance because I feel so much better when I do.  It may be a gamble, but I know it has better odds than Atlantic City.  Stay healthy my friends.  Doug

5/25/20 CORONAVIRUS COUNTS AND CASUALTIES

This is the last day of the three-day weekend, so I promise this time to keep it short and sweet.  The total California counts are 94,444 cases (+1,751) and 3,755 casualties (+18) for a new daily average of 2,034 cases and 73.6 casualties per day. I really think the counts should be higher, for instance Tulare county has not reported any change for Saturday and Sunday so I know that this is not the case because their counts remained constant.  I am sure the Holiday weekend is contributing to the lower counts and we will see a rebound in the next few days. 

CALIFORNIA COUNTY COUNTS AND CASUALTIES

1. Los Angeles with 45,024 cases and 2,108 casualties (+16)
2. San Diego with 6,701 cases and 249 casualties (unchanged)
3. Riverside with 6,464 cases and 290 casualties (unchanged)
4. Orange with 5,336 cases and 131 casualties (+1)
5. San Bernardino with 4,365 cases and 176 casualties (unchanged)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,824 cases (+67) and 29 casualties (unchanged)
2. Tulare with 1,641 cases and 75 casualties (both unchanged) *
3. Fresno with 1,482 cases (+34) and 22 casualties (unchanged)
4. Kings with 647 cases (+130) and 2 casualties (unchanged) **
5. Merced with 261 cases (+10) and 6 casualties (unchanged)
6. Madera with 84 cases and 2 casualties (both unchanged)

**There was a large outbreak of over 100 cases in Avenal prison yesterday

Quote of the Day: “I am not what happened to me, I am what I choose to become. -Carl Gustav Jung

On this Day in History: In 1977, Star Wars opened in theaters and in 1935 the great Babe Ruth hit his last home run.

 A lot has happened to us over the past few months, and I must say, I am proud of how most of us came together when we were asked to.  It showed me that, in spite of what the politicians and news stations would have you think, we have more in common than we realize.  We came together to make this country a better and safer place. Not  “A long time ago, in a galaxy far, far away… but here, right now in the United States of America. In spite of what happened to us we need to become that great country again.  A country that has been through many trials and obstacles and continues to hit a home run every time.  Okay that last part was a little corny, but I had to try and tie it into the quotes.  Have a great day and enjoy the rest of your Holiday weekend. Stay healthy my friends.

 Happy Anniversary to LaDonna and Mike B.  I am proud of you two.  Keep it up.  

 5/24/20 CORONAVIRUS COUNTS AND CASUALTIES

I hope you Memorial Day Holiday if off to an awesome start.  I will try to keep it short today so you can continue to enjoy the Holiday and official kick off to the summer season. The California totals are 92,672 cases (+1,958) and 3,737 casualties (+68) for a daily average of 1,977 cases and 75.6 casualties per day.

1. Los Angeles with 44,121 cases and 2,092 casualties (+41)
2. San Diego with 6,559 cases and 249 casualties (+7)
3. Riverside with 6,464 cases and 290 casualties (unchanged)
4. Orange with 5,157 cases and 130 casualties (+12)
5. San Bernardino with 4,315 cases and 176 casualties (+3)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,695 cases (+51) and 27 casualties (+2)
2. Tulare with 1,641 cases and 75 casualties (both unchanged) *
3. Fresno with 1,417 cases (+45) and 22 casualties (unchanged)
4. Kings with 506 cases (+18) and 2 casualties (unchanged)
5. Merced with 251 cases (+17) and 6 casualties (unchanged)
6. Madera with 82 cases (+1) and 2 casualties (unchanged)

Quotes of the Day: 

“What we once have enjoyed we can never lose.  All that we love deeply becomes a part of us”-Helen Keller

“Don’t cry because it is over; smile because it happened”-Dr. Seuss

On this day: 

In 1543 Nicolaus Copernicus published his proof that we live in a sun-centered solar system.  He died just 2 months later.

In 1844 Samuel Morse taps out the first telegraph from Washington D.C. to Baltimore, Maryland.  Does anyone know what the first message was?  Answer: “What hath God wrought” Numbers 23:23

I picked the two quotes because I think, too often, we forget about why we are celebrating this weekend.  Of course, we owe all of our freedoms to the men and women of the military who sacrificed everything to maintain these rights.  We also remember all of our loved ones who have passed away.  These individuals contributed to our freedoms and successes as well.  We all have special people in our lives who are physically gone but need to be memorialized every day because a part of them will always be with us.  There are those who lived a long life and others who were taken away too early.  I think of my grandparents often, thinking of all that they did to ensure our family could have the opportunity to do better. My grandmother Morine and her Leslie clan lived in tents as they migrated from the Midwest during the dust bowl.  My grandpa Diamond hopped trains from Missouri as a teenager with his two brothers when they were orphaned with their father’s passing.  They made it to the West coast ultimately being kicked off a train with his 2 brothers resulting in a fractured leg and a month-long hospitalization in Los Angeles county.  His life long limp and bowed legs were a daily reminder to him as he hobbled his way to create a wonderful life living the American dream. I think of my grandpa Pilar who immigrated to the United States from Mexico and started as a farm laborer then an Electrolux vacuum salesman and the pride of Tulare.  I also miss my brother, who was a great guy who unfortunately was diagnosed with schizophrenia ultimately taking his own life.  I hope to think he was sane enough at the time to realize that he was institutionalized and could no longer deal with a life in and out of prison or crazy enough to think that it was what he was supposed to do. I miss my cousin Bud, who was essentially my brother and best friend, who died in his sleep due to a heart attack prompted by poor health and attempting to act on it too late.  All of these individuals made a tremendous contribution to my life and I would not have become who I am today without them.  I tell my kids I would be dead in or in prison with out these special family members who have passed and for other’s who are, fortunately, still living.  So, think about who in your life has passed and remember them today and every day for they are a part of you.  Don’t cry when you do.  Just smile.  And when you think your life is tough right now, realize we live in the greatest time EVER in the history of mankind.  We are at the pinnacle of civilization and we need to stay focused to ensure that we will continue to climb.  We need to remember what these special people in our lives have done and continue to pass the baton.  I am doing all I can to make sure I remain in the race for years to come. Are you?  Think about it and do something to stay in the race.  Enjoy the rest of you weekend and stay healthy my friends.  Doug

5/23/20 CORONAVIRUS COUNTS AND CASUALTIES

Good morning everyone. Try to enjoy this last cool day as it is expected to reach 107 next week. The counts continue to remain stable. The daily counts are consistently above 2000 and the casualties remain low. California's totals are 90,697 cases Which is 2218 more than yesterday. the total casualties are now 3669, an additional 65 from yesterday for a daily state average of 1965 cases and 73.6 casualties. 

1. Los Angeles with 43,085 cases and 2,051 casualties (+30) for 20.3/100K
2. Riverside with 6,464 cases and 290 casualties (+6) for12.2/100K
3. San Diego with 6,434 cases and 242 casualties (+1) for 7.3/100K
4. Orange with 4,941 cases and 118 casualties (+6) for 3.7/100K
5. San Bernardino 4,146 cases and 173 casualties (+9) for 8.1/100K

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,695 cases (+51) and 27 casualties (+2) for 3.1/100K
2. Tulare with 1,641 cases (+38) and 75 casualties (+1) for 16.3/100K *
3. Fresno with 1,417 cases (+45) and 22 casualties (unchanged) for 2.0/100K
4. Kings with 506 cases (+18) and 2 casualties (unchanged) for 1.3/100K
5. Merced with 251 cases (+17) and 6 casualties (unchanged) for 2.2/100K
6. Madera with 82 cases (+1) and 2 casualties (unchanged) for 1.3/100K

*Tulare is the second highest County in the state in terms of deaths per 100,000 only second to Los Angeles.

 Quote of the Day: “Don’t ever take a fence down until you know why it was put up”- Robert Frost

 On this day: In 1934 police shot to death the famous outlaws Bonnie Parker and Clyde Barrow (“Bonnie and Clyde”) also, Benjamin Franklin announced his invention of bifocals in 1785

 I would say we are climbing the fence this weekend and it will be a few months before we can take it down.  I am settling for putting a gate in at the moment. :)  I know we all want to be an outlaw and go back to the way it was, but we need to accept the way it is and the way it is going to be. (Kind of like when you realize you need bifocals to read because your arm can only stretch so far or reading with the book or paper on the floor just doesn't look right) :)  Did you ever think you would have to take off your shoes and belt while going to catch a flight at the airport?  Or be told that you cannot bring any liquid that is more than 3.4 ounces or you family could not walk you to the gate to say goodbye? To quote a famous line in one of my favorite films The Hangover, “thanks bin Laden”.  Drastic times lead to drastic measures but soon it will be a new normal.  A life that we will get used to.  A life that just requires a little more common sense.  Wash your hands, don’t be a close talker and don’t go out when your sick.  Just like our mothers and grandmothers have always told us.  Have a great day and stay healthy my friends.  Doug

5/22/20 CORONAVIRUS COUNTS AND CASUALTIES

Wow!  That week went by fast.  Happy Friday everyone.  It looks like the city will finally be opening after the holiday weekend.  I want you all to realize that nothing has changed from last week to this week.  The risks are still there.  It does not mean go back to the way it was.  I have already been seeing more people hanging out.  Going to parties with multiple friends and it appears that social distancing has become a thing of the past.  You really still need to take all of this seriously.  It does not mean go back to the way it was in early March.  It means keeping your distance, washing your hands and avoid groups of people, particularly when you are < 6 feet away.  I have received several calls from parents whose teenagers and young adults have been exposed to someone who has had been diagnosed with COVID 19. The questions have been on how to isolate, when to be tested and what to do.  The rules remain the same.  Just because the restrictions have been lifted does not mean forget all we have done to get here.  The counts are going to go up exponentially if this continues.  I am just saying and for most of us, we will all be fine, but you need to be cognizant of the people you may expose (older relatives, people with risk factors) again everything is the same. Don’t blow this.  The total California counts are 88,664 cases (+2,313) and 3,609 casualties (+104) for a daily average of 1,932 cases and 79 casualties a day.

1. Los Angeles with 42,138 cases and 2,021 casualties (+45)
2. Riverside with 6,343 cases and 284 casualties (+14)
3. San Diego with 6,315 cases and 241 casualties (+11)
4. Orange with 4,841 cases and 1123 casualties (+14)
5. San Bernardino with 3,984 cases and 164 casualties (+6)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,644 cases (+39) and 25 casualties (unchanged)
2. Tulare with 1,603 cases (+51) and 74 casualties (+1)
3. Fresno with 1,372 cases (+34) and 22 casualties (+2)
4. Kings with 488 cases (+31) and 2 casualties (unchanged)
5. Merced with 234 cases (+8) and 6 casualties (unchanged)
6. Madera with 83 cases (+1) and 2 deaths (unchanged)

Quote of the Day: “You can have anything you want if you want it bad enough.  You can be anything you want to be, do anything you set out to accomplish if you hold to that desire with singleness of purpose” -Abraham Lincoln

On this day in 1992 American comedian Johnny Carson, considered by many to be the king of late-night television (no one even close), made his final appearance as host of the Tonight Show.  He had a way of telling stories and a way of making people laugh without involving politics.  He was a master of this as well as many other things.  We need to use a little more Johnny Carson to get us through this.  I wonder what Carnak the Magnificent would predict about all of this?  I apologize for the delay.  Long day at work and mountain biking again.  Getting better but damn it sucks getting old:)  Have a great weekend and stay healthy my friends.  Doug

5/21/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I forgot to mention  yesterday that the Tuesday’s casualty count in California of 132, was the highest daily count we have had.  I really think it was a discrepancy in the counting from the previous 2 days and based on today’s numbers that appears to have been the case.  The daily documented cases continue to stay above 2,000 with total counts of 86,227 cases (+2,322) and 3,501 casualties (+82) for a daily average of 1,861 cases and 75.3 casualties per day.  Again, and I know I sound like a broken record (for those of you who remember what a record was) the more cases that are documented the more deaths we will see.  Most all of the deaths will be from older individuals with significant risk factors (Obesity, Hypertension, Diabetes, Kidney disease, COPD/Asthma/Emphysema, Elderly >65 and Immunocompromised individuals).  I think another qualifier would be individuals with these diseases that are not controlled.  Unfortunately, we physicians are not hearing much when it comes to the individuals who are dying from this.  There has been a theory that Vitamin D deficiency could be a contributor as well.  70 % of the U.S. population is deficient in Vitamin D.  Vitamin D deficiency is more common in the obese, pigmented populations (Hispanic, African decent, Indian decent) and individuals who do not get outside to exercise.  Vitamin D is something I typically order with your annual labs and if you were deficient, I recommended supplementation to get you to the desired range of 40-60 for the maximum effects.  I would not recommend blindly taking Vitamin D because excessive Vitamin D can accelerate the calcification of blood vessels therefore increasing the risk for cardiovascular disease.  There is a lot to learn about this virus but we will soon have more information to help us in the future.  On to the counts.

1. Los Angeles with 40,975 and 1,976 casualties (+50)
2. Riverside with 6,184 cases and 270 casualties (unchanged)
3. San Diego with 6,140 cases and 230 casualties (+8)
4. Orange with 4,742 cases with 98 casualties (+10)
5. San Bernardino with 3,795 cases and 158 (+1)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,605 cases (+34) and 25 casualties (unchanged)
2. Tulare with 1,552 cases (+13) and 73 casualties (+2)
3. Fresno with 1,338 case (+51) and 20 casualties (+3)
4. Kings 457 cases (+41) and 2 casualties (unchanged)
5. Merced with 226 cases (+4) and 6 casualties (unchanged)
6. Madera with 82 cases (+1) and 2 casualties (unchanged)

Quote of the Day: “It had long since come to my attention that people of accomplishment rarely set back and let things happen to them.  They went out and happened to things.”-Leonardo da Vinci

 On this Day: In 1979 Dan White had gone to see San Francisco Mayor George Moscone and Supervisor Harvey Milk to ask for his old job back, when they refused to give it back to him he shot and killed them both.  He was convicted of voluntary manslaughter (Rather than first degree murder) after his defense lawyers argued his mental state at the time of the killings was one of diminished capacity due to depression, caused by his consumption of sugary junk food.  White’s defense was labeled by the press as “the Twinkie defense”.  Maybe that is what is going on with are politicians today.  It sounds like the sugar high has passed and they are coming out of their coma to realize this defense won’t work.  We are smarter than they thought.  I look forward to a little more freedom after the Memorial Day holiday with a little rocky road and chuncky monkey to top it off.  Let's make something happen :)  Stay healthy my friends.  Doug

Happy Birthday to Susan D. I hope you are able to get out and roll a 300 score soon.

5/20/20 CORONAVIRUS COUNTS AND CASUALTIES

Happy Humpday again everyone.  I think this is the eighth one since the shutdown.  Can you believe ~ 2 months have come and gone.  It does not feel as we had a spring and I cannot believe that summer is just around the corner, with the Memorial Day Holiday this weekend.  The counts and deaths increased with the California totals now 83,864 (+2,017) and 3,420 casualties (+132) for a new daily average of 1,828 cases and 76.7 casualties per day. 

1. Los Angeles with 39,632 cases and 1,926 casualties (+84)
2. Riverside with 6,053 cases and 270 casualties (+9)
3. San Diego with 6,026 cases and 222 casualties (+11)
4. Orange with 4,500 cases and 88 casualties (unchanged)
5. San Bernardino with 3,707 cases and 157 casualties (+2)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,571 cases (+34) and 25 casualties (unchanged)
2. Tulare with 1,539 cases (+103) and 71 casualties (+4)
3. Fresno with 1,287 cases (+24) and 17 casualties (unchanged)
4. Kings with 416 cases (+4) and 2 casualties (unchanged)
5. Merced with 222 cases (+2) and 6 casualties (unchanged)
6. Madera with 81 cases (+3) and 2 casualties (unchanged)

Quote of the Day: “Nothing in this world can take the place of persistence. Talent will not; nothing is more common than unsuccessful people with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; The world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan” press on” Has solved and always will solve the problems of the human race. “-Calvin Coolidge

 On this day: In 1927, the first non-top trans-Atlantic flight took place by Charles Lindbergh and in 1990 the Hubble Telescope sent back its first photos from space.

We need to be persistent in our quest to reach the new normal.  We have some distance to go but we are finally moving in the right direction. Talent, education and genius are not enough.  Looking at what took place nearly 100 years ago, attempting to fly across the Atlantic, took an immense amount of courage as well as persistence and determination.  The Hubble allowed us to realize the reward of the determination and persistence it took to develop such a telescope.  It allows us to realize that we are so, very, young when it comes to the age of the world, let alone the universe.  Pandemics, such as these, have happened for millions of years and, again, we will come out of this stronger than we ever have been.  Be persistent and stay healthy my friends.  Doug

5/19/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

The cases continue to remain steady but the casualty counts continue to stay low. These are the first two consecutive days that we have been below 50 deaths since early April when the counts started to rise.  We are now at 81,903 total cases in California with 3,296 casualties.  Yesterday was an additinal1,662 cases and 47 casualties for a daily average of 1,783 cases and 72.6 casualties per day.

1. Los Angeles with 38,466 cases and 1,842 casualties (+21)
2. Riverside with 5,952 cases and 261 casualties (+19)
3. San Diego with 5,946 cases and 211 casualties (+2)
4. Orange with 4,443 cases and 88 casualties (unchanged)
5. San Bernardino with 3,593 cases and 155 (unchanged)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,537 cases (+22) and 25 casualties (unchanged)
2. Tulare with 1,436 cases (+6) and 67 casualties (unchanged)
3. Fresno with 1,263 cases (+71) and 17 casualties (+1)
4. Kings with 412 cases (+13) and 2 casualties (unchanged)
5. Merced with 220 cases (+20) and 6 casualties (unchanged)
6. Madera with 78 cases (+7) and 2 casualties (unchanged)

Quote of the Day: “ There are only two mistakes one can make along the road to truth; not going all the way and not starting”-Buddha

 On this Day: In 1884 the Ringling brothers opened a small circus in Baraboo Wisconsin

It is time to avoid the two mistakes.  Let us start by opening up slowly (I believe you will see this really start happening after this weekend because with the Memorial Day kick off, we the people will not continue to be suppressed by the officials we elected and by rules that do not make sense. (Seriously?? If you are caught swimming in the ocean in New York they are going to pull you out of the water??  Oh, that’s right. You can get the virus if you breath it in and if you are swimming your going to breath in water. Wait that's a fish, right?? Are we fish now??  Thank you Mayor de Blasio, for your excellent scientific knowledge.  Let us finish by going all the way to where we used to be (with some changes of course).  Otherwise, this small circus, we call politics in the United States, will make the Ringling brothers look like a dog and pony show.  Stay healthy my friends.  Doug

Happy Birthday to Kai Butler (I hope the Chick-fil-A and golf were all that you could of imagined), Louise H. ( have fun in Cayucos, Bass Lake or wherever you are) and Patty M. (Make sure you enjoy your 51^st either here or Morro Bay-just keep your 6 feet or wear your mask). :)

5/18/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

It was on this day in 1989 where over a million protesters in China marched through the streets in Beijing calling for a more democratic political system.  The largest protest was in Tiananmen Square.  It is amazing how I can remember the one protester standing in front of the tank not letting it pass.  One person’s action was a symbol of strength and determination to fight for something they knew was right.  Something that China did not have but what its people wanted and knew was fair.  I think it is our time to stand up for what was once ours and has been unfairly kept away.  If the restrictions do not begin to open up more after Memorial Day, I predict you will see our own “Tiananmen Square “here in the states.  Particularly since the counts continue to remain steady and are actually dropping.  The California counts are now 80,299 (+1,347) with 3,240 casualties (+32) for a daily average of 1,747 cases and 74.6 casualties per day.

1. Los Angeles with 38,011 cases and 1,821 casualties (+28)
2. San Diego with 5,836 cases and 209 casualties (unchanged)
3. Riverside with 5,618 cases and 242  casualties (unchanged) *
4. Orange with 4,376 cases and 88 casualties (+2)
5. San Bernardino with 3,511 cases and 155 casualties (unchanged)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,515 cases (+42) and 25 casualties (unchanged)
2. Tulare with 1,430 cases (+4) and 67 casualties (unchanged) **
3. Fresno with 1,192 cases and 16 casualties (both unchanged) *
4. Kings with 399 cases (+7) and 2 casualties (unchanged)
5. Merced with 200 cases and 6 casualties (both unchanged) *
6. Madera with 71 cases (+1) and 2 casualties (unchanged)

*Riverside, Fresno and Merced did not report yesterday’s counts

** This was Tulare’s lowest daily count since March (hopefully the start of a good trend as opposed to an error)

Quote of the Day: “ A person with a new idea is a crank until the idea succeeds” -Mark Twain   It is time to start cranking harder.  Have a great day and stay healthy my friends.  Doug

Happy Birthday: To Roy C and Warren P.  Damn you guys are really old now.  :)

5/17/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I hope you have more great things planned today.  If any of you are interested in a fun little hike, you should try Big Baldy Trailhead in Kings Canyon. It is about 1 hour 20-minute drive up the 180 and you want to veer right after the gate.  It is a 2.3 mile hike to the top of a granite dome that has an unbelievable view of the valley below and the Sierra Nevada mountain range eastward.  You cover about 650 feet elevation to reach the peak which is 8,211 feet above sea level. It will take ~1:15 minutes at a decent pace to get to the top and ~1:05 minutes to get down.  It is an amazing place to just take in all of what is around us and realize how small we really are in the grand scheme of things.  The total California counts are now 78,859 cases (+1,877) and 3,208 casualties (+54) for a daily average of 1,721 cases and 73.6 casualties per day

1. Los Angeles with 37,374 cases and 1,793 casualties (+41)
2. San Diego with 5,662 cases and 209 casualties (+1)
3. Riverside with 5,618 cases and 242 casualties (unchanged)
4. Orange with 4,222 cases and 86 casualties (+2)
5. San Bernardino with 3,463 cases and 155 casualties (+5)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,473 cases (+45) and 25 casualties (+1)
2. Tulare with 1,426 cases (+88) and 67 casualties (+3) *
3. Fresno with 1,192 cases (+36) and 16 casualties (unchanged)
4. Kings with 392 cases (+20) and 2 casualties (unchanged)
5. Merced with 200 cases and 6 casualties (both unchanged)
6. Madera with 70 cases and 2 casualties (both unchanged)

*Tulare will likely surpass Kern county with total documented cases and deaths in the next 48 hours. 

Quote of the Day: “I find that the harder I work, the more luck I seem to have “- Thomas Jefferson

It is time to start working harder on keeping our social distancing and hand washing when we begin to open up the businesses that need to be open to turn around the economy. In doing so, I know we will have more luck in our future.  Luck is just the intersection of preparedness and opportunity.  I know we are prepared for the, much needed, opportunity and take back what is constitutionally ours.  It will not be taken away.  At least not in my lifetime. We will not let this happen again. Enjoy your Sunday and stay healthy my friends.  Doug

Happy 39^th birthday to Amy T.  and 51^st to my best friend Garon Chester-Do something great to celebrate while you still can Garon.  It is official you, can shoot your age on the front nine now:)

5/16/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Good morning everyone.  Time to enjoy this awesome weekend that we have been dealt.  I believe the parks are beginning to open, I know the golf courses have, like it or not:). Did you know on this day in 1929 the first Academy Awards started as a dinner party for about 250 people held in the Blossom Room of the Roosevelt Hotel in Hollywood California? (Do you remember when we were able to go to movie theatres?)  Also, on this day in 1980 the rookie, Earvin “Magic Johnson” stepped in as center for the injured Laker’s center, Kareem Abdul-Jabbar and scored 42 points, carrying the Lakers to a 4-2 series win against Dr. J and the Philadelphia 76ers.  (Remember when we were able to watch live sports on television or could you imagine a live game?).  Hard to believe that was forty-freaking years ago.  As I type this it reads like an episode from the twilight zone.  We will get there again someday.  The counts are relatively stable.  **(The counts and numbers may not make sense because of my late input from last night.  The site I use has a running tab that is updated frequently.  The daily changes are accurate and, in the future, if I don’t post the counts in the morning, I won’t post them because it is too damn confusing). California now has 76,941 cases (+1,984) and 3,154 casualties (+102) for a daily average of 1,774 cases and 74.9 casualties.  There are more cases being diagnosed daily because we are testing more.  So, you will expect more deaths as well.  Nothing alarming here.  

1. Los Angeles with 36,324 cases and 1,752 casualties (+41)
2. Riverside with 5,618 cases and 242 casualties (+7)
3. San Diego with 5,523 cases and 208 casualties (+8)*
4. Orange with 4,125 cases and 84 casualties (+4)
5. San Bernardino with 3,311 cases and 150 casualties (+11)

*San Diego is catching up to Riverside county and will likely surpass it in the next few days.  This may be from the influx of Mexican- Americans with dual citizenship or illegal aliens crossing the border for better care.

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,428 cases (+35) and 24 casualties (+3)
2. Tulare with 1,338 cases (+43) and 64 casualties (+10) *
3. Fresno with 1,156 cases (+82) and 16 casualties (+3)
4. Kings with 372 cases (+14) and 2 casualties (+1)
5. Merced with 200 cases (+11) and 6 casualties (+2)
6. Madera with 70 cases (+1) and 2 casualties (unchanged)

*This was the largest daily death total in the valley.  The more cases we get the more deaths will occur.  The general rule is that you typically only die if you have significant risk factors: 1. Obesity 2. Hypertension 3. Kidney disease 4. Asthma/COPD 5. Cardiovascular disease 6. Diabetes and 7. Cancer.  Age is a general risk factor, but I believe mainly because as we age, we tend to be more prone to get the diseases that were listed.  It is true that our immune status decreases as we get older, but the diseases are more of a risk compared to age itself.  The current numbers are suggesting that the mortality rate from COVID 19 will likely be 0.4% (2-3 x as deadly as the flu).  If you are healthy, and you adhere to the current recommendations of social distancing and washing your hands, you SHOULD be fine.  I would only recommend the masks if you feel that the 6 feet of social distancing will be compromised on a regular basis or if you feel you may be sick (If this is the case you should not be leaving your home). I would also recommend that you use them when it is mandated that you do, otherwise you tend to get irritated looks and it is not worth the argument.

Quote of the day: “Only the wisest and stupidest of men never change”-Confucius

I think you can list the scientists who are leading the recommendations as the wisest and some of the politicians as the stupidest in this quote.  Both have to see that change is needed.  Have a great day and stay healthy my friends.  Doug 

 

5/15/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Happy Friday everyone. Sorry about the delay today.  Another week has passed, and summer is almost, officially here. Can you believe that Memorial Day is next weekend? Take advantage of the great weather while it lasts because triple digits will soon be here.  There were no major changes from yesterdays trends.  The total cases for California are now 76,618 (+1784) more than yesterday starting this morning with 2,974 casualties (+92).  (If you subtract from the previous days numbers, they will be substantially higher because the totals are pulled from later today, which is why the numbers are off).  The daily average is 1,784 cases and 72.4 casualties per day.

1. Los Angeles with 36,316 cases and 1,753 casualties (+90)
2. Riverside with 5,618 cases and 242 casualties (+14)
3. San Diego with 5,391 cases and 200 casualties (+6)
4. Orange with 4,125 cases and 84 casualties (+4)
5. San Bernardino with 3,311 cases and 150 casualties (+12)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,428 cases (+85) and 24 casualties (+7)
2. Tulare with 1,338 cases (+70) and 64 casualties (+10)
3. Fresno with 1,074 cases (+60) and 13 casualties (unchanged)
4. Kings with 358 cases (+10) and 1 casualty (unchanged)
5. Merced with 189 cases (+9) and 4 casualties (unchanged)
6. Madera with 69 cases and 2 casualties (both unchanged)

Quote of the Day: “I do not think there is any other quality so essential to success of any kind as the quality of perseverance.  It overcomes almost everything, even nature"-John D. Rockefeller

We will persevere.  Come Hell, high water or a virus we will get through this.  We are getting through this, as this country has always done and will continue to do.  Stay healthy my friends.  Doug

5/14/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

We will keep it short and sweet today.  Fresno surpassed 1000 cases yesterday and the country surpassed 80,000 casualties earlier in the week.  I am thinking we will be seeing ~120,000 to 150,000 deaths before the year is over. Better than the initial predictions but still not a good thing.  California now has a total of 73,143 cases (+2,097) and 2,974 deaths (+92).  So, we will be surpassing 3,000 casualties in California today.  This brings the daily averages of 1,789 cases and 73.1 casualties per day.

1. Los Angeles with 34,552 cases (+1,305) and 1,663 casualties (+46)
2. Riverside with 5,343 cases (+95) and 228 casualties (+3)
3. San Diego with 5,278 cases (+117) and 194 casualties (+4)
4. Orange with 3,749 cases 9 (+147) and 80 casualties (+3)
5. San Bernardino with 3,153 cases (+75) and 138 casualties) (+18)

CENTRAL VALLEY COUNTS AND CASUALTIES

1.)  Kern with 1,343 cases (+27) and 17 casualties (unchanged)

2.)  Tulare with 1,268 cases (+27) and 54 casualties (+2)

3.)  Fresno with 1,014 cases (+30) and 13 casualties (+3)

4.)  Kings with 348 cases (23) and 1 casualty (unchanged)

5.)  Merced with 180 cases (+3) and 4 casualties (unchanged)

6.)  Madera with 69 cases and 2 casualties (both unchanged)

Quote of the Day: “Whoever fights monsters should see to it he/she does not become a monster.  And if you gaze long enough into the abyss, the abyss will gaze back into you.”-Friedrich Nietzsche

The politicians started fighting this monster with good intentions but now they have become the monsters that we need to fight.  You will not see me staring into the abyss I will be doing my best to ensure that that bottomless chasm gets filled one shovel at a time with the sh*t they are dishing out. Be smart. Ask questions and stay healthy my friends.  Doug

5/13/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Happy hump day everyone.  I hope all is well.  Make sure you look for the F15-c Fighter jets with the 144^th Fighter Wing who are doing flybys to salute all of the healthcare workers out there who are doing their part.  There is nothing alarming with the latest counts.  The total cases in California are 71,081 (+1700) with 2,883 casualties (+103) with a daily average of 1,761 cases with 71.9 casualties.  Again, THE COUNTS WILL GO UP and as the counts increase the casualties will increase and based on the trend the overall death rate will likely be in the range of 0.3 to 0.6 %.  Some are at higher risk than others (we have gone over who is at risk multiple times).  Some of you may be asking “Wait, the percentage based on the total numbers you have given equates to 4.05% !!”  These numbers are based on the cases that we know about.  There are so many more cases out there that we don’t know about but they are there.  As the denominator gets higher the percentage gets lower.  Kern counties death rate is 1.2%, Tulare 4.2% and Fresno 1.01%.  Here is an analogy to help you understand a little about the virus.  Do you remember the old war films?  Let’s set the scene.  The Americans parachute into enemy grounds under the cover of darkness.  They thought that they made it without anyone noticing but a German soldier was relieving himself, having a cigarette looking to the dark, moonless night and caught a glimpse of something falling from the sky. (I am not being racist here; if your offended with German you can add whichever country you want-China, Russia, Canada, Mexico etc..)  He moved in closer and saw the Americans and notified his commander.  When the sun rose, his unit snuck up on the Americans and starting shooting.  Fortunately, the Americans were able to find shelter in an old, brick, abandoned home. (This is an old war scene so there are no drones that can take out this building from a gamer in the states). :) Here is the catch.  They are both in the middle of nowhere.  The house they found, surprisingly, has enough food and water for 18-24 months (The amount of time we would be waiting to develop a vaccine or herd immunity).  Occasionally, an American will try to go outside because they are going nuts doing nothing.  So, they open the door, it creaks slowly and the first guy, an older fellow who is obese and has hypertension, gets shot and dies. (Gets the virus and dies) A separate time, another guy (young whipper snapper who is fast and spry; a lot like my friend and fellow mountain biker Sullivan) stays out longer and gets shot at but doesn’t get hit (Gets virus but is asymptomatic). Another guy, let’s call him Shawn, middle age, such as myself, gets wounded but survives.  Shawn was slow and has arthritic knees and a bad back that he needs massages and physical therapy for. (caught the virus, had some symptoms but survived) Now, some of the younger ones get confident and try to push their luck and stay out longer.  Occasionally one of these guys get shot and dies but this is extremely rare because younger people are smarter and know more than the older people- at least that is what they tell me. (The occasional younger person who dies from the disease) but we are talking 1 in 20,000.  Here is the kicker.  The Germans have enough ammunition to wait this out. The Germans (virus) are not going away.  They will be there forever or until we come up with enough weapons or troops (vaccine or medicine) to take them out. But the more we sneak out, the more learn about them. We hope to come up with a plan before waiting 18-24 months in hopes that we can do something sooner. (because we are losing our minds and we have businesses back home that need tending to or they will never financially recover).  I hope this helps.  Just trying to have a little fun.  Now for state breakdowns.

1. Los Angeles with 33,247 cases and 1,617 casualties (+47)
2. Riverside with 5,248 cases and 225 casualties (+8)
3. San Diego with 5,161 cases and 190 casualties (+15)
4. Orange with 3,602 cases and 77 casualties (+1)
5. San Bernardino with 3,078 cases and 120 casualties (+5)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,316 cases (+30) and 17 casualties (+2)
2. Tulare with 1,241 cases (+102) and 17 casualties (+2)
3. Fresno with 984 cases (+39) and 10 casualties (+1)
4. Kings with 325 cases (+6) and 1 casualty (unchanged)
5. Merced with 177 cases (+4) and 4 casualties (+1)
6. Madera with 69 cases (+2) and 2 casualties (unchanged)

Quote of the day. “The greatest oak was once a little nut who held its ground”-Anonymous . This one is for all of my almond guys out there who are literally nuts. :)

We need to continue to hold our ground.  There may be drought, wind, hail or freeze but we will become the great oak once again.  Stay healthy my friends. Doug

Happy Birthday to Michael T. (speaking of nuts) :) Do something to celebrate while you still can. :)

5/12/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I hope all is well. The counts continue to stay low but realize they will start to climb once the easing of the “shelter in place” orders take effect. It is shocking to hear Dr. Fauci make a statement today stating that if we lift the current restrictions the counts will go up and people will die.  No sh*t!!  Everyone knows this.  I know he has helped the nation with over four decades of dedication but I would like to know what his plan is.  Wait for a vaccine? (Which may take up to 18 months and we cannot guarantee that it will even work). Wait for a treatment? (When there isn’t one that is making a significant difference, particularly at the start of the disease).  Wait for herd immunity? (When that may take 18-24 months).  We need to know the alternative plan that he has. Is he is holding an ace in the hole that we don't know about?  Because I believe he would be happy to sit this out for the duration which may be 1-2 years.  If you feel you can wait that long then I guess you go along with his plan.  Everyone I know cannot afford to.  This is not reality.  Most people I know don’t want to and are willing to take their chances, while still being cautious.  You are beginning to see how the sheltered individuals live their lives.  These are academics, not physicians who out in the community.  I would like to know when the last time Dr. Fauci spoke to a patient in an office.  Listening to them tell him how if this continues, they will not make it so life would not be worth living.  Individuals whose American dreams have been crushed, burned and buried.  Or the patient who is dying of metastatic lung cancer who just wants to live his last months doing something he wants to do.  Or the elderly patients who live alone and are told to not leave their house.  It sounds good on paper when someone tells you to stay home because if you do the numbers will stay down but I am tired of living on theory when the reality of the matter is this sh*t is real!  The doors have to open someday and when they do you are going to have more cases and more death.  If you continue to smoke you are likely going to die earlier than someone who doesn’t.  If you drive 100 mph you will likely crash and die.  If you drink and drive, your odds of killing yourself or others goes up. Being a parent, I know you sometimes have to tell your children the reality of the world.  Some people are evil, life is difficult and bad things will happen.  You will have to make decisions and you may be and will be wrong occasionally and you will learn from these decisions.  There are no guarantees in life but all you can do is be the best you can be, be kind to others give 100% effort and know you did all you could.  It’s time to act like real parents and not the helicopter type.  Now onto the counts.

California’s total is now 69,346 (+1,410) with 2,779 (+61) The daily averages are 1,886 cases and 70.3 deaths per day.

1. Los Angeles with 32,269 cases (+566) and 1,570 casualties (+39)
2. Riverside with 5,189 cases (+50) and 217 casualties (50)
3. San Diego with 5,065 cases (+139) and 175 casualties (unchanged)
4. Orange with 3,557 cases (+55) and 76 casualties (unchanged)
5. San Bernardino 3,015 cases (+51) and 115 casualties (+1)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,286 cases and 15 casualties (both unchanged) *
2. Tulare with 1,159 cases and 50 casualties (both unchanged) *
3. Fresno with 945 cases (+60) and 9 casualties (unchanged)
4. Kings with 319 cases (+32) and 1 casualty (unchanged)
5. Merced with 173 cases (+10) and 3 casualties (unchanged)
6. Madera with 67 cases and 2 casualties (both unchanged)*

*The counts for Kern, Tulare and Madera country were unchanged.  I think because the counts were not turned in based on the trends they have had prior to today.

Quote of the Day: “If you never try you’ll never know”-Anonymous

It is time to try, friends, or we will never know if our actions have resulted in the slow destruction of this country as we once knew it.  Stay healthy my friends. Doug

Happy Birthday to Frank C. (Do something exciting while you still can) :) and Ashley D. (Enjoy your 21^st) :)

5/11/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

It’s another Monday and I hope all of you told the Mother’s in your life how much you love them and how sorry you are for the crap you put them through when you were younger or currently.  Now start saving up for the Father’s Day presents that we all want and deserve:) I’ll take a place in Pebble Beach, Cayucos or Pacific Grove.  A cabin up at Shaver (and it doesn’t even have to be on the point) or 200 acres of almonds or pistachios with plenty of water and great farmers such a Juan, Shawn, Jose  or the Honey badger to help me.  I can dream, can’t I? :)  Speaking of dreaming, the counts are lower today but, unfortunately, it appears there were some counties that were left out yesterday (Los Angeles, San Diego, Riverside, Santa Clara, Fresno, Kings, Merced and Madera to name a few). The total are now 68,221 cases and 2,724 casualties with a daily average of 1,859 cases and 71.9 deaths per day.

1. Los Angeles with 31,703 cases with 1,531 casualties (both unchanged)*
2. Riverside with 5,039 cases and 205 casualties (both unchanged)*
3. San Diego with 4,926 cases and 175 casualties (both unchanged)*
4. Orange with 3557 cases (+55) and 76 casualties (unchanged)
5. San Bernardino with 3,015 cases (+113) and 115 casualties (+1)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,286 cases (+32) and 15 casualties (unchanged)
2. Tulare with 1,159 cases (+19) and 50 casualties (+2)
3. Fresno with 885 cases and 9 casualties (both unchanged)*
4. Kings with 287 cases and 1 casualty (both unchanged)*
5. Merced with 163 cases and 3 casualties (unchanged)
6. Madera with 67 cases and 2 casualties (both unchanged)

Quotes of the Day: “Some people want it to happen, some wish it would happen, others make it happen.”  “They told me I couldn’t.  That’s why I did”-Michael Jordan

My son and many of my friends told me to watch the Michael Jordan documentary, Last Dance on ESPN. The Chicago Bulls were never my team but I loved watching the teamwork they displayed and the leadership and confidence that Michael Jordan always showed on and off of the court.  He was a competitor in all aspects of his life.  If you asked his teammates if he was a nice guy the answer was typically not when they practiced or played.  He expected everything out of them.  He never asked anything of his teammates that he didn’t ask of himself.  Sometimes what he asked was painful and not the easy way out but in order to get to the goal they all desired, when they worked as a team it payed off in the end.  I think our leaders, scientists and politicians need to take a few pages out of Chicago’s play book.  Since we all have some extra time, I highly recommend watching this.  There will be 10 episodes and they already have released 8.  It will bring back memories for those who remember watching him and it will motivate others to bring out the best in themselves.  He was not a perfect man, nor did he claim to be. He was human (in spite of what many others may have thought) but he made it happen. We will get through this and make the greatness of what this country was founded on happen again.  Stay focused and healthy my friends.  Doug

5/10/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I hope you all did something great for your all of the mother’s in your life.  I will keep it short today.  The total California counts are now 67,874 (+2,244) and 2,718 casualties (+63).  The daily average is now 1,872 cases and 71.6 casualties.

1. Los Angeles with 31,703 cases and 1,531 casualties (+61) 15.2/100K
2. Riverside with 5,039 cases and 205 casualties (+1) 8.6/100K
3. San Diego with 4,926 cases and 175 casualties (+6) 5.3/100K
4. Orange with 3,502 cases and 76 casualties (+5) 2.4/100K
5. San Bernardino with 2,902 cases and 114 casualties

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,254 cases (+88) and 15 casualties (+2) 1.7/100K
2. Tulare with 1,140 cases (+137) and 48 casualties (+4) 10.4/100K
3. Fresno with 885 cases (+44) and 9 casualties (unchanged) 0.9/100K
4. Kings with 287 cases (+22) and 1 casualty (unchanged) 0.7/100K
5. Merced with 163 cases and 3 casualties (unchanged for both) 1.1/100K
6. Madera with 67 cases (+1) and 2 casualties (unchanged) 1.3/100K

Quote of the day: “The influence of a mother in the lives of her children is beyond calculation”-James E. Faust

Happy Mother’s Day to all of the beautiful mothers out there who have made us who we are today.  I am fortunate enough to still be able to see and talk to mine. My mom is the main reason I am who I am and what I am today. She was always there to tell me things would get better.  She gave me the confidence to succeed in life and to encourage me to be the best I could be. (Something I continue to work on). We can’t take our moms for granted.  I know I am lucky to still have my mother in in my life.  I know there are many people who don’t have that opportunity now, but they will live forever through us and their memories last forever as long as we continue to share them.  So, if you are fortunate enough to have you mother present call her and tell her you love her.  For those of you whose mothers have passed on, share a memory of them to your family.  It shouldn’t take one day out of the year to do this.  Everyday should be considered Mother’s Day.  Thank you Mom for everything you have done and continue to do for me. I love you. You are the greatest.  Stay healthy my friends.  Doug

5/9/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

It’s going to be a hot one. I hope you are able to get out and enjoy the day.  Don’t forget it is Mother’s Day tomorrow guys.  Do something nice for the wonderful women who brought us into the world and dealt with the Hell we put them through and one point or another; or continue to put them through (You know who you are).   Total documented cases have increased, which is to be expected because we are testing more, but casualty rates continue to be steady.  The total California counts are now 64,597 (+2,052) and 2,630 (+85) with a daily average of 1,756 cases and 70.9 casualties per day.

1. Los Angeles 30,334 cases and 1470 casualties (+50) 14.6/100K
2. Riverside 4,817 cases and 204 casualties (+12) 8.6/100K
3. San Diego 4,662 cases and 169 casualties (+4) 5.1/100K
4. Orange 3,240 cases and 71 casualties (+5) 2.2/100K
5. San Bernardino 2,629 cases and 128 casualties (+20) 6.7/100K

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,166 cases (+33) and 13 casualties (+2) 1.7/100K
2. Tulare with 1,013 cases (+45) and 44 casualties (+1) 9.6/100K
3. Fresno with 841 cases (+28) and 9 casualties (unchanged) 0.9/100K
4. Kings with 265 cases (+21) and 1 casualty (unchanged) 0.7/100K
5. Merced with 163 cases (+6) and 3 casualties (unchanged) 1.1/100K
6. Madera with 66 cases (+4) and 2 casualties (unchanged)

Quote of the day: “ Success is not final; failure not fatal:  It is the courage to continue that counts”-Winston Churchill

I received a lot of requests to review the video that was circulating called “Plannedemic”.  The was a previous employee/colleague of Dr. Fauci. She has come out with some significant statements, accusations and thoughts concerning the coronavirus.  I feel you need to be careful with statements and theories that she is proposing.  There are two sides to every story and I am sure more information will become available to determine the real facts.  You cannot pick and choose tid bits of information to build a case.  Many of you are asking my opinion and I will touch on the key points. First, I do not believe that this virus was created by the Chinese, or any other government, for that matter.  I could see that this may have come from a lab, particularly in Wuhan. It may have been studied and researched and escaped the confines of the lab, as we can see how easy it is transmitted.  The genome of the virus does not seem to match the proposal of it crossing from animals in the wet market to humans as quickly as it did.  The lab in Wuhan was essentially across the street from the wet market that has been referenced as the location of where the virus first emerged.  Another assumption by her was that the reason that Italy was hit so hard by the virus was because they were vaccinated with a flu virus that had coronavirus in it.  The reason that Italy was hit so hard was that they have a substantially older population compared to other countries.  She states that coronavirus was used in the vaccine.  I will need to research this further, but we are constantly looking for a vaccine for the common colds that we get every year. The main causes of the common colds are cononaviruses.  Lastly, she proposes that Dr. Fauci is recommending the treatments and recommendations because he has a financial interest based on his involvement in many pharmaceutical companies that and could stand to profit tremendously.  I can say with certainty this is way off and borderline crazy on her part.  I do not care what kind of person you are; NO ONE would do this intentionally for a profit.  If there was someone who was capable of doing such a heinous act, you would be able to sense their sociopathic state from a mile away.  This has changed life as we know it forever.  It will never be the way it was.  What I do think is that Dr. Fauci may be blinded by how immersed he is in this situation.  This happens to all of us when it comes to working on a problem that we just can’t figure out.  The models that he has suggested have, fortunately, been overexaggerated.  I respect him for erring on the side of caution but, as I have stated before, the plan needs to be adjusted.  Sometimes it takes a new set of eyes or a different opinion to right the ship.  Please understand that with the easing of the restrictions we were all placed under the number of cases WILL rise as will the number of deaths.  When you hear politicians say “every life matters” they are correct as I think every life does matter but eventually everyone will be exposed to the virus in one way or another. If every life matters why don’t we ban all tobacco products which kill over 500 people every day and has been doing so for over 100 years?  Why don’t we mandate that cars should not be able to go faster than 45 mph?  Why don’t we do away with alcohol and all narcotics? Why don’t we ban all firearms? I think we know the answers to these questions; because these are rights that we have always had and when you take one away you are opening the door to take all of them away and that is not how democracy works. So, for this virus we hope for herd immunity or a vaccine but that may not even come into fruition.  The flu vaccine is only 45% effective.  So, ask yourself are you willing to live this way for the next 18-24 months, let alone the rest of your life?  The individuals I know answer with a resounding no.  We know who are most at risk: Obese, elderly (older than 65), people with hypertension, cardiovascular disease, lung disease, cancer or diabetes.  Yes, it sucks to be in this category of patients, or as my kids say at times, it sucks to be you, but this is not a misery loves company country; or at least it shouldn’t be.  Yes I am also aware that younger people also die from this virus but that is the extremely rare exception and not the norm. This is a democratic country and as long as I am living I will do what I have to, to make sure it stays that way.  That being said, those who are at increased risk should be allowed to do what they want as long as they are aware of the risks and it does not affect the population by overwhelming the hospital system.  Back to the “flattening the curve”.  That is their right as well.  Enjoy your weekend and stay healthy my friends.  Doug

5/8/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

It’s Friday!!!!!  It is going to be a hot one so stay cool.  Poolside activities, golf, hiking, mountain biking, walk, jog, swim, crawl; just do something.  The counts remain stable.  The total counts for California are 62,477 cases (+1842) and 2,545 casualties (+83) for a daily average of 1,723 cases and 71.7 casualties.

1. Los Angeles with 29,526 cases and 1420 casualties (+49)-14.1 per 100K
2. Riverside with 4,756 cases and 192 casualties (+6)-8.1 per 100K
3. San Diego with 4,429 cases and 165 casualties (+7)- 5 per 100K
4. Orange with 3,092 case and 66 casualties (+1)- 2.1 per 100K
5. San Bernardino 2,562 cases and 108 casualties (+3)- 5.1 per 100K

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,133 cases (+60) and 13 casualties (+2)-1.5 per 100K
2. Tulare with 969 cases (+53) and 43 casualties (+2)- 9.3 per 100K
3. Fresno with 813 cases (+36) and 9 casualties (unchanged)- 0.9 per 100K
4. Kings with 244 cases (+21) and 1 casualty (unchanged)-0.7 per 100K
5. Merced with 157 cases (+5) and 3 casualties (unchanged)-1.1 per 100K
6. Madera with 62 cases (+7) and 2 casualties (unchanged) 1.3 per 100K

Quote of the Day: “We generate fears while we sit. We overcome them by action”- Dr. Henry Link  It is time to get off of your asses everyone :) Doctor’s orders.  Stay healthy my friends. Doug

Happy birthday to Cynthia H., Skip K. and Harty S. Do something fantastic to celebrate. While you still can :) especially the old guys.  Cynthia has plenty of time :))

5/7/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

There hasn’t been much of a change when it comes to the state trends.  This is good and bad especially now that we are easing up on some of the restrictions.  The total counts in California are now 60,635 cases (+1,911) and 2,462 casualties (+83).  The daily averages are now 1,687 cases and 72.6 casualties per day.

1. Los Angeles with 28,665 cases and 1,369 casualties (+54)
2. Riverside with 4,672 cases and 186 casualties (+2)
3. San Diego with 4,319 cases and 158 casualties (+8)
4. Orange with 3004 cases and 65 casualties (+3)
5. San Bernadino with 2,432 cases and 105 casualties (+4)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,073 cases (+28) and 11 casualties (+3)
2. Tulare with 916 cases (+58) and 41 casualties (+1)
3. Fresno with 777 cases (+53) and 9 casualties (unchanged)
4. Kings with 223 cases (+12) and 3 casualties (unchanged)
5. Merced with 152 cases (+6) and 3 casualties (unchanged)
6. Madera with 55 cases (+1) and 2 casualties (unchanged

Quote of the Day: “The way you make people resilient is by voluntarily exposing them to things that they are afraid of and that make them uncomfortable”-Jordan Petersen

We essentially volunteered to do what they government wanted us to do because we were afraid; we were told to be afraid. We did as we were asked in hopes of helping this country, and we did.  In doing so, the elected officials are not willing to loosen their grip of the power they feel they still have.  The science shows they were off and we need to step away from the models and focus on the real-life scenarios we, are now facing. This makes me uncomfortable. Fool me once, shame on you; fool me twice, shame on me.  There will not be a twice.  Now, it is time to show our resilience.  Stay healthy my friends.  Doug

Happy birthday to Ty H. and Deb (you know who you are) :) Do something fantastic to celebrate your special day.

5/6/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Happy Humpday everyone.  I hope all is well with you and your families.  I was able to get out and golf yesterday and damn, in spite of a few bad shots, it was nice to be out there.  I have had many requests from fellow golfers to write medical excuses for them to be able to use carts, so if that is needed just let me know.  It is part of the phasing in per the rules of the city.  The total daily cases increased substantially, but this is to be expected because we are checking more people.  The casualties are remaining steady.  The total counts are nor 58,790 (+2557) and 2,379 deaths (+92). The daily averages are now 1754 cases per day with 72.3 casualties per day.

1. Los Angeles with 27,866 cases and 1,316 casualties (+55)
2. Riverside with 4,454 cases and 184 casualties (+3)
3. San Diego with 4,160 cases and 150 casualties (+6)
4. Orange with 2,873 cases and 61 casualties (+4)
5. San Bernadino with 2,329 cases and 101 deaths)
6. **Santa Clara dropped out of the top 5 which is a great sign because they Were one of the first counties with a documented case.

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,045 cases (+29) and 8 casualties (+3)
2. Tulare with 858 cases (+101) and 40 casualties (unchanged)
3. Fresno with 724 cases (+52) and 9 casualties (unchanged)
4. Kings with 211 cases (+13) and 1 casualty (unchanged)
5. Merced with 146 cases and 3 casualties (both unchanged)
6. Madera with 54 cases and 2 casualties (both unchanged)

Quote of the day: “Don’t sail out further than you can row back”-Danish quote

With the easing of restrictions, we have to realize that we need to be cautious.  Do not relax the measures that have afforded us the right to relax a bit.  DO NOT lose sight of the fact that the virus is here to stay and there will still be new cases and more deaths.  We need to keep our eyes on the shore and make sure we have enough energy to get back if we have to.  Have a great day and stay healthy my friends. Doug

There were no birthdays today.  I guess it was too hot in August for our parents to think about getting hot and heavy. :)

5/5/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Good morning.  It is started to feel a lot like summer.  Congratulations to all the golfers in the city who now get to take their frustrations out on a little white ball.  The daily cases remaining steady with 1,244 and casualties of 72.  Now, the California totals are 56,167 with 2,287 deaths.  The daily averages are 1,567 cases and 71.6 casualties per day.

1. Los Angeles with 26,238 cases and 1,260 casualties (+25)
2. Riverside with 4,354 cases and 181 casualties (+20)
3. San Diego with 4,020 cases and 144 casualties (+5)
4. Orange with 2,819 cases and 57 casualties (+5)
5. Santa Clara with 2,244 cases and 117 casualties (+2)

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,016 cases (+9) and 8 casualties (unchanged)
2. Tulare with 757 cases (+14) and 40 casualties (unchanged)
3. Fresno with 672 cases (+49) and 9 casualties (unchanged)
4. Kings with 198 cases (+26) and 1 casualty (unchanged)
5. Merced with 146 cases (+4) and 3 casualties (unchanged)
6. Madera with 54 cases (+3) and 2 casualties (unchanged)

Quote of the day:  Trust because you are willing to accept the risk, not because it’s safe or certain-Anonymous

With the easing of the lockdown you will have to realize there will be risks.  The virus has not gone away and, eventually, most of us will be exposed to it in some fashion or another. There is no certainty when it comes to the virus or life, for that matter.  Treat each day as if it could be your last and when you get a taste of what we temporarily lost, remember it, savor it and maybe we won’t be as passive when it comes to taking it away again.  Enjoy the great weather and stay healthy my friends.  Doug

 Happy birthday wishes to Susie H., the best first mate in La Paz

5/4/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Well I hope all of you had a great weekend.  It is nice to hear the public ask more questions about this whole situation and the inconsistencies we are hearing.  Always question authority, especially when it does not make any sense.  Why is it okay to purchase furniture from Costco but not okay to purchase furniture online from a local store and have it loaded safely without any contact utilizing social distancing?  Why can you golf in the bay area or at a course if it is in Fresno county but not if it is in Fresno city (which is in Fresno county if I am not mistaken)?  Why are certain beaches closed when others remain open if the counts and casualties have decreased in the areas involved? When the answer by the city is “we are afraid of lawsuits”, why don’t we try to ban lawsuits concerning issues when it comes to pandemics.  Everyone is aware of the risks when it comes to the coronavirus.  Are we allowed to sue places where we may have gotten the flu or a cold that kept us from going to work?  If so, there are going to be a lot of happy attorneys out there. I can see the commercials already.  “Have you or a love one been diagnosed with the flu? If so, please call (insert the attorney of your choice) you may be entitled to substantial compensation”. If it sounds ridiculous, it’s because it is.  Now for the daily totals.  California now has 54,971 cases (+1,253) and 2,215 casualties (+23).  The daily averages are now 1,603 cases and 70.7 deaths per day.

1.)  Los Angeles with 25,699 cases and 1,231 casualties (+19)

2.)  Riverside with 4,180 cases and 161 casualties (unchanged)

3.)  San Diego with 3,927 cases and 139 (+1) casualties

4.)  Orange with 2,743 cases and 52 casualties (unchanged)

5.)  Santa Clara with 2,231 cases and 115 casualties (+1)

** L.A.’s death counts have dropped substantially as has Santa Clara’s

    Outside of L.A. the remaining top 4 had only 2 casualties.

CENTRAL VALLEY COUNTS AND CASUALTIES

1. Kern with 1,005 cases (+36+ and 8 casualties (unchanged)
2. Tulare with 743 cases (+23) and 40 casualties (unchanged)
3. Fresno with 633 cases and 8 casualties (both unchanged)
4. Kings with 172 cases (+14) and 1 casualty (unchanged)
5. Merced with 142 cases (+2 ) and 3 casualties (unchanged)
6. Madera with 51 cases and 2 casualties (both unchanged)

Quote of the day: “You can’t connect the dots looking forward; you can only connect them looking backwards.  So, you have to trust that the dots will somehow connect in your future.  You have to trust in something-your gut, destiny, life, karma, whatever.  This approach has never let me down, and has made all the difference in my life”-Steve Jobs.

We need to be able and look back at the decisions we have made with this virus and adjust.  It may be scary to some but obvious to others.  We have to trust our gut and my gut is telling me it is time to make a change.  No one will ever be blamed for trying; but you can be sure they will be blamed for not trying when the facts and our gut are telling us it is time.  Have a great day and a wonderful week ahead.  Stay healthy my friends.  Doug

Happy birthday to my favorite wine maker Noah K.  Cheers.

5/3/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I apologize for not posting yesterdays counts.  I decided to take a break and decompress a bit :). The mountain biking on Friday was amazing, with the exception of my friend Shawn taking a spill that I had to throw three stitches into.  When it is man versus granite, granite will always win. Also, when one of you riding partners is in their twenties, they will always win and make you feel your age. :)  We were able to ride down to the mouth of the San Joaquin as it comes into Millerton Lake.  It is a trail called Well barn, which is a nice hike if you have the time.  The weather is amazing and makes us remember why we love living in Fresno.  The California totals remain steady with a total of 53,732 cases (+1,433) and casualties of 2,192 (+58).  The deaths continue to remain on the lower side when it comes to daily averages and the new cases are about the same, which would be expected as we are testing more.

1.)  Los Angeles with 24,936 cases and 1,212 casualties (+93 over 2 days)

2.)  Riverside with 4,164 cases and 161 casualties (+18 over 2 days)

3.)  San Diego with 3,842 cases and 138 casualties (+14 over 2 days)

4.)  Orange with 2,636 cases and 53 casualties (+7 over 2 days)

5.)  Santa Clara with 2,204 cases and 114 casualties (+3 over 2 days)

CENTRAL VALLEY COIUNTS AND CASUALTIES

1.)  Kern with 969 cases and 8 casualties (+1 over 2 days)

2.)  Tulare with 720 cases and 40 casualties (unchanged over 2 days)

3.)  Fresno with 633 cases and 8 casualties (+ 1 over 2 days)

4.)  Kings with 158 cases and 1 casualty (unchanged over 2 days)

5.)  Merced with 140 cases 3 casualties (unchanged over 2 days)

6.)  Madera with 51 cases and 2 casualties (unchanged over 2 days)

Quote of the day: “Don’t count the days, make the days count” -Muhammad Ali

I feel this really makes a difference.  Try to get the most out of each and everyday we are dealing with this situation we are in.  Make your mental and physical health a priority.  I would also add to this make your vote count at the next election, be it local or national.  Power is a potent drug and there are a lot of addicted politicians out there these days.  Stay healthy my friends. Enjoy your Sunday. Doug

Happy birthday to Marilyn H. and Michael B.  Both of you enjoy you 51 st ;)

 

 

5/1/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

It’s Friday!!!!  I will keep it brief because I am hoping to get out and go mountain biking and enjoy the outdoors.  It appears that Mayor Brandt has decided to extend the shelter in place until May 31^st.  I am unclear as to how this will change anything.  The cases will continue to climb, but they have been steady without drastic changes over the previous 2 weeks.  The death rates have declined substantially.  The hospitals are empty and they are laying off employees because there is nothing for them to do.  I wish some of these politicians would have the courage to make a decision that is based on fact and not feelings.  We will understand if deaths go up because we know the cases will go up.  The number of cases will not change over the year; it is just when they will occur.  I love how a governor is going to punish a community (Southern California) for not listening to him on his first go around last weekend for being on the beaches.  I understand if people are not social distancing then punish them but to punish all of us?  You’re my governor but you’re not my parent.  The likelihood of passing this virus outdoors when social distancing is adhered to is near zero.  Again, this is based on science and fact.  Not on “I feel I know what is right”.  Enough of my bitch session. Here are the numbers.  California now has 50,430 cases (+1,582) and 2,047 deaths (+90).  The new daily average is 1,541cases and 73.3 deaths per day

1.)  Los Angeles with 23,233 cases and 1,119 casualties (+54)

2.)  Riverside with 4,031 cases and 143 casualties (+6)

3.)  San Diego with 3,564 cases and 124 casualties (+4)

4.)  Orange with 2,393 cases and 45 casualties (+1)

5.)  Santa Clara with 2,163 cases and 11 casualties (+4)

CENTRAL VALLEY CASES AND CASUALTIES

1.)  Kern with 893 (+27) cases and 7 casualties (+1)

2.)  Tulare with 640 (+14) cases and 40 casualties (+4)

3.)  Fresno with 564 (+26) cases and 7 casualties (unchanged)

4.)  Merced with 125 (+7 ) cases and 3 casualties (unchanged)

5.)  Kings with 123 (+27) cases and 1 casualty (unchanged)

6.)  Madera with 46 cases and 2 casualties (both unchanged)

Quote of the day: “Well done is better than well said”-Benjamin Franklin

I am getting sick and tired of politicians saying things they will do and change what they say later, ultimately doing nothing!!  We, as a society and a city have done what they have asked us to do.  It is time for them to do what they are SUPPOSED to do!!  Have a great day and a wonderful weekend.  Stay healthy my friends.  Doug

4/30/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

Fear not friends.  We were not shut down by the internet gods.  I was told “my server went down” unlike the poor docs that went on line with their findings down in Bakersfield and were taken off of the internet and blackballed by the American Board of Internal Medicine as well as many in the media.  They were just pointing out what I we are seeing.  It is the true observation here in California, particularly here in the valley.  The deaths are 0.7 per 100,000 people in the valley as opposed to Los Angeles, which is 10.5 per 100,000.  The total counts are now 48,828 (+2,828) with 1,954 (+81) casualties.

1.)  Los Angeles with 22,522 cases 1,065 casualties (+61)

2.)  Riverside with 3,942 cases and 143 casualties (+2)

3.)  San Diego with 3,432 cases with 120 casualties (+2)

4.)  Orange with 2,252 cases and 44 casualties (+2)

5.)  Santa Clara with 2,134 cases and 107 casualties (+1)

CENTRAL VALLEY CASES AND CASUALTIES:

1.)  Kern with 866 (+21) and 6 casualties (+1)- 0.7 deaths per 100K

2.)  Tulare with 626 cases (+48) and 36 casualties (+1)-7.8 per 100K

3.)  Fresno with 538 cases (+17) and 7 casualties (unchanged)-0.7 per 100K

4.)  Merced with 118 cases (+2) and 3 casualties (unchanged)-1.1per 100K

5.)  Kings with 96 cases (+17) and 1 casualty (unchanged)-0.7 per 100K

6.)  Madera with 46 cases (+1) and 2 casualties (unchanged)-1.3 per 100K

Quote of the Day: “If the battle for civilization comes down to the wimps versus the barbarian, the barbarians are going to win”-Thomas Sowell

It is time to pull from the Mongolian in all of us and play a barbarian for a change.  It is time to be a leader and not a follower.  This country was not founded on following.  Have a great day and stay healthy my friends.

 Happy birthday to Natasha Harris, the best medical assistant in the whole world and Kelle Butler, a great friend.  Enjoy your 40^th Kelle.

 4/28/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND CASUALTIES

Well at least the weather is great.  Get out there and take advantage of it while you can.  Someday you worker bees will be back at it again.  Hopefully, sooner rather than later.  Thank you for all of you out there doing your jobs, working from home, teaching the rug rats and not killing your teenagers:) . The daily average decreased to 1,618 but the casualties increased, slightly to 79.9.  The total counts for California are now 45,218 (+1,496) and 1,793 casualties (+66).  This is still substantially lower from the trends over the previous 2 weeks.

1.)  Los Angeles with 20,460 cases and 948 casualties (+32)

2.)  Riverside with 3,643 cases and 141 casualties (+23)

3.)  San Diego with 3,141 cases and 113 casualties (+2)

4.)  Orange with 2,126 cases and 39 casualties (unchanged)

5.)  Santa Clara with 2,105 cases and 103 casualties (unchanged)

**Orange county increased to the 4^th position over Santa Clara

CENTRAL VALLEY COUNTS AND CASUALTIES

1.)  Kern with 828 cases (+19) and 5 casualties (+1)

2.)  Tulare with 532 cases (+18) and 32 casualties (unchanged)

3.)  Fresno with 498 cases (+40) and 7 casualties (unchanged)

4.)  Merced with 110 cases (+5) and 3 casualties (unchanged)

5.)  Kings with 71 cases (+4) and 1 casualty (unchanged)

6.)  Madera with 44 cases (+3) and 2 deaths (unchanged)

Quote of the day: “The big lesson in life, baby, is never be scared of anyone or anything”-Frank Sinatra

I’m not scared of this situation, just frustrated.  There is a difference between being scared (when nothing gets accomplished) and being cautious (when we require action).  It is time for action.  Stay healthy my friends.  Doug

4/27/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND CASUALTIES

Well happy Monday everyone.  I hope you had a great weekend.  The daily average cases increased slightly to 1732 but the average deaths decreased to 77.4.  The totals for California are now 43,703 (+1,074) with 1,720 (+25) casualties. (This is the lowest daily casualty count for the past 4 weeks).

1.)  Los Angeles with 19,567cases and 916 casualties (+20)

2.)  Riverside with 3,563 cases and 118 casualties (+1)

3.)  San Diego with 3,043 cases and 111 casualties (unchanged)

4.)  Santa Clara with 2,084 cases and 100 casualties (unchanged)

5.)  Orange with 2,074 and 39 casualties (+1)

CENTRAL VALLEY COUNTS AND CASUALTIES:

1.)  Kern with 809 cases (+54) and 4 casualties (unchanged)

2.)  Tulare with 504 cases (+13) and 32 casualties (unchanged)

3.)  Fresno with 458 cases and 7 casualties (both unchanged)

4.)  Merced with 105 cases (+3) and 3 casualties (unchanged)

5.)  Kings with 67 cases (+15) and 1 casualty (unchanged)

6.)  Madera with 41 cases (+1) and 2 deaths (unchanged)

It is another plus to see that there were no further deaths in the valley and outside of L.A. county, there were only 5.  Keep up the great job.

Quote of the day: “When you reach the end of your rope, tie a knot in it and hang on”-Franklin D. Roosevelt

Keep hanging on. I see the tides changing soon,  Stay healthy my friends.  Doug

4/26/20 COVID 19 CORONAVIRUS COUNTS AND CASUALTIES

I hope your weekend has been a great one.  I know the weather is.  I went for a run and saw Woodward park was alive and well (I counted over 100 people out and about before I stopped counting).  I took my metal detector to the neighborhood elementary school and found $1.58 in change, a Chuck E. Cheese token, a BFF charm and a clip-on turtle earring and embarrassed my son in the process :) If it sounds like I’m bored, I wouldn’t say that.  Actually, I would, but I’m passing time and getting sun in the process. My old neighbors invited me over for a social distancing (>6 feet separation) on the driveway talking about the virus, life and our parenting issues. Now on to the numbers. The average daily California counts decreased slightly to 1,680 and 78.1deaths per day.  The California totals are now 42,609 cases and 1,695 deaths.

1.)  Los Angeles with 19,159 cases and 896 casualties (+46)

2.)  Riverside with 3,409 cases and 117 casualties (+5)

3.)  San Diego with 2,943 cases and 111 casualties (+9)

4.)  Santa Clara with 2,040 cases and 99 casualties (+1)

5.)  Orange with 1,969 cases and 38 casualties (+2)

CENTRAL VALLEY CASES AND CASUALTIES:

1.)  Kern with 755 cases (+20) and 4 casualties (unchanged)

2.)  Tulare with 491 cases (+19) and 32 casualties (+4)

3.)  Fresno with 458 cases (+15) and 7 casualties (unchanged)

4.)  Merced with 102 cases and 3 casualties (both unchanged)

5.)  Kings with 52 cases (+5) and 1 casualties (unchanged)

6.)  Madera with 40 cases (+1) and 2 casualties (unchanged.

I thought I would change the term deaths and exchange it for casualties. For this feels more like a battle, not just a daily count.  The only difference is that there really isn’t and enemy, just a virus.  There really isn’t a winner, just an end result.  The viruses have been doing this for millions of years.  They never win, they just die off, and we become a stronger group.  In this case, both mentally and physically. So this leads me to the Quote of the day: “In three words I can sum up everything I’ve learned about life: It goes on”-Robert Frost  Enjoy the rest of you weekend and stay healthy my friends.  Doug

 

 4/25/20 COVID 19 CORONAVIRUS COUNTS AND DEATHS

Good morning.  I hope you all have something fun planed for this great weekend.  The California counts continue to rise at an average pace of 1,692 and 80.1 deaths per day.  Yesterday there were 1,718 new cases with 87 new deaths.  This brings the totals to 41,338 cases and 1,618 deaths to date.

1.)  Los Angeles with 18,545 cases with 850 deaths (+52)

2.)  Riverside with 3,315 cases and 112 deaths (+12)

3.)  San Diego with 2,826 cases and 102 deaths (+2)

4.)  Santa Clara with 2,018 cases and 98 deaths (+3)

5.)  Orange with 1845 cases and 36 deaths (unchanged)

CENTRAL VALLEY CASES AND DEATHS

1.)  Kern with 735 cases (+36) and 4 deaths (unchanged)

2.)  Tulare with 472 cases (+19) and 28 deaths (+3)

3.)  Fresno with 443 cases (+24) and 7 deaths (unchanged)

4.)  Merced with 102 cases (+2) and 3 deaths (unchanged)

5.)  Kings with 47 cases (+12) and 1 death (unchanged)

6.)  Madera with 39 cases and 2 deaths (unchanged)

I will reiterate my belief that it is time to change course and see how this plays out.  We need to admit that our initial models and estimates were way off and based on a worst-case scenario that, thankfully, has not played out.  What we know is that this is ~ 3 x more infectious than the flu and probably has a death rate that is 2-3 x that of the flu, which was 0.1 %.  So, let’s run some numbers.  There are 40,000 to 60,000 deaths due to the flu EVERY year in the United States. Let’s start with the lower estimate of 40,000.  Being that the COVID 19 is 3 x as infectious and 2 x a deadly estimate, that would result in 240,000 total deaths for the year.  If we estimated that it was 3 x as deadly that would result in 360,000 deaths for the year. If we said it was only 2 x as infectious that would be 160,000 to 240,000.  Now with the higher end of flu deaths yearly (60,000) with 2 x as infectious and 2 x as deadly.  It would result in 240,000 deaths in a year.  If 3 x as infectious and 3 x as deadly would equate to 540,000 yearly deaths. So, we are likely to see as many as 160,000 to 540,000 deaths in a year as a result of this pandemic.  Neither is a small number, but neither is close to the estimated 1.2 to 1.6 million we were told when this first broke out.  The numbers that we cannot calculate are the increased number of deaths that are the result of patients not wanting to come to the hospital for fear of “catching the virus”. Cancer, strokes, heart attacks have all decreased by 40-70%.  The hospitals are <50% capacity in the state of California and lower than that in the valley.  Is this because the virus is protecting these patients from getting these diseases? Obviously, that is not the reason.  People are afraid to come in. My daily patient load has dropped 80-90% and I am not alone when talking to my colleagues.  It is the same across the board.  People are being furloughed from the hospitals; practices are closing down.  Surgical centers are shut down and we are waiting to start helping our patients again.  This is not limited to health care industry as it is affecting every aspect of our life.  Unfortunately, this has become a political issue now.  I reflected on my first post when this started how this should not be a tribalized issue and that, is now, what it has become.  When I can palpate a political pulse to this disease is when my senses become heightened and, again, ask what does the science tell me?  

Quotes of the day: “Ponder and deliberate before you make a move”. “In the midst of chaos, there is also opportunity”. “There is no instance of a nation benefitting from a prolonged war” -Sun Zu-The Art of War

We have pondered and deliberated for some time now and it is time to commit to action.  It has been a chaotic time, but we have learned much about this and now we have to take what we have learned and make a move.  We are not benefitting  from waiting for this to burn out because that will not happen.  The only thing that is burning out is our spirits and the life that are relatives fought hard for us to have.  Stay healthy my friends.  Doug

 

4/24/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND DEATHS

We made it.  TGIF.  The daily counts were an additional 1,913 cases with an additional 93 deaths in California yesterday.  The valley counts are decreasing and there were no additional deaths in the valley.  The total state counts are now 39,620 total cases with 1,531 deaths.

1.)  Los Angeles with 17,567 cases and 798 deaths (+66)

2.)  Riverside with 3,218 cases and 100 deaths (+1)

3.)  San Diego with 2,643 cases and 100 deaths (+4)

4.)  Santa Clara 1,987 cases and 95 deaths (+1)

5.)  Orange with 1,827 cases and 36 deaths (+2)

CENTRAL VALLEY CASES

1.)  Kern with 699 cases (+16) and 4 deaths (unchanged)

2.)  Tulare with 453 cases (+13) and 25 deaths (unchanged)

3.)  Fresno with 419 cases (+35) and 7 deaths (unchanged)

4.)  Merced with 100 cases (+6) and 3 deaths (unchanged)

5.)  Madera with 39 cases (+3) and 2 deaths (unchanged)

6.)  Kings with 35 cases (+3) and 1 death (unchanged)

Quotes of the day: “Better to fight for something than live for nothing.”  “Take calculated risks.  That is quite different than being rash”- General George S. Patton.  I believe it is time to fight for what made this country great. It is time to take a calculated risk and slowly open this country back up.  To keep doing what we are doing is a rash decision that is not based on science.  If we find that cases begin to creep up then we slow down.  If not, keep it going.  Have a great day and a wonderful weekend.  Stay healthy my friends.  Doug

 

4/23/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND DEATHS

I hope all is well. Yesterday was the largest daily death toll for the state with 118.  There were 1,876 additional cases since yesterday as well.  The total cases are now 37,787 cases with 1,438 deaths.  The state daily average is now 1,509 and 78.4 deaths. 

1.)  Los Angeles with 16,449 cases and 732 deaths (+66)

2.)  Riverside with 3,084 cases and 99 deaths (+6)

3.)  San Diego with 2,491 cases and 96 deaths (+9)

4.)  Santa Clara with 1,962 cases and 94 deaths (+6)

5.)  Orange with 1,753 cases and 34 deaths (+1)

CENTRAL VALLEY COUNTS AND DEATHS

1.)  Kern with 683 cases (+12) and 4 deaths (+1)

2.)  Tulare with 441 cases (+5) and 25 deaths (+3)

3.)  Fresno with 384 cases (+13) and 7 deaths (unchanged)

4.)  Merced with 94 cases (+2) and 3 deaths (unchanged)

5.)  Madera 36 cases and 2 deaths (unchanged)

6.)  Kings with 32 cases and 1 death (unchanged)

“They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety”-Benjamin Franklin.  Now it is time for me to vent a little.  The whole point of giving up rights as a citizen was to “flatten the curve”, which we have done but the politicians (federal, state and local) have gotten a taste of the power which they feel they can wield as they deem appropriate.  I am a scientist by trade.  I believe in science and I would like to see the science that says that walking at Woodward park is safe but walking at a golf course that is within the city is unsafe.  That shopping at Walmart is safe but shopping at a clothing store is unsafe.  The science that says going to a liquor store is safe but shopping at a book store is unsafe.  There are surgeons in town who are still operating in private surgery centers deeming simple shoulder, knee and joint surgeries as “emergent” lying to make sure they can still make the money they are accustomed to having while other, more reputable, surgeons and specialists are following the recommendations that have been mandated to protect their patients and the community at the cost of losing their livelihood.  There are businesses that have been closed and have lost everything waiting for the state and city to tell them when “they feel” it is safe.  Let’s not lose sight of the reason we did what we did.  The real question we need to ask ourselves is are we willing to do this for 18 months?  If not, then we need to open up a bit and see what happens.  It is time to slowly open up or else there will be thousands that will be losing the life that they once knew at the cost of pretending we are saving lives when all we are doing is putting off the inevitable exposure that we will have.  It is temporary, people. Ben Franklin was correct.  Those who are high risk need to continue with the guidelines that we are all aware of, but those of us who are low risk should not be punished.  Be safe and it’s time to start questioning why we are giving up what we have worked so hard to attain and achieve. If science shows that I am wrong I will believe it.  If a politician tells me I am wrong, I will ask them to prove it.  It is time to start asking questions.  Doug

4/23/20  MASKS

I have received several questions as to whether you should be wearing masks.  My feeling is that if you are able to maintain 6 feet of distance you should be fine and the masks are not as important as washing your hands.  I still do not wear one in a grocery store.  I will if they mandate I do but it  does little to prevent you from getting the virus.  It does slow the spread if you are sick with the virus.  A funny analogy I heard was that when you pass gas when you are wearing underwear you still smell it. :) Same principle.  If you are going to wear a mask please wear it correctly or else it is a waste of time and embarrassing to see.  It needs to cover both you face and your nose, not either or.  Also, there is no benefit wearing your mask while you are driving alone.  If you feel there is a benefit, I guess you should be wearing it when you sleep as well. (Again, no benefit).  Stay healthy my friends.  Doug

4/22/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND DEATHS

 Happy hump day everyone.  I hope the week continue to be a good one. The upward trend continues with daily increases of 1,978 new cases and 93 deaths reported since yesterday.  This brings the state total to 35,843 total cases with 1,320 deaths.  Again, there have been no changes in the state’s top infected counties.

1.)  Los Angeles with 15,165 cases and 666 deaths

2.)  Riverside 2,960 cases with 93 deaths

3.)  San Diego with 2,434 cases and 87 deaths

4.)  Santa Clara with 1,946 cases and 88 deaths

5.)  Orange with 1,691 cases and 33 deaths

CENTRAL VALLEY COUNTS AND DEATHS

1.)  Kern with 671 (+28) and 3 deaths (unchanged)

2.)  Tulare with 436 (+14) and 22 deaths (+4)

3.)  Fresno with 371 cases (+20) and 7 deaths (unchanged)

4.)  Merced with 92 cases (+2) and 3 deaths (unchanged)

5.)  Madera with 36 cases and 2 deaths (both unchanged)

6.)  Kings with 32 cases and 1 death (both unchanged)

My hope is that the city will begin to lift is shelter in place order by the beginning of May but it appears that the Fresno officials are going to defer to ease the restrictions once the state shelter in place order is lifted.  I know a lot of us (myself included) are going a little crazy and I really think we need to ease up the restrictions, albeit slowly.  We need slow exposure to get to the herd immunity we are needing to stop this.  The goal of the stay in place was to flatten the curve so the hospitals were not overrun, and they are fine so come on officials.  It is time to take that first step.  We won’t judge you on your decision.  You need to follow the science and see where it leads us.  Daily quote: “Life is like riding a bicycle.  To keep your balance, you must keep moving”-Albert Einstein.  It is time to start pedaling people.  Stay healthy my friends.  Doug

4/21/20 COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND DEATHS

I hope all is well with you and your families and your Monday started out great.  It appears that the testing has increased as evidenced by the increase in diagnosed cases yesterday (+2,335) and the death rate stayed steady with an additional (+49) yesterday.  This brings the total counts to 33,865 with 1,227 deaths.  There has been no change in the position of the top counties.

1.)  Los Angeles with 13,823 cases and 619 deaths

2.)  Riverside with 2,847 cases and 85 deaths

3.)  San Diego with 2,325 cases and 72 deaths

4.)  Santa Clara with 1,922 cases and 83 deaths

5.)  Orange with 1,676 cases and 33 deaths

CENTRAL VALLEY COUNT AND DEATHS:

1.)  Kern with 643 cases (+20) and 3 deaths (Unchanged)

2.)  Tulare with 422 cases (+11) and 18 deaths (+1)

3.)  Fresno with 351 cases (+36) and 7 deaths (Unchanged)

4.)  Merced with 90 cases and 3 deaths (Unchanged)

5.)  Madera 36 cases (+2) and 2 deaths (Unchanged)

6.)  Kings with 32 cases (+2) and 1 death (Unchanged)

The state average is now 1,356 new cases per day with an average of 1 deaths per day.  The death trends are staying steady.  Fortunately, the valley hospitals have not been overrun by the virus and I hope the trend continues.  Being that this situation appears to be with us for some time I will try to initiate some quotes in the daily briefings to help us get through this.  I found this one from The Road Less Travelled by Scott Peck, M.D.  “Life is difficult.  This is a great truth, one of the greatest truths.  It is a great truth because once we truly see this truth, we transcend it.  Once we truly know that life is difficult-once we truly understand and accept it-then life is no longer difficult.  Because once it is accepted, the fact that life is difficult no longer matters.”

 So, our lives may seem difficult now but we will get through this. Life is filled with difficulty and struggle and a life without either is not a life that is real.  Life, by definition, is how we handle the challenges and problems that we are given. So, address the issues in a way that you can be proud of.  Make yourself a priority and stay healthy my friends.  Doug

 4/20/20      COVID 19 CORONAVIRUS CALIFORNIA COUNTS AND DEATHS

Good morning, I hope you had a great weekend. Todays counts actually dropped with 717 cases from yesterday and 30 deaths. The total cases now are 31,530 and 1,178 deaths.  The daily average is 1,176 new cases and 71 deaths.

1.)  Los Angeles with 12,349 and 601 deaths

2.)  Riverside with 2,638 and 75 deaths

3.)  San Diego with 2,268 and 71 deaths

4.)  Santa Clara with 1,870 and 73 deaths

5.)  Orange with 1,636 and 32 deaths

CENTRAL VALLEY CASES AND DEATHS

1.)  Kern with 623 cases and 3 deaths

2.)  Tulare with 411 cases and 17 deaths

3.)  Fresno with 315 cases and 7 deaths

4.)  Merced with 90 cases and 3 deaths

5.)  Madera with 34 cases and 2 deaths

6.)  Kings with 30 cases and 1 death

Many of you have been asking about the availability of antibody testing.  I have seen news stories about finger prick testing, but the accuracy has been questionable.  I am waiting for recommendations once the sensitivity and specificity of a particular lab gets verified.  I believe it will be prioritized for healthcare workers as well as essential business employees, but I will make sure I post the latest recommendations once they become available.  Let’s keep our fingers crossed for a continued downward trend.  Stay healthy my friends.  Doug

4/17/20      COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

Well, at least it is Friday. 😊 There are no major changes in the trends today. 28,195 total cases with 976 deaths. The state is continuing to average 1,135 cases a day and 60.9 deaths per day.

1.)  Los Angeles with 10,895 and 457 deaths

2.)  Riverside with 2,264 with 59 deaths

3.)  San Diego with 2,087 and 63 deaths

4.)  Santa Clara with 1,833 and 69 deaths

5.)  Orange with 1,425 and 25 deaths

CENTRAL VALLEY COUNTS:

1.)  Kern with 565 (+12) and 3 deaths (Unchanged)

2.)  Tulare with 372 (+20) and 17 deaths (+2)

3.)  Fresno with 295 cases (+30) and 7 deaths (Unchanged)

4.)  Merced with 82 cases (+4) and 3 deaths (Unchanged)

5.)  Madera with 33 cases and 3 deaths (Unchanged)**

6.)  Kings with 18 cases and 1 death (Unchanged)

** I think Madera quit counting as the number has not changed in the past 72 hours.  President Trump announced his phases that are required for the opening up the states for business which requires a region to show a 14day downward trend, the capability to screen rapidly and having hospitals that have room for future patients.  Believe it or not, we are fortunate that the hospitals are not even close to full in preparation for a wave that we hope does not hit.  Keep up the great job and enjoy your weekend.  Doug

4/16/20      COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

I hope all is well with you and your family.  Yesterday was another big day in terms of deaths caused by the coronavirus in California.  The total number of documented cases in the state is 27,108 (+1,320) and 889 deaths (+101).

1.)  Los Angeles 10,517 with 405 deaths.

2.)  Riverside with 2,105 and 54 deaths

3.)  San Diego with 2,012 and 60 deaths

4.)  Santa Clara with 1,793 and 65 deaths

5.)  Orange with 1,376 and 22 deaths

CENTRAL VALLEY COUNTS:

1.)  Kern with 553 (+37) and 3 deaths (Unchanged)

2.)  Tulare with 352 (+56) and 15 deaths (+2)

3.)  Fresno 265 (+14) and 7 deaths (Unchanged)

4.)  Merced 78 cases (+5) and 3 deaths (Unchanged)

5.)  Madera 33 cases and 2 deaths (Both unchanged)

6.)  Kings with 13 cases (+1) and 1 death (unchanged)

It is looking more like a marathon and not a sprint.  We have to be patient and we will get through this.  I feel the best option is to take the foot off of the brake a bit and slowly get the economy back.  Individuals <65 will be fine.  Yes, there will be outliers and exceptions but overall, they will be fine.  The same can be said for the older generation but with a slightly higher risk, especially if you are not healthy and with known risk factors besides their age.  They will have to continue to adhere to the shelter in place and 6 feet of separation.  Stay positive and invest in your health.  It really does make a huge difference.  Stay healthy my friends.  Doug

4/15/20      COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

Good morning and happy hump day.  I hope all of you are doing well.  So much for the downward trend.  California’s total count increased to 25,777 (+1406) and total deaths of 788 (+57).  The increase in counts are from the increased availability of testing but the deaths are remaining consistent with a slight increase.  Again, deaths lab about 18-21 days after the presentation of symptoms.  Riverside was a big mover again jumping to 2 on the list of California counties which are most affected.

1.)  Los Angeles 10,075 cases with 366 deaths

2.)  Riverside with 1,961 cases and 50 deaths

3.)  San Diego with 1,930 cases and 53 deaths

4.)  Santa Clara with 1,666 cases and 60 deaths

5.)  Orange with 1,299 cases and 19 deaths

CENTRAL VALLEY COUNTY COUNTS AND DEATHS

1.)  Kern with 516 (+70) and 3 deaths

2.)  Tulare with 296 (+32) with 13 deaths

3.)  Fresno with 251 (+31) with 7 deaths

4.)  Merced with 74 (+5) cases and three deaths

5.)  Madera with 33 cases (no change) and 2 deaths

6.)  Kings with 13 cases (+1) and 1 death

Continue with your 6 feet of isolation but get out and enjoy this great weather we are having.  Wash your hands and stay safe.  Doug

4/15/20      OBESITY ANOTHER KEY RISK FACTOR

Studies are revealing that obesity is one of the main risks factors in those who are diagnosed with the COVID 19 coronavirus.  The good news is that this can be corrected by you, the patient, with diet and exercise.  I think it is more of an indicator of poor health and not necessarily having to do with adipose tissue (fat). Obesity is defined as a BMI (Body Mass Index) of >30.  You can figure out what yours is by going to the ANNUAL PHYSICAL ASSESSMENT AND PLAN I send you annually or just go on line and input your height in inches and weight in pounds.  All the more reason to get off of your asses and get healthy.  What else are you doing right now?!  Make your health a priority before it is too late. Literally!! Doug

4/14/20      COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

Good morning.  Well, here we go again.  The counts are climbing but not exponentially, just at the previous rate near 1200 counts and 50 deaths per day. The current count is 24,371 (+ 1,071) cases with 731 (+50) deaths. The only change in the top 5 counties is that Riverside surpassed Santa Clara for the third spot.  The list is as follows:

1.)  Los Angeles with 9,480 cases and 326 deaths (+26)

2.)  San Diego with 1,847 cases and 47 deaths (+2)

3.)  Riverside with 1751 cases and 50 deaths (+9)

4.)  Santa Clara with 1,666 cases and 60 deaths (+6)

5.)  Orange with 1,283 cases and 19 deaths (No change)

CENTRAL VALLEY COUNTIES:

1.)  Kern with 446 cases (+50) and 3 deaths (Unchanged)

2.)  Tulare with 264 cases (+37) and 13 deaths (+2)

3.)  Fresno with 222 cases (+21) and 5 deaths (Unchanged)

4.)  Merced with 69 cases (+4) and 3 deaths (Unchanged)

5.)  Madera with 33 cases and 2 deaths (Both unchanged)

6.)  Kings with 12 cases (+2) and 1 death (Unchanged)

Keep up the great job and enjoy this awesome weather we are having social distancing, of course.  Stay healthy my friends.  Doug

4/13/20      COVID 19 CORONAVIRUS COUNTS AND DEATHS:

Good morning.  I hope you had a wonderful Easter Holiday.  California continues to decline in total cases and deaths with a total of 23,300 (891yesterday which is the first time we have been below 1000) since the beginning of the increase) and 681 total deaths (47 deaths since yesterday.  The following counties continue to be the top 5 in the state:

1.)  Los Angeles 9,197 cases with 300 deaths (+ 33)

2.)  San Diego 1,804 cases with 45 deaths (Unchanged)

3.)  Santa Clara 1,621 cases with 54 deaths (+3)

4.)  Riverside 1,619 cases with 41 deaths (Unchanged)

5.)  Orange 1,277 cases with 19 deaths (+1)

 

CENTRAL VALLEY COUNTIES:

1.)  Kern 396 cases (+27) and 3 deaths (Unchanged)

2.)  Tulare 227 cases (Unchanged) and 11 (Unchanged) *

3.)  Fresno 201cases (Unchanged) and 5 deaths (Unchanged) *

4.)  Merced 65 cases (+1) and 3 deaths (Unchanged)

5.)  Madera 33 cases (+1) and 2 deaths (Unchanged)

6.)  Kings 10 cases (Unchanged) with 1 death (+1)

 

** Tulare and Fresno cases are unchanged from the previous day’s so I believe they were not updated from yesterday.

I feel with the total state numbers declining is an indicator that this first wave is on the downward path.  There will be multiple waves which will eb and flow for the next 12 months so don’t stop with the precautions, which, unfortunately, will be our new normal.  Have a great day and a wonderful week.  Stay healthy my friends.  Doug

4/12/20     COVID 19 CORONAVIRUS CASES AND DEATHS

Happy Easter everyone.  I hope you have something fun planned today.  I keep telling my family it feels more like the movie Groundhogs Day than Easter but still it's something to celebrate, nonetheless.  Another thing to celebrate is the fact that both new cases and deaths decreased substantially from the typical trend.  New cases in California were 1,028 and deaths decreased to 35.  This is two days out of the last three that total cases were below 1,200 and deaths were below 50.  I really think the all of our hard work is paying off, so keep it up.  The leading counties remain the same in order:

1.)  Los Angeles with 8,889 and 267 deaths

2.)  San Diego with 1,761 and 45 deaths 

3.)  Santa Clara with 1,566 and 51 deaths

4.)  Riverside with 1,431 and 41 deaths

5.)  Orange with 1,221 and 18 deaths

Los Angeles accounted for 23 of the 35 deaths yesterday and the remaining top 4 counties accounted for 5 additional deaths.  This is great news as I am hoping this is the beginning of the plateau and the numbers will begin to decline.

The following are the Central Valley Counties:

1.)  Kern with 369 cases-up 6 from yesterday and deaths unchanged at 3

2.)  Tulare 227 cases-up 24 from yesterday and deaths unchanged at 11

3.)  Fresno 201 cases-up 10 from yesterday and deaths unchanged at 5

4.)  Merced 64 cases up 5 from yesterday and deaths unchanged at 3

5.)  Madera 32 cases unchanged from yesterday and no change in deaths

6.)  Kings 10 cases up 1 from yesterday with zero deaths listed

Keep up the great job. It really is making a difference. Have some fun today.  Now I have to go hide the eggs for my four children who are age 25, 23, 20 and 16. :)  Sorry (I mean the Easter bunny is dropping by). Keeping his 6 feet of isolation of course. :)  Some things will never change and that is a great thing.  Stay healthy my friends.  Doug

4/11/20     COVID 19 CORONAVIRUS CASES AND DEATHS

Good morning. I hope you have something fun planned this weekend. The total documented cases for California are 21,374 with 598 deaths. The number of new documented cases continue to be below 1200 (1,162 new case but deaths creeped up back to above 50 with 51) as of yesterday. 

1.)  Los Angeles with 8453 and 244 deaths

2.)  San Diego with 1693 and 44 deaths

3.)  Santa Clara with 1484 and 50 deaths

4.)  Riverside with 1350 and 39 deaths

5.)  Orange with 1138 and 17 deaths.

Central Valley Counties:

1.)  Kern with 363 and 3 deaths

2.)  Tulare with 203 and 11 deaths

3.)  Fresno with 191 cases and 5 deaths

4.)  Merced with 32 cases and 3 deaths

5.)  Madera with 32 cases and 2 deaths

6.)  Kings with 9 cases and 0 deaths

When you put it all in perspective we have ONLY (and I do not use this word lightly) had 24 deaths from the COVID 19 Coronavirus.  Death of any cause is bad, but death is inevitable.  We have had substantially more deaths in the valley from cardiovascular disease, COPD/ emphysema, cancer, motor vehicle accidents, murders etc...  We are doing a good job slowing the frequency “flattening the curve” but we will not change the number of cases that we will have.  We are hoping for the “herd immunity” and I truly believe that California already has this working in our favor.  So, keep doing what you a doing.  Social distancing is working.  Washing your hands whenever you think about it and self-isolate when you are sick.  Don’t forget that seasonal allergies are cranking up so if you have a headache, cough, congestion itchy eyes, sneezing, lack of sense of smell, think allergies before you think corona virus:)  The medical school saying was “when you hear hooves think horses not zebras”.  But realize that there are a few zebras in the valley right now.  Be safe and stay healthy my friends.  Doug

4/11/20     COVID 19 CORONA VIRUS TESTING

I was told that Willow Urgent Care, 6721 N. Willow Fresno CA, 93710 just south of Herndon, is doing COVID 19 testing.  I still would recommend that you be tested ONLY if you are having symptoms.  They recommend that you call ahead at 559-324-0911 to see if they are still doing it and they can check you in your car. 

4/20/20 REMEMBER TO SUPPORT YOU LOCAL EATERIES

The kids and I went to Doghouse grill and it is alive and well.  The parking was a little easier but still nearly full.  You can call ahead, but the phones are extremly busy, or you can just wait in line (6 feet of social distancing of course) and place you order.  All the food continues to taste amazing.  It makes you realize that some things will never change and normalcy will be around the corner someday with some slight changes. They are even selling their tap beer in 64 ounce growlers to go for $9. (Tioga-Sequoia).  Enjoy.  Doug

4/10/20 COVID 19 CORONAVIRUS COUNTS AND DEATHS

Happy Friday everyone.  I hope you have something fun planned this Easter weekend.  I just wanted to go over the recent counts.  The total cases in California are now 20,212 (up 1,149 from yesterday) and 547 deaths (up 40 from yesterday as well).  The good news is that this has been the first time the daily increase was less than 1,200 and the deaths less than 50.  I think it is too soon to consider this a downward trend but the total diagnosed cases are a good sign.  I will continue to keep my fingers crossed and hope for a continued downward trend. The county counts have not changed much as far as the order.  1.) Los Angeles 7,984 with 225 deaths.  2.) San Diego with 1,628 cases and 40 deaths.  3.) Santa Clara with 1,442 with 47 deaths.  4.) Riverside with 1,280 and 33 deaths and 5.) Orange with 1,079 cases and 24 deaths.  The Central Valley counties are as follows:  1.) Kern with 330 (Previously 303) cases and 3 deaths.  2.) Tulare with 187 (Previously 168) cases and 10 deaths.  3.) Fresno with 173 (Previously 156) cases and 3 deaths.  4.) Merced with 52 (Previously 40) cases and 3 deaths.  5.) Madera 30 (Previously 28 cases) and 2 deaths) and 6.) Kings with 8 cases (Previously 8) and 0 deaths.  Keep up the great job and stay healthy.  Doug

4/9/20 COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS:

Again, the rate remains steady which can be interpreted as a good thing because we are not seeing the exponential rise many were expecting.  Based on the trends our "peak" is supposed to be in the next 7-10 days.  The total cases in California are 19,127 (Up 1524 from yesterday) and 508 deaths (Up 57 from yesterday).  1.) Los Angeles with 7,573 and 200 deaths.  2.) San Diego with 1,530 and 36 deaths.  3.) Santa Clara with 1,380 and 46 deaths.  4.) Riverside 1,179 and 32 deaths and 5.) Orange with 1,016 and 17 deaths.  Central Valley Top Counties: 1.) Kern 303 with 2 deaths.  2.) Tulare 168 with 9 deaths.  3.) Fresno 156 cases with 3 deaths.  4.) Merced with 40 cases and 3 deaths.  5.) Madera 28 cases with 1 death and 6.) Kings with 8 cases and 0 deaths.  Keep up the great job of social distancing, washing your hands and isolating when you have to.  I am a firm believer that this is helping but I also think we have some herd immunity going on in this state because I feel this virus may have been here since December.  Let's continue to cross our fingers and stay healthy my friends.  There will be brighter days to come but there are still some bumps and pot holes in the upcoming road. Come on, this is California right? :)  Stay healthy my friends.  WE CAN DO THIS!!!  Doug 

4/8/20 COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

As of this morning the counts are continuing to rise at a similar rate as the previous days with total documented California cases of 17,674 (Up 1,261 from yesterday) and 451 deaths (up 56 from yesterdayl).  1.) Los Angeles with 7,025 cases and 173 deaths.  2.) San Diego with 1,454 cases with 31 deaths.  3.) Santa Clara with 1,285 cases and 43 deaths.  4.) Riverside with 1,016 and 28 deaths and 5.) Orange with 931 cases and 15 deaths. The Central Valley's top counties are as follows:  1.) Kern 261 up from the previous 226 with 2 deaths.  2.) Tulare 157 up from the previous 135 with 6 deaths.  3.) Fresno 146 up from 124 with 3 deaths.  4.) Merced 34 up from 29 with 1 death.  5.) Madera 28 up from 26 with 1 death and 6.) Kings with 5 cases unchanged from previous and 0 deaths.  Try to stay inside this week as the counts are supposed to rise substantially.  What you will also see is an increase in the deaths which typically occur 18-21 days afetr the first sign of symptoms.  Death is still considered quite rare.  The current mortality rate in Fresno county is 2.05% but this is based on documented cases and the actual percentage is likely at ~1% or even lower.  Another risk factor that we are finding is obesity.  Obviously, obesity is also a risk factor for diabetes, coronary artery disease and hypertension, just to name a few.  Take this time of self isolation to make your health a priority.  It could save your live.  Literally.  Maintain your space, wash you hands and stay healthy.  Doug

4/7/20 COVID 19 CORONAVIRUS STATE COUNTS AND DEATHS

The total confirmed cases as of today are 16,413 with 395 deaths.  The rate of diagnosis and deaths is continuing at the same pace.  The following counties continue to lead the state:  1.) Los Angeles 6391 cases with 147 deaths.  2.) San Diego 1404 cases with 19 deaths.  3.) Santa Clara 1224 cases with 42 deaths.  4. Riverside 946 cases with 25 deaths and 5.) Orange with 882 cases and 14 deaths.  The Central Valley Counties are as follows:  1.) Tulare with 135 cases and 6 deaths.  2.) Fresno 124 cases with 2 deaths.  3.) Merced with 29 cases and 1 death.  4.) Madera 28 cases with 1 death and Kings with 5 cases and 0 deaths.  Again, there are counties that have not changed in their counts.  I don't believe this is because it is plateauing inasmuch as they are not testing as frequently.  Continue with the safety measures which should be second nature by now.  Stay healthy.  Doug

4/6/20

This was a great article written by Dr. Victor David Hanson in the National Review on 3/31/2020.  I feel it gives us hope as to the possibility we may have had the virus in the state earlier in the year and maybe we are seeing the result in the form of less cases and possible protection from those who have already been exposed.  I think we all know someone that had flu-like symptoms this year but when tested came back negative.  I know I had symptoms of what was an awful case of what I thought was the flu in mid to late January.  The whole office eventually was out sick with similar symptoms.  I hope it was but we will need to wait for the antibody testing to be avaiable.  Enjoy this article 

CORONAVIRUS: THE CALIFORNIA HERD

The bluest state’s public officials have been warning for weeks that California will be overwhelmed, given federal-government unpreparedness and the purported inefficacy of the local, state, and federal governments.

California governor Gavin Newsom has assured his state that over half of the population — or, in his words, 56 percent — will soon be infected. That is, more than 25 million coronavirus cases are on the horizon, which, at the virus’s current fatality rate of 1–2 percent (the ratio of deaths to known positive cases), would mean that the state should anticipate 250,000–500,000 dead Californians in the near future. Los Angeles mayor Eric Garcetti predicted that this week Los Angeles would be short of all sorts of medical supplies as the epidemic killed many hundreds, as is the case in New York City.

It’s been well over two months since the first certified coronavirus case in the United States, so one might expect to see early symptoms of the apocalypse recently forecast by Governor Newsom. Yet a number of California’s top doctors, epidemiologists, statisticians, and biophysicists — including Stanford’s John Ioannides, Michael Levitt, Eran Bendavid, and Jay Bhattacharya — have expressed some skepticism about the bleak models predicting that we are on the verge of a statewide or even national lethal pandemic of biblical proportions.

The skeptics may be right. As of this moment, California’s cumulative fatalities attributed to coronavirus are somewhere over 140 deaths, in a state of 40 million. That toll is a relatively confirmable numerator (though coronavirus is not always the sole cause of death), as opposed to the widely unreliable denominator of caseloads (currently about 6,300 in the state) that are judged to be only a fraction of the population that has been tested. The Iceland study, for example, suggests that half of those who are infected show no symptoms. Currently, even with fluctuating statistics, California is suffering roughly about one death to the virus for every 250,000–300,000 of its residents.

The rate certainly will go up each hour, and no doubt in geometric fashion, as the virus spreads. Yet we should remember that California loses about 270,000 lives to all causes every year — meaning, on any given day, around 740 Californians die. So far there is no published clear evidence that in January, February, and March more Americans have died from pneumonia-related diseases than in an average year. Note too that not all deaths attributed to coronavirus are the work of COVID-19 alone; they are often accompanied by advanced age and serious chronic conditions that may have soon led to death without any accompanying viral infection.

In contrast, as of Monday morning, New York State, with about half of California’s population, has about eight to nine times the number of deaths, and 20 times the per capita rate, at 60 deaths per million residents. In fact, California has a much lower per capita death rate than many of the nation’s largest states; for that matter, its per capita death rate is similar to that of nations that so far have mysteriously escaped the virus’s modeled wrath. Currently, California has lost fewer than 4 people per million, roughly between South Korea’s 3 deaths per million and Germany’s 5, which are both being studied as outliers. Of course, statistics change hourly, but for now California’s data remain mysteries.

Even at this midpoint in the virus’s ascendance, most believed that California would be faring far worse. And they have good reason for such pessimism. California in a normal year usually experiences the greatest number of deaths associated with the flu in the United States, and it ranks about midway among the states in flu deaths per capita. The state was hit hard by influenza unusually early in the first weeks of November, including a strain that at the time was characterized as probably not “A” but a rarer “B” — and on occasion quite virulent. A typical news story related, in early 2020, “California health officials have identified 16 outbreaks since the start of the flu season Sept. 29. Flu cases, hospitalizations and flu deaths are all higher than anticipated, according to the health department.” Many Californians complained late in 2019 of getting the flu a bit early, with flu symptoms that were somewhat different from the norm, at times including severe muscle aches, some digestive cramping, an unproductive cough, and days or even weeks of post-fever fatigue.

Forty-million-person California, in normal times — that is, until around or shortly after February 1, 2020 — hosts dozens of daily direct flights from China in general to San Diego, SFO, LAX, and San Jose, and in particular, since 2014, several weekly nonstop flights from Wuhan. Of the nearly 15,000 passengers who were estimated to be arriving every day in the U.S. on flights from China in 2019 and 2020, the majority flew into California. After the ban, there were thousands of Chinese tourists who remained in California and could get neither direct nor indirect flights home to China.

Travel forecasts from China for 2020, even amid the trade war, had estimated more than 8,000 daily arrivals in California. Two years ago, Los Angeles mayor Garcetti bragged that 1.1 million Chinese tourists had visited L.A. — more than 3,000 per day. The greatest number of foreign tourists to Los Angeles are Chinese, and the city is the favorite spot in America of all visitors from China. During the months of October, November, January, and February alone — before the travel ban — perhaps nearly 1 million Chinese citizens arrived in California on direct and indirect flights originating in China.

Moreover, researchers in Italy believe that the Chinese were not telling the truth about the origins or birth dates of the virus; they argue that COVID-19 was first loose worldwide in the middle of Autumn 2019 rather than in Winter 2020. Reuters recently reported:

Adriano Decarli, an epidemiologist and medical statistics professor at the University of Milan, said there had been a “significant” increase in the number of people hospitalized for pneumonia and flu in the areas of Milan and Lodi between October and December last year. . . . He told Reuters he could not give exact figures but “hundreds” more people than usual had been taken to hospital in the last three months of 2019 in those areas — two of Lombardy’s worst hit cities — with pneumonia and flu-like symptoms, and some of those had died. . . . Decarli is reviewing the hospital records and other clinical details of those cases, including people who later died at home, to try to understand whether the new coronavirus epidemic had already spread to Italy back then. . . . “We want to know if the virus was already here in Italy at the end of 2019, and — if yes — why it remained undetected for a relatively long period so that we could have a clearer picture in case we have to face a second wave of the epidemic,” he said.

In a recent Oxford study, a heterodox hypothesis was offered questioning the widely circulated study of Neil Ferguson, an epidemiologist with Imperial College London. He and his team had offered a worst-case projection of as many as 2.2 million American and 510,000 British deaths. Ferguson has now emphasized the low-end estimates of death rates in some of his modeling, for example, suggesting that maybe only 20,000 in Britain may die from the virus, given how Britain has taken actions to curb and treat it. In any case, other models from the Oxford authors offer far less pessimistic hypothetical scenarios. In one, they suggest that viral infections in the U.K. might have begun almost 40 days before March 5, which was the first confirmed death there. If that is true, they argue, then to square the current figures of transmission, perhaps 68 percent of the British population would have had to be already infected by at least March 19 — reflecting a herd immunity that will radically curtail future transmission. Of course, without widespread antibody testing alongside testing for current infections, no one knows the number of past and present infections. Regardless, the Chinese notion that the world was not seriously infected until mid February increasingly seems mathematically unlikely.

In the case of California, again, unfortunately, the state still should have had many things going against it, at least in terms of susceptibility to any pandemic infection that curbs its huge tourist and commercial travel with China. The state has the nation’s highest poverty rate (affecting over 20 percent of the population, or some 8 million people); the greatest number of homeless people, at somewhere over 150,000; and the most residents in the nation on some form of public assistance, one-third of the nation’s total.

Over a quarter of the state’s population was not born in the U.S. Until recent bans, many frequently went to and from their countries of origin. It has the largest number of non-English speakers in the U.S., suggesting that public dissemination of key information might become far more problematic.

The state is not especially healthy and rarely rates among the top ten states in terms of per capita health, by whichever metrics one uses. A decade ago, studies suggested that one in three admissions of those over 35 to California hospitals were suffering from either diabetes or pre-diabetes — a known risk factor for coronavirus patients.

California ranks near the bottom when we count the number of available hospital beds per 1,000 population, at about 1.8. Likewise, its number of active doctors per 100,000 is similarly unimpressive, about midway among state rankings, at 276 per 100,000 — versus Massachusetts’s high of 450 and Mississippi’s low of 191. In most surveys of nurses per 100,000 population, California ranks near last (664).

How, then, has California in the third month of known COVID-19 infections in the U.S. lost between 140 and 150 lives to it?

Again, a number of experts have offered hypotheses. Is it a question of the statistical anomaly — as some have suggested is the case for Germany, which similarly posts few total deaths from the virus — given differences in how countries and perhaps even states record the chief causation of death (i.e., are some places listing COVID-19 as the cause of death, even when the decedent suffered from underlying chronic conditions)? Is California experiencing a brief lull, in the fashion of Japan, which likewise has suffered few deaths so far but may be poised to suffer far more?

Is there a lag in ascertaining and determining deaths in a state that’s geographically huge and linguistically diverse, a lapse that will shortly cease, correcting such misimpressions with a radical increase in corona-associated deaths — as is now forecast for Japan and to a lesser extent Germany?

Did California’s Draconian shelter-in-place policies that antedated many of those in other states simply arrest (so far) what should have been by now a lethal epidemic?

Did California’s proverbial warmer weather slow down the virus? Did its suburban ranch-home lifestyle and the large open spaces in the Central Valley, Sierra Nevada, desert and northern counties make transmissions harder than it has been in, say, the high-density living of New York City?  Maybe and maybe not.

While testing tardiness might explain outliers in terms of California’s relatively small number of proven cases and lethality rates, it would not greatly affect accurate statistics of deaths attributed to the virus. If anything, as the number of known cases grows, the lower the lethality rate will likely appear.  While California adopted shelter-in-place policies on March 19, other states did the same about the same time. And visiting a California Costco on any Saturday morning is a reminder of current mob frenzies. After a near-record dry and warm January and February, the state has been unseasonably cold and wet for most of March during the epidemic’s spike. True, California encompasses an enormous area, but it also is home to the country’s largest population and thus still ranks about eleventh in population density among the states. Some districts in San Francisco and Los Angeles are as densely populated as East Coast cities.

One less-mentioned hypothesis is that California, as a front-line state, may have rather rapidly developed a greater level of herd immunity than other states, given that hints, anecdotes, and some official indications from both China and Italy that, again, the virus may well have been spreading abroad far earlier than the first recorded case in the U.S. —and likely from the coasts inward.

So given the state’s unprecedented direct air access to China, and given its large expatriate and tourist Chinese communities, especially in its huge denser metropolitan corridors in Los Angeles and the Bay Area, it could be that what thousands of Californians experienced as an unusually “early” and “bad” flu season might have also reflected an early coronavirus epidemic, suggesting that many more Californians per capita than in other states may have acquired immunity to the virus.

Here in Fresno County (1.1 million people), we are warned daily that we are the next hot spot. But as of late March, we’ve had no recorded deaths and only 41 known cases. The figure will no doubt multiply rapidly and geometrically, but it still seems incomprehensible that not a single death was attributed to the virus in its first 60 days of visitation. I live near the Kings County line in rural Fresno County (which is not so rural anymore, given urban sprawl from greater Fresno). There have been two recorded cases and no deaths among the county’s more than 150,000 residents.  We won’t know the answers until antibody testing becomes widespread enough to determine who has already been infected, and who carried the virus without symptoms, and who wrongly attributed symptoms to the flu or a bad cold. Or epidemiologists will have to go over average daily pre-coronavirus death rates in California to determine whether, in comparison with past years, the state had any per capita spikes in deaths in October, November, December, and January, or an increase in hospitalizations attributed to the flu.  In the meantime, for a few days at least, we are left with the California paradox. As with the apparent outliers of Germany, South Korea, and Japan, it reminds us that there are endless known unknowns about the origins, lethality, infectiousness, and patterns of travel of the coronavirus — and that today’s latest frightening statistical model is often superseded tomorrow by more realistic appraisals and theories, and then again rendered naïve by even more frightening new backlash models. Until now, without either widespread antibody or current-infection testing, the number of people who die from the virus in comparison to a given population base is about all we can rely on to determine the lethality of the disease. And in that regard, at least for a few days or weeks longer, California remains a mystery.

 4/6/20 COVID 19 CORONAVIRUS COUNTS AND DEATHS:

I hope you all had a great weekend.  The state counts continue to climb with a total of 15,238 cases and 351 deaths.  The folowing are the counties with the most cases:  1.) Los Angeles county continues to lead with 5955 cases and 132 deaths.  2.) San Diego with 1326 cases and 19 deaths.  3.) Santa Clara 1207 cases with 39 deaths.  4.) Orange with 834 cases and 14 deaths and 5.) Riverside with 799 cases and 19 deaths.  The Central valley is as follows:  1.) Tulare with 116 cases and 5 deaths.  2.) Fresno with 108 cases and 1 death (I know of 2 deaths that have not been counted yest so the actual number should be at least 3 deaths).  3.) Merced with 29 cases and 1 death.  4.) Madera with 28 cases and 1 deaths and 5.) Kings with 5 cases and 0 deaths.  We are expecting the death counts to start rising as they typically occur 18-21 days after the presentation of symptoms.  You will find more individuals who may become exposed and it is extremely important to adhere to the 14 day self isolation (quarantine) after a known exposure.  This is the only way we can make a true dent in supressing the spread. Keep your distance and wash your hands.  Stay healthy my frineds.  Doug

4/3/20 COVID 19 CORONAVIRUS COUNTS AND DEATHS:

There have now been 11,207 documented cases in California with 246 deaths.  The rate of incline is similar to the day before for both documented cases and deaths.  It is unclear if this is related to frequency of testing being unchanged or that that the cases are decreasing. (I suspect the former not the latter).  1.) Los Angeles has 4071 cases with 80 deaths.  2.) Santa Clara 1019 cases with 36 deaths.  3.) San Diego has 966 cases with 16 deaths.  4.) Orange has 656 cases with 13 deaths.  5.) Riverside has 493 cases with 14 deaths.  San Francisco and San Mateo's numbers did not change from the previous count.  I assume that this is because they did not report.  The Central Valley's top 6 is as follows:  1.) King with 155 cases and 1 death.  2.) Fresno 94 cases with 0 deaths.  3.)  Tulare 74 cases with 2 deaths.  Madera 28 cases with 1 death.  5.) Merced 16 cases with 0 deaths and Kings with 5 cases and 0 deaths.  Keep washing your hands, social distancing and stay healthy my friends. We will get through this.  Have a great weekend,  Doug

4/2/20        ZINC FOR COVID-19 CORONAVAIRUS??

I have been asked about the efficacy of zinc in preventing someone from getting the COVID 19 Coronavirus. Unfortunately, a lot of the push behind this is from literature concerning the use of Zinc in fighting the symptoms of a routine cold (which are typically caused by, anyone?  Anyone?, Anyone?  You guessed it. CORONAVIRUSES!! The only difference is that the coronaviruses we are used to typically do not kill us or lead to pneumonia and acute respiratory failure. They are typically just a nuisance.  I found this web article from uchealth.org to be very informative.  I believe the take home would be it would not hurt to try if you are having symptoms.  Continue doing what we DO KNOW that works.  Social distancing, washing your hands and self quaratining when you have cold-like symptoms or fever.  I wouldn’t make a run on this like the toilet paper though.:)  Stay healthy my friends.  Doug

A study published in 1996 shuffled 100 Cleveland Clinic employees who self-reported catching colds into two groups. Fifty took lozenges containing 13.3 milligrams of zinc gluconate – the dosage of today’s Cold-Eeze and other over-the-counter lozenges – every two hours as long as they had cold symptoms. Fifty others took placebo lozenges. The study was double-blind, so neither patients nor researchers knew which patients had the placebo. The findings: the zinc group cleared symptoms more than three days earlier – 4.4 days versus 7.6 days of the placebo group, and, until that point, suffered fewer days with cough, headache, hoarseness, nasal congestion, and sore throat (fever, muscle aches, scratchy throat and sneezing remained similar during the cold’s duration). Zinc has side effects – “bad-taste reactions” (understandable) and, among 20 percent of those taking zinc, nausea.

Learn more:

• For all updates and to read more articles about the new coronavirus, please visit uchealth.org/coronavirus

That study wasn’t, it turned out, a fluke. A Cochrane review updated in 2013 summarized 18 randomized controlled trials involving 1,781 participants across all age groups found that zinc – particularly in lozenge or syrup form – “inhibits replication of the virus” that cause the common cold and shortens average duration of the common cold when taken within 24 hours of onset of symptoms at a dose of more than 75 milligrams a day.

A 2010 study led by University of Leiden Medical researchers in the Netherlands sought to understand how zinc inhibited that replication. The team reported that zinc inhibits a cousin of SARS-CoV-2: SARS-CoV, the original SARS of the 2003 outbreak. Click through for details, which get into the biochemical nitty-gritty, but the gist is that zinc throws a wrench in the virus’s RNA-synthesis machine.

Now, there are caveats with zinc. First, like everything else, there can be too much of a good thing – more than 150 milligrams a day for adult. That’s about 11 lozenges; the recommended zinc-lozenge maximum for adults being six and just four for children ages 12-17 (research has shown younger children to not benefit from taking zinc). Second, zinc nasal sprays shouldn’t be used, Tullberg says. In 2009, the U.S. Food and Drug Administration warned against such products because people who used them lost their sense of smell.

What does that background say about the effectiveness of zinc and the SARS-CoV-2 now known as coronavirus? It is, at best, effectiveness by association. But an email that recently went viral as a blog post indicates that Tullberg is in good company with his openness to zinc lozenges as a way to at least try and mitigate COVID-19 flu symptoms.

A virologist’s take on Zinc and COVID-19

The email was one that James A. Robb sent to friends and family. He is University of Colorado School of Medicine MD, a pathologist, and molecular virologist who, while at the University of California, San Diego in the 1970s, did pioneering work in understanding coronaviruses. He wrote:

Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

Snopes.com, a website dedicated to debunking (or confirming) internet myths, investigated after his words were twisted by others and reposted with exaggerated claims such as zinc being a “silver bullet” against coronavirus. In an email to Snopes, Robb confirmed that he’d written the above and added, “In my experience as a virologist and pathologist, zinc will inhibit the replication of many viruses, including coronaviruses. I expect COVID-19 will be inhibited similarly, but I have no direct experimental support for this claim. I must add, however, that using zinc lozenges as directed by the manufacturer is no guarantee against being infected by the virus, even if it inhibits the viral replication in the nasopharynx.”

In short, if coronavirus is like an SUV, zinc lozenges may well be something like an oil change, though we’ll need many more miles to really know for sure.

 

4/2/20 CALIFORNIA CORONAVIRUS TOTAL COUNTS  AND DEATHS

There have now been 10,018 documented cases with 215 deaths.  The top five California counties are as follows:  1.) Los Angeles 3528 with 66 deaths.  2.) Santa Clara 956 cases with 32 deaths.  3.) San Diego 849 cases with 15 deaths.  4.) Orange 606 cases with 10 deaths. 5.) San Mateo 453 cases with 10 deaths and 6.) San Francisco 450 cases with 7 deaths.  Top 6 Central Valley Counties:  1.) Kern 126 cases with 1 death.  2.) Fresno 82 cases with 0 deaths.  3.) Tulare 59 cases with 2 deaths.  4.) Madera 25 cases with 1 death.  5.) Merced 12 cases with 0 deaths and 6.) Kings  with 5 cases and 0 deaths.

4/1/20 CALIFORNIA CORONAVIRUS TOTAL COUNTS AND DEATHS

Good morning.  I wish it was an April fools prank but the counts continue to rise.  The following is the latest count which is rapidly changing.  As of this morning there have been 8,704 doucumented cases and 184 deaths.  The top five of California counties are as follows:  1.)  Los Angeles-3,037 cases with 54 deaths.  2.)  Santa Clara 890 cases with 30 deaths.  3.)  San Diego 734 cases with 9 deaths.  4.)  Orange 502 cases with 7 deaths and  5.)  San Francisco 397 cases with 6 deaths.  In our central valley the top 5 counties are as follows:  1.)  Kern 98 cases with 1 death.  2.)  Fresno 68 cases with 0 deaths.  3.)  Tulare 45 case with 1 death.  4.) Madera 23 cases with 1 death. 5.)  Merced 10 cases with 0 deaths and 6.)  Kings with 4 cases with 0 deaths.  Please continue to adhere to the stay and shelter recommendations.  Wash your hands.  Keep you 6 feet of distance and we will get through this.  Doug

3/31/20 CALIFORNIA CORONA VIRUS COUNTS AND DEATHS

As of this morning there have been 7,426 diagnosed cases and 149 deaths.  The following counties in order of highest down:  1.) Los Angeles-2505   2.) Santa Clara-848  3.)  San Diego-603  4.)  Orange-464  5.)  San Francisco-375  *Fresno-53   *Madera-21  *Merced-10  *Kings-3  Tulare-43  San Luis Obispo-77

3/30/20         SHOULD I CONTINUE TAKING MY STATIN (CHOLESTEROL LOWERING) MEDICATION ?

 I have received several questions from patients pertaining to whether or not it is safe to continue taking their cholesterol lowering medications “statins” (Atorvastatin-Lipitor, Rosuvastatin-Crestor, Simvastatin-Zocor, Pravastatin-Pravachol etc…)  There have been several reports on the internet and social media stating that this class of medication can potentially be bad and “patients should stop it if they are taking it”.  After researching this further it was found in 2014 that treating patients with Ebola virus disease a generic statin and a generic angiotensin receptor blocker (ARB), experimental studies had shown that both drugs improved outcomes in experimental acute lung injury/acute respiratory syndrome (ARDS).  The reasoning appears to be because the tissue receptor for the virus (ACE2), which is also the receptor for the SARS corona virus, showed that ARBs and statins upregulate the activity of ACE2, and higher levels of ACE2 are associated with a reduced severity of ARDS.  Both statins and ARBs target the host response to infection, not the virus.  They act largely (although not exclusively) on endothelial dysfunction, which is a common feature of many virus infections.  Both drugs counter the endothelial dysfunction and the combination of these two drugs appear to accelerate a return to homeostasis, allowing patients to recover on their own.

There is no clinical evidence to date that statins are beneficial for patients with COVID-19, however, there are at least 4 reasons we might consider them for these patients. 

1.)  Risk Factors for Severe COVID-19 Presentations:  Diabetes and pre-existing cardiovascular disease are 2 of the major risk factors for severe COVID-19 disease.  In a series of 138 hospitalized patients’ cardiovascular disease was found in 25% of patients in the ICU compared with 10.8% non-ICU patients and diabetes in 22.2% of ICU patients and 5.9% of non-ICU patients.  In another study of 191 hospitalized patients, 31% of non-survivors had diabetes compared to survivors and 24% of non-survivors had coronary artery disease compared to 1% of survivors.  In a series of 1099 patients, 16.2% of sever patients had diabetes compared with 5.7% of non-sever patients and 5.8% of sever patients had coronary artery disease compared to 1.8% of non-severe patients.

2.)  Cardiovascular Complications of COVID-19: From many of the studies discussed above, we know that elevated troponins (suggestive or myocardial-“heart” injury are more frequently seen in patients with severe presentations compared to non-severe presentations. Furthermore, patients with pre-existing cardiovascular disease seemed more likely to have cardiac complications with COVID-19 (This may have to do with ACE-2 receptors present in the myocardium (heart muscle) which permit a direct pathway for the virus to travel and affect the heart).

3.)  Statins and Innate Immunity:  There is additional theoretic role that statins might play in helping protect the bodies immune response.  Statin are found to inhibit an inflammatory pathway that promotes ARDS and inflammation of the lungs.

4.)  Statins and Viral Pneumonia:  Again, while no clinical data yet exists for a protective role for statins in COVID-19 infection, there is some data that is suggestive that statins may be associated with less severe viral pneumonia (perhaps by the mechanism mentioned in section 3 above).  A large matched cohort study found a reduced risk of COPD death and influenza death for patients on moderate dosed statins compared to not.  Another found a statistically significant but small protective effect against influenza mortality among statin uses.

Based on these findings I would recommend that all of you who are on a statin continue with the medications as it may have some protective effects and for those of you who have an indication to be on a statin and I recommended starting one in the past, it may be a great time to start one.  Have a great day. Wash your hands, keep your distance and stay healthy my friends. 😊  Doug

3/28/20

 RISK FACTORS ASSOCIATED WITH THE FIRST 21 PATIENTS  IN KIRKLAND, WASHINGTON WHO DIED FROM COVID-19 CORONAVIRUS

The importance of this study is the first American population that we are getting information on concerning the characteristics of the patients who have died.  The drawback to these findings is that it is an older population and only 21 patients.  It is important to know that having diseases are the main risk factor and, not necessarily age, but with age comes disease. (Another reason to stay healthy but we will deal with that when this passes). :). 85.7% of the initial 21 individuals had at least one co-morbidities.  (More than one disease).   Of the diseases the highest percentage was ~57% had CKD (Chronic Kidney Disease), ~43% had CHF (Congestive Heart Failure), ~33.3% had T2DM (Diabetes), 33.3% had COPD, 28.6 % had OSA (Obstructive Sleep Apnea ) and ~9.1% had Asthma.  The admission symptoms:  76% shortness of breath, 52% fever and 48% cough, which is initially non-productive.  Just some information to emphasize the importance of adhering to the “stay at home” recommendations.  Make sure you wash you hands frequently and adhere to the 6 feet of spacing.  Particularly those of you with these potential risk factors.  Stay Healthy.  Doug

 

3/28/20

 SHOULD PATIENTS ON ACE INHIBITORS OR ARBs  (BLOOD PRESSURE MEDICATION) STOP THEIR   MEDICATION?

 Despite the lack of evidence, there have been advocates from both the use and cessation or ACE inhibitors (Lisnopril, Fosinopril, Ramipril, Enalapril, Benazepril, Quinapril,  etc…) and ARBS (Losartan, Valsartan, Irbesartan, Candesartan, Olmesartan, Telmesartan etc…), or both during the treatment of COVID-19 in patients with hypertension.  This has prompted some individuals to solicit changes in their hypertensive medications and growing uncertainty from physicians on what should be done.  In response, the Council of Hypertension of the European Society of Cardiology made the following statement, “The Council of Hypertensions strongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACE inhibitors or ARBs should be discontinue because of the COVID-19 infection.”  On March 17, 2020, The American Heart Association, the Heart Failure Society of America and the American College of Cardiology put out a joint statement advocating for patients to continue with ACE inhibitors  and ARBs as prescribed  and that changes in medications in the setting of COVID-19 should be completed only after careful assessment.  That being said, I am advocating that all my patients on these classes of medication continue taking them.  DO NOT STOP THEM thinking you are protecting yourself from getting the COVID-19 Coronavirus.  What we DO know is that hypertension (high blood pressure), especially poorly controlled, is a DEFINITE risk.  Doug

3/27/20      FDA ADVISES PATIENTS ON USE OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) FOR COVID-19

 I have received several questions concerning the use of NSAIDS (Aleve-Naproxen sodium, Advil-Ibuprofen, Celebrex-Celcoxib, Mobic-Meloxicam, Voltaren-Diclofenac).  The FDA is aware of news reports stating the use of NSAIDS could worsen coronavirus disease (COVID-19).  These news reports followed a 3/11/20 letter in the Lancet medical journal which hypothesized that an enzyme is increased by NSAIDS and could aggravate COVID-19 symptoms.  At this time, the FDA is not aware of scientific evidence connecting the use of NSAIDs with worsening COVID-19 symptoms. The agency is investigating this issue further and will communicate publicly when more information is available.  However, all prescription NSAID labels warn that “the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections”.  For those of you who wish to use treatment options other than NSAIDs there are multiple over the counter medications (oral and topical) approved for pain relief and fever reduction.  Most notably, Acetaminophen (Tylenol) that I would recommend starting with.  For those of you who have been on chronic NSAIDs and appreciate significant improvement of your symptoms while doing so, I recommend continuing with your current medications.  Please realize a lot of the hysteria is stemming from isolated cases that people are sensationalizing. 

3/27/20      CALIFORNIA COVID-19 CASE COUNT

As of today, the top 5 counties with documented COVID-19 are as follows: 

1.)  Los Angeles-1230   2.)  Santa Clara-542   3.)  San Diego-341   4.)  Orange-256   5.)  San Francisco-223

• Fresno-27
• San Luis Obispo-54

Anyone who leaves these high-risk areas should be quarantined for 14 days when they arrive to your residence.  I know many of us have family members who want to visit but they really shouldn’t at the current time.  Particularly when they have upper respiratory symptoms.  I know loved ones want to be together when they are ill but when they are coming from areas with high a high level of disease, it is best that they stay at their place of residence until they improve.  I believe that with the inevitable spread this recommendation against travel may be lifted.

3/27/20      SAINT AGNES MEDICAL CENTER PUBLIC HOTLINE

Saint Agnes has A COVID-19 Hotline 559.450.2322 to answer questions/concerns from the public.  The hotline is manned M-F, 8 a.m. – 5 p.m.

3/25/20

 Saint Agnes Medical Center (Trinity Health) Antiviral Treatment Algorithm

 The World Heath Organization (WHO) stakes that there is no current evidence to recommend any specific anti-COVID-19 supportive or antiviral treatment for patients with confirmed COVID-19.  There are many ongoing clinical trials and data is emerging frequently.  Use of investigational anti-COVID-19 therapeutics should be done under approved, randomized, controlled trials whenever feasible.

  ANTIVIRAL TREATMENT ALGORITHM:

•  This information is provided to help guide treatment conversations.  State mandates, medication availability/shortages and access to infectious disease resources may impact some of these recommendations at given sites.  As additional information becomes available, this information will be updated accordingly.
• Prophylaxis:
  • Evidence does not support use of Hydroxychloroquine (Plaquenil), or any other agent, for the prophylaxis of COVID-19.  Use of hydroxychloroquine for prophylaxis will rapidly deplete the limited supply and lead to the inability to treat the acutely ill.  Supply of these medications will only be used for treatment.
  • Treatment:
    • COVID-19 positive, or suspected patients, should be approved by Infectious Diseases and/or a Critical Care Provider/Intensivist at sites with these services prior to dispensing
    • Due to demand, intermittent shortages of these agents can be expected
    • Patient Subset: 
      • MILD SYMPTOMS:  Confirmed COVID-19 AND No radiographic evidence of pneumonia. No therapy and clinical observation & supportive care 
      • MODERATE SYMPTOMS:  Confirmed COVID-19 PLUS any of the following:  a.) Radiographic evidence of pneumonia b.) Hypoxia requiring supplemental oxygen c.)  Oxygen saturations <90%  (This patient would qualify for treatment)

BOTTOM-LINE: This medication is currently restricted to inpatient use ONLY.  Please adhere to these recommendations or we will have family and friends die because of a shortage created by individuals who do not need it and will be wasting it.  Doug

 

3/24/20  SAINT AGNES MEDICAL CENTER UPDATE NON-ESSENTIAL PLANNED SURGERIES

To aggressively address COVID-19, Saint Agnes Medical Center has adopted the CDC's revised guidance for limiting all non-essential planned surgeries and procedures until further notice.  Effective Wednesday, March 25, they will be following the CMS recommendations.  Any scheduled surgery or procedure that does not qualify as a Tier 3a or 3b will be reviewed by the Department Chief or Division Head, and the scheduling physician will be contacted.  A Tier 3a Procedure is defined as High acuity surgery/healthy patient that would take place in the hospital.  These include most cancers, neurosurgery and highly symptomatic patients.  A Tier 3b Procedure is defined as High acuity surgery / unhealthy patient that would take place in the hospital.  These include: Transplants, trauma, cardiac with symptoms, limb threatening vascular sugery.   All other surgeries:  Carpal tunnel release, EGD, colonoscopies,cataracts, endoscopies, low risk cancer, non-urgent spine and ortho (including hip, knee replacement and elective spine surgery), elective angioplasty and stable renal stones are to be postponed if possible.

I do not know if the physician owned facilities:  Sierra Pacific Orthopedic Center, Fresno Surgical Center and Summit Surgical Center are following the same recommendations.  I would hope they would be.  

3/24/20  INFORMATION CONCERNING TREATMENT PROTOCOL COMMUNITY HOSPITALS

I am still getting requests for treatment "to have on hand".  Particularly the combination of Plaquenil (hydroxychloroquine) and Zithromax (Azithromycin).  This is the combination that you hear President Trump mention as well as many in the media. Again, I am emphasizing this is TO ONLY BE USED FOR SEVERE, SYMPTOMATIC patients.  The following is what we are being instructed to do.  In order to be considered for this medication you have to TEST POSITIVE FOR COVID-19 and have severe respiratory tract disease with hypoxia (low oxygen levels typically <88% saturations)and any of the listed risk factors. 1.)  Immunocomprimised  2.)  Pregnant  3.)  Age greater than 65 years and less than 12 months  4.)  Chronic cardiovascular, pulmonary, hepatic, renal, hematologic or neurologic conditions.  NOTE: The Pharmacy will ONLY verify these orders for patients with a confirmed COVID-19 test result.  So, that being said any physician that is currently prescribing the medication "to have on hand" may have death on their hands for individuals who will truly need it in the coming weeks.  The medication does not help anyone when it is in someone's medicine cabinet or being taken by individuals who feel they "think they have the virus".  Please try to be ethical and understanding during this difficult time.  If we find that it does make a difference or we can use it with softer indications I will keep you posted. Bottom-line is that if you need it we will get it but if you do not need it, please don't ask for it.  WE will get through this.  Stay healthy.  Doug

3/23/20   LACK OF SMELL COULD BE A CLUE TO CORONA VIRUS INFECTION

Several patients who have had symptoms consistent with corona virus described losing sense of smell and taste, even though their noses were clear and were not congested.  Anosmia (the loss of sense of smell) and Ageusia (a diminished sense of taste), have emerged as a peculiar telltale sign of COVID-19.  On Friday, British Ear, Nose and Throat doctors, citing reports from colleagues around the world, called on adults who lose their sense of smell or taste to isolate themselves for 7 days, even if they have no other symptoms, to slow the disease spread.  The published data is limited, but doctors are concerned enough to raise warning.

3/23/20 DETERMINING WHETHER OR NOT YOU NEED TO BE TESTED OR QUALIFY TO BE TESTED

Saint Agnes Medical Center has a website (www.samc.com) that will direct you to whether you qualify to be tested for the COVID-19 virus.  You have to meet certain criteria in order to be tested.  I am sure the criteria will continue to change as the days go by but this is where I would recommend starting.

1.) Go to www.samc.com.  You will see a bar on top of the site  -Coronavirus (COVID-19) click the "Click here" highlighted section.   2.)  The next section will be listed as "Coronavirus Information".  A name will pop up in the lower right corner of the page.  Currently the name is Catherine but I do not know if this changes.  Click the (+) on the right side of the blue bar.  From this point follow the prompted questions and they will direct you to whether you need to be tested and will give instructions otherwise.  It is EXTREMELY IMPORTANT to follow the recommendations of self isolation.  Adhering to the 6 feet of social distancing and washing you hands regularly.

3/22/20   I AM ADVISING THAT ALL ELECTIVE PROCEDURES BE CANCELLED FOR A LATER TIME

We are beginning to see more cases pop up in the valley. On that note, it is not unexpected and it should be further evidence that we need to adhere to the policies that we’ve been told to help decrease the potential burden on the hospitals. Believe it or not, there are still surgeons doing elective surgeries.  Unless it is an ABSOLUTE EMERGENCY I would advise against having surgery at this time. There will be plenty of time to reschedule and I really do not believe this to be safe. Stay strong, stay healthy and WE will all get through this.  Doug

3/21/20

KEEPING THE CORONAVIRUS FROM AFFECTING HEALTH CARE WORKERS

(This is based on the Article in the New Yorker 3/21/20) What Singapore's and Hong Kong's success is teaching us about the pandemic

The message is getting out: #StayHome.  There are many people the country needs to keep going into work-grocery cashiers, first responders, factory workers for critical businesses.  Most obviously, we need health care workers to care for the sick, even though their jobs carry the greatest risk of exposure.  How do we keep them seeing patients rather than becoming patients?  In the index outbreak in Wuhan, 1,300 health-care workers became infected; their likelihood of infection was 3 x as high as the general population.  When they went back to their families, they became prime vectors of transmission.  The city began to run out of doctors and nurses.  42,000  more had to be brought in to treat the sick.  Luckily methods were found that protected all the new health care workers: none-zero- were infected.  Those methods were Draconian.  As the city was locked down and cut off from outside visitors, health-care workers seeing at risk patients were housed away from their families.  They wore full body protective gear, including goggles, complete head coverings,N95 particle filtering masks, and hazmat-style suits.  There is no way we could do that here in the United States let alone in the central valley. Myself and many other physicians have asked for the appropriate protective gear and we are being told that they do not have enough and they are limiting it to the hospitals, and testing sights which are the current front lines.  A valley ER physician reached out via the Nextdoor App asking if ANYONE could give him an N95 mask because he did not have one at work (A FREAKING EMERGENCY ROOM!!) for him to wear.  Local anesthesiologists are given one a day if they are lucky and told to keep in in a bag and if they run out to use a bandana!!  Fortunately , I was able to get him two because he is immersed in the heart of the battlefield which will only be getting worse.  There are lessons to be learned from two places that saw the new coronavirus before we did and have had success in controlling its spread.  Hong Kong and Singapore detected their first cases in late January, and the number of cases escalated rapidly.  Officials banned large gatherings (That's why we are really pushing for <10 people), directed people to work from home and encouraging social distancing.  Testing was ramped up as quickly as possible (This is lagging locally).   But even these measures were never going to be enough if the virus kept propagating among health-care workers and facilities.  Primary care clinics and hospitals in the two countries, like in the U.S., didn't have enough gowns and N95 masks, and at first, tests weren't widely available.  After six weeks, though, they were able to get a handle on the outbreak.  Hospitals were not overrun with patients.   By now, businesses and government offices have even begun reopening, and focus has shifted to controlling the cases coming into the country.  Here are the key tactics, drawn from official documents and discussions with health-care leaders in each place.  All health-care workers are expected to wear surgical masks ( Not necessarily N95) for all patient interactions, to use gloves and proper hand hygiene, and to disinfect all surfaces in between patient consults.  Patients with suspicious symptoms (a low grade fever coupled with a cough, respiratory complaints, fatigue or muscle aches) or exposures (travel to places with viral spread or contact with someone who has tested positive) are separated from the rest of the patient population, and treated whenever possible-in separate respiratory wards and clinics, in separate locations, with separate teams.  Social distancing is practiced within clinics and hospitals:  waiting room chairs are to be placed six feet a part; direct  interactions among staff members are conducted at a distance; doctors and patients stay six feet apart except during examinations.  What was equally interesting was what they didn't do.  The use of the N95 masks, faceprotectors, goggles and gowns are reserved for procedures where respiratory secretions can be aerosolized (for example, intubating a patient for anesthesia) or for known or suspected cases of COVID-19.  Their quarantined policies are more nuanced, too.  What happens when someone unexpectedly tests positive--say, a hospital co-worker  or a patient in a primary care office or an emergency room?  In Hong Kong and Singapore, they don't shut the place down or put everyone under home quarantine.  They do their best to trace every contact and then quarantine only those who had close contact with the infected person.  In Hong Kong "Close Contact" means 15 minutes at a distance of less than 6 feet and without the use of a surgical mask; in Singapore, 30 minutes.  If the exposure is shorter than the prescribed limit but within 6 feet for more than 2 minutes, workers can stay on the job if they wear a surgical mask and have twice-daily temperature checks.  People who have had brief, incidental contact are just asked to monitor themselves for symptoms.  The fact that these measures have succeeded in flattening the curve of COVID-19 carries some hopeful implications.  One, is that this coronavirus, even though it appears to be more contagious than the flu, can still be managed by the standard public health playbook:  social distancing, basic hand hygiene, cleaning, targeted isolation and quarantine of the ill and those with high risk exposure, a surge in health-care capacity (supplies, testing, personnel, wards) and coordinated, unified public communication with clear, transparent up-to-date guidelines and data. OUR GOVERNMENT OFFICIALS HAVE BEEN UNFORGIVABLY SLOW TO GET THESE INTO PLACE.  We have been playing from behind but we now seem to be moving in the right direction and the experience in Asia suggests that extraordinary precautions don't seem to be required to stop it.  Those of us who must go out into the world and have contact with people DON'T HAVE TO PANIC if we find out that someone with the corona virus has been in the same room or stood closer than we wanted for a moment.  Transmission seems to occur primarily through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions. 

(I know I am in search of information and reasoning to what we are being told, just as I am sure all of you are.   I wish the government, hospital and local officials would share more information like this so we know why we are being asked to do what we are doing.  I hope this helps.  Doug

 

 

DOES USING IBUPROFEN WHEN YOU HAVE CORONAVIRUS MAKE THE SYMPTOMS WORSE?

 I have been receiving several questions concerning the use of ibuprofen versus Tylenol when you may have symptoms of the coronavirus. The question is essentially, does using ibuprofen when you have coronavirus make the symptoms worse?  A French public health official tweeted a warning for coronavirus patients using ibuprofen over last weekend, helping spark alarm among many who fear the common pain and fever treatment could prove harmful as people around the world increasingly become sick during the COVID-19 pandemic.   Anecdotal stories about people‘s experiences have received international attention, as guidance from health experts has been at times are unclear. Publications have cited professors and medical doctors offering seemingly conflicting takes on the matter. One professor told the BBC that previous studies have linked the use of ibuprofen to the worsening of respiratory infection in general although there is not strong data on COVID-19 specifically.  Other experts essentially dismissed the concerns about ibuprofen while noting that avoiding pain killers may help the immune system fight the virus.  The consensus among experts about the lack of evidence:  There is no widely accepted data about ibuprofen and COVID-19. However many credible organizations have advised caution on the matter and often suggest acetaminophen (Tylenol) as a possibly preferable treatment.  If you are already taking ibuprofen or another NSAID (non-steroidal anti-inflammatory on the advice of a doctor, do not stop taking it without checking first.  My recommendation would be that if you are having symptoms from what may be the flu or COVID-19 (fever, muscle aches) start with the acetaminophen and if it is not helping you can add ibuprofen (Advil) or naproxen sodium (Aleve) but not both to the acetaminophen.  Stay healthy my friends.  WE will get through this.  I promise.  Doug

 

3/20/20  SAINT AGNES PROVIDER INFORMATION

The following is information that was provided to me last evening.  I hope it helps answer questions.  

What is the hospital visitor policy?  Effective 3/19/20 at 5 pm their policy was to have no visitors, with exceptions on a case by case basis for maternity, end-of-life and day of surgery/procedure.

Is SAMC closing more entrances?  Effective yesterday all patients and visitors will be directed to enter an exit through the Outpatient Center Entrance on 1-North.  All other entrances will be closed.  The ER also remains a point of entry for emergency patients.

How will patients know where to go?  SAMC has developed signage at all key entry points to inform patients about their no-visitor policy and about the single point of entry.  They will be contacting scheduled patients ahead of time to direct them where to enter and explain the visitor policy.

Are we seeing patients in the tent in front of the ER?  The tent is supposed to be fully operational today 3/20/20.  I am not sure how it will be used but I believe it is a point of screening those that currently meet the criteria for screening.

Why aren't we testing all colleagues/providers for the coronavirus?  There are currently ONLY A LIMITED NUMBER OF TEST KITS AVAILABLE, AND A LIMITED NUMBER OF LABORATORIES PERFORMING THE TEST, so we are being advised by local and state health agencies to only test individuals who meet the following criteria: * Has fever, cough or shortness of breath.  * Has recently returned from travel to any areas within the U.S. or outside the U.S. currently having widespread, sustained transmission of COVID-19.  *Person thinks they may have been exposed to someone who has tested positive for the coronavirus.

How are patients notified of their test results?  * If a patient tests POSITIVE, the Chief Medical Officer will inform the patient's primary care doctor who will then be asked to follow-up with their patient.   **If a patient tests NEGATIVE, the patient and the patient's primary care doctor will be informed by the pathologist.

 

3/19/20   ~1:00 pm  (SCREENING  AND ISOLATING)

I contacted Saint Agnes Medical Center, Clovis Community Hospital and Community Regional Medical Center and they reported that if anyone feels they need to be screened for the COVID 19 Corona virus they need to go to the emergency department.  All other access to the hospital is locked down.  Based on your symptoms they will triage you.  i would not recommend screening unless you have significant symptoms:  cough, fever and significant shortness of breath.  Especially if you are worsening after 48 hours.  Otherwise, I would do what you do when you have the flu.  (Rest, fluids and treat your symptoms).  

The current guidelines, based on the "Shelter In Place" order was enacted, is for any individual coming from a significant outbreak area (>10 individuals diagnosed) should self quarantine for 14 days before exposing yourself to the public.  At a minimum I would keep your 6 feet of separation and stay to one room if possible.   Los Angeles County currently has 192 documented cases, Santa Clara 170 and Sacramento 45.  I believe once it becomes more widespread that this rule will change because it will be a matter of time before we all will be getting it. (Remember most of us WILL BE FINE.  Stay healthy.  Doug

3/19/20    ~8:30 am

I know a lot of you have questions concerning the treatment for this that is being circulated in the press.  It has been found in a small study in France that Plaquenil (Hydroxychloroquine sulfate) and Zithromax (Azithromycin) has been found to potentially be successful in treating the disease once it reaches a pneumonia stage.  At this point the treatment is based on individuals who had pneumonia.  As of yet, there is no indication for mild symptoms.  I foresee that there may be an indication for increased risk patients (Greater than 60 yo with comorbidities).  Not everyone develops pneumonia and those who do will likely be hospitalized.  We are still waiting for information concerning the ability to write these prescriptions.  I have been in contact with local pharmacies and ER physicians and they have not been given direction as of yet.  It would be unethical to write a prescription for this medication for every person who is requesting me to do so.  We would deplete the current stock of the medication and wasting it on individuals, particularly those who are under age 60 who have been asking for it for their entire family "to have on hand just in case".  This could deplete the supply for the hospitalized patients who actually need it.  I know that many of you may be upset but we need to be realistic here.  99% of us who will get it will survive.  Some of us will have mild flu-like symptoms and others more severe.  If you are severe with shortness of breath then you may have pneumonia but would need to be in the hospital to help increase your chance at survival.  This would be the type of individual who would benefit from the medication.  Please understand there is a method to the madness I am spelling out here.  Please adhere to the "Shelter In Place Order"  and  we WILL get through this.  Stay healthy my friends.  Doug

3/18/20

The practice is trying to address all issues via phone, text email etc... until we get more direction from the authorities.  I know this may be difficult and I know some of you will need to be seen and we are always striving to do what is best for you as well as all of the other patients.  What many of you do not understand is that if you come in infected the whole facility and staff will need to be quarantined for a 14 day period. That means we are not available to provide the care when it is needed.  Also, if  elderly patients who come in for a routine check up are exposed to the virus that was brought in by a patient, it could be an illness and/or death that could have been avoided.  We are here for you.  WE will get through this.  We are fortunate that this practice has, essentially,  been working in this fashion since its inception.  Please be understanding when Kristen or Natasha asks questions unrelated to you initial complaint concerning: cough, shortness of breath or fever.  It is part of the protocol to prevent the spread of the virus.  Stay inside, catch up on your reading, card games and dice with the kids and try to have some fun.  You can still exercise (outside) but keep you six feet of isolation.  No excuses.  It is also a great time to work on the nail biting and picking habit.  It has worked for me:)   Stay healthy my friends.  Doug

3/16/20   SHELTER IN PLACE ORDER (San Francisco)

The  health officer of the city and county of San Francisco gave an order to "Shelter in Place" of one's place of residence starting at midnight tonight.  Individuals may leave to provide or receive certain essential services or engage in certain essential activities and work for essential business and government services.  They are directing all business and governmental agencies to cease non-essential operations at physical locations in the county; prohibiting all no-essential gatherings of ANY number of individuals; and ordering cessation of ALL non-essential travel.  I foresee this coming up next for the central valley.  If so, please adhere to it  Stay healthy.  We will get through this.  Doug

3/15/20.   FOLLOW UP APPOINTMENTS

Kristen will be calling to cancel routine follow up appointments for individuals 60 and above, particularly if you have underlying medical problems that put you at increased risk. There is no reason to bring you in for a checkup if you are doing fine.  Obviously, if you need to be seen or want to be seen for a problem we will see you as we always do but I feel if you are well just stay home for the next few weeks.  Having sick patients on a regular basis puts patients at risk who are not sick.  We will be handling a lot of the issues over the phone or telemedicine if needed.  Please bear with the questions from Kristin and Natasha because they are just doing what I am asking.  Thank you. Stay healthy. 

COVID 19 UPDATE  3/13/20

I have been getting a lot of questions and we do not have a lot of answers right now.  I would like to relay you some information from a UCSF Biohub panel on COVID-19 (Wuhan Corona virus) that took place on 3/10/20.  Please know that not everything is absolute but a majority of the information is coming from the countries that have already been affected.  What is listed are essentially direct quotes from the panelists: Joe DeRisi: UCSF's top infectious disease researcher. Emily Crawford:  COVID task force director focused on diagnostics.  Christina Tato:  Immunologist and Rapid Response Director.  Patrick Ayescue:  Epidemiologist. Leading Outbreak and Response and surveillance.  Chaz Langelier UCSF Infectious Disease Physician

Top Takeaways:  At this point we are past containment.  The cat is already out of the bag, so to speak. Containment is basically futile and our efforts won't reduce the number who get infected in the U.S.  Now we are just trying to slow the spread to help others in the healthcare industry deal with the demand of the inevitable peak.  Now the containment plan is to "flatten the curve", to lower the peak of the surge of demand that will hit healthcare providers and to buy time in hopes that a drug can be developed.  We are moving from containment to care.  No one knows how many in the community already have the virus.  Some estimates reveal that 40-70% will contact the virus in the next 12-18 months.  We believe that when more people are screened and diagnosed that the mortality will drop to ~1%.  Which means that 99% of us who get it will survive but the rate of survival varies drastically based on age.  At 1 % that makes this virus 10 times more deadly than the seasonal flu which kills, on average 40,000 to 60,000 Americans a year.  Based on these numbers we could expect 400,000 to 600,000 deaths this year and some estimates as high as 1,600,000 (1.6 million Americans in the next 12-18 months).

THE DEATH RATE VARIES HUGELY BY AGE:  The death rate for individuals less than 50 yo can be viewed as near influenza levels: 0-29 yo ~0.2%.  40-49 yo=0.4%.  50-59 yo=1.3%.  60-69 yo=3.6%.  70-79 yo=8% and older than 80 yo=14.8%.  Although age is a risk factor I think a true reason for this is that as we age we develop more diseases and become less healthy.  Our immune system decreases after 50 yo as well.  So I feel if you are a healthy 70 yo you would have better odds of survival compared to a 70 yo with multiple diseases.  50 % of the deaths of China were in individuals who had hypertension (High blood pressure)  We do not know the correltion as of yet but are learning more about the disease as each day passes.  Other disease that contribute to the risks are lung disease (Asthma, COPD/Emphysema). Heart disease (Coronary artery disease, Congestive heart failure) and Diabetes.  The bottom line is that there is a reason I want all of you healthy.  Each of us need a reserve tank when it comes to our health.  For those of you who value your health, good for you.  For those of you who have been lacking, we will work on this when this passes but it is not too late to start now.  I am recommending that individuals who are unhealthy and are older than 60 should stay at home for the next week or two to see what direction this takes.  If you can work from home, that would be great.  I would tell your children that you need to take a break from the grandchildren as well.  We are finding out the children can carry the disease and not be symptomatic or just have mild symptoms.  It is up to your children to find health care from someone else and preferably someone who is younger <50, otherwise they are putting you in danger.  I know this will be a major issue now that all of the central valley closed schools down for the next month.  If you have parents in nursing homes who are >60 yo and you have the capability of taking them home with you for a few weeks I would recommend doing so.  If you don't, I could foresee these sites as potential powder kegs once someone there gets diagnosed and they will likely have to put the facility on a lockdown, similar to the cruise ships you have heard about.  I know I am sounding dramatic and paranoid and I hope I am wrong but I would rather be safe than sorry. This is a once in a lifetime event.  The only thing close to this was the Spanish flu in 1918.  We are trying to avoid overwhelming our current medical system.  You may find that elective procedure will be put on hold as well and this doesn't take into consideration the other diseases and medical problems we are already dealing with prior to the virus hitting us.  Everyone knows what the hospitals were like before and this could make the situation exponentially worse. 

WHAT SHOULD YOU DO NOW?:

It appears that one can be infectious before being symptomatic.  This is a reason it would be best to just stay home with the exception of getting essentials for living, (food, medicines, supplies etc...).  The highest level of virus shedding coincides with the symptoms of the disease. Sore throat, fever, cough, muscle aches.  Similar to the flu.  A majority of these symptoms will usually present 5-6 days after the exposure but some have been delayed up to 14 days after the exposure.  So we currently think that one is infectious 2 days before through 14 days after the onset of symptoms.  There are exceptions as we are finding some quarantined individuals are still are infectious >30 days after being infected.  For teachers, and other employees of jobs that have closed down this IS NOT a time to consider it a holiday or vacation.  It defeats the purpose of shutting down your places of employment when you are out spreading the virus.  For lower risk individuals you are fine to go out but keep your space.  We are recommending a 6 foot barrier around your personal space, WASH YOUR HANDS WHENEVER YOU CAN.  REGULAR SOAP IS FINE. IT DOES NOT HAVE TO BE ANTI-BACTERIAL.  

HOW LONG DOES THE VIRUS LAST?:

On surfaces our best guess is 4-20 hours depending on the surface type. (It could be up to a few days) but there is still no real consensus on this.  The good news is that the virus is very susceptible to common anti-bacterial agents: bleach, hydrogen peroxide, alcohol based products >70% if possible. (Tito's Vodka is only 40% so despite the recommendation by some this does not work but it can taste good ;).  Avoid concerts, movies and crowded places. We consider crowded >50. I can see this number decreasing as well.  This would include weddings, church, parties, fundraisers etc...  They can always be rescheduled.  I know this sucks but it is important for the betterment of all of us.

WHAT IF SOMEONE IS SICK?

If someone is sick have them stay home and socially isolate themselves.  There is very little you can do at a hospital that you couldn't do at home.  Remember this is like the flu.  Do what you do when you get the flu.  Rest, fluids, treat the symptoms and isolate.  We never plan on dying with the flu and don't plan on dying with this.  But they both can kill us and therefore kill others (particuliary the elderly if you give it to them).  So again, stay home!!!. At this point, if someone calls me with flu-like symptoms I would assume you have it.  There are no medications for it at this time so treat your symptoms.  The concern would be if your breathing becomes affected.  I am not talking about, "I think I am not breathing right" or "I am scared and nervous and I can't breathe".  I am talking about a severe cough and difficulty oxygenating one's self.  If you find yourself rapidly deteriorating YOU NEED TO GO TO THE HOSPITAL!!  Do not try to nebulize your way or use supplemental oxygen to get you over the hump.  You will need appropriate ventilation with a ventilator.  I have been asked by patients to write them prescriptions for oxygen concentrators for their home in case they get the disease.  I WILL NOT write for this for two reasons. First,  if you need oxygen for this disease after being relatively healthy prior YOU NEED HOSPITALIZATION!! Secondly, doing this would deplete the need for equipment for someone who actually needs it.  There WILL be a shortage.  Please don't do this.  Relax.  We will get through this.  We need to look at the big picture.

WHAT ABOUT TESTING TO KNOW IF SOMEONE HAS COVID-19?

I wish I had more information on this but we physicians have not been given much.  I know that Quest diagnostics will be having test swabs this next week but DO NOT GO TO QUEST OR ANY OTHER LAB AND ASK TO BE TESTED!!  I know the hospitals have the capability but it is currently reserved for the very sick.  I foresee that we will have a facility to send you to in the next week or two.  My feeling is that in the next few weeks there will be thousands that are positive and we will just be in the self isolation mode.  It would not be possible to quarantine everyone.  Estimates are 40-70 % of us will get it and also remember that 99% will survive. WE WILL BE FINE!

BOTTOMLINE: This is a once in a lifetime event.  It will be in history books and I look forward to the day when we are able to say how we came together as a country to kick the ass of this thing as we have done with multliple other obstacles in our past.  We need to forget about politics for now.  I am thankful for the virus for this reason alone. (Thank you COVID-19 :)  It is time to stop with the tribalism  and remember we are one tribe. One team.  We are Americans and we can do this and WE will get through this   I want to emphasize the fact that I hope I am wrong with this and I hope the experts are overshooting their estimates.  The worse case scenario would be me saying "Damn I really was off with what I thought".  But just as I couldn't sleep last night knowing I hadn't  shared the information and my thought to you this morning, I would not have been able to sleep in good conscience the rest of my life  knowing I didn't do my part  telling you what I did today.  I ask that you enjoy your time at home with family and friends (small groups of course).  Try reading, find new hobbies, garden, exercise, golf.  Do what you enjoy.  This is the time to make family a priority.  Call your parents and family to check on them or just "shoot the shit" as my cousin Bud used to say.  Ask your elderly neighbors if they need anything-supplies, food or just an ear to talk to. Think of your community when you are buying all of the toilet paper and hand sanitizer.  Leave some for others who need it as well.  Don't be selfish.  We have been doing this too much lately.  We will be fine.  We will lose love ones (but we always do) but lets try to keep the losses as low as we can.  Have a great day and stay healthy my friends.

Douglas Shane Stanley, M.D. "Doug"

 

**(I apologize for the typos as I was in a rush to get this out and this freaking program does not have spell check. Might be time for a change when this is all over:) )

 

***Thank You K.B for helping with the editing 3/24/20