The plight of American Health Care aides

-“Doctor…Now I get why all aides get fed up with my Mom—she’s impossible.”

Dianne X. is a successful corporate lawyer with a beautiful family that, due to the Social Distancing and sanitary measures of the pandemic, had to take her mother out of an assisted living facility and re-settled her in her home temporarily. She has a large house, with plenty of help, good resources, but all those accoutrements of a wealthy lifestyle are often not enough to make her mother comfortable as she has Alzheimer’s Disease. She had to change several times her live-in aide, but she lately found a middle-aged Haitian lady that seems to have “connected well” with her Mom. Appreciating the great help she represents, she willingly raised her salary. She can’t live without her.

Unfortunately, many workers in the USA that are engaged in the care of vulnerable individuals—teachers, day care workers, social workers and health care aides—do not receive the proper financial and labor consideration, even though many are well educated and trained. The large majority of them are women from Minority groups. The recent spate of adulation for all those that stayed in the first lines of care during the pandemic, even though many got infected, did not come along with a just raise in their wages, which has remained stuck at U$ 7.25—the Federal Minimum wage.

Kathryn E.W. Himmelstein and Atheendar S. Venkataramani published an article in the American Journal of Public Health that discussed “the racial/ethnic and gender inequities in the compensation and benefits of US health care workers and assess the potential impact of a $15-per-hour minimum wage on their economic well-being.” They studied the 2017 Annual Social and Economic Supplement to Current Population Survey to compare the wages, job benefits, and labor distribution of both the male and female health care workers of different socio-ethnic communities.

They found that: “of female health care workers, 34% of earned less than $15 per hour. Nearly half of Black and Latina female health care workers earned less than $15 per hour, and more than 10% lacked health insurance. A total of 1.7 million health care workers and their children lived in poverty. Raising the minimum wage to $15 per hour would reduce poverty rates among female health care workers by 27.1% to 50.3%.” During our medical practice, we have seen numerous women who, in spite of working full time, do not qualify for basic insurance coverage, including Medicaid. Their children might qualify for state and federal aid but they do not. This has been discussed in a previous article of this series called The Medicaid Coverage Gap.

The researchers studied the possible effects of raising the minimum wage to $15 of these workers and they considered two scenarios. In the first scenario, they assumed that there is zero elasticity for labor demand (meaning that raising the wages will not decrease the labor opportunities)  One of the most discussed issues in the challenge of raising the minimum wage to enable workers a better quality of life is that employers will either start laying off workers or simply stop hiring them. However, there is strong empirical evidence that in Health Care, due to the increased needs of an ageing population and the rising sophistication of medical services, that might not apply. There are much less incentives for dis-employment.

In the second scenario, they assumed that there was great elasticity of the demand for low wage-health care labor, based on a study done in Seattle, Washington state, that showed that raising the minimum wage to U$13 per hour produced a 9.4% loss of work hours for them.

In the first scenario, that increase in hourly wages would increase their average annual income by $7653 ($7682 for all women, and $8236 for Black, Latina and native American women) for an estimated value of almost U$ 45 billion, or the equivalent of a meagre 1.3% of the total health care spending in the USA. Moreover, it would lift almost 900,000 women and their children out of poverty and into the lower middle class.

In the second scenario, the socio-economic gains were more subdued as the average concerned worker would only get an increase of U$5103 ($5152 for all women and U$5769 for Black, Latina and Native American women) The total cost for the system was calculated to be U$24 billion; only 215,476 workers and 163,472 children were taken out of poverty.

It is clear that in both scenarios, there would be an improvement for those hard-working women and their children. Don’t we owe them, as a grateful society that appreciates their work, at least the gesture of discussing a wage raise?

Justice now for American Health Care aides!

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What do you think? Please tell us.

Don’t leave me alone.

 

Increased COVID-19 infection in Hispanics

In the USA there has been heated discussions about how the Covid-19 pandemic has affected different socio-economic, ethnic, and cultural groups. Hispanics constitute 18% of the country’s population—representing its largest ethnic and racial minority group—but they account for one in three—33%—of all the confirmed Covid-19 cases where the appropriate data has been collected. They have the highest age-adjusted rates of Covid-19 hospitalizations at 117 per 100,000 and the highest rate of mortality—one in five of the confirmed Covid-19 related deaths with good data.

Carlos E, Rodriguez et al., from the Milken Institute of Public Health at George Washington University and other institutions, studied the publicly available datasets to determine “the differences in county-level characteristics of counties with a greater share of Latino residents that the U.S. average (more than 17.8% of Latino population) compared to all other counties (less than 17.8% of Latino population) Additionally, we examined the association between the proportion of Latino residents and Covid-19 cases and deaths.” The County-level collected data included the following information:

  1. County population
  2. Percentage of Latinos
  3. Percent of residents aged more than 65 years old
  4. Percent of residents under 35 years old
  5. Percent of the under-65 population without health insurance
  6. Occupants per room
  7. Language spoken at home
  8. Ability to speak English

“Fourteen percent of U.S. counties (443/3143) are disproportionately Latino. As of May 11, there were 700.169 Covid-19 cases and 42,674 Covid-19 deaths in disproportionately Latino counties. Up to 91.2% of disproportionately Latino counties (404/443) reported a Covid-19 and 54.4% (241/443) reported a death versus 92% (2484/2700) and 49.4% (1335/2700) in all the other counties.” The incidence of the infection increased with a higher proportion of Latinos, especially in the Midwest and the Northeast regions of the country. The researchers found in the disproportionately Latino counties the following features:

  1. A younger population
  2. Lack of health insurance
  3. Greater number of individuals per room in each household
  4. Fewer number of monolingual English-speaking Latinos
  5. Greater number of monolingual Spanish—speaking or bilingual

Hispanics are disproportionately young and usually work in service industries—like the meatpacking plants—that, deemed as “essential” by the authorities, did not close during the pandemic and were more likely to expose their workers to infection as they demanded the physical presence of many workers clustered in small spaces. The monolingual Spanish speakers were more likely to be healthier, younger, and without the legal residency documents, which limited their access to health care. Moreover the undocumented immigrants are less likely to get the proper testing due to lack of insurance, inadequate coverage, and the ever-present fear of deportation.

The researchers call for more focused and committed policy planning responses to confront the Covid-19 epidemic in Latino communities, as due to structural barriers, the same polices for the general population might be not be as effective with them. They suggest expanding the access to Medicaid and Children’s Health Insurance (CHIP) programs for qualified non-citizens because Hispanics usually work in jobs that do not offer employer sponsored insurance and they have difficulty navigating the meandering modern yet highly fragmented health care delivery in the USA. The occupational risk in Latino communities should be studied with reliable data that, not only captures information for laboratory purposes, but also for hospitalizations and death certificates.

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What do you think? Please tell us.

Don’t leave me alone.

 

 

 

SARS-CoV-2 infection rates in London health care workers

Since the beginning of the SARS-CoV-2 pandemic, health care workers (HCWs) have been valiantly performing their critical duties in spite of being very exposed to infection. Not only their ranks have been decimated by a surge of infections and deaths, but they also have contributed to the dire spread of the virus in their own communities. The possibility of a second wave of the infection has alerted the Public Health authorities to the need to properly determine the incidence of infection in their rank and file.

In the United Kingdom, the rate of infection in London is double than the rest of the country, which prodded several institutions to pool their human and material resources to conduct a prospective cohort study of HCWs between March 26 and April 8, 2020 in several city institutions. Clinical cohort studies can either be:

  1. Prospective: a group of participants is selected and then studied forward to find out if there are any changes from the baseline data.
  2. Retrospective: a group of participants is selected, and their past data is studied to find any meaningful features.

For this prospective cohort  they recruited 200 patient-facing HCWs from a National Health Service (NHS) hospital trust in London; they collected nasopharyngeal swabs for RT-PCR twice per week, symptom data, and blood samples monthly for high-sensitivity serology assays (ELISA and flow cytometry for spike glycoprotein) The median age of the participants was 34 years old. They found that 44% (87) of the HCWs had evidence of infection at any moment during the study. Based on the serological results, 45% (82) were seropositive one month after the starting date, 20% (36) seroconverted during the study period, 25% (46) were already positive at the study’s start and 21% (42) tested positive in at least one nasopharyngeal swab.

They also found a trend towards a higher infection rate in younger participants than in the older ones; 31 out of 56 persons younger than 30 years got infected, while only 10 out of 30 persons older than 50 years old actually did. There was a significant number of asymptomatic carriers as 38% of the 42 positive HCWs did not report any meaningful symptomatology within 7 days of testing positive for SARS-CoV-2. The median age of onset of symptoms for those that were positive RT-PCR until they reported symptoms was 4 days; none of the participants had to be hospitalized.

The researchers said: “Notwithstanding the short follow-up period, these results suggest a protective effect, correlating with the presence of spike protein-specific antibodies, on subsequent infection within a 1-month period in a high risk setting.”

The featured photo was taken from: By University of Liverpool Faculty of Health & Life Sciences from Liverpool, United Kingdom – Anenurin Bevan, Minister of Health, on the first day of the National Health Service, 5 July 1948 at Park Hospital, Davyhulme, near Manchester, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=40414909

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What do you think? Please tell us.

Don’t leave me alone.

 

Leftover victims of the SARS-CoV-2 pandemic

On May 8, 2020, the U.S. Department of Labor issued its monthly employment report, which showed that the national unemployment rate jumped to 14.7% in April, its highest level since the Great Depression of the 1930s; it said that 20.5 million people had suddenly lost their jobs due to the country’s lockdown, erasing a sustained rise of employment of the past ten years. A more detailed analysis of those that are abruptly working part-time instead of full-time and those that are not counted showed that the unemployment rate might even be higher. Moreover, the tightening of the federal, state and county budgets will inevitably furlough many more people.

In the previous recession of 2007-2009, the majority of lost jobs belonged to men, as the construction and manufacturing sectors ground to a halt; but this time the real losers are often women as thousands upon thousands of their positions as clerks, secretaries, hairdressers, health care aides, travel consultants, stewardesses, airplane and ship chandlers, restaurant servers and cashiers, dry cleaning employees, etc., evaporate. Once the lockdown is finally levied, albeit in various progressive stages according to the local public health characteristics, many of the once thriving small businesses that used to predominantly employ women will be gone. And there will be hardly any credit for entrepreneurial initiatives as the banks will be reluctant to lend.

Not only did women hold most of the positions offered in the Education and Health Care realms—the hardest hit sectors—but they were also furloughed in greater numbers than men. In a Washington Post article, Heather Long and Andrew Van Dam said: “Before the pandemic, women held 77%of the jobs in education and health services, but they account for 83% of the jobs lost in those sectors…Women made up less than half of the retail trade workforce, but they experienced 61% of the retail job losses. Many of these women held some of the lowest-paid jobs.” A large proportion of those workers are single women with children and members of the Latino and Black minority groups.

These disadvantaged single women usually lack a strong social or family support, for which they disproportionately rely on their children’s school services for their care, instruction, and meals. If they cannot take their kids to school, they will not be able to resume their previous positions, even if they are asked back to work.

In order to re-start our economies we must first help the women that sustain it.

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What do you think? Please tell us.

Don’t leave me alone.

 

Physician and Nurse burnout – Part V Suicide

The  stressed-out E.R. personnel of the New York-Presbyterian Allen Hospital

Got used to the company of the little sparrow flying over their place of penance

She was always the first one present when the doors of the ambulance opened

She was always the first one present when they took a patient to an exam table    

She was always the first one present when they hooked the whirring machines

She was always the first one present when the drilled routine of care kicked in

 But one day her heart could not resist so much suffering and stopped beating

 Plunging into the depths of their sorrowful spirits, she gave them a final cheer.

On April 27, 2020, Dr. Lorna Breen, chair of Emergency Medicine at the Columbia-affiliated hospital, committed suicide in her parent’s home in Virginia. She had been diagnosed with a Coronavirus infection, but she fully recovered; she was given a leave of absence from work and she decided to spend it with her folks. In a communication with The New York Times her father said: “She tried to do her job, and it killed her…Make sure she’s praised as a hero, because she was. She’s a casualty just as much as anyone else who also died.” [i] Her father said that she had told him that many patients were already dead when they opened the doors of the ambulances. She never had a history of Mental Health issues, but she seemed detached to him.

 Once a suicidal patient decides to act, a Buddhist peace of mind sets in.             

Physicians have been trained to face most of the stressful situation of our careers with a stiff upper lip and the steely determination to carry on, nonetheless. If you are taught in Medical School and  professional training about the values of fortitude and resiliency, you will be the last one to ask for any help. As a result medical personnel are hard hit by an unusual incidence of suicidal acts and attempts, which will surely worsen after the Coronavirus pandemic finally ends.

Unfortunately, there are personal and institutional barriers  blocking the remedies.

In a 2008 Health Affairs article [ii], Donald M. Berwick, Thomas W. Nolan and John Whittington coined the term “triple aim” to define the simultaneous pursuit of three objectives—improving the experience of care, improving the health of populations and  reducing per capita costs of health care—to fix the care system. In 2014, considering the increasing burn-out and dissatisfaction of physicians and nurses with medical practice, Drs. Bodenheimer and Sinsky argued that: “the Triple aim be expanded to a Quadruple Aim, adding that the goal of improving the work life of health care providers, including clinicians and staff.” [iii]

Professional burn-out is characterized by a most evident and ignored tragic triad:

  1. High emotional exhaustion
  2. High depersonalization
  3. Low sense of personal accomplishment

A – High emotional exhaustion

The increasing demands of payors, administrators and patients on the time and resources of the health care personnel produces a generalized dissatisfaction with the perceived quality of their delivered care services. The level of resilient frustration is so pervasively high in our system that physicians, nurses, technicians, receptionists, and other ancillary personnel are literally “counting the days” until finally the day of salvation arrives—their retirement date.

B – High depersonalization

The negative feelings and bad vibe will inevitably foster the emergence of cynicism and sarcasm in the ranks of providers, with the resultant degradation of their rapport with the patients and families. It is a self-sustaining vicious circle. Patients complain that they are being ignored and/or mistreated, which triggers more negativity and disdain for the staff. As a result, the latter keep their bad attitudes without the possibility of pausing for a moment and reflect calmly on the impasse.

C – Low sense of personal accomplishment

For the majority of us who have chosen the medical career, profit and social standing are secondary considerations. What we most value is the possibility of helping our fellow human beings and at  the same time enjoy the unique standing conferred by possessing a voice of authority. With the landing of the abominable “bean counters”  in both the public and the private payor system, our maneuvering room is being steadily curtailed. Our decreasing satisfaction not only fosters our  early retirement but also all kinds of drug and alcohol abuse in our ranks plus the potential of one day, out of the blue, start mulling about the unthinkable.

Shanabelt et al. studied the incidence of burnout with work-life balance in the US physician and general workforces in 2011 and 2014 to compare the results and significant trends, using the Maslach Burnout Inventory; they invited more than 35,000 physicians to participate and 19% completed the survey. [iv] They said that:  “54.4 % (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.50 % (n=3310) in 2011.Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty.” They found minimal differences in the general workforce between those years.

Early on during our training, a taciturn hitchhiker steps into our cockpit.      

Douglas A. Mata et al. conducted a meta-analysis of 31 cross-sectional  and 23 longitudinal studies of the incidence and prevalence of depression in resident physicians.They found : “the overall pooled prevalence was 28.8 % of participants, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year.” [v] One in four physicians-in training has depression.

To glean more information on this issue, Lisa S. Rotenstein et al. extracted data from 167 cross-sectional studies and 16 longitudinal studies from 43 countries. They found: “the overall pooled crude prevalence of depression or depressive symptoms was 27.2%…Depressive symptom prevalence remained relatively constant over the period studied…In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n=2432), the median absolute increase in symptoms was 13.5 %.” [vi] They also found that only 15.7% sought medical treatment for their symptoms. There is a tall price to pay.

Amy M. Fahrenkopf et al. studied the incidence of medical errors among resident physicians of three urban children’s hospitals by evaluating the depression with the Harvard National Depression Screening day scale, the burnout using the Maslach Burnout Inventory, and the rate of medication errors per resident per month. They found: “24 (20%) of the participant residents met the criteria for depression and 92 (74%) met the criteria for burnout. Active surveillance yielded 45 errors made by participants. Depressed residents made 6.2 times as many medication errors per resident month as residents who were not depressed. Burn-out residents and not-burnt out residents made similar rates of error per resident month.” [i]

There are several factors that block physicians, and other medical personnel, to seek the needed counselling. The crazy work schedule of physicians and residents, the confidentiality issues that might affect the licensing status of practitioners, the personal issue of loneliness and divorce, all contribute to it.  

We have dawdled about writing a book on Physician/Nurse burn-out                 

Lorna’s valiant sacrifice shook our torpor and took us immediately to task

(This article is based on our upcoming new book Emotional Frustration- the hushed plague)

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

References

[i] Amy M. Fahrenkopf, Theodore C. Sectish, Laura K. Barger, Rates of medication errors among depressed and burn out residents: prospective cohort study. British Medical Journal. 2008 March 1: 336 (7642) ; 488-491. Doi: 10.1136/bmj. 39469.763218 BE. https://ncbi.nlm.nih.gov/pmc/articles/PMC2258399

[i]  Top E.R. Doctor Who Treated Virus Patients Dies by Suicide, The New York Times, April 27, 2020. https://nytimes.com/2020/04/27/nyregion/new-york-doctor-suicide-coronavirus/

[ii] Donald M. Berwick, Thomas W. Nolan and John Whittington, The Triple Aim: Care, Health and Cost, Health Affairs, May/June 2008. https://doi.org/10.1377/hltaff.27.3.759

[iii] Bodenheimer T., Sinsky C., From triple to quadruple aim: care of the patient requires care of the provider, Annals of Family Medicine, 2014, November-December; 12(6)573-6. Doi:10.1370/afm.1713. https://ncbi.nlm.nih.gov/pubmed/25384822

[iv] West CP, Dyrbye LN, Shanafelt TD, Physician burnout: contributors, consequences and solutions, Journal of Internal Medicine 2018 June 283 (6) 516-529 doi 10.1111/joim. 12752. Epub 2018 March 24. https://ncbi.nlm.nih.gov/pubmed/29505159/

[v] Douglas A. Mata, Amarco A. Ramos, Narinder Bansal, Prevalence of depression and Depressive Symptoms among resident physicians. A Systematic review and Meta-analysis, Journal of the American Medical Association, 2015, December 8: 314(22) 2373-2383. Doi: 10.1001/jama 2015.15845. https://ncbi.nlm.nih.gov/pmc/sticles/PMC4866499

[vi] Lisa S. Rotenstein, Marco A. Ramos, Matthew Torre, Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation among Medical Students, Journal of the American Medical Association. 2016 Dec.6:316 (21); 2214-2236. Doi: 10.1001/jama 2016.17324. https://ncbi.nlm.nih.gov/pubmed/27923088

Do not listen to (some of) the French

As millions of other citizens and residents of the United States of America that have complied with the largely state-mandated “staying-at-home” guidelines, we have been glued to the television screens when the official daily news conference from the White House appears between 5 and 6 PM Eastern Standard Time. It usually involves the top administration officials and renowned public health and emergency officials that are dealing with the Coronavirus pandemic and the remedial measures.

One of the most mentioned and debated  issues is whether to use chloroquine, an anti-malarial drug, to treat the acute symptoms of the grave infection, which is based on some incidental reports from French physicians that treated patients with Coronavirus. Event though they do clarify that much more comprehensive clinical research studies, which are underway, are needed to give a seal of approval to this drug, the legend of its usefulness persists; it has been used “off-label” by some physicians with mixed results. However, it has produced serious cardiac arrhythmias in others.

In a recent correspondence to The Lancet, Dr. Joan Paul Moattti, a professor of the University of Aix-Marseille, questioned the responses of the French administration. He said : “Faced with criticisms, French authorities claim that their policy towards the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been evidence-based—they appointed an advisory board of 11 scientists to help manage the crisis. However, in situations where decision makers face radical uncertainty, sticking to conventional approaches might jeopardize the science-policy interface.”

First of all, he criticized the lack of massive testing of the first responders and possible cases in the beginning of the pandemic in March, unlike the authorities of South Korea that tackled the pandemic following the guidelines of the WHO:

  1. Massive tracing
  2. Contact tracing
  3. Social distancing

France did not implement a national lockdown until March 17, many days after the pandemic had been identified. Moreover, he claimed that the country was not prepared to carry out the critically needed massive testing as it only had 45 public health laboratories that could process the samples for a definitive diagnosis of cases. Rather than designing a rational plan to scale up the testing, the authorities argued that massive testing was not needed once the infection became generalized; they only changed course on March 28, after  a national uproar about their carelessness.

The widespread diffusion of the very preliminary—and inconclusive—results of treatment with Chloroquine fueled big speculation in the world media and an acrid controversy in the biomedical community; he claimed that there are alternative methods to evaluate the safety of some drugs without the need to wait months for the definitive opinion of the clinical researchers that conduct rials of the same. This dereliction of duty in a context of urgency: “has reduced the ability of authorities to mitigate the effects of irrational online rumors and regulate prescription practices of health professionals.”

The author has high hopes in a much smarter commission of 12 experts designated by the French authorities on March 28—they seemed to have done a radical public about-face that very day. It is chaired by Dr. Françoise Barré-Sinoussi, a renowned virologist and Nobel Laureate of Medicine in 2008.who, as a highly educated woman, might be endowed with a bigger dose of common sense in the public forum. He said: “the second commission seems an implicit recognition of the intrinsic difficulties of directly using science in political management of a health crisis.”

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

 

Is the SARS-CoV-2 virus a man-made biological weapon?

One of the most resilient conspiracy theories that has emerged during our forced isolation in the midst of the SARS-CoV-2 pandemic is that it is a man-made virus. Some officials of the Trump administration are squarely laying the blame of this pandemic on a bio-engineering product let loose from the Wuhan Institute of Virology, a few kilometers away from that infamous “wet market” in the city center. They claim that lax security measures at the institute provoked the fatal accident.

The SARS-CoV-2 virus is the seventh coronavirus that infected humans recently; SARS-C0V, MERS-CoV and SARS-CoV-2 can produce grave clinical symptoms while HKU1, NL63, OC43 and 229E produce much milder ones. The viral load of bats has been studied for many years, but it is woefully under-sampled at present. Kristian G. Andersen, Andrew Rambaut, W.Ian Lipkin and Edward C.Holmes studied the genomic material of the virus to determine if it was actually man-made.

Based on structural studies and biochemical experiments, the researchers found that:

  1. The virus seems to be optimized for binding to the human receptor ACE2
  2. The spike protein of the virus has a functional (furin) cleavage site at the S1-S2 boundary, which predicted an acquisition of three O-linked glycans.

Viruses bind to a host cell in order to invade them for replication of their genetic material through their receptor-binding domain (RBD) The researchers found that SARS-CoV-2 has an RBD that binds with optimal affinity to ACE2 from human beings, ferrets and cats. However, analysis made with computer programs showed that the RBD sequence is not the ideal one for optimal receptor binding. Therefore they concluded that it was the result of a natural selection process of trial and error and not the calculated result of some perfidious manipulation by wacky warmongers.

The second characteristic of this virus is that it has a polybasic cleavage site (RRAR) at the junction of two subunits of the spike, S1 and S2; this enables the cleavage of proteases like furin, which has a critical role in the high infectivity and host range. These cleavage sites have not been observed in other coronaviruses, but they appear in other kind of betacoroanviruses infecting humans, which indicates they will be found in other species. Some experiments showed that the insertion of a furin at the cleavage site enhance the anchoring to the host cell without affecting viral entry. The function of the predicted 0-linked glycans has not been determined but it could represent a “mucin-like domain” to mask the virus spikes, thus fooling our defenses. This highly favorable medium had not been previously discovered by scientists.

Moreover, these scientists affirmed that if there had been a willful genetic manipulation, one of the previously existing reverse-genetic systems would have been used as a viral scaffolding to construct a biological weapon worthy of the Devil. The authors propose two alternative scenarios of the origin of the SARS-CoV-2:

  1. Natural selection in an animal host before the zoonotic jump into humans.
  2. Natural selection in a human being after the zoonotic jump had happened.

Considering that the SARS-CoV-2 is very similar to other bat SARS-COV-like coronaviruses, it is possible that an animal source was present in that Wuhan market; the illegally imported Malayan pangolins harbor coronaviruses similar to SARS-CoV-2. But neither the bat nor pangolin coronaviruses have the polybasic cleavage sites, which questions their possible progenitor role for this virus. They said: “For a precursor virus to acquire both the polybasic cleavage site and mutations in the spike protein suitable for binding to human ACE2, an animal host would probably have to have a high population density (to allow a natural selection to proceed efficiently) and an ACE2-encoding gene that is similar of the human ortholog.”

The genetic study of all the different variants of the SARS-CoV-2 indicate that there was a common ancestor that made the jump from an animal to a human being—the definition of a zoonosis or a human disease of animal origin. The RBD found in the virus infecting the pangolins is similar to the human variant; the insertion of the polybasic cleavage might have happened during the human-to-human transmission. Computer analyses point to an emergence of the virus in late November 2019, which implies that there was a silent transmission in humans between the zoonotic jump and the insertion of the second feature, the polybasic cleavage site.

Based on these findings, the researchers concluded that there is no scientific basis to determine that this lethal agent was the product of bioengineering in a military lab.

Imbued with Humanistic values, we cannot fathom that it could be a human product.

Sadly, the amazing capacity of human beings to harm other species, including their own kind, has been an historically tragic box of nasty surprises.

 

Dr._Strangelove

The troubling image of Dr. Strangelove (played by the great Peter Sellers) jumps into our mind…

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What do you think? Please tell us.

Don’t leave me alone.

Physician and Nurse burn-out – Part IV Vagina penalty

“Le plus scandaleux du scandale c’est de s’y habituer” Simone de Beauvoir

One of the more irritating and at the same time pressing issues that we have to quickly correct in most of our health care delivery systems – not only to stop the “hemorrhage” of so many disillusioned professionals into early retirement that we just cannot afford to continue unabated, but also to promote the recruitment of younger cadres as well – is the thorny issue of Gender Inequality in pay scales and benefits. And let us make a point very clear from the start. It not only affects our women colleagues but, us men, too. We cannot expect to have a congenial workplace if whomever is daily working shoulder to shoulder with us is being paid less than we are for an otherwise totally similar task.

On what grounds does this scandalous state of affairs stand?

A teeny-weeny detail: she is a woman. She is being fined with the vagina penalty.

In our new book Emotional Frustration – the hushed plague we have extensively discussed the various forms of financial and economic discrimination that our dear women are being subjected to, even in our supposedly much more egalitarian times. We will discuss this issue many more times in this series but today we are showing you what we wrote about the inequality in the British National Health Service (NHS)

“In May 2018 the United Kingdom’s Department of Health and Social Care did a study on gender equality in the NHS [i], led by Professor Dame Jane Acre; it used data from 10 years of electronic records of 16,000 general practitioners and 96,000 trust physicians. They found that the gender gap was 17% based on total pay, which contributes to the overall 23% NHS pay gap. “Male doctors are earning 1.17 pounds for every pound earned by female doctors in the NHS, and new data reveals that women are still not represented in equal proportions in senior medical grades, with nearly 32,000 male consultants to just 18,000 females. The General Practice gender gap is 33%, which is far higher than the average in medicine.” [ii]

Even though half of the physicians in training were female, only a third of the most coveted positions were held by women—18,000 women in a total of 32,000 consultants. They were disproportionately present in lower-paying specialties like Dermatology, compared to the higher number of men in higher-paying ones like Surgery. The same study showed that the demands of motherhood and the burden of irregular working hours seriously harmed their career advancement. [iii]

If this abject pay scale disparity for men and women can occur in a supposedly modern society that had recognized the societal value of equitable access for Health Care, what can we expect of other less enlightened ones?  We, the XY-healers, know that our female peers often work much harder than we do. Noblesse oblige.”

What do you think? Please tell us.

Don’t leave me alone.

[i] https://www.gov.uk/govenment/organisations/department-of-health-and-social-care

[ii] Laura Butler, “Male doctors earn 1,17 pounds for every pound earned by female doctors”, Press release, March 29, 2019. https://www.surrey.ac.uk/news/male-doctors-earn-ps117-every-ps1-earned-female-doctors

[iii] Denis Campbell, “Male NHS doctors earn 17% more than their female peers”, The Guardian, March 28, 2019.

https://www.theguardian.com/society/2019/mar/29/male-nhs-doctoors-earn-17-more-than-their-female-peers

Physician and Nurse burn-out – part III  Obnoxious pinging

Historians claim that we wouldn’t be able to stand the atrocious stench that arose from the open gutters of the Middle Ages cities, except for a few that had sewers. Likewise the inhabitants of those same cities would quickly become demented if they were subjected to the humongous noise pollution that we get in public spaces. Steadily yet alarmingly we have become accustomed to multiple noises that creep from all the portable and fixed electronic devices that crowd all the available space.

In our new book Emotional Frustration-the hushed plague, we discussed the trolling toll of Technology (that’s the title of the chapter) in our daily lives, especially after the invasion of the small screens in 2007—those ubiquitous mind-snatchers. Almost all our human relationships have been drastically changed by the gawking at those devices that continually transmit all kinds of information—as well as dis-information—to our minds; at the same time they function as surreptitious emitting antennas that transmit our preferences, contacts, choices, inquiries, to total strangers.

One of the most frustrating experiences that many medical professionals encounter at present is the inability to concentrate properly to fill the humongous amount of paperwork that public and private payors demand to reimburse their care services. For years physicians and nurses have had to write comprehensive medical notes where the main complaints—and all the accompanying modifiers of diagnoses—had to be carefully and honestly described for all kind of care reviewers, including the administrative personnel of the institution and the utilization  review specialists. We discussed in another blog about data how once the patient leaves our office, a torrent of medical information is instantaneously shared out with multiple digital endpoints.

In order to comply with all those strict requirements—especially with the time-sensitive parameters of Electronic Medical Records (EMR)—those professionals need to put some distance with all the noise pollution from colleagues’ and patients’ devices. Who can reasonably focus on an accurate clinical description of a serious illness or a major procedure when there is a multi-faceted explosion of pinging all around? The least we can expect is to have some quiet to reflect on our very difficult choices. The brutal demand of our time should not be synonymous with its constant sullying out.

Like the “loose lips” of World War II, those “loose noises” can still sink our ships.

What do you think? Please tell us.

Don’t leave me alone.

Physician and Nurse burn-out – part II Jockeying games

One of the more insulting and disgusting maneuvers that most physicians and nurses have to contend with in our tough professional careers is the sickening, absurd re-positioning of our roles in a care team by the hospital and clinic administrators. Feverishly eager to find a “better edge” to supposedly deliver a much more “efficient care”—a not so subtle euphemism to mask their perennial quest to save a buck—they usually sit down in their plush air-conditioned offices to concoct all kind of specious changes to our work schedules and organigrams–effectively treating  us as inter-changeable peons in the big chessboard of their institutional structure. And, being usually totally ignorant of how a particular health care delivery team really works, they almost never fail to pick a humble nurse who, being very professional and committed, seemingly does not make much ado at her critical role in the team. She just soldiers on. Their maladroit tampering will trigger a chain reaction with unforeseen consequences.

The jockeying games.

Abusing an equine metaphor, we could say that they treat us as just a bunch of race horses—highly trained but docile animals all the same—whose standing they must continually re-arrange in the start line to get the best performance in the race track; infused with a self-serving objectification of their subalterns,  they “candidly” believe they can make do without any consideration whatsoever for our thoughts, desires, personal issues—let alone our feelings and aspirations. After all, horses do not feel. Or do they?

We have been far too meek to confront them in order to at least voice our concerns. Unfortunately, this perverse maneuvering affects our nursing colleagues the most. Career nurses have taken a long, long time to acquire the skills and expertise to fill critical positions in a specialized care team, something that cannot be replicated “on demand” by the bureaucrats manipulating their schedules and labor requirements.

Moreover, the same difficult and exhausting learning process involves all the other members of a particular care team, which endows them with their precious value. If a careless bureaucrat decides one day, out of the blue, to take one of these highly skilled nurses from that habitat and force-land her in a completely different team altogether, often great misery ensues for all, including the sacrosanct “bottom line.” Even the humblest of nurses is usually much more important than all the physicians combined in order to secure the smooth functioning of a specialized care team. What would happen to the daily surgical schedule of a major hospital if the nurse that does the final check-up at 6 AM is being replaced by a novice graduate in the OR suites?

Worse of all, these committed and expert women have painstakingly accommodated their family obligations to the draconian demands of their career obligations, which is no easy feat. The daily schedules of these devoted wives, mothers and daughters have been methodically calibrated to the latest minute in order to achieve their utmost efficiency for good outcomes for their loved ones. How can they suddenly switch gears and find the alternate arrangements for their partners, children, elderly parents, pets, etc., in that gratuitously provoked (often manly) mess in their agendas?

The institutional mandarins should stop playing around with our personal lives.

What do you think? Please tell us.

Don’t leave me alone.