Plum Health Blog
Coronavirus Update for Detroit on April 5th, 2021
The house is on fire.
Michigan reported 8,413 new Covid-19 cases on Saturday, bringing the state's total pandemic case count to 692,206.
There were 8,413 new Covid-19 cases on Saturday - we’re getting close to that big spike that we had around the holidays in November and December of 2020, and that’s not good news.
16,218 Michigan residents have died over the last 13 months from the Coronavirus.
Just because you're "over it" doesn't mean that Coronavirus will magically disappear.
We're all tired - we all want this to be over with.
But now is not the time for recklessness.
Be safe, be smart, mask up, keep your distance, and get the vaccine as soon as you can.
On the bright side, 31% of Michigan residents have gotten at least one dose of the vaccine, and 19% are fully vaccinated.
I was on Daily Detroit with Jer Staes talking about Coronavirus and why cases are skyrocketing here in Metro Detroit.
Listen here: http://www.dailydetroit.com/2021/03/30/the-house-is-on-fire-with-coronavirus-in-metro-detroit/
Or listen here:
Thanks for reading and have a great week. - Dr. Paul Thomas with Plum Health DPC
Coronavirus Vaccine Update for March 23rd 2021
Coronavirus status for march 25th 2021
I'm upset about this most recent spike in Coronavirus cases here in Michigan and Detroit/Southeast Michigan.
Yesterday, the State of Michigan reported 4,454 new cases, and sadly we are nearing 16,000 deaths from COVID.
We can do better. We all need to get vaccinated to protect ourselves, our loved ones, and our community. So far:
- 25.12% of Michiganders have received a single dose
- 14.31% of Michiganders have received both doses
That's great, but it will take 60 to 70% of us getting vaccinated to reach herd immunity.
I know that a lot of you are hesitant to get the vaccine, that's why I created this video and I answer as many questions as I possibly can to address these concerns. And, I'm happy to answer any other questions you have in the comments below.
Please - get the shot. You hold the power to save a life (or multiple lives) by getting vaccinated.
Coronavirus update march 2021
This is a presentation by Dr. Paul Thomas of Plum Health DPC in Detroit Michigan regarding Coronavirus, COVID 19, Coronavirus Vaccines, and frequently asked questions about COVD 19.
Topics:
Rising cases in Michigan, potentially due to lessening of restrictions
Age groups that are at the highest risk for Coronavirus
Comorbidities and Coronavirus, and why these pre-existing conditions lead to a higher risk of dying from Coronavirus
Hospitalizations and deaths related to coronavirus in the context of coronavirus and underlying medical conditions
How the mRNA vaccines work to create the Coronavirus Spike Protein
The difference between Pfizer, Moderna, and Johnson and Johnson Vaccines
What is the Adenovirus Vaccine Vector for the Johnson and Johnson Vaccine
Addressing a myth: the vaccine will alter my DNA - this is not true, the mRNA vaccine does not alter your DNA
Why the mRNA is easier and safer to produce and why it’s safer for patients
When will you get your vaccine? ie When will the coronavirus vaccine be available to me? (12:00)
Comparing and contrasting the Pfizer, Moderna, and Johnson & Johnson Vaccines
all of the vaccines are 100% effective in preventing hospitalization and death
The Johnson & Johnson vaccine is a 1 shot vaccine, so it may be better for specific populations
Comparing Polio to Coronavirus and Elvis Presley to Dolly Parton
How many vaccine doses have been given?
Is the Coronavirus Vaccine safe? (22:00)
If I’ve already had Covid, should I still get the Coronavirus Vaccine?
Should I get vaccinated with the coronavirus vaccine if I’m currently sick with Coronavirus?
Should I get vaccinated with the coronavirus vaccine if I’m currently pregnant or breastfeeding?
Vaccine efficacy against the South Africa and United Kingdom variants?
When will the Johnson and Johnson Vaccine be available?
What is Coronavirus Antibody testing (34:00)
What about myocarditis in college athletes who’ve had coronavirus?
Will there be a booster shot for Coronavirus vaccines?
What vitamins should you take to help ward off Coronavirus?
How common is Anaphylaxis after you get the Coronavirus Vaccine?
Can getting the Coronavirus cause problems with your immune system?
Thanks for reading and watching and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
How to Get the Coronavirus Vaccine at Ford Field in Detroit
This letter from Governor Gretchen Whitmer elucidates how to get the Coronavirus Vaccine at Ford Field:
The Ford Field site will operate from 8 a.m. to 8:30 p.m., seven days a week, for eight weeks under the federal government's vaccination pilot program. The community vaccination site is set to officially open on March 24.
After the registration process is completed, Michiganders who have registered will receive an invitation either by voice or text when it’s your turn to schedule the appointment. Vaccine appointments will be scheduled a few days in advance.
Sign-up is available through these three options:
Text EndCOVID to 75049
Call the MDHHS COVID-19 Hotline at 888-535-6136 (press 1)
Residents who don’t have access to the internet or need assistance navigating through the registration process can use the MDHHS COVID-19 Hotline to register. Call Monday through Friday from 8 a.m. to 5 p.m., and Saturday and Sunday 8 a.m. to 1 p.m. It is expected that the call center will have long wait times, so calling is recommended only if you cannot register online or by text.
The vaccine will be offered at no cost, and insurance is not required, nor will it be requested at the vaccination center.
Free parking will be available at the vaccination site. For those who indicate, during the registration process, they need assistance obtaining transportation to and from the vaccination site, the state is working to provide free of charge ride share options.
The Ford Field community vaccination site is a testament to what we can do when we work together. I am grateful for President Biden’s leadership and for the partnership of the Detroit Lions, Meijer, Wayne County, the City of Detroit, and our federals partners at FEMA.
We will keep ramping up our equitable vaccine rollout, and with the addition of the Ford Field community site, we are taking a significant step towards returning to normal as we continue rebuilding our economy.
Let's end this pandemic together.
Governor Gretchen Whitmer
Ford Field has hosted different health related events in the past - check out our blog post from two years ago where we participated in a Men’s Health event at Ford Field.
Also, let me clear on this point: getting the Coronavirus Vaccine at Ford Field will not be the most painful experience that you’ve ever had at Ford Field, especially if you’re a Lion’s Fan. If you’ve lived through this moment, then you can tolerate the Coronavirus Vaccine.
Thanks for reading all of that, as a reward, here’s a video of me kicking a field goal at Ford Field:
More information on the Coronavirus Vaccine at Ford Field:
Vaccine is offered at no cost
No insurance required to get the vaccine
Any Michigan resident, 16 or older, can register
After registration, the Michigan Dept. of Health and Human Services will offer you a time to schedule the vaccine
Folks who are eligible now include:
65 years of age or older
50 to 64 years with a medical condition or disability
health care workers
long term care residents and staff
frontline responders
school and childcare staff
mortuary service workers
correctional staff and detained individuals
congregate care facility staff and residents
food workers
caregivers for children with special needs
Free parking is available at the Gem Theatre if you’re entering through Gate A (red gate)
Free parking is available at the Ford Field Parking Deck if you’re entering through Gate G (green gate)
Free transportation is an option, and you can request free transport at the time of registration
In short, get your COVID vaccine now, and let's end the pandemic, just like the Green Bay Packers end our playoff hopes every season.
Thanks for reading and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
Coronavirus Update for March 2021 - Understanding the Vaccines
There are a ton of questions about the Coronavirus and what's going on with the virus and the vaccines in the City of Detroit and in Michigan, so I try to answer as many of those questions as I can in this video.
Low Rate of Pediatric Flu Deaths This Year
Did you know that there's only been 1 pediatric flu death this entire flu season? That's down from 150 to 200 pediatric flu deaths annually and it is likely attributed to mask wearing, physical distancing, and children being out of school.
Number of Coronavirus Cases in Michigan are on the Decline
In the State of Michigan, there have only been 1,400 new cases each day on average over the last 7 days, which is tremendous improvement from 9,000 cases each day in late November and early December 2020.
Coronavirus Death Toll in Michigan Hits a Grim Milestone
That being said, 15,610 Michigan residents have died from the coronavirus. To put that into perspective, there are 15,570 residents in Traverse City and 15,498 residents in Grosse Pointe Woods. To say that the coronavirus death toll is staggering is an understatement.
Coronavirus Vaccine Distribution in the State of Michigan
Fortunately, the vaccine doses are being distributed efficiently here in the State of Michigan and in the City of Detroit. 2.48 million vaccines have been given state-wide, and 8.92% of Michigan residents or 891,000 people have received 2 doses. Michigan ranks 9th in number of vaccines distributed nationally, and that's great.
How Does the mRNA Vaccine Work?
Next up, the Pfizer and Moderna Coronavirus Vaccine are made by injecting mRNA into your body, and that mRNA makes a spike protein which elicits an immune response from your body. People often think that the mRNA vaccine changes your DNA, but it doesn't.
Who is Eligible for the Coronavirus Vaccine in the City of Detroit?
Many more people are eligible for getting the coronavirus vaccine as time goes on. In Detroit, if your 50 or older with a pre-existing condition, you're eligible. If you're a food service worker, you're eligible. If you're a member of the clergy, a factory worker, a janitor, or a teacher, you're eligible.
You can see full details on who is eligible by going to this link or call 313-230-0505 Monday-Friday from 9 am until 6 pm to schedule an appointment.
The Johnson and Johnson Vaccine
The Johnson and Johnson vaccine is now available - it only requires one dose and it's a adenovirus vaccine, which means the vaccine is packaged in a virus vector. The J&J vaccine is 85% effective agains severe disease and 100% effective against hospitalization, and you only need one shot. If you're offered any of the available vaccines, get the shot, protect yourself, and protect your loved ones.
Stay safe and healthy,
- Dr. Paul Thomas with Plum Health DPC in Detroit, MI
City of Detroit Vaccine Rollout Update
The vaccine rollout here in Michigan has been relatively slow compared to other states. The Washington Post has a great article tracking vaccinations. Here’s where Michigan stands in the COVID vaccine effort:
At least 222,379 first doses have been administered (total population is 9.987 million)
covering 5.2% of the prioritized population...
and 2.2% of the state’s population.
Michigan has been allocated 696,600 doses,
enough to vaccinate 16.0% of the prioritized population...
and 7.0% of the state’s population.
On Monday, we received a press release from the City of Detroit about the Coronavirus Vaccine out of the TCF Center. Here it is, in full:
Statement from Detroit COO Hakim Berry on TCF COVID Vaccine Scheduling process
Since 9am this morning our COVID vaccine scheduling call center staffed by Rock Connections has experienced extremely high volumes, receiving more than 100,000 calls. Those who predicted that Detroiters would not be interested in receiving the vaccine were clearly incorrect.
Rock Connections has already increased its call center staff from 42 to 56 representatives booking the appointments. Call Center hours have now been increased by two hours a day and will operate 9 AM and 8 PM.
Our system is set up so that calls will not be kept on hold if there is more than a half-hour wait to speak to a representative. If your call is dropped, please call later today or anytime this week. At any point the wait time is under 30 minutes, your call will go through.
A major cause of call volumes is a large number calls from individuals who are not eligible. We do not have the capacity to answer questions from people under 75 or non-Detroiters about vaccinations in general. If you are not eligible to book the vaccine, please do not tie up the call lines.
As a reminder, people should call 313-230-0505 to schedule an appointment only if they meet the following qualifications:
A Detroit resident 75 and older
Any “good neighbor" 65 and older who drives a 75 year old (or older) Detroit resident to TCF
The following Group B essential workers: K-12 teachers and support staff and child care workers
We are booking 20,000 appointments through February 5th. The call center has the ability to book up to 4,000 appointments per day, so we expect to be booking appointments at least through the end of the day Friday. We will add to those appointments as fast as the federal government provides vaccines.
We thank Detroiters for their patience in this process and, most of all, for their commitment to being vaccinated so life can get back to normal as soon as possible.
This is somewhat frustrating, because the listed qualifications above are narrower than what was previously released. The previous statements from the State of Michigan include more people in the Phase IB, but the City of Detroit must be focusing on Group A only at this time, which includes only seniors over the age of 75:
Group A:
Persons 75 years of age or older not covered in Phase 1A.
This includes those in a congregate setting that were not reached in Phase 1A.
Henry Ford Health System Vaccine RollOut
Henry Ford Health System is also rolling out the vaccine here in Detroit, so if you have a MyChart account with Henry Ford, you could potentially receive an email from Henry Ford Health System (HFHS) about this vaccine option. See below for full details - this information was sent out to HFHS staff on January 8th.
What’s interesting to note is that Henry Ford is following the State of Michigan guidelines for eligibility, including “anyone 65 years and older and a broader category of essential workers.”
We have made considerable progress vaccinating our team members, having administered first doses to nearly 17,000 employees, with second doses underway for those vaccinated during our first days of the campaign. We are now expanding eligibility to volunteers, Henry Ford retirees 65 years and older, and approximately 3,000 students from our clinical education community. Additionally, we are partnering with multiple leaders across our region in a collaborative effort to vaccinate private practice physicians and other healthcare workers.
As you likely know, the state of Michigan has also expanded guidelines for eligibility to include anyone 65 years and older and a broader category of essential workers. Based on that guidance, we are finalizing our plans to begin vaccinating patients and members that meet those guidelines beginning next week.
Sites: We plan to launch two types of sites over time – those that will operate from our existing primary care clinics and others designed to serve as “mass vaccination sites” to accommodate larger numbers of patients safely, provide greater access and parking, and operate without disruption to our normal clinical activities. Here’s a breakdown by market:
South - The K-building at Henry Ford Hospital will open Monday, Jan. 11, with Henry Ford Medical Center – Ford Road expected to open by the end of next week
North - Three sites are expected to open by the end of next week: Henry Ford Medical Centers Lakeside and Columbus and the HAP Troy administrative building
Central - Two sites are expected to open next week: One Jackson Square as early as Monday, Jan. 11, followed by Henry Ford Allegiance Specialty Hospital, the current site for drive-through testing
Staffing: We know staffing continues to be a challenge but we have identified a number of viable options including our own primary care team members to staff the medical center locations. Additionally, HR plans to activate our central staffing model early next week to help identify needs, as well as team members who may be able to redeploy.
Scheduling & Patient Engagement: Initially, we will need to prioritize existing Henry Ford patients 65 years and older and plan to contact them proactively via email, providing resources to help them make an informed decision and encouraging them to sign up for MyChart if they haven’t already, for online scheduling when appointments become available.
We know that much of this is new territory and we will need to be agile as things change. A complex, community-wide vaccination campaign of this size and uniqueness requires unprecedented partnership, innovation and determination. We can’t imagine pulling this off with any other team and we are so proud of your efforts in service to our communities and each other.
Thanks for reading, and best of luck navigating these vaccine resources.
-Dr. Paul Thomas with Plum Health DPC
Frustrations Around Vaccine Rollout are Palpable
As we learn more about Coronavirus Vaccine availability, we'll keep you updated.
Vaccine Options for Oakland County Residents
For residents of Oakland County, there are some options, but they are not robust at this time.
One option would be the Oakland County Health Department. It looks like they are not yet vaccinating https://oaklandcountyvaccine.com/eligibility/
You could periodically check this website to see when they are opening up mass vaccinations.
The other option would be Beaumont Health. However, their website crashed on Friday from people trying to make appointments.
You could try to create an account via the MyBeaumont Chart, here: https://www.beaumont.org/my-beaumont-chart and hope that they send an email to you.
Some of our patients have received an email invitation via the Beaumont MyChart system to get the vaccine. They are trying to give it to people over 75 and then over 65 years of age.
Henry Ford Hospital is doing something similar. Here’s some information from the Detroit Free Press:
Don't call us. We'll call you.
That's what the state's COVID-19 vaccine website and many local health departments are telling seniors, teachers, child care workers and law enforcement officers who will be eligible starting Monday for coronavirus vaccines through an expansion of the statewide immunization program.
In part, that's because local health officials had almost no heads up before Gov. Gretchen Whitmer announced anyone 65 or older would soon be eligible to be vaccinated.
Whitmer announced Wednesday that starting next week, people in Priority 1B group will be able to get COVID-19 vaccines along with health care workers, people living and working in long-term care facilities and emergency medical responders who are part of the 1A Priority group.
In short, a lot of people are feeling frustrated and confused about the vaccine roll out - you're not alone in this.
As we know more information, we will share it with you.
As an addendum, in yesterday’s blog we talked about the Vaccine Rollout at the TCF Center in Detroit. Some of our patients have been calling the number since 9 am and it has been continually busy. If you get through, please send me an email or drop a comment on the bottom of this post.
- Dr. Paul Thomas with Plum Health DPC
How To Prepare for the Holidays During the Coronavirus Pandemic
As winter approaches with COVID cases surging, taking steps to keep yourself and your loved ones both physically and mentally healthy is of paramount importance.
Get a Flu Shot
First and foremost, those who are able should receive the annual influenza vaccine as soon as possible. The CDC defines flu season as the period from December to January, meaning the peak for influenza cases this year is rapidly approaching.
While the flu shot will not specifically protect you from COVID, the vaccination confers a host of benefits, including reduced likelihood of hospitalization or exacerbation of chronic diseases such as COPD, diabetes, or heart disease. Reducing hospitalizations can relieve some of the burden on our already-strained hospital system as we contend with the rising number of patients with COVID.
For context, influenza caused 38,000,000 symptomatic illnesses, 18,000,000 medical visits, 400,000 hospitalizations, and 22,000 deaths in the United States during the 2019 to 2020 flu season. If everyone got a flu shot prior to this season, we could see a dramatic reduction in these numbers.
Winter Holiday Planning
Another consideration is planning for the winter holidays and the gatherings that tend to accompany them. As the cold weather drives more people inside and impairs the ability to gather outdoors, we expect to see the number of COVID cases increase markedly.
This is obviously a touchy subject; this has been a stressful year, and most of us want nothing more than to spend time with our friends and families. A strong social support network lowers stress, promotes good mental health, and can even lower your blood pressure.
While these benefits from social support systems are certainly desirable, steps should be taken to ensure everyone can enjoy the festivities without increasing the risk of getting sick. The current statewide restrictions limit indoor gatherings to a maximum of 10 people and no more than two households, so it is important to plan accordingly.
To maximize safety, anyone you invite should be practicing safe habits, including wearing a face covering like a mask, maintaining physical distancing at 6 to 10 feet at all times, and washing their hands regularly, prior to coming to the event to reduce the likelihood of catching COVID from community spread.
If there is any doubt as to whether someone may have acquired coronavirus before coming to your house, there are many sites where free testing is available, including the City of Detroit testing site at the Joseph Walker Williams Community Center on Rosa Parks Boulevard and most commercial drug stores like Walgreens and CVS.
If you test positive or test negative and have symptoms highly suspicious for COVID, including fever, dry cough, and loss of taste or smell, the safest course of action is to stay home and self-quarantine for 10 days. The worst case scenario would be to spread coronavirus from yourself to an older, sicker, or more vulnerable member of your family who could die from COVID or suffer significant physical impairments from the virus.
At the gathering, try to maintain physical distance as much as possible, wash your hands frequently, avoid sharing utensils, and consider shortening the duration of the event, as longer time spent indoors is associated with a greater risk of spreading the virus.
How a Healthy Lifestyle Can Help
Finally, try to maintain your regular healthy lifestyle habits, even during the winter months. If you typically exercise outside, dress in layers and ensure you are well-hydrated. Do your best to get eight hours of sleep each night, and practice healthy eating as much as possible.
There is always the temptation to overeat during the holidays, so conscientious eating and portion control can help reduce excess calorie intake and still allow you to enjoy your favorite holiday dishes.
The changes in weather and lack of sunlight can also trigger or worsen depression in some individuals, so it is important to communicate with your primary care physician about any depressive symptoms you may be experiencing. In general, it is good practice to keep in touch with your primary care physician, as they are best equipped to manage your healthcare concerns.
For those without a Primary Care Physician, my practice, Plum Health DPC, is currently accepting new patients. We offer subscription-based care and affordable testing and medications, including flu shots and COVID antibody testing. Anyone interested in signing up or seeking additional information can visit our website, here.
Thanks for reading and watching,
-Dr. Paul Thomas with Plum Health DPC, written with Geoffrey Ginter, Third Year Medical Student at Wayne State University School of Medicine
Coronavirus Update for August 2020 in Detroit
This is Dr. Paul Thomas with Plum Health DPC https://www.plumhealthdpc.com/ and I'm giving a Coronavirus Update for August 2020.
What's up with the spikes of cases in Oakland and Macomb County recently? It's likely that people are gathering for big events (I'm looking at you Jobbie Nooner, 43rd Port Huron Float Down, and the unofficial Woodward Dream Cruise) and not wearing masks or maintaining social distancing.
Stay safe. Wash your hands. Wear a mask. Protect yourself, your loved ones, and your neighbors, near and far.
#PlumHealth #CoronavirusUpdate #DirectPrimaryCare
Help Protect Other People From Coronavirus, Wear A Mask
How can you help protect yourself and other people from coronavirus? Wear a Mask
This week, Daily Detroit asked me a ton of questions about the Coronavirus and how to protect yourself, your family, and your community from the spreading virus. It boils down to wearing a mask. I answer many other questions during the podcast, listen here:
Why Should I wear a Mask?
You should wear a mask to prevent the spread of coronavirus. Here’s why:
Coronavirus has a long incubation period. People can have the virus without knowing it or having symptoms for about 4 to 5 days on average. This 4 - 5 day period of having the virus without showing symptoms is known as the incubation period. Some people can be in this incubation period for up to 14 days! Therefore, you could be walking around, infected with coronavirus and unknowingly spreading the virus to your friends, family, coworkers, and vulnerable people in your community. This is the main reason why you should wear a mask.
Coronavirus does not always cause symptoms. For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. So, in most cases, if you get the Coronavirus, you’ll be asymptomatic. If you’re asymptomatic, you can still spread the virus, so it’s important to wear a mask to prevent spreading the virus to your close contacts.
Wearing a mask prevents you from spreading the virus via respiratory droplets. When you talk, cough, sneeze, sing, yell, or breathe, you give off tiny respiratory droplets. These droplets carry the coronavirus and can land on surfaces or land in the noses or mouths or eyes of your close contacts. Wearing a mask puts a physical barrier between your nose and mouth and those around you, and therefore decreases the spread of droplets and the spread of coronavirus. If you want to explore this further, check out this blog post from Indian Express. Briefly, if you wear a mask it reduces the amount of bacterial and viral particles that you expel from your mouth when talking, as demonstrated in this image.
This PhD Scientist demonstrates bacterial growth related to wearing a mask vs not wearing a mask.
Why are bars being told to shut down?
Many bars in Michigan are closed or being ordered to close after outbreaks of coronavirus. There are four big reasons why bars are the best places to get coronavirus:
People drink at bars, and it’s difficult to wear a mask while drinking. Without a mask, it’s easier to spread Covid 19.
There tends to be loud music at bars, so people tend to raise their voices and speak more forcefully. This forceful speech tends to spread more respiratory droplets, which leads to an easier spread of coronavirus.
People tend to get closer to one another at bars - the less physical distance between people, the easier it is to spread Covid 19.
Bars are enclosed, intimate spaces, usually with poor ventilation. Many bars are windowless with low ceilings and poor ventilation systems. This can serve as a great space for a virus to circulate.
This is why bars like Harper’s in East Lansing have seen outbreaks of Coronavirus.
Here’s what Daily Detroit had to say:
Welcome to the holiday weekend, everybody. This is certainly a strange one, with coronavirus numbers once again on the upswing in Michigan and across much of the country, adding a complicated wrinkle to what is normally one of the busiest travel weekends of the year.
On today’s show, we make a house call to our friend Dr. Paul Thomas, founder of Plum Health Direct Primary Care in Detroit, for help answering your burning questions about COVID-19. We talk face masks, whether it’s safe to eat at restaurants or fly on airplanes, what to make of coronavirus liability waivers and more. And we’ll remind you that if you’ve got health-related questions about coronavirus, send ’em to us at dailydetroit@gmail.com and we’ll do our best to include them in future episodes with Dr. Paul. You can even send us audio of your question and we’ll try to work that audio into the show.
Also, we talk the latest, dispiriting COVID-19 data from the state and how we’re holding up from a mental health perspective more than three months into this weird, horrible quarantine that unfortunately shows little sign of ending anytime soon.
Thanks for reading, and stay safe out there!
-Dr. Paul Thomas with Plum Health DPC
Paul Thomas MD Interviewed on Model D Media
On April 7th, 2020, Dr. Paul Thomas was interviewed by Dorothy Hernandez during Model D Media’s Facebook Live stream. The topic was Coronavirus and how we are managing this pandemic in the Detroit community.
Here’s what Model D Media wrote about this:
Editor’s note: This guest column by Dr. Paul Thomas, a family medicine doctor and founder of Plum Health Direct Primary Care, has been adapted from this blog post on the health center's website. Click here for the full post published on April 4.
The COVID-19 pandemic has brought an overload of information — and there's a lot of misinformation out there. Do you have a question for Dr. Thomas about coronavirus? Join us on our Facebook page for a Facebook Live Q&A at 10 a.m. Wednesday, April 8, with Dr. Thomas.
Q: Which counties nationwide have been impacted the most by coronavirus?
A: From the perspective of the number of cases and the number of deaths, the following counties/areas have been impacted the most by the coronavirus:
New York City (Queens, Bronx, Manhattan, Brooklyn, Staten Island)
Wayne County, Michigan
King County, Washington
Orleans County, Louisiana
Cook County, Illinois
Oakland County, Michigan
Bergen County, New Jersey
This comes from the Johns Hopkins Coronavirus Resource Center and it's notable that Michigan has two neighboring counties in the top six hardest-hit counties: Wayne County and Oakland County.
Q: Why has Michigan and Southeast Michigan been hit so hard by the coronavirus?
A: Bridge Magazine wrote an excellent article on this and I agree with their assessment with one addition that we haven't been talking about.
In the article, Bridge Magazine talks about the following factors causing Michigan to be more susceptible to the virus:
Automotive trade with suppliers in Wuhan China
Detroit Metro Airport with Direct Flights to Wuhan, China
Michigan’s March 10th Presidential Primary
Ties between Detroit and Italy via Fiat Chrysler (FCA)
In addition to these factors, I would want to add a few others, including higher rates of overweight and obesity in Detroit and Michigan - rate of overweight is 47.5% in Detroit (34% in NYC) and rate of obesity is 34.6% in Detroit (22% in NYC).
All of these factors have led to a higher case fatality rate here in Detroit and Michigan than the national case fatality rate:
National case fatality rate is 2.47%
Michigan case fatality rate is 3.75%
Detroit case fatality rate is 3.29%
Q: What are the comorbid conditions increasing the risk of mortality in COVID-19 positive patients?
A: [Last] week, I spoke with a physician colleague at one of the nearby regional hospital systems and we discussed the conditions that lead to a higher mortality rate. These comorbid conditions are as follows:
Cardiovascular disease (High blood pressure)
Diabetes
Pulmonary Disease
Obesity
Cancer
These factors that we discussed were similar to those studied in Wuhan, China.
While it’s still too early to state exactly why this is the case, I have a few theories. First, African American folks have higher rates of diabetes, hypertension, and obesity than their white counterparts here in Detroit and in Michigan. As we stated above, these are risk factors for higher mortality from the coronavirus. Next, African American people may be more likely to depend on low and minimum wage jobs that put them at a higher risk of contracting the coronavirus.
Q: Should I wear a mask to prevent the spread of the coronavirus?
A: Yes, the CDC now recommends that all Americans wear a mask when in a place where they have a higher chance of contracting the Coronavirus, like grocery stores. This can be a cloth or fabric mask. Please wash these each day if you wear them. Please do not hoard surgical or N95 masks as these are needed at hospitals at this time.
Q: What can you do to slow down the coronavirus?
A:
Stay at home
Donate extra supplies to hospitals or your primary care doctor’s office
Unused N95 masks
Unused nitrile gloves
Donate blood
DO NOT congregate in large groups
DO NOT visit elderly or vulnerable relatives, even if you feel fine
Act as though you have the virus
Coronavirus Update: What's Up With Antibody Testing?
Coronavirus Update for Detroit Michigan
As of April 16th, 2020 at 3 pm, there have been 673,215 cases of Coronavirus in the United States and 34,384 deaths from the Coronavirus in the US. This is a case fatality rate of 5.1%.
There have also been 29,263 Total COVID-19 cases in Michigan and 2,093 deaths in Michigan, for a case fatality rate of 7.15%. Further, Detroit has seen 7,383 Coronavirus cases and 546 Coronavirus deaths, for a case fatality rate of 7.3%.
Racial Disparities in Health Outcomes for the Coronavirus
There have been and there continue to be racial disparities in health outcomes related to the Coronavirus. Here in Michigan, African Americans make up only 14% of our state population, but account for 41% of the deaths due to Coronavirus statewide.
Here in Michigan, African Americans make up only 14% of our state population, but account for 41% of the deaths due to Coronavirus statewide.
In other regions, the disparities are even more evident. In Chicago, where African Americans make up only 30% of the population, they account for 52.1% of the COVID-19 cases, and 68.6% of the COVID-19 Deaths. You can read more about Chicago specifically, here.
In Louisiana, the disparity is similar. Louisiana’s population is 33% African American, according to 2019 U.S. Census data. According to the Governor of Louisiana, 70% of Louisiana’s coronavirus deaths are African Americans.
In Chicago, where African Americans make up only 30.1% of the population, they account for 52.1% of the COVID-19 cases, and 68.6% of the COVID-19 Deaths. You can read more about Chicago specifically, here.
When these stats are brought up, some people point to disparities in underlying health conditions as the reasons for these disparities in death rates among African American communities. And yes, that is the point - there are huge underlying health disparities between African American people, Caucasians, and other minority populations, and if we as a society want to stop pandemics from disproportionately affecting minority communities in the future, we will have to work tirelessly to address these health disparities.
Comparing Coronavirus and Influenza
Both Coronavirus and the Flu are spread by droplets, but Coronavirus may also be airborne, making transmission that much easier for Coronavirus. The incubation period for Coronavirus can be 1 to 14 days. This makes transmission of the Coronavirus much easier because during that incubation, the person who is infected may not have any symptoms, but they may be infecting others by shedding virus. This paired with the Transmission rate or R0, leads to a greater rate of spread and infection. This is why our stay-in-place orders statewide here in Michigan are so critical - we’re saving lives by staying at home and preventing the virus transmission.
Unlike the Flu, there are no available antiviral treatments and there are no vaccines for the Coronavirus. For the Flu, we have Oseltamivir (Tamiflu) and the Flu Shot to help us treat and prevent the Flu from spreading, but we don’t have these options for Coronavirus.
The hospitalization rate is much higher for Coronavirus, at 12 to 20%, whereas the hospitalization rate is only 0.6% to 1% for the Flu. Death rates are also very high for the Coronavirus. As discussed above, the case fatality rate for the US is 5.1% and the case fatality rate for Michigan is 7.15%. This makes the Coronavirus 50 to 70 times more deadly than the Flu.
How Much Does Coronavirus Care Cost?
The President has worked with health insurance companies to make Coronavirus testing free, but there are other costs that patients incur when seeking care for the Coronavirus. If you’re uninsured, you can be charged $149 for a 15 minute visit with your doctor, $86 for flu A and flu B testing, and $94 for some basic lab work.
Compare that with the cost of care in a direct primary care practice, where you pay a monthly membership of $49 to $99 monthly and all of your visits - in person and telemedicine - are included in the membership package. The membership also allows you to get steeply discounted labs, medications, and imaging services.
Comparison of Coronavirus care costs between those who are uninsured, those who have insurance, and those who are members of a direct primary care practice.
What is antibody testing for Coronavirus?
Antibody testing will become increasingly important as we as a Nation confront and manage the Coronavirus pandemic.
Currently, we as a medical community are offering RNA testing, which involves a nasal swab or a posterior pharyngeal swab. This test helps us identify those who actively have the virus and are shedding RNA. This is a good test and it tells us who is actively infected with the Coronavirus. The downside to this test is that there is a relatively short window of time when this test will detect the Coronavirus.
Soon, more and more private labs and hospitals will roll out Coronavirus antibody testing. The procedure looks like taking a prick of blood from the finger and testing that blood for antibodies, or proteins that your immune system makes to fight off this virus. First, your body makes IgM, and then your body makes IgG. IgG gives you long-term immunity to the Coronavirus, and immunologists anticipate that we will carry this immunity for 1 to 3 years.
So, if you test positive for IgM, only, you likely have only recently recovered from Coronavirus. If you test positive for IgM and IgG, you may have had Coronavirus approximately 14 days ago.
The only downside to these antibody tests is that we’re relying on the test manufacturers to produce an accurate test. That being said, this is the best tool that we have right now to find out who has had Coronavirus and who has built a robust immune response to Coronavirus.
What Can you do to Prevent the spread of Coronavirus?
Stay at home
When you go outside of your home, wear a mask and keep 6 feet between yourself and other people. Only go to the grocery store once each week to minimize unnecessary contamination and spread of the virus.
Donate extra supplies to hospitals or your primary care doctor’s office - we currently are running low on masks, so if you have them, we would appreciate a donation to keep our staff, patients, and community safe.
Unused N95 Masks
Unused Nitrile Gloves
Donate Blood
Donate Plasma if you’ve had Coronavirus and recovered - your plasma could be used to save a life.
DO NOT congregate in large groups
DO NOT visit elderly or vulnerable relatives, even if you feel fine
Act as though you have the virus
Thanks for reading and watching, and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
Dr. Raquel Orlich Featured on WDET's Detroit Today
This week, Dr. Raquel Orlich was featured on WDET’s Detroit Today radio program. Dr. Orlich answered many insightful questions from both the host Stephen Henderson and callers. To listen to the show, follow this link.
Raquel Orlich, DO is a board certified family physician. She has been with Plum Health since July 2019 and everyday she works to deliver affordable and accessible health care in Detroit. She is passionate about quality patient-centered care and establishing strong doctor-patient relationships. Her clinical interests include osteopathic manipulative medicine for chronic musculoskeletal issues, women’s health, and preventative health. She is a graduate of Michigan State University College of Osteopathic Medicine and completed her residency training at Ascension Macomb-Oakland Hospital.
Dr. Paul Thomas and Dr. Raquel Orlich are family medicine doctors with Plum Health DPC in Detroit Michigan. Recently, Dr. Raquel Orlich was featured on WDET to discuss Coronavirus.
Here’s the abbreviated transcript from WDET:
Guests
Dr. Anne Messman, emergency room doctor at a Detroit Hospital
Dr. Raquel Orlich, family doctor at Plum Health Direct Primary Care in Corktown, Detroit
I live alone and have been sheltering in place. Is it OK for me to visit other people who have also been sheltering in place by themselves?
No. The social distancing guideline still stands not to visit people. Until we know how to identify asymptomatic carriers, we must stay apart, unfortunately.
Do asymptomatic people ever show symptoms, or do they stay asymptomatic?
“Asymptomatic carriers, by definition, never get sick or show symptoms, but they can still pass on the virus,” says Dr. Messman.
Can COVID-19 survivors get infected by coronavirus after they have recovered?
We don’t know, yet. We do know the coronavirus has mutated several times, so, at this time, we believe it is possible that a survivor could get the virus again.
How long does it take for someone to shed the virus?
It varies greatly. Some people stopped shedding the virus soon after recovery, and for others, it took up to a month. We also don’t know yet if you can infect someone while you’re shedding the virus.
I was exposed to someone who later tested positive for coronavirus. I have had symptoms including a cough and low energy, and I passed out recently. What should I do?
Since there is still no treatment for COVID-19, if you are experiencing mild symptoms, it is best to stay home and recover. Do not take NSAID medications like ibuprofen or Motrin. It is okay to take Tylenol if you want to treat a fever. If your symptoms are severe and you need medical attention, you should go to the hospital.
I had a cold last month and some of those symptoms are still lingering. Is that a symptom of coronavirus?
If you’ve had a cold, or have had seasonal allergies in the past, don’t worry. A tickle in the throat can last weeks after having a cold. However, if you have symptoms that are unusual for you, pay attention for symptoms of COVID-19 and take extra care. If you experience sever symptoms, go to a hospital.
Does using Tylenol to treat a fever negatively impact my immune response? Should I just leave the fever untreated?
Healthcare providers have differing opinions on this question, but if you have a fever and want to treat it, Tylenol is OK. A very high fever can be very dangerous and should not go untreated.
Does wearing a mask protect me, or other people?
Wearing a mask protects both you and other people. The main function of the mask is to catch droplets from someone coughing or sneezing before they get in the air. It is best to wear a mask if you need to go out.
I had a stomach virus recently. Is that a symptom of COVID-19?
Some patients who tested positive have experienced symptoms like diarrhea or vomiting. There are other reasons you might experience gastrointestinal issues including influenza or food poisoning.
I may have been exposed to someone with COVID-19, but I’m showing no symptoms. Can I get an antibody test to find out if am an asymptomatic carrier?
We do not have an antibody test, yet.
This week, Dr. Raquel Orlich was featured on Detroit Today with Stephen Henderson. She was able to answer many listener’s questions about Coronavirus and Covid-19
Coronavirus Update for Detroit Michigan
My name is Dr. Paul Thomas and I'm a Family Medicine Doctor in Detroit, Michigan with Plum Health DPC and this is my update for the Coronavirus as of Saturday April 4th.
Which Counties Nationwide Have been Impacted the Most by Coronavirus?
From the perspective of the number of cases and the number of deaths, the following Counties have been impacted the most by the coronavirus:
New York City (Queens, Bronx, Manhattan, Brooklyn, Staten Island)
Wayne County, Michigan
King County, Washington
Orleans County, Louisiana
Cook County, Illinois
Oakland County, Michigan
Bergen County, New Jersey
This comes from the Johns Hopkins Coronavirus Resource Center and it's notable that Michigan has two neighboring counties in the top 6 hardest hit counties - Wayne County and Oakland County.
What are the current number of cases and deaths from Coronavirus in Michigan?
Currently, there's 12,744 Coronavirus cases in Michigan and 479 deaths from the Coronavirus in Michigan. What's most troubling about this is the rapid and almost exponential growth of cases here in Michigan. We've seen cases doubling every 2 to 4 days, and that trend does not look like it's slowing down any time soon. That's why it's so crucial that we socially distance our selves to stop the spread of the coronavirus from person to person.
The alarming increase in new cases is also why the CDC now recommends face masks for individuals in the community.
Why Has Michigan and Southeast Michigan Been Hit So Hard by the Coronavirus?
Bridge Magazine wrote an excellent article on this and I agree with their assessment with one addition that we haven't been talking about.
In the article, Bridge Magazine talks about the following factors causing Michigan to be more susceptible to the virus:
Automotive trade with suppliers in Wuhan China
Detroit Metro Airport with Direct Flights to Wuhan, China
Michigan’s March 10th Presidential Primary
Ties between Detroit and Italy via Fiat Chrysler (FCA)
In addition to these factors, I would want to add a few others, including higher rates of overweight and obesity in Detroit and Michigan - rate of overweight is 47.5% in Detroit (34% in NYC) and rate of obesity is 34.6% in Detroit (22% in NYC).
All of these factors have lead to a higher case fatality rate here in Detroit and Michigan than the national case fatality rate:
National Case Fatality rate is 2.47%
Michigan Case Fatality rate is 3.75%
Detroit Case Fatality rate is 3.29%
What are the Comorbid Conditions Increasing the Risk of Mortality in Covid-19 positive patients?
This week, I spoke with a physician colleague at one of the nearby regional hospital systems and we discussed the conditions that lead to a higher mortality rate. These comorbid conditions are as follows:
Cardiovascular disease (High blood pressure)
Diabetes
Pulmonary Disease
Obesity
Cancer
These factors that we discussed were similar to those studied in Wuhan China.
Why are African Americans disproportionately affected by Coronavirus?
African Americans in Detroit and Michigan have been disproportionately affected by the coronavirus. Even though African American people make up only 13.8% of the population in the State of Michigan, 35% of the Coronavirus cases and 40% of the Coronavirus deaths have been experienced in the African American community.
Coronavirus Cases by Race in Michigan. This according to Michigan.gov/Coronavirus. Note the higher rates of infection and mortality in the African American community relative to the population. African Americans make up 13.8% of the population in the State of Michigan.
While it’s still too early to state exactly why this is the case, I have a few theories. First, African American folks have higher rates of diabetes, hypertension, and obesity than their white counterparts here in Detroit and in Michigan. As we stated above, these are risk factors for higher mortality from the Coronavirus. Next, African American people may be more likely to depend on low and minimum wage jobs that put them at a higher risk of contracting the Coronavirus.
What is the Hospitalization Rate for Covid-19?
Currently, the hospitalization rate for Covid-19 is about 20% or only 1 in 5 people who get the coronavirus will require hospitalization. However, the rates of hospitalization increase with age, meaning that the older the patient, the more likely that they’ll need to be hospitalized for the Coronavirus. That’s why it’s so important to avoid visiting elderly and vulnerable residents in our community.
The older the patient, the more likely it is that they’ll require hospitalization for management of their Coronavirus infections.
Unfortunately, there is a very high mortality rate once a patient needs to be placed on a ventilator. According to studies out of Wuhan, China, the Mortality rate from Coronavirus is 62% among critically ill patients with COVID-19 and the Mortality rate from Coronavirus is 81% among those requiring mechanical ventilation. That means that if you require mechanical ventilation, only 1 in 5 Covid-19 positive patients will come off of the ventilator.
Limited Availability of Ventilators in Michigan Hospitals
The rapid increase in the number of coronavirus patients and the increasing demand for ventilators is putting hospitals, doctors, and nurses in a terrible situation. We’ve now reached the point where doctors are having to decide who lives and who dies from Coronavirus based on ventilator availability. I spoke with a colleague at a large hospital in the Detroit area who relayed that there were only two ventilators for the hospital remaining and that treatment decisions were being made based on comorbidities.
This is a very sad day because we should have never gotten to this point. If we had a functioning Federal Government with a coordinated response and if we had forward-thinking hospitals with greater capacity for disasters like this, we in the medical community wouldn’t have to be making these terrible life and death decisions based on lack of supplies and equipment.
Should I Wear a Mask to Prevent the Spread of the Coronavirus?
Yes, the CDC now recommends that all Americans wear a mask when in a place where they have a higher chance of contracting the Coronavirus, like grocery stores. This can be a cloth or fabric mask. Please wash these each day if you wear them. Please do not horde surgical or N95 masks as these are needed at hospitals at this time.
What can you do to slow down the Coronavirus?
Stay at home
Donate extra supplies to hospitals or your primary care doctor’s office
Unused N95 Masks
Unused Nitrile Gloves
Donate Blood
DO NOT congregate in large groups
DO NOT visit elderly or vulnerable relatives, even if you feel fine
Act as though you have the virus
Thanks for reading and watching, and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
Coronavirus Update March 26th for Detroit Michigan: Can you be Immune to the Coronavirus?
Coronavirus Update March 26th for Detroit Michigan
The Coronavirus continues to spread in Michigan. As of today at 2 pm, the Michigan Department of Health and Human Services has reported that there have been 60 deaths and 2,856 cases. That is a mortality rate of 2.1% as of today.
The Coronavirus is concerning for so many reasons, but the two biggest reasons are the rate of transmission and the mortality rate. The Coronavirus spreads, on average, to 2.5 to 2.9 people once an individual is infected. Also, the global mortality rate has been in the 3 to 4% range. Compared to the Flu, these numbers are staggering. The Flu has a rate of transmission of 1.3 and a mortality rate of 0.1%. That makes the Coronavirus 30 to 40 times more deadly than the flu.
Below are the number of cases by Health Department here in Michigan and the number of deaths by Health Department. Detroit is within Wayne County, but it has its own health department, so those numbers are separate from Wayne County Cases.
How Many People Have Tested Positive and How Many People Have Tested Negative?
The State of Michigan today released their data regarding positive tests and negative tests.
30 of 744 outpatient tests have been positive, or a rate of 4.03% at the doctor’s office
1866 of 5261 hospital-based tests have been positive, or a rate of 35.4% at the hospital
557 of 3104 health department cases have been positive, or a rate of 17.9% at the health department
This tells us that if you’re well enough for your doctor to test you at the office and send you home, you are unlikely to have the Coronavirus. It also tells us that if you’re sick enough for your doctor to direct you to the hospital and you meet the testing criteria at the hospital (fever, cough, potential exposure), then you have a good chance of testing positive at 35.4%. This information can be found on the MDHHS Website.
Data from the Michigan Department of Health and Human Services showing the number of positive and negative tests in the State of Michigan as of 03/25/2020.
Hospital Beds are Filling up in Detroit
According to this article in the Detroit Free Press, the Beaumont Hospitals in Detroit and West Bloomfield are filling up with patients.
The health system is "facing limitations and nearing capacity with our testing, personal protective equipment and mechanical ventilators," said Beaumont Health Chief Operating Officer Carolyn Wilson. “We are taking steps to increase our capacity, such as converting some of our operating rooms into intensive care units.
“We have been actively transferring COVID-19 patients within our system to other Beaumont hospitals, as appropriate, if one hospital has more capacity than another."
According to this article in the Detroit News, Henry Ford Health System is facing the same challenges.
"Today our capacity is quite full at those two hospitals — West Bloomfield and Henry Ford Hospital in Detroit," said Dr. Betty Chu, associate chief clinical officer and chief quality officer. Chu is leading the health system's coronavirus response.
"We fortunately have the luxury right now of having additional capacity at some of our other campuses."
This is concerning because there are a limited number of staff, beds, and equipment to adequately are for Coronavirus patients here in the Detroit and Metro Detroit area.
As beds fill up and as our hospital personnel are stretched thin, we may be in a situation where doctors have to pick who lives and who dies simply based on issues of capacity. This is truly a terrible situation and one that we want to completely avoid.
That is why it’s so important to stay at home and avoid any unnecessary contact with people, by which you may become infected.
City of Detroit Will Begin Offering Free Coronavirus Testing Tomorrow
Unfortunately, the City of Detroit has been hit hard by the Coronavirus. But, Mayor Mike Duggan and the City of Detroit will begin testing people at the State Fairgrounds at 8 mile and Woodward to hopefully stem the tide. The aim is to test 50 people every hour and 400 people every day with this drive-through testing.
Testing is important because it can help us track the spread of infection and it can help people prevent the spread by self-quarantine if they find out that they are infected. You can learn more about this testing via the City of Detroit, here.
How Can I Become Immune to the Coronavirus?
Yes, you can become immune to the Coronavirus. When you get infected with the Coronavirus, your body will produce antibodies or immunoglobulins to the Coronavirus. First you’ll make IgM, and then IgG. This will confer long-term immunity to you.
Scientists estimate that you’ll be immune for 1 to 3 years based on previous infection and immunity rates from other Coronaviruses. This is why you can’t get re-infected by COVID-19. Once you have the virus, you’ll be immune to future infection.
This is important for several reasons. Over the next few weeks to the next few months, there will be a test of immunity. It will likely be a finger-stick blood test, using a drop of blood to measure the immunoglobulins like IgM or IgG to make sure folks are immune.
This will be especially important for doctors, nurses, hospital workers, and other critical staff. If we know that these folks are immune to Coronavirus, they can go back to treating patients with minimal risk of infection going forward. This test is pending as of now.
HOw will the Coronavirus Pandemic End?
The Coronavirus pandemic will end when we reach a Herd Immunity. Herd Immunity means that enough people in the population are immune to the Coronavirus, which will greatly limit its spread.
This Herd Immunity can be achieved in a few different ways. First, once a number of Americans get the Coronavirus, they will fight off the infection and become immune, limiting the spread of the virus once they recover. Second, once a vaccine is developed, many more people will become immune through vaccination.
Just like being vaccinated for the influenza virus or for Measles, Mumps, and Rubella, once you’re vaccinated for these viruses, your body creates immunoglobulins or antibodies to help protect you from infection from these viruses.
Unfortunately, the Coronavirus or COVID-19 vaccine will take 18 months to 2 years to develop, so this option will take a long time to achieve.
This image demonstrates Herd Immunity. The left hand panel shows what we’re dealing with right now with the Novel Coronavirus or COVID-19. No one is immune to this COVID-19 yet. The right hand panel shows Herd Immunity. The yellow figures are immune to the virus, so the spread of the virus will be limited. Herd Immunity defined: the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination.
Thanks for reading and watching. Please stay safe and healthy in this time,
-Dr. Paul Thomas with Plum Health DPC
Single Largest Jump in Coronavirus Cases in a 24 Hour Period
Coronavirus Update: United States sees the single biggest increase in cases in a 24 hour period
Unfortunately, the United States has just witnessed the single largest increase in Coronavirus cases of any country in a 24 hour period. Over the last 24 hours, there have been 14,550 new cases reported in the United States according to this website.
Why is the Coronavirus Spreading so quickly in the United States?
It comes down to the concept of R⌀.
R⌀ is the average number of people that an infected person transmits the virus to.
If R⌀ is <1, the epidemic will burn out.
If R⌀ = 1, then epidemic will continue at a steady pace.
If R⌀ >1, the epidemic will increase exponentially.
Current estimates put R⌀ at about 2.5 to 2.9 (Peng PWH et al, 2/28). In plain English, this means that the average person with the Coronavirus will give the virus to 2.5 to 2.9 other people. This transmission rate is a bit higher than seasonal influenza. R⌀ is a reflection of both the virus and also human behavior. Interventions such as social distancing and improved hygiene will decrease R⌀.
Control of spread of COVID-19 in China proves that R⌀ is a modifiable number that can be reduced by effective public health interventions. The R⌀ on board the Diamond Princess cruise ship was 15 – illustrating that cramped quarters with inadequate hygiene will increase R⌀ (Rocklov 2/28).
The Coronavirus started with a single infected person, and it spread to roughly 2.5 to 2.9 other people. Once infected, those people passed the Coronavirus to another 2.5 to 2.9 people each. This is how a virus can exponentially spread. The Coronavirus spread has been hard to diminish because people have a relatively long incubation period or they have the virus and they don’t show symptoms of having the virus for a relatively long period of time, like 5 days to 10 days.
What should I be doing during the Coronavirus pandemic?
Definitely stay at home as much as possible. If you must go outside your home, practice social distancing and act as though you have the virus. Essential tasks done outside the home include buying groceries, making visits to the doctor, and picking up medications from the pharmacy.
How do I protect myself when I go outside?
First, avoid going outside unless you’re going for a walk or otherwise exercising in your neighborhood. If you must go outside, wear disposable latex gloves when you touch high-risk surfaces. For example, when you pump gas at the gas station, put on a pair of latex gloves during the credit card use, key pad entry, and handling the gas pump. Then, dispose of the gloves responsibly in a nearby trash can. Use hand sanitizer once you’re back in your car. Don’t touch your eyes, nose, or mouth after touching potentially contaminated surfaces. You can also use this routine of wearing latex gloves when grocery shopping or when handling a grocery cart.
Is it safe to get food delivered?
Yes, it’s safe to have food delivered and it’s safe to get take-out food. The best practice is to wash your hands after touching any packaging and to wash your hands again before eating. For instance, if you get your food in a brown paper bag, take your food out of the brown paper bag, recycle or discard the brown paper bag, and wash your hands before touching the food or individually wrapped food. Then, transfer the food to a plate or glass bowl and microwave the food for 30 seconds. This will kill any germs or bacteria in or on the food. Wash your hands again prior to eating.
What can you do to boost your immune system?
Many people want to know what they can do to boost their immune system to protect themselves from the Coronavirus. You can do the following to boost your immune system:
Sleep 7 to 9 hours each nigh
Eat nutritious and healthy foods
Drink plenty of fluids, mostly water
Exercise for 1 hour each day
Meditate to keep your stress levels low
When we’re stressed out, we tend to produce more cortisol, a steroid hormone that can weaken our immune system. That’s why it’s important to meditate, sleep well, and exercise.
What are good exercises during the Coronavirus quarantine?
You definitely want to exercise every day during the Coronavirus quarantine. Exercise will be good for your physical health, immune system, and emotional wellbeing. The best exercises will be to go outside of your house for a walk, jog, run, or bike ride. This is one of the few exceptions to the “stay at home” rule above. When you exercise, make sure that you’re keeping your distance from other people by at least 6 feet. You can exercise in your neighborhood or a nearby park. Avoid mall walking or any exercise where you’ll have to open a door/use a door handle for entry. That’s why we recommend folks avoid gyms and pools because there are just too many surfaces that could harbor the Coronavirus and potentially spread the infection. Therefore, exercise at home: lift weights, do floor exercises, do yoga or pilates. Fortunately, several health and fitness companies are giving free 30 day trials of home exercises - take advantage of these programs.
What can you do to slow down the Spread of Coronavirus?
Stay at home.
Act as though you have the virus and any interaction is a potential to spread the virus to a vulnerable person. People who are the most vulnerable are older adults or those with pre-existing medical conditions like lung diseases or cardiovascular diseases.
Do not visit nursing homes or elderly relatives, even if you feel well. You could be an asymptomatic carrier of the coronavirus and you could potentially endanger or kill the older adults that you visit.
Should you be sitting on a stockpile of extra medical supplies and equipment, please donate it to your nearest hospital or primary care physician office. If you have new and unused N95 masks or gloves, please donate them to these healthcare facilities.
Thanks for reading and watching, and have a wonderful day.
-Dr. Paul Thomas with Plum Health DPC
Detroit Doctor on AskASwimPro Show with Fares Ksebati
This week, I was invited on the AskASwimPro Show with Fares Ksebati. Fares is the CEO of MySwimPro, an App that helps swimmers improve their stroke, among other things. From their website:
MySwimPro is using technology to advance the sport of swimming and help swimmers all over the world achieve their goals in new and exciting ways. The platform is more than just an app, it's a community that keeps you accountable and pushes you to do your best.
In general, we had an informative discussion about the Coronavirus and its impact on our communities, specifically swimmers. Here’s what the MySwimPro team wrote about on their blog, found here:
In this episode of the #AskASwimPro Show, we interviewed Dr. Paul Thomas of Plum Health about the novel coronavirus, how to practice social distancing, the importance of “flattening the curve” and how swimmers can stay safe.
Dr. Thomas explained that many of us have had a coronavirus before, but that COVID-19 is more contagious. COVID-19 has a mortality rate of 3.5%, compared to the seasonal flu’s mortality rate of 0.1%, he says.
The virus spreads through coughing and inhaling someone else’s respiratory droplets. Due to this, Dr. Thomas explained that it isn’t wise to fly right now, since airplanes place you in close proximity to others.
He also noted that COVID-19 can live on surfaces for up to 3 days:
Stainless steel and plastic: 3 days
Cardboard and paper products: 24 hours
Copper: 4 hours
We go on to discuss social distancing:
Social distancing involves staying 6 feet away from others when you are outside, and avoiding contact with others while at home. You risk transmission any time you talk, shake hands or spend time around others. Dr. Thomas recommends that people avoid gathering with others and stay home in “self-quarantine,” noting that in cultures where it is common to kiss each other on the cheek or shake hands, COVID-19 can spread very quickly.
If you get COVID-19, you will be quarantined for at least 14 days, Dr. Thomas said. However, researchers have mentioned that you may be able to infect others for up to 20 days after showing symptoms.
We then discuss Flattening the Curve:
The healthcare system in the United States can only manage so many patients at one time, Dr. Thomas said. By practicing social distancing, we can “flatten the curve,” reducing the number of COVID-19 cases at a given time and keeping healthcare providers within their capacity. If we don’t do this, Dr. Thomas noted that the U.S. healthcare system will be unable to effectively care for patients.
We then talked about how you can stay safe during this Coronavirus Pandemic:
Dr. Thomas shared tips to stay safe and healthy:
Wash your hands: Before you prepare food, after going to the bathroom and before touching your face.
If you have a cough or a low grade fever (99 or 100 degrees Fahrenheit): Stay home, drink lots of fluids, take Tylenol and get some rest. You likely are not sick enough to benefit from a doctor’s treatment. Save the hospital beds — and the healthcare providers’ time — for those who are sickest!
If you have severe symptoms, such as a high fever and trouble breathing: Go to the hospital.
Thanks for reading and watching,
-Dr. Paul Thomas with Plum Health DPC
Detroit Doctor Answers Questions about Coronavirus on WDET's Detroit Today
Dr. Paul Thomas, MD, a family medicine doctor in Detroit answers many questions that Detroiters have about the Coronavirus and its impact on our community.
From WDET:
Dr. Paul Thomas is a primary care physician at Plum Health direct primary care in Corktown, an office that utilizes a monthly membership to treat patients rather than through insurance. He says that with job security threatened and instability on the horizon it is important to have comprehensive health care not tied to employer-based insurance.
His tips:
Keep a pair of gloves in the car to use at the gas station or grocery store to prevent touching contaminated surfaces when running essential errands.
The virus can live on cardboard for up to 24 hours. For this reason, leave mail out for roughly two days before picking it up.
Swap Tylenol for ibuprofen (based on an evolving scientific study).
To boost your immune system get eight hours of sleep, get some vitamin D when the sun is out and take a long (isolated) walk once a day.
If you are experiencing fever or shortness of breath seek medical treatment at the hospital.
Listen to the full episode, here.
Thanks for reading and listening!
-Dr. Paul Thomas with Plum Health DPC in Detroit Michigan
Flattening the Curve for Coronavirus in Detroit Michigan
Coronavirus is here in Michigan. As of now, there are 53 cases in the State of Michigan. So what can we do to prevent the spread of the virus? What does it mean to practice social distancing? What does it mean to flatten the curve?
What’s the best thing you can do to prevent the spread of the Coronavirus?
The best thing to do to prevent the spread of the virus is to act as if you already have the virus and do everything that you can to prevent transmitting it to your loved ones and vulnerable people in the community.
What is social distancing?
Social Distancing is a term applied to certain actions that are taken by Public Health officials and all of us to stop or slow down the spread of a highly contagious disease. Cancelling events that are likely to draw crowds is an example of social distancing enacted by Public Health officials. Social distancing enacted by us as individuals means deliberately increasing the physical space between yourself and the people in the community. This may look like staying at home away from other people or it may mean keeping a 6 foot space between yourself and other people in the community.
What does it mean to flatten the curve?
To flatten the curve is to decrease the rapid transmission of the Coronavirus and therefore decrease the peak number of actively infected individuals at any one time. This is important because if there are too many infected individuals, we will exceed our hospital bed and ventilator capacity. If we don't flatten the curve, there will be unnecessary deaths due to the spread of the Coronavirus.
What is the most common presentation for the Coronavirus?
A: The most common presentation for the Coronavirus is a one-week prodrome of myalgia or muscle aches, malaise or generally not feeling well, cough, and low-grade fevers. This gradually leads to more severe trouble breathing in the second week of illness. There is an average of eight days to the development of dyspnea and an average nine days to onset of pneumonia or pneumonitis.
How is the presentation of Coronavirus different from the presentation of Influenza?
A: Coronavirus tends to have a gradual onset. Influenza tends to have a sudden onset. Coronavirus tends to have a cough and fever. Influenza tends to have fever, chills, muscle aches, nausea, vomiting, and diarrhea.
What are the lab findings like for the Coronavirus?
A: The most consistently present lab finding was lymphocytopenia (with either leukocytosis or leukocytopenia). Lymphocytopenia is the condition of having an abnormally low level of lymphocytes in the blood. Lymphocytes are a white blood cell with important functions in the immune system. It is also called lymphopenia. The opposite is lymphocytosis, which refers to an excessive level of lymphocytes. During other infections, we typically see lymphocytosis or an increase in white blood cells to fight off the infection. Aside from the depressed white blood cell count, other markers like C-reactive protein or pro-calcitonin were not as consistent.
What are the most common radiographic findings for Coronavirus?
A: The most consistent radiographic finding, discovered on chest x-ray, is bilateral interstitial infiltrates also known as ground glass infiltrates or ground glass opacities. A radiograph is an image produced on a sensitive plate or film by X-rays, gamma rays, or similar radiation, and typically used in medical examination.
Can you get a co-infection with another virus or bacterial infection when you get the Coronavirus?
A: Co-infection rate with other respiratory viruses like Influenza or respiratory syncytial virus (RSV) is less than two percent. Basically, if you have a positive test for another respiratory virus, then you do not test for COVID-19. This information is based on a large dataset from China.
When people get the Influenza virus, they don’t often die from the Influenza virus, but from a subsequent and opportunistic bacterial infection like a bacterial pneumonia. Is this the case for Coronavirus?
So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
How much does it cost to get the Coronavirus test?
A: It depends on the lab, the health system, and the insurance company. LabCorp is offering a test for roughly $50, Quest Diagnostics is offering a test for roughly $250, and the test may be free for those who have insurance, depending on your symptoms.
What can we do to treat the Coronavirus?
A: To date, patients with severe disease are mostly getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s randomly controlledtrial or the National Institute of Health’s “Adaptive” randomly controlled trial (Remdesivir vs. Placebo). Others have tried Kaletra, but that medication was not beneficial.
How long are patients contagious after they contract the Coronavirus?
A: The short answer is that patients are likely contagious for 20 days after contracting the Coronavirus. The more complicated answer is that patients can shed RNA from one to four weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are cleared of isolation once they have two consecutive negative RNA tests collected more than 24 hours apart.
Thanks for reading and stay safe out there.
-Dr. Paul Thomas, MD with Plum Health DPC
Coronavirus Update for Detroit Michigan March 2020
Coronavirus Update for Detroit, Michigan for March 2020
I’m a Family Doctor in Detroit, and today I’ve gotten a ton of questions about the Coronavirus - ask me anything!
For starters, here’s what I sent out to all of my Plum Health DPC (https://www.plumhealthdpc.com/) patients earlier today and I thought everyone should know these things as well. Beyond what’s written below, ask me anything:
Plum Pack!
The Coronavirus is causing concern at this time - the President spoke last night about closing access to the USA from Europe, the NBA, NHL, and NCAA have cancelled/postponed all of their games, and other major events have been cancelled - but do not panic.
People Will Become Sick This Spring
Many people will get sick and have upper respiratory symptoms over the next few days and weeks. Most of these will be from the common cold, many of these symptoms will be from seasonal allergies, some will be the flu, and some may be due to the Coronavirus.
What I can do for you is to help you triage - I can help you determine if you're sick with the flu, a cold, or having an allergy flare up. I can help you determine if you have symptoms that are concerning for the Coronavirus.
If you contact me and I'm concerned, I may send you to the emergency department for further testing. As of now, Coronavirus testing is not available at our clinic.
Here are some algorithms about how I approach caring for our patients, caring for all of you.
Additionally, heres information from the State of Michigan regarding Coronavirus, released earlier today:
Finally, below is what we know and what you can do to protect yourself:
What You Can Do to Prepare for the Coronavirus
You can prepare for the Coronavirus by taking several actions and non-actions:
wash your hands thoroughly before eating
wash your hands thoroughly after using the bathroom
wash your hands thoroughly before touching your T-zone (eyes, nose, or mouth)
Cough or Sneeze into the crook of your arm/the bend in your elbow; again, wash your hands after coughing or sneezing
purchase food and supplies in case you need to be self-quarantined
if you become sick with a respiratory infection, but you’re not sick enough to require hospitalization, you may need to self-quarantine or stay at home to avoid infecting your neighbors and co-workers
if you become ill, call your doctor and discuss your symptoms. It may be better to call or text your physician, as going to the doctor’s office may
cancel any non-essential travel to areas where the virus is spreading like China, Iran, South Korea, and Italy
avoid large gatherings - parades, sporting events, campaign rallies - to avoid catching the virus or spreading the virus
What We Know About the Coronavirus or Covid-19
Here’s what we know thus far:
Every single one of us has had a coronavirus infection in the past — it’s one of the viruses (along with rhinovirus, adenovirus, etc.) that causes the common cold. This novel Coronavirus (COVID-19) is just a variation (or mutation).
This new coronavirus can cause anything from nothing to a mild cold to a potentially lethal viral pneumonia.
Those who seem to be most affected by COVID-19 thus far are those who are more at risk to begin with: those who are older, those with multiple chronic health conditions, etc.
The evidence out of the initial outbreak in Wuhan, China revealed:
Median age = 59 years of age
Estimated basic reproduction number (the number of people an infected person infects) is approximately 2.2
The average length of time from the onset of symptoms to hospitalization was 9.5 to 12.1 days
There have been new coronaviruses in the past — most notably the SARS (2002, 2003) and MERS (2012 – Present) epidemics; however, the mortality rate of COVID-19 (2.0% to 4.0% or below) is notably lower than SARS (9-10%) and MERS (36%).
From the WHO, they estimate that the mortality rate is somewhere around 3 - 4%. We are more concerned about this Coronavirus than the typical flu virus because of this higher mortality rate. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_2
This virus spreads from person to person, though we aren’t exactly sure how. Our best hypothesis is that it is spread via bodily fluids and droplets from speaking, breathing, coughing, sneezing, etc (and potentially through the GI tract).
Children absolutely can get the Coronavirus that causes COVID-19. Two interesting points about pediatric patients: 1) there is early evidence that they carry a high “viral load” and — combined with the fact that they aren’t great at washing hands, not touching their face, etc. — because of this may be more likely to spread the illness and 2) children who do get COVID-19 seem to have a lower mortality rate than those who are older who contract the disease.
Here’s what we don’t know:
We don’t know if this virus will peter out as the warmer months kick in; we also don’t know if this is a one-season thing or if it will come back strong again next cold & flu season.
We don’t know when or if we’ll have a successful vaccine to prevent against this new virus. In a late February 2020 press conference, Dr. Anthony Fauci did a great job describing how a vaccine is created (starts at about 11:00 into the clip) and how far we are away from a successful vaccine.
How to Protect Yourself and Others from the Coronavirus
How to protect yourself & others:
Just like any other respiratory virus: stay home if you’re sick!
Just like preventing any other respiratory virus: take good care of yourself! Exercise regularly, eat nutritious, balanced meals, practice stress mitigation techniques, and get a solid 7-9 hours of sleep a night, etc.
Just like preventing any other respiratory virus: wash your hands! A lot!
Just like preventing any other respiratory virus: don’t touch your eyes, mouth, nose, etc., and get into the habit of washing your hands before eating.
If you can, avoid contact with those who are sick or are caring for the sick.
If you are not actively sick (or caring for someone who is), ear-loop/surgical masks are not likely helpful. Healthcare workers will wear masks (and often higher-rated ones than the ear-loop masks), as they have a much higher likelihood of caring for someone with the disease and are prioritizing mitigating the spread to others.
Those who are exposed to someone with COVID-19 or those who are being tested for COVID-19 will likely be asked to self-quarantine (currently not mandatory). If your job permits, start asking your employer about work-from-home opportunities; if your job doesn’t permit work-from-home, ask your employer what their plan is to keep you safe!
Because of the real possibility of a quarantine, stock a couple week’s worth of non-perishable foods items in a pantry. Also make sure you have the basics — like medications, OTCs like ibuprofen, acetaminophen, diphenhydramine, and pseudoephedrine, and (a rational amount of) toilet paper, facial tissues, etc.