What a crazy season this has been with influenza and coronavirus, I wish I could say it is coming to an end but in fact it is not. This year we started with Influenza B hitting early, a virus that typically hits later in the season. We then had the start of the coronavirus in early January, as this was playing out we saw a decrease in the Influenza B and overall influenza for one week before we saw a shift and now the predominant strain is Influenza A.
Overall influenza mortality has been low as one would expect with the early influenza B, a virus that classically in adults is not as severe as Influenza A. However we did see the impact on the pediatric patients as we are over 100 pediatric deaths this season. We have seen 16,000 adult and senior deaths which is low however the surge of Influenza cases we are seeing now will make that number increase shortly.
The concern for coronavirus has continued with over 50 cases being reported in the US as of last week, and those infected here have been or are being cleared. Let’s put the concern for coronavirus in perspective. This year so far we have had at least 29 million cases of influenza in the US alone. 280,000 people have been hospitalized, not to isolate them but to actually treat them, and 16,000 deaths have occurred from influenza, a disease we have a vaccine for yet not everyone gets the flu shot, in fact we are usually around a 40% vaccination rate for the entire country. So should we have a concern for the larger long term impact of coronavirus, absolutely but we should also be aware of the common influenza season we see each year.
Match of vaccine against this year’s flu was a 50/50 story. The early impact of Influenza B was felt so strongly because the strain of Influenza B that hit was not a great match for the vaccine. We saw about a 50% effective rate, couple that with children who had never been exposed to Influenza B and you saw its impact. Influenza B is starting to decrease and now we are seeing Influenza starting to rise. The good side to the story is that the strain of Influenza A H1N1 that is now being reported as increasing is a fairly good match to one of the strains noted in the vaccine this year, with over a 55% effective rate. Historically overall the rate is usually around 40% and last year with an unexpected mutation we saw only a 29% effective rate. You may feel those numbers are low and decrease the reason to get vaccinated, but a quick somewhat painless shot that insurance covers is much better than 10 days of fever and body aches.
So if you have not gotten a flu shot, you can still get protection from the strain that is around and increasing now. Just because you got the flu with the B strain earlier does not protect you from getting the A strain now, that would be a bad year and another reason to get the flu shot each year.
The coronavirus story gets more confusing every day, recently China started to show a decrease in the number of new cases. Is that good? One would think so but don’t get so reassured, let’s look at how the Chinese have been tracking
First they started out tracking by counting individuals who tested positive for coronavirus and the numbers were fairly low, as the story spread clinics and hospitals were swamped with patients and the supply of tests ran low. They then decided to use CT scans and symptoms for those they would call positive, as the test results were taking days but a CT scan can be done in minutes, this occurred 3 weeks ago, and on that day we saw a jump of 12,000 cases in one day, this was back when there were about 20,000 reported cases, they used this measure for a few days and you saw the number of cases rise dramatically. Then 2 weeks ago on Wednesday the Chinese Government decided it would no longer use symptoms and CT scans as the measure it would go back to using the test to declare a positive, in that one day alone the number of reported cases dropped 80%. Couple this with the fact that many patients may be infected and are not seeking testing as there is no treatment and the results of being found to be positive can be very restricting so patients may be just staying home. Remember the impact of the virus has huge variability, we all have seen the quarantined US citizens on cruise ships who have tested positive yet look very healthy and with few symptoms. This is one extreme and the other extreme is respiratory illnesses that can cause death in some people.
So the big message is we really have no idea as to the extent of this illness in China and time will tell. This is very important as the economy of China supplies us with many important products, including generic medications. Many compounds need for generic medications come from China, and 60% of generic medications come from India and China. If this virus is not under control soon we may start to see shortages of many medications, including ones millions of American’s use every day.
The spread of the virus outside of China has certainly gotten the attention of the world. With over 40 countries now reporting positive cases of the virus, the CDC has said more cases will be here in the US soon. It is time for Hospitals and public health departments to formulate plans as to how they can be prepared for cases here in the US.
Initial work is being done on a vaccine, however production and testing is expected to take 12-18 months. The impact of this vaccine on the influenza vaccine production is also a concern as it is the time of the year that we begin to prepare for next year’s influenza vaccine.
Right now Health Systems, Hospitals and Department of Public Health’s across the country are preparing for the inevitable cases of coronavirus that we will see. Schools will be prepared to shut down and do teaching via internet, employers will need to have plans to shift workers to home or alter production process.
The bigger hope is that this virus acts like the seasonal influenza virus and that as we see warmer temperatures the virus spread decreases and becomes virtually nonexistent and that it is a seasonal issue that we will have 5-6 months to work on our options. If this happens the disruption on the economy also will see a lower impact
Physician shortage
We all are listening to the Political rhetoric around the cost of healthcare in this country. Medicare for all, Prescription drug costs are skyrocketing, coronavirus and other emerging illnesses. Perhaps one that is not getting the attention it should is the looming physician shortage that is coming upon us. We are fortunate to live in a robust medical community in the Chicago, Wisconsin, Indiana metro area. For many of us, we have access to our primary care physician with the action of a simple phone call. That is not the case nationwide, in fact close to 50 million Americans lack access to primary care because of current physician shortages in their communities now.
As we see the impact of Baby Boomers hitting Medicare we also see the impact of Baby Boomers in the medical field closing in on the end of their careers. In 2015 25% of physicians were over the age of 65, that number has increased since then with over 125,000 physicians aged 65 or over were practicing. By 2030 estimates predict a shortage of over 55,000 primary care physicians in the United States. Why are we discussing this now? It is important to understand how the system works as 2030 will be here before we know it.
In a few weeks will be hearing about Match Day and the excitement for those involved. Let’s give everyone a quick course on how this all works. First you apply and get accepted to Medical School, which on its own is no small feat, average GPA is 3.80/4, score really well on the MCAT exam, acceptance rates in many medical schools is under 10%, get accepted and then have 4 years of grueling study. And Oh, by the way it is a little expensive with some tuition fees over $70,000 a year, that is before housing, food and clothing. The average debt a physician finishes medical school with is about $200,000. Now I am not giving those numbers for pity or determent, they are what they are. Students studying medicine go in for as Michael Jordan used to say “the love of the game”
So back to the upcoming Match Day. This is the day when a finishing medical student finds out where they will be going on to for the next step of their training, their internship and residency. What happens with Match Day is medical students rank their top choices across the US for where they want to study and in what specialty, the hospitals in turn rank the students that they would like in their program. A computer program puts the 2 ballots together and a “Match” is formed. It is the highlight of your final months of medical school as you find out where and what you will be doing. The goal of the program is to match the doctors and hospitals with their top choices.
The interesting thing is that we do not have enough residencies to fill the needs we expect in the future, especially when it comes to primary care. One of the main reasons for this is the need for federal funding to have a residency sustainable at a hospital.
I would like to share one important one with you as it sits here in our backyard and is an important part of the future of medicine especially for the underserved. Family Medicine is one of the lowest paid specialties in medicine. Doctors who complete their Family Medicine residency are now in big demand as the shortage in this field is one of the greatest.
Couple that fact with the need we have for physicians in underserved areas, such as Chicago’s own Humboldt Park. We are very fortunate to have in Humboldt Park one of only 56 programs in the US that are deemed Teaching Health Centers. This is a program of family medicine residents who are completing their training not in the big academic hospitals, this program is embedded in an underserved area where residents work in the ambulatory setting and work with the community on preventative care and deals with the primary health care needs of this community. This includes high numbers of diabetics, heart disease and high blood pressure. It is in a community where things we take for granted are not readily available, such as fresh produce, big box pharmacies, and safe streets.
Programs like this graduate residents who have a mission to serve the underserved in often dangerous neighborhoods, they have a mission to take care of a population that is often shunned or ignored. This is the neighborhood where chronic disease if not cared for cause catastrophic health injuries that end up costing the health care system billions of dollars. The doctors who complete these programs often remain in these areas, they are the most underpaid physicians in the spectrum, yet the impact they make on the healthcare and cost of healthcare in the US is unbelievable. The doctor who practices in a clinic in this area, that treats the high blood pressure of a patient who cannot pay and prevents them from ending up on dialysis or a kidney transplant is the doctors we need to reward and promote, not only for their well-being but for the health and finances of the country. This doctor who starts a medication that costs pennies a day can prevent a cost to the country of billions of dollars over their career.
Congress is looking at possibly eliminating these 56 clinics across the country to “save money”, we need to educate all of us that closing these clinics does not save money at all. In fact it will actually take money needed for the care of many others for simple chronic problems as we will have spent large sums on a small number of patients that with the right care will not have catastrophic health problems.
We need all of our legislators to understand the impact of a small clinic in Humboldt Park that prepares residents to go into the underserved areas are “saving more money” then we can imagine for decades to come.
