Plum Health Blog
Coronavirus Update For Detroit Michigan: What Happens Next?
Current Number of Coronavirus Cases and Deaths in Michigan
Covid 19 has been with us for well over 2 months now, and here’s where we stand:
45,045 Cases in Michigan
4250 Deaths in Michigan
657 new cases today
71 new deaths today
Despite the high numbers of total cases (cumulative cases) and cumulative deaths, there is a distinct downward trend in new cases each day. This is great, and it demonstrates the effectiveness of increased testing, social distancing parameters, government interventions like shutting down bars and movie theaters, as well as limiting the capacity of restaurants.
Percentage of People Testing Positive for Covid-19 in Michigan
In Michigan, about 23% of those who have been tested have tested positive for Covid-19. From April 6 to April 27th, the average percentage of positive tests has declined from almost 40% to just over 16%, which is well above the World Health Organization's 3% to 12% recommendation, but moving in the right direction.
Comparing Coronavirus in Finland, Sweden, and Norway
Some groups in the United States have demanded a re-opening of the country, and some of those have pointed to Sweden as a model country. However, Sweden has had worse outcomes with Coronavirus than its neighboring Scandinavian countries.
Finland has 5,573 cases and 252 total deaths
Norway has 7,915 cases and 215 total deaths
Sweden has 23,918 cases and 2,941 total deaths
It’s important to understand what’s working and what’s not working globally so that we can inform our own public policy at the National, State, County, and City level.
When will the Coronavirus Vaccine Be Available?
The Coronavirus vaccine will likely be ready in late 2021. There are multiple phases and stages that the vaccine has to go through, and we’re near the beginning of that process.
What is Direct Primary Care?
Some of you have asked more about Plum Health and Direct Primary Care - we provide a membership model for health care and we believe that health care should be affordable and accessible for everyone. We take care of patients of all ages and stages, from across the metro region, and of varying insurance coverages (including uninsured and underinsured folks). We love saving people money on healthcare services and delivering excellent care and service for our members.
A Few Thank You Notes!
Thank you to Max and his team at Commonwealth Sewing Company for the work they’re doing around making masks in Detroit. Thank you to Tyson Gersh at the Michigan Urban Farming Initiative for delivering 100 KN95 masks to our office - we appreciate you! And thank you to the team at MI FACE SHIELDS for providing us with 60 face shields - this is just another way we can protect ourselves and our patients during this time.
Thanks for reading and watching - Dr. Paul Thomas with Plum Health DPC
Dr. Paul Thomas Interviewed on Mix 92.3 with Cheron
This week, we had a great interview with Cheron of Mix 92.3 about our direct primary care services here in Detroit Michigan.
We're at Plum Health in Detroit's Corktown Neighborhood and we operate a membership model for health care. Our members pay $10 each month for children, and it starts at $49 each month for adults. With that membership, our patients can call, text, or email us anytime.
Our members at Plum Health also have access to 50 to 90% savings on medications, lab work, and imaging services. A big thanks to Cheron for the great interview!
- Dr. Paul Thomas with Plum Health DPC
Direct Primary Care Book Reaches 50 Reviews
Today is an amazing day and I’m very excited that my book Direct Primary Care: The Cure for Our Broken Healthcare System has reached 50 reviews on Amazon! A sincere thank you to everyone who helped me write, edit, and publish the book, and a heartfelt thank you to everyone who has read the book and reviewed it on Amazon.
I wrote this book because I wanted to communicate the ethos of the direct primary care movement - why do we do what we do as direct primary care doctors and how it impacts our patients, our communities, and the greater healthcare system. A year and a half after its publication, I believe the book is continually achieving those aims.
Here’s the latest review:
This was a fantastic, passionate, and very simple approach to addressing a huge problem in the American healthcare system. I learned a lot from reading Dr. Thomas’s book. I highly recommend any physician read it if anyone is considering going into direct primary care.
There’s a lot of crazy stuff happening in our world right now, but there’s a lot that I’m grateful for as well, so thank you again.
-Dr. Paul Thomas with Plum Health DPC
Today, May 5th, 2020, I just received my 50th review for my book, Direct Primary Care: The Cure for Our Broken Healthcare System, and I couldn’t be happier!
What are the ages of patients at Plum Health DPC?
How Old are the Patients at Plum Health DPC?
We are often asked how old are your patients at your practice?
First of all, we are primary care physicians and family medicine doctors, and that means that we take care of patients of all ages and stages. All patients are welcome at our practice regardless of age.
Currently, our youngest patient is two months old and our oldest patient is 102 years old. That being said the majority of our members at Plum Health DPC are between the ages of 20 and 65 years.
I think there are a number of factors at play that cause the majority of our patients to be in that demographic.
First of all, we are a primarily urban practice, and we take care of several young urban professionals who are highly mobile and without children. Detroit and Southeast Michigan has a strong economic output, that attracts top talent to the region in various professions like law, medicine, automotive engineering, and others. Perhaps we would have more pediatric patients if we were in a suburban community where there are more children and families.
Second, the people that I know trust me and are more likely to become my patients. The people that I know are mostly my age, plus or minus a few years. That probably skews our data or the number of patients in our practice who are around the age of 33 somewhat.
Third, our country provides health insurance coverage for people under age 26 through the affordable care act. As long as a child’s parents have health insurance, that child will be covered under their parents’ health insurance plan. Also, those individuals over 65 are covered by Medicare, and because they may be on a fixed income they may be less inclined to seek out a direct primary care practice where they have to pay over and above their Medicare coverage.
Even thought we take care of patients of all ages and stages, one thing that we don’t do in our practice is deliver babies.
If you Don’t Deliver Babies, Who Do you Recommend for Obstetric Services?
We don’t deliver babies in our office and we don’t have hospital privileges to deliver babies at the hospital. However, we do take care of moms and growing babies during the first trimester of pregnancy. During that first trimester visit, we can perform a pregnancy test and also screen for conditions that may be harmful to the growing fetus, like blood sugar testing, sexually transmitted infection testing, and making sure there’s no bacteria in the urine.
During the second and third trimesters, we make sure to coordinate care with practicing Obstetricians and Gynecologists who are trusted in our community. We’ve developed a list of trusted professionals in Metro Detroit and we share it here to help our patients and the greater community find the Doctors or Midwives who can help them with a successful delivery.
This list includes doctors that we have worked with personally and doctors who our patients and greater community members have had great experiences with. Here’s that list:
Essam Khraizat, MD
Michigan Women's Care
Obstetrician-gynecologist in Canton Township, Michigan
Address: 6300 N Haggerty Rd #200, Canton, MI 48187
Phone: (734) 981-8181
Paige E. Paladino DO
Address: 11012 E Thirteen Mile Rd #212, Warren, MI 48093
Phone: (586) 582-7150
https://healthcare.ascension.org/doctors/1255651170/paige-e-paladino-warren-mi?&i
Cara Speier, DO with Beaumont
Address: 27750 Middlebelt Rd #150, Farmington Hills, MI 48334
Phone: (248) 476-7650
https://doctors.beaumont.org/provider/Carrie+Lynn+Speier+Schafer/225128
Dr. Soheyla Pezeshki
Metro Partners in Women’s Health out of Providence Park
Address: 26850 Providence Pkwy c500, Novi, MI 48374
Phone: (248) 662-4388
Beata Weiermiller, MD at Somerset Gynecology and Obstetrics
Address: 3290 W Big Beaver Rd Suite 444, Troy, MI 48084
Products and Services: somersetgynecologyobstetrics.com
Appointments: somersetgynecologyobstetrics.com
Phone: (248) 816-9200
https://www.somersetgynecologyobstetrics.com/md/BWeiermiller
Eastside Gynecology & Obstetrics, P.C
Address: 29751 Little Mack Ave # B, Roseville, MI 48066
Phone: (586) 415-6200
https://doctors.beaumont.org/provider/Carrie+Lynn+Speier+Schafer/225128
Women First OB/GYN Center
Medical clinic in Royal Oak, Michigan
Uses a Natural Birthing Center out of Beaumont
Address: 326 N Main St, Royal Oak, MI 48067
Phone: (248) 584-7600
List of Doctors, Nurses, and Midwives at this practice: http://women-firstobgyn.com/our-experts.html
IHA Nurse Midwives in Ann Arbor
Address: 4200 Whitehall Dr Suite 350, Ann Arbor, MI 48105
Phone: (734) 572-9600
https://ihacares.com/locations/mi/ann-arbor/iha-nurse-midwives
Covenant Community Care
Address: 27776 Woodward Ave, Royal Oak, MI 48067
Phone: (248) 556-4900
Appointments: covenantcommunitycare.org
Able to care for Medicaid-enrolled patients
Coronavirus Update: Have we Flattened the Curve in Michigan?
Coronavirus Update for Detroit and Michigan
As of the filming of this video, there were 32,967 coronavirus cases in the State of Michigan and 2,700 confirmed deaths in the State of Michigan. The increase from April 21st to April 22nd was 967 new cases and 232 new deaths.
This death count was pushed up by deaths that occurred previously and were not attributed to Coronavirus, but are now attributed to Coronavirus. In the video, we mistakenly attributed this jump in new deaths to perhaps an accurate counting of bodies at DMC's Sinai Grace Hospital (https://www.wxyz.com/news/coronavirus/disturbing-images-show-bodies-piled-up-at-sinai-grace-hospital-in-detroit), but this was not the case.
Flattening the Curve
In Detroit and in Michigan, we seem to be flattening the curve. Our public health efforts and the greater community support of these measures seems to be working to reduce the number of new infections. On April 3rd, there were nearly 2,000 cases reported that day. As of April 22nd, there were only 967 new cases reported. This is a good sign that we're being effective in our community strategies and social distancing efforts.
How Vaccines Work and How They May Help Us Prevent Coronavirus in the Future
Vaccines work when scientists are able to take a virus, break it down, and inject only the protein capsule into the body. That's what we, as scientists, do with the flu vaccine. We remove the RNA from the virus, the part of the virus that replicates and creates more viruses, and we give our patients only the viral proteins.
This way, our bodies can create antibodies or a robust immune response to the viral proteins, and prevent a larger infection from taking hold when we're exposed to the actual virus.
What's an Example of a Successful Vaccine from the Past?
Let's use Polio as an example.
In the late 1940s, polio outbreaks in the U.S. increased in frequency and size, crippling an average of more than 35,000 people each year. Parents were frightened to let their children go outside, especially in the summer when the virus seemed to peak. Travel and commerce between affected cities were sometimes restricted. Public health officials imposed quarantines (used to separate and restrict the movement of well people who may have been exposed to a contagious disease to see if they become ill) on homes and towns where polio cases were diagnosed.(https://www.cdc.gov/polio/what-is-polio/polio-us.html)
In 1952, the number of polio cases in the U.S. peaked at 57,879, resulting in 3,145 deaths. Those who survived this highly infectious disease could end up with some form of paralysis, forcing them to use crutches, wheelchairs or to be put into an iron lung, a large tank respirator that would pull air in and out of the lungs, allowing them to breathe. (https://www.discovermagazine.com/health/the-deadly-polio-epidemic-and-why-it-matters-for-coronavirus)
The first polio vaccine was available in the United States in 1955, invented by Jonas Salk.
Thanks to the polio vaccine, dedicated health care professionals, and parents who vaccinate their children on schedule, polio has been eliminated in this country for more than 30 years. This means that there is no year-round transmission of poliovirus in the United States.
Since 1979, no cases of polio have originated in the U.S.
However, the virus has been brought into the country by travelers with polio. The last time this happened was in 1993.
Hopefully, we can achieve the same results with a future Coronavirus Vaccine.
What is 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 Polio, or for Measles, Mumps, and Rubella, once you’ve been 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.
Thanks for reading and watching,
- Dr. Paul Thomas and Dr. Raquel Orlich 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
Detroit Family Medicine Office Open During the Coronavirus Pandemic
Detroit Family Medicine Office Open During the Coronavirus Pandemic
We’ve received a lot of questions about whether or not we’re open during this Coronavirus Pandemic. Yes, we are open during the pandemic and we plan on remaining open for as long as it’s safe to treat patients. We are taking several precautions to keep our patients safe during this time.
We are open and we are continuing to offer telemedicine appointments for all of our existing patients and new members. We are also offering in-person appointments to our patients when necessary. For example, we recently sutured a dog bite for one of our patients to prevent an emergency room visit.
Where we can, we will treat patients in the office to save them money and decrease their risk of Coronavirus at hospital and urgent care settings. We are also open for medication pick ups and lab draws for patients who need medication refills or their necessary lab work completed, like hemoglobin a1c testing for our diabetic patients. We are coordinating testing for COVID-19 and we will soon have antibody testing in our office.
How Has COVID-19 Changed Our Business?
We have always been able to text and email our patients, and conduct some visits by phone and video chat. We never thought that we'd have to completely rely on digital communication to take care of our patients, but COVID-19 changed all of that.
We’re used to seeing patients in our office face-to-face and developing genuine relationships with the people we take care of during that process, but due to COVID-19 we've been limiting our face-to-face visits as much as possible to limit the potential spread of the Coronavirus. The health and safety of our patients is paramount and by limiting our contact with patients in the office, we're doing our part to limit the spread of the virus.
Thanks for reading and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
Dr. Paul Thomas on My Dream Big Club Podcast
Last week, I had a great conversation with Seun Phillips of the My Dream Big Club Podcast.
Episode 6 Link:
Show notes:
Dr. Paul Thomas sits down to discuss:
-Health care issues head on by spreading his innovative Direct Primary Care model, which provides affordable and accessible health care services
-How insurance plans directly correlate to doctors starting their practices in affluent areas
-Done is BETTER than perfect. Spend your time being decisive in your decision making process to keep the momentum going. Make the decision and deal with the consequences later
-Visualizing your dreams and creating a system to help you focus on your goal, revisiting your system when you're down and continuously progressing forward
Dr. Paul Thomas on Leading Questions
This week, I was interviewed on Leading Questions with Calvin Moore, Kent Straith, and Steve Phelps. Also on the show was Dr. Abdul El-Sayed a political pundit on CNN and author of the new book Healing Politics. We discussed the coronavirus and the flaws in our current healthcare system and political system that have allowed this virus to spread more widely and infect and kill more people.
Here’s the general topics we discussed:
Question: Tell us a little about yourself as a medical professional. How long have you been doing it and do you have a specialized area of focus?
Answer: For me, I’m a family medicine doctor. I started our direct primary care service, Plum Health DPC, to make healthcare more affordable and accessible here in Detroit. My practice started in 2016, and we’ve grown into a larger location in Corktown, Detroit on Michigan avenue. I work with a second doctor and we care for a diverse group of patients in terms of age, race, gender, abilities, orientation, socioeconomic status, and other factors. We’re proud to serve at the community level and to advocate for better health for our patients.
Question: Healthcare is an issue that is on everyone’s mind. What are some the glaring issues surrounding healthcare as you understand it?
Answer: Currently, the for-profit practice of medicine and the insurance based system of care has devalued primary care services that would help us prevent the spread of viruses. in our current system, elective surgeries like knee replacement surgeries and other procedural work receives the largest reimbursement from private health insurance companies and Medicare. So, our corporate hospital systems have maximized their ability to perform these procedures at the expense of a robust and well-functioning primary care delivery system. This disorientation has caused us to be vulnerable to pandemics like this.
Question: In 2019, “telehealth” was considered part of the future of medical care; however, the current pandemic has accelerated the progress and use of telehealth services. Do you see a time in the near future where telehealth successfully replaces some or most in-person office visits for routine services?
Answer: in our practice at Plum Health DPC, our patients can call, text, or email us anytime. We can also use video chats and we can text photos to help us better understand the conditions affecting our patients. We’re able to do this because WE DO NOT BILL OR USE INSURANCE. You see, your doctor cannot and will not text you after hours or even as a replacement for a typical visit because your doctor can only get paid by the insurance company for face-to-face visits. In our model, because our patients pay us directly, we change the way we deliver primary care to maximize the efficacy of our time and resources, and to give our patients an amazing customer experience.
Question: In an effort to curb the rising costs of health care and limit instances where patients have to pay out-of-pocket for services denied by their insurance companies, more and more medical procedures require prior authorization. Do you believe any changes are necessary to the prior authorization process that will allow you to better serve your patients, while at the same time reduce the rising costs of providing health care?
Answer: again, because we don’t bill or use insurance at Plum Health DPC, we don’t often go through the prior authorization system. In our model, we are extremely effective at lowering the cost of care, so it’s often times cheaper to buy the medication or get the lab test by paying cash for the service than by using the insurance policy to pay for an over-inflated cost of a lab test or medication. For example, if you got a complete blood count at the local hospital, they might charge you $125. That same complete blood count only costs $4 in our office.
Thanks for reading and have a wonderful day,
-Dr. Paul Thomas with Plum Health DPC
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
Social Entrepreneurs Speak with Challenge Detroit Fellows at TechTown
On Friday February 7th, 2020, I was invited to be a panelist at TechTown Detroit to discuss social entrepreneurship. It was formally called “The Leadership Panel on Social Entrepreneurship” and we were invited to speak to a group of young professionals who are also known as the Challenge Detroit Fellows. From their website:
Challenge Detroit cultivates diverse, innovative, community-minded leaders from the city and across the country, fostering their talents to support local initiatives that move Detroit forward.
It was very nice to be thought of as someone who could make an impression on these Challenge Detroit Fellows and help them grow into more community-minded leaders.
I was invited by Shelley Danner, the Program Director for Challenge Detroit, and she also invited some influential leaders to the program. They include David Merritt of Merit Goodness and Pastor of the Straight Gate International church, Katrina Turnbow of KanopiSocial, and a mother-daughter entrepreneur team behind Black Girl MATHgic, Brittany A. (Sanders) Rhodes and Veneda Sanders.
We tried to share insights with the Challenge Detroit Fellows that would be meaningful for their work in Detroit and for their professional development.
I’ve been meaning to write about this experience for some time now, and I had a few moments to put together this blog post. But the bottom line is that I miss doing this sort of work, meeting with community leaders and meeting with emerging young professionals, and helping them to take the next step on their career path while learning from them and my peers.
It’s impossible to count how many events like this that the Coronavirus Pandemic has prevented us from engaging in, but I’m looking forward to doubling down on future events when the Covid-19 virus passes us by, after we flatten the curve and get back to normal life. I miss the handshakes, hugs, fist bumps, and pats on the back, the encouragement for the journey that you can only get in person.
Stay safe out there,
-Dr. Paul Thomas with Plum Health DPC
Speakers for The Leadership Panel on Social Entrepreneurship for Challenge Detroit, from left to right, David Merritt, Veneda Sanders, Brittany A. (Sanders) Rhodes, Paul Thomas, MD, Shelley Danner, and Katrina Turnbow.
Speakers for The Leadership Panel on Social Entrepreneurship for Challenge Detroit, from left to right, Katrina Turnbow, Paul Thomas, MD, Brittany A. (Sanders) Rhodes, Veneda Sanders, and David Merritt. Not pictured and moderating the panel is Shelley Danner, the Program Director of Challenge Detroit.
Paul Thomas MD interviewed on the Soul of Enterprise Podcast
This week, I had a one-hour conversation with Ed Kless and Ron Baker. Here’s the full audio recording:
Ed and Ron both asked some amazing questions, here’s what we discussed on the show, via their website:
Join Ed and Ron for our second interview with Dr. Paul Thomas, Founder of Plum Health DPC (Direct Primary Care), to discuss COVID-19, and his experience dealing with this from the front lines. Also, his new revolutionary business model in medicine. Is this the cure for our broken healthcare system, and how’s it going so far?
A Quick Bit About Dr. Paul Thomas
Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit. He is a graduate of Wayne State University School of Medicine and now a Clinical Assistant Professor. Finally, he is an author of the book Direct Primary Care: The Cure for Our Broken Healthcare System.
Here are Ed’s questions from the interview:
How are you?
What about the people in your local community, how’s it going there?
About 40% of hospital beds in Michigan are filled with COVID patients, does that sound right?
Is there a difference between intubation and being on a ventilator, or are they the same thing?
And that’s different from being on oxygen?
There are potentially long-term risks with being intubated, even after you come off it, such as challenges with your lung capacity coming back?
What has been the effect, if any, on your business model? Has there been any significant challenges with Direct Primary Care (DPC) model?
Are they waiving any regulations to be able to provide telemedicine, for example?
Do you think COVID-19 might lead to a significant increase in DPC?
Will doctors get acclimated to provide telemedicine?
The numbers we’re all seeing at John Hopkins or Worldometer, the numbers are pretty scary, but they are also are staggeringly incomplete. I don’t think we can really believe the number of cases in China being limited to 81,000, for instance.
You talked a little bit about the tests with Ron, what are your thoughts about the at-home tests? Will we all be able to test ourselves at home and get some better numbers about what’s happening?
The FDA and CDC sort of messed up the process with the test when all this began. What are your thoughts on that?
This is less political than governmental. The nature of bureaucracy that may have been the downfall, regardless of the administration.
On your website blog, you did a great job debunking the Vitamin C myth that’s out there. What about hydroxychloroquine as a possible treatment?
What about the potential vaccine for this? If one was quickly developed would we be able to get it out quick enough, or would that run into bureaucratic hurdles?
Does that 15-18 months include the testing and verification, or just the development of a vaccine?
What about links you’ve seen to diabetes or pre-diabetic condition, or does it mostly just affect those who are older?
Age and diabetes are correlated aren’t they?
…and here are Ron’s questions:
In times like this, do you think this business model has deepened your relationship with patients?
Do you think the subscription model helps you weather a storm like this rather than a more transactional business model?
Can you explain the protocol for a COVID-19 test? Don’t they test for the flu first, and only as a last resort test you for COVID-19?
We don’t have a clear idea of the “denominator,” we don’t how many people are walking around with asymptomatic symptoms, right?
Settle a big dispute: Should we be wearing masks when we go out? [Yes!]
Does it have to be an N95 mask? [No]
You probably remember that in 2009-10 we had the Swine Flu, and between April 12, 2009 and to April 10, 2010, 12,469 people died in the USA alone, with 87% being under age 65. What makes COVID-19 deadlier than the swine flu?
Can this can back in different strains? Can you get again once you’ve had it and recovered?
Have you seen any granular demographic, age, comorbidities information on the reported deaths and/or cases?
With older patients, there’s a difference between dying from and dying with corona virus. How do they make that distinction when they gather the death statistics?
The University of Pittsburgh has developed a vaccine, they say they’ve seen development antibodies in mice. And I just finished a book by the oncologist Dr. Azra Raza, who wrote The First Cell. She says, at least for cancer, having anything to do with mice doesn’t really work when translating to humans. But is that not true with vaccines? The fact it works with mice, is that promising for humans?
We say it takes 12-18 months to develop a vaccine. Is there a way for the FDA to expedite this process. What is the risk of a vaccine developed quickly?
On your website blog video from March 26, 2020 you answer the question, “How can I become immune?” You listed two ways:
Get Infected then Recover (your body produces IGM/IGG) and you now have the antibody
Vaccination
You said to create herd immunity you need 50-60% of people, can that immunity happen plasma transfusions from people who had the virus and recovered?
What about this virus running it course and achieving of herd immunity? How long does that process take without a vaccine?
Unless it comes back in a different strain?
I’m looking at Worldometer, and Michigan has now surpassed California in cases. We were taking flights from China during December and January, at the rate of at least 7,000 per day. There’s only 246 deaths in CA—each a tragedy—can you account for that? Why wasn’t CA hit has hard as New York, New Jersey, or even Michigan?
Could it be herd immunity, why CA wasn’t hit as hard?
Where do you see this ending? How and when?
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
Can Vitamin C Treat the Coronavirus?
Can Vitamin C Treat the Coronavirus?
No.
At this time, there is no evidence that Vitamin C can prevent or treat the Coronavirus.
In late March, I began to receive an uptick in questions about vitamin supplementation. There is little to no evidence that high doses of vitamin C will prevent or treat the Coronavirus. But some people have been recommending these supplements as a panacea for all viruses and all seasonal afflictions. There’s also been a few social media posts promoting vitamin supplementation as a cure for Coronavirus. In this blog post, I aim to set the record straight on vitamin C and Coronavirus.
What is Vitamin C?
First of all, Vitamin C (ascorbic acid) is an essential nutrient as it supports normal growth and development and it helps your body absorb iron. Your body doesn’t produce or store vitamin C, so it’s important to get enough vitamin C by eating a healthy diet.
Next, and according to the Mayo Clinic, the average adult needs 65 to 90 mg of vitamin C each day. Again, we can get enough vitamin C by eating a healthy, well-balanced diet. There’s 190 mg of vitamin C in a raw sweet red pepper and there’s 97.5 mg of vitamin C in a large orange. Other foods high in vitamin C include guava, tomato juice, orange juice, strawberries, papayas, and broccoli.
Here’s an awesome chart from Medical News Today that shows which foods are rich in Vitamin C.
The best way to get enough Vitamin C? A healthy diet. The above foods have adequate amounts of Vitamin C.
Where is this Bad Advice on Vitamin C coming from?
Here’s the issue, in late March I was forwarded general advice from a holistic doctor who went so far as to recommend as much vitamin C “as your body can handle” but at least 3,000 to 5,000 mg each day. In their words, this would protect you from the Coronavirus.
Not only is this person misleading their patients and giving potentially dangerous medical advice on a non-individualized basis, but he is also profiteering on their lack of knowledge. The doctor has an online supplement store where patients can purchase his recommended vitamins without a prescription for a hefty sum.
This email was forwarded to me from a holistic doctor who has been prescribing the above supplements as Coronavirus “protection.” As a family medicine doctor who follows evidence-based guidelines, it is very frustrating to see this type of bad information circulating via email and on social media channels.
Can Too Much Vitamin C be Dangerous?
When people think of vitamins, minerals, and supplements, they think of good health. If supplements are good, then more supplements are better, right? But what people don’t know, and what this vitamin-pushing doctor should know, is that mega doses of supplements can have negative consequences.
Most adults only need 65 to 90 mg of vitamin C each day, and adults shouldn’t take more than 2,000 mg each day. Although too much dietary vitamin C is unlikely to be harmful, mega doses of vitamin C supplements might cause diarrhea, nausea, vomiting, heartburn, abdominal cramps, headaches, and insomnia.
Let’s create a hypothetical patient who is a middle-aged adult man who takes Metformin 500 mg twice daily for his long-standing diabetes. The Metformin works well, keeping his blood sugar and hemoglobin a1c levels near normal. It’s important to know that adverse effects of Metformin include diarrhea, GI complaints, nausea, vomiting, and abdominal distention.
If both the Metformin and the high-dose Vitamin C are taken at the same time, the side effects from Vitamin C supplementation may be incorrectly attributed to the Metformin, potentially causing the patient to stop a beneficial medication.
Always Talk to Your Doctor about Your medications and your supplements
It’s entirely possible that in some cases, a patient might be taking mega doses of vitamin C, and not inform their physician of these supplements. Usually a doctor only asks their patients about which medications they’re taking, and not specifically about supplements. If the doctor doesn’t know about these mega doses of vitamins, those adverse effects caused by the vitamin C mega doses may be blamed on or attributed to a life-saving or life-prolonging medications prescribed by your doctor.
And this is just one example - many medications, from blood pressure medications to SSRIs for depression to other medications for diabetes like glipizide can have gastrointestinal side effects. So, please, talk with your family medicine doctor or internal medicine doctor about the medications and supplements that you’re taking.
What Can You do to help improve your immune system?
Here’s my recommendation for a healthy lifestyle during this time:
Exercise: 1 hour daily
Sleep: 7 - 9 hours daily
Eat: a balanced, healthy diet
Meditate: 30 minutes to 1 hour daily
If you choose to supplement with Vitamin C, talk with your doctor.
As a final note, the USA Today wrote a good article about this topic, and Harvard Health has another good article about this topic.
Thanks for reading, - 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