12 minute read
Covid, The Aftermath
What We as Physicians Will Be Left With
By JOSEPH F. ANSWINE MD FASA
At this time, our EMR has a red “+” present on the record of many if not most of the patients that come to the operating room. That signifies a previous Covid infection. Thankfully, the majority of patients had a distant past positive Covid test, suffered minimal or no symptoms, and are now at baseline health. But for a small but definitely present few, it means residual problems. These are the individuals suffering from secondary organ damage, or have “long Covid”.
According to the CDC, lingering effects from a Covid infection are due to obvious organ damage from the initial infection or less obvious etiologies especially in those with minimal or no initial symptoms. For those with organ damage; whether the heart, liver, lungs, kidneys, brain and so on; direct damage from the virus, autoimmune attack or extended hospitalizations are the culprits. These will likely now be life-long problems, and pose future difficulty as we care for them. As for those experiencing symptoms after mild or no obvious initial symptoms, the etiology is not well understood.
With the Covid pandemic continuously evolving, the data too are evolving, therefore, much is incomplete, or the data are conflicting. Any data in this editorial came from the CDC, Pubmed searches, or from a major institution’s website.
According to the CDC, those with long Covid with less understood etiologies experience shortness of breath (SOB), fatigue, post-exertional malaise, difficulty concentrating, cough, chronic pain, palpitations, diarrhea, sleep disorder, and many other vague but life-altering symptoms. SOB, fatigue, and cognitive changes are the three most commonly described of the actually hundreds of documented conditions. Long Covid can last weeks or months after first being infected or can appear weeks after infection. It can occur in anyone who has had Covid, even if the illness was mild, or if they had no symptoms. Since the definition of long Covid varies, consistent statistics prove difficult but data have been published stating that 50% of unvaccinated Covid sufferers experience the syndrome and 19% of those vaccinated with Covid do. Patients may or may not have abnormal laboratory values consistent with lingering infection or inflammation.
There are at least three theories of the etiology of long Covid. One is that the virus is still present in the body and becomes intermittently reactivated. Two is that left over inflammatory cells continue to produce an inflammatory response. Lastly, the Covid infection has led to an autoimmune process therefore our own immune system is creating ongoing symptoms. It’s probable that a combination of two or all the theories are correct.
A process described with Covid is Multisystem inflammatory syndrome (MIS), a continuing process seen in post-Covid patients. It has been seen in adults and children. MIS is not common but if present, is a serious condition in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.
As for mental health, literature describes a one in three likelihood of having generalized anxiety disorder post-Covid. Furthermore, one in four have disorganized sleep, one in five have depression, and one in eight have PTSD.
As for treatment of all these processes, they are supportive and minimally defined.
What this all means is lingering problems after surviving the acute infection, as if that was not enough, will be with us for years to come; and we will be treating them with a myriad of therapies that are as yet probably unknown.
LEGISLATIVE UPDATES
PENNSYLVANIA MEDICAL SOCIETY
Quarterly Legislative Update
Prior Auth—SB 225—PAMED is part of a 40+ member coalition pushing for the passage of SB 225. At present, a final omnibus amendment to SB 225 is being drafted after extensive meetings between stakeholders. Commitments from Senate republican leaders and the bill’s sponsor, Sen. Kristin Phillips-Hill, has been the driving force to reach meaningful agreements with the health insurers. Although a “date certain” for a senate floor vote remains somewhat elusive, all indications point to late May. PAMED will begin a grassroots campaign to get physicians engaged in calling their senators. (PAMED initiated this initiative nearly 6 years ago.)
IMG Licensure Parity—HB 245—After several years of navigating the legislative process, this legislation won the approval of the General Assembly and was signed into law on April 19 as ACT 16 of 2022. The bill reduces the number of resident years, from 3 to 2, that IMGs must complete to qualify for a medical license. This brings IMGs into parity with graduates of American and Canadian medical schools. (HB 245 was legislation sponsored on behalf of PAMED.)
Pharmacy—HB 1535/SB 515—This bill proposes to, among other things, grant pharmacists with the authority to provide childhood immunizations for children ages 3 and above. It also grants the ability of pharmacists to provide flu and Covid-19 vaccines to children. PAMED has joined with our physician coalition partners in opposing these bills. We are aware that Rep. David Hickernell will be introducing his own version of HB 1535 that will limit expanded services by pharmacists to flu and Covid-19 vaccines for individuals aged 9 and above.
Since 2002 the Pharmacy Act has authorized pharmacists to administer injectable medications, biologicals and immunizations to individuals ages 18 and above. The Act was amended in 2015 to allow pharmacists to administer flu vaccines to children ages 9 and above. Pharmacists are prohibited from delegating their injectable authority but pharmacy interns under the direct, immediate and personal supervision of a pharmacist are also allowed to administer injectables under the same conditions applicable to pharmacists.
Restricted Covenants—HB 681—This bill was approved by the House Health Committee last year and is currently awaiting final passage by the full House of Representatives. Opposition by the Hospital Association, in conjunction with a number of legislators, has dramatically slowed the consideration of this proposal. PAMED continues to coordinate legislative strategy.
EPT—SB 317—Expedited Partner Therapy (EPT) legislation has now cleared the Senate and the House Health Committee. The bill provides liability protections to physicians who elect to treat the sexual partner of a patient who has contracted an STI. PAMED has joined with the OB/GYNs in supporting this initiative. Final passage is expected in the near term.
Test Records—HB 1280—Originally initiated by PAMED after the passage of ACT 112 of 2018, this bill will significantly change the requirements that currently exist under ACT 112. The bill will require imaging facilities to provide a written notice to patients undergoing an imaging study (excluding x-rays) reminding them to contact their referring physician for the test results if they have not heard from them within 21 days. The bill has passed the House and is currently awaiting Senate Health Committee consideration.
Stay up to date on PAMED’s legislative priorities at www.pamedsoc.org/Advocacy
RESTAURANT REVIEW
EL SOL CANTINA
By ROBERT ETTLINGER, MD
Acomedian once joked about Mexican food having 100 recipes made out of 6 ingredients. If you take a look at the offerings at that fast-food restaurant featuring a chihuahua, it’s kinda true. Refried beans, salsa, cheese, and guacamole if you’re lucky. But there’s another kind of cuisine from our neighbors to the south. Mexican food was introduced to the US in the 19th century when settlers entered Texas and encountered Mexicans who had the territory of San Antonio. Beans and spices were combined with the beef that was plentiful from the cattle supply, to make chili con carne. In the 1890’s, the term Tex-Mex came to be, as food ideas were shared by the different ethnicities, and these grew into what most of us think of as Mexican food. However, it differs from authentic Mexican. The Texas brand uses cheese more often, and is more likely yellow, as opposed to the usually milder white queso of Mexican cuisine. Cumin is much more common in the Tex-Mex version, and tortillas are commonly made of wheat, rather than the original ones of corn. So, if you›d like to experience the real deal, the recently opened El Sol Cantina is the place to try.
Located at the site of the old Federal Taphouse, the southwestern style dining area is decorated with arts brought from Mexico. The menu mirrors that of its city counterpart, El Sol in downtown Harrisburg, down the block from the Whitaker Center. The food is a step above the others.
The drink menu has just about anything, including wine and beer selections, variations of margaritas and sangrias, as well as dozens of tequilas. Apps include guacamoles (with crab, goat cheese, and a surprisingly mild grilled jalapeno), served with baked crisps and enough for a table to nibble on before the main course. The chefs use avocados grown on a farm in Mexico of ESC’s owner, Juan Garcia. A wide selection of tacos, ceviches, quesadillas, burritos, fajitas, and queso fundidos (melted Mexican cheeses, gussied up) make it hard to choose. Carne and pollo entrees are unique, with rice and beans. Lobster Enchiladas had fresh chunks of meat, sauteed spinach, and portabella mushrooms, topped with a smoky pepper reduction and white queso. A big sizzler plate of Fajitas Mixtas had chicken, steak, and shrimp, with another plate of the fixins. If you still have a little room at the end of the meal, Tres Leches Cakes (traditional or chocolate), flan, fried ice cream, and churros are destined to be shared. By the way, I don’t care what anybody thinks...every so often, yo quiero Taco Bell!
EL SOL CANTINA
3721 Market Street, Camp Hill, 717-635-9800
FRONTLINE GROUPS
The Dauphin County Medical Society thanks the following for their 100 percent membership commitment and their unified support of our efforts in advocating on behalf of physicians and the patients they serve.
Allergy Asthma & Immunology Brownstone Dermatology Associates Conestoga Eye-Hershey Cummings Associates PC Elena R Farrell DO Family Practice Center PC-Millersburg Forti & Consevage PC Gastroenterology Associates of Central PA PC Harrisburg Gastroenterology Ltd Hershey Pediatric Ophthalmology Associates PC Hershey Psychiatric Associates Houcks Road Family Practice James R Harty MD Jatto Internal Medicine & Wellness Center PC John E Muscalus DO Morganstein De Falcis Rehabilitation Institute-Harrisburg Patient First-Harrisburg PinnacleHealth Express PinnacleHealth Radiation Oncology Premier Eye Care Group Saye Gette & Diamond Dermatology Assoc PC Schein Ernst Mishra Eye Stratis Gayner Plastic Surgery Tan & Garcia Pediatrics PC Todd R Fisher MD Family Medicine UPMC Heart and Vascular Institute-LCV UPMC Pinnacle Colon & Rectal Surgery UPMC Pinnacle Harrisburg Transplant Services UPMC Pinnacle Harrisburg-Emergency Room UPMC Pinnacle PHCVI Cardiovascular & Thoracic Surgery Woodward & Associates PC
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MAY 15, 2022 ~ HOMELAND 155TH ANNIVERSARY
CELEBRATION Honoring Betty Hungerford
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SUMMER TOURS AVAILABLE
AT LANCASTER COUNTRY DAY SCHOOL challenging academics are only the start of each student’s opportunities for personal discovery and growth. From preschool to 12th grade, LCDS students are able to develop established passions or try new activities in a supportive independent school environment. Schedule a tour today!
www.Lancastercountryday.org | 717-392-2916
The Latest Advances in Neurosurgery for Your Patients— Right Here, Close to Home
The Penn State Health Neurosurgery team provides comprehensive treatment for common to complex conditions of the brain, spine and nervous system. Our world-class neurosurgeons have specialized expertise in many neurosurgical subspecialties to bring both children and adult patients lifesaving care tailored to their specific needs.
Patients also benefit from research conducted at Penn State College of Medicine, with access to innovative clinical trials – with the latest treatments and new hope.
Contact a Penn State Health neurosurgical expert near you: Penn State Health Neurosurgery
Milton S. Hershey Medical Center 30 Hope Drive, Entrance B, Suite 1200 Hershey, PA 17033
717-531-3828
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