Category Archives: Healthcare

Health: Who is at risk for novel coronavirus?

The above comes from the Asthma and Allergy Foundation of America, and is sourced to WHO.

Update: On March 12th, the CDC – finally – updated its health conditions list with more detail, albeit, buried in an item about the situation in Santa Clara County, California.

https://www.cdc.gov/coronavirus/2019-ncov/downloads/Santa-Clara_Community_Mitigation.pdf

Appendix A: Underlying medical conditions that may increase the risk of serious COVID-19 for individuals of any age.

•Blood disorders (e.g., sickle cell disease or on blood thinners)

•Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because kidney disease, or is under treatment for kidney disease, including receiving dialysis

•Chronic liver disease as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the dose of medications because liver disease or is under treatment for liver disease.

Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as chemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant medications, HIV or AIDS)

Current or recent pregnancy in the last two weeks

•Endocrine disorders (e.g., diabetes mellitus)

•Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)

•Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)

Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic conditions associated with impaired lung function or that require home oxygen

•Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders),stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].

Coronavirus: What does “elderly” or “Older” mean?

CDC has, on various pages, defined older as “60+” based on the sharp increase in mortality of SARS-CoV-2 infections that occur at age 60 and up. For those age 50 and up, the curve is also several times higher than below 40,

Unfortunately, there is no clarity on what is meant by officials when they warn us about risks to “older” people or the “elderly”.

CDC seems to imply that with regards to novel coronavirus, “older” is age 60 while some public health districts in California use age 50. Although regarding the warning against traveling on cruise ships, the LA Times says this applies those age 70 or older.

Similarly, there are references to “the elderly” – what does that mean?

  • Social Security says age 65.
  • The U.S. Housing and Urban Development Administration says age 62.
  • This page says the term “senior citizen” applies to those at age 60 or 65.
  • Officially, if you are past “middle age”, you may be considered “older” or “elderly”.
  • Interesting items here suggest it has become associated with “feeble” but the root word is actually “elder”, which describes someone to be respected.

There does not seem to be a precise definition – but it seems to fall somewhere in the 60-65 age range and occasionally in the 65-70 range.

The lack of any definition does not help the CDC’s communication. How do individuals know if they are the target audience for the recommendation when vague terms like “older” or “elderly” are given, but not defined?

Health: Mixed messages on coronavirus covid-19

F5 today, closed their skyscraper in downtown Seattle to disinfect the entire building because one worker had been in contact with someone that later tested positive for COVID-19.

France canceled an outdoor half marathon and closed all indoor activities having more than 5,000 attendees.

Many tech conferences have been canceled, postponed or moved to online presentations. Amazon canceled warehouse tours. Nvidia just canceled a tech conference. The EU has closed its headquarters to visitors.

In King County, Washington, 11 schools are closed because an associate of a staff member or student has become ill (not even diagnosed with COVID-19). The schools are in process of being sanitized. The entire North Shore School District will close on Tuesday to provide staff training on conducting remote education/telelearning …

Nike’s headquarters in Oregon was closed this past weekend for deep sanitization – even though they said they had no reports of any exposure by anyone.

The Washington State Department of Health urges those with unspecified pre-existing medical conditions or over the age of 60 [1] to avoid public gatherings:

“Persons who are older or who have underlying health conditions are at higher risk to develop complications from this virus. Your health and the health of those you care about are important to us and it may be recommended that you stay at home and away from other people during this time. “

In 24 hours, deaths went from 2 to 4, confirmed cases in Washington increased, and there is community transmission in Oregon, now including Eastern Oregon.

Meanwhile, ReedPop Entertainment announces its Emerald City Comic Con, with 100,000 people confined in close quarters in the Washington State Convention Center, with many visitors from other countries, will go on as planned – in Seattle, which is apparently ground zero in the U.S. for the spread of the COVID-19. They assure us that the health of their guests is their highest priority and they are following government guidelines (except those of the Washington State Department of Health but what ever).

So who do we believe?

There is a lack of leadership and clarity as to what steps the public should take. This leads to companies, like Nike, closing for cleaning – without exposure – while ReedPop plans a 100,000 person event in confined quarters at ground zero of the disease spreading in the U.S. and saying it will be safe for all.

Footnotes

[1] We assume the DoH is referring to people over age 50 or 60 but the State lacks clarity in its communications. They say, for example, that people with “underlying health conditions” should avoid contact with other people – but then provides no explanation of “underlying health conditions”.

Health: “Swiss government bans all events over 1,000 people”

Source: Swiss government bans all events over 1,000 people – MarketWatch

Numerous tech industry conferences have been canceled in the U.S. already. Flights to and from Asia have been slashed or eliminated.

The modern world has no effective way to deal with a spreading virus except to shut down the entire economy – potentially destroying entire economic systems and causing additional harm to populations.

Disease: Good summary of coronavirus COVID-19 situation

Summarizes possible impacts to the U.S. and economic issues. CDC is planning for possible school and business closure mandates, summer Olympics could be canceled, and hoping the disease, like many, subsides during warm summer conditions.

The total number of COVID-19 cases climbed above 80,200 as of Tuesday with deaths climbing to at least 2,704.

Source: Coronavirus live updates: US confirms 53 cases, CDC outlines pandemic planning

U.S. firms discouraging or prohibiting travel by employees to affected areas now including China, Italy, South Korea and southeast Asia including Australia.

Personal finance: “FIRE” doesn’t really mean “retire early”

True:

In truth, “FIRE” should be “FICC” for “financial independence change careers.”

Source: What I learned about the FIRE movement while making a doc about it

I have followed several “FIRE” blogs from people who save aggressively (generally a good thing) and “retire” at 30 or 40. I admire them for practicing frugality (something we have practiced too). I am now retired, albeit, at the age when many people have retired (old dude, ok?)

I too noticed that most FIRE practitioners did not retire, exactly, but often took advantage of their near financial independence to work independently, on their own schedule – instead of the usual corporate rat race. That’s not  bad thing either – in fact, it sounds like a great opportunity for many!

But there are some hidden “gotcha” expenses that may be lurking for FIRE adherents in the near future …

Continue reading Personal finance: “FIRE” doesn’t really mean “retire early”

Increases in student loan availability lead to increases in tuition and fees

Stated another way, the more money poured in to student loan programs, the higher the tuition charged. Tuition goes up because of student loans rather than the view that student loans go up in response to higher tuition.

Consistent with the model, we find that even when universities price-discriminate, a credit expansion will raise tuition paid byall students and not only by those at the federal loan caps because of pecuniary demand externalities. Such pricing externalities are often conjectured in the context of the effects of expanded subprime borrowing on housing prices leading up to the financial crisis, and our study can be seen as complementary evidence in the student loan market.

From: Lucca, D., Nadauld, T., Shen, K. (2015, 2017). Credit supply and the rise in college tuition: Evidence from the expansion in Federal student aid programs. Staff Report no. 733. Federal Reserve Bank of New York.

As the authors note, this is similar to other areas where a third party supply of money causes prices to rise – such as the effect of cheap mortgages causing home prices to rise.

A similar effect occurs in health care where third party “insurance” benefits are an enabler of higher priced health care services.

Whenever the cost of goods are services are subsidized such that their immediate direct costs are lower than the market clearing price, demand for those goods and services will increase. As demand increases relative to supply, the prices charged increase to a new actual and higher market clearing price.

Student loan programs are a major cause of tuition hikes. Cheap mortgages are a major cause of rising home prices. Health “insurance” is a major cause of higher prices charged in health care.

Health: Insurers pay $15-$85 for “free” flu shots; I paid $19.99 cash at Costco. “Insurance” is an enabler of high costs in health care.

Although many consumers pay nothing out of pocket for flu shots, insurers foot the bill. And those prices vary dramatically.

Source: The Startlingly High Cost Of The ‘Free’ Flu Shot | Kaiser Health News

Insurance has made possible random pricing for what should be fixed price goods and services. Contrary to widespread misunderstanding, insurance does not make health care cheaper, it merely makes someone else pay for it. Kaiser found that 3rd parties pay $15 to $85 for the same flu shot.

I paid $19.99, cash, at Costco, because we no longer have 3rd party paymet for prescriptions or vaccinations. Fred Meyer wanted $60 – it was hard to get a price quote from them as they were flustered when I asked for a cash price, as if they didn’t know what to do. Several minutes later they got back to me with a price.

Since I have skin in the game, I shop around. There is no reason for anyone or any insurer to pay exorbitant (and secret) prices for a fixed service like a flu shot. But they do it anyway.

All proposals for addressing health care issues in the United States are of the form “health care costs too much so let’s find someone else to pay for it“. This strategy will only work as long as you can find someone else to pay for it, and then it collapses.

The reality – as shown by prices paid, time after time – is that 3rd party payers enable high prices and do not control them, as they claim.

Off topic: New brain scan technique finds evidence of brain changes long after concussion/TBI/Brain injuries

Off our usual topics here but … Having experienced six traumatic brain injuries in life, this study is of great interest to me:

The authors point out that there is growing evidence of persistent changes in the brain that last well beyond clinical recovery and clearance to return to play. This study confirmed those findings showing clear brain changes in both structure and function that persisted six-months after injury. They also showed that these persistent brain changes related to concussion history, even in healthy athletes.

We were able to show evidence of prior concussion history through this method,” said Menon who is also a scientist at Robarts Research Institute and the director of the Western Centre for Functional and Metabolic Mapping. “This component correlates directly with the number of previous concussions that an athlete has had. This hasn’t been shown before.”

Source: MRI technique shows unique signatures of concussion in rugby players – Media Relations

Very interesting!

I have had six traumatic brain injuries (TBIs) ranging from about age 5 or 6 up through about age 50. One included a skull fracture (and unconsciousness) and 3 others involved knock out blows. Two did not knock me out but left me disoriented or with other affects such as “slow brain” and (oddly enough) arrhythmia for a couple of weeks.

In the past, these were called “head injuries” not “brain injuries” and were mostly ignored by doctors. Associated broken bones got attention! This is why TBI has been called an “invisible injury”.[1]

Incredibly, I did not know what a “TBI” was until 2018! I had, at various times, and in some cases still, experienced a variety of common TBI symptoms including “word finding” (knew what word I wanted to say but was physically incapable of saying the word), “stabbing” headaches, “throbbing” headaches, tinnitus, visual migraines, “slow brain”, emotional lability (since my third TBI, I found myself breaking into tears at emotional movie scenes or news stories), irritability, anxiety, “negatavistic thinking” including rumination and perseveration, sensitivity to low frequency sounds and noise and very short term memory issues (but not long term). For example, I tend to misplace tools I am working with and then spend 10 minutes looking for them, misplace my reading glasses, leave a stove burner on, etc. I developed coping strategies to avoid this now and it no longer happens as often as it once did!

I had no idea my brain was not behaving as it should. I learned just this year that this was not normal brain functioning and these were common after TBI (and sometimes long term after TBI). Merely learning this has left me with a wonderful feeling – finally – a coherent explanation and treatment options for a few things that linger on from long ago TBIs.

I learned that some people had very mild head injuries – but very debilitating brain injuries. There are some who have severe head injuries – but have made fantastic recoveries. There are also those who have had injuries and have had very difficult recoveries. Personally, I feel incredibly grateful that I came through a staggering six TBIs quite well and without diagnosis or appropriate treatment – not everyone has been so fortunate.

The above study has found a method for doctors to finally see evidence of physical changes, which they were previously unable to see. Lacking physical evidence, many patients with brain issues were ignored. More recently neuropsychologists have been brought in to evaluate cognitive functions and diagnose brain disorders that show no physical evidence.

Help for TBI patients is available.

Notes

[1] When I was 11 1/2 and recovering from a skull fracture, I remember I felt odd being so affected but nothing to show for it. Back in those days, kids with broken arms and legs got sympathy – but most didn’t know I too had a significant bone fracture and brain injury. TBI is mostly invisible. Yet my skull was fractured from my left temple to behind my left ear due to my bicycle striking a small pot hole, turning the front wheel into the curb, and throwing me over the handle bars, landing on the back of my head (per witnesses and evidence – obviously I have no memory of it). This was back in 1971 before bike helmets existed.