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Posts from the ‘Flu Vaccines’ Category

A Busy Week in Washington


If you’ve been keeping up and I am not sure how you could avoid doing so, it’s been a busy week in politics. There was an IRS issue, the debates, and the announcement that the president and his wife had tested positive for Covid. Now he is in the hospital and his drug regimen suggests a very serious case of Covid but he and his physicians say that he’s doing fine. I have no opinion because I think the scope of Medical Practices differs a little for the president.

Now even more people in his immediate circle are known to be sick and regardless of your political views, this is not good news. I would not wish Covid on anyone and I wish the President and the first lady Godspeed in their recovery. Consider that wanting a new president is a lot different than wanting someone dead.

In our media fatigued nation, we were becoming sensitized to Covid after months of death tallies and counting cases. People are tired and broke and healthcare is still overwhelmed. After the president’s announcement, interest has peaked again making this a very good time to talk to your patients again about Covid, how it is spread and how to protect themselves. Be prepared to discuss the following information that is being widely disseminated on the ever present, 24 hour news channels and the always reliable internet.

  1. Testing does not cause the virus. The United States does not have more cases because we test more than other countries.
  2. Covid is more dangerous than the flu. More people die and there are serious lingering effects in a small number of patients including strokes and other neurological symptoms and permanent heart damage. This information can be given to patients without creating panic.
  3. Masks are effective at preventing the spread of Covid. The masks prevent the majority of droplets from entering the air so the people who do not know they have Covid are less likely to infect others. Masks are not a guarantee that you will not contract the virus and a mask does more to protect others than the one wearing it. Wearing a mask is a way of protecting the community. Your friends and neighbors and even strangers are protecting you when they wear a mask. Masks are at times unpleasant but they are such an easy way to be kind and who doesn’t want to be a little more kind.
  4. There are some activities and places that are safer than others. An outdoor porch with two people wearing a mask and sitting six feet apart is a low risk situation. Being in a small room with no masks in use creates a high risk situation if someone is infected with Covid. The problem is that we don’t always know who is infected. One study indicated that people are the most contagious the day or two before they show symptoms.
  5. Children do contract and spread the virus. The list of symptoms for children is similar to the list for adults but symptoms may be milder. Death has occurred but at a lower rate than adults. My question is about quarantine and isolation. If anyone has a known exposure to Covid, they should quarantine for 2 weeks. Any parents out there with small children who think that would be an easy task? I didn’t think so.

At this point in time, treatment is directed at symptoms. Information about specific medications should be referred to their physicians unless the medication is Hydroxychloroquine. In that case, your medical director might be called on to intervene. The first two medications given to the president are Remdisivir and Regeneron. Remdesivir has been given emergency approval because it has proven to reduce hospitalization time by a few days and Regeneron is experimental and the President received it following an FDA expanded use exception which provides that an experimental drug can be administered to a patient if the following conditions are met:

  • Patient has a serious disease or condition, or whose life is immediately threatened by their disease or condition.
  • There is no comparable or satisfactory alternative therapy to diagnose, monitor, or treat the disease or condition.
  • Patient enrollment in a clinical trial is not possible.
  • Potential patient benefit justifies the potential risks of treatment.
  • Providing the investigational medical product will not interfere with investigational trials that could support a medical product’s development or marketing approval for the treatment indication.

The third medication is run of the mill steroids like Solumedrol or Dexamethasone. They have been used in Covid in the past to treat inflammation. Because steroids seriously impair immune responses, these are usually given late in the disease to patients on ventilators.

In other words, there isn’t any one medication or treatment approved for the treatment of Covid so in general, the best advice is not to become infected.

Patients should be advised that the following is a list of symptoms for Covid (and other illnesses):

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Because this looks a lot like the flu, there has never been a more important time to get a flu vaccine. That goes for visiting clinicians, too. Although there is no mandate for home health and hospice providers to offer annual flu shots, the cost of having visiting staff out sick for an extended period more than covers the minimal cost. Fun Fact: Medicare covers flu immunizations for hospice patients, too.

Your patients are at higher risk for serious illness and death from Covid due to age and underlying chronic conditions. Heart and lung disease and diabetes seem to be more prevalent in the underlying conditions category. Again, that can be conveyed to patients without causing panic. You know how to approach your patients because you have spent time with them. No need for police tape blocking off their homes.

Equally as important is educating non-homebound family members about the highly contagious nature of the virus. Teaching of family members is not covered in home health but it is not prohibited when another covered skill is rendered. Hospices are covered when teaching family members.

Should you have any questions, please email us so that we may refer you to someone who knows more like the CDC. Comments are always welcome.

Guess What Happened!


3D_Influenza_blue_no_key_full_med

Image of the Flu virus courtesy of the CDC.

Guess what happened this past weekend?  The flu season officially started.  Although most people don’t like the flu season, the advent of flu season is better news than the LSU homecoming game score.  Someone should invent a vaccine for the malaise that oozes out of Tiger Stadium and infects the entire state of Louisiana when LSU loses a game deliberately stacked in their favor.  Where is Les Miles when you need him?  I’m not even sure where Troy is.

Back to the flu.  Last year’s flu season certainly wasn’t the worst we’ve seen but an estimated 71,000 flu related hospitalizations were prevented because people received the flu shot.  Is your hospitalization rate high?  Lower it with the flu vaccine.  A full 2.5 Million MD visits were prevented because people received the flu shot.  That’s about equal to the population of the state of Oregon.

We know that Medicare doesn’t give away stuff for free so have you asked why there is no charge for the vaccine?  The total number of hospitalizations for the flu each year runs about 200,000.

And yet, in home health and hospice, our hands may be tied depending state specific pharmacy laws.  In Louisiana, you have to figure that if LSU can’t beat Troy at our homecoming game, we are likely worthless against a deadly virus that kills between 3,000 and 50,000 people each year depending on the severity of the flu season.   Because most states do not allow nurses to carry medications that are not labeled for individual patients, multi-use vials are not allowed to be carried by nurses just in case a patient is in the mood for a flu shot.  While getting an order is not difficult, many nurses are not comfortable with injecting someone with the vaccine without having an emergency kit available for a possible reaction and it is impractical and wasteful to carry around a patient specific emergency kit for every flu vaccination given since it won’t be used.

According to the World Health Organization, for every 500,000 vaccinations given, someone will go into anaphylaxis (a condition causing the inability to breathe kind of like the way Louisiana residents gasped for air after Troy beat LSU on Saturday Night).

There is also a small but significant risk of coming down with Guillain-Barre’ after the flu vaccine.  Although this is one of the more undesirable effects of the vaccine, many people don’t realize that the flu causes more cases of Guillain-Barre’ than the vaccine.  So, roll the dice.  Get no vaccine and hope you don’t get the flu or get the vaccine and have a tiny chance of contracting Guillain-Barre’.  Of course, if you or your patients opt to forego the flu vaccine from your fall schedule this year and wind up sick with the flu, your chances of coming down with a pesky paralytic illness will be greater than those who didn’t get a flu shot and those that did get a flu shot combined.

So, here’s what you do.

  1. First go to the CDC Flu page.  There you will find all kinds of teaching materials for both patients and staff in multiple languages designed for various education levels.
  2. Check on your state’s regulations about the flu vaccine.  If permitted to do so, get said permission in writing.
  3. If you can’t carry flu unlabeled flu vaccine (much like LSU can’t carry a football), use this nifty widget to find out where your patients can receive a vaccine. You can even put it on your website if you want.
  4. Coordinate with your patients and physicians to get orders for patients who are truly bedbound or live in rural areas so distant that a simple trip to the drug store is out of the question.
  5. Encourage everyone in the household to get vaccinated. Leave one of those cute flyers from the CDC website taped to the refrigerator along with the list of nearby flu shot providers to reach the maximum number of family members.
  6. You can also vaccinate other Medicare beneficiaries in the household if you get orders from their physicians. (Technically, Medicare doesn’t require an order but I highly recommend that you give nobody any medication without one; especially someone you haven’t fully assessed and are unaware of their history and physical).
  7. If your agency is going to vaccinate a lot of people, consider billing for the flu shot. I have no earthly idea of how this is done but Medicare has graciously published a little info sheet for people who know what they are doing.  Note that you can only bill for patients with Part B.

The truth is that no matter what you do, the fact that Troy beat LSU cannot be changed.  But imagine if you or your patients get the flu and are too sick to do anything that takes your mind off the greatest LSU humiliation in recent history.  A situation like that could be the end zone for countless Louisiana residents.

And if you see Les Miles, tell him to come back.

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