Retirement Planning

February 23, 2021

Next year will be my 48th year in clinical practice, and my 40th year of using homœopathy as my main therapeutic tool   While I have not yet set a definite date, I plan to retire in that year, most likely in the spring.  I will make every effort to finalize the date at least 90 days in advance.

I will be saying more about this in future posts and mailings. I’m beginning the process of informing you quite early as I don’t have anyone to take over the practice, and we don’t have a surplus of physicians in Eastern Connecticut.

Those of you who are on conventional medications prescribed by me will especially need to make arrangements with another physician because I will not be able to schedule refills dated for after I retire.

In April 2020 I assumed the Presidency of the Homœopathic Pharmacopoeia Convention of the United States.  I have been on the Board of Directors of that organization for about 30 years.  These are very challenging times for homœopathy in many parts of the world, and the United States is no exception.  I am already spending a good amount of time on various projects connected to this work, and expect that to continue for several years.

I have stopped taking new patients so that I can focus on those of you that I have been seeing over the years.

The issue of transfer and copying of medical records is complex and I will send information on that at a later date.

The office will continue to be open for appointments on Tuesdays from 10 am to 5 pm, and Wednesdays from 9 am to 5 pm.

Nationally, cases and deaths continue to rise, though at a lower rate than 2 weeks ago.  Connecticut ranks as the 17th state from the top of the list of cases per 100,000 persons.  In comparison, Rhode Island is at the 4th place, New York in the 9th place, and Massachusetts  is in 10th place.

In Connecticut , Windham and New London counties top that list, at 95 and 93 cases per 100,000 persons, while the other counties are in the 50’s to the 70’s.

Now that vaccination has been introduced world-wide we are starting to see more data on adverse events.   But before addressing what has recently come out in scientific and news reports, I would like to set the stage:

  • The first dictum for an individual physician is “Primum non nocere”, a Latin phrase which means “first do no harm.” An individual physician deals with individual patients, one at a time.  In the sphere of public health, however, medical science deals with populations as a whole.  Large populations can of course be divided into smaller units such children, young adults, middle-aged, the elderly, those with or without various chronic diseases like diabetes, heart disease, autoimmune disease, allergies, etc.  But still those subunits are composed of people who may differ in many other categories of health, to say nothing of their race, their stress levels, their socioeconomic status, their histories as groups, etc.  These differences, in various combinations and permutations may become significant when individuals have to make choices and seek guidance from their doctors.  When the science is not adequately settled, the situation becomes much more complicated.
  • In the present situation, the question of vaccination is clouded by all of the above factors. Those who deny the existence of the pandemic have no basis in fact for that view.  As I have previously discussed, pandemics are part of human history, and will continue to occur.  COVID-19 is the 3rd major epidemic from the family of Coronaviruses.  The first was SARS (Severe Acute Respiratory Syndrome) which began in 2003.  The second was MERS (Middle East Respiratory Syndrome)in 2012.  Those two were lethal enough that their spread was easily contained, since people got sick and died quickly.  COVID-19 is much less lethal and much more easily transmitted and as a result has spread globally.
  • I have previously noted the failures of many governments to limit the spread of the virus. I have also noted that even in countries which did well (China belatedly but then efficiently), South Korea, and New Zealand most notably, 2nd waves are occurring at higher levels than the first wave.

So here we are a few weeks after the introduction of the mRNA vaccines from Pfizer and Moderna.  Allergic reactions can be severe, although rarely, and can result in death, even more rarely.  A Florida physician in good health developed a fatal autoimmune blood disorder on day 3 after the vaccination and died.

In Norway, the government has revised its guidance to physicians who treat the elderly based on a number of deaths soon after vaccination in already frail persons aged 85 and older.  Assuming that vaccination and those deaths are related, this is obviously a “harm”.  But these people would presumably have died of COVID-19 had they been both unprotected and exposed.  How can an individual physician distinguish which of the many very elderly and frail people in nursing homes (high-risk environments) might not be able to tolerate the vaccine?  That this intolerance would exist was never in doubt, and such deaths were “expected.”

In Israel, as reported in the Jerusalem Post 13 cases of Bell’s palsy occurred after vaccination.  Most people recover completely from an acute Bell’s palsy (one-sided facial paralysis), while a few will be left with some residual paralysis.  Assuming firstly that the reported cases of paralysis are firmly linked to the vaccine, would the outcome for those particular patients have been worse if they were both unprotected and exposed?

In the development of previous coronavirus vaccines (SARS and MERS)  enhanced immune system reactivity to other infections, such as influenza, was found.  This includes enhanced reactions (stronger symptoms that might otherwise have occurred) to other coronaviruses, some of which have long been known to “cause” some common colds.  I put quotes around the word “cause” because illness is often as much or more about susceptibility to a noxious stimulus (bacteria or virus, toxins, etc.) than to the presence of that noxious stimulus.  Of course, when a virus is introduced to a population that has had no previous exposure to it, as is currently the case with COVID-19, the results can be severe, as evidence by the reaction of Native Americans to exposure to smallpox and measles when the Americas were colonized by Europeans.

The last item of news for this post is the introduction of a newer vaccine (Novavax) which is now in production.  While this is also a “spike protein” vaccine, it is formulated in an entirely different way from the Pfizer and Moderna vaccines.  The “spike protein” which is used by COVID-19 to attach to human cells (establishing the infection) is composed of 2 “subunits” named S1 and S2.  While the Pfizer and Moderna vaccines are aimed at S2, the Novavax product is aimed at S1.  Since S1 is the subunit that the spike protein uses to attach to the cells, the Novavax product may actually reduce the risk of infection, as noted in the early investigations of the vaccine conducted in monkeys.  S2 has to do with the virus’s entry into the cell after attachment so that it can multiply inside the cell.  We do not yet know if the Pfizer or Moderna vaccines actually reduce the likelihood of infection or spread.  The effectiveness of those vaccines appears to be that people don’t get sick, with an impressive protection rate of 95%.  But we know already that asymptomatic people spread the disease.  This is why recipients of those vaccines are still going to have to wear masks and practice social distancing.  Whether they will choose to do so is unknown.  Please note:  one can be infected but not sick (asymptomatic), and spread the virus to others.

While I am neither an immunologist nor a virologist, if the Novavax vaccine proves to be effective and safe, it might be a better choice than the currently available vaccines.  But the Phase III trial has just begun and early results will not be available until March 31st 2021, and the trial will not be concluded until December 30th 2022.  We also do not presently  know if the vaccine will pass scrutiny and be authorized for Emergency Use Authorization.  The Phase III trials for the Pfizer and Moderna vaccines have both reported their preliminary results and have gained Emergency Use Authorization from the FDA,  but the final reports will also not be issued until the end of 2022.  That means that these trials are still in process.

There are also many other vaccines in development.   It is more traditional for vaccines to not be licensed until Phase III trials are complete and have undergone scientific and regulatory review.   As a society however, we find ourselves in a crisis situation, which might have been avoided had world reacted more quickly or had been better prepared when this all started in the fall of 2019.

Getting back to “first do no harm”, my duty is to inform my patients to the best of my ability.   Even though we don’t yet have all the information that would make for a fully-informed choice, when vaccines are available, choice is unavoidable.  The choices:  vaccinate now; wait for more data or other vaccines; or never vaccinate. All choices contain potential risks and benefits.    We should all understand that those risks and benefits pertain both to ourselves and to our family members, to our friends and people that we come in contact with, and to society as a whole.   To not vaccinate ourselves eliminates possible risks from the vaccines (which so far have for the most part been “tolerable” from a public health standpoint) but also exposes us to infection and sickness from the virus.  This then creates the possibility of spreading the virus to other people who may then suffer a disease which can be asymptomatic (but spreadable), or result in a mild illness, or a more serious one that can later lead to significant disability or even to death.

In America, individual rights are strongly emphasized.  The pandemic has exposed us to the consequences of not sufficiently taking the collective interest into account.

Finally, as of the week ending on January 9th, the CDC reports continuing “unusually low” levels of flu activity.

As I’m sure you all know, COVID-19 is spreading across the country in a 2nd or 3rd wave (depending on how one counts the waves) and reaching new highs in terms of test positivity, cases, and the number of deaths.  Hospitals in many areas, especially in the more rural parts of the country, are stretched very thin.  Front-line and supporting health care workers are especially hard hit.

Locally the situation is much the same.  The post-Thanksgiving holiday time, as expected created a further uptick, and this can be expected to happen again after Christmas.  Countries which had been very successful at containing the virus (South Korea, New Zealand) are also experiencing substantial increases.

All precautions previously mentioned and promoted by the CDC are still in effect.  The current guidance for Quarantine in Connecticut can be found here.

As to the two newly approved vaccines, I would make the following points:

  • Everyone knows that the vaccine has been rushed into production, but that makes sense given that the disease can be severe and that there is no effective conventional treatment.  Although the outlook for hospitalized patients is better now than it was in the spring, mortality for hospitalized patients remains high, especially for those on ventilators, and some people with milder symptoms and who do not require hospitalization are experiencing prolonged and debilitating problems.
  • This is a disease that is therefore worth preventing, if that can be done safely.
  • Although there have been a few reported severe reactions to the vaccine (see below), those appear rare, at least so far. More common is a “flu-like” state following the vaccine, which is mild-to-moderate (worse than with the influenza vaccine) but short-lived (1-2 days).  The vaccine should be given in a facility which can monitor the vaccine recipient for possible allergic reactions (which can be severe, even life-threatening) and  treat (with epinephrine, etc.) if necessary.
  • The long-term side-effects of the vaccine will take more time to be properly appreciated. Since most people will not have access to the vaccine for at least 3-4 months, by that time we will have more data.
  • The vaccine appears to be highly effecting (90% or greater), which is obviously a very good number. If widely used, this could reduce transmission to such a low level that fewer people would get sick and so that the economy could gradually reopen and family and community life could become more normal.  In the most currently optimistic assessment, this might happen as early as the summer of 2021.
  • 2 doses of the currently available vaccines, a few weeks apart, are currently being recommended to establish adequate immunity.
  • The high level of effectiveness of these vaccines is presumably related to their ability to promote activation of the body’s “innate” immune system, which is more basic than just promoting high antibody levels as other conventional vaccines do. I like this aspect.
  • What is not yet  known about these vaccines is whether they will prevent vaccinated persons from harboring and transmitting the virus. Therefore, until vaccination levels are widespread (late summer or fall most likely), or subsequent studies show this not to be a problem, vaccine recipients should continue to wear masks and practice social distancing.  The current  Connecticut regulations on Quarantine can be found here.
  • Regarding testing, DNA tests are still the “gold standard.” These can be done through nasal swabs  or through so-called “rapid” tests.  The rapid tests are just coming onto the market and may soon be available on pharmacy shelves for home use.  While these are not as accurate as the nasal swabs that use PCR amplification techniques, they are certainly better than nothing, and their substantially reduced costs may allow for repeated tests which will reduce the likelihood of a “false negative” result.The Nasal swab test that has been in use for several months now has been accused as being oversensitive because it can detect COVID-19 dna in amounts that are so small that the person may not be able to transmit the disease.  The likelihood of such a “operationally” false positive result depends on the extent of  “amplification” used by the laboratory.  More information on such “false positive” tests can be found here.

Seasonal Flu:  Currently there are extremely low levels of influenza-like-illnesses across the country.  There is a slight uptick in Oklahoma as of December 12th but activity is “minimal” in the rest of the country.  The most recent report from the CDC can be found here.

It is possible that the upcoming flu season will be very mild.  This may be due to reduced transmission from COVID-19 precautions (masks, social distancing, etc.) as well as the possibility that people will not seek care and testing for flu because of the COVID-19 pandemic.  More information regarding this can be found here.  Regardless, the flu virus will certainly circulate in North America this winter.

For those of you who use Influenzinum, there is no compelling reason to start taking it as yet.  But there is no harm in doing so either.  I am getting more calls as the season progresses.  I will continue to post as circumstances warrant.

 

COVID-19 10/15/2020

October 15, 2020

I haven’t posted in quite a while because my recommendations have not really changed. As predicted by epidemiologists and virologists, the virus is still circulating almost everywhere in the world, and continues to cause outbreaks. Even New Zealand, which was one of the most successful countries in terms of managing the initial wave, the relaxing of restrictions was followed by an increasing number of new cases prompting a resumption of restrictions, albeit in a more geographical focused way.

As I’m sure that you all realize, the United States has not managed the pandemic well at all, and we are now seeing a 3rd rise in case loads in many parts of the country, including newer areas in the midwest and rural areas of the country.

Connecticut, in the last two weeks, has seen a 102% rise in cases, along with smaller increases in New York, Massachusetts, and Rhode Island. Although the Connecticut doubling seems drastic, we ae still in good control and my supposition is that the increase has mostly to do with the reopening of colleges and schools and will hopefully be temporary.

It clearly remains necessary to continue the use of masks, social distancing, hand-washing, and common sense. All of my previous recommendations still hold.

As for my practice, I have been very busy, even though I am working a reduced schedule, but other than counseling people about COVID, I haven’t treated anyone who I thought might have COVID-19 since I last posted. I have still not seen any patients inside of my office, but have seen 9 people outside the office door when a virtual visit would not have sufficed. Fortunately, the weather has cooperated.

I have purchased an air purifier, which provides both robust HEPA filtering with a single wavelength ultraviolet light and strong air exchange which should be effective in terms of virus particles as well as mold spores and other impurities. Together with scheduling in a way that avoids more than 3 people (including myself and Donna), 4 at the most being in my small office at one time, I should be able to see people in person (everyone masked, of course). I will try to continue to schedule as many people with virtual appointments as possible. Ironically, I get better non-verbal information from a virtual visit than a face-to-face but masked encounter. I also find that I am much more on time with my appointments since working virtually.

I look forward to the day when all this is behind us, but I don’t expect that day to arrive until next fall at the earliest, and possibly until spring of 2022. An effective vaccine might change that timetable, but that has not yet materialized.

COVID-19 8/16/2020

August 20, 2020

This will be a short post, as there hasn’t been much change, at least not for the better…

Re-opening has not worked well in many areas that have done so. In the Northeast, while the experience has been better owing to better leadership with regional cooperation among the states, there have been small “upticks” in the case counts, and schools and colleges and universities have not yet re-opened.

I have spoken with a number of parents, some of whom are also teachers, and as you might imagine there is quite a lot of anxiety around reopening the schools.

We still don’t have adequate testing capacity, a problem which is greatly compounded by delays in getting results.

I wish that I could feel more optimistic about the near future. My heart goes out to teachers especially, as well as to parents of school-aged children. There is currently some sense that school reopening could be safer for elementary school students than for middle and high school level students, who can at least benefit from online instruction. But we still don’t have enough understanding of the virus and its behavior to be certain of this.

As far as seeing patients in person, at the moment I am only seeing those people whose issues necessitate an in-person visit, and I am dong those visits outside, with masks and social distancing when near-proximity is not required. This have been only 4 instances of this since the pandemic started.

As you know, my office is small, and even to have myself, Donna, and one other patient in that space is questionable. I am looking into whether there is a way that I could improve the ventilation so that there is inflow of outside air, and exhaust of inside air to the outside so that there can be adequate air exchange. I think that is the main issue. I’m not sure how that would work in the cold winter…

Fortunately, I can do most of what I need to do by “virtual” appointments. I am hoping that insurance carriers will continue to cover these visits.

Lastly, now that the Federal Government has not been able to cope with the ending of the stimulus packages, we may be facing even more widespread financial distress. People tend to not seek care when they don’t have the financial resources to pay for it. I like to work with “good faith” (on my part as well as on yours), and so if you are experiencing financial distress and are contemplating forgoing care, please reach out to me.

If there was ever a time when so many people, and so many groups and institutions needed to come together for the common good, this is certainly that time.

COVID-19 7/19/2020

July 19, 2020

This is my first post in a few weeks because nothing much has changed, at least in the northeast US. Other areas of the country are not so fortunate, largely due to the premature opening from the “lock-down.” We are vulnerable to the same thing and need to continue to take precautions.

In my practice, since the 8 or 9 patients that I’ve previously reported on, I’ve not needed to treat anyone else in whom I suspected COVID-19. I did find out that one of those 8 or 9, that the sickest one was later confirmed to have antibodies to Sars-coV 2. This is the only confirmed case of this group. She was (in my estimation) sinking into a more serious stage when I gave one of the 3 remedies that I’d sent out. She threw a high fever that night, with delirium, and woke the next morning feeling much better. Within another 2 days she was back to normal.

The international homeopathic community is collaborating on collecting and analyzing cases, and we hope to have something that will demonstrate the validity and effectiveness of homeopathy.

An interesting video from a vaccine scientist from Cuba surfaced in my email the other day. She discusses her experience with vaccines prepared homeopathically. It is well worth watching.

A closely related 10 minute video clip from a recently released movie called “Magic Pills” should also be watched. This one will only be freely available for another 6 days, so I urge you to watch it.

Homeopathy has a very strong track record in the treatment of epidemic diseases, but this has not yet been accepted in conventional medical circles. Perhaps this time will be different…

I received the following guidelines on testing from the Connecticut Department of Health today. There are two documents, and I have simply copied them here: The second one is a FAQ (frequently asked questions) I have not included the references although for the sake of time I’ve left the footnotes in.

INFECTIOUS DISEASES SECTION
COVID-19 Testing: Recommendations for the Use of Nucleic Acid Tests to Diagnose Persons with Current Infection with SARS-CoV-2 Virus
(6-16-2020)
This guidance details the current public health recommendations for COVID-19 testing in Connecticut. Health care professionals will order this kind of test to diagnose and treat a person who is sick or may be infected with COVID-19. Public health professionals will use the results of these tests to identify and control new outbreaks of COVID-19, especially in communities where the risk of serious illness and death from COVID-19 is high.
TYPES OF TESTS1
SARS-CoV-2 is the name of the virus that causes COVID-19. Nucleic acid tests such as reverse transcriptase polymerase chain reaction (RT-PCR) help determine if a person is infected with the SARS-CoV-2 virus.
The following recommendations are for the use of nucleic acid tests to diagnose persons with current infection with SARS-CoV-2 virus and will be updated periodically, as needed.
This document does not cover the use of antibody tests to help determine if someone was infected with SARS-CoV-2 virus in the past.
WHO CAN ORDER A DIAGNOSTIC TEST FOR COVID-19?
An order by a licensed health care provider is required to obtain a test for COVID-19.2 Health care providers who can order a COVID-19 test include physicians, nurse practitioners, physician assistants and pharmacists. An individual health care provider for a specific patient may issue an order or a provider facilitating COVID-19 testing at a community, hospital, pharmacy, or other site may issue the order. A consultation with a provider may be advised but is not required before getting the test.
Information about testing sites in Connecticut is available from 2-1-1. Some sites only test symptomatic persons and others test both symptomatic and asymptomatic persons. Page 2 of 5

WHO SHOULD GET TESTED?
At the onset of the COVID-19 pandemic, nucleic acid testing was not widely available, and testing was limited to symptomatic individuals who may have been in contact with someone who was ill with COVID-19. Now that testing is more widely available, testing is recommended for all persons who are symptomatic and for those without symptoms in certain circumstances.
The goals of testing people without symptoms in certain populations or groups include the following: 1) prevent transmission in congregate settings among high risk persons; 2) inform infection control measures in healthcare settings and congregate facilities; and 3) protect persons living and working in high risk settings.
Symptomatic persons
Symptomatic persons are the highest priority for testing. Persons who test positive for the virus that causes COVID-19 need to be isolated and their close contacts need to be identified and asked to self-quarantine.
The virus that causes COVID- 19 is still being passed from person-to-person in Connecticut, although much less than what was seen in April and early May 2020. Persons that have any of the following symptoms should talk to a health care provider about being tested for COVID-19 or seek testing at a community site, even if these symptoms are mild:
a. Fever or feeling feverish
b. Cough
c. Difficulty breathing
d. Sore throat
e. Muscle or body aches
f. Vomiting or diarrhea
g. New loss of taste or smell

Contacts to persons with COVID-19
Testing is recommended for asymptomatic persons who are contacts of persons with confirmed or probable COVID-19.3,4 Persons who are contacts to a person with COVID-19 should quarantine for 14 days after their last exposure to that person. If an asymptomatic person who had been in close contact with a person with laboratory-confirmed COVID-19 tests negative during their 14-day quarantine period, this person should continue to observe quarantine for the full 14-days by remaining separated from others within their residence and monitoring for symptoms.
The Centers for Disease Control and Prevention (CDC) defines a close contact as someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to specimen collection).5
Asymptomatic persons
Testing of asymptomatic persons is not a replacement for other measures to prevent the spread of SARS-CoV-2, including wearing appropriate personal protective equipment (PPE)6, social distancing (when possible), wearing of facemasks or cloth face coverings in congregate settings (“universal source control”), good hand hygiene, and regular cleaning and disinfection procedures.
Because some groups (see below) have been shown to be at higher risk for infection and rapid spread of COVID- 19, repeated testing is recommended for asymptomatic persons without a history of recent infection in these groups for as long as infection remains present in those settings. Page 3 of 5

RECOMMENDATIONS FOR TESTING CERTAIN GROUPS
Nursing Home and Assisted Living residents and staff7–10
Symptomatic residents and staff should have rapid access to testing. In addition, to contain spread both the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) recommend weekly testing of asymptomatic nursing home residents and staff (who have not previously tested positive) until there have been no new positive test results for 14 days among either residents or staff. Once these criteria are met, testing of asymptomatic residents and staff can be discontinued; weekly testing should resume when a single new confirmed or suspected case of COVID-19 is identified among residents or staff.
Residents and staff who have previously tested positive for SARS-CoV-2 do not need to be included in subsequent rounds of testing of asymptomatic individuals. Only residents or staff with no prior positive viral tests should be included in repeated testing of asymptomatic individuals. The same recommendations outlined above should also be applied to assisted living residents and staff.
Department of Correction staff and inmates
Department of Correction (DOC) facilities should have procedures in place to screen all new admissions for symptoms consistent with COVID-19 to facilitate isolation and rapid access to testing.11 In addition to symptom-based screening, DOC facilities should test all new asymptomatic persons on admission before they enter the general inmate population. If it is possible to quarantine new inmates before they enter the general inmate population, testing should be considered at the end of the 14-day quarantine period. Testing should also be considered at the time of release to the community and on transfer to other DOC facilities.
Testing of all staff and inmates currently underway should be completed for all facilities. Retesting of previously negative asymptomatic staff and inmates should continue until there are no new positive test results in a facility. Consideration can be made for retesting to be focused on subunits within a DOC facility if positive test results are concentrated in one area of the facility.
After current testing plans are completed, testing of asymptomatic persons in DOC facilities (staff or inmates) should be conducted for close contacts of confirmed cases among other staff or inmates.
These recommendations might change as CDC recommendations for correctional facilities are updated.
Persons living in high risk communities
COVID-19 incidence has been higher among certain racial and ethnic groups, as well as in low income and densely populated areas. To reduce the impact of COVID-19, testing of symptomatic individuals in these groups should be a priority. Asymptomatic adult individuals should also be offered testing within these communities. This can be done regularly (e.g. monthly) at community-based facilities, through mobile units, or at community testing events with local partners.
Homeless shelters
Shelters should have procedures in place to screen all persons staying at the shelter on entry to the facility for symptoms consistent with COVID-19 and to refer symptomatic persons for rapid access to testing. A negative test should not be a requirement for entry to a homeless or other shelter. If a new case of COVID-19 is identified in a shelter resident or staff, testing of all asymptomatic residents and staff in that facility, should be conducted.12 Page 4 of 5

First responders and law enforcement
Symptomatic first responders and law enforcement staff should have rapid access to testing. Testing should be conducted for asymptomatic first responders and law enforcement staff who have had known close contact to a person with laboratory-confirmed COVID-19, if appropriate personal protection equipment (PPE) was not worn at the time of the interaction.13
Healthcare organizations
Symptomatic health care workers who provide direct patient care are among the highest priority to have rapid access to testing for COVID-19. Many Connecticut acute care hospitals are currently testing asymptomatic health care workers and staff to determine prevalence of infection.
Healthcare organizations should develop protocols for testing health care workers and other staff working in their facilities based on CDC recommendations.13 Testing should be conducted for asymptomatic health care workers who have had known close contact to a person with laboratory-confirmed COVID-19 if appropriate PPE was not worn at the time of the interaction.
Congregate Residential Facilities
Many group living facilities (e.g. group homes, residential care homes, residential substance use disorder treatment facilities) are currently testing asymptomatic health care workers, staff and residents to determine prevalence of infection.
Symptomatic residents and staff should have rapid access to testing. If a resident or staff person tests positive, testing of asymptomatic residents or staff who are considered close contacts should be conducted. Testing should be conducted for asymptomatic staff who have had known close contact to a person with laboratory-confirmed COVID-19 if appropriate PPE was not worn at the time of the interaction.

1

Frequently Asked Questions (FAQs) on State Testing Strategy June 17, 2020
The Connecticut Department of Public Health (CT DPH) is sharing these Frequently Asked Questions (FAQs) to help answer common inquiries about how to get tested for coronavirus disease 2019 (COVID-19).
If you have additional questions, please visit the state coronavirus website at ct.gov/coronavirus or call 2-1-1.
1. Who should get tested for COVID-19?
• If you are experiencing any symptoms that the Centers for Disease Control and Prevention (CDC) has identified for COVID-19, you need to get tested.
o What are the symptoms of COVID-19?
– People with COVID-19 can have mild symptoms to severe illness. Symptoms can appear two to 14 days after being exposed to the virus.
– Symptoms can include: cough, shortness of breath or difficulty breathing, fever or chills, muscle or body aches, sore throat, headache, nausea or vomiting, diarrhea, runny nose or stuffy nose, fatigue, recent loss of taste or smell. Children have similar symptoms to adults and generally have mild illness.
• In certain situations, it is recommended that you to be tested if you are a health care worker, first responder, congregate care facility resident or staff (includes nursing homes, assisted living facilities, residential care homes, group homes, correctional institution) homeless, or living in communities hardest hit by the pandemic. Some of these situations include being exposed to someone with COVID-19 or working in a congregate setting where COVID-19 can spread easily (e.g. nursing homes, assisted living or correctional facilities).

2. What type of test should I get for COVID-19?
• There are two types of tests available for COVID-19: a nucleic acid test which is used to diagnose a person with current infection with the SARS-CoV-2, the virus that causes COVID-19, and an antibody test that helps determine if someone was infected with the SARS-CoV-2 virus in the past.
• If you are having symptoms for COVID-19, or are not sick but want to know if you might have the virus right now, you should have a nucleic acid diagnostic test.
2

3. How do I get tested for COVID-19?
• If you think you have COVID-19 and feel like you have symptoms, you should first call your primary care provider to talk about your symptoms and get scheduled for a test. Many primary care providers are set up to test their patients on site.
• Drive-up and walk-up testing is available at acute care hospitals, urgent care centers, community health centers and certain pharmacy based testing sites. Please call 2-1-1 or visit www.211ct.org to find a testing location near you.

4. I don’t have a primary care provider. Does that mean I can’t get tested?
• If you don’t have a primary care provider, you can still get tested for COVID-19. There are places like community health centers across the state that are taking new patients. They offer on-site health evaluations as well as on-site COVID-19 testing. Please call 2-1-1 or visit www.211ct.org to find a testing location near you.
5. I’ve heard that there are walk-up COVID-19 testing sites. Is this true?
• Yes. There are many walk-up testing sites available in Connecticut. Please call 2-1-1 or visit www.211ct.org/search to find a testing location near you.
6. What will I be charged for a COVID-19 test?
• For those with symptoms of COVID-19, private insurance carriers and the state’s HUSKY Health Program will not charge out-of-pocket costs for COVID 19 testing. Health insurers have voluntarily waived cost sharing for testing on a temporary basis. Any person enrolled in a fully-insured or self-insured health plan will not pay any out of pocket costs. The State Medicaid and Children’s Health Insurance programs, known as HUSKY Health, are covering all costs for testing. Any individual enrolled in a HUSKY Health plan will not pay out of pocket costs. In addition, HUSKY Health is now covering COVID-19 testing for uninsured Connecticut residents who are U.S. citizens or have a qualifying immigration status, regardless of income; and covering COVID-19 testing for residents without a qualifying immigration status if they meet HUSKY income requirements and have COVID-19 symptoms.

7. Can I get tested for COVID-19 if I don’t have health insurance? 3

• Yes. There are several options to get a free COVID-19 test, regardless of your health insurance or immigration status:
o Make an appointment to get tested at a community-based health center or one of their pop-up locations. Many of these sites offer drive-up and walk-up testing options. When you make an appointment, confirm that the site provides free testing and related services for people without health insurance, regardless of immigration status. Please call 2-1-1 or visit www.211ct.org/search to find a testing location near you.
o Testing is available at various pharmacy based testing locations throughout the state. Go online to be pre-screened for CVS rapid testing and get an appointment.

8. How can I get a COVID-19 test quickly?
• If you need to get a COVID-19 test quickly, CVS Health is offering free drive-up rapid testing. Go online to be pre-screened for an appointment. The rapid testing site will not test people who do not have an appointment or who do not meet the testing criteria.

9. How long will I have to wait to get the results of my COVID-19 test?
• CVS Health testing sites will offer rapid results, usually within 15 minutes. Tests done at other sites will come back in about three to five days. While you are waiting for your test results, it is very important to stay at home and isolate yourself to avoid spreading your symptoms to others.
10. What happens if I test positive?
• Stay at home, wash your hands frequently, wear a face mask (or a cloth face covering if a mask is not available), stay away from other people in your home, and clean “high-touch” surfaces” (doorknobs, railings, phones, counters, faucet handles) every day.
• Your name and contact information will be shared with public health staff at the Connecticut Department of Public Health to help with contact investigation.
4

• Someone from CT DPH or your local health department will call you and ask you for a list of people you have had close contact with while you were sick or just before you got sick.

• A contact tracer will only contact you for health matters related to COVID-19 and not for any other reason
• You can leave your home if these two things have happened:

o You must have had no fever for 72 hours (three days) without the use of fever reducing medications, and your respiratory symptoms (cough, shortness of breath) must be getting better; and
o At least 10 days have passed since your symptoms first appeared.
• If you had no symptoms but tested positive, you should stay home until 10 days after your positive test.
• If any of your symptoms get worse, call your healthcare provider.

11. What happens if I test negative?
• If you start having any symptoms of COVID-19 after the test, call your healthcare provider and ask if you should be tested again.
• Wash your hands often and practice social distancing (six feet between you and other people).
• Wear a cloth face covering when you leave your house.
• If you get sick, stay home from work.
• Clean “high-touch” surfaces” (doorknobs, railings, phones, counters, faucet handles) every day.
If you test negative for COVID-19, you most likely were not infected at the time of your test. It is also possible that you were tested very early in your infection and you could test positive later. It is also possible you could be exposed later and get sick. This means that even with a negative test, it is important for healthcare workers and others who work with vulnerable populations to stay home from work while experiencing any symptoms.
12. Why isn’t the State testing everyone in Connecticut? 5

• Testing is an important part of our pandemic response, but it is not the only part. Other behaviors – wearing a mask, hand washing, social distancing, and cleaning – are equally important tools.
• Testing people who have COVID-19 symptoms is still critical.
• For people without symptoms, we are focused on testing people in areas hit hardest by the virus. We are also offering testing to people working in close-contact environments. This will help us monitor the virus and identify places that need support from the health department.

COVID-19 6/17/2020

June 17, 2020

Not much has changed since my last post. In my practice, I am not seeing any increase in respiratory or febrile illness in the last few weeks.

The New York times now follows COVID-19 numbers county by county across the country. The site for Connecticut can be found here.

The current numbers do show a slight uptick in the last few weeks in Windham county, more so in New London County, but have been falling in Tolland county.

Other states can also be accessed from that site. Rhode Island is showing a current uptick in Providence County, and Massachusetts is showing falling rates across all counties.

Some of the increases may be due to changes in the way that the statistics are compiled, with “probable” cases now being included, but I don’t know if that applies in Connecticut or the other states I’ve mentioned.

Nationally, as you probably know, with the recent re-openings many places are showing an increase in cases. As I have previously discussed, rural areas are relatively protected due to the ease of social distancing which is otherwise very difficult in more population-dense areas.

All this leads me to maintain caution. With attention to masks and social distancing, outings which are necessary are probably low-risk, assuming that your destination is not over-populated and is one where others are maintaining proper precautions.

The current situation: In Windham and Tolland counties there are still a small number of cases that have been reported. Undoubtedly there are many more. I have seen estimates stating that for every case that is identified, there may be 100 more that have not been included in the count.

It has become very clear that unlike Influenza, which tends to present with a common pattern of symptoms, COVID-19 can present with a wide-variety of symptoms alone or in combination. While it still appears to be true that the vast majority of cases occur with no or very mild symptoms, there are some very unusual presentations, some of which can lead to death. MIS-C (for Multi-inflammatory syndrome – Coronavirus) is in the news now, with the occurrence of rare cases with cardiac and/or gastrointestinal or other severe inflammatory reactions in children and young adults.

Despite a lot of research and investigation, the science on COVID-19 is not complete, and many important questions remain unanswered:
— the availability of testing is still too limited
— the quality of available testing is variable, and the results are difficult to interpret. Unfortunately, neither a positive nor a negative test result may not always be true
–if antibody tests show the existence of antibodies, and that result is accurate, we still do not know whether this means that the person tested is immune

There are many other questions.

The Next Few Weeks: Northeastern Connecticut, while so-far having relatively few cases, may see a more rapid rise in the next few weeks. At least this is the projection from public health authorities, and our levels of caution should be high.

The “re-opening”: In the United States as a whole, public health officials are warning that it is too early yet to consider a broad-scale reopening. In more rural areas, a cautious resumption of “normal” activity may work out, but in more population-dense areas the risk for a “2nd wave” is higher. In my opinion, caution is advised, especially in Northeastern Connecticut and other more rural areas.

For a good discussion of some of the risks, see Erin Bromage’s blog post.

Alternatively, it is important to realize that the closing of much of our economy has created a huge amount of suffering in large portions of society. Furthermore, the suffering is not equally shared by all. There is much to think about here, and there are many important decisions that we need to make, individually and collectively, to emerge from this crisis and create a healthier environment. Much has been written about this. A column by David Brooks in yesterday’s New York Times is worth reading in this regard.

In general, I am not advising any changes from my prior recommendations. Influenza cases have dramatically declined across the country, and for those of you taking Influenzinum, you can stop.

I will continue to post from time-to-time.

COVID-19 4/13/2020

April 13, 2020

I have not posted in about a week, primarily as there was not much to report.  The international homeopathic community has been actively communicating online, with some of the top homeopaths in the world teaching about the homeopathic approach to epidemics, and their particular experiences in treating patients during this pandemic.

Of particular interest is a report from the American Institute of Homeopathy that just came in this morning, reporting on the experience of a physician for a nursing home in France:

On March 27th, as part of a report on the AIH COVID-19 Data Collection Project and given the urgency of the moment, I (the AIH project coordinator) included verbatim reports from physicians in France and Italy who were treating COVID-19 patients.  The French account was from a French physician reporting on events in a nursing home in Lyon France.  In that account, it was said that all 120 residents of the nursing home had tested positive for COVID-19.  I have received a subsequent report providing far greater detail.  Those follow:

“On March 15, the physician in charge of the Lyon nursing home heard of the beneficial use of Camphora in Iran, he gave one or two doses of Camphira 1M to 118 out of 120 pensioners. He said he followed the protocol indicated in the Iran report. The pensioners in this retirement home are as a rule between 85 and 105 years old and with rare exceptions are quite handicapped mentally (i.e., dementia) or physically (i.e., quadriplegic) 

This retirement home is on three floors: there are 27 pensioners on the ground floor, about 53 on the first floor and about 40 on the second floor. The day after Camphora, fifteen pensioners developed diarrhea, but only on the second floor and for only one day, nothing serious, he said.

On March 19, the first cases with flu-like symptoms made their appearance but only on the first floor. He thinks that eventually all 54 of the first-floor pensioners became infected. Of the first 6 that he tested four were COVID positive. He thinks the other two would have likely been positive, as if they both died of the typical COVID dyspnea. He tested only six pensioners as he had access to only 6 tests.

Incidentally, the two pensioners who refused to take Camphora were among the first ones to die of the 10 who have so far died of COVID. When he saw that the epidemic was taking hold of the first floor, he treated everyone affected with Bryonia. He said that they all got better. However, two days after he stopped Bryonia most relapsed. He resumed Bryonia and they all improved again. However, some of these became worse with time.

He has had no Covid cases on the ground floor or second floor. However, no staff can cross to the other floors from the first floor without changing their entire PPE (personal protective equipment)..

The latest report:  only 5 of the severely ill pensioners with COVID still need to be monitored hour by hour and all five were doing quite well by the end of the night last night. It appears the hemorrhaging of lives has stopped, as no one has died since last Tuesday, thanks to Bry. (3 patients), Carbn-o. (2 patients), Hyos. (one patient) and Op. (2 patients).” [end report from France]

The take-home message here is that Camphora and Bryonia remain the mainstays of treatment.  Camphora is for late-stage disease with sudden collapse, severe weakness, and severe internal coldness.  Even the breath can be cold. Of course there are other remedies that can be useful  Bryonia represents an earlier stage of the illness, and may be used as a preventative (although it is not clear that Bryonia is the best choice for the current situation in the USA).

This report from France illustrates why I’ve acted to attempt to provide my patients with at least some of the medications that might prove useful, although my real hope is that it will not be necessary to use them.

In my own experience, over the last few months (since mid-January) I have treated several people with unusual respiratory infections, none (except possibly one) of which fit the classic description of COVID-19, but all of which were accompanied by low-grade fever, cough, a prolonged course, great fatigue, and some with conjunctivitis.

The first person, who became ill in mid-January had a severe cough with shortness of breath while coughing, fever, strong fatigue (partly due to lack of sleep from coughing at night), responded very well to Kali carbonicum;
One person with chronic asthma (but no acute respiratory distress) needed Gelsemium and then Pulsatilla, with a very nice response;
One person had very low grade symptoms which resolved without treatment;
One person with strong fatigue and a severe conjunctivitis responded well to Bryonia (COVID test negative);
One person with a fever for 4 weeks (but no respiratory distress, but who started to feel fullness in the chest) responded very well to Petasites tussilago (I had to send a higher potency);
One other person, living in NYC, with a cough but no respiratory distress, and great sleepiness, did not respond to Gelsemium but had a dramatic improvement with Phosphoric acid.  I think it very likely that she had COVID-19 but she was not able to obtain testing.

Several of my American colleagues have over the years noted that maintaining a good level of vitamin D seems to provide a good level of protection for Influenza and seems likely to do the same for Coronavirus.  As you all know, Vitamin D is something that I have stressed for several years.

Although the number of cases in Northeastern Connecticut continues to be very low, computer modeling suggests that this may change in the next few weeks.

Please take all the proper precautions that have been recommended.
I will continue to post as needed.