Apr 20, 2020

New Facts on COVID-19: "Don’t Come In Unless You’re Short of Breath" Doesn't Apply Anymore

I had an annoying, dry cough in the beginning of February. Then the cough roared like a hungry beast. No fever ever. Just the cough, with shortness of breath and fatigue that escalated quickly over a two-week period. I drank at least three strong coffees a day. Nothing. Was it COVID-19, I asked myself repeatedly? I don't know now, and maybe I wouldn't ever know, unless the testing starts very shortly to all people, rich or poor, healthy (for the asymptomatics amongst us) or sick, despite what Jared Kushner, the Moron and Golden-Spoon-in-Mouth syndrome, says, as a spokesman for President Trump, there are enough tests for now. I haven't had one at the peak of coughing/shortness of breath/fatigue. Have you? Just to make sure what you thought were cold symptoms wasn’t the dreaded coronavirus? Wouldn’t you like to know, through antibodies, if you already had it?

But with Trump in charge, forget that option. "Coming up shortly," or "Within the next two weeks," or, my favorite, "Soon" is Trump-speak, when most people, after the passage of time, forget he made those promises in the first place. But I remember. You can count on that.

WIRED had an article written by Megan Molteni who says that scientists are running like crazy to comprehend why some patients also develop neurological ailments like confusion, stroke, seizure, or loss of smell. Stories of other, stranger symptoms like severe headaches, tingling and numbness, or the loss of smell or taste have been going on for weeks. 

“The medicines we use to treat any infection have very different penetrations into the central nervous system,” says S. Andrew Josephson, chair of the neurology department at the University of California, San Francisco. He is saying that most drugs can’t pass through the blood-brain barrier, a living wall around the brain. He also says if the coronavirus is penetrating the barrier and infecting neurons, that could make it more difficult to find appropriate treatments.

When the virus first started in Wuhan, China, health records indicate that 214 patients admitted to the Union Hospital of Huazhong University of Science and Technology, 36.4 percent of the patients showed signs of nervous-system-related issues, including headaches, dizziness, confusion, strokes, prolonged seizure, and a slowly disappearing sense of smell, some before the fever and cough were apparent. 

“We’ve been telling people that the major complications of this new disease are pulmonary, but it appears there are a fair number of neurologic complications that patients and their physicians should be aware of,” says Josephson.

Without that information, datasets in particular, there’s no way to know how to interpret reports on patients, and "single cases are tantalizing, but they can be fraught with coincidence,” says Josephson.

COVID-19’s horrendous death toll, 61, 656 as of this writing, is other-worldly, science fiction-like worthy, and not many autopsies are being done. Only some pictures of the lungs, but a good chance that there’s some viral invasion of the brain.

A paper in the New England Journal of Medicine examining 58 patients in Strasbourg, France, found that more than half were confused or agitated, with brain imaging suggesting inflammation.

“You’ve been hearing that this is a breathing problem, but it also affects what we most care about, the brain,” says Josephson. “If you become confused, if you’re having problems thinking, those are reasons to seek medical attention,” he added.

Viruses affect the brain, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota. The brain is protected by something called the blood-brain-barrier, something that Josephson says, too, which blocks foreign substances but could be penetrated if compromised.

Since loss of smell is one of the symptoms of COVID-19, some have hypothesized the nose might be the pathway to the brain. But in the case of the novel coronavirus, doctors hold on to current evidence that the neurological impacts are more likely the result of overactive immune response rather than brain invasion.

Jennifer Frontera, who is also a professor at NYU School of Medicine, explains documenting notable cases including seizures in COVID-19 patients with no prior history of the episodes, and new patterns of small brain hemorrhages.

“We’re seeing a lot of consults of patients presenting in confusional states,” said Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital, adding that more than 40 percent of recovered virus patients. "Returning to normal," added Arora, "appears to be taking longer than for people who suffer heart failure or stroke." [Apparently, Dr. Arora hasn't worked extensively with stroke patients. After 11 years, I'm still recovering. Just sayin'.]

Anyway, good advice if you have any of those symptoms--headaches, dizziness, confusion,  prolonged seizure, and a disappearing sense of smell--go to the doctor. Many doctors are seeing patients through tele-conference now. If you had a stroke as a result of COVID-19, you probably have already gone to the hospital where there are tests but not too many of them.

One more thing. How about Trump supporters try injecting or swallowing disinfectants to see if they work or this headline: Online demand for hydroxychloroquine surged 1,000% after Trump backed it, study finds. I say that statement with sarcasm, but unlike Trump, he said it confidently when he recommended Lysol, Clorox, and 
hydroxychloroquine, despite his walkback when people were alarmed and others broke into peals of laughter. It's on tape, Mr. President. 

Apr 1, 2020

Consumer 101: How to Beat an Unjust Bill from Anywhere, Even If You Have a Brain Injury!

Before the coronavirus disaster struck, I believe you all had this experience at least once in your lifetime, where you make some purchase and bring it home and the color is wrong, or the taste is horrid, or you've just spent money foolishly and regret your purchase, and then you have to deal with the store owner in returning it or the corporate and unseen signs on day 8 that say "No returns after 7 days." Or you get some unjust bill and, after calling customer service, you can't adjust it and you pay it out of sheer desperation. Let me tell you my story first and then I'll tell you about the unfair bill. 

At 14-years-old, I started to return things for my mother because she couldn't think fast on her feet with her anxiety. She waited in the car and trusted that the return would go smoothly. When I came out of the store, I saw her quizzical look turn into a grin as I nodded my head that all had gone well. Back in the 1960s, nobody wanted to say no.

She went on sending me into the stores, plus a new thing developed. She trusted me at 16 to pretend  that I was her, calling about an unjust bill. Everybody had a boss, I learned from my father, and I went right to the top, bypassing customer service. If the operator didn't say who was in charge, I hung up and called an hour later, falsely saying that I wanted to speak to the "person in charge" because so-and-so treated me "extraordinarily well." Then the operator had zero reluctance to connect me and, once she did, I let that CEO or Assistant or VP have it with utter animosity that the bill was wrong. 

"How did you get my number?" the person in charge sometimes said.

"Heh, heh," I said to myself.

I told that same person that I was going to report the company to the Better Business Bureau (back when the BBB meant something) and 9 out of 10 times the issue was resolved. When I threatened legal action, even though our family didn't even have a lawyer, the 10th one came through, too. 

All through college I did the same thing for my mother, and when I was married at 21, and had a job right out of college as an English teacher, I went into the quiet nurse's office from 12 o'clock on from time to time (she was gone by noon every day), closed the door, and did the identical thing. 

So I was totally prepared to accept the position at the Philadelphia Daily News as a Consumer Columnist at 31, except now I had the power of the press behind me. As I got letters from Philadelphia and environs with people having trouble with the supervisor, and sometimes the head honcho, all the cases were settled, with the businesses scrambling to adjust or eradicate the bill that was charged to my reader. 

All except one, years later, because the CEO threatened to withdraw his $500,000 advertising every week from the Philadelphia Daily News and, as a result, I was fired, out of the job I loved. But even so, the same techniques worked! Using an authoritative voice like I used to do, every case was resolved. 

Fast forward 30 years and I received an unjust bill, but the techniques that I developed weren't working  anymore. I had a stroke at sixty, a very significant one, that affected the right side of my body and affected my speech early on, that sometimes, particularly if I was tired, people wouldn't understand my slurred speech. Often times, the person who answered didn't connect me to the person in charge, much less to the CEO's office. Or they would just hang up on me.

I stopped calling places and let my caregivers do it but, invariably (except Joyce #2 and Clare), they put a finger up for me to be still while they were saying the wrong thing. It was a mess. But as my speech improved over time, I made the calls myself. And then I got a bill that the was so unjust, I had to call again.

I fell off the chair in the Fall of 2018, which was stupid enough, and the bill was from the ambulance company for $1450 and was for a ride to the hospital, which I didn't pay, resulting in my credit score going down over a hundred points.

After the hospital checked me out and the ER doctor said all was intact, the hospital's ER nurse, unbeknownst to me, called for a ride back to return home. (She called, not me!) Medicare said the ambulance company didn't cover my ride going to the hospital, but they covered my ride back. That logic was unacceptable, so I appealed the decision. 

But Medicare didn't receive the pile of papers that I sent them (and I appealed their decision, rejecting me once again) even though I sent them certified, including the the primary doctor's letter that I couldn't walk, and all the correspondence that I had collected over more than a year since then. I also sent the stack to the local ambulance company in Portland, the headquarters in California, the appeals officer--again, and to the CEO of the hospital.

I spoke with the Assistant to the CEO and she kept transferring me to the Business Office. 

Before she transferred me one recent time, she said, "You know, the CEO is so busy with COVID-19 and...."

I shot back and interrupted her, "This issue has been going on a year and a half, and COVID-19 wasn't even in the picture yet," in a clear voice that even surprised me. And her, I'd like to think! 

In short, I was getting nowhere. A representative from the Business Office said that information was wrong, a year and a half later. Medicare covered the ride to the hospital, but they didn't cover the ride back.

So my successful technique that I had years before wasn't working now. So out of pure desperation, I decided to contact the hospital once, and at times, twice a week for two months, and the old expression, the squeaky wheel gets the oil, came into play. I pestered them, and thought soon they would cave because of my annoying calls.

(By the way, says the Quote Investigator, "The earliest appearance of this expression located by QI occurred in a collection of stories published in 1903. Cal Stewart the author constructed a colorful raconteur character that he called Uncle Josh Weathersby. The saying under investigation was contained in an epigraph that was ascribed to this character: 
“I don’t believe in kickin’,
It aint apt to bring one peace;
But the wheel what squeaks the loudest
is the one what gets the grease.”
—Josh Weathersby.")
Anyway, as result of doing that very annoying strategy for two months, the Assistant to the CEO and I spoke, tired and annoyed to get a call from me every week, and she said the hospital would pay the bill, adding, "It's not our fault." 
Yeah, right.
In the case of the unjust bill, what do you do? Just what did. Do it all!

1. Call to the top tier of an organization first and maybe threaten to call your lawyer even if you don't have one.

2. Send an email after every call to tell them what occurred, even if you know they remember. If you don't have their email address, use the same method I did, by calling back in an hour and saying you want to give good news directly to the person in charge who helped you in an extraordinarily way.

3. Call the heck to the top tier (a la squeaky wheel and oil) They want you to forget, just to pay the damn bill. 

Or write to me. I'd be happy to combat those shop owners or corporate monsters. But not now. So many people are out of work. I wouldn't want to pile on. But when the virus isn't a problem anymore, you know where to find me--hcwriter@gmail.com. 

And this is me 3 months later. One more thing--this method that I used since I was a teenager works, and it did in my most recent case as well to have the hospital pay the bill, and I was especially happy, sheltered in place for now in these troubling  times, that it happened on my birthday!