Which raises the question: are we going to haphazardly respond to each new emerging virus as a singular event or develop a national policy to prepare for emerging viruses as a continuous public health challenge?
Why are emerging viruses here – and why now?
The US is on the brink of a new virus epidemic; a virus that wasn’t there ten years ago but which is now worrying officials. Chikungunya, which causes an incapacitating fever, is spread via Aedes mosquitoes and usually found across Africa and Eurasia. But it is now the most recent example of an emerging virus – viruses that are rapidly changing their geographic distribution and/or their incidence.
Other emerging viruses such as the Ebolaviruses – which go on to cause ebola haemorrhagic fever – and severe acute respiratory syndrome coronavirus (SARS-CoV), are less common while others like mumps virus, are re-emerging after a period of relative absence in the western hemisphere. These viruses arise, often unexpectedly, amid some level of mystery about where they come from and why they are spreading. Their origins are more complex than they might appear.
WHO publishes list of top emerging diseases likely to cause major epidemics
10 December 2015 — A panel of scientists and public health experts convened by WHO met in Geneva this week to prioritise the top five to ten emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist. These diseases will provide the basis for work on the WHO Blueprint for R&D preparedness to help control potential future outbreaks.
The initial list of disease priorities needing urgent R&D attention comprises: Crimean Congo haemorrhagic fever, Ebola virus disease and Marburg, Lassa fever, MERS and SARS coronavirus diseases, Nipah and Rift Valley fever. The list will be reviewed annually or when new diseases emerge.
NOTICE THAT IN 2015 ZIKA WAS NOT ON THE LIST!!
Is Another Zika Brewing in the Caribbean?
Florida researchers have discovered a mosquito-borne virus called Mayaro in Haiti, where it had never been observed before.
They found the virus in a blood sample taken in January 2015 from an 8-year-old boy who had tested negative for other mosquito-borne illnesses, including chikungunya and dengue. Researchers don’t know yet how widespread the infection could be or whether they will find it in other parts of the Caribbean, but the specific strain they identified is different from those previously seen in the Amazon, where most cases of Mayaro have historically been reported.
Dr. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute, which identified the virus, says the findings underscore how additional viruses are “waiting in the wings” and may pose future threats.
Predict Zika’s Spread? It’s Hard Enough to Count the Cases
Virtually no entomologists believe that the transmission of Zika is limited to a few square miles of downtown Miami and Miami Beach, no matter how vigorously state officials insist it is.
“That’s just dreaming — it’s totally unrealistic,” said Duane J. Gubler, a former director of the vector-borne diseases division of the Centers for Disease Control and Prevention. “Mosquitoes move around, people move around. Mosquitoes even move by car sometimes.”
Putting Zika in Historical Context
Wouldn’t it be nice, then, if medical researchers could simply develop a vaccine? Sure, but this is likely to take at least two years to develop. Even then, there’s no assurance of success: scientists have never been able to produce a vaccine against dengue fever, which is in the same flavivirus family as Zika. So at present, and perhaps into the foreseeable future, our only option appears to be mosquito abatement. Both speakers stressed that the success of such measures depends on the compliance of civil society, which is problematic in the present social and political environment. Still, the story of public health responses to earlier mosquito-borne diseases in the Americas demonstrates that they can achieve significant results. Furthermore, the failure to act could be catastrophic. Humphreys reminded her audience that the drug thalidomide produced large numbers of terribly deformed babies in the 1960s. She asked: will Zika be the thalidomide of our generation?
Everyone knows, including our physicians, that proper hand washing is the most effective patient safety measure right?
Your physician and other clinicians (e.g. nurses, PTs, lab techs drawing blood) should wash their hands before and after each patient, and when beforehand wash in front of the patient.
Do you ask “Doctor, Did You Wash your Hands?” If not, why not?
First some history.
“Ignaz Semmelweis, a young Hungarian doctor working in the obstetrical ward of Vienna General Hospital in the late 1840s, was dismayed at the high death rate among his patients.
He had noticed that nearly 20% of the women under his and his colleagues’ care in “Division I” (physicians and male medical students) of the ward died shortly after childbirth. This phenomenon had come to be known as “childbed fever.” Alarmingly, Semmelweis noted that this death rate was four to five times greater than that in “Division II” (female midwifery students) of the ward.
One day, Semmelweis and some of his colleagues were in the autopsy room performing autopsies as they often did between deliveries. They were discussing their concerns about death rates from childbed fever.
One of Semmelweis’ friends was distracted by the conversation, and he punctured his finger with the scalpel. Days later, Semmelweis’ friend became quite sick, showing symptoms not unlike those of childbed fever. His friend’s ultimate death strengthened Semmelweis’ resolve to understand and prevent childbed fever.
In an effort to curtail the deaths in his ward due to childbed fever, Semmelweis instituted a strict hand washing policy amongst his colleagues in “Division I” of the ward. Everyone was required to wash their hands with chlorinated lime water prior to attending patients. Mortality rates immediately dropped from 18.3% to 1.3% in 1848 in Semmelweis’ division. (A)”
(1861) “…. Louis Pasteur was showing the world that microorganisms did indeed exist, that they acted on our world in myriad ways and that the ancient wisdom about “bad vapors” and spontaneous generation were wrong. Dead wrong. Prior to Pasteur and what would become known as “germ theory,” the prevailing theories held that organisms, like maggots and fleas, were spontaneously originated from other matter, like raw meat or diseased flesh…..
Pasteur is credited with opening the world’s eyes to the new science of microbiology and ushering in a brand new form of preventive medicine: immunization. …Building on what Pasteur was discovering, British surgeon Lister began to use this new germ theory to demonstrate the lifesaving value of disinfectant. Despite his skill at surgery, Lister knew that half his amputee patients would die of infection after the procedure…..
He began to treat his surgery equipment, before and after use, with carbolic acid. He also treated his patients’ wounds with it…..within two years, operative mortality decreased from nearly 50 percent to just 15 percent.” “Much of the greatness of Pasteur and Lister lies in their dogged persistence to spend 20 years convincing the rest of the medical world of the truth of their investigations,” ….. (B)
“What Dr. Towsend did next was something that Joseph Lister, despite years spent traveling the world, proving the source of infection and pleading with physicians to sterilize their hands and instruments, had been unable to prevent. As the president (Garfield) lay on the train station floor, one of the most germ-infested environments imaginable, Towsend inserted an unsterilized finger into the wound in his back, causing a small hemorrhage, and almost certainly introducing an infection that was far more lethal than Guiteau’s bullet.” (C) (1881)
FAST FORWARD 150 YEARS. 50% COMPLIANCE.
“Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’
It’s a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse: Have you washed your hands?
Hospitals are encouraging patients to be more assertive, amid growing concern about infections that are resistant to antibiotics.
Strict hand hygiene measures are the gold standard for reducing infections associated with health care. Acquired primarily in hospitals but also in nursing homes, outpatient surgery centers and even doctor’s offices, they affect more than one million patients and are linked to nearly 100,000 deaths a year, according to the Centers for Disease Control and Prevention.
The CDC aims to engage both patients and caregivers in preventing dangerous hospital infections. Centers for Disease Control.
Yet despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time. (D)
In can be done! “How a team of doctors at one hospital boosted hand washing, cut infections and created a culture of safety.” (E)
BUT! THE MOST EFFECTIVE SOLUTION IS FOR YOU AS A PATIENT TO ASK “Doctor, Did You Wash your Hands?” Every time!
(C) DESTINY OF THE REPUBLIC, 2011
The federal and state governments still have not seen the need to designate Zika Regional Referral Centers.
Maybe that’s because the number of newborns with Zika related abnormalities is small. But we continue to learn more about what we don’t know about Zika then the full range of possible sequela.
Common sense still seems to me to refer all Zika babies to regional centers to bring the best science, care and case management together.
Take a look at these abstracts. Zika care is expensive. Diagnostics and care are complex. Use of resources must be maximized. The babies will wind up at academic medical centers.
Zika babies require estimated $10M each in lifelong medical care
Eighteen babies have been born in the United States so far with severe brain defects tied to Zika infection, the start of a huge toll to families and an estimated price tag of $10 million each in lifelong medical care, according to a medical panel Tuesday.
Congenital Zika: Updated Guidance for the Care of Infected Infants
Congenital Zika infection can result in a wide spectrum of structural and functional abnormalities. These range from microcephaly and other brain abnormalities leading to neurologic deficits, seizure disorders, hearing and vision abnormalities, and developmental delay. Developed with input from a multidisciplinary task force, the CDC has now published updated recommendations for the initial and ongoing clinical and laboratory evaluation of infants born to women with documented Zika infection or with signs suggestive of congenital Zika infection with the appropriate maternal exposure history. All infants who undergo testing should be reported to the Zika Pregnancy Registries in the United States.
Laboratory testing: •Real-time reverse transcription–polymerase chain reaction (rRT-PCR) in the first two days of life on serum and urine. •Zika immunoglobulin M confirmed with plaque neutralizing antibody testing.
Clinical examination: •Comprehensive physical exam with special attention to head (occipitofrontal) circumference and neurological examination. •Complete blood count and comprehensive metabolic panel. •Head ultrasound. •Auditory brainstem response testing.
Subspecialty consultations: •These should include ophthalmology, infectious diseases, neurology, endocrinology, and genetics.
Care coordination/referrals: •Infants with confirmed infection require identification of a medical home for coordination of complex care and referrals to developmental specialists, early intervention services, and social support for families.
What the world has learned about Zika — and what it still needs to know
This virus has so many tricks up its sleeve. It causes birth defects in babies and neurological conditions such as Guillain-Barré syndrome, a type of temporary paralysis, and encephalitis (inflammation of the brain) in some adults. We still don’t know, though, how often infection leads to one of these serious problems.
One thing that has become clear is that while there are potential risks to the fetus at all stages in pregnancy, when it comes to Zika and trimesters, first is worst.
But as babies born to women who were infected in pregnancy are assessed and their early development followed, researchers have discovered that a range of birth defects can occur after infection in the womb, and no point in pregnancy appears to be 100 percent safe.
Researchers have warned that babies who appear unscathed at birth may have problems that only become evident later, including hearing and vision loss. There are even questions about whether damage to brain tissues continues after birth.
Investigation: Unique Utah Zika case remains medical mystery
SALT LAKE CITY (AP) — A case of the Zika virus in Utah is now the only one in the continental U.S. that’s still puzzling researchers on exactly how it spread, health officials said Tuesday.
The man caught the illness after caring for his infected father, who had an extremely high level of the virus in his blood when he died in June, according to a report released by the U.S. Centers for Disease Control and Prevention. One possibility is that he transmitted the virus to his son through a bodily fluid in a way that hasn’t been recognized with Zika yet, officials said. The son kissed and hugged his dying father and helped care for him in a hospital, according to the report.
Investigators couldn’t test the unidentified Salt Lake County man because he had already been cremated by the time he was diagnosed, said Angela Dunn with the Utah Department of Health. Signs of Zika have been found in blood, urine, semen and saliva, and the case could direct new research into whether it can also be carried in things like tears or stools, she said.
Florida state health officials confirm Zika diagnoses in 84 pregnant women
Eighty-four pregnant women have tested positive for Zika in Florida, according to a report issued by state health officials on Thursday. Doctors speaking at the “Zeroing in on Zika: From the Front Lines” forum said that they had asked the women to go public about their diagnoses in order to better educate the public, but that so far only one woman has agreed to do so.
The announcement came just a day after officials confirmed that a baby had been born with microcephaly at Jackson Memorial Hospital in Miami. According to Dr. Christine Curry, 15 pregnant women who delivered at the hospital tested positive for Zika. “Zika is a thing. Zika is real, and while we don’t understand it fully, that is not a reason to dismiss its impact,” said Curry.
MIAMI – A baby girl who tested positive for the Zika virus is being treated by doctors in South Florida.
The baby’s mother contracted the Zika virus while traveling while pregnant off the coast of Venezuela.
The baby has not been diagnosed with microcephaly, but doctors said the child is suffering from other Zika-related side effects.
Photos taken inside the baby girl’s eyes at the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine help give doctors a clearer vision of how to treat the baby.
Baby born with Zika virus at Jackson Memorial Hospital
MIAMI – A baby has been born at Jackson Memorial Hospital with microcephaly, according to Dr. Christine Curry.
In total, 15 pregnant women who have delivered at the hospital have tested positive for the mosquito-borne virus, Curry said.Those women are being monitored by doctors at the hospital.
(Jackson Health System has two primary affiliations with leading academic institutions in South Florida: the University of Miami Miller School of Medicine and the Florida International University Herbert Wertheim College of Medicine.)
How to Fight Zika and Cure Our Nation’s Ailing Public Health System
Establishing a model that is quantitative and based upon measurable changes in public health conditions around the world as well as within the U.S. and having the capacity to react quickly can save lives and assures public health system stability. Our nation has some local health-care systems that are second to none, such as the Houston Medical Center, but our national public health system has glaring weaknesses when handling pathogens that may be as dangerous as Ebola and as contagious as the Spanish Flu. There are only four hospitals in the U.S., and a total of 15-16 beds, for persons infected with a human viral hemorrhagic fever: Emory University Hospital in Atlanta has two Ebola beds; St. Patrick Hospital in Missoula, Montana, has one or two; National Institutes of Health in Bethesda, Maryland, has the capacity to treat two patients in its Special Clinical Studies Unit, according to the National Institute of Allergy and Infectious Diseases at the NIH; and Nebraska Medical Center in Omaha, reportedly has a biocontainment facility with 10 beds total.
The public health challenge for our nation is to effectively address the sudden emergence of a highly contagious pathogen with a mortality rate of 1 in 5 so that the public health threat may be identified within hours of patient zero, a team of public health experts deployed with the requisite equipment and resources within 24 hours to any point on the globe, establish field labs, hospitals, coordinate with local public health officials, communicate with public health and disease experts globally; type and identify the threat; its method of transmission; and determine what is needed to contain the threat; while beginning work on treatments and potential cures. Their work would also be to calculate mortality rates and the point when the disease may become endemic over a 25 week time period to stop its spread, which should include communicating to local, state and tribal public health officials’ the information they will need to prepare to face the threat that may be just a flight away.
CDC Deploys New Rapid Response Teams To Fight Zika
But building on its experiences with Ebola in 2014, the agency also has created new rapid response teams, called CDC Emergency Response Teams (CERT), that bring expanded expertise to contain an outbreak as quickly as possible.
The teams include not only epidemiologists but also scientists with backgrounds in a particular disease itself, such as Zika. Entomologists, vector technicians, communications specialists and public health scientists have been part of the Zika teams.
Menendez Makes Personal Plea for Zika Funding
U.S. Senator Bob Menendez’s daughter Alicia six months pregnant with the senator’s first grandchild. She lives in Miami, Fla., ground zero for the Zika virus in the United States.
“I rise today to voice my concern as an American and my outrage as a grandfather to be about the lack of action to fund our response to the Zika epidemic,” Menendez said. “Zika has come to Miami, Florida, and congress needs to step up and provide the necessary funds to fight this terrible virus.
Menendez said that Zika is a national epidemic and that the decision to recess congress of the summer without implementing a plan to halt the spread was a failure on behalf of legislators.
Let’s start off by making it clear that most adverse clinical outcome are not medical errors. OK?
Back about twenty years ago during my tenure as President and CEO of Jersey City Medical Center, insurers when reviewing a claim for hospital reimbursement, would “deny” days. More specifically the hospital got a per diem payment for “approved” days only. But even if the insurer reduced the number of approved hospital days say from six to four, they still reimbursed the physician for six days. With no disincentive for physicians to be concerned about length-of-stay, denied days were costly to the hospital.
Fast Forward. Medicare is penalizing hospitals for certain readmissions.
“Generally speaking, a hospital readmission occurs when a patient is admitted to a hospital within a specified time period after being discharged from an earlier (initial) hospitalization. For Medicare, this time period is defined as 30 days, and includes hospital readmissions to any hospital, not just the hospital at which the patient was originally hospitalized.
Medicare uses an “all-cause” definition of readmission, meaning that hospital stays within 30 days of a discharge from an initial hospitalization are considered readmissions, regardless of the reason for the readmission.” (A)
Some systems are working to align hospital and physician performance, avoid reimbursement penalties, and increase patient satisfaction.
“In 2006, Geisinger Health System transformed the health care industry by testing and rewarding how elective cardiac surgery was performed and by offering a “warranty” on coronary artery bypass surgeries. That innovative effort marked the birth of the Pennsylvania-based health system’s eminent ProvenCare program, which applies evidence-based protocols aimed at reducing mortality rates, improving outcomes and reducing costly readmissions”…..”By eliminating unwarranted variation and applying scientific best practices to coronary artery bypass graft (CABG) patients, Geisinger has been able to reduce readmissions, complications and length of stay while raising its profit margin by 17 percent.” (B)
”Patients who undergo routine hip or knee replacements at Seattle’s Virginia Mason Medical Center, and their employers, now can worry less about paying twice if surgical complications occur. That’s because the hospital has decided to offer a warranty to privately insured patients on avoidable complications stemming from total joint replacements, making it one of the first hospitals in the nation to do so.” (C)
“Surgical warranties vary somewhat in terms of what they cover. Generally, though, it’s a guarantee to fix any avoidable complications related to surgery — at no extra charge to the patient. Warranties are offered as part of a group of bundled services that come as one-price package deals.” (D)
“Hospital readmissions occur for a number of reasons: infections and other complications; premature discharge; failure to coordinate and reconcile medicines; inadequate communication among hospital personnel, patients, caregivers and clinicians; and poor planning for care transitions.” (E)
Warranties sound innovative but can only work to improve outcomes and reduce expense if physicians share the rewards and risks with the hospital. This sounds easy with employed physicians but will it work with unpaid voluntary physicians in private practice or will they simply move their practices to hospitals without warranties?
(D) http://www.latimes.com/business/ Considering surgery? Some healthcare providers offer warranties
Suddenly a huge white military hospital ship with four Red Crosses steamed by and docked right across river. I thought how this hospital ship brought the war even closer to home but mostly about how the hospitals in Hudson County had responded and performed so magnificently.
Liberty HealthCare System is comprised of Jersey City Medical Center, Greenville Hospital, and Meadowlands Hospital Medical Center. The Medical Center, the County’s Trauma Center, treated 175 patients. Greenville treated 11 patients and processed over 500 volunteers who wanted to give blood; Greenville had originally been asked by the Red Cross to be a blood center but this was changed early on so donor information was passed (every volunteer was “typed and matched”) to the blood collection centers. Meadowlands treated 7 patients and was preparing to be a command center given its heliport; late Tuesday night Governor DiFrancesco used the heliport to depart from his visit to the triage center at Liberty State Park.
Every hospital in the County provided emergency services to victims. According to the Jersey Journal: Palisades Medical Center treated 12 patients; St. Francis Hospital treated 67 patients; Christ Hospital treated 54 patients; St. Mary Hospital treated 74 patients. Bayonne Hospital treated 58 patients.
At the Medical Center staff watched from windows the attack on the World Trade Center, then immediately went on Disaster Alert. Over 150 physicians covering all medical and surgical specialties were in the building as they are every day, and over 1000 other staff joined predetermined teams – trauma and surgery in the emergency room, and “walking wounded” in the auditorium. The library was organized for aftercare and rooms were set up for family members arriving from all over the metropolitan area. The injured started arriving around 10AM and suddenly, and sadly, everything stopped about 6PM. We hope and waited for more patients, and still wait “on alert”, our hope fading.
Since the New York City Command Center was in the World Trade Center complex and destroyed, good information was not available. We were told to expect somewhere between 2000 and 5000 injured.
Many others contributed to our success in handling the medical response to this act of war:
– Over 200 ambulances simply appeared from all over the state to assist. They were restocked from Medical Center inventory and dispatched by Medical Center EMS.
– New Jersey Commissioner of Health and Senior Services George DiFerdinando was in contact with us immediately and made sure we were re-supplied, and developed a plan with whereby trauma centers outside of Hudson County were on high alert so patients could be transported there to prevent Hudson County hospitals from being overwhelmed.
– Every hospital in the New Jersey was on disaster alert with elective admissions and surgery cancelled, and disaster teams ready until late Tuesday evening.
– Providers of food, IV solutions, medications, surgical supplies, and much more sent in truckloads of supplies without being asked.
– Volunteers poured in to help us in any way possible. For example with their help a “Hot Line” was set up at the Medical Center with up-to-date information on all disaster victims seen at New Jersey hospitals. This “Hot Line” was soon designated as “official” until the New York City Command Post was reestablished.
– Hudson Cradle opened its doors, wanting to help, wanting to serve.
– Mayor Cunningham and Jersey City police and fire officials coordinated all local efforts while supporting the recovery in New York City and securing the waterfront where victims were arriving by ferry in great numbers to several sites including Exchange Place and Liberty State Park. I know public officials in Hoboken, Secaucus, Bayonne and Weehauken did the same.
– And untold numbers were praying for the victims and those providing care – we could feel those prayers.
How can you help? Volunteer to give blood; blood will be needed for weeks and months to come. If you can, make a cash donation to help the families of those killed in this tragedy. Certainly go to community vigils and prayer services. Befriend someone who does not look like you and let them know that all Americans share this pain together and that the beauty of America is that we all came from somewhere else, and now live and work harmoniously side-by-side.
On a practical level we and other local hospitals can use your help. If you are a mental health worker and want to help with World Trade Center disaster Crises Counseling in hospitals, schools, and offices please call us. If you are a nurse who works outside the County or doing something else right now – particularly emergency room, critical care and operating room nurses, though all nurses are welcome – and want to be on our roster of volunteers for future emergencies please us. And if you just want to join the cadre of volunteers at our hospitals please call us. Please call 201 915-2048.
Finally I want to thank all the staff at Liberty, who once again, provided services so well. They acted heroically while worried about missing family and friends, and their children at home who had to cope with this tragedy without them nearby. I am honored to work with you.
*written on September 14, 2001; published in the Jersey Journal on September 18, 2001
Zika virus: CDC offers tips while hospitals partner with local institutions
Amid increasing concerns about the spread of Zika virus in the United States, the Centers for Disease Control and Prevention (CDC) has released a series of tips on what hospitals must do to prepare for the worst.
As of this week, the CDC has logged 2,517 total Zika cases throughout the nation. In preparation for the virus, providers and healthcare personnel should take several steps, according to a new guide (.pdf), including:
Recognize symptoms and clinical manifestations of the virus
Scrutinize all pregnant women for both symptoms of Zika and potential exposure, and be sure to update during every clinical encounter
Advise all pregnant patients how to prevent sexual transmission of the virus
Go over necessary preventive measures with all patients and families
Follow all standard patient care precautions, with particular attention to those pertaining to labor and delivery care
Post links to the CDC’s Zika site on hospitals’ internal and external sites
Communicate with local and state apartments about all possible cases
To fight Zika, Central Florida hospitals and doctors ramp up patient education, surveillance
In the fight against the spread of Zika, local doctors and hospitals are ramping up education and surveillance in Central Florida to contain the spread of the virus.
There is a heavy emphasis on patient education, while providers are on high alert for travel histories and on the lookout for potential cases that should be tested for Zika.
“There’s a limit in what we can do to reverse the effects of Zika,” said Dr. Vincent Hsu, hospital epidemiologist at Florida Hospital. “So what we do is a combination of supportive care and making sure that babies are referred to the right specialists. It’s really ensuring that there’s coordination of care among specialties.”
“We haven’t had pathogens in the past that have done all of these,” said Dr. Asim Jani, hospital epidemiologist for Orlando Health.
Jani and Hsu are former CDC disease detectives. The two have been collaborating since earlier this year to align their health systems’ Zika preparation efforts, most of which involve updating and educating their staff on the evolving Zika screening and testing guidelines.
The two systems, which have well-established labor and delivery units and maternal-fetal specialists, have also taken on the responsibility of caring for pregnant women who test positive for the Zika virus.
Johns Hopkins Opens Unique Comprehensive Care Center for Zika Virus Led by the Wilmer Eye Institute
As the number of patients with Zika virus grows worldwide, Johns Hopkins Medicine announces the opening of the new Johns Hopkins Zika Center, dedicated to caring for pregnant women and newborn babies, but also men and women of all ages with the mosquito-borne and sexually transmitted virus. The center will focus not only on diagnosis and treatment of infected individuals but also on the assessment of long-term effects, as well as new approaches to prevention and treatment of Zika virus infection. It is composed of providers and staff members from adult and pediatric departments and divisions within Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health, including cellular engineering, epidemiology, infectious diseases, maternal-fetal medicine, neonatology, neurology and neurosciences, ophthalmology, orthopaedics, pediatrics, physiotherapy, psychiatry, psychology and social work. Medical experts from Brazil, a country greatly affected by Zika virus, are also members of the center.
I don’t get an annual physical since I see my PCP a few times a year, but I do ask him periodically whether it is time for a “full” blood profile since I am treated with prescriptions for various “senior” conditions such as high cholesterol.
“Worthless is a very strong word and it provokes a very emotional reaction from not just patients but doctors. But the reality is we like to practice evidence-based medicine, and the evidence today does not support the idea of the annual physical exam,” …. (A)
“But what are the true benefits of this practice? Careful reviews of several large studies have shown that these annual visits don’t make any difference in health outcomes. In other words, being seen by your doctor once a year won’t necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm. For example, lab tests and exams that are ordered for healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be “false positives” — that is, when test results suggest a problem that doesn’t exist.” (B)
“Sometimes there is confusion about preventive health exams versus preventive care in general. Things like mammograms, pap smears, PSA testing, those are considered preventive care procedures — and there’s a clear evidence base that these are very important for patients to receive. What we’re talking about [in our] study is the special visit for [general] preventive care.” (C)
“…. the American Medical Association and other similar groups have moved away from the yearly exam. They now suggest that medical checkups be referred to as Periodic Health Assessments or Examinations and that they be performed every five years (for adults over 18) until age 40 and every one to three years thereafter. The requirements are for more frequent evaluations for those taking prescription medications. (D))
“Other experts say a yearly checkup is an important part of building a physician-patient relationship and can lead to unexpected diagnoses such as of melanoma and depression. I think there are probably subsets of people who can go longer than a year between visits but I think it’s quite important for people to know their doctor before they get sick,”………………(E)
BEWARE! “Under the law, most health insurance plans must cover a set of preventive services without any cost to patients. Services include vaccines, colonoscopies, mammograms, pap smears, diabetes screenings and tobacco use screenings – all aimed at helping doctors and patients catch problems early, so they don’t become costly and more difficult to manage later.
Patients are soon discovering, however, that anything else discussed during a visit with their health care providers could cost them.
“There are times when a person might be charged cost-sharing for a service that is unrelated to the screening or preventive service, while they are not charged cost-sharing for the screening or preventive service itself,”…….(F)
So………discuss with your PCP the plusses and minuses of a physical examination for you specifically in place of the seemingly now outdated generic annual physical for everyone.
Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.