Posts for: October, 2014
I recently had the pleasure of listening to a live educational webcast of medical experts, sponsored by the New England Journal of Medicine, on what is known about Ebola transmission. I would like to share with you some of their conclusions and key points. If you have additional questions after you read this, I will be happy to answer them to the best of my ability.
Ebola is NOT a new disease. It has been studied for decades. What is new is its current dramatic spread internationally out of local communities in West Africa. This is thought to be occurring because of the societal transition from smaller local rural communities to much larger urban centers in West Africa.
Because of decades of study, experts know exactly how the virus is spread, and they have had decades of success containing Ebola and eradicating local epidemics. The challenge is applying these fundamental principles of epidemic control to larger urban areas and international communities.
Principle Number One: train healthcare workers how to put on and take off protective equipment and practice, practice, practice.
Principle Number Two: healthcare workers should have no exposed skin when working with patients.
Principle Number Three: a trained observer should be present when workers put on and take off protective equipment; there was absolutely nothing wrong with a supervisor NOT wearing protective covering on the airport tarmac when a patient was boarding a plane to travel to hospital as was recently covered and implied by the news media, because the supervisor was not in direct patient contact nor in contact with the patient's body fluids.
Principle Number Four: disinfect protective clothing and equipment of visible contamination before removing personal protective covering.
These four principles have stopped ALL past local epidemics of Ebola in Africa over past decades.
The reason this works is that Ebola is NOT airborne but is transmitted by direct contact with body fluids, NOT by cough or runny nose. What is meant by body fluids? The experts do not mean perspiration, runny nose or saliva. Body fluids are blood, vomit and diarrhea.
Ebola is very rare. It is not transmitted from drinking water or by exposure to urban sewage. A study from 2007 found virus ONLY where blood contaminated environmental surfaces. Virus was NOT found on surfaces without visible contamination such as blood, vomit or diarrhea. Much is known about Ebola transmission. If you wish to read more about it, go to cdc.gov/ebola.
Aerosolized contamination (blood, vomit, diarrhea) is NOT a significant form of transmission. A past study found NO transmission between sick and well monkeys kept caged at a close distance.
The risk to the public from a person incubating Ebola while he or she is well is NONE, whether that person is in a bowling alley or flying in an airplane or shopping in a grocery store or urban mall. This is a known fact and not speculation after decades of study of the Ebola virus in Africa’s recurrent local outbreaks.
The experts report that even in the initial early hours or first few days of an exposed person’s fever, the risk of transmission to others in the absence of vomiting, bleeding or diarrhea is Nil to none. Once an individual begins to vomit, have diarrhea or bleed, however, the risk of contamination and spread of virus directly from those body fluids is high. Isolation of the sick contact, providing that person health care by properly protected professionals, tracking of the sick person’s other contacts directly exposed to his/her body fluids and observing those contacts daily for 21 days (while they are well and are going about their normal daily routines) for the first evidence of illness is known to control and stop the spread of Ebola. This is fact, not speculation.
The mandatory confinement and isolation of people who are well, but have been directly exposed to the body fluid of people ill with Ebola is NOT necessary to stop Ebola. Tracking and daily monitoring of well people who had direct exposure to the body fluids of someone sick with Ebola, and then isolation of those people at the first sign of illness is what stops the spread of Ebola. Fact, not speculation.
In the first days of illness from Ebola without vomiting or diarrhea, there has NOT been transmission of Ebola observed in decades of study. Fact, not speculation.
There is NO transmission of Ebola from casual contact from well persons exposed to Ebola. The U.S. patients who were out in the community did NOT lead to secondary cases of Ebola. Family members and friends who were in contact with them were NOT infected. Limited data indicates that Ebola virus does NOT persist on environmental surfaces for long periods of time.
Consistent with all these facts is the observation that NO cases of Ebola have developed from the initial Dallas patient’s family members who lived in normal close family contact with him prior to his admission to the Texas hospital. Moreover, NO secondary cases of Ebola have occurred from normal family close contacts to the other Ebola U.S. patients prior to their hospitalizations.
Much is known about Ebola and how to control and stop its spread
Stopping air travel of well persons to and from infected areas is not currently needed and in all probability would not be helpful.
Well persons at risk of developing Ebola from direct exposure to an Ebola patient’s vomit, diarrhea or blood are not contagious when they are well AND are not contagious in the initial period of fever as long as they have not developed vomiting, diarrhea or bleeding.
Well persons who have had direct exposure to an Ebola patient’s blood, vomit or diarrhea are at risk of developing Ebola for 21 days and do not need isolation when well. They only need daily monitoring for the onset of early symptoms of illness for 21 days. This does not require mandatory confinement.
These persons in the first hours to days of becoming ill with fever are not contagious to the public or their families or their environment as long as they do not have vomiting, diarrhea or bleeding.
These persons who present themselves to a hospital ER for care, observation, treatment and isolation when they first develop fever but before the onset of vomiting and diarrhea, present very little, if any risk to the general public or their families and friends.
These persons, in the absence of vomiting , diarrhea or bleeding, are not contagious to anyone no matter where they have been before the onset of their symptoms.
Although the national news media are carrying daily updates and stories about Ebola which are disturbing and upsetting, the media are not sharing these known facts adequately with our public. If these facts were emphasized daily, public fear and panic would be at a minimum.
Recent Headline: “Cuomo and Christie Order Strict Ebola Quarantines
By MARC SANTORA
Gov. Andrew M. Cuomo of New York and Gov. Chris Christie of New Jersey said all people who had direct contact with Ebola patients in three West African nations would be quarantined.”
I hope you conclude from the information shared above, that this action by these officials is not rational, but caters to public fears and political pressures, instead of being a helpful response to Ebola control in the U.S. The mandatory confinement of healthy, well nurses and doctors who return from patient care in West Africa to secure facilities is not consistent with the science of Ebola transmission.
Let’s continue to watch the news to see if science and evidence inform the judgements of politicians and lawmakers. We all will be safer it this happens.
Day, Night, Weekends or Holidays: How to Reach Me When You Need Me.
The other day a Mom in my practice asked me the following: “In the event of some kind of medical emergency here, if it weren't serious enough to warrant a call to 911, what would the protocol be (if we couldn't get hold of you e.g. it was the middle of the night, etc)? This is my first baby and I’m not sure how things work. A friend of mine recently had to take her baby to Urgent Care and I thought I should know what I would do in the same situation. Are there certain Urgent Care centers or Emergency Rooms that are particularly [appropriate] for infant care”?
These are excellent questions and worthy of reviewing with everyone. So here goes.
First of all, I want to remind you that I am available to you 24 hours a day. My patients can call me overnight, if they feel they have a concern that cannot wait until the sun comes up. I have even been known to respond to texts sent to me in the middle of the night; but remember, a text ringtone is not a phone call ringtone, so a call is preferred overnight if I am truly needed. If together we feel your child needs to be seen, I will come to your home unless together we decide that urgent care or the ER is the preferable choice. I am reachable even when I am out of town.
When I am briefly unable to answer the phone (weddings, medical conferences, etc) my voicemail message should indicate that fact and reference the phone number of a covering pediatric colleague who is available to take your urgent call. Please do leave a message for me, in any case, and I will call back as soon as I am available, even if you do call my colleague because of the urgent nature of your need. I should normally call back within an hour_that is my goal.
However, sometimes life intervenes, and acts of nature, e.g. ice and snow storms that down wires, and power outages can take out infrastructure. Very rarely, your call may not come through. If your gut tells you that I missed your voicemail message, and the message on my phone does NOT indicate a covering doctor, please call my practice manager, Shelly, on my general practice number, 404-654-0426.
Now, to answer your question about locations for care if I am out of town. If it is during the day, my voice message will give you the information identifying my covering pediatric colleague. If it is after hours, then urgent care or Kids Time Pediatrics will be where you could go to be seen. If it is late in the evening or the middle of the night, then an ER is your only option_preferably the Children’s Healthcare of Atlanta ER at Scottish Rite or Egleston. Please take note of your nearest pediatric urgent care center. I’ve included a link for your convenience.
There are the Children's Healthcare of Atlanta (CHOA) Urgent Care Centers, the CHOA Scottish Rite Hospital & Egleston Hospital Emergency Rooms, and Kids Time Pediatrics, an after hours non-emergency facility staffed by pediatricians for non-office hour care.
I do not recommend your going to other Urgent Care Centers which are almost always not Pediatric oriented. I also do NOT encourage use of the CVS or Walgreen's Minute Clinics which offer nurse practitioner care, unless you are out of town traveling and have no other alternative.
CHOA Urgent Care Locations: http://www.choa.org/Childrens-Hospital-Services/Urgent-Care/Locations
625 Big Shanty Road NW
Kennesaw, GA 30144-6812
1001 Johnson Ferry Road NE
Atlanta, GA 30342-1605
Kids Time Pediatrics - Sandy Springs & other locations
5252 Roswell Road NE
Atlanta, GA 30342
Phone: (404) 943-1979
For general information even if you choose to call me, I recommend as a parent resource: http://www.healthychildren.org/English/Pages/default.aspx
This web link is an excellent source of general information offered by the American Academy of Pediatrics. It has an excellent search window that leads you to valuable and credible information.
I hope this Blog post has been helpful. Please let me know if you have other questions about health care I can address in my Blog.
Open Enrollment Time Will Be Here Again for Family Health Insurance Coverage
The Healthcare.gov Open Enrollment period is November 15, 2014 to February 15, 2015. Coverage can start as soon as January 1, 2015. Private Insurance may have a different Open Enrollment time-frame. Please double check.
Signing up November 15, 2014 to December 15, 2014; coverage starts January 1, 2015.
Signing up December 16, 2014 to January 15, 2015; coverage starts February 1, 2015.
Signing up January 16, 2015 to February 15, 2015; coverage starts March 1, 2015.
Can You Answer These Questions?
Do you want to have freedom of choice to pick your child’s pediatrician without undue pressure from the insurance industry?
Do you want your child’s pediatrician to make recommendations regarding your child’s health without pressures or incentives from the insurance industry?
Do you want to have real-time access to your child’s pediatrician without having to go through multiple layers of personnel and telephone trees?
Do you want direct access to your doctor by phone, text, email and other IT modalities, e.g. Skype?
Priority Pediatrics PC, the practice of Dr. Marc Tanenbaum, offers personalized primary pediatric care in your home. As a small out-of-network practice, Dr. T is able to offer infants, children, adolescents and their parents his time and expertise without constraints dictated by the insurance industry. This means more time spent with you and your family and the availability to have medical care that works around your schedule__all at a very affordable price. Dr. T has over 36 years of experience in pediatric medicine and you can be sure your children will receive superior medical care.
Priority Pediatrics, PC blends the best of 21st century medicine with the care, time and convenience of 50 years ago, when doctors made house calls.
Open enrollment is the one time each year, families can change their health policies and health savings accounts.
Not all policies are the same. Open Enrollment time-frames may differ between Insurance Carriers. Don’t miss this important annual opportunity to choose a policy that will reimburse you for an out-of-network provider like Priority Pediatrics PC, whose services to your children are provided in your home.
Summary of Benefits and Coverage (SBC)
An SBC is an easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You'll get the "Summary of Benefits and Coverage" (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company.
Health Insurance Solutions for Individuals
Many individuals find their annual health insurance costs increasing exponentially. Others find that even with a “catastrophic” insurance plan, basic medical care (the type of care that is used most often) is not covered, resulting in more out-of-pocket expenses.
Priority Pediatrics PC’s solution to this is for patients to combine a high-deductible insurance coverage plan with an HRA (Health Reimbursement Arrangement) that will allow you to reduce the monthly expense of your insurance plan while getting excellent direct, primary preventative pediatric wellness care and sick care from Priority Pediatrics PC delivered in your home.
High Deductible Insurance Plans
A deductible, in insurance terms, is the amount you must pay for health care before payments from the insurance company begin. After the deductible is met, insurance companies typically pay 50 to 80 percent of covered expenses up to certain annual limits, depending on the plan. In general, the higher the deductible, the lower the monthly premium. You will save a substantial amount in premiums, in exchange for paying more in out-of-pocket costs before insurance coverage begins, including expenses for routine primary and preventive care. To be a member patient in Priority Pediatrics PC entails an out-of-pocket cost approximating the cost of one cafe-latte per day for your first child, and even less for subsequent children. A further discount is offered for older children
Health Savings Account
One way to ensure that you are able to meet the increased out-of-pocket expenses associated with a high deductible health insurance plan is to set money aside each month in a readily accessible tax-free savings account. Thanks to recent federal legislation, a Health Savings Account is a current option that is growing in popularity for this purpose. Certain “qualified” high deductible insurance plans allow you to open a health savings account and make tax-exempt contributions that can be used for medical expenses not covered by your insurance.
Flexible Spending Account
A Flexible Spending Account (FSA) allows you to contribute money from your paycheck to a special fund that can be used for eligible healthcare expenses. Your contributions are made pre-tax, which saves you money, and can be used for medical expenses and dependent care, including child-care costs. Some employees have been wary of FSAs since unused funds generally expire.
Questions to ask Potential Insurers As You Shop & Compare
What is the best way to find out in advance what I will have to pay for out-of-network care? Is the policy for reimbursing out-of-network care posted on your insurer’s website or otherwise available?
What are the rules for accessing care outside my plan’s network? For example, how will I know if a service or test needs to be pre-authorized? Is there a phone number that I need to call?
What services and tests are covered by my plan (well check ups, sick care, home visits, immunizations)? Will they be covered if performed by an out-of-network provider (an out-of-network pediatrician)? What services or tests are excluded?
What happens if my out-of-network doctor sends my child to an in-network laboratory? Would I be responsible for additional costs? If so, how can I guard against this additional expense?
Is there a deductible? Do both in-network and out-of-network services count towards the same deductible? Do pharmacy services and laboratory services count towards the same deductible?
How does the plan cover emergency & urgent care services when referred by a non-network provider? How does the plan define “emergency” services? If I (or my child) am brought by ambulance to a non-participating Emergency Room, am I financially responsible for a decision that was not in my control?
Always make a note of the date and the name of the person(s) you spoke with.
Priority Pediatrics for Your Children's Primary Care
The combination of Priority Pediatrics PC plus a high deductible insurance plan, leverages the best characteristics of both types of health care coverage: better access, exceptional service and affordable pricing that are the hallmark of direct primary care plus the affordable coverage provided by your high-deductible insurance. We support your "obtaining out of network" benefits through our invoice statement summary sent to you and your claim submission to your insurer for reimbursement for needed health care. We will itemize our invoiced services to you as best we can for your insurance claim, but we must leave it to you to confirm your out-of-network benefits with your chosen insurer.
Priority Pediatrics PC accepts new patients throughout the year, however, we do limit membership to maintain our high standards of excellence and service.
Clearly, health insurance options for families and their children are complex and in flux. The following articles have been chosen to offer you consumer advice on using your Open Enrollment period to make good choices about your doctors and health insurance coverage. Consulting with your financial and legal advisors as you shop for health insurance may be in your best interest.