Eye Health

Coronavirus: a doctor’s-eye view of the public health threat

Last week, like millions of others, I found myself reading about the emergence of a new virulent strain of coronavirus in a Chinese city I’d never heard of. It seemed comfortably far away, and reassuringly foreign.

That changed this week, when I found myself standing in a respiratory isolation room, wearing a gown, gloves, a mask and eye protection, taking a detailed medical history from a young Chinese graduate student who had recently returned from an extended trip home. She’d developed a cough and a fever after arriving back in Albuquerque, N.M., for the spring semester.

This world is indeed a small place. Wuhan and Albuquerque are about as far away from each other as it’s possible to be on Earth. Yet there she was, coughing miserably into her mask, as I stood there like an astronaut.

The Ebola outbreaks in West Africa of recent years were frightening and tragic, but ultimately public health experts were not concerned about a pandemic. Ebola is relatively difficult to catch, and so virulent that its spread can be contained, because patients can be quickly identified and isolated.

Not so this new coronavirus. Although highly contagious, it has a long incubation period, and the majority of cases are relatively mild.

Rather than being reassuring, from a public-health perspective, this is a potential disaster. Many patients will have symptoms indistinguishable from other common viral infections, will never know they are infected, and will thus continue to pass the virus onto others. Great numbers of people could become infected over time.

At the moment, much remains to be learned about the new virus. Its true virulence is unclear, and only a few percentage points either way will determine whether this epidemic becomes a catastrophe or a manageable threat.

Current strains of influenza, for example, kill roughly 650,00 people around the world every year. Although the overwhelming majority of people with the flu recover in just a few days, a small percentage of patients with influenza develop severe complications. Since hundreds of millions of people get the flu every winter, that small percentage translates into a tragically large number of deaths.

The influenza strain of 1918 that killed approximately 50 million people worldwide was much more virulent than the influenza strains of today. But in an emptier world, before commercial air travel, with fewer densely populated cities, humanity was also less vulnerable. Despite the medical advances of the past century, it’s estimated that as many as 100 million people would die if the same 1918 influenza strain were ever to rise again. So far, we’ve been lucky.

These are staggering numbers, horrifying numbers. And they explain why the Chinese government has quarantined over 50 million people and is building brand new hospitals with such astonishing speed.

We may be lucky this time too. It’s possible that this particular coronavirus is less virulent than feared. It’s possible that an effective vaccine can be developed quickly. It’s possible that the current ferocious containment measures being taken by the Chinese and other governments will work.

But it’s also possible that our luck has run out, and we are seeing the beginnings of a global pandemic of the sort that no one alive today has experienced.

At the moment, simply too little is known for confident predictions. That will likely change soon, but right now we’re still in the dark.

So I looked at that young woman, and thought: I have no idea. Probably it’s just a cold. Probably it’s nothing. But I wasn’t certain, and neither was the Department of Health or the infectious disease specialists I called. They checked the Centers for Disease Control website in Atlanta. The recommendations are changing rapidly, and inevitably lag behind, because data takes time to collect.

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No, she wasn’t sick enough to be hospitalized. Yes, she’d been in China for many weeks. Yes, she had flown on domestic flights and ridden on buses and trains. No, she was not from Wuhan, had not traveled there or knowingly had contact with anyone who had. But she didn’t have the flu or any other of the common viruses we test for, either, and her symptoms fit perfectly.

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The CDC recommendations were clear. She did not meet the criteria for the specialized and expensive viral testing that my hospital does not have in any case. Testing, too, must be selective, because resources are limited, and the tests themselves are not yet widely available.

So I followed the recommendations and discharged her. I told her to stay at home, and to call us immediately if she got sicker. But as I watched her walk out from a safe distance, with her cough and her fever, wearing her mask, I wondered nonetheless.

If there is a larger lesson to be found in the eerie footage of Wuhan’s deserted streets, where the traffic lights keep changing for absent cars, it’s a simple one. It’s a lesson that extends beyond public health, beyond medicine and beyond even science itself.

This world is extraordinarily small. Humanity is frail. Nowhere is far away. Our fates are collective, for better and for worse, now more than ever before.

Huyler is an emergency medicine physician in Albuquerque. His latest book, White Hot Light, will be published in August.

ReFocus Eye Health Acquires Soll Eye

Pioneer of Dynamic New Approach to Healthcare Management Increases Market Presence, Adds Four Locations with Leading Eye Care Brand

RYE BROOK, N.Y., Jan. 28, 2020 /PRNewswire/ -- ReFocus Eye Health, a nationally-focused, collaborative healthcare organization, announced that it has acquired Soll Eye. The acquisition, effective immediately, brings all four Soll Eye locations across Pennsylvania and New Jersey to the Refocus Eye Health family, as well as Soll Eye's team of doctors and staff.

"I am thrilled to share the news that Soll Eye has partnered with ReFocus," said Dr. Stephen Soll, Founder of Soll Eye. "My team and I will have greater access to cutting-edge technology and other resources to better serve our patients and community at all Soll Eye locations."

With more than 60 years of serving patients, Soll Eye is one of the top eye health providers in the Northeast. Its team of seven doctors are among the most nationally recognized leaders in their clinical fields, delivering a spectrum of vision services ranging from primary eye care, cataract surgery, vitreo-retinal procedures and other treatments. Its optical center carries dozens of leading brands, with custom fitting, specialty glasses, and more.

"Providing the strategy, innovation, and support to bring better eye care to people is our primary goal at ReFocus," said Dan Doman, CEO of ReFocus Eye Health. "Our acquisition of Soll Eye helps us further build on this mission, while lending the power of our expertise and resources to the talented doctors and team at its locations."

"This partnership establishes an important foothold for ReFocus in the Pennsylvania and New Jersey markets," added Sean Hayes, Partner at Zenyth Partners. "We look forward to working with Dr. Soll and his team to extend our footprint while continuing to deliver exceptional eye care to our patients."

ReFocus Eye Health was founded in 2018. Its collaboration of ophthalmology and optometry practices are committed to providing the highest level of care, with top-quality medical expertise, advanced technology and business management.

For more information about ReFocus, visit www.refocuseyedoctors.com.

About ReFocus Eye Health:ReFocus Eye Health takes a fresh, enlightened approach to health practice ownership and management. As a source of permanent capital, ReFocus invests in ophthalmology and optometric practices exclusively for long-term growth. Its experienced team of investment professionals, business builders, and clinicians work alongside local physicians to transform the total eye care experience for patients through the use of clinical and management best practices. ReFocus Eye Health is headquartered in Rye Brook, NY. To learn more, visit www.refocuseye.com.

View original content:http://www.prnewswire.com/news-releases/refocus-eye-health-acquires-soll-eye-300994595.html

SOURCE ReFocus Eye Health

To Your Good Health: For cataracts, the treatment is surgical

ANSWER: Weight loss, when it's due to illness such as cancer, can be very problematic. It leads to frailty and increased susceptibility to infection, bone fractures and many other adverse medical outcomes. There have been many medications used to stimulate the appetite, including mirtazapine (Remeron), as weight gain is a side effect when Remeron is used as an antidepressant.

When used for cancer-related weight gain, about 25% of those on Remeron treatment noted increased appetite, and the same number gained a kilogram or more. About 12% withdrew from the study for reasons including excess sedation and confusion. Among those taking Remeron as an antidepressant, 54% note drowsiness.

Although 7.5 mg is a low dose (15 mg is the usual starting dose for adults), older adults may be more sensitive to the adverse effects, and if your mother is very thin, as you suggest, 7.5 mg may not be such a small dose after all. I suspect that her listlessness and excess sleeping may very well be related to the Remeron. A trial off the drug would answer the question. Alternatives are available. The most commonly used in this situation in my experience is megestrol (Megace). Sedation is not common with megestrol, but it does increase risk of blood clots.

Finally, the data I am quoting are for people with weight loss due to cancer. I don't know what the cause of weight loss is in your mother. Advanced dementia is a common cause; here, appetite stimulants have also been shown to be beneficial in small studies. If the cause of the weight loss is unknown, finding out why might lead to a more effective treatment.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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