I got vaccinated!

General

It’s amazing to reflect on how much effort and ingenuity has gone into making this possible. I really hope more people around the world can benefit from this as soon as possible.

My vaccination was delivered by UC Davis Health. It was a very well run experience and I was very impressed with the way the logistics and process was handled. And I loved the bandage 🩹 with the UC Davis logo on it 🙂

My personal experience with the current US response to COVID-19 (Mar 2020)

General

More than a week ago I had low fever and cold-like symptoms and dry cough. But most of those symptoms subsided. Then 4 days ago I had extreme fatigue and I couldn’t even get out of bed for almost 2 days. Very bad headache. I never take meds for headaches but I had to take an excedrin last 4 days. But no fever. And no real cold and very minor mostly dry cough. Then yesterday I had tightness in my chest and I felt my breathing was slightly labored. Today just before waking up I felt I wasn’t breathing well. When I sat up I was able to breathe better. But I felt a shortness of breath. And my voice was weaker than usual. But I wasn’t breathless or struggling to finish sentences. It just felt markedly worse than the day prior. And then I also threw up. But I didn’t have diarrhea.

None of the symptoms were serious on their own. But this quick development of things made me concerned. And I have never had panic/anxiety or asthma or allergies.

That’s when I became curious to see what it’s like to navigate the system for someone who has more severe symptoms. I was disappointed to find out that testing was highly discouraged here in the US for the same reason that wearing masks is discouraged – there are not enough of those to go around. Germany, South Korea etc would at this point direct you to get tested. The US is still catching up. Hopefully it looks like we will be there in April. Wide testing is very crucial from a public health perspective. It will help us understand the extent of the outbreak, get a truer picture of mortality rates, and more quickly and more confidently help us open up the economy. Lack of testing has severely handicapped our response here in the US.

Then I found out through a friend that CA had setup a drive-through testing center 20 min from where I live. They yesterday expanded their criteria to include my symptoms. So I was curious to see how that was working. I was too late to get there yesterday in time, but I went anyway just to see. It was an impressive setup and they had managed to get more than 200 people tested in one day. (https://www.hayward-ca.gov/discover/news/mar20/results-announced-first-day-covid-19-testing-city-hayward).

I found out that they still don’t have enough tests and though I qualified I decided I didn’t want to take away from folks who might need them more urgently.

I then called an urgent care and described my symptoms and told them I didn’t want to come in for something unnecessary as I didn’t want to overload the system. They said I should come in and they could see me in half an hour. I was surprised at the promptness of this. This is something I am not used to with healthcare here.

So I went in. The parking lot was empty. I was the only patient when I walked in for my 7pm appointment. They had set up outdoor triage with social distancing and masks. And they had a separate entrance to the building for folks with respiratory symptoms like me.

(I was surprised that I had to touch the door bell to enter. I used my hand sanitizer to wipe it clean before pressing the button. The last thing I want is to spread it to folks who come in here!)

I was led into an air-tight examination room. It had a ball in a tube in the wall that helped indicate when the room was air-right. Not sure exactly how it works but that’s what they said it does.

The nurse was wearing proper PPE and she took down my cell phone number and said the doctor will call me from another room. He called me and did the whole consult from next door. I repeated what I had earlier told the nurse before coming in for the appointment. He then directed the nurse to swab me for Flu A & B. So they did that. It takes 15 mins and that came out negative. My temp was normal and my blood pressure was slightly elevated. And my blood oxygen was normal.

Then the doctor who was also wearing proper PPE came in and checked my lungs etc. He said since I am not at risk of complications/death they were still rationing out the COVID tests. He said regardless I should self quarantine for 14 days.

I told him that makes sense and I told him I was even reluctant to come in as I know you are swamped. He said it was very good that I came in. And he said that if my symptoms get worse we could consider an x-ray to see what was going on there. He also recommended I get an inhaler and use it if I have trouble breathing. I have never used one before but decided to take a prescription for it as it seemed like a useful thing to have.

I asked him about how they were doing on supplies, masks etc. and he said they are running low and could use donations. I asked him how many they might need and he said someone brought in 3 today and they are immensely grateful. They specially need the N95 ones as those are the hardest and they have been burning through those. He said they are not overwhelmed yet but are expecting a huge spike in ER, hospitalizations and ICUs in a couple of weeks as the initial wave of infections in CA enter that phase.

I thanked all the nurses and the doctor individually for all the brave and heroic efforts they have committed to. Everyone was cheerful and waved at me as I was walking out.

I came home and I was able to sleep better last night. Today I don’t have the headache. I still feel unwell, and fatigued. I still feel tightness in my chest but it doesn’t feel like it’s getting worse. I still don’t have a temperature. And I have very little phlegm. Overall, in net, I feel a little better than yesterday, and it could be a placebo effect. I will keep you posted if I notice anything get worse.

In some ways I am glad I got to experience the calm before the storm. Seeing how empty and non-busy it was made me feel less guilty about going in. But I still feel slightly embarrassed.

Our doctors and health care workers are doing their best to prepare for what’s coming. They are facing a lot of stress. Let’s be extra kind to them and wish them the best luck. If you have any extra masks please consider donating them to your local hospitals.

I was already self-quarantined but I was going out for essential errands, or a walk in an empty park etc. Now I will be fully inside for at least 2 full weeks.

The fundamental problem with using insurance for all health care

General

Did you know that even people who are insured in the US, many of them still can’t afford to even go get their symptoms checked?

That is because there’s this thing called co-pay. Which means if the doctor bills $100, you have to pay $50 and your insurance pays the other $50.

And then there are also deductibles. So in each year, until the first $1500 you have to pay out of pocket. And your insurance only kicks in after that.

You see, health insurance is insurance. It protects you from going bankrupt. It protects that downside. But for the model to work, they have to raise the barrier to entry using co-pays and deductibles.

So now you know you need an anti-biotic. But you need to get a prescription from a doctor. But you don’t want to go see a doctor. So you try to self medicate or wait it out. Even if you are insured.

The insurance financial model is not designed for ensuring well-being. It’s designed for protecting from catastrophes. But with no incentive for well-being, catastrophes hit more often. And it’s easier to just raise premiums than to address the systemic problems.

This is not the fault of insurance companies. We can’t blame the hammer if it can’t turn a screw.

When I almost lost my hand

Travel

For those who were following along at the time, it’s been 5yrs now since I almost lost my right hand!

For those who came in later, here’s what happened. This may be a little graphic so please only continue if such content doesn’t bother you.

I caught an infection in Tanzania that started developing symptoms on my flight to India. But I went straight to a wedding first, which is the main reason I had flown to India that day ☺️

My Facebook post on that day. My swollen hand is not visible in this picture.

Next morning my hand was very swollen and it hurt very bad – like a semi truck had just run over it. I also started to develop a fever. Went to the doctor who said I needed to be operated on right away.

8hrs later I was on the operating table inside a hospital in Mumbai, under general anesthesia, and the surgeon made an incision in my hand and drained all the pus and then closed it up. That was the easy part. 🤞

We didn’t know what the infection was and my fever raged on. My hand hurt like hell. And every 6-8hrs they had to remove the bandages, stuff a bunch of gauze and cotton deep into the hand cavity and squeeze out the pus like we squeeze out toothpaste. There was no anesthesia involved in this step. It helped me understand pain, my thresholds for pain and offered me a great opportunity to practice integrating into discomfort rather than fearing it. I remember how traumatizing those days were – to feel the pain, to know that more is coming at regular intervals, and the powerlessness around it. Also in an interesting way, I think my family was affected more by it then I was. I was never shrinking or crying or squirming during the procedure. I had mostly resigned to it and was mostly detached from it. Mostly! 😛

4 days later we got the culture results and the right antibiotic started to work. My fever was finally coming down and I could think again. But my hand still was no where close to healed. I could see raw flesh and the deep cavity every time the bandage was taken out. I didn’t think that was ever going to heal. Funny the narratives our brain can tell us 😆 I had to leave my hand raised in a sling to avoid accumulation of fluids. I started doing my tasks and working on my laptop etc with my left hand. I had accepted a future where I didn’t have use of my right hand and had simply moved on. (And you guessed it right, I’m right handed 🤓)

After a month of daily change of bandages and cleaning, I was amazed at how much the body starts to heal. The cavity was closing in, new flesh had formed. And I was also able to finally close my fist again. It then took me 1yr of physical therapy to get my grip back. And now, after 5 yrs all I have left is a scar and memories!

Lesson learned: don’t pluck feathers off dead flamingoes 🦢 😇

I just took an ECG on my Apple Watch

General

My Apple Watch ⌚️ got a software update this weekend and now I can take ECGs on it. Looks like it’s already saving lives:

“Fine I walk in and sign in. They ask what’s wrong and I’m embarrassed. ‘Ok so there is a new watch feature….hahaha….I’m silly but can we check this?”

“I did not know that this comment was a quick queue pass for Patient First. I’m taken right back and hooked up. The technician looks at the screen and says “I’m going to get the doctor”

“Doctor comes in, looks at the screen, looks at me and says “You should buy Apple stock. This probably saved you. I read about this last night and thought we would see an upswing this week. I didn’t expect it first thing this morning.”

It was so easy to set up and worked so flawlessly. Apple’s still got it 🙂

Thoughts after reading the 1,990 page health care reform bill H.R.3962

Uncategorized

The bill is broken down into 4 main divisions. I admit that I just breezed through division B, which talks about reforms and cost savings in Medicare, and division D, which talks about reforms for health care for Indians (Native Americans, not me 🙂 ).

Here’s highlights of the other two divisions:

Division A

  • Insurance becomes a heavily-regulated, highly accountable, fixed-margin marketplace – you make a profit? pass it back to the insured as a dividend
  • Enforcement of consumer protection, reduced variability, increased guarantee and reliability of health care
  • Ensures higher quality of coverage, regardless of impact on insurance premiums

Division C

  • Introduces a bunch of incentives for wellness programs, positive behavior, preventive care, research into effective, evidence based medicine
  • Introduces incentives to increase the health workforce in the country

Division A levels the playing field, sets some tough but humane standards that really should be met for health coverage to be meaningful. It’s a sweeping reform in this area. Division C attempts to offset the costs in the long run by introducing incentives for preventive care and increasing health workforce.

Whether Division C offsets the cost of Division A is debatable, and I personally think it won’t magically reduce the bottomline cost of healthcare. What this does succeed in is establishing quality standards which will expose the true cost of real health coverage for everyone in the country. It ensures that cutting health care costs by reducing coverage or turning a blind eye to the problem is no longer an option. The bill is an embodiment of the country’s belief that everyone has a basic right to reliable and affordable health care, no matter the cost to everyone. It forces everyone to look at other creative ways to reduce costs and raise money to support this right, starting with increasing Medicare efficiency and taxing the super rich. However, I could’t understand how this bill achieves a reduction in insurance premiums. Isn’t that the bottomline cost that should be of concern? If you have any insight into this, please leave a comment or email me.

Having read the earlier bill at the start of the summer, this bill comes across as a little more exhaustive and reflects the incorporation of a wider set of opinions, which explains the additional 1000 pages 🙂 Would be interesting to see how it evolves as it passes through the senate.

Have you read the bill before forming an opinion? Of the 40,000 people who have read the bill so far, 80% oppose it. http://www.opencongress.org/bill/111-h3962/show Also consider reading the NY times comparative report.

[Note: Even in the case of the earlier draft that was hotly debated, 77% people who actually read the bill voted against it http://www.opencongress.org/bill/111-h3200/show Either supporters access the bill through some other source that I am not aware of, or they just rely on trust and summaries by others, or only the opposers care to scrutinize the bill in detail. If you want to show your support for the bill, consider voting “Aye”, after reading the bill, of course!]

Appendix:Understanding the numbers using some crude, loose calculations

Number of uninsured people this bill would help = 36 million [source: ny times summary]

Cost of proposed plan = $110 billion per year [source: ny times summary]

Assumed average individual premium for job-based insurance = $5,000 per year [source: about.com 🙂 ]

Assumed average family premium for job-based insurance = $10,000 per year [source: about.com 🙂 ]

Cost of insuring 36 million people with existing average individual premiums  = $180 billion per year [source: calculation]

Cost of insuring 36 million people with existing average family (assuming family of 4) premiums  = $90 billion per year [source: calculation]

Cost of the two wars in the last nine years = $919 billion or averaging $91 billion per year [source: http://costofwar.com/]

Number of people in America that die each year due to lack of insurance = 45,000 deaths per year [source: Harvard study]

Number of people in the world that die of malaria each year = 1 million deaths per year [source: Gates foundation]

Cost of completely eradicating malaria from the world = $5 billion per year for 12 years [source: Roll Back Malaria]