bmagnus@bridgetmagnus.com

Thirty Six, Four, and One

Image courtesy of Pexels

This morning we came back from a long holiday weekend. The weekend’s lab results were waiting for me. These included:

Thirty Six cases of influenza, mostly Flu A
Four cases of RSV
One case of COVID.

Several facts struck me about this haul. One is of course that these all have vaccines available to prevent them — your insurance might even cover them at no charge to you. I must of course make the caveat that these vaccines are not available to everyone. There are restrictions based largely on age. Some of them work better than others, but all of them are “better than nothing.”

Another interesting fact is that although COVID is still with us, RSV and Flu were far bigger problems. Before you start saying “oh come on, it’s just the flu!” I’d like to point out that every year thousands of people die of influenza. RSV is also a potential killer, mostly in children on one end and older adults on the other.

Not so fun fact, we’re just barely getting to the middle of “flu season,” so you can expect even more of this lovely stuff wherever in the Northern Hemisphere you may be.

But the thing I found saddest is the number of children who passed through our Emergency Department and Freestanding ED (FED in hospital-talk). The saddest part is that most of them got sick after Christmas. It’s very likely some selfish relative who just had to see the kids/cousins/niblings/grandkids left an unintended extra gift this year: getting sick enough go to an Emergency Department for a respiratory illness panel. And that makes me unhappy.

My job is literally preventing infections. Please, do your part. Stay home if you’re sick rather than “power through it.” In particular, show love for the kids by not going to visit them when you’re sick. Wear a mask when appropriate. Keep your hands clean — literally the number one thing you can do to prevent all illness. And it’s still not too late to get vaccinated against preventable illnesses.

Vaccines Save Lives

A child with measles.

This link has a chart of measles cases since 1919. What happened to cause that drop in the 1960’s? Vaccines.

This link has a chart of smallpox cases. That flat line? Caused by vaccines.

This one is diphtheria. Again, vaccines.

And here’s polio. Again, vaccines saved lives and prevented suffering.

For this one you’ll have to scroll down for a whooping cough chart. The CDC helpfully added arrows to point out when certain vaccines were introduced.

These are things that killed lots of children over the centuries. Only relatively recently have we been able to prevent the suffering and death that they can cause. Many of them do not have cures, only prevention.

Saying any of them cause autism — in addition to being flatly untrue — is saying you’d rather have a dead kid than an autistic kid.

But hey, here’s one more chart. It’s COVID. Yeah, that vaccine isn’t perfect (most aren’t) but it does work. In fact the President just got his COVID booster.

Vaccines save lives. Make sure your family stays up to date.

Spectrum Extended

Image courtesy of the CDC

Many of you know that I work in a hospital as an Infection Preventionist in Fabulous Las Vegas. In that capacity, I see a lot of lab results. Recently, there has been a notable number of cases of urine cultures growing germs with an interesting pattern of multi-drug antibacterial resistance. The strangest part is how many of these samples did not come from our very ill inpatient populations. No, they are coming from our walk in patients in the Emergency Department.

Now make no mistake: I am aware that the plural of anecdotes is not data. However, we are certainly in a “huh, that’s funny” place with this.

It’s called Extended Spectrum Beta Lactamase producing bacteria, ESBL for short. To explain what that means, I’m going to step back and somewhat oversimplify things.

Bacteria are very simple single cell organisms. They have a cell wall instead of the cell membrane you and I have around our cell. That cell wall is made up of big molecules just like the walls in your house might be made of studs, drywall, and nails. Beta lactam antibiotics like penicillin work by pulling the bacterial “nails” so the cell wall can’t be built. This prevents baby bacteria from being made and fairly quickly results in the existing bacteria dying off.

Chemists provide clues for what things do when they name things. When you see something that ends with –ase, it neutralizes something. You take lactase so you can comsume lactose, for example. So Beta lactamase neutralizes those Beta lactam antibiotics. No chemical nail puller? Cell wall construction is back on!

The ESBL germs that I am seeing are also often resistant to other drugs like Cipro and Macrobid. While Cipro is the “old” front line UTI drug, Macrobid is considered the newer, better alternative.

So then, what do my ESBL urine cultures have to do with you? It means your UTI might have hard-to-kill germs. The drugs your doctor orders without a second thought may not kill the germs. Worse yet, you might think they’re working only to find your symptoms returning a month later — which is what I am convinced happened to the woman whose advertising claims she developed her product after “7 UTIs in one year!!”

My advice to anyone who believes they are having a UTI is to respectfully insist on a culture to make sure the drugs you are prescribed actually kill the germs that are present.

A Few Words about Aaron Ford

Picture courtesy of Wikipedia

I first met Aaron Ford in what must have been 2012. He literally knocked on my door to ask for my vote! I told him as long as he had a D behind his name, don’t worry I was voting for him. I had the door halfway closed when he said “WAIT! It’s a primary!” Then we talked for a bit.

Since then, he has risen through Nevada politics like a warm ice cream scoop. Now he’s our state Attorney General. Meanwhile, I moved out of the old neighborhood by the Greek Orthodox Church, but work down the street.

This week, he announced that he’s running for Governor. Just as in 2012, he has a primary fight ahead of him. To be sure, he has had his share of controversy. It looks like the state Republicans are going to fall back on calling him a radical, for doing such outlandish things as looking out for the people of Nevada. People and organizations I respect support him, and I think there’s an extremely chance I will do exactly what I did in 2012: vote for him in the primary. His views and political positions are much closer to my own than any Republican candidate.

But a warning both to Mr Ford and the Democratic Party: We The People are tired of business as usual, of being told that policies that would benefit us are “too radical” and “will never pass.” We The People are tired of being told to “Be reasonable.” That’s why the Democratic Party has been losing. Hillary told us to be reasonable and lost. Sisolak told us to be reasonable and lost. We The People are tired of the Pelosis and Schumers of the world telling us we mustn’t make the other side mad, we must negotiate with people whose idea of negotiation is “do what we want or else.” We The People want bold change that clearly benefits us now and for the future. Democrats win when they do what the voters want, not when they do what the elite donors want. Don’t be afraid to Dare Greatly and Boldly Go.

In closing: It is of great concern that today’s labor statistics report was awful, with previous months being revised sharply downward. And there are logical reasons for the decline; it’s not an aberration or “rigged” numbers. It is of even greater concern that Mr. Trump’s reaction was to fire the Commissioner of the Bureau of Labor Statistics. This act calls into question future government statistics: are they true, or doctored to appease the President? I predict that private data — such as payroll data from ADP and Paychex — will become much more important to economists. The President does not control their analysts’ jobs.

Son of Evil

Picture courtesy of Wikipedia.

A number of years ago I wrote about Evil:

“It was enough to know that The Joker™ was trying to bury Gotham City under six feet of strawberry jam because he was Evil…. We grew up, and found that the Joker was also criminally insane….

When your world-view is that somebody or some group is simply evil, there is no room for negotiations.”

Unfortunately we’ve reached the point where we are talking about even larger groups of people being “Evil.” It’s not just terrorists. Or criminals. Or immigrants. It’s an entire political party. This is a deterioration from merely thinking members of the other party are stupid. Even more dangerously, people in power are implying that if you don’t espouse certain political viewpoints, there’s something wrong with you. And when someone in power thinks there’s something wrong with you, there is the potential for “doing something about it.”

Let me be clear. A person using language that implies that the other party is evil, demons, or similar, can’t be reasoned with. And that is dangerous for all of us.

The Founding Fathers thought certain things were so important they put them in the First Amendment before anything else: We The People have freedom of speech, religion, of the press, to peaceably assemble, and even to access the courts. If you want to believe that the Flying Spaghetti Monster freed us from the menace of piracy on the high seas, so be it. But when religion clashes with our other freedoms, things get messy. You don’t have the right to tell others what to worship, revile, or read. And you certainly don’t have the right to endanger others because of your beliefs.

Do not use good and evil in political rhetoric. It leads to people being imprisoned or executed.

The Fixer

Five years ago we were in the midst of a pandemic. And panic was a real thing. Many supplies were scarce, either because they were suddenly desperately needed, hoarding over potential need, or broken supply chains. The panic buying that occurs before a hurricane or blizzard happened everywhere at the same time. Some of the items in short supply were surprising, just like some of the workers determined to be essential were surprising. In addition to shortages, this caused higher prices for available products.

And maybe you remember that your workplace had a “fixer.” You know: the guy who managed to find workarounds. The guy who managed to get hand sanitizer made at a random booze distillery. The guy who found an oddball vendor or contractor to Get Stuff Done expediently.

Here’s the thing. Some of those workarounds became semi-permanent. A few because it turned out they were better than the way things had been done previously, breaking the “we’ve always done it this way” mentality. But a few are simply not. They remain because of a new “we’ve always done it this way” mentality. Your workplace is particularly susceptible to this if you had staff changes during COVID and the new staff legitimately don’t remember the way things were done in The Before Times. And hey, if it’s not broken don’t fix it, right?

It’s never wrong to evaluate business practices to make sure you are still doing things the best way possible — balancing safety, efficiency, and cost. This is a great time to look for things The Fixer fixed. Some of those fixes are no longer needed, are no longer appropriate, and should be discontinued.

“We’ve always done it this way” is not and never has been a valid reason to do something. Always look for why it came to be done that way and whether that’s still true.

Richard Nixon: Notorious Liberal

Now I do know what you’re thinking: Liberal? Wasn’t Nixon a conservative Republican? And, ya know, kind of disgraced in the Watergate scandal? Are we talking about the same Richard Nixon? Dear reader, that illustrates just how far the standards have moved in the last 50 years.

Nixon wanted to be a uniting force in the United States. Hmm, sounds like a big tent Democrat kind of idea.

Sure, he expanded the Vietnam War. He also got us out of Vietnam and made attempts to bring POWs home. And when he was done with that he ended the draft. Hmm, sounds like a weak Democrat kind of idea. Oh yeah, and then he opened relations with China.

During his entire presidency he issued 364 executive orders. Heck, the current president is on track to do that before Memorial Day. Slacker.

He signed the EPA into law. Hmm, a liberal tree-hugger.

And get a load of this list of liberal policies Nixon either enacted or tried to enact:

Despite expectations from some observers that Nixon would be a “do-nothing” president, his administration undertook a number of important reforms in welfare policy, civil rights, law enforcement, the environment, and other areas. Nixon’s proposed Family Assistance Program (FAP), intended to replace the service-oriented Aid to Families with Dependent Children (AFDC), would have provided working and nonworking poor families with a guaranteed annual income—though Nixon preferred to call it a “negative income tax.” Although the measure was defeated in the Senate, its failure helped to generate support for incremental legislation incorporating similar ideas—such as Supplemental Security Income (SSI), which provided a guaranteed income to the elderly, the blind, and the disabled; and automatic cost-of-living adjustments (COLAs) for Social Security recipients—and it also prompted the expansion and improvement of existing programs, such as food stamps and health insurance for low-income families. In the area of civil rights, Nixon’s administration instituted so-called “set aside” policies to reserve a certain percentage of jobs for minorities on federally funded construction projects—the first “affirmative action” program. Although Nixon opposed school busing and delayed taking action on desegregation until federal court orders forced his hand, his administration drastically reduced the percentage of African American students attending all-black schools. In addition, funding for many federal civil rights agencies, in particular the Equal Employment Opportunity Commission (EEOC), was substantially increased while Nixon was in office. In response to pressure from consumer and environmental groups, Nixon proposed legislation that created the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA). His revenue-sharing program, called “New Federalism,” provided state and local governments with billions of federal tax dollars.

Expanding Social Security and Welfare?? Worker safety initiatives?? Desegretation and gasp Affirmative Action??? This little list does omit various healthcare initiatives such as the Rehabilitation Act of 1973, an attempt at true universal health care, creating HMOs, and Medicare coverage for dialysis as well as kidney transplant. Typical “tax and spend liberal” ideals!

And to top it all off, he had the temerity to only have one wife — and be faithful to her!

So yes. We have moved so far to the right that conservative Richard Nixon is — by modern standards — more liberal than Barack Obama.

Music Monday: Allentown

When I was young, I knew that The Nylon Curtain by Billy Joel was some great music. It would be many years later that I understood that the concept and lyrics were also brilliant. But why am I talking about 40 year old music?

Billy Joel sings in this song about how they’re shutting the factories down. That did happen. But it was over 40 years ago. The workers are gone: retired, deceased, moved on to other jobs. Their kids — and their grandkids — don’t have the same skillset even if they wanted to work in those factories. The equipment in those factories? Sold for scrap decades ago. The land? Redeveloped.

If you wanted to build factories to build things here in the United States and avoid tariffs as the President has suggested, you’d face some obstacles. Like the NIMBY crowd that doesn’t want a factory in their town. Like EPA regulations that still mean it’s more expensive to build a factory here — and that’s not actually a bad thing. Training new workers. And realistically most of the work that they would have done by hand in Billy Joel’s Allentown would now in a new modern factory be done by robots. At least there’s jobs for robot maintenance technicians!

It would take at least 5-10 years to get it running. That’s a minimum of one President from now, possibly two or even three. Will the same rules still apply? Your guess is as good as mine.

Tariffs aren’t bringing jobs to the United States. They’re only bringing economic…. Pressure.

Music Monday: Born in East L.A.

Hey! It’s been a while since we did a Music Monday!

They made a whole movie of this plotline. Far more recently, this and this happened.

Remember: a drivers license is evidence that you can legally drive a vehicle, and evidence of your identity. It is not and never has been evidence of citizenship. Most of us cannot prove our citizenship with documents we carry daily.

Measles and Tuberculosis

The old Oak Forest Hospital is slated for demolition and site redevelopment now. At one time it was a tuberculosis sanitarium. That’s when my grandmother was a patient there. She was one of the first patients who was actually cured of tuberculosis, or TB. The drugs which killed the bacteria left her deaf.

Tuberculosis and measles are both diseases that can travel quite a long way. That’s why patients with those diseases are placed on airborne precautions. You probably know there’s currently a measles outbreak impacting 13 states as I write — probably more by morning. That’s serious, make no mistake. But Tuberculosis is also a serious and much more common problem.

Every year near the end of March is World Tuberculosis Day. Normally the CDC has a massive release of data on that day. At this time I do not know whether the CDC will release that data. My local health district has already quietly released their data, which they normally hold until World Tuberculosis Day. My state has not. It is worth noting that locally, cases are up over where they were 2 years ago (but down from last year). This data is vital to me in a professional capacity to determine how much risk my patients and staff face from TB in the community.

Believe it or not there is a vaccine for TB! It was developed a couple of decades before we had a cure. We don’t generally use it here in the United States because it’s not as effective as would be desirable, we have a relatively low prevalence, and it interferes with the cheap “skin test” you may remember having done at some point in your life. But many of our nurses from places like South Korea or the Philippines have had this vaccine.

Now about curing TB. It’s not fun. Remember from the beginning of my post that the first treatments we had often had horrible life changing side effects. However, it was better than the alternative: dying. Unfortunately TB has developed resistance to many drugs over the years. It is important to treat TB even if it’s latent — meaning it’s not causing you to be very sick right now. Treatment can often involve multiple, very strong antibiotics, every day for months. In some cases, the local health department might call every day to make sure you took it.

And this brings me to another important point. People without insurance — or with lousy insurance — might not be able to afford those antibiotics. When that happens, they are not only a walking petri dish for incubating drug resistant strains of the disease, they are sharing their germs with everyone around them.

Also, tuberculosis does not care about your immigration status.

Places where people are crowded together — like jails and immigration detention centers — are a perfect place for one TB case to turn into dozens. Are you wondering how many undocumented immigrants are going to seek medical care for their TB or measles symptoms?