Tag Archives: father’s day

Father’s Day Visits and Flying During Covid-19: What Activities Are Safe To Resume?

Since COVID-19 struck America, most of us have stopped lots of heretofore normal activities in an effort to limit the spread of SARS-CoV-2. The curve has been flattened in most states and now the burning questions relate to when we can get back to normality.

Health care facilities have made the decision to resume most elective diagnostic procedures and are gradually moving from telemedicine to real in-person office visits. Hair stylists have gone back to cutting and colorizing hair.

For most activities, however, the decision to resume normality remains intensely personal and complicated.

For example, the skeptical cardiologist really wants to visit his 94-year-old father on Father’s Day weekend.

Pops Pearson lives in Tulsa, Oklahoma some 400 miles away, and I haven’t seen him (excluding Facetime sightings) since Christmas of last year.

 

How do I balance the risk of giving him COVID-19 versus the benefit of us spending time together? Would the risk/benefit change in 3 to 12 months? In a year or two?

There is no CDC or state or WHO guidance on whether I should make this trip.  However, the NY Times published a piece today which sampled the opinion of 511 “epidemiologists,” which offers some perspective on when it is right to resume certain activities.

The majority of the 511 epidemiologists who responded to the survey felt comfortable currently bringing in the mail and getting a haircut.

Screen Shot 2020-06-09 at 6.05.26 AM

My wife (the ex-eternal fiancée) and I still put the mail in quarantine and treat all packages as potentially contaminated. The epidemiologists were split on visiting hair salons or barber shops with 41% comfortable now and 39% in 3 to 12 months.

We have acquired hair cutting equipment for her to use on me and home hair colorizing stuff (not for me) and neither of us has seen a barber for 3  months. We plan to continue that for the foreseeable future.

It is interesting that 60% of epidemiologists are comfortable seeing a doctor for a non-urgent appointment. My patients also seem comfortable now coming into the office. We take a lot of precautions, but ultimately exposure risk for both patients and physicians is higher than if they had both stayed at home.

Resuming Activities in 3 to 12 Months

The majority of epidemiologists felt comfortable resuming ten activities in 3 to 12 months although a substantial minority were OK with doing them now.

Screen Shot 2020-06-09 at 6.05.46 AM

Two of the activities above are relevant to my “Pops Pearson visitation” decision.

Only 20% of the respondents felt comfortable visiting an “elderly relative or friend in their home” now, but this increased to 41 % by 3 to 12 months. This surprised me and suggests that most Americans may not be going into their relatives’ homes and/or spending significant time with their elderly parents.

Similarly, only 20% of respondents would travel by airplane now, but 44% would in 3 to 12 months.

A substantial minority of the respondents felt they would not be comfortable visiting relatives in the home (39%) or flying (37%) until over a year from now.

Of the other activities on the above list, I am uncomfortable right now with all except a “hike or picnic outdoors with friends.”  We have had close friends over to our house for outdoor socially distanced gatherings, two at a time. We have gone for bike rides with friends outdoors.

I’m not sure when I will feel comfortable attending an indoor dinner party, exercising at a gym, or eating at a dine-in restaurant.

To Visit Or Not To Visit?

After much discussion with family and rumination,  I have decided to drive to Tulsa and stay with Pops Pearson for Father’s Day.

The decision to drive was an easy one. Although we usually choose the one-hour SouthWest Airlines flight from St. Louis to Tulsa we still consider flying a  COVID-19 a high-risk activity. The airlines have made considerable strides in reducing the possibility of transmission in flight, but we still hear that it is not mandatory for fliers to wear masks.

The CDC website confirms that flying increases the risk of contracting COVID-19:

” Air travel requires spending time in security lines and airport terminals, which can bring you in close contact with other people and frequently touched surfaces. Most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on airplanes. However, social distancing is difficult on crowded flights, and you may have to sit near others (within 6 feet), sometimes for hours. This may increase your risk for exposure to the virus that causes COVID-19.”

For those of you with more distant relatives, the decision to fly or drive is more complicated. I know that when we visit my wife’s relatives in Wilmington, NC in August  (which will be a 14 hour drive) we are still planning on driving.

To minimize the risk of me transmitting coronavirus to my dad, I have put myself in a modified quarantine. I will be conducting office visits by telemedicine and one of my partners has kindly offered to cover my hospital patients during this time. In the two weeks leading up to the visit, I and my wife have agreed to avoid any activities which might increase our risk of exposure to SARS-CoV-2.

Resuming Activities in > 1 year

When will it be safe to attend a large wedding or funeral service, go to church or attend a baseball game? Definitely not now.

Of note, the majority of epidemiologists did not respond to this survey and were uncomfortable making such predictions:

About 6,000 epidemiologists were invited to participate in the survey, which was circulated to the membership of the Society for Epidemiologic Research and to individual scientists. Some said they were uncomfortable making predictions based on time because they didn’t want to guess the timing of certain treatments or infection data. “Our concern is that your multiple choice options are based only on calendar time,” 301 epidemiologists wrote in a letter. “This limits our ability to provide our expert opinions about when we will feel safe enough to stop social distancing ourselves.”

I, too, am uncomfortable making predictions and doling out advice on behaviour during COVID-19. There is much uncertainty as evidenced by the reluctance of 90% of scientists to answer this survey.  The pace at which important data emerges is dizzying. For many personal decisions like mine, we must make critical decisions based on imperfect guidance.

Epidemiologically Yours,

-ACP

Getting To The Heart Of Father’s Day

The skeptical cardiologist received an email from the folks at AliveCor a few days ago with the subject line:

Dad’s heart matters – Kardia Mobile for Dad will give you peace of mind and make Dad happy

The email contains this image of an older well-dressed man (withScreen Shot 2016-06-18 at 9.03.26 AM lots of bling) standing in a beautiful meadow near the ocean. The man has decided to turn his back on the ocean and check his heart rhythm using the AliveCor/Kardia (AliveCor has changed the name of its ECG devices to Kardia) mobile ECG. This man is a happy dad! (Unless his heart rhythm is interpreted as atrial fibrillation. Then the beach walk is ruined.)

The email asks the question “What if Dad’s heart really was an open book?”

Uhh, he’d be dead? Clearly books don’t function well at pumping 5 or 6 liters of blood through the cardiovascular system every minute whether they are open or closed. Perhaps  the question is using either  the heart or an open book as a metaphor?

The advertisement goes on to suggest that I get my dad an AliveCor device for father’s day  “So you always know what his heart is thinking.”

I believe this is the marketing person’s attempt to extend the metaphor of the open book, i.e., you know exactly what dad’s brain is thinking, now you can extend this knowledge to his heart.  The metaphor of the heart “thinking” is quite poor but poor metaphors are the norm today.

Bad metaphors and bad writing abound on father’s day because 90 million greeting cards are purchased and given as (according to the Greeting Card Association)  “a meaningful expression of personal affection for another person.” Despite the increasing use of Facebook and its ilk to transmit emotions, the Greeting Card Association assures us that “The tradition of giving greeting cards … is still being deeply ingrained in today’s youth, and this tradition will likely continue as they become adults and become responsible for managing their own important relationships.

Mobile Ecg Monitor As A Father’s Day Gift

I have to say that despite the horror of the writing in this email advertisement it got me thinking about getting my father a Kardia device. I’ve suggested  previously that  an AliveCor device would make a good gift for Christmas for a loved one who has intermittent unexplained palpitations or atrial fibrillation but had not considered this for my dad.

For one thing he does not possess a smart phone which is required to  make the Kardia device functional. For another, he doesn’t have atrial fibrillation (that we know of. Perhaps if I knew what his heart was thinking we would find out that it likes to fibrillate late at night,)

Perhaps it’s time to upgrade my Dad to an iPhone I began thinking.

But wait! He has an iPad mini (that he seems to only use for FaceTime conversations.)

Further research reveals that Kardia is not only compatible with iPhone and Android smartphones but apparently iPads and IPod Touch.Screen Shot 2016-06-19 at 8.04.27 AM

Taking Care of Dad’s Heart

What about the rest of the slick advertising copy in my email?

And now you can know the way to help take care of it. Kardia gives Dad a medical-grade EKG in only 30 seconds. It even gives him expert analysis and tracking, with reports getting shared directly with his physician

This part is pretty clear and correct. I use Kardia daily in my office to record patient’s heart rhythm and I have a dozen patients now who make recordings outside of the office. They can have their recordings read by a random cardiologist for a fee or establish a link with me as their provider and I can review them through my account for free.

 Is It The First Father’s Day Gift That Leads To More Father’s Days?

The ad ends with the remarkably brazen statement that “It’s the first Father’s Day gift that leads to more Father’s Days.”

While I find the device more helpful in many instances than current expensive and intrusive long term monitoring devices for detecting and monitoring atrial fibrillation and other abnormal heart rhythms, it is a huge leap to suggest that this translates somehow into a longer life span.

To AliveCor’s credit, despite such ridiculous marketing drivel , studies presented at the recent Heart Rhythm Society Scientific Meetings suggest:

  • Kardia Mobile Superior to Conventional Monitoring: Researchers at the Leeds General Infirmary found that the AliveCor monitor is superior to conventional Holter monitoring in patients with palpitations, providing a higher diagnostic yield, more detected arrhythmias, with a similar workload.

  • Kardia Mobile Leads to Improved Patient Compliance:Researchers at the University of Buffalo found that AliveCor provides a diagnostic yield comparable to a 30-day ambulatory looping event monitor and that the smartphone-based ECG monitor can be used as a first approach for the diagnosis of palpitations.

  • Kardia Mobile provided more information resulting in changes in arrhythmia patient management than traditional external event recorders in a study from researchers at the University of Miami.

  • AliveCor’s AF algorithm was reported to be superior by researchers at Arizona State University to the patient’s own ability to detect AF via symptoms.

    But even if these studies make it to publication they don’t suggest the device provides any improved longevity. In fact, such data, do not exist for any monitoring device.

Happy Father’s Day, Dad! Don’t be surprised when we FaceTime later today that I’ve found another use for your iPad.

Paternally Yours,

-ACP

N.B. Clearly I receive no consulting, speaking or P.R. writing fees of any kind from AliveCor. Nor do they provide me with any free devices. What’s more, when I lose one of their devices they don’t replace it.  I am totally free of any conflict of interest.