Posts made in April 2020

Six Things Employees Don’t Know about Coronavirus

By Al Lewis

Here are the six corona tips, covering issues from the large to the smallest imaginable, that most seem to check the twin boxes of generally not known but generally helpful to know for health and/or financial reasons.

1. You may be able to skip a mortgage payment…but you still owe it

Most people don’t know whether their mortgage is backed by the government or not, since it’s a “mortgage servicer” that sends them the bills and answers the phone. If it is, you get a reprieve. That doesn’t mean you never have to pay. You just don’t have to pay now. To find out if yours is or isn’t, call the number on your bill, but expect to wait on hold long enough to make Comcast blush.

2. Your landlord may not be able to evict you

Likewise, if you rent an apartment in a building with a government-backed mortgage as many tenants do, a specific provision in the CARES Act applies—there is a 120-day moratorium on evictions.

Obviously, no one ordinarily has any clue whether this applies to them or not, but it’s worth finding out. Otherwise, no CARES Act provision benefits renters. As a practical matter, eviction proceedings have come to a halt in many states or cities, and some are outright preventing it. There is no “official” list of these jurisdictions but try this website. They seem legit.

There may be no risk to your credit score either — landlords rarely report to credit agencies because for them eviction has been the go-to remedy for non-payment. Yours may start doing this but obviously they would threaten you with it first since reporting does no good if the tenant doesn’t know they’re being reported.

Not just for rent, but In all bill-paying cases, those of us who are not familiar with “stretching” strategies might not realize that, for just about any bill, partial payments and proactive communication go a long way towards not getting cut off.

3. Baby, you should drive your car

Spending insufficient time in their car is not a problem most Americans have ever experienced, to put it mildly.

It’s not enough to idle the car…or even to drive to the store, as many of us do. You actually have to drive it once a week and far enough to get the engine fully warmed up. If you can take a spin on the highway every other week, all the better. No need to take our word for this. Cars are designed in the expectation that they will be driven. Just google it. Attention to this now may save you expensive repairs down the road, so to speak.

4. No product on the internet “boosts” your immune system

Google on “boost your immune system to prevent coronavirus” and you’ll get 11 million hits, virtually all of which are wrong – including zinc, essential oils, and the “electrolyte elixir drink.” (We can’t make this stuff up.)  Here is a good example of the right answer:

“Obviously good and balanced nutrition is important, but I actually do not think there is any strong scientific evidence for any specific type of food being linked to better immune function, and certainly there is no serious work on the are that I am aware of,” says Shiv Pillai, a professor of medicine at Harvard Medical School and director of the Harvard immunology program.

5. Drink gallons of tonic water only if that’s your idea of a good time

Tonic water is flying off the shelves, because the active ingredient is quinine, as found in the remedy-du-jour of hydroxychloroquine (Plaquenil).

Where to start? First, you’d have to drink maybe a dozen bottles of tonic water to get to the level of quinine found in Plaquenil. Even then, it’s not the same formulation, and even then, it is very far from clear that the latter has any noticeable beneficial impact in the prevention or treatment of coronavirus. (We were skeptical of this one early on.)

6. No need to take daily showers

And finally, as promised, the smallest “healthful hint” in the Quizzify quiz quiver…

…No co-located colleagues to impress? Then no need to shower every day. It’s best for skin health to shower less often. Your skin is less dry and less prone to infection/itch/rash etc. Honestly, the odds of anything bad happening to anyone other than Janet Leigh by taking daily showers are pretty slim, but why take the chance? We are all trying to save a little money here and there too.

Chloroquine: Six Things Employees Need to Know about the Latest Coronafad

This blog was written by Al Lewis

It’s human nature to look for a cure or treatment for a serious disease. People tried to ward off the plague with garlic. Those with long memories might recall Laetrile, for example. Laetrile was relatively harmless – at least in comparison to chloroquine or hydroxychloroquine, which self-medicating people have already died from. That stuff is figuratively flying off the shelves — in what could possibly be a useful treatment in some cases – but could also be nothing more than the latest coronafad. (If that is not a word, it should be.)

It is featured in our current quiz, which also introduces our first picture questions.

1. All the studies are small

And all the analysis is rushed. But studying the impact of an intervention on an acute condition doesn’t take years, the way a diabetes prevention study might.

There is also a rule of thumb in these situations that if an impact is big, it should show up in a small sample. The best example of how few patients were needed to conclude that smoking caused lung cancer or that severe hypertension caused strokes. (In both cases, those weren’t even acute events. Yet the results were known relatively quickly because they were so clear.)

2. The French study, which launched this, was not controlled

Yes, hydroxychloroquine was given to a small group of patients, and yes, they improved. But the results were largely anecdotal. In normal times, no respected journal would even let it get to peer review. But these aren’t normal times. Nonetheless, there is something called a “meta-analysis,” where multiple results showing minor changes can be combined into one ersatz study that would be statistically significant.

3. The most recent study, from China, was also small and shows no impact

Unfortunately, the reverse was true here. The “confirming” study showed the opposite.

Of the 15 patients who got treated, 13 tested negative (you probably know this already, but “negative” is good, as this brief video demonstrates) after a week of treatment. That sounds promising — except that of the 15 patients in the “usual care” control group, 14 also tested negative. This is why control groups are considered the “gold standard.” Most of us over 60 had our tonsils out as kids, to make earaches go away…but it turns out earaches would have gone away anyway. There was no control, merely pre-post.

That sample of 30 is too small to say that the drug does not work. However, it can clearly be stated that it doesn’t work well in an undifferentiated population hospitalized with pneumonia. It can’t be ruled out that it has a positive impact if administered at an early stage, or on some cohort (younger people or women might be examples of discrete cohorts).

However, people with mild cases need to consider the side effects…

4. …There were side effects in that study

The more serious the condition, the more side effects are tolerable. So chemotherapy and HIV drugs have substantial side effects…and yet get approved by the FDA because the alternative may be death.

Hence, an approved (though not for this use!), powerful drug that somehow treats both malaria (caused by a parasite) and allegedly coronavirus (caused, of course, by a virus) could be expected to have some side effects…and indeed it appeared to, in the study group.

Once again, though, some patients in the control group got complications too. Because the patients were so ill, attribution to the drug itself would have been difficult even in a larger sample.

5. Side effects, in general, are serious and substantial

For malaria, this drug was researched multiple times, because during World War II so many troops in the South Pacific were getting it. While showing some promise as a treatment, the side effects were unbearable for many subjects, even prisoners who were promised early release if they followed through.

The dose that triggered these toxicity effects was a small fraction of the dose in the French study, though the specific French formulation should be safer in similar dosages.

6. This could be another case of confirmation bias

It’s possible or even likely that this drug will go the way of zinc, elderberry concentrate, essential oils, and other alleged cures as just another coronafad. Hopefully, that won’t happen, and it finds a niche in the treatment of certain patient cohorts in which the benefits exceed the possibility of harm. However, self-funded employers may want to consider prior authorization, or at a minimum suggesting that employees take Coronaquiz IV: Mythbusters, which addresses chloroquine. Remember our mantra: “Just because it’s healthcare doesn’t mean it’s good for you.”

 

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