COVID-19 – Pandemic 2020

(168 countries/regions — 303,180 confirmed cases — 12,950 deaths – 91,676 recovered as of 03/21/2020 at 2:13:30 PM)

While COVID-19 is a serious illness that has rocked not only our nation, but also countries around the globe with some countries being harder hit than others, this isn’t the time to let fear overwhelm logic.

One of our greatest challenges is to combat what I can only describe as “fear mongering” being generated by various sources. In some cases these “bad actors” are members of our Fifth Estate (i.e. the Media), some of our erstwhile elected leaders and other social influencers.

While this worldwide pandemic continues to burn its way through country after country and state after state, I think its time to put a few things into perspective. I decided to do this after listening through several days of “Coronavirus teleconferences” and far too many numerous LA County Coronavirus updates. While its important that our elected officials provide timely and accurate information in times of crisis, and in this case pandemic – its not helpful when the information is provided in such a way as to cause even more panic, consternation, and fear.

A case in point: the now nearly daily and sometimes hourly reporting on the increasing number of cases in Los Angeles, State of California, United States and other countries. Without a doubt both Iran and Italy are in the midst of a true medical disaster and crisis. According to a report from Reuters ( in Iran a person is dying every 10 minutes with the number of deaths climbing to 1,284 as of 03/18/2020. In 2019, Iran reported a population of nearly 83 million, so let’s do the math and the death toll represents less than one percent of the population. This isn’t to say that 1,284 dead isn’t tragic and scary because it very much is and can’t be ignored. However it puts into perspective the scope of this pandemic, but when everyone is focused on the number of dead and ignore the number of the Iranians (6,745) that have recovered we can and do loose focus. It’s important to note that if the information being put forth by the Chinese government (the epic center of this pandemic) is accurate then there is sound reason to believe that when appropriate measures are taken that the COVID-19 pandemic can be slowed and then stopped. Let’s remember that China, at least for now, seems to be slowly emerging from the COVID -19 that nearly crippled their nation and saw some of the most aggressive containment measures to-date.

On 03/19/2020, California Governor Newsom announced even stronger measures to stymie the growth of the Coronavirus that has struck our state and called for all Californians to “shelter in place” ( This was quickly followed with pronouncements of a spike in new cases. A headline from the LA Daily News announced in a banner headline that “New coronavirus cases in LA County jump by 101 in 48 hours now up to 292”( Scary news indeed, but what we should take away from this increase in new cases is first and foremost is more testing is being done thus more cases are being discovered – a logical progression. As testing becomes more available and wide spread we will probably continue to see even more “spikes” of new cases, but it would also be helpful if those individuals who are holding a daily press conferences to keep everyone informed would also remind us that with more testing we should expect the number of new cases to grow and this is to be expected as we learn the full scope of this pandemic. Just as 292 cases of Coronavirus in LA County is serious we should also keep in mind that nearly 10 million people live in LA County, it is still a serious issue but one that needs to be kept in perspective. It would be great if the public would understand that in the USA you must have a doctor’s order to get a test (except for approved home tests) and also that at this time there is criteria list to be met before you can get tested.

So to help those keep things both in perspective and to stay informed here are two links that should prove helpful. The Centers for Disease Control and Prevention (CDC) has a website dedicated to following the Coronavirus in the United States. You can find the link here – Coronavirus Disease 2019 (COVID-19) ( Johns Hopkins has a Coronavirus tracking website (Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)) that provides a global perspective which and can be found here – ( – /bda7594740fd40299423467b48e9ecf6) This website updates throughout the day and provides a breakdown by country/region with confirmed cases, total deaths, and total recovered.

While the true scope of the Coronavirus continues to be discovered it’s imperative that we do heed the warnings of our Public Health officials, so wash your hands repeatedly, cover your cough should you have one, same goes for sneezes as well, and continue practicing social distancing and don’t forget to get the flu vaccine if you have not done it yet. However, don’t allow the self-quarantine orders to define your life or you’ll find yourself quite possibly facing depression and other mental health issues. Remember while the order is to “shelter in place” we aren’t restricted to the four walls of our home. If you have a backyard or patio go out and enjoy it, take a book or simply sit out in a chair and enjoy at least 10 minutes of sunshine a day – this is great way to improve you mental well being while getting your needed dose of vitamin D, take a walk, call, Skype or Face Time with family and friends you won’t feel as disconnected from the world. When you do venture out to do your shopping bring a list and try not to fall into panic buying, buy what you need and be sure to leave behind items so others can fulfill their shopping needs as well.

In closing stay tuned to your local news station so you can stay up to-date on developments and changes, but be careful not to fixate on just the Coronavirus news – doing so will simply drive you mad.

Thanks to several high profile news articles and news reports a heightened awareness of opioid pill mills and the doctors that run them came into the awareness of not only the American people, but various government agencies, as well. This was not such a bad thing, but what was never addressed by the news articles (many covered in the Los Angeles Times) were the thousands of patients living with chronic pain that were finding benefit from opioids and the conscientious doctors that made a point to monitor their patients for compliance.

The constant focus on those who die from opioid abuse and the doctors that prescribe opioids willy-nilly overlooks the reality that many more people have benefited from opioid use and do so without abusing the medication. The 2012 LA Times series on opioid abuse and deaths has been referenced in nearly all opioid cautionary articles since the series first ran with the factoid that between 2006 and 2011 there were 3,733 opioid-related deaths in four Southern California counties (Los Angeles, Orange, San Diego and Ventura). Though 3,733 is a staggering number of opioid-related deaths, the LA Times reporter failed to provide perspective; such as, during this same period of time there was a total population of 16.9 million people (as of June 2011) in the abovementioned counties and these opioid-related deaths though tragic represents .0002% of the population – my question then how does this make a raging epidemic?

Also missing in many of the reports of opioid abuse is how many individuals were not only addicted to opioids but to other drugs (both legal and illicit), and alcohol. Little effort was done on the part of the experts and reporters alike to deduce which came first the opioid abuse or the alcohol/illicit drug use. Actually in the LA Times series, it was noted that in many of the deaths that were reported as being opioid-related could only be assumed, since at the time of death the death wasn’t identified as an opioid-related death.

While the LA Times did a relatively good job at highlighting deaths related to opioid-abuse they did a disservice by not providing context and by failing to present stories from those living with chronic pain for which opioid use is the only treatment. Instead as a response to the LA Times and other similar articles various agencies and regulatory bodies began to discuss ways to “curb” the opioid epidemic. Meanwhile, few if anyone was talking about what could be done to provide support to those living with chronic pain for which opioid treatment was the only option or one very important part of their therapy to alleviate the constant, chronic pain– because that would be too easy! While the LA Times targeted California for its pill mill and opioid-related deaths (remember 3,733 people died), they failed to mention that California had the lowest person to opioid rate of all 50 states. They failed to address how insurance, in particular Workers’ Compensation, seemed reticent to provide alternative treatment for people living with chronic pain. For example, Workers’ Compensation puts a cap on the number of physical therapy (PT) sessions an injured worker can have, in total, over the course of an injury. This doesn’t mean that a Workers’ Compensation adjuster can’t approve more (PT), but far too many adhere to the strict guideline; even if PT is the recommended course of treatment for recovery from a particular procedure, so all too often doctors have to rely on opioid treatment in lieu of PT.

While it may seem as though states regulatory agencies have done little to curb opioid abuse a map/document produced by Progressive Medical outlined with some thoroughness state opioid rules by restriction, and though this document was published in 2013 it provides a good snapshot of these restrictions by state and can be found here – OpioidRulesByRestriction + MAP_10-15-13_FINAL.

So with so many people and agencies focused on the “problem of opioid-abuse” no one seems willing to advocate and address the needs of people living with chronic pain for which opioid treatment is the only option. There’ve been a few groups that have spoken out, but their voices are often muted by the screams of those who seem intent of removing opioids completely from all formularies. Prescription Drug Monitoring Programs (PDMP) such as California’s Controlled Substance Utilization Review and Evaluation System (CURES) programs have shown little effectiveness. Meanwhile, CURES has a very low utilization by California physicians and pharmacists. Meanwhile few states, including California’s CURES updates in real-time. Oklahoma is one of the few states whose program updates with very little lag-time which allows both prescribing physicians and pharmacists to access the Oklahoma PDMP in real time which helps weed out pill shoppers and helps in the identification of possible pill mills.

Draconian measures will not solve the challenge of opioid-related deaths or abuse or those running pill mills. What’s needed is a balance and sane approach. Doctors need to be well educated on when opioid use is optimum, how to detect possible doctor shopping, non-compliance and so forth. In turn patients and their families need to be educated on appropriate opioid use and provided tools to be both compliant with treatment protocol and to be aware of possible signs of opioid dependency. For example patients who are in extreme pain may not be cognizant that they just took their Vicodin because when a patient is in a state of extreme pain they experience time differently. I should know I had to endure an Ilizarov external fixator for a time and if not for a note that I kept at my bedside where I would document each time I took the Vicodin that had been prescribed to me there would’ve been times when I could’ve sworn that two hours had already passed since my last dose. I can’t recall one occasion where physician, nurse practitioner or nurse ever recommended a method to track when medication, especially opioids, that had been taken.

On the upside conferences such as PainWeek offer caregivers, practitioners and patients alike an opportunity to learn about the various manifestations of pain and the different modalities to treat pain. I’ve truly enjoyed attending PainWeek these past two years and I am looking forward to more networking this year.