The COVID-19 Second Wave Is Already Here Says Dr. von Schwarz

Don’t go back to normal – adopt and observe a “new normal”.

By Prof. Dr. Ernst von Schwarz

It appears that the expected second wave of COVID-19 infections has already arrived.

On June 11 Florida reported the highest number of new cases since the beginning of the pandemic, averaging an additional 128 hospital admissions per day. The day before, Texas recorded 2,504 new cases. This represents the highest number of reported cases in one day. Also on June 10, California recorded 3090 newly infected COVID-19 patients. Altogether more than 20 states have now reported a second spike in coronavirus cases.

As healthcare providers we must distinguish between:
(a) new COVID-19 diagnoses, and
(b) new COVID-19 related hospital admissions.
(c) new COVID-19 related deaths.

It appears that there are more diagnosed cases for COVID-19 right now. This is because:

  1. More testing is being provided for the public.
  2. The reopening of the country and the reopening of businesses with the subsequent reduction of social distancing and gatherings likely is resulting in a higher transmission rate.

There are multiple reasons for the higher rate of hospital admissions but they include:

  1. More testing is being provided for nursing home residents and positive cases are often directly transferred to the hospitals.
  2. The currently increased transmission rate from asymptomatic individuals due to the lack of social distancing affects the elderly and more vulnerable patients who end up with symptoms in the hospitals.

As a physician in California dealing with more than 100 patients every day in hospitals I am not seeing as many healthy patients who contracted COVID-19 in dire physical conditions as had been reported initially in Italy and in New York months earlier.

On the other hand, we see more chronically ill patients who are now diagnosed with COVID-19 and end up in critical condition with respiratory failure. These patients require intubation and ventilator therapy in the Intensive Care Units.

In particular the elderly (above 75 years of age) and those with underlying chronic lung conditions such as chronic obstructive pulmonary disease (COPD) and those with chronic heart or vascular illnesses such as congestive heart failure appear to be at highest risk for compromised respiratory conditions and subsequent death. Even though we have also seen a reduction in the number healthcare providers dying in California compared to New York or Italy, we currently do see more COVID-19 related death cases in those high-risk populations.

As a result of the recent mass gatherings with many people who are not adhering to social distancing recommendations we likely will see more transmissions from healthy people who remain completely asymptomatic. The R-value, which represents the reproduction value of the virus, has creeped up above 1.

The R-value is a virtual number, which means that if it is 1.5, 100 people transmit the virus to 150 others. The goal is to reduce the R-Value value below 1 so that less people will be infected and the virus would disappear in the future. At the current time, however, the R-value in many states has increased above 1, so more infected cases are expected within the next weeks.

Obviously, the virus is not going away and we may have to deal with coronavirus infections for a prolonged period of time.

Public heath experts are developing models which show the real numbers while frontline health care providers are now dealing with more COVID patients. The numbers we are now seeing might be also related to gatherings during the Memorial Day weekend, and recent mass gatherings might increase those numbers further.

As a healthcare provider I have the following suggestions:
 

  1. Continue to stay within your own community “bubbles”, which means to stay within your close family members or groups. Remind each member of each particular bubble to get COVID-19 testing, ideally on a regular basis and possibly repeatedly over time, so that anyone who tests positive should either be separated within the bubbles or asked to stay out and to avoid close contact with the elderly and those with underlying pulmonary and cardiac diseases.
  2. Continue to avoid exposure to large crowds. The soccer stadiums in Italy represented a Petri dish for the transmission of the virus and the attendance of mass events should be strongly discouraged at the current time.
  3. Evaluate the daily news with a critical eye. Several statements that have been made were retracted just days later. As an example, the hype about a registry demonstrating a very high death rate of patients receiving Hydroxychloroquine for COVID-19 published in the Lancet medical journal within the last month was retracted by the authors since they were unable to verify their own data. Still, in my opinion, Hydroxychloroquine remains controversial and should not be used at this time as a treatment or prevention for COVID-19 until further validated data are available.
  4. Continue adhering to precautionary measures such as using personal protection devices, masks, gloves and eye shields as well as frequent hand washing with soap and the use of hand sanitizers.
  5. Continue healthy habits of exercising at a distance to others, i. e. at least six feet away from others in a gym or an outside environment, observe healthy food habits by eating a balanced diet and avoid toxic substances.
  6. Adopt a “new normal” to protect yourself and your loved ones, rather than returning to the behaviors of the pre-pandemic era.
     
    Almost everybody has contact with those at highest risk, whether it’s a family member, parent, grandparent or even younger people with immunosuppression. It is our duty to protect those most vulnerable ones even though the younger and healthier ones might not develop symptoms or illness from the infection.
     
    We all welcome the opening of businesses, restaurants and gyms for the sake of the economy and our psychological and social well-being, but we should not underestimate the constant risk, which might stay with us for a prolonged period of time, at least until appropriate vaccination will be available.

Together we can fight the virus by staying healthy and safe and to some degree by keeping social distancing measures in place.

This article is part of the Ask Dr. von Schwarz series of health and medical articles, expert comments and medical news updates.

Treatment For Heart Attack Shown by Cardiologist Dr. Ernst von Schwarz

Los Angeles cardiologist Dr. Ernst von Schwarz treats a heart attack patient, showing how he clears a blockage in this one minute video edit shot in the operating room.

Also: New Implantable Device To Treat Chronic Heart Failure

Protests Spur Stress-Related Conditions, May Contribute To Covid-19 Second Wave

Stressors such as the ongoing nationwide demonstrations weaken the immune system while the lack of social distancing opens the door to more person-to-person virus transmission, says Dr. Ernst von Schwarz.

“As a result, many of the elderly are even more fearful of venturing outside, especially those living in the cities,” says Dr. von Schwarz. “I have received several phone calls from patients living in the Grove / Fairfax / Mid-Wilshire and Beverly Hills areas in Los Angeles. The patients are complaining about chest pain, anxiety, and they fear to go to even the nearest hospital, especially as the massive protests have turned violent with break-ins, arson, and looting. The stress on the elderly population can be devastating to their cardiovascular and immune systems.”

“Even though most people are protesting peacefully, as a doctor on call I am seeing the consequences in the hospital emergency rooms because of bodily injuries.”

“The increased risk of a potential second wave of Coronavirus infections as a result of lack of social distancing is exacerbated by these large-scale protests. The COVID-19 outbreak in Italy started during a Champions League soccer game with a majority of young soccer fans in the stadium, the outbreak in Germany started in a beer tent, so do we really think that hundreds of people gathering in protests in close proximity will be immune?”

“As a physician I recommend that everyone continue to observe the same guidelines of social distancing and using masks during this difficult phase.”

Dr. Ernst von Schwarz Warns Against Hydroxychloroquine For Covid-19 On CBS News

Los Angeles cardiologist and researcher Dr. Ernst von Schwarz appears on CBS 8 News San Diego to warn of the risks in prescribing hydroxychloroquine / hydrochloroquine for treatment or prevention of COVID-19 infections. Link:

https://www.cbs8.com/video/news/local/morning-extra/discussing-hydroxychloroquine-with-southern-california-doctor/509-d833f59b-201c-485a-b1c0-7b982d0ef2ba

drvonschwarz.com

No Evidence That Hydrochloroquine Prevents Or Cures COVID-19 says Cardiologist Dr. Ernst von Schwarz

Doctors who prescribe hydrochloroquine / hydroxychloroquine as a prevention for COVID-19 act irresponsibly, says Los Angeles cardiologist Dr. Ernst von Schwarz.

“Hydrochloroquine is a well known drug used for malaria as well as for certain inflammatory connective tissue diseases such as lupus or rheumatoid arthritis. Hydrochloroquine toxicity for the heart has been reported as early as in 1987. Several case reports in the scientific literature show rare but sometimes life-threatening conditions such as heart failure and arrhythmia, in some cases leading to permanent heart damage due to thickening of the heart walls, congestive heart failure even occurring rapidly, and different kinds of heart irregularities. Some of those patients needed a heart transplant, while others died.”


“There is no evidence that hydrochloroquine prevents a bad outcome after someone has contracted COVID-19 and does not seem to prevent the infection.”


“Doctors should be cautious to prescribe hydrochloroquine / hydroxychloroquine for COVID-19 patients without proper evaluation of the heart. Patients receiving the drug need to undergo frequent cardiac testing, even in the long run.”

Website: drvonschwarz.com

Heart Disease In Young Women Is Often Misdiagnosed Says Renowned Cardiologist Dr. Ernst von Schwarz

Los Angeles – Dr. Ernst von Schwarz says that women often experience unique warning signs of heart disease that can be mistaken for other health issues or disregarded by their doctors. “This is especially dangerous in younger women who may not realize that they are at risk. Women of all ages should familiarize themselves with symptoms that are unique to females so they may become better advocates for their own healthcare when seeking medical advice.”


Dr. von Schwarz appeared in this interview on ABC 7 News in Los Angeles with his patient Tara to show how heart disease in women is often misunderstood or misdiagnosed. “This is largely because women often experience symptoms that differ from those typically reported by male patients,” says Dr. von Schwarz.


A Surprising Diagnosis
Tara, now 41, first learned that she had heart disease at 29 after going misdiagnosed for several years, even though she was experiencing chest pains and arrhythmia. Tara was advised by doctors that she was just “too stressed” or was “drinking too much coffee.” Eventually she found herself in a hospital emergency room, in shock from an adverse reaction to a pain medication she had used for the first time. In the emergency room, Tara’s heart function was found to be “extremely low” and Dr. von Schwarz was called in to assess her condition. Tara ultimately underwent several procedures including having a pacemaker implanted and a later surgery to repair a damaged heart valve.


About a year after her heart valve surgery Tara learned that she was pregnant. She was advised by her primary care physicians that her pregnancy would present a serious risk to her health, Tara was determined to have at least one child with her husband. When her doctors were reluctant to care for her during her pregnancy she turned to Dr. von Schwarz who saw her through to term. Tara beat the odds, ultimately giving birth to healthy twin boys who are now 9 years old.
Dr. von Schwarz practices in Los Angeles, Culver City and Murrieta / Temecula, CA. Visit http://www.drvonschwarz.com

This story is part of the Ask Dr. von Schwarz series of news stories, expert comments and health & medical updates.

The Future Of Medicine After COVID-19

Los Angeles cardiologist and researcher Dr. Ernst von Schwarz appears on Fox News to explain how COVID-19 is changing the ways that physicians and their patients interact. From the expanded use of telemedicine to the adoption of enhanced safety measures in the medical office, things will never be the same.

“Telemedicine is useful and follow – up visits for patients that do not require a full physical examination are now handled via phone, Skype, FaceTime, Zoom or other video media. This trend will definitely continue,” says Dr. von Schwarz.

“We have used telemedicine for many years (initially for the Texas prison system where inmate patients were evaluated via tele media). In some cases, home health nurses are now on-site with the patients to talk with the patient and the doctor. In some cases we can provide an electronic stethoscope so the doctor can remotely listen to the patient’s heart and lungs. In other cases, doctors can provide a high resolution camera to the patient’s home that can be zoomed in to view the patient’s eyes very closely or to examine other body parts that require attention.”

“Finally, many insurance companies have agreed to reimburse telemedicine visits. This allows patients easier access to their doctors without the trouble of traveling to the office clinics and without spending time in waiting rooms. Patients welcome these conveniences and we currently are conducting approximately 40% of our daily patient encounters via tele media. This definitely will continue and will likely increase in the future.”

Visit http://www.drvonschwarz.com Dr. Ernst von Schwarz practices in Los Angeles and Temecula / Murrieta, CA.

Staying In Shape During The Covid-19 Lockdown

Sheltering in place, lack of exercise and weight gain

The lockdown caused by the COVID-19 pandemic forced most of us to either stay home or definitely reduce our outdoors and out-of-the-house activities. Gyms, public pools, golf courses, tennis courts, soccer fields are closed. All of these sport activities are at least in part still on hold. Even the daily 1-2 hour walk that many were used to perform as part of a moderate exercise regimen are on hold right now due to restrictions but also fear.
The American Medical Association’s recommendation of moderate exercise for a minimum of 30 minutes per day for 5 days per week (minimum of 150 minutes per week) for all of us has hardly been feasible to follow within the last two months. As a result, many of our patients did report weight gain and less physical activity.

At this point, I have the following 5 suggestions:

  1. Try to use 30 minutes per day to do home exercises, whether it is walking around the house, stretching, going up and downstairs or even arm exercises by repeatedly lifting up your water bottle 30 times per arm until your heart rate goes up and you feel a bit short of breath.
  2. When the gyms etc re open, do not overdo it! You might create a muscle breakdown (even in young and healthy people) which in turn can lead to kidney failure among other health problems.
  3. Stretch, ease into a progressive exercise regimen, and be well hydrated in order to avoid injuries and damage.
  4. Eat a healthy balanced diet, avoid overeating, ideally what we a call a Mediterranean type diet.
  5. Track your activities in a log book including the activities and time spent as a referral to measure further progress.

Important to know: you want to challenge your heart and blood vessels a little bit by doing exercises that make you either sweat or get your heart rate up or develop a bit short of breath to keep your blood vessels elastic, train your hearts capacity, and to loose these extra lockdown pounds!

Five ways COVID-19 infection can affect your health and body:

“The COVID-19 virus can affect your health in many ways,” says Dr. von Schwarz.
The respiratory system, meaning the lungs is often affected. The virus causes swelling of the airways as a result of the inflammation which in turn reduces the oxygen absorption in the lungs and this can lead to lack of oxygen in all organs. Patients then might end up on a ventilator with adult respiratory distress syndrome (ARDS) in many cases.


The heart, where the infection can cause lack of oxygen especially in patients with underlying coronary artery disease, meaning calcification of the blood vessels in the heart, causing more lack of oxygen with possible heart muscle damage. In addition, the virus can directly weaken the heart muscle even in young and completely healthy individuals by causing a virus-induced myocarditis, an inflammation of heart muscle cells which can result in arrhythmia and sudden death or progressive weakness with congestive heart failure. In fact, most of the young doctors and nurses who died from COVID-19 died of acute heart failure. The virus can bite the heart and leave a scar – or it can eat it alive!


The vascular system can be affected as a result of an inflammation of the blood vessels with resulting clots that can lead to blockage of arteries in every organ from the brain to the kidneys among others.


The virus causes a generalized inflammatory response called a cytokines storm with activation of clotting factors, fever, muscle weakness, and general malaise similar to the way we feel when we get any infection like a flu. This then can lead to a reduction of blood pressure secondary to a widening of the blood vessels and in severe cases to a shock with multi organ failure.


In addition our gut organs, the liver, the intestines and the kidneys can be affected, likely as a result of the bodies immune reaction rather than by the virus itself with reduced metabolic and blood cleaning functions of the liver and kidneys, diarrhea and gastrointestinal bleeding complications.

Cardiologist Dr. Ernst Von Schwarz Implants New Device to Treat Chronic Heart Failure

Los Angeles, CA – “Rather than timing the heartbeat as in a pacemaker, the new device improves the pumping ability of the heart to improve ‘cardiac contractility’ which is the squeezing action of the heart as it pumps blood,” says Dr. Ernst von Schwarz.

Over 6 million Americans suffer from heart failure, a condition in which the heart cannot pump enough blood to meet the body’s needs. The leading causes of heart failure are diseases that damage the heart such as calcification of arteries, high blood pressure, diabetes but also virus-induced inflammation of the heart muscle.

A 79-year-old woman recently became the first patient in California to receive the new “Optimizer Smart” system designed for patients with chronic moderate-to-severe heart failure. Dr. von Schwarz performed the implantation procedure. The device benefits patients with chronic, moderate-to-severe heart failure.

“The FDA recently granted the Optimizer a ‘Breakthrough Device’ designation because it treats a life-threatening disease and addresses an unmet medical need in heart failure patients in addition to standard therapy since heart failure is a chronically progressive incurable disease leading to recurrent decompensations, hospital admissions, multi-organ failure and death,” says Dr. von Schwarz.

The system includes the implantable stimulation device which is similar in size to a pacemaker and an external charging station. The device is implanted in a small pocket made under the skin of the upper chest, along with pacemaker leads that are placed in the heart’s ventricular septum, performed while the patient is under light sedation.

After implantation, Dr. Von Schwarz programmed and activated the device, which sends electrical pulses to the heart muscle for a total of five to seven hours a day, in one-hour treatments separated by regular intervals. The patient charges the device for one hour per week using the external charger. The Optimizer device is expected to last for at least 15 years before requiring replacement. Link to video: https://youtu.be/EhXYlW9JGMY

Professor Dr. Ernst von Schwarz, MD, PHD, FESC, FACC, is one of the most published cardiologists in the world. He is a board-certified Clinical and Academic Cardiologist, Director, Southern California Hospital Heart Institute and Professor of Medicine at several academic institutions worldwide, and Clinical Professor at UCLA and UC Riverside.

Dr. von Schwarz is considered a worldwide pioneer in the field of stem cell research. He has published over 150 scientific papers in international peer-reviewed journals as well as several books and book chapters in Medicine. Dr. von Schwarz is a prolific speaker lecturing worldwide at International scientific conferences including American Heart Association, American College Of Cardiology, European Society Of Cardiology and more.

Dr. von Schwarz practices in Los Angeles, Beverly Hills, and Temecula, CA.

This article is part of the Ask Dr. von Schwarz series of medical news stories, expert comments and health & medical updates.