Author, Doctor, Speaker, Joseph Bentivegna

Doctor Bentivegna is an ophthalmologist living in Connecticut. He has written numerous op-ed pieces for The Hartford Courant and The New York Times regarding health care, tort reform, and the political situation in Haiti.

The Coronavirus Epidemic Explained

 

       The world is in a panic over a coronavirus, specifically COVID-19 (Coronavirus Disease 2019). The stock market has dropped precipitously, airport travel has plummeted, vacations are being cancelled and students are returning early from foreign countries. There is a lot of misinformation about COVID-19, and perhaps reviewing some basic concepts will allay readers’ fears or at least enhance an understanding of the situation.

      1. What is a virus? Viruses are microscopic organisms that do not have the ability to reproduce. Thus, they survive by becoming parasites, invading the cells of host organisms, hijacking the cells’ functions, replicating, and then invading other cells.

      2. How are viruses classified? Viruses may be classified according to their microscopic appearance, how they reproduce or what diseases they cause. For example, the AIDS virus (also called HIV), rabies virus and polio virus are named after their respective diseases. The coronavirus, on the other hand, is named after its microscopic appearance, it which crown-type protuberances project from its outer layer. There are several types of coronavirus. One is called SARS (Severe Acute Respiratory Syndrome), after the epidemic it caused in 2003. The present coronavirus is called COVID-19, an abbreviation of Coronavirus Disease 2019.

      3. Are viruses dangerous? It depends on the virus. The AIDS virus is diabolical in that it invades cells that create antibodies to fight infection, rendering the patient helpless. The polio virus attacks nerve cells that control muscle function, rendering the muscles useless. Rhinoviruses (named after the Greek word for nose) cause varieties of the common cold and are relatively benign.

      4. How are viruses spread? Again, it depends on the virus. The AIDS virus is usually spread by sexual contact. The polio virus is usually spread by poor sanitation, such as when the septic system mixes with drinking water. Coronavirus attacks the respiratory cells and thus can be spread to others by airborne saliva created by coughing or sneezing, or by physical contact, such as shaking hands. The best way to contain spread is by quarantining those who are infected or may be infected.

      5. What are the symptoms and course of the disease of the COVID-19? The most common symptoms are fever and cough, although diarrhea is seen in 4% of cases. Most cases are mild and last about one week. However, severe cases can result in hospitalization and even death, although this tends to happen in elderly or debilitated patients. The mortality rate is between 1% and 2%.

      6. What is the incubation period of COVID-19? The incubation period, defined as the period of time between being infected and having symptoms, is two to seven days.

      7. Is COVID-19 the same as the flu? No. Remember that viruses are often named for the diseases they cause. “Flu” is short for influenza, the name of the virus that causes the flu. However, they symptoms are similar. Keep in mind that there are many different flu viruses so that a different vaccine is needed when a new one arises.

      8. Is there any treatment for COVID-19? Not at this point. There is no medication that can destroy the virus or prevent it from spreading to other cells in the body. Thus, treatment is symptomatic. A patient with difficulty breathing will be placed on a respirator. A patient was severe diarrhea will be given intravenous fluids. In these instances, it is hoped that the patient’s immune system counters the virus until these modalities are no longer necessary.

      Viruses in general are notoriously difficult to treat. But there have been successes, especially with the AIDS virus. Thirty years ago, the diagnosis of AIDS was usually a death sentence. Now it is a chronic disease with a low mortality rate. But the main treatment of viruses has been prevention through vaccination. At this time, there is no vaccine for COVID-19.

      9. How fast is COVID-19 spreading? At the time of this writing, there are about 86,000 cases in over sixty countries. Viral epidemics accelerate at different rates and then decline in a matter of months. No one can predict how COVID-19 will act at this early stage which is why there is so much anxiety.

      10. Is there a laboratory test for COVID-19? Yes.

      11. Have there been any recent viral epidemics? Yes. The most severe one was the Swine Flu epidemic in 2009. Twenty-two million Americans were infected and 4,000 died.

      12. Why is everyone making a big deal about COVID-19 when the Swine Flu epidemic was much worse? At this point, nobody knows how many deaths COVID-19 will cause, resulting in considerable anxiety. Also, we live in a much more polarized political environment. If you are a Trump fan, you believe the President is doing his best to contain the problem. If you dislike the President, you believe he is handling the situation incompetently. Take your pick.

An excellent resource for readers with more questions is the CDC (Centers for Disease Control) website. (www.cdc.gov/coronavirus/2019-ncov/faq.html)

The Insurance Companies Don’t Care if my Patients Go Blind

         One of the proudest accomplishments of my profession, ophthalmology, is the reduction in blindness from glaucoma. Decades ago, it was common to hear “Uncle John went blind from glaucoma.” Now such tragedies are rare. But now the insurance companies are refusing to pay for the most effective glaucoma medicines while increasing the patients’ deductibles. The result will be that more patients go blind.       Unlike many diseases, glaucoma has few symptoms in its initial stages. In most cases, the pressure in the eye is elevated causing damage to the optic nerve, the nerve that transfers visual images from the eye to the brain. Usually, glaucoma affects the peripheral vision first. But many patients don’t notice this as it occurs gradually. This is why ophthalmologists advise all patients to have their eyes checked, even if they have no visual complaints. A simple eye pressure check along with examination of the optic nerve can identify patients at risk for glaucoma.       Over the past generation, the pharmaceutical companies … [Read more...]

Dr. Bandy Lee is Damaging the Psychiatric Profession

January 21, 2018       A Yale psychiatrist, Dr. Bandy Lee, is enjoying her fifteen minutes of fame as the editor of the bestseller “The Dangerous Case of Donald Trump.” This book contains the opinions of 27 psychiatrists and psychologists, some of whom believe the President suffers from cognitive dysfunction and mental illness. In doing so, they are damaging a specialty that has struggled to gain respectability among the general public and making it more difficult for those with mental disorders to receive treatment.       Psychiatry is a tough profession. Unlike other medical specialties such as ophthalmology, cardiology and orthopedics, our understanding of the brain is still in the Stone Age. The underlying physiology of the eye, heart and skeletal system is well understood. If a cataract is blurring vision, take it out. If a heart artery is blocked, unblock it. If a bone is broken, set it. But what do you do with a drug addict, an alcoholic, a schizophrenic or a depressed patient? There are no blood tests or radiological studies that give a definitive diagnosis of these entities let alone … [Read more...]