Showing papers by "Charles H. Hennekens published in 2021"
TL;DR: The United States remains the world leader with 33 million of 165 million cases worldwide (20%) and 590,000 of 3.4 million deaths worldwide (17%) from the COVID-19 pandemic as discussed by the authors.
Abstract: As of May 2021, the United States remains the world leader with 33 million of 165 million cases worldwide (20%) and 590,000 of 3.4 million deaths worldwide (17%) from COVID-19. Achieving herd immunity by disease spread and vaccination may result in 2 million to 4 million total US deaths. The future perfect of the vaccine should not be the enemy of the present good, which is masking. Masking, especially when combined with social distancing, crowd avoidance, frequent hand and face washing, increased testing capabilities, and contact tracing, is likely to prevent at least as many premature deaths as the widespread utilization of an effective and safe vaccine. Worldwide, masking is the oldest and simplest engineered control to prevent transmission of respiratory pathogens. Masking has been a cornerstone of infection control in hospitals, operating rooms, and clinics for more than a century. Unfortunately, since the epidemic began in the United States, masking has become politicized. All countries, but especially the United States, must adopt masking as an urgent necessity and a component of coordinated public health strategies to combat the COVID-19 pandemic. Any economic advantages of pandemic politics are short-lived and shortsighted in comparison with public health strategies of proven benefit that can prevent needless and mostly avoidable premature deaths from COVID-19. During the worst epidemic in more than 100 years, most Americans (75%) trust their health care providers. As competent and compassionate health care professionals, we recommend that effective strategies, especially masking, and not pandemic politics, should inform all rational clinical and public health decision-making.
3 citations
TL;DR: This patient is an active and vigorous 79-year-old man who plays competitive tennis and pickleball and steadfastly adheres to an antediluvian regimen for the management of his atrial fibrillation.
Abstract: During the last several decades, there have been major advances in the evolution of drug therapies for the rate management of atrial fibrillation (AF). Initially, the drug of choice was digoxin but currently, the drug of choice is beta-adrenergic blockers. Drug therapies for stroke prevention in AF have also evolved. Initially, the drug of choice was aspirin, then became warfarin, and now in the current era, there are newer oral anticoagulants, such as apixaban, which are the preferred drugs. In this case report, we present the details of a 79-year-old athletic man who developed palpitations due to rapid AF at age 31. At the time of his initial presentation, he was treated with digoxin and aspirin and has remained on these drugs to the present. In 1973, 28 years after his initial presentation, he became the United Kingdom (UK) amateur tennis champion in the 55 and over division at age 59. At present, the clinical applications of advances in the management of AF should include quality of life considerations in the context of patient preferences. This patient is an active and vigorous 79-year-old man who plays competitive tennis and pickleball. He steadfastly adheres to an antediluvian regimen for the management of his AF, but this may be viewed in the context of the famous quotation by Bert Lance, Director of the Office of Management and Budget in the US under President Carter who said "sometimes, if it ain't broke, don't fix it." In addition to the evolution of drug therapies from digoxin to beta-adrenergic blockers for rate control as well as from aspirin to warfarin to apixaban for the prevention of stroke, there have been other recent remarkable advances. For example, recent promising findings from randomized trials include that early rhythm control was more effective than rate control as well as that cryoballoon ablation was superior to drug therapies. These findings require confirmation in additional randomized trials designed a priori to test these promising but unproven hypotheses.