Feature Article: January/February 2022 – How Has COVID-19 Impacted Physicians Who Practice Age Management Medicine?

How Has COVID-19 Impacted Physicians Who Practice Age Management Medicine?

Jeff Morris

The coronavirus pandemic has had a profound effect on many aspects of life over the past two years. How has it impacted age management medicine practices? We asked some of age management’s leading practitioners about their experiences. Here, they reveal the sometimes surprising impact that COVID-19 has had on their practices.

Paul Thompson, M.D., at Thompson Clinic in Fort Worth, TX, said, “We are very active front line doctors. We have adopted Ivermectin, zinc , hydroxychloroquine, vitamin D, and Budesonide. Many nights were spent helping patients and their families with nowhere to turn for help. We have delivered meds all over the metroplex, close to 100 miles away sometimes.”

Dr. Thompson said telemedicine has always been a part of the practice but now it has increased. When we contacted him earlier in January, he said, “We have added new patients daily this month—over 20 new, not counting all the consults for COVID and their care. Due to this increase I have doubled my staff one nurse and a NP.”

He said they are doing testing in the parking lot for patients and family/friends, and then initiating treatment if positive.

“We have less time with patients due to the overload of symptomatic COVID patients,” said Dr. Thompson, “but I see it slowing down the second half of the month. Our entire staff is not vaccinated, and we don’t wear masks. If a staff is symptomatic, they are tested, sent home and treated, with no return for 10 days.”

Summing up, Dr. Thompson said, “Overall, it’s been a sh*t show. We are overwhelmed, but like I said, these people have nowhere to turn and unless we help them many could end up in the hospital to be placed on vents.”

Jeffrey P. Leake, M.D., Senior Physician and Director of Education at Cenegenics in Las Vegas, NV, said, “At the beginning, when we weren’t sure what was going on, we had many annual exams cancelled that were already scheduled, and many were not scheduled as the year went on.”

”Once the vaccines were available and on board,” continued Dr. Leake, “an unwillingness to travel was not a valid reason for refusing in house visits so we resumed our standard practice, and patients were dismissed if they didn’t meet the requirement. Most people came in. Many were frequently traveling on vacation or business anyway.”

”Pre vaccine we had a low positive rate (we were testing antibodies) and those who acquired COVID generally had mild clinical courses,” Dr. Leake said. “I suspect this is due to a healthy user bias. Our patients have good immune systems because they attend to their health. There have been no COVID deaths yet among our patients, vaccinated or not.”

”Other than the transient drop in annuals the first year or so, nothing was different,” concluded Dr Leake.

Mickey Barber, M.D., founder of Better Life Carolinas, said, “We actually experienced growth that was unprecedented. I think patients appreciated that we were open, maskless and willing to treat COVID. I believe individuals became acutely aware that being healthy protected them. We have always done a considerable amount of our care through telemedicine and using independent phlebotomist all over the country.”

Most extensive in her response was Florence Comite, M.D., CEO and Co-Founder of the Comite Center for Precision Medicine and Health in New York City. Dr. Comite and her staff put together an entire paper in response to our query, which we present here in its entirety:

COVID-19 challenged all of us in New York City. Sadly, most physicians shut down their practices, their employees were let go or furloughed. Several physicians turned to telemedicine to be available to their patients. It is 2022, and yet many physicians and clinicians have still not recovered, some have even left medicine, long before retirement would naturally occur.

Two years after COVID first struck us, and that was quite severely in New York City – first in the country, many doctors no longer practice medicine and have not recovered, emotionally or physically. Several of my colleagues who were hospitalized with COVID, and required respirators, are still not completely back to their baseline function. They may never get back. I was fortunate, though I also had COVID early – contracted after a 36-hour trip to San Francisco March 10 to 12, 2020, the week that city shut down. San Francisco was the 1st city in the US to shut down. The strangest experience was to travel from the city to Silicon Valley in 20 minutes instead of 2 hours!

I was ‘volunteered’ to be the guinea pig in my office, tested on Wednesday, March 18th. Friday night, March 20th, in fact, I stayed late at work, to send out a personal communication to our email list, that masks were an imperative – prior to the CDC decision.Then the shock, when the test – both at Quest and Boston Health – returned positive on Monday March 23rd! I was dressing for work, about to leave, when I got the call. My symptoms were mild, though I had some affects as I was not taking my medications and supplements. Fortunately, I did well with few after affects except fatigue. That lasted quite a while though and was not fun.

Truth be told, Covid was a shock to all of us, the city felt and looked as if an apocalypse had struck. People died, even as they attempted to get to hospitals or in emergency rooms. I cried many nights watching the news. The medical professionals did not yet know what to do, admissions could not keep up. People were told not to go to the hospital. It was crazy and sad. I wanted to volunteer, but I had Covid. It was so hard to watch what the first responders had to do, without proper gear or protection for way too long. Many first responders, unhealthy due to co-morbidities, also got sick and ended up on respirators too.

Then that changed – rapidly. Doctors are trained to save lives and they did not give up. At the bedside of ill patients, new therapies were introduced and helped many survive. In the beginning, we had little knowledge of how long the infection lasted and how contagious we were – in fact, PCR tests remained positive in many, including myself, for months. At that time, we sought answers, but we had many more questions. My insatiable curiosity was a positive, my clinical research background supported our ability to read the scientific literature and sort out the wheat from the chaff. We were on a mission to find out how to manage, what to do, and how to guide our patients and their loved ones, as well as our colleagues, their families, and the community.

We were among the lucky few because we were able to continue practicing the way we always did due to our clinical and business model in Precision Medicine & Health. Comite Center never shut down, employees were fully paid, most were home for almost 2 months while several extraordinary souls kept the office open. That especially had a huge positive impact on morale, our clients, their friends and family, and business. All were thrilled because we were available to answer questions and help them through these terrifying times. We took care of our clients and opened to their loved ones and friends, to help guide and manage.

We operated by pivoting to remote and hybrid work immediately. Prior to the NYC shutdown, the week of March 16th, 2020 (my birthday, no less!), we were in the office while we spent the week to reach out across the country to our clients.Our team continued to monitor them throughout. Immediately as the pandemic fears heightened, we instituted processes that allowed us to assess people across the tri-state (New York, New Jersey, Connecticut). We hired a driver and phlebotomist to offer mobile tests, which was not being done by anyone else. We tested more people as outpatients before any other practice was set up. People were thrilled because they were scared, many had symptoms but not Covid – we learned quickly that a loss of sense of smell and taste was pathognomonic- and absolutely a diagnosis of Covid. Fever or sore throat or a GI complaint was not necessarily Covid, though any symptom could be. We were lucky due to our personal relationship with the labs, Boston Heart, in particular. Though every lab was hurting as was FedEx and every company; people stayed home to avoid Covid or because they had Covid. Our people made it work; we were grateful to those who kept the office opened throughout. One of our team slept in an apartment we secured (in the building) to avoid going home to older parents and a young niece. I will never forget that sacrifice. It touched my heart and soul.

Comite began by integrating innovative protocols and embracing clinical analyses adapted to the pandemic. We had a basis instituted in our practice, already utilized pre-pandemic that incorporated telemedicine assessments and connected with our clients anywhere they lived in the country and world. That was always efficient and appreciated, it saved time and money, and allowed for economy of scale in many ways. We made it clear to clients that they could reach out to us, and we stayed connected to them. Once the office reopened, Florence offered weekly webinars to share updates about Covid and answer questions and concerns that mattered to her clients and the medical community. These webinars were so popular that many physicians tuned in weekly for months. Our office opened its doors to physicians and their families as well as others, to test for Covid and antibodies for free in 2020 and 2021. We ordered rapid tests as soon as available and sent off PCR at the same time.

Turning to the business of medicine, we were able to operate much as we did prior to the Covid pandemic and due to our revenue model, we were able to sustain the office employees – though it was challenging and frankly, in all transparency, scary from time to time. Government support for employees with Covid and the PPP support made a difference. Clinically, we continued our medical model, which was core to our business. That made a difference. Almost every physician had to quickly adapt to TeleMed consultations, while this was built into our DNA. On a positive note, my twin sister, Harriet Comite, a dermatologist, finally understood why I was always on the phone consulting with my clients over the years (and not helping to do the cooking or cleaning at holidays!)

Telemedicine, also called a TM at Comite, has been integral to the experience at the Center for over two decades. We regularly review data with our clients as they progress through our program. Our initial engagement with clients actually begins with an intake by Florence Comite, that ultimately captures a client’s health story and any available diagnostic data. Our first in-person meeting occurs only after several TMs based on our protocols honed > 2 decades by Comite. Our analysis of each client is based on the integration and interpretation of what we learn through TeleMed interactions and ‘marrying that intel’ to their biomarker data. This allows us insight into their current and future health trajectory and incorporates biomarkers as well as performances analyses that give us vital insights into the client’s baseline status.We continued this process throughout the Covid pandemic and were able to delay the in-office assessment until after the pandemic began to recede.

There are several other adaptations we chose to initiate during the pandemic. Many protocols have been adopted long-term as the pandemic continues to ebb and flow, affecting our clients’ lives and their families’ choices about how to live in a world that is radically differs in contrast to 2019 and earlier:

  • Offer at-home and in-office support with COVID rapid and PCR tests, blood draws, specific IV therapies
  • Encourage masks in advance of CDC recommendations, while at risk among others
  • Keep clients informed with COVID webinars and newsletters
  • Researched and identified unique Zinc-infused masks from Israel that blocks >99.9% of viruses and other germs. We first bought these masks in 2020. Amazingly, only recently, this month due to Omicron, is this info being shared by the CDC. Covid is a tiny virus, the blue surgical mask is not sufficient to protect. Neither are the vast majority of cloth masks though K95 or NK95 are protective.
  • January 2021, we ordered >1300 Zinc- infused masks, labeled with our new startup’s Groq Health’s logo as we anticipated that COVID was going to demand protection. And that has turned out to be true and helpful to our clients and others who wear these masks, which can be washed and utilized for >year as well.
  • Assess COVID antibodies before the assays were commercially available, due to our personal and professional relationship with a few research facilities. Special shout-out to Dr. Ernie Schaefer, Chief Medical Officer & Founder, Boston Heart. We worked closely with Ernie and ultimately data collected on our patients and those we tested in the tri-state area were published in the scientific literature.
  • Applied to New York city to quality for Moderna vaccination. We were approved in February 2021 however the vaccines were only made available to us in May. We continue to offer boosters now and believe that cross-vaccination makes sense for coverage.
  • Hired additional staff to institute and oversee strict cleaning protocols at our facilities

Our New York office continued to do well. The most amazing turn of events was our decision to launch Comite Center Palo Alto in July 2020, amid the pandemic. Silicon Valley was essentially shut down, as the tech community it is. Our west coast and California clients were extremely grateful as they had no plans to travel to New York City due to fear of Covid and flying to New York. In fact, most of the folks in California continue to stay remote.

In turn, the business is growing, and we can accommodate the influx of new clients while supporting our current patients. I am extremely proud and grateful to my team for making this possible. Ten of us traveled regularly every month from July 2020 and worked throughout a week seeing and managing many clients and new patients. The days start as early as 7 am and typically end after 5 pm!We now plan to open Comite Center Miami Beach within the next few months.Stay tuned!

Covid has dramatically changed our world forever, who ever imagined that 2-year-olds and our school-age children and grandchildren would wear masks to play with their friends in playgrounds, and that going to school with or without a mask might be a battle between the courts and the teachers? Nevertheless, we are grateful that we can continue to care for so many people in a meaningful way. Not one of our patients with Covid has had to go to the hospital or needed a respirator. Why? That may seem incredible unless you are familiar with our field of Precision Medicine & Health.

Our work in Precision Medicine & Health identifies co-morbidities that undermine people who contract Covid – we can predict and reverse diseases, such as diabetes, heart disease, lipid disorders, and more, that leads to reversing biological aging despite chronological age. We protect the immune system thereby strengthening our clients’ health physiologically, recovering their function to a younger age, energy and sleep improves, muscle increases and visceral fat disappears, over time, health optimizes. We are excited to see people achieve healthy longevity, which keep our clients healthier even when they contracted Covid. That is why hospitalization and respirators were not necessary.

Perhaps the most vital lesson absorbed throughout the pandemic is the recognition that our investment in health to “predict and reverse aging and disease” is a choice that will impact the quality of your life, now and forever. Whatever you do to optimize your health is worth it.

“When you have your health, you have everything!”

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