GLP-1 medications1 like Ozempic appear to be that drug. Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly — and perhaps even more as newer drugs come to market. And though evidence is still being gathered, they may have benefits beyond weight loss: potentially curbing drinking, treating sleep apnea, and reducing risk of stroke. They’ve been called, in many places, a miracle drug, and as such, the category is poised for massive growth. Gallup estimated that 15.5 million Americans have tried them, and half as many are currently using them.
My forecast predicts that the supply of GLP-1s will increase from eight million patient-years to roughly enough for approximately 23 million Americans by 2030. Still, this is only enough supply for about 15% of the 147 million Americans with diabetes or obesity.
Wild. There is definitely some value to these drugs but at what cost over natural measures? For some, I’m sure Ozempic represents a miracle but it’s also a drug that doctors and researchers are still experimenting with and trying to fully understand.
When the first lock downs in the United States were announced I was returning from a work trip to Montreal. On the flight home I had not felt great but was not worried about Covid-19. The next day I felt a little better and went out for a lunch at a restaurant not knowing it would be the last time I’d have a sit down meal inside of a place for now 9 months. On Saturday I woke up with what I can only describe as the worst ear pain I have ever experienced. My left ear felt like it was going to explode. Nothing I did relieved the pain and I eventually gave in and went to a ZoomCare clinic because finding an appointment at my primary care physician was not possible. The ZoomCare nurse said “yep, you have an ear infection”, gave me some antibiotic drops and sent me home. At first it seemed like the drops were working but on the second day of using them I noticed fluid coming from my ear and then blood.
I returned to ZoomCare and they put me on stronger antibiotics but also suggested I see my primary care doctor. I gave that doctor a call as I left and while my doctor wasn’t available his nurse practitioner was so I was able to get in. When the nurse practitioner looked at my ear she became very concerned that the infection had moved into the bone in my ear canal. A couple of higher strength antibiotics were given, including an oral one to try and fight the infection internally. They also made an emergency appointment with an ENT (ear, nose, and throat) specialist in case the infection was in the bone.
The scheduling process for the ENT was not easy as Covid had pretty much shut the practice down. The schedulers wanted to make sure that the appointment was absolutely necessary and that I had no symptoms of Covid. Again, I was in excruciating pain, I couldn’t drive because it hurt to move my head certain ways.
My appointment required a Covid test but the visit itself went fine. The ENT was convinced that the infection was not in my bone. He did confirm that my eardrum had burst and applied some thick steroids and antibiotics to the eardrum and kept me on heavy duty antibiotics. He also stated that he thought it would be a quick recovery and that the pain should really start to fade in the next day or two.
Returning home from that appointment felt like relief. There was a plan, some meds, and an optimistic view from the doctor. Sure enough, the pain started to fade away the next day and I started to really feel like I was improving. A week went by and the pain was completely gone but I was still having fluid in my ear so I returned to the ENT (after another Covid test) where I was told that stronger steroids needed to be applied, so that was done. I was also told that my hearing would eventually return and to be patient.
The waiting
After two months of carefully treating my ear I still felt like I could not hear very well still had a constant ringing in my left ear from when all of this started. The ENT wanted me to come in and having a hearing test and to just double check my ear. My hearing test came back with my results essentially being no different than a test that was performed a few years ago. The doctor did notice some scar tissue on my eardrum but did not see any fluid behind it. His explanation for the ringing was that eventually it would fade.
But, here we are 7 months later and my left ear still rings. I still have trouble understanding conversation when there is a lot of background noise or if the conversation is more on my left side. Even small background noises interfere with my ability to fully hear and distinguish words in a conversation. During conversations the ringing is there but is mostly just an annoyance. During silent moments the ringing is distracting and frustrating because it is all I hear.
As a Covid vaccine makes its way around the world I am really hoping it is easier to find a new ENT to get a second opinion. The reduced hearing is my biggest concern with the ringing a close second. I’d like to be able to have a conversation with people without having to adjust my head or hear ringing in the background. That’s all I really want in 2021.
European Union countries rushing to revive their economies and reopen their borders after months of coronavirus restrictions are prepared to block Americans from entering because the United States has failed to control the scourge, according to draft lists of acceptable travelers seen by The New York Times.
and
A prohibition of Americans by Brussels partly reflects the shifting pattern of the pandemic. In March, when Europe was the epicenter, Mr. Trump infuriated European leaders when he banned citizens from most European Union countries from traveling to America. Mr. Trump justified the move as necessary to protect the United States, which at the time had roughly 1,100 coronavirus cases and 38 deaths.
The Times is making a bit of a reach on implying that this is due to Trump banning European citizens from the United States at the beginning of the European surge. I am sure there is a tiny bit of truth to it but I doubt anyone in the EU delegation will say it. To me the move seems more of a pragmatic decision based on where the U.S. and other countries are when it comes to containing Covid-19. I’ve seen posts on Facebook and Twitter of U.S. citizens hopping around European countries because the entry procedures are not uniform, so locking down access at the entry points makes a lot of sense.
Of course this stinks if you are an American wanting or needing to travel to the European Union over the next few months but since we can’t seem to wear masks or socially distance, we reap what we sow.
I recently posted a quick poll on Twitter asking how many people are planning leisure travel via airplane and was surprised by the response. So far out of 334 responses, nearly 40% plan to travel in the next 1-3 months. Only 22% have no plans to travel. With this EU news and the fact that we still can’t seem to get the disease under control here in the States, I am not convinced it is time to travel again. It honestly seems like it is more of a pain than it’s worth and the risks are still far too high.
One of the more troubling trends during the Covid-19 pandemic is the refusal to wear a mask by segments of the U.S. population. The reason to wear a mask while in a building or in large groups is simple; When everyone (or a majority) of people are masked, the spread of the disease will be minimized by limiting how much of the disease makes it into the air. And researchers are investigating the possibility that exposure to less of the virus means either not catching Covid-19 or only having very minor symptoms.
by Stefano Annovazzi Lodi
The reasons people don’t want to wear masks are varied and in some cases ridiculous. One of the crazier claims is that wearing a mask will make the wearer inhale too much CO2. Unless you have an underlying medical condition or difficulty breathing to begin with, this claim is simply false. From Dr. Bill Carroll PhD at the University of Indiana:
“It has to be a pretty high concentration to be capable of causing harm. CO2 is present in the atmosphere at a level of about 0.04%. It is dangerous in an atmosphere when it is greater than about 10%.”
Funnily enough, you can also be harmed by a lack of CO2 as well. From the same article, if you held your breath too much:
“If you hold your breath, you wind up with too much CO2. The core issue is that CO2 regulates the pH of the blood—too much CO2 and the blood becomes too acidic; too little and it becomes too basic (alkaline). In either case, your body detects the change in acidity and you pass out, which is the body’s way of saying, ‘please stop fooling with me and breathe normally.’”
So, if you insist on not wearing a mask because you think you’ll breathe in too much CO2, please also don’t hold your breath either.
And most places asking (or telling) you to wear a mask are making it clear that children are not required to wear one nor are people with breathing problems. In fact, in the requirements I’ve seen, places are explicitly stating that those groups shouldn’t wear a mask.
The other strange, but less surprising, reason that people are refusing to wear a mask is the “personal freedom” argument. This is the notion that wearing a mask violates some kind of personal freedom you have. I feel that this argument holds little water simply because in this case a personal freedom puts others at risk. The wearing of a mask isn’t just to protect you the wearer, it’s to also protect the others around you and with large segments of the population wearing such a mask, the risk goes down, even for those who can’t wear one. So, by arguing that your personal freedom is being violated you are essentially saying you don’t care what happens to anyone around you (or yourself).
Is it fun wearing a mask? No, not really. But my personal, temporary discomfort is a small price to pay to help fight the fight against Covid-19 and help make the reopening process less dangerous.
I am fascinated that this is such a controversial issue in the United States. In East Asia wearing a mask is commonplace when there are public health risks and in Japan, this practice stretches back to the 1918 Flu pandemic. This Time article gives some insight into why here in the States it’s such a big deal:
The difference in perception of the mask comes down, in part, to cultural norms about covering your face, he says. “In social interactions in the West, you need to show your identity and make eye contact. Facial expression is very important.”
I say, social norms be damned. A few paragraphs later in the story, there is the sentiment in Hong Kong:
“Wearing a face mask is just common sense. It creates a barrier, so nothing can touch your nose and mouth. Why wouldn’t I wear a face mask?” Says Ho.
So, there are very few negative aspects of wearing a mask and while it’s effectiveness will likely never be completely understood, there is some evidence that it helps, so why not wear one?
Lastly, airlines are now enforcing their face mask requirements more stringently and in some cases saying that passengers could be banned from flying the carrier if they refuse to wear one. I’m nearly 100% positive someone out there will challenge this in court and such a move goes back to my above point, personal comfort should not trump public safety in the time of a pandemic. But again, I am sure someone will try to make the argument that they shouldn’t have to wear a mask.
In any case, unless you are someone who can’t wear mask due to health reasons, please, please, please, put the mask on when you go into a business or are around a lot of people. Please.
By now I am sure you are all too familiar with Coronavirus Disease 2019 (COVID-19) but I wanted to write about some of my recent travel experiences and what all of this could mean for the future of aviation and travel. I am not a doctor or epidemiologist so my health expertise is limited to what my doctor friends tell me and what I read from the World Health Organization or CDC.
A lot of corporations have already put restrictions on travel. Some have said no travel to places affected by the virus while others have stopped all non-essential travel. The impact that these travel restrictions will have on the travel industry are already being felt. For example, Lufthansa has announced a 50% cut in capacity. That’s huge.
In addition, the extent to which the entire Airbus A380 fleet (14 aircraft) can be temporarily taken out of service in Frankfurt and Munich is currently being examined.
They are even considering grounding the A380 during the cuts!
Hong Kong’s battered flagship airline will reduce overall flight capacity by about 30 per cent, its chief executive Augustus Tang Kin-wing said on Tuesday.
The carrier, one of Asia’s premium airlines and one of the biggest corporate victims of several months of anti-government protests in Hong Kong, has seen passenger numbers collapse by 50 per cent in recent days, sources said, citing comments from a briefing on Monday led by Mark Hoey, the airline’s general manager of operations.
On the United States side of things, all of the major carriers have significantly reduced their amount of flying to Asia. These reductions started with China and Hong Kong but have been expanded to Japan, South Korea, and other Asian destinations. A recently leaked internal memo to United Airlines staff stated that the international flight schedule will be reduced by 20% in April and those cuts will likely last until the end of May. Domestic flying will also see cuts of around 10% in April and it is unclear when that capacity will return to the schedule. You can read the full memo on JonNYC’s Twitter post.
All of these cuts add up to real dollars. The International Air Transport Association (IATA) has stated that the coronavirus could impact global airline revenue anywhere between $63 billion and $113 billion. There is not much to say to that except, wow. The landscape of the airlines could drastically change by the time this illness is contained and the number of cases starts to dwindle.
*Update – I have left this post in a draft form as I wrote it. As the news has evolved, I have tried to update the post. Some of the latest news from Delta is that bookings are down 25-30% (worse than expected) and that demand erosion is very evident. Not good times for airlines. That’s the story.
My Recent Travel Experiences
For me, my recent flights and overall travel experiences have been relatively uneventful and normal. What has surprised me the most is that the airports I frequent (O’Hare, Portland, Newark, and Montreal) have been very busy even as airline schedules have been reduced. A lot of travelers are wiping down their seat area with sterile wipes and wearing masks and/or gloves. There is also the strange phenomenon of seeing people leave the restroom without washing their hands, a bizarre choice in these times.
Personally I have tried to be more aware of touching my face. It’s more difficult than it seems, especially while I sit and work on my laptop. I think the best advice is not “No face touching” but to be aware of when you are doing it and to make an effort to correct the behavior. There is no way you’re going to stop it completely so don’t beat yourself up over it.
What should you be doing with your travel plans? Make sure the flights and hotels are still open and operating as expected. If you are worried about travel, all three of the major US carriers (Delta, United, and American) are allowing changes for free for flights until late April. Call your airline and move the trip. If you are still planning to take your trip, wash your hands, be aware of how much you touch your face, and cover your mouth and nose when coughing and sneezing.
The Future
I am generally concerned about the airline industry and the travel industry as a whole. A number of airlines are already struggling, cutting massive numbers of flights yet hoping to stay alive long enough for demand to bounce back. A few more months of depressed travel and the potential for airlines being unable to sustain their operations financial becomes much more real. The same could be said for industries where customers showing up is the whole business (restaurants, brick & mortar stores, etc). Fewer people coming in means less cash while expenses stay the same. That’s what concerns me the most.
