Dear Patients,

Over the past month or so, before I turn the lights off to go to sleep, I have been reading quotes from famous people. I keep circling back to Winston Churchill. He was known for being rebellious and stubborn, and it was these very traits that saw him achieve a great deal. The film, Churchill, is worth watching. He was persistent and courageous. He was known for facing problems head-on and for his famous quote "never never never give up." And he was also not afraid to change his mind. He once said, "those who never change their minds, never change anything."

One of the ways I face adversity is to study the way other people have faced it. Of course, one person's adversity is another person's bad day.

A few more quotes from Sir Winston Churchill:

• Attitude is a little thing that makes a big difference.

• Success is not final; failure is not fatal: it is the courage to continue that counts.

• If you're going through hell, keep going.

• A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.

• You have enemies? Good. It means you've stood up for something sometime in your life.

• Out of intense complexities, intense simplicities emerge.

Thank you:

As I've previously mentioned, my oldest daughter, Rachel, is a nurse anesthetist who has spent the past two weeks serving at Jacobi Medical Center in the Bronx. Below are a few recent photos of her while there. Thank you to Rachel and all of the other front-line health care workers.

The numbers:

Maryland:   17,776 cases -/- 797 deaths -/- 4.48% fatality rate (up)

-- -- -- --(deaths are +74, up from +43 yesterday)

The Maryland Ro: (for Ro explanation, see April 23 Update)

Our level is the same. It is updated every day.

These numbers show that we need to see improvement before we can safely go forward with relaxing our stay at home policy.

Diagnostics and Therapeutics:

• More written about Vitamin D: it may be that having adequate Vitamin D levels could be important in suppression of the inflammatory cytokine response thus causing less overreaction to viral pathogens. I take 2000 units per day and I try to get some daily sunshine.

• A recent study from one of the hardest-hit areas in Italy found that 43.2% of confirmed COVID-19 infections were asymptomatic.

• Miami-Dade County antibody testing showed 6% of residents have antibody; this is 16 times the number of confirmed cases.

• There has been a question about continuing two common types of cardiovascular drugs during this pandemic (ACE inhibitors and ARB's); a consensus continues to confirm that patients should stay on these drugs.

You will see more and more innovation for minimizing transmission and prevention of COVID-19; it has been shown that using the correct spectrum of UV light will kill the virus in seconds.

On a musical note:

Bless the Broken Road by The Piano Guys. The Piano Guys are one of my favorites. This is a piano version of this Rascal Flatts song, and at about 4:40, a special message. 

And on lighter note, another thank-you to our front-line health care providers: (thank you SO).

Reach out. Stay connected. Stay home. Save lives.

The power of one. Be well. Feel free to forward this on: spread the word, not the virus.

Harry A. Oken, M.D.