If you take a prescription medication—whether regularly, or only on occasion when you need it for a specific issue—chances are you were given some information on how to take your medication safely. But you might not have been told how to store or manage your medication, and these are also key to making sure it works properly! Read on for some basic advice.

At ADV-Care Pharmacy, your pharmacist follows best storage practices. 

Before your pharmacist filled your prescription, ADV-Care pharmacy managed all its medication supplies using proper storage and inventory control methods.These standards include keeping medication between 15 and 25 °C and dry by avoiding humid or hot environments. It also includes keeping refrigerated medication in a controlled refrigerator at 2 to 8 °C. ADV-Care Pharmacy also follows strict protocols for the disposal and return of expired medications, for preventing cross-contamination, and for product rotation to make sure you always get medication with the longest possible expiry date.These practices make sure your medication is safe, secure, uncontaminated, and maintained properly for peak quality and effectiveness.But then it comes to your door… and chances are, you don’t have specialized pharmacist training! So what now? Not storing or managing your medication properly can affect its effectiveness, meaning how well it works in treating your condition, whether chronic or short-term. In some cases, improperly stored medicine could even make you ill.

Let’s talk about good medication storage habits at home! 

Many people keep their medication in a drawer, or in a kitchen cupboard, or on a shelf in the medicine cabinet. If you take a lot of medications for chronic conditions, you may keep all your medicine together in a basket or a box on the kitchen counter.Unlike the conditions managed by your pharmacist in the drugstore, the storage conditions in your home may be hot or humid, and the lack of safe, secure storage may mean a child or someone unfamiliar with your medications could misuse your medicine.For best results and safety, always follow these guidelines:

1) Keep medicines safe in a childproof, locked drawer or cupboard.

2) Avoid storing medications next to the stove or in the bathroom where variable temperatures and humidity can cause them to deteriorate. In these conditions, gel capsules and pills can break down, which can affect the release of the medication or alter its makeup.

3) Store medications in a dry, cool, dark place, as heat, light and humidity are bad for medicine.

4) Always keep your medications in the container provided by your pharmacist to avoid mixing them up with each other or with supplements like vitamins.

5) Remember to remove any cotton or desiccant packages from your prescription containers. Once the bottle’s seal is broken, these things don’t keep your medicine dry; in fact, they can draw moisture in, thus affecting the effectiveness of your prescription.

6) If your medicine has changed colour; sticks together; smells different than when you first got it; or crumbles, chips or cracks easily—please don’t take it! Consult your pharmacist at ADV-Care, your doctor, or another trusted health care professional.

Manage your medicine carefully for best results. 

Many people use daily or weekly pill containers to manage their medications—you can ask for a free one from ADV-Care when you fill your prescription. Alternately, by request, your pharmacist can give you specially prepared blister packs to organize your medications for weekly use or for travel.Your doctor may prescribe medicine that needs to be taken with meals, or on an empty stomach, or at certain times of the day. You may need to avoid certain foods like dairy or citrus because these foods can alter the way medicine is absorbed in your body. If you think you might have trouble remembering, write down the specific instructions and keep them with your medications so you can refer to them every time your pill container, or set a reminder on your smartphone.Your ADV-Care pharmacist can help answer any questions you may have about how to best take the medication your doctor has prescribed for you and whether there are side effects to watch for. Make sure to follow the instructions for taking your medicine carefully—it can make all the difference to your health!

Don’t neglect proper pill disposal. 

Sometimes your doctor may change your medications. What should you do with your leftover, old or expired medicines?First, here’s what not to do! Never share them with other people. Your doctor has prescribed the type and dosage of medicine just for you. Also, never flush them down the toilet. Unused prescriptions can contaminate the water supply.Instead, to dispose of them in your garbage, mix them with an organic substance, such as kitty litter, coffee grounds or vegetable clippings, and seal the mixture in a plastic bag. This makes it less likely they’ll be taken from the garbage and used unsafely.Now you’re all set to keep your medication safe and ensure that it’s effective!

Until a few years ago, when giving a prescription for antibiotics, healthcare providers advised us to finish the entire course of medication. Even if you felt better, you were supposed to carry on until the often bitter end.

Even the World Health Organization (WHO) says you should “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria.”

Historically, a full prescription for most infections has been a minimum of seven days and as long as 14. For stubborn infections, a second round of a higher and stronger dose might be given. This approach began in the 1940s.

Recently though, infectious disease experts, educators and physicians are saying we need to rethink this approach, which they say is a habit rather than a sound practice standard.

Let’s take a look at why this way of prescribing antibiotics took root so strongly.

Some medical practitioners believe this started with Alexander Fleming, the discoverer of penicillin. In his 1945 Nobel Prize speech, he said if not enough penicillin was given for an infection, bacteria would develop resistance to the antibiotic.

It turns out that’s not true for all infections or for all forms of bacteria. Tuberculosis, gonorrhea and malaria are all infections with a high risk of producing mutations resulting in antibiotic-resistant bacteria. But generally speaking, most other types of bacteria do not share the same risk.

Does that mean antibiotic resistance isn’t really a concern?

No, antibiotic resistance is a real concern. It just doesn’t work the way we used to think it did. The discovery of penicillin and other antibiotics in the 20th century  radically transformed how we deal with infection. In the United States alone, 150 million prescriptions for antibiotics are ordered every year.

However, it’s become clear that the more antibiotics we use, the more resistance we see. Estimates say two million people a year get antibiotic-resistant infections. Over-prescription and overuse are the real culprits here, not people failing to finish a course of treatment. 

Staying the course, rather than quitting when you feel better, is causing harm rather than preventing it.

That’s because longer courses of antibiotics end up killing all types of bacteria, including the good ones, and this broad-spectrum effect can lead to the development of resistance across the board.  

The bacteria facing the biggest threat of developing resistance are: Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter app, Pseudomonas app, and Enterobacter app. We all have these bacteria in our bodies. While they are not harmful, they are carriers for drug-resistant genes. The risk lies in how easily they can swap resistance with other bacteria through a process called conjugation. As a result, drugs lose their power over subsequent generations of bacteria.

What does the research say about drug-resistant antibiotics?

There has been growing concern about antibiotic use for many years, and now there’s new evidence to consider, as published in the British Medical Journal.  The authors had this to say: “The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.”

The lead author, Marin Llewellyn, said the team reviewed research which showed that for some infections, like those affecting the ear, a longer course is needed, while for others, like pneumonia, a shorter course is just as effective.

So how are doctors tackling the problem of antibiotic resistance?

First, many doctors have begun to write prescriptions for shorter rounds of drug therapy. They may also advise the patient stop a course of antibiotics early if they are feeling better. This means the patient has to pay attention to how they’re feeling at the start so they can make a good assessment of their response to the medication.

Second, if patients keep coming back with repeat infections, doctors are beginning to look at what lifestyle changes the patient can make, what environmental factors are at play, and what approaches, including prescription management, need to be considered.

Never stop a course of medication unless you have discussed it with your healthcare provider. But remember, you can express your concerns about antibiotic resistance to your doctor or pharmacist, just as you can ask them about anything else you should be aware of when taking medications.

Winter travel to exotic locations may be on your New Year’s list, but if you’re taking medication for a chronic illness, make sure to find out what you need to travel across borders with your medications.

Both the US and the Canadian governments provide travel guidelines for people who must take their medications with them. Information varies and isn’t always up to date online, so the wise traveller should call the numbers provided to get the most accurate information.

When you plan a trip, plan your medications too!

Once you know where you’re going (hitting the slopes or hitting the beach), have a conversation with your physician and pharmacist about managing your medications.

Your doctor can advise you on what you need to look out for. As an example, some medications may make you more sensitive to the sun or others may not work well in combination with alcohol or certain foods. Your doctor may also speak with you about what you need to avoid when it comes to allergies and sensitivities to other medications (if applicable). Finally, your doctor may also provide you with a letter to carry as part of your travel documents  explaining what medications you need and why, especially if you use medical devices and controlled medications, in case any authorities should inquire.

Your pharmacist can give you useful advice on how to travel with your medications, how to store them properly, and what prescription renewals you may need. Chatting with them in advance can also give them the chance to suggest appropriate ways prepare your meds for travel (blister packs, cold packs and so on).

Other things you may want to think about include how you may deal with any medical issues related to your condition that might arise while you’re gone, the standards of care available at your destination, and any dietary concerns you may have related to maintaining your medication schedule.

What are some things you can do to make traveling with medication easier?

• Put your medication in your carry-on or “personal item” (purse or small bag), and not in your checked luggage. This helps ensure you won’t be separated from a necessary medication. Remember, airlines may require you to check your larger carry-on.
• Make sure your prescriptions are in their original packaging so that any travel authorities who may search your belongings can see they are genuine prescriptions. Your pharmacist can prepare blister packs of your medication for convenience when taking shorter trips.
• Don’t put all your medication in one container to save space; this increases the risk that you might mix up your pills and take the wrong one by accident.
• Carry a week’s extra supply to cover you in case of travel delays or emergencies.
• Carry a copy of your medication record in case of emergencies where you are may be unable to explain what you are taking. You may also want to carry a copy of the prescription or a doctor’s note in case of loss or theft. It’s helpful to list the pharmaceutical name of your medication, the brand name and the generic equivalent to avoid confusion about your medicine in other countries should you need an emergency replacement.
• Ask your doctor for a letter supporting your prescription for any controlled substances you may be carrying, including painkillers, stimulants and injectable medications. If travel authorities raise any concerns, this will help you demonstrate and justify your medical need for these items.

• Some countries have limitations on particular types of medications, including over-the-counter medications, that you can bring in. Check your federal government website for advice. Most embassy staff in your country will also provide advice about what you can or cannot take with you when you visit their country.
• If part of managing your chronic disease involves special equipment such as needles, check with the federal agency regulating travel and security in your country to see about the legalities of crossing a border with this equipment.
• Most jurisdictions exclude liquid medications like insulin from your one-litre/quart liquid and gel allowance at air travel security. To avoid delays, carry a separate small bag with medically necessary liquids, and let the security screening officer know what it is. Most airlines and travel agencies provide links for specific information relating to the rules in the countries you are visiting.

Can you bring medical cannabis with you on a trip?

In Canada, citizens can take their medical cannabis with them when they travel within the country. However, you are not permitted to take any form of cannabis, recreational or medical, across the Canadian border to the United States or any other country.

Carrying any amount of cannabis out of Canada or back into the country can lead to you being charged with a criminal offence. If you are charged or convicted, this could lead to your being denied entry to other countries in the future.

Can you get a prescription refilled early before your trip?

So you’re all set: you’ve checked the regulations, you know what you can bring… but then you realize you don’t have enough medication to cover your trip. Now what?

It depends on the type of medication. Many prescriptions, such as those for chronic illnesses like diabetes, can be written for longer periods—three to six months, or even a year. Your pharmacist can issue an early refill (if you have any left) because you plan to travel.

However, some medications may require advance approval from your insurance company for an early refill, particularly when it comes to medication considered a controlled substance. These are drugs federal agencies consider to be at risk for  abuse or diversion. Most doctors are able to prescribe a 30-day supply but there may be limits on refills.

What if you have medication problems when you arrive at your travel destination?

If you should lose your medication, have it stolen, or even have it confiscated at the border, report your loss to the appropriate authorities. Both Canadians and Americans can contact their local consular office for help locating a physician or pharmacist for help, and consular staff can also help you if you experience a medical emergency.

An ounce of prevention is worth a pound of prescription refills

Good planning can solve the vast majority of medication-related problems that come up when you’re traveling. There are no perfect guarantees of a trouble-free trip, but when it comes to your health, it’s always best to manage your medication the way you manage your travel tickets: get it done as far ahead of time as possible, and keep it safe at all times.

ADV-Care wishes you a fantastic trip!

Have you ever had that pain and burning sensation in your chest as you’re just getting ready to sleep after a hard day’s work? Well, I have. And in case you haven’t – lucky for you – I assure you it is not the most pleasant feeling. But if you have you are not alone. It is estimated that 40 percent of people suffer from gastric reflux at some point.

So what is heartburn? We feel that burning feeling and tightness in our chests and behind our breastbone when the acid made by our stomach travels through esophagus and damages it’s mucous membranes causing them immense pain and discomfort. It is important to realize that the location – rather than the amount – of acid is responsible for the symptoms. However, reducing the amount of acid is probably the most effective way in treating this condition. Normally a muscular doorway (Lower Esophageal Sphincter) should block stomach contents from gaining access to esophagus but certain situations can interfere with this protective mechanism. Some of these causes include:

• Consumption of certain foods
• Smoking and Alcohol use
• Pregnancy
• Many medications
• Increased abdominal pressure, because of obesity or pregnancy

Also prolonged exposure to acid may further weaken the tone of the sphincter or result in more chronic and complicated lesions.

So what can we do about it? First let me point out the obvious; while there are ways to relieve yourself of acid reflux and pain associated with it, it is always a wise choice to see a physician who can properly diagnose and treat the disease accordingly. This is especially important if you are presented with 1 or more of the alarming conditions (eg, difficulty swallowing, painful swallowing, gastrointestinal bleeding, iron deficiency/anemia, weight loss, early satiety, and vomiting) or your symptoms continue beyond 2 weeks regardless of appropriate lifestyle changes and over the counter therapy.

In many cases patients feel discomfort primarily when they sleep or lie down. In  these cases a simple adjustment of head position and elevation by 6 to 8 inches might do trick or decrease the episodes occurrence. avoiding certain foods (eg, chocolate, peppermint, fatty foods, caffeine, citrus, and tomatoes) has been shown to be helpful in decreasing the number of episodes. Cigarette and alcohol consumption should be avoided as both of which are important culprits in onset and severity of this problem.

The other approach which could also be attempted is over the counter heartburn medications. Any OTC heartburn therapy is a member of 3 major categories which I briefly explain efficacy and mechanism of action below:

1. Antacids; these medications act by deactivating the acid already present in the stomach and esophagus thus providing the patient with a rapid relief. However, antacids also decrease the amount of acid in the stomach and when the stomach realizes this change in PH responds by secreting more acid and potentially causing another episode. This is the reason why antacids are only transiently effective and require multiple dosing(upto 12 times per day) .
2. Histamine 2 (H2) blockers(eg, Famotidine and Ranitidine); these drugs interfere with a pathway responsible for acid secretion thereby slowing the acid synthesis. While these drugs are very effective at treating single episodes of heartburn their effects start to wane with frequent dosing (eg, more than twice a week).
3. Proton Pump Inhibitors (PPIs); they inhibit release of a key factor in acid synthesis and are very effective treatment option for Gastric reflux episodes. PPIs do not develop tolerance (i.e. become less effective with time) in fact they have been shown to generate a more significant response after several days(starting after day 4) which means these drugs are the most effective in controlling recurrent conditions with frequent episodes. PPIs effect is dependent upon the dose consumed however anything higher than 20 mg per day is not associated with a stronger control so it is believed that 20mg per day is the optimal dose for treating frequent heartburns.

According to the FDA, over 1.3 million people are injured annually due to medication mistakes, which include dispensing errors in U.S. hospitals and pharmacies. Roger Bate, an economist and public health expert at the American Enterprise Institute, believes it may be safer to receive your medications in blister packs, whether dispensed locally or shipped by mail, and the FDA seems to agree. ADV-Care have been dispensing all its medication in its original manufacturer container including plaster packs.

The FDA supports use of blister packs to tackle problems of medication errors:

“Thoughtful use of unit-of-use container closures (e.g., blister packaging, calendar packaging, sachets, and pouches) that can be dispensed intact to patients may help to reduce medication errors. Such packaging may minimize certain medication dispensing errors that can occur when repackaging from a bulk container into patient-specific containers.”

ADV-Care Pharmacy Do Not Deal With Loose Pills

ADV-Care Pharmacy, do not deal with loose pills at all. Instead, they use blister packs or sealed bottles straight from the manufacturer. The fact is that the process of transferring pills at the pharmacy from a large container into a smaller pill bottle for final dispensing has opened the door to human errors in the U.S. and Canada. We avoid these mistakes by dispensing medication in blister packs or its manufacturer sealed packages. They are safer (per the FDA, even!).

“Blister packs from ADV-Care are directly from the manufacturer, eliminating the room for error that is present is U.S. pharmacies where technicians count out each tablet,” said Dr. Patel from PharmacyChecker. “Those blister packs are labeled with the drug name, strength and expiry date. In addition, ADV-Care places another patient prescription label on the medication.”

ADV-Care dispense medications in line with FDA’s blister pack recommendation. 

What is the definition of “immunocompromised”?

Being immunocompromised means that your immune system is weakened, either by a disease or by a medication. It means you are more likely to get an infection and more likely to have a severe illness if you are infected than someone who has an immune system that is working well (this is known as being immunocompetent). 

You can become immunocompromised in different ways, either through immunosuppression or through an immunodeficiency.

• Immunosuppression is when your immune system is deliberately weakened with medications, for example, after an organ transplant.  
• Immunodeficiency is when the body cannot produce enough of certain blood cells to defend against infection. You can be born with an immunodeficiency (also known as a primary immunodeficiency), or you can get an immunodeficiency later in life due to an illness or medication (also known as a secondary immunodeficiency).

What diseases and medications can cause you to become immunocompromised?

Some people are born with a primary immunodeficiency, and a healthcare provider will usually pick this up when the individual is still a child. If this is you, you will know about it. 

Secondary, or acquired, immunodeficiency is the much more common kind in adults. It can be caused by life events, diseases, and medications.  Here’s a pretty complete list of the causes of secondary immunodeficiency:

1. Any type of cancer can make you immunodeficient, like solid (organ) cancers and blood cancers such as Hodgkin’s disease, leukemias, and myelomas
2. Chemotherapy or radiation therapy for cancer
3. Medications that treat autoimmune diseases (for example, corticosteroids, cyclosporine, methotrexate, azathioprine, and biologic therapies like rituximab and etanercept, to name just a few)
4. Any infections, including bacterial infections, mycobacterial infections (such as tuberculosis), and viral infections (for example, HIV/AIDS, measles, herpes, glandular fever (EBV), CMV, and chickenpox)
5. Chronic diseases like diabetes type 1 or type 2, kidney failure, liver cirrhosis, and liver failure
6. Malnutrition
7. Autoimmune conditions such as lupus (SLE) and rheumatoid arthritis
8. Extensive burns
9. Exposure to environmental toxins (like radiation and toxic chemicals)
10. Having no spleen function due to not having a spleen (asplenia) or reduced spleen function (hyposplenism), which can happen because of physical trauma or sickle cell disease, among other causes   
11.  Pregnancy
12.  Aging
13.  Stress 
14.  Tobacco smoking and alcoholism

And then there are those medications that are prescribed to deliberately make you immunosuppressed, when you need your immune system to be forgiving. Examples include:

• Medications that destroy the bone marrow before a transplant
• Medications to prevent or treat graft-versus-host disease, a rare and serious condition that can happen after bone marrow transplant when donor cells attack the recipient’s cells
• Medications that prevent or treat rejection after an organ transplant (for example, mycophenolate, tacrolimus, or cyclosporine)  

The Covid-19 pandemic has affected many aspects of our daily lives, and with the current restrictions imposed on businesses to maintain social distancing, it’s changing how we consume.

Consumers are now turning to online ordering for all their needs, which includes groceries, legal services, and medication. As it’s become risky and inconvenient to pick up medicines from a community pharmacy, ordering prescriptions online is a more safe and convenient option. 

Consequently, all customers with recurrent needs of medication supplies or medical devices can purchase from ADV-Care Pharmacy. As a leading Mail-order pharmacy in Canada since the year 2000, our endeavour is to deliver your Canadian medication and specialty drugs wherever you need it worldwide on time at the best cost possible. ADV-Care Pharmacy have perfected Tele-pharmacy services for over 20 years unlike new businesses trying to win your sales without proper knowledge or experience that leaves you, the patients, wondering if you ever going to receive your essential medication in the promised time.  

Customers can order their prescription drugs and all their health and PPE supplies from us online 24/7, or use our mobile app that is available for download on Android and Apple app stores for processing orders and securely sending documents and payments.

The process starts when your doctor sends your prescription (by fax or e-script) to the pharmacy. Patients can confirm their order requirements online, by telephone or using the mobile app from the comfort of their home or on the go 24/7. 

The payment for the medicines can also be made securely either online, by phone or via the ADV-Care mobile app. So, if you want to avoid the inconveniences and the risk of going to the community pharmacy, we suggest that you go online. Not convinced yet? Read on.

With many years of experience in delivering medications by mail, you will have only pleasant surprises, see customer’ testimonials. As an online Canadian drug-store, our team renders confidential, comprehensive, and customized pharmaceutical services on a one-to-one basis.

Patients talk directly to our pharmacists for all their concerns and counselling about their prescriptions, and medicines can be delivered directly to patients globally.

If you have any questions about ADV-Care Pharmacy in Markham, Ontario, please contact us by clicking here. And you can view customers’ testimonials here.

Key takeaways:
Risk factors for severe COVID-19 infections and poor outcomes include comorbid conditions, low socioeconomic status, lack of access to healthcare, low-quality healthcare, and race and ethnicity.

Black and Hispanic patients are most at risk for a severe case of COVID-19.
The severity of a COVID-19 infection varies depending on the patient. Some patients will have more complications with the infection that could lead to hospitalization, ventilator use, or even death.

Researchers are still examining the exact factors that can lead to a more severe COVID-19 diagnosis, but one thing is becoming clear: The disease can be affected by both health and non-health-related factors.

Comorbid conditions can increase the risk of severe COVID-19 complications, and lack of access to healthcare and poor quality of care can make a patient’s situation worse. Patients of certain races and ethnicities, particularly Black and Hispanic people, are more at risk for severe COVID-19 due to higher rates of comorbidities and poverty, and difficulties accessing and receiving care.

In this piece, we’ll examine these factors in more depth.

Certain comorbidities lead to more severe COVID-19 cases
A comorbidity is when a person has more than one disease or illness at the same time — like if a patient has diabetes and coronary heart disease.

According to the Centers for Disease Control and Prevention (CDC), having the following conditions with COVID-19 can increase the risk for severe illness:

Chronic kidney disease

• Chronic obstructive pulmonary disease (COPD)
• A weakened immune system (immunocompromised state) from a solid organ transplant
• Obesity (body mass index [BMI] of 30 or higher)
• Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
• Sickle cell disease
• Type 2 diabetes

The CDC has released preliminary data on the top comorbidities reported in patients testing positive for COVID-19. The two leading comorbidities seen in patients with severe COVID-19 cases were obesity and hypertension. Among the patients who had to be hospitalized, data showed that 49% were obese and 56% had hypertension. A person who is obese is not only at increased risk for severe illness but also increased risk of infection with COVID-19.

Other reports have noted a similar pattern. A study done in France found that 76% of patients admitted to intensive care for COVID-19 were obese. Similarly, a study conducted on factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 in New York City found that obesity was one of the biggest risk factors for hospitalization. Another study on 5,700 hospitalized COVID-19 patients in New York City found the most common comorbidities to be hypertension (56.6%), obesity (41.7%), and diabetes (33.8%).

Overall, the presence of hypertension, diabetes, obesity, and coronary artery disease (CAD) seem to lead to higher rates of severe COVID-19 complications.

Certain races face a higher risk of developing comorbidities and severe COVID-19
Comorbidities put a patient at risk for developing a more complicated and serious case of COVID-19. And a patient’s race can place them at a high risk of comorbidities. Several studies and data show that some races are disproportionately affected by comorbidities in the United States.

In April 2019, the CDC published their findings from the National Health Interview Survey, which identified racial and ethnic disparities for certain diseases. Black and Hispanic people had higher prevalence rates for three out of the four top comorbidities associated with severe COVID-19 cases.

Rates of Comorbidities by Race

As we discussed above, high blood pressure can lead to severe COVID-19 complications. But controlling hypertension and taking the recommended medications varies by race. According to the CDC, 32% of non-Hispanic white patients control their blood pressure with medication. In contrast, only 25% of Black and Hispanic adults and 19% of Asian adults control their high blood pressure.

Sickle cell disease is a particular risk for African Americans
Additionally, the CDC has recently listed sickle cell disease as a comorbidity that increases the risk of a severe case of COVID-19. Sickle cell disease is a blood disorder that affects approximately 100,000 people in the United States and is most commonly seen among people whose ancestors came from sub-Saharan Africa; Spanish-speaking regions in the Western Hemisphere (South America, the Caribbean, and Central America); Saudi Arabia; India; and Mediterranean countries such as Turkey, Greece, and Italy.

CDC data shows that 1 out of 365 Black or African-American babies are born with sickle cell disease and 1 in 13 are born with the sickle cell trait. If a baby is born with the sickle cell trait, they are a carrier for the disease but will not develop it.

The Agency for Healthcare Research and Quality produced a Healthcare Cost and Utilization Project statistical brief that includes data on inpatient hospital stays for sickle cell patients from 2000 to 2016. Nearly 90% of hospital stays were for Black patients, and most of those patients (52.5%) were from the lowest-income communities.

Overall, comorbidities are higher among Black and Hispanic populations compared to white populations. Since comorbidities increase the chances of severe COVID-19 infections, this makes Black and Hispanic people more at risk.

Lower socioeconomic status puts patients at higher risk of severe COVID-19
Other than comorbid conditions, a person’s economic status also plays a role in their vulnerability to not only contracting COVID-19, but also their risk for a severe case.

A well-known and accepted theory among public health specialists is the “health gradient.” It is when lower socioeconomic status leads to higher illness and mortality rates.

Data from a Los Angeles County Department of Public Health report appears to support this theory in regard to COVID-19. The report’s findings made it clear that as income decreased, rates of COVID-19 cases and deaths increased — likely due to low-income patients having less access to care and lower quality of care. This unfortunate truth will be a crucial factor during the COVID-19 pandemic and who will disproportionately be affected.

Socioeconomic status and race/ethnicity
Socioeconomic status can determine how severe a COVID-19 infection will be. But certain races tend to have lower incomes than others.

Case in point: Black and Hispanic people over time have had lower median incomes and higher poverty rates than white people.

In 2018 the official poverty rate in the United States was 11.8%. However, Black people had a 20.8% poverty rate and Hispanic people had a 17.6% poverty rate in comparison to white people, who had a 10.1% poverty rate and white, non-Hispanic people, whose rate was even lower, at 8.1%.

Research indicates that Black and Hispanic populations are at heightened risk for severe COVID-19 due to lower incomes and higher poverty rates. In order to properly protect these vulnerable populations, the U.S. needs to provide them with accessible testing and affordable care.

Poor access to care makes it harder to get treatment for COVID-19
In a 2013 report, the CDC found that people who have lower income levels will have higher rates of mortality, morbidity, and decreased access to healthcare. The report also stated that low-income levels are frequent and constant with groups who demonstrate the poorest health. Those who already have trouble accessing healthcare are more likely not to receive treatment if they have a severe case of COVID-19, since getting care is so difficult.

Below is a chart showing the relationship between poverty level and ability to access healthcare. Those who had an income below 100% or at 100% to 199% of the federal poverty level were three times more likely to delay or not receive medical care compared to those with an income at or above 400% of the federal poverty level.

Percent of Delay or Non-Receipt of Healthcare Based on Poverty Level

In 2018, a report published by the Agency for Healthcare Research and Quality (AHRQ) also showed that lower-income individuals experienced worse access to healthcare than higher-income individuals. In their research, they looked at 20 measures of access to care including the following: having health insurance, having a usual source of care, encountering difficulties when seeking care, and receiving care as soon as wanted. Overall, lower-income individuals had worse access for 19 out of these 20 measures.

Finally, in a healthcare survey conducted on 722 low-income families in Oregon, lack of insurance coverage, poor access to healthcare services, and unaffordable costs were recorded the most by respondents. On average, 25% of publicly insured respondents noted that they were not able to access healthcare services. On top of that, 30% of respondents with private insurance noted concerns over the cost of their care.

So just because low-income families have insurance does not mean they are accessing care. And not all of those who have access to care are getting treated fully due to costs.

Access to care and race/ethnicity
The AHRQ report also showed that access to care differed not only by income, but by race as well.

The chart below shows how income and race groups differed in their experience with access to care. The data collected was based on different measures (ex., number of people with a usual primary care provider) to help quantify experiences with access to care. The number of measures that were compared per group was based on the available data. The year used was either 2016 or 2017 depending on the data that was available.

How Different Groups Rated Access to Care Measures Compared to White People

Hispanic people had the worst experience with access to care. They reported 75% of their measures being worse than white people. Black people experienced worse access to care for 43% of measures compared to white people, and Asian people experienced worse access than white people for 37% of measures. Black and Asian people had the largest disparity compared to white people for the measures related to timely access to care. Of the measures being reported, the largest disparities between Hispanic people and white people were those related to health insurance.

It’s important to identify people who struggle to access healthcare so the appropriate resources can be focused on supporting these people. Although this is important to recognize in normal times, it’s even more crucial during a pandemic. People who can’t access care may be more at risk of developing a severe case of COVID-19 that goes untreated and ultimately could be fatal.

Low quality of care among low-income patients can also lead to worse COVID-19 outcomes
Low-income patients are not only finding it difficult to access healthcare, but their quality of care can suffer, too. A study examined the effect of income on five patient-reported healthcare experiences (access to care, provider responsiveness, patient-provider communication, shared decision-making, and patient satisfaction) from 2010 to 2013.

A total of 16% of low-income patients reported poor communication with a provider. But only 9% of high-income patients responded the same. Very-low-income patients also reported poor provider responsiveness and poor shared decision-making twice as much as higher-income patients. The conclusion from this study was that low-income patients had overall a more negative healthcare experience.

Adults Who Had a Doctor’s Office or Clinic Visit in the Last Year Whose Providers Sometimes or Never Explained Things in a Way They Could Understand

Data from 2016 shows that double the amount of low-income adults (8.9%) than high-income adults (3.5%) had a doctor’s office or clinic visit in the last 12 months where health providers sometimes or never explained things in a way they could understand. This further supports the idea that low-income populations experience lower quality of care due to poor communication with their healthcare provider.

Quality of care and race/ethnicity
The AHRQ report referenced in the last section also looked at quality measures based on race. Black, American Indian or Alaska Native (AI/AN), and Native Hawaiian/Pacific Islander (NHPI) patients each reported worse quality of care compared to white patients on 40% of measures. Hispanic patients experienced worse quality of care compared to white patients on 35% of measures.

How Different Groups Rated Quality of Care Measures Compared to White People

In addition, a review of studies from 1995 to 2016 explored patient-physician communication between Black patients and doctors. This review found that in over 50% of studies, Black patients reported worse communication, more negative talk, less participatory decision-making, and shorter visits compared to white patients.

Lastly, a phone survey was conducted from 2007 to 2008 with a random sample of 8,140 patients with a chronic illness. The aim of the study was to examine the patient-physician relationship with regards to race and if it had an effect on a patient’s role in their own health. The results found that both Black and Hispanic patients saw their role in the patient-physician relationship to be less equitable than white patients did.

A similar phone survey study was done with Veterans Affairs (VA) patients to determine if there were racial differences in care. Results showed that Black patients had less trust in their VA care provider and system than white patients. They were also less satisfied with patient-physician communication.

Like comorbidities, Black and Hispanic patients are most vulnerable for a severe COVID-19 infection due to the likelihood of having lower quality of care. Even though they may have worsening symptoms from COVID-19, they may not try to get treatment due to poor quality of care in the past. And even if they seek care when they start to experience serious symptoms, their healthcare providers tend to deliver lower quality of care. Their symptoms may be dismissed due to the lack of communication and trust between the patient and the provider.

Summing it all up
The healthcare system is built in a way such that quality and access to healthcare, as well as overall health, depend on one’s race, ethnicity, socioeconomic status, and comorbid conditions. While patients have long faced the trials and tribulations of the healthcare system, certain inequities are becoming even more apparent during the COVID-19 pandemic and can no longer be ignored.

Due to the drastic difference in health outcomes based on these inequities, certain groups are more at risk for not only contracting COVID-19, but experiencing a more severe case and possibly death. For example: A county-level analysis of zip codes in Illinois and New York and concluded that the COVID-19 death rate is disproportionately higher among areas of poverty, crowded housing, and populations of color.

Data shows that depending on your race, you are more likely to have a lower socioeconomic status and a higher likelihood of suffering from a comorbidity. As described throughout this post, these factors can contribute to a person being more susceptible to having a severe Covid-19 case that could lead to hospitalization or worse. Black people in particular are one of the most vulnerable populations to COVID-19.

For example, preliminary Medicare data was recently released showing COVID-19 hospitalization rates by race. Black Medicare patients have almost four times the hospitalization rates compared to white Medicare patients, and Hispanic Medicare patients have double the hospitalization rate compared to white Medicare patients.

The CDC has also released hospitalization rates by race for patients with COVID-19. Hospitalization rates for non-Hispanic American Indian or Alaska Native and Black patients are both five times that of white patients. According to their data, Hispanic or Latino patients have a hospitalization rate that is four times that of white patients.

The data clearly shows who in our communities is most vulnerable to severe COVID-19 infections that lead to hospitalization. We must provide the resources to help mitigate the devastation happening to these populations

I’ve been fielding questions all week from my patients about hand hygiene — and rightly so, given the current cold and flu season, and concerns about the outbreak of coronavirus disease (or COVID-19). When should you use a hand sanitizer, and when should you wash your hands? What should you look for in a hand sanitizer? Here’s what you need to know.
Is using a hand sanitizer or washing your hands better?

The mistake we make is using alcohol-containing hand rubs as a substitute for washing our hands with soap and water. Generally speaking, the only time to pick a hand sanitizer is when you don’t have access to soap and water. So, it’s about convenience.

While hand sanitizers do help, studies consistently show that handwashing with soap and water is better. For example, one study found that handwashing was better than an application of an ethanol-based hand sanitizer for removing rhinoviruses from the hands. Rhinoviruses cause the common cold.

Another study found that handwashing also worked better than ethanol- and propanol-based hand sanitizers at removing rotavirus and influenza A from the hands. Rotavirus can cause diarrhea. Influenza A is the type of virus that typically causes the seasonal flu.

And yet another study found that handwashing was better than alcohol rubs and antiseptic wipes at removing the bacteria C. difficile from the hands. C. diff is the type of bacteria that can cause symptoms ranging from diarrhea to serious inflammation and damage to the colon.

To sum it up, the evidence largely suggests that washing your hands with soap and water is better than using alcohol-based hand sanitizers for removing viruses and bacteria from the hands.

When might hand sanitizers be a good option?
Hand sanitizers can be helpful when you’re on the go. You can easily carry a bottle of it in your purse or backpack. If you’re traveling, it can tide you over until you find running water. And they do help to remove some of the germs on your hands.

What should you look for in a hand sanitizer?
People most often use alcohol-based hand rubs in the form of gels. But as it turns out, it doesn’t matter whether you pick a foam, gel, or wipe. They all significantly reduce microscopic bugs and germs on your hands.

Alcohol solutions containing 60% to 95% alcohol are generally effective and usually contain ethanol, propanol, or a combination of both. Popular products include Purell (70% ethanol) and Germ-X (63% ethanol).

A good thing to know is that ethanol, the most common alcohol ingredient, appears to be the most effective against viruses. Propanol, another type of alcohol ingredient, is better against bacteria. For that reason, many hand sanitizers contain a combination of both. Look for these ingredients on product labels when you go to choose one.

One downside to alcohol-based hand sanitizers is that they can be very drying to the skin. That’s why many of these products also contain glycerin, an ingredient that can help prevent skin dryness. Emollients or moisturizers, like aloe vera, can also help replace some of the water in your skin that is stripped away by the alcohol.