Coronavirus: My weekly review

3/21 Update- #WhatDidYouDo when the world stopped in 2020

This is the 22nd day of my preparedness and attempt to educate everyone about the coronavirus. I am trying to update people about the reality that we are likely about to face.

I have counseled countless people, patients, friends, and leaders of the private and public sectors. I’m going to try to get my doctors office ready for the new normal that will follow the original 4-6 week surge in cases.

More schools are shutting (at least 124 countries have shut down all schools), and more countries are closing down their borders and shutting down elective services.

Source and get the timeline:

unesco- school closures

The White House has asked that bars and restaurants close, and to not hold gatherings of more than 10 people. This shouldn’t mean that people should try to stay at 10 people. All people should try to limit exposure to others. We need to prevent anyone who has coronavirus to spread it to someone else (many people don’t know they have it). It is easy to catch. Also wash your hands for 20 seconds with soap and water.

SIgn my petition for people of the world to do their part: We can stop the spread of the virus by avoiding contact with people as much as possible. I still work as a doctor which is an essential service, so some people still will need to work. So if you have to work or your parents have to work, pray for the best.

Petition to self isolate

My data shows we are 11 days behind Italy and we are already on the upslope of the exponential curve which can’t be bent for 14 days until after we make changes. Sources and live links are below.

Cases and deaths in US, Italy,Spain,France,Germany,NJ,NY,CT

I endorse these articles that explain the science about the spread of the coronavirus and how long things will take to stop the initial spread. Find the petition to the White House at the top of the second document which I signed.

Thomaspueyo- coronavirus-act-today-or-people-will-die

Tomaspueyo- coronavirus-the-hammer-and-the-dance

My gaming company: I’d like to bring some calm to my social media family and my gaming community, Legendary Alliance Gaming, (LA Gaming) to let you know most people will be OK and recover, but many people will become sick and many people will not live through this pandemic. The most important way that all people can help is to try to avoid other people. When the virus gets into a new person it can spread and we can give it to our parents and grandparents or elderly neighbors. My partner Joel (jmf) and our team are working on ways to help our gaming community with a plan to expand our community to follow.

Twitter: @LAEsportsOP

Discord: LA Gaming discord

Website: (under construction):

You can learn more about me and can educate friends and family at my website:

Dr. Savatta’s website

That website includes a live town hall with my NJ Assemblyman Jon Bramnick at 7PM on 3/17 that can be watched on:

Town Hall with Assembly Bramnick

I have a facebook group that people can join and contribute to, as can anyone they know:

Lets learn from the Chinese on how to stop the pandemic in the short term- SHUT DOWN AS MUCH AS POSSIBLE:

Countries that I have been following that have not taken precautions early enough: Spain is 5 days behind Italy, France 8 days, Germany 9 days, and the USA 11 days. It takes 14 days for changes made today to have an impact.

The data can be seen with daily cases at:

Italy Coronavirus: 53,578 Cases and 4,825 Deaths

Updates from around the world:

John Hopkins data for new cases and deaths:




TownHall with my Assemblyman
I was honored to be the guest of my Assemblyman Jon Bramnick. My friend and infectious disease expert, Dr Juan Baez was on the phone with us. Watch the townhall for important info.
I will plan on having my own Q&A on coronavirus in the near future.

The main point was that the coronavirus is very dangerous and will be slowed best by social isolation and distancing.

My new website will has a petition I ask all people to sign and links to my social media

The reason the world is shutting down

Many people are finding it hard to understand the alarm and the unprecedented closures we have been seeing around the world.

You can see how many people are getting sick from the coronavirus or the daily cases in countries and states I have been tracking.

It’s hard for people to understand exponential growth. 36 hours ago an educated friend of mine told me there were just a few cases in US and that we were doing a better job than Eu at preventing this and 8 hours ago someone with about 8 degrees felt that we would only have a few hundred people die in NYC.

Being able to predict that cases in US will be over 600 the next and Italy over 5000 despite being shut down for a week will help explain what is happening to people.

The best practice in the community is to self isolate as much as possible and we still aren’t doing that in the US.

As I am typing this I am listening to CNN talk about how ER doctors and nurses in Washington and NJ are coming down with COVID-19.

The amount of cases diagnosed in most countries is very under-estimated and when countries shut down it takes 12-14 days for the cases to stop being created. Things are much worse than they seem and will be much worse for 2 weeks. Also the amount of people dying is under-estimated since many deaths aren’t found out to be due to coronavirus. Tests aren’t available and populations that have many cases think they have few or none. Everyone needs to see how many people they can avoid ASAP.

The US says that people should avoid crowds over 50 people. I think we should have isolation as much as is practical and possible.

Renal cell carcinoma growing into the renal pelvis and mimicking transitional cell carcinoma: A case report and literature review – Abstract

Renal cell carcinoma growing into the renal pelvis and mimicking transitional cell carcinoma: A case report and literature review – Abstract.

My partner and I had a similar patient that presented with a large kidney tumor that was growing into the renal pelvis and ureter. We performed a ureteroscopy and the tumor appeared as a large bulge growing down the ureter that reminded me of renal cancer growing into the renal vein. A biopsy came back as benign urothelium.

On these rare cases, I have developed a protocol to perform a robotic radical nephrectomy and transect the ureter by stapling it. I obtain pathological analysis at the time of surgery, and if the diagnosis is transitional cell cancer, I proceed to remove the rest of the ureter and a bladder cuff with robotic surgery at the same time.

BBC News – TED 2013: Uchek app tests urine for medical issues

Uchek tests for 25 different health issues and could help diagnose and treat diseases in the developing world.Increasingly mobile health is being talked up as a lifesaver in such areas.The app is the brainchild of TED fellow Myshkin Ingawale.”I wanted to get medical health checks into users hands,” he told the BBC.

via BBC News – TED 2013: Uchek app tests urine for medical issues.

As technological advances are made, how we screen and test for many conditions will be simplified and streamlined.

This article discussed an app for the iPhone that will read a dipstick in an automated manner.  This will need to be tested against current standards, but I am confident in the near future (5 years) there will be testing available in ways that we would not have thought possible 5 years ago.




FDA approves Botox to treat overactive bladder

FDA approves Botox to treat overactive bladder

The U.S. Food and Drug Administration today expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics.

via Press Announcements > FDA approves Botox to treat overactive bladder.

Men and women both can suffer from overactive bladder.  Patients usually are treated with exercises and medications (anticholinergics) to help reduce the overactivity of the bladder.  Symptoms such as frequency of urination, urgency of urination, and leakage of urine from the overactive bladder usually improve.  These medications can cause constipation, dry mouth, and other side effects.  Patients that can not tolerate medications have another option now.  Urologists can inject botox into the bladder and improve urinary symptoms.

Patients that have had prostatectomies sometimes have urge incontinence after prostatectomy and botox should be considered if other options have not worked or have not been tolerated.

The price of defensive medicine

New Study Compares Tort Systems — Reform Improves Health Care for Patients

A new study by the Pacific Research Institute, US Tort Liability Index: 2008 Report, measures the best and worst tort systems in America. In the report, the authors examine evidence provided by top economists and legal scholars on the benefits of tort reform in peoples’ lives and conclude that, among other things, reform improves health care and health care access. The report also discusses the cost of defensive medicine – most of which is prompted by medical liability concerns – which has now reached the astounding total of $163 billion a year. This is the sum of the direct costs of defensive medicine, estimated to be $124 billion a year by PriceWaterhouse Coopers, and PRI’s own estimate of the $39 billion indirect costs from lost productivity due to reduced access to health care attributable to defensive medicine. According to PRI, increased health-care costs brought on by defensive medicine have also added some 3.4 million Americans to the rolls of the uninsured.

I used to work in Indiana, which has one of the more doctor friendly malpractice systems. Potential lawsuits are brought before a panel for an opinion prior to a lawsuit being filed. Indiana also has a cap, or limit, on how much money a plaintiff can win for pain and suffering. All this led to low malpractice insurance costs. In New Jersey it is quite different.

Obese patients at higher risk during surgery

Straightfromthedoc: Risk of Post-Operative Complications, Higher in Obese Patients:

Morbidly obese patients had a death rate nearly twice as high as that of all other patients, had higher rate of cardiac arrest and have significantly higher risk of complications following surgery, including heart attack, wound infection, nerve injury and urinary tract infection.
Such were the findings of a new study of a research team at the University of Michigan Health System.

Bamgbade and the other researchers found much higher rates of the following complications in obese patients: heart attack, with obese patients experiencing five times the rate of attack than non-obese patients (0.5 percent versus 0.1 percent); wound infection, with a 1.7-times higher rate (6 percent versus 3.5 percent); peripheral nerve injury, with a four-times higher rate (0.4 percent versus 0.1 percent); and urinary tract infection, with a 1.5-times higher rate (3.9 percent versus 2.6 percent).

This is another study that confirms that obese patients are at increased risk during surgery. I think minimally invasive and robotic surgery has the greatest benefit on obese patients.

Thromboembolic disease after renal surgery

UroToday – Perioperative Clinical Thromboembolic Events after Radical or Partial Nephrectomy

This study demonstrates that while the incidence of thromboembolic phenomena is low in patients undergoing renal surgery, there are specific subsets of patients that can be identified that are at increased risk and therefore deserving of more aggressive prophylaxis. These include older patients, those with a history of cardiac disease, those with a history of prior DVT, and those who have increased blood loss at the time of surgery. Prophylactic anticoagulation might be considered in addition to pneumatic compression groups in these specific subpopulations.

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