It's the Wild COVID-19 Frontier

Earlier this week, my researcher braved a trip to her local pharmacy to pick up some medication. She tied on her homemade mask as she approached the store.

"I was worried I'd be the only one in there with a mask and everyone would assume I was sick," she said.

But to her surprise, nearly everyone in the store wore some sort of face covering. From proper medical masks to bandanas and even a T-shirt tied around someone's face, all the workers and patrons looked like they'd just stepped out of a Sergio Leone picture.

Only two folks didn't wear a mask – both men.

As we mentioned in our Tuesday issue, men have a higher risk for COVID-19 complications. Part of that is due to risk analysis.

We've seen plenty of studies showing that men and women view risk differently. One paper from University of Gothenburg in Sweden said that women have higher risk perception when it comes to "threats to their family and their home." In other words, women take medical risks more seriously. It's also likely the reason women go to the doctor more regularly than men. So fellas, listen to your wives – wear a mask if you're going out in public.

There are still so many questions we're getting from our readers: When should I wear a mask? What type is best? Should I wear it if I'm just going to walk the dog?

Originally, the U.S. Centers for Disease Control and Prevention ("CDC") and the World Health Organization ("WHO") said only folks who were sick should wear a mask to avoid spreading the virus. But the problem is this: Many folks are sick without symptoms... meaning they could still spread the virus in the air without realizing it.

And even though most non-medical-grade masks won't totally block the virus from getting to you, they'll significantly cut down the number of viral particles you're exposed to. That includes homemade masks like these.

Honestly, I think it's a bit of overkill. Do what I do and follow some common sense. If you're going to a public place like the grocery store or the pharmacy, wear a mask if you want to. But more than that, stay six feet away from other people. And wash your hands when you get home.

If you're going to a park or for a walk around the neighborhood, you don't need a mask unless you could come in contact with other folks (like at a busy walking trail). From what we've seen, most people are fine moving out of the way to maintain that social distance. But take a mask just in case you run into some coughing, rule-breaking renegade who won't give you your space.

Now, onto this week's Q&A...

Q: I've been advised that I don't have to take RMD for 2020? Last year was the first year I had to take it. I was 71 August of last year. Can I defer this year? – J.S.

A: On March 27, the president signed the CARES Act into law. Among the provisions for stimulus checks and small business relief, the law also has a provision for required minimum distributions ("RMDs").

The CARES Act suspended 2020 RMDs for anyone, regardless of age or whether or not you've already begun taking your RMD. This applies to IRAs, 401(k)s, and inherited IRAs. This doesn't apply to defined benefit accounts.

If you've already taken your RMD for 2020, there may be a way to reverse it. But the rules around this are more complicated than we'd like to explain here. So for folks who have questions about their specific situations, we recommend contacting a tax adviser for help.

Q: I have been using famotidine rather than ranitidine for a number of years and my doctor says this is OK. I take 20 mg in the morning and at night as a preventive procedure. What do you think about this? – J.R.

A: Famotidine and ranitidine are both types of H2 antagonist. But, as we mentioned before, ranitidine drugs, like Zantac, were found to contain high levels of cancer-causing chemical NDMA. So not all H2 antagonists are safe.

When it comes to heartburn medicines, there's another group called proton pump inhibitors ("PPIs"). I've recommended against these before because of their link to heart attacks. Many other studies have also shown correlations between taking PPIs and increased incidences of chronic kidney disease, along with an increased risk for hip fractures.

H2 antagonists, on the other hand, don't have the same heart attack and stroke risks. But given the news about Zantac, I find myself repeating what I've said for years: Lifestyle changes should be your first line of defense.

There are folks who have severe heartburn that lifestyle changes just can't fix. In that case, an H2 antagonist is a safer option than a PPI. And there's no indication that famotidine drugs, like Pepcid, carry the same risks as ranitidine.

The key here? If you don't need to take heartburn medication, don't. And if you think you do, try making lifestyle changes first. Why waste your money by unnecessarily loading up your body with drugs?

Q: What is the difference between the CPAP and the ventilator? They both force air for breathing. – J.P.

A: CPAP (continuous positive airway pressure) machines are used for patients who can breathe on their own. All they provide is a constant amount of pressure into the lungs. They're commonly used for obstructive sleep apnea, or in the acute setting for patients with pulmonary edema (fluid in the lungs). CPAP machines can't breathe for someone.

A ventilator is much more invasive than a CPAP machine and can do a lot more. Ventilators can provide a wide range of ventilatory support. They're able to fully take over the act of breathing. Some ventilators can also provide CPAP.

A drawback of using CPAP machines for COVD-19 patients is the mask. The mask doesn't prevent the pathogens from escaping into the air. A ventilator is a closed system, so most of the air that does escape gets filtered.

But again, the main difference is that a CPAP can't handle breathing for patients the way a ventilator does.

Keep your questions, suggestions, and comments coming our way... [email protected].

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
April 17, 2020