CV🦠News – Week of April 20, 2020 – The Village Doctor

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CV🦠News – Week of April 20, 2020

Greetings, Friends of TVD!

Here we are, the third issue of CV🦠News! Again, thank you to all five physicians at The Village Doctor for their brainstorming and contribution to this newsletter effort, thank you Drs. Abrams, Phillips, Pittson, and Sangani! Let me also give thanks to the various contributors to our Hope and Grace page, a collection of works and perspectives gathered from around the world. 

HOME ALONE?
Yes, it’s been six weeks since we’ve been sheltered at home: how time flies by… For some of us 6 weeks have Zoomed by (get it?), however, for others this has been difficult especially if you are older, alone and not so tech savvy. So, I have a favor to ask: Are you helping keep the spirits up of an older family member, perhaps a parent or grandparent? I am looking for suggestions for ways to lift their spirits, but mostly for ways to engage them, ways to fill their days with activity which has meaning. Where is the win-win? Teaching history by sharing stories to kids stuck with online distance learning? Sewing masks for people that need them? Participating in some sort of distance volunteering? I look forward to your ideas and feedback! (You can email me directly at drweiss@villagedoctor.com). Thank you.

RECENT NEWS – MORE ABOUT BLOOD TESTING
As we noted last week, the news continues to be dominated by the challenges with testing patients for coronavirus, or COVID-19. Recall that on April 10, Stanford University announced a blood test for coronavirus serology, a potential game changer. These new blood tests measure coronavirus antibodies (IgM, IgG) that the body makes in response to COVID-19 infection.  These antibody tests, also called ‘serology’ tests, are different than the nasal swab “PCR” tests used to detect the presence of SARS-CoV-2 genetic material currently present in respiratory secretions.   It can take 1-3 weeks before an infected person makes enough antibodies to be detected by antibody tests.  Testing too early could yield a false negative result.  

We know many people would like to know if they have been exposed and may have immunity to COVID.  While Stanford does now have a serology test, we are not yet recommending our patients have this test done.

While we all hope a positive serology test means a person is immune and “safe,” we do not yet know if, or for how long, that immunity may last. Doctors worry that knowing you have a positive IgG response could lead you to feel more comfortable being less careful with social distancing, decreasing protection of at-risk loved ones or yourself, which could be harmful until we know more about how protective an IgG response is. 

In other interesting news, Stanford recruited 3300 residents of Santa Clara County for serology testing over the weekend of April 3rd to estimate the percentage of the county that had been infected with COVID.  We know that coronavirus can cause mild and even asymptomatic infections in many people.  Antibody testing can help inform our understanding of coronavirus infection prevalence and identify those who have already been exposed. 

The study estimates as many as 81,000 people could have been infected, or between 2.5 to 4.2% of residents.  If true, this would suggest the death rate may actually be much lower than previously thought.  The study, which is still in pre-publication phase, has received a lot of criticism, mostly focused on biases in recruitment (which was done through social media platforms such as Facebook and was likely subject to bias – patients most worried about prior symptoms would be more likely to sign up) and on the error rates of the test kits used (even a small false positive rate could account for much of the findings – while the study authors argue they controlled for the known false positive rate of the test in their projections, many statisticians feel this was not adequate). 

We are eager to review additional information the study authors plan to release this week and agree that more studies are needed to provide a reliable picture of community prevalence.  

WE’RE FLATTENING THE CURVE!

Hospitalizations for confirmed and suspected cases fall in Bay Area: The number of people in Bay Area hospitals with COVID-19 or suspected of having the illness has declined over the past few weeks, a sign that early and aggressive social restrictions appear to have calmed the spread of the virus, public health experts said. State data show that the number of people hospitalized for COVID-19 in the nine-county Bay Area fell from a high of 471 on April 7 to 403 on April 19. The number of people in the hospital with symptoms consistent with the respiratory disease dropped from 360 to 203. So, we’re not out of the woods, but there is perhaps some light at the end of the tunnel?

WE STILL NEED TO BE CAREFUL, AND NOW THAT MEANS WEARING MASKS
When combined with physical distancing and frequent hand washing, we know that wearing face coverings may reduce the risk of transmitting coronavirus so Bay Area health departments have made this a requirement. Masks, bandanas or scarves that cover the nose and mouth should be worn to the grocery store, pharmacy and doctor appointments. This is punishable as a misdemeanor, but more importantly, it’s for your own safety and the safety of our community, so if you must go out, please cover your beautiful face!

SPEAKING OF GOOD BEHAVIOR
I’m delighted to introduce you to a newly formed non-profit called San Mateo County Strong. Added benefit? Some terrific videos to watch! Back on March 24, 2020, the San Mateo County Board of Supervisors approved $3,000,000 in emergency funding to support those most impacted in San Mateo County in partnership with the Silicon Valley Community Foundation. San Mateo County Strong was developed to allow people from San Mateo County and beyond to join the County’s relief effort and make directed donations that will specifically benefit San Mateo County residents, small businesses and nonprofits. There are some great videos from Joan Baez, Jerry Rice, Steve Young and other local celebrities to reinforce how we can still help each other out even while we all stay at home.

SPEAKING OF BAD BEHAVIOR… WHAT ABOUT VAPING AND CORONAVIRUS?
One of our patients asked: “does vaping increase my risk for COVID 19?”  The answer is: maybe. Bottom line, as with so many things related to COVID-19, we don’t really know yet. In a hat tip to #science, on 4/16/20, the FDA issued a statement that modified it’s stance saying vaping has unknown effect on the novel coronavirus. The statement reads, “E-cigarette use can expose the lungs to toxic chemicals, but whether those exposures increase the risk of Covid-19 is not known,”  

That said, there are plenty of reasons to recommend that you NOT vape during this coronavirus pandemic (or really any time, say the doctors at TVD). We definitively know that cigarette smoking causes heart and lung disease and that it suppresses your immune system. We know that vaping causes harm to the lungs, leaving lung tissue inflamed, fragile and susceptible to infection.

We also know that coronavirus specifically attacks your lungs, filling them with fluid making it hard to breath, or worse. We have heard horrible stories from our colleagues in New York City about putting young people on ventilators and even then their lungs fail them, and those same NY doctors (#healthcareheroes!) have noted that many of these patients have a history of vaping. Yes, these are anecdotal stories and not real #science, but if I were you, I’d do everything to keep your lungs healthy and happy during these times! This includes you smokers (see also the image below). We believe this strongly enough to have even put up a fun video (with a serious message) on TikTok

Related, from our friends at the American Lung Association, for those that are hunkered down, this might prove to be the best time to quit smoking.

  • Identify your smoking triggers.  You may be more apt to light up when you’re out with friends or on a long commute to or from the office.  Social distancing and working from home could provide the perfect opportunity to lay low for a little while and focus on your quit.  
  • Refresh your space and day.  Whether it’s a specific chair on the porch or at the dining room table after a meal – doing a little Feng Shui with your living space can help you relearn certain rituals to avoid smoking. And hey – you’ve got more time on your hands to play interior decorator!
  • Stay connected.  Our hangouts are going virtual – which is the perfect time to connect with others that are quitting smoking.  Join our online support community and join the Quarantine Quitters!  
  • Get proven support.  Join Freedom From Smoking – our quit smoking program that walks you through the step-by-step process of quitting smoking.   Through the program, you’ll have access to tobacco cessation counselors who can counsel and support you one-on-one. 

HOPE AND GRACE
If you have made it this far, time for a reward, something to lighten your day, and acknowledge the human spirit. Find some escape, or perhaps even inspiration, in this collection of works and perspectives gathered from around the world. Please contact me directly if you have come across something that has lifted your heart today.  Dr. Eric Weiss

We are in the midst of the Spring holidays–Easter, Passover, Greek Orthodox Easter, and Ramadan. These are interesting times for those of faith, who may find these musings compelling: ‘Here in Spirit’: An Oral History of Faith Amid the Pandemic

And further on the topic of faith, be reminded of your good fortune as you read briefly about the enduring legacy of Teresa of Ávila here in an interesting new Blog entitled Women Doing Theology.

And from a group I have been associated with for many decades,  my colleagues at the International Society of Travel Medicine, “To Our Global Healthcare Family:  We celebrate your dedication, bravery, empathy and compassion during this extraordinary pandemic. Thank you to all who submitted a Video Portrait to this project; the response around the globe has been incredible.”  Watch on Vimeo, And Still We Dance.

And lastly,

Thank you, Connor (!), for sharing your big feelings. All, please read this thoughtful poem from one of The Village Doctor’s delightful 3rd graders…

 

*****

Yours, in health and resilience,

Eric and the TVD MD team…