News

CV🦠News – Week of June 1, 2020

Thoughtful greetings, TVD friends,

Here we are, the ninth issue of CV🦠News to hit your email inbox. But different this week is the convulsion that our country is in, pushing even the coronavirus pandemic to the back burner. I have mentioned our remarkable team many times in these pages, but with this issue I want to draw attention to our diversity; diversity of age, gender, orientation, and color. During this ugly week I want to clearly note that Anti-Black racial violence is not solely a national issue: Anti-Black attitudes infect not just Minneapolis, Minnesota, and Louisville, Kentucky, but every American institution and locality. This includes Stanford (see below). This includes The Village Doctor. I ask you, our patient family, to read below, first a letter from the Stanford Daily editors in solidarity with our Black community, and second,  a non-exhaustive list of resources and materials specific to the Stanford community and the Bay Area, published on the June 2 Editorial Page of The Stanford Daily. It is time for all of us to step forward in support of our black and brown brothers and sisters.

IN SOLIDARITY WITH THE BLACK COMMUNITY: A LETTER FROM THE EDITORS
The Stanford Daily stands in solidarity with the Black community. We acknowledge that it’s easy to make a statement of support — it’s harder to back that up with action. In this historic moment, we have a particular obligation to report and publish on the ongoing movements and protests. However, we have an even greater responsibility to listen to and support the community we serve. Black communities are making themselves heard around the world — and we are listening, with a commitment to amplifying these perspectives in our publication not just in times of crisis, but at all times in the future. We recognize the power of journalism and our ability to use our platform to uplift Black voices and narratives.

We also recognize the responsibility that such power brings. To that end, we acknowledge the difficult relationship between the media and Black community members, particularly at Stanford. We do not pretend to fully understand the experiences of Stanford’s Black community, but we know we can do more to diversify our coverage, engage with our community respectfully and make our organization as welcoming to Black community members as possible. We acknowledge that we have not adequately addressed these measures in the past, but this is no excuse for inaction in the present. The Daily would be nothing without its readers, its contributors and its critics, and we welcome any feedback on how we can more proactively share voices from Stanford’s Black community in the future. Doing so will be a priority moving forward.

Right now, though, our publication joins millions of Americans in demanding accountability for police violence and participating in the ongoing struggle for racial justice. The Daily’s editorial board has compiled a non-exhaustive list of resources and materials specific to the Stanford community and the Bay Area. Included are links to donate to bail funds, find essential readings in African and African American studies and act in other important ways to engage the Stanford community in a more lasting effort toward racial justice. We are using these resources to reflect, educate and better The Daily for our Stanford community — we hope you share in this goal. 

Read the Editorial Board resources article here.

Holden Foreman ’21, editor-in-chief
Liz Lindqwister ’21, deputy editor
Claire Dinshaw ’21, opinions editor
Adrian Liu ’20, opinions editor
Layo Laniyan ’22, opinions desk editor

Contact the editors at opinions ‘at’ stanforddaily.com.

(Please take a quiet minute to reflect on all of this. Your TVD COVID19 updates continue below.)

REVISED SHELTER IN PLACE ORDER
On May 29, San Mateo County Health Officer Dr. Scott Morrow released a revised shelter in place order which went into effect on June 1. The importance of wearing a face covering and adhering to social distancing guidelines will still be required anywhere that is opening. With continued limitation and safety measures, the following changes are now in effect:

  • Retail stores can now open their doors to allow customers inside although curbside pickup and delivery is still encouraged when feasible
  • Places of worship can hold services with a maximum of 100 people or 25% of the building capacity (whichever is lower). 
  • Beaches in the county can now operate normally as well. 

Dr. Morrow further revised the order today, on June 4, to allow for restaurants with outdoor dining facilities to reopen to the public. Tables must be 6 feet apart and no more than 6 people can be seated at a table. Face masks are required until you are seated and in general are recommended unless you are actively eating or drinking. This revision goes into effect Saturday June 6. 

In the most recent Health Officer Statement, Scott Morrow says: “These modifications seek to increase the immunity of the population slowly and methodically, while minimizing death. We are trying to keep equity in mind and minimizing economic damage, while not overloading the healthcare system. The virus continues to circulate in our community, and the increase in interactions among people that these modifications allow is likely to spread the virus at a higher rate. The risk of exposure to COVID-19 looms large for all of us. The public and open businesses need to fully do their part to minimize transmission of the virus.” 

You can read more of the thoughtful Health Officer Statement here and find more details on the May 29 order here. Of note, the seven counties that initially ordered the “Bay Area Shelter in Place” order in mid-March are no longer necessarily working together as a unit. Some of the counties are more restrictive while others have progressed further into the state’s reopening plan, so if you live in a neighboring county, make sure you’re familiar with the appropriate regulations. 

COVID TREATMENT UPDATE?
Eli Lilly announced on Monday, June 1st that the first doses of its Phase I clinical trial study drug LY-CoV555 have been given to patients in New York and California. This 32-person trial will test the safety of this first investigational medicine to emerge from the collaboration between Lilly and AbCellera to create antibody therapies for the prevention and treatment of COVID-19. Derived from a blood sample of early US COVID-19 survivors, LY-CoV555 marks the first trial of a treatment developed specifically for COVID-19. Results of the trial are expected to be available later this month. A larger Phase II trial testing safety and efficacy in non-hospitalized patients could start later this summer. Eli Lilly states they are already working to scale up production, with the aim of making the drug available as early as this fall, if it is demonstrated to be safe and effective.

ARE THERE “HOME TESTS” FOR CORONAVIRUS?
As of June 2, 2020 there is wider availability of at home testing for COVID19. Note these are nasal swabs looking for actual virus (not immune response) using PCR technology. LabCorp introduced Pixel in May for health care workers and it is now available to anyone. You must go to their website, fill out a screening questionnaire and after that Labcorp can bill insurance or collect payment and Fedex to your home. You will follow the instructions for a self-collected nasal swab and return the kit with the shipping label. This may take up to 5 days to get a result.  Everlywell also offers a direct to consumer nasal swab kit to be used in home. These tests are under the FDA’s Emergency Use Authorization (EUA) designation,which means they have not gone through rigorous review. For saliva-collected specimens, Rutgers University is the only test that has EUA. Their test is available through Vault Health and 1Health.io. The test costs $150 and includes a telemedicine visit and shipping. There are many other kits made in the US and other countries that are being advertised and distributed, but they do not have EUA or other authorizations. We have no data to show if their results are valid or invalid.

WHAT CAN YOU TELL ME ABOUT HOME TESTS FOR “IMMUNE RESPONSE”?
Better information on the reliability of home-based fingerprick lateral flow tests is needed before we recommend them. UCSF is studying the sensitivity (ability to detect exposure) and specificity (ability to distinguish people who are infected from those who are not) of these tests and has so far tested 12 of them against blood samples of patients with known infection and blood samples of patients prior to the outbreak (i.e. with known lack of infection). While many have specificities greater than 95%, if infection is rare in a population, a false positive rate of 5% can cloud the picture of the true infection rate. For an individual patient, this means a 5% chance your positive result isn’t real. With the uncertainties of serology testing in mind, if you are interested in knowing whether you have positive antibodies to COVID-19 (evidence of past infection), the three following options seem to be the best right now:

  • Stanford serology test: You need an order from your doctor for this test and it is drawn at a Stanford lab draw center. If you are a patient of ours and are interested in serology testing, you may contact your doctor to discuss this further. 
  • Quest Diagnostics serology test: You can order this yourself and schedule online for an appointment at a Quest Diagnostics lab draw site.
  • LabCorp serology test: You can order this yourself and schedule online for an appointment at a LabCorp lab draw site.

WHY DOES IT TAKE SO LONG TO DEVELOP A (COVID19) VACCINE?
With persistently conflicting messaging, it is difficult to understand how some estimates of COVID-19 vaccine readiness promise a vaccine by the end of the year, and others have repeatedly cautioned us that a safe and effective vaccine, in the most optimistic of scenarios, will take 12 – 18 months. Why the disparity and why so long? For perspective, it helps to know our track record of vaccine development. The fastest we’ve previously developed a vaccine was for mumps, and it took 4 years. Overall, it has taken 10 to 15 years to develop a vaccine — so 12 to 18 months would itself be a record-breaking achievement.   Are we skipping phases this time, or just racing through them? The answer is a combination of factors, including urgent global need, the magnitude of resources being devoted internationally enabling clinical trials to simultaneously conduct multiple phases, the scientific advancements learned from developing a vaccine for the original SARS-CoV-1virus leading to the unprecedented strategy of nucleotide based vaccines. All of this combined with preparation of multiple manufacturing sites to allow rapid upscaling of production once a vaccine is developed. To learn more, watch this excellent video by Dr. Seema Yasmin produced by Wired.

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

NOTE ALSO: CV🦠News is a labor of love. If you enjoy reading this, please share widely! Was this forwarded to you by a friend? Please subscribe here.

 

Music! You know those times when you’re in casual conversation with a friend and they say, “hey, I wrote some songs and made them into an EP”? Yeah, that doesn’t happen to me too often either. So a big shout out to Alison Albers who recently dropped her album “Balboa” on Spotify! Give her new album a listen here, or find her on Spotify or Instagram. Dang. You go, girl!

LABYRINTH.
Have you ever “walked” a labyrinth? This is much more than following a concentric path towards a center point. With all of our current surrounding chaos, there has never been a better time to explore the labyrinth path. Throughout history and today, labyrinths are used as part of the practices of a variety of faith traditions and spiritualities. Labyrinths were common in Europe in the Middle Ages and walking them was part of popular culture. Recently, labyrinths have been rediscovered as a tool for Christian prayer and meditation. Labyrinths and mazes are often confused. When most people hear of a labyrinth they think of a maze. A labyrinth is not a maze. A maze is a puzzle to be solved. It has twists, turns and blind alleys. Labyrinths are sacred spaces that represent the intersection of humanity and the divine. Labyrinths represent a journey to our own centre and back again out into the world – this meandering path can be seen as the journey of life. It can also be viewed as a path of truth through the maze of choices that the world presents. Fascinating. And beautiful. Learn more about
how to “walk a labyrinth” here.

*****

Yours, in health and resilience,

Eric and the TVD MD team…