CV🦠News – Week of June 22, 2020

Historical greetings, TVD friends,

Juneteenth. I learned a lot about this last week. I hope you did too. Again, thank you to my team for opening my eyes. If you did not, I encourage you to read more here (on Wikipedia) or here (The New York Times).

Also, Tulsa. May / June, 1921. The “burning of Black Wall Street”. The first aerial attack on US soil was actually against our fellow citizens. If you didn’t know about it already, learn more here. I’ve since learned that The Tulsa Tribune removed the front-page story of May 31st that sparked the chaos from its bound volumes, and scholars later discovered that police and state militia archives about the riot were missing as well. As a result those 18 hours during which 100 – 300 people were killed and over 8000 were made homeless, are rarely mentioned, much less taught. Read more here.

All of which raises the question, what else do I not know enough about? Not surprisingly, there is a lot. Let me encourage you to continue our efforts at “opening our eyes”, below.

Move over Edward Jenner, inoculation against smallpox was introduced to America by a slave in 1721. Read more about Onesimus, and his owner (!), Puritan minister Cotton Mather, here.

One in four cowboys was Black, despite the stories told in popular books and movies. In fact, it’s believed that the real “Lone Ranger” was inspired by an African American man named Bass Reeves. Learn more about black cowboy history here.

Read about other little known facts about black history here. Let us continue together to work on opening our eyes.

NOTE: 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.

As of June 19, testing for active COVID-19 (by nasopharyngeal swab) for symptomatic patients (people with symptoms) continues to be available at Stanford through their Express Care program by appointment. Drive-through testing at the Emergency Department is no longer available. Appointments for Express Care can be made online through MyHealth or the MyHealth app, or by calling 650-736-5211. Our experience is that you will first get a call back from a nurse who will screen you for your telemedicine video visit with the doctor, who will then schedule you for your drive-by test, which takes only a few minutes. The testing sites are at The Hoover Pavilion and at the Galvez Street location in Palo Alto from 9 a.m. to 6 p.m., seven days a week. Patients with positive results will be called back and care plans established. Negative results can be found online on MyHealth after 24 – 36 hours.

Testing is also available through PAMF (Palo Alto Medical Foundation) Urgent Care “drive through”, but only in selected locations (Palo Alto and San Carlos), and only to PAMF patients with an order from their PAMF primary care doctor. Kaiser also has a similar program for their patients.

**If you get tested through any of the above pathways, please be sure to keep your phone handy and answer unknown numbers to avoid delays in processing and getting your results**

Asymptomatic patients (people who do not have symptoms) who would like to be screened for active disease (“asymptomatic shedding”) with a nasal or nasopharyngeal swab test now have many options of varying quality. We recommend the following two for their combination of convenience and reliability:

  1. Pixel by LabCorp: A home test, this is most convenient and a fairly quick turn-around. Ordered online, it is mailed via FedEx Express (next day), picked up from your home by FedEx Express to send back next-day, and results take 24 hours after arrival back at their lab. A total turn-around time of 72 hours, (labs are processed over the weekend as well), and we found the whole process to take only about 15 minutes of total coordination time (ordering, collecting the specimen, calling for pick-up).

  2. Project Baseline / Verily (working with the county public health system): With drive-through testing options in Redwood City and San Mateo, appointments can be scheduled online 48-72 hours in advance, and results take 3-4 days.

There are a few components to explore in answering this question. First, when you test in relation to possible exposure, is important. If you had a possible exposure 3 days prior to your COVID-19 nasal swab, you could still develop COVID-19 over a week after the negative swab – that swab just meant you hadn’t built an infection enough to be shedding virus yet. A study on incubation period published in the Annals of Internal Medicine estimates 50% of people develop symptoms by day 5, 75% by day 7 and >90% by day 11 after exposure.

Second, we know that the “presymptomatic” period is a major source of exposure risk. A study based on data in and around China suggests that 44% of transmission comes from people who are about to get sick but don’t yet know they are infected. We know the amount of virus builds over time, peaking at or right before symptom onset. COVID-19 tests are better at detecting virus in this time frame. It’s still unclear how good tests are at finding presymptomatic cases before that time, when viral shedding is less but growing.

When considering your risk for exposing others, a negative COVID-19 nasal swab can be part of your assessment, but know that it’s not fail-proof. We recommend weighing your overall risk into the equation, borrowing a rhyme Bill Miller, an epidemiologist and physician at Ohio State University, uses: Time, space, people and place. If your COVID-19 test is negative in the setting of having spent little time around other people, with a lot of space between you and anyone you did see, with those people being people you know well who were socially distancing carefully themselves and you saw them in an outdoor environment, you are probably pretty low risk.

Is it safe to fly? Far-flung Bay Area families weigh coronavirus risk
Abstracted from an article by Sarah Feldberg
June 20, 2020 | Updated: June 25, 2020 1:39 p.m. | San Francisco Chronicle

For Bay Area residents with relatives nearby, visiting during the pandemic comes with extra precautions: masks, backyard meals with physical distancing, and no hugs or handshakes. But for those with loved ones a flight away, the decision is more complicated. It means considering the threat of infection while flying versus the pain of missing funerals, births, and graduations. And considering your own infectious threat to those you are visiting and how much of a quarantine to self impose.

“Flying is an accumulation of a bunch of things that in general imply higher risk,” says Bob Wachter, chair of UCSF Medicine. “It is staying in fairly close contact with a whole lot of people you don’t know, it is doing that indoors, it is doing that for long periods of time.” There’s the ride to the airport, security lines, using a public restroom, buying a snack and walking down the jetway to board — a process bringing you in contact with strangers and the surfaces they touch every step of the way. None is particularly dangerous on its own, but each adds to the overall chance of exposure.

Airports and airlines are taking measures to mitigate risk, like physical distancing markers, providing masks, new cleaning procedures, boarding protocols, limited capacity (but often only by 30%), and suspending food and beverage service to minimize contact between crew and passengers. They have also begun requiring face masks, the single most important safety measure. But these have not been consistently enforced until Monday (June 22) when the trade group Airlines for America announced its seven member carriers — Alaska, American, Delta, Hawaiian, JetBlue, Southwest, and United — would be “vigorously enforcing face covering policies.” And on United and JetBlue, those not complying will be added to a restricted list and banned for a period of time. So at least airlines are getting more serious about the safety of all onboard. But the decision to fly is still a very personal one, based on need and the risk to yourself and those you are visiting.

If you do fly: Smart precautions for air travel

Minimize contact: look for an airline that has blocked middle seats, fly at less crowded times, book a window seat so you’re in proximity to fewer people during the trip. Carry on: the fewer people who touch your bag the better. BYO-everything: bring your own snacks and water bottle.  Sanitize: TSA allows up to 12 oz of liquid hand sanitizer in carry-ons. Clean your hands every time you touch a public surface. Avoid the tiny airplane bathroom: go before you board. Wipe down: bring alcohol wipes to give your seat area a thorough cleaning. Mask up: wear a mask the entire time, and notify flight attendants if others are not wearing theirs.

And if at all possible, just drive. Even with stops for fuel and bathroom breaks, there’s no question that driving is safer than flying, says Wachter. “It’s shelter in non-place.”

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

“Did I Miss Anything?” Daniel Thorson went into a silent retreat in mid-March, meditating through 75 coronavirus news cycles, Boris Johnson’s hospitalization, social distancing and sourdough starter. Now he’s catching up. Hard to imagine! Read his story here.

Again, 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.


Yours, in health and resilience,

Eric and the TVD MD team…