CV🦠News, Week of June 29, 2020 – The Village Doctor

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CV🦠News, Week of June 29, 2020

Greetings, TVD friends, and Happy 4th of July!

As I, and we, continue our journey into Black history and awareness, please continue our “eye opening” work below.

In addition, do not let this sidebar distract us from the fact that our Coronavirus situation is getting worse, not better. Don’t even get me started about failed leadership and inconsistent messages, our message is clear:

Wear a mask when out in public. Read more about masks on our website here, about kids and masks here, and a nice recent overview piece from UCSF here.

Use “physical distancing” when going out. Read more about the power of social distancing here and its importance here.

Shelter in Place as much as possible. Reflect on “essential services” and stay home for anything but. Enjoy some suggestions for how to stay entertained at home here. Learn more about “Quarantine Bubbles” here.

                                             

CONSIDER “TIPPING YOUR CAP”
For 40 years, from 1920 to 1960, black players — African Americans, dark-skinned Latinos, men and women — played joyous and brilliant baseball in the Negro Leagues. The Negro Leagues were both a tragedy and a triumph. The Leagues only came to be because of an unwritten law in Major League Baseball preventing any team from signing a black player. The tragedy is easy to see. This year marks the 100th anniversary of the Negro Leagues. We ask you to take a moment and tip your cap to these extraordinary people who just wanted to play ball and, in the process, changed baseball and America.

You can read more about the Negro Leagues Baseball Museum here, and about “tipping your cap” in honor of this 100th anniversary here.

THE (LOCAL) COLOR OF LAW
Wow. Palo Alto?  Richard Rothstein’s book ‘The Color of Law’ documents how American communities — including much of the Bay Area — were purposefully segregated along racial lines. Let me repeat that. Much of the Bay Area… was purposefully segregated along racial lines… in the 1950’s. Not the 1850’s. Not in some southern red states. But in our backyard. Rothstein, a research associate with the Economic Policy Institute, has documented a lengthy list of historical examples which suggest that housing segregation was not only intentional, but that it still remains at the heart of so many racially oriented disparities within our nation: education, income, health and more. Rothstein believes that the biggest single cause of racial inequality in this country is the ongoing enormous wealth gap between African Americans and whites. African Americans have household wealth that is 5% on average of white household wealth. (Let me repeat that, black household wealth is, on average, 5% of white household wealth. 5%!). And that enormous disparity is largely attributable to the fact that African Americans have been restricted to neighborhoods where if they own homes at all they don’t appreciate in the same way that homes in white neighborhoods do, and that African Americans in the 20th century were prohibited from moving into neighborhoods where appreciation was rapid. So the wealth gap, and all of the other social inequalities that stem from the wealth gap, they all are continuations of residential segregation. Please read more about this author and his book in Palo Alto Online here, or about how the black-white economic divide today is as wide as it was in 1968 here.

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.

 

I’M THINKING OF TRAVELING / VISITING OLDER RELATIVES, HOW DO I REDUCE MY RISK?
It’s summer and many of us have dear friends and family, parents and grandparents who live in another town. It is tempting to visit, especially after months of isolation. There are several things to consider before you go. First, assess the risk. We know people over the age 65 are at higher risk of contracting COVID-19, and if they have an underlying health condition, this increases their risk even more.  It’s important to start here and decide if the risk is worth taking. Next, if you are going, plan ahead by 2 weeks. Do your best to reduce your personal risk so that the risk of transmission is very low. Try to come as close to a complete quarantine as possible, be socially distant, wear your mask and don’t go out unless it is essential. You can also check your local infection rates by going to your county’s health department website. If you live in an area with high transmission rates, your risk of infection is going to be higher. Then, if you can make a road trip, do that. Air travel has many more touch points within the airport and airplane even with the highest level of caution.  If you take a plane your exposure is much higher and it would be safest to quarantine upon arrival for 14 days before seeing your loved ones. This may not be possible if you do not have long to visit. If you drive, stop only if needed, wash hands often after filling gas and eating snacks. Limit the bathroom breaks and only use very clean rest stops. Should you consider getting a nasal swab / PCR test before you go? If testing is readily available in your community then, yes, it would be another safeguard. But know that even if you test negative, the tests are not perfect. You could test in a window of time where you have not developed detectable viral particles. That said, testing within 72 hours prior to departure would be ideal. Lastly, If you do travel, once you arrive do your best to keep your older loved ones safe by keeping your bubble intact. This means only the people in your group who have travelled together should stay together and interact. Plan outdoor activities as much as possible and avoid large gatherings or theme parks and restaurants. This is a  great time for the summer backyard barbecues and water games and music.

Abstracted from NPR’s “Taking A Trip To Visit Grandparents Or Older Relatives? Tips To Reduce The Risk”

WHAT IS “HERD IMMUNITY” AND WHY DOES IT MATTER?
In an interview on June 26th on CNN, Dr. Anthony Fauci acknowledged we don’t yet know what the efficacy of a COVID-19 vaccine will be, but that he would “settle” for 70 to 75% effective.  Why that number?  If 70 to 75% of the population is immune to COVID, we would achieve “herd immunity” to quell the outbreak. Herd immunity is when a sufficient proportion of the population is immune to an infectious disease, either by vaccination or prior infection, so that spread from person to person is unlikely.  A population with 75% immunity to COVID-19, therefore, would mean that 3 of every 4 people exposed to the virus won’t get sick (and won’t spread the virus any further).  Achieving that level of immunity allows a level of safety for others, who because of age, having a weakened immune system or other medical considerations, cannot be safely or effectively vaccinated.The challenge, however, is not just to manufacture and distribute enough vaccine to 75% of a population, but for 75% of people to agree to be vaccinated.  A CNN poll in May found that one-third of Americans said they would not try to get vaccinated against COVID, even if the vaccine is widely available and low cost.  Asked if a vaccine with 70-75% efficacy taken by only two-thirds of the population would provide herd immunity, Dr. Fauci answered “No — unlikely.” Fauci noted that “there is a general anti-science, anti-authority, anti-vaccine feeling among some people in this country — an alarmingly large percentage of people, relatively speaking.”  Given the power of the anti-vaccine movement, “we have a lot of work to do” to educate people on the truth about vaccines.

IF A VACCINE MIGHT BE A WHILE AWAY, WHAT ABOUT “ANTIBODY TREATMENT”?
Antibodies are the proteins the body makes to fight infection.  During the 1918 flu pandemic doctors proved giving convalescent blood plasma from those who had recovered from the flu to those currently suffering from it could provide useful antibodies to help fight the infection.  Since then, convalescent plasma treatment has been used in many infections, including severe flu, MERS, SARS and now with some success in SARS-CoV-2 as well.  While many recovered COVID-19 patients are donating blood plasma to help others and studies are still underway to prove efficacy, there isn’t enough donated plasma to treat all patients.  Thankfully, scientists can create what are called monoclonal antibodies: lab-made antibodies created to target a specific infection.  An antibody treatment could be used to treat active infection, or to prevent infection in high risk people who have been exposed.  The development of antibody treatments for COVID-19 has skyrocketed – currently there are at least 102 antibody treatments in various stages of development.  Four have already gone into human trials in June and many experts believe, if all goes well in the first phases of these trials, therapies could potentially be available by the fall.  Others, including Harvard T.H. Chan School of Public Health professor of immunology and infectious diseases Phyllis Kanki, caution that not everything works as planned outside of research studies and that it can take time to get the right antibody.  Stanford Internal Medicine Ground Rounds recently focused on the topic of monoclonal antibody development for COVID-19, with biotech experts expressing hope for a shorter timeline, explaining that in the current pandemic atmosphere, pharmaceutical companies are willing to shorten the traditional development and manufacturing timeline by taking more financial risk – many have already begun diverting whole manufacturing plants to development of monoclonal antibodies that are still in research phase, to get a jump start on the large production numbers that will be needed should the evidence prove safety and efficacy. Stay tuned for more information on antibody treatments under development as phase 2 and 3 trials are completed in the late summer and fall.

ARE CHILDREN LESS LIKELY TO SPREAD CORONAVIRUS THAN ADULTS?
As with most things related to Coronavirus, we don’t yet know for certain. Fortunately, there are some big studies underway to answer this question and there is some preliminary data that seems promising, but most investigators are afraid to fully trust the incomplete data. In the US, kids under 18 years of age represent 2% of the known coronavirus cases and it is known that they are more likely to be asymptomatic or to only have mild symptoms. There is some suspicion (or maybe hope?) that they may be less contagious than adults, especially when looking at young children (up to about age 10). In one ongoing study in the US by Brown University economist Emily Oster, data collected from childcare centers points to low transmission rates in younger children in schools and among staff. However, the investigator herself says “that she’s ‘reluctant’ to glean too much actionable information from her findings.”  Her data reveals that of 27,000 students surveyed, there were 42 cases (0.15%) of COVID-19 and among the 9,000 staff members, there were 106 (1.1%) confirmed cases. Of course it is very likely that the cases are under-reported as not everyone is being tested and there are likely more asymptomatic cases. That said, this data does resemble information coming out of other countries as well. A study out of France looked at 600 children under 15 years who were in school and found that kids are both “less contaminated and less contaminating, and that in 9/10 cases,  it was infected adults contaminating the children.” The reasoning behind why kids are less likely to get it and less likely to spread it is not known, but scientists suspect they have fewer virus receptors in their mucous membranes, they may have better cross-immunity because they’ve been infected with other coronavirus types and their constantly running noses may help them resist infection better. A study in Wuhan found that children are about 1/3 as susceptible to infection as adults, but the trouble is that when schools are open as normal, kids have 3 times as many contacts as adults and thus 3 times more chances to get infected.

So what does all of this mean? We don’t know for certain what will happen as more and more children head to summer camps, back to daycare or back to school in the fall. We do know that the CDC has set recommendations for all of the above and that most importantly, enforcing hand washing, strict health screening policies, limiting the number of interactions (keeping groups small without mixing), and wearing masks and maintaining social distancing when possible and appropriate will help keep our kids and our communities safe. Each family will continue to have to reassess their own risk-tolerance as the situation evolves.  The good news is that Yale has just completed a large study looking at kids in school settings and the NIH is conducting a study specifically to look at incidence of COVID in US children, so we will be following for results as soon as they become available.

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

Are you a “Hamilton” fan? Enjoy watching members of the original cast of Hamilton, along with the Roots, stage a virtual reunion to perform the musical’s “Helpless” in support of Global Citizen’s “Global Goal: Unite for Our Future”. Turn up the volume and watch here!

Market Street, San Francisco, April 14, 1906
Wow, check this out! Upscaled with neural networks, enjoy this trip down Market Street, San Francisco, 1906. This film was shot on April 14, 1906, just four days before the San Francisco earthquake and fire which killed an estimated 3 000 people and destroyed over 80% of the city of San Francisco. It was produced by: Harry, Herbert, Earle and Joe. Note this is actually a staged shoot, so it’s not actual traffic from that time but still worth watching!

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.

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Yours, in health and resilience,

Eric and the TVD MD team…