Reflective greetings, TVD friends,
Wow, we’ve hit TEN issues of CV🦠News to arrive in your email inbox.
I don’t need to point out that these continue to be difficult days for our country, our community, and yes, even members of the TVD Team. Hard conversations are happening, followed by tears, and the sharing of truly horrible life experiences. “Woodside, Check Your Privilege” read a sign outside of Roberts a few days ago, held up by daughters of a dear friend. Let me suggest more: reach out to your friends of color to acknowledge these disturbing days, even if you do not know what to say. Acknowledge their long standing reality, which I am, from my place of privilege, seeing played out, disturbingly and over and over, on social media. Just reach out and sit with them, figuratively speaking. I know I had my eyes opened with such a conversation yesterday. A conversation which is both ongoing, and I hope just the beginning. The beginning of true acknowledgement, of sharing, of healing, of hope.
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ARE ASYMPTOMATIC PEOPLE SPREADING THE CORONAVIRUS? (A WHO OFFICIAL’S WORDS SPARK CONFUSION AND DEBATE).
The World Health Organization clarified on Tuesday (June 9th) its position on whether people without symptoms are widely spreading coronavirus, saying much remains unknown about asymptomatic transmission. In her initial comments, the head of the WHO’s emerging disease and zoonosis unit Dr. Van Kerkhove said: “We have a number of reports from countries who are doing very detailed contact tracing. They’re following asymptomatic cases. They’re following contacts. And they’re not finding secondary transmission onward. It’s very rare.” Within minutes, that single stray comment regarding initial reports and experiences from tracers from other countries, was seized upon and amplified by some news outlets as proof that physical distancing, face masks, and safer-at-home orders are unnecessary. Networks, programs, and hosts with science editors and fact-checking resources at their beck and call, preferring not to call upon them, not to responsibly report, but rather politicize a comment that should not have gained such attention or certitude.
Experts pointed out several problems with the WHO’s initial statement. “All of the best evidence suggests that people without symptoms can and do readily spread SARS-CoV-2, the virus that causes Covid-19,” the Harvard Global Health Institute said in a statement Tuesday. “In fact, some evidence suggests that people may be most infectious in the days before they become symptomatic.” An influential study published in April in the journal Nature found evidence that people can be very infectious roughly two days before symptoms appear. The study estimated 44% of infections are coming from people not yet showing symptoms. A review published just last week in the Annals of Internal Medicine of 16 of the most relevant studies of asymptomatic infection found a likely rate of 40 to 45% of those infected don’t have symptoms. But the authors concluded that every study on the subject has been “imperfect in many ways.”
We don’t really know the contribution of asymptomatic transmission. Sometimes it is best to say exactly that.
HOW DOES BLOOD TYPE INFLUENCE COVID-19?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study (NYTimes, June 5, 2020). Many people are surprised to learn that their blood type is not routinely checked except in certain circumstances in the newborn nursery, if you need a blood transfusion or if you donate blood. If you think you have had it checked for a medical reason, you can contact our office so we can check your records. We can of course check your blood type if you are due for routine labs, but at this point we wouldn’t recommend an extra lab draw just to check your blood type. If you do want to know, you can get a home test kit that offers immediate results. In a study with almost 3000 of these kits compared to traditional blood type testing, this kit was shown to be 99.9 percent accurate as long as the instructions were carefully followed. Of note, the inaccuracies that did occur were not in the ABO typing, but rather tended to relate to Rhesus-D factor (whether the blood is positive or negative), so are less important if you are purely curious to know if you’re at increased risk because you have type A blood.
IF I’VE HAD COVID, CAN I DONATE MY PLASMA TO HELP OTHERS?
Yes, if you meet certain criteria. Stanford Medicine is working with the Stanford Blood Center to create a convalescent plasma program. This would allow individuals who have recovered from COVID to donate plasma to be transfused into critically ill patients to potentially save their lives. This treatment does seem promising in the many early studies that have been done, but there is still no guarantee that the transfusions will work consistently. Prospective donors must meet the following criteria (in addition to the usual blood donor eligibility requirements):
- Have had a positive test for COVID-19 or have lab evidence of SARS-CoV-2 antibodies (once antibody testing is available).
- Have been recovered and symptom-free for at least 14 days.
- If only symptom-free for 14-28 days, donors will be asked to retake a COVID-19 test at no cost to the donor. This repeat test must be negative to be eligible to donate.
- If symptom free for 28 days or more, a negative COVID-19 test is NOT required.
You can read more about the program here.
WHAT ARE THE MENTAL HEALTH IMPACTS OF THIS PANDEMIC?
While there are many examples of love and connection all around us every day, the loss of lives and of economic stability for so many throughout the world related to the COVID-19 pandemic has been devastating. Compounding what has already been an unsettling and challenging time of heightened stress and change for all of us, recent violent and tragic losses of our black and brown brothers and sisters and recognition of how far our country needs to come to begin to address the discrimination at the root of so much suffering has deepened feelings of anger, helplessness and despair. We have been hearing many of our patients apologize for bringing us their concerns about what they perceive as more minor mental health struggles in the face of such devastation around them. But it is important to recognize that even in the homes where our own personal health and that of our loved ones has been preserved, the sadness, anger, fear, numbness and anxiety that so many of us have felt is very real for all who experience it, and is increasingly common. For some of us, these feelings may be new. For others, they may be all-too-familiar signs of a known history of clinical depression.
Symptoms of depression are common after a traumatic event. In medicine, to help differentiate between depression and periods of grieving, such as after the death of a loved one, we are more concerned about depressive symptoms if they last six weeks or longer. This distinction is problematic during the pandemic, as the social isolation, economic stressors and infection risks have been long-lasting and, for many, appear likely to be present for a while. “Our nation is under stress. It may be that more people need [medical] treatment. It may be that we need to, as a population, do more to relieve the stress,“ says Jennifer Leiferman, a researcher at Colorado School of Public Health featured in a recent article on the topic in The Atlantic. Leiferman is one of many in the medical community who have seen a tidal wave of depressive symptoms in the US since the pandemic began. Before this year, approximately 5-7% of people met the criteria for a diagnosis of depression. Given the somewhat subjective nature of the diagnosis, depending on how you define the condition, orders of magnitude more people are now meeting diagnostic criteria. A recent Lancet study estimated about 50% of the US population is currently experiencing depressive symptoms. Feelings of hopelessness, powerlessness, numbness, excessive fatigue and sleep problems are now so common many seem to consider them the new normal. This creates a diagnostic conundrum for patients and their providers – how do we know when these symptoms are a normal part of grieving and adjustment vs. when these symptoms have become something more that should be discussed with a medical professional?
For those who have had a clinical diagnosis of depression before, the risk of developing a clinical depression again is higher. We recommend those of you in this category reach out early to your doctor or therapist if you are experiencing depressive symptoms. For those on the other end of the spectrum, who are experiencing less frequent and more fleeting depressive symptoms, who are able to find enjoyment in activities you typically enjoy and who wake up most days feeling like you are ok, symptoms are more likely to return to their baseline eventually, as long as they are addressed. Talking with loved ones about how you’re feeling, making sure to create daily time and space for social connection (via Facetime or socially-distanced in-person time) and healthy living such as adequate sleep and exercise, will be helpful. And if things don’t improve or if you or a loved one is worried about your symptoms, call your doctor. For those who are experiencing more consistent depressive symptoms, give your doctor a call. It may be that urgent, basic interventions that help create healthy routine and structure will be enough – this might involve creating more of a normal schedule around sleep and food, minimizing alcohol and other substances, exercising, avoiding the news and cutting back on aimless habits that might have emerged that were easier to moderate in normal times. But it may be that additional medical care is needed.
We are living in complicated times. Know that no matter what category you fall into above, you are not alone. And know that we are here for you.
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
In closing, please enjoy this lovely piece from my friend, Nichola ‘Nirmala Devi Maa’:
The presence of Shiva and Shakti permeate the Indian (Hindu) culture with ease. Daily, lamps and incense are lit, flowers and fruit offered with various chants and prayers observed in recognition of the dance of creation. Throughout India and other Eastern tradition countries, there is a deep resonance with the play of destruction and creation. The mythology expressed in the epic writings (Mahabharata, Ramayama) and deeply symbolic teachings (Puranas) is an expression of the relationship between destruction and creation.
How you were raised and your ‘creation story’ is both personal and communal. In today’s world as the boundaries, physically and metaphorically, are being broken down traditions are overlapping and influencing one another. Maintaining distinct boundaries requires a significant mindset. Did you see this last week that the Greek Orthodox Church deemed yoga incompatible with the Christian faith? Announcing that yoga is not a physical exercise, rather a tenet of the Hindu tradition. Indeed, yoga originated in the early Vedic teachings however, todays yoga has morphed into a multi-faceted activity. Interesting, right?
What I would like to address is the manner in which the Shiva Shakti relationship has permeated the world stage in unspoken ways and how that might inform our Western perspective at this time.
It is useful to understand, from an Eastern perspective, Shiva is part of the triple deity of supreme divinity in Hinduism. This triad includes the deity responsible for higher order creation (Brahma-God), maintenance of the system (Vishnu), and destruction of old paradigms (Shiva). Shiva is understood to be formless, nameless, and to hold emptiness. The caldron for unmanifested possibility.
Shakti intersects with Shiva as creation potential moves into form. She is the energy, ability, strength, effort, power, and capacity which represent the dynamic forces moving through the entire universe and that which brings creation potential into form. In other words, Shiva is the unmarked, limitless stage for the unmanifested form which Shakti brings into being. They work in tandem. Shiva is known as Ardhanareshwara; half man and half woman. See image above. Both Shiva and Shakti are required in the process of creation to perpetuate the wheel of unmanifest potential into manifest form.
While we were not watching, Shiva Shakti slipped into our reality. As we sat and sheltered in place, isolated and barricaded we found ourselves in the DISSOLVING of our rhythms, patterns and the systems we had concretized. Shiva in action. This has been both painful and liberating. And it has not been an overnight process. We have been in this dissolving for months. Now in the caldron of unmanifest possibility (Shiva), as we are about to open the floodgates to our lives, we have the opportunity, NO the RESPONSIBILITY to ask ourselves, “What did we drop from our lives during this dissolution/ destruction that can be permanently cast aside as we move into a new world, a new paradigm?” Shakti is poised to create anew. Your slate is clean, the emptiness is palatable. The choice is yours. Take this time to reflect before you enter the world with abandon. Use your Shakti energy to manifest your deepest alignment with the universe. BE CONSCIOUS. BE AWARE. BE RESPONSIBLE. You are in the beautiful dance of Shiva Shakti. Blossom, explode and manifest beyond your craziest dreams. Now, at this time, the window is open. Blessings.
Yours, in health and resilience,
Eric and the TVD MD team…