CV🦠News, Week of October 19, 2020 – The Village Doctor

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CV🦠News, Week of October 19, 2020

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Healthy greetings, friends and patients of TVD,

Oh, the soap box beckons, but I must resist… but don’t you wish we had a national, cogent, and evidence-based plan for balancing the health and economic consequences of this pandemic?

Until then, this is pretty good: Hands. Face. Space.

From our friends at the Department of Health and Social Care, the United Kingdom:

“We know that #coronavirus spreads when you are in close contact with others and you touch surfaces which have been contaminated.”

You can stop the spread of infection: 

✅wash your hands

✅wear a face covering

✅make space

You can read more about the UK approach to Coronavirus and COVID-19 here. As always, please give me a call if you have any questions or concerns.

(Eric Weiss, MD, September 28, 2020)

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.

 

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UPDATE! WHERE CAN I GET TESTED LOCALLY FOR COVID-19?

10/19/20 Note: Result turn-around times appear to remain considerably decreased across most lab testing sites compared to how slow things were in the summer. Currently Stanford lab and LabCorp Pixel test turn-around are both about 24-48 hours.

**We recommend the options starred below for their combination of relative convenience and reliability. We are actively monitoring testing options for more availability and will be adding to this area as soon as we have reliable information.

**Stanford Express Care — Testing can now be scheduled without the need for a prior video conference appointment screen. Drive-through testing is no longer available but testing is done in a large athletic facility with excellent social distancing protocols.

How: Register online through MyHealth if not already a MyHealth patient. To schedule your appointment through MyHealth, go to ‘Appointments,’ ‘Make Appointment’ and select ‘COVID Testing,’ or download their App for iOS or Android. To schedule over the phone, call (650) 736-5211. Having a primary care physician at Stanford is not required.

Where: Most testing is now done at the Galvez Street Arrillaga Center for Sports and Recreation (drive-through testing has been discontinued since the recent fires and poor air quality). Hours 9AM to 7PM.

Who: Children and adults. Asymptomatic or Symptomatic.

Note: 

-Priority is given to those who are symptomatic or were exposed to confirmed or suspected COVID contacts. 

-If you need a test within 72 hours of a particular date, log on to MyHealth to schedule your testing appointment at least a week in advance to grab a spot as close to 72 hours before as you can to allow sufficient lab turn-around time.

**LabCorp Pixel — An at-home test, self-ordered and self-collected test, this is convenient and a fairly quick turn-around. 

How: Order online through the link above, filling out the questionnaire. The kit is mailed via FedEx (next day), picked up from your home by FedEx to send back next-day (not available to send back over the weekend), and results have been taking 24-48 hours after arrival back at their lab. We found the whole process to take only about 15 minutes of total coordination time (ordering, collecting specimen, calling for pick-up).

Where: A self-collected kit at your home

Who: Adults (over age 18), Symptomatic or Asymptomatic but live or work in a high-risk environment (defined as ‘communal,’ meaning you come within 6 feet of multiple people throughout the day). 

**The IV Doc COVID PCR testing in the comfort of your own home. Quick video appointment with MD prior to RN home visit to obtain the PCR test (via AccessMedical).  

How: Similar to the IV Doc for IV fluids, one calls to make an appointment, 844-843-4836. Currently appointments are scheduling out by about a day. Same-day appointments may be available for an added fee. Results back in 24 – 48 hours (best if ordered Monday through Thursday, as things are slower over the weekend). The MD calls the patient with results. Cost: $599.

Where: From the comfort of your own home.

Who: Adults (18 and over).

**Vault Health – PCR saliva test ordered online, self-collected at home (over a Zoom video call with a test supervisor) and mailed in, providing results within 72 hours and meeting the State of Hawaii’s pre-travel testing program requirements.

How: Sign up for your kit at their website. It is recommended to order your kit at the time of booking or at least 10 days prior to your date of departure. *Note: Vault Health only ensures 24-hour lab turn-around for those ordering through their Hawaiian Airlines partnership – otherwise, they only promise a 48-72 hour lab turn-around (upon receiving your sample). Cost: $150/person.

Where: From the comfort of your own home.

Who: Children and Adults (age 5 and over).

Stanford Emergency Department – Can provide same-day PCR lab results for those who need such PCR verification last-minute for a flight or procedure, or for those with urgent symptoms.  

How: Walk-in at the Stanford Emergency Department. There is a reasonably efficient “swab only” path in the emergency department now in which patients have found the wait time to be reasonable (generally 1-2 hours). This will be charged as an emergency department visit – not cheap, but can be reasonable depending on insurance.

Where: Stanford ED, 1199 Welch Road

Who: Adults and children

Project Baseline — Drive-through test (no video visit or doctor’s order required).  Working with the county public health system through Google’s company Verily.  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.

How: Schedule online through the Project Baseline website. Select a nearby location – in our experience San Mateo is often unavailable (they stop at 500 tests/day), but San Jose often is.

Where: Locations throughout CA and several other states.

Who: Adults (age 18 or older). Asymptomatic or  Symptomatic.

Santa Clara County Testing — Drive-through test (no video visit or doctor’s order required), but backed up about  2 weeks (as of 8/12/20).  

How: Schedule online here.

Where: Multiple sites located in Santa Clara, San Jose, and Morgan Hill.  

Who: Children and adults who DO NOT have symptoms of COVID-19 (ASYMPTOMATIC patients only). Residency in Santa Clara County is not required.

Dignity | GoHealth Urgent Care — Video appointment prior to drive-through test.  These appointments often book up with no available slots online.

How: Visit their website to schedule a video visit.

Who: Children and adults, symptomatic and asymptomatic.

Where: Testing sites in Redwood City, San Bruno, the Castro, Mill Valley, Piedmont (Oakland).

Note: GoHealth uses the Abbott point-of-care test which has less sensitivity than the tests listed above. This means higher false negatives. However, results are available within an hour. Priority is given to those who are symptomatic or were exposed to confirmed or suspected COVID contacts.

Color Genomics / SF.Gov — Free testing for those who live or work in San Francisco using Color Genomics. This is part of  a COVID response group which offers multiple test sites around the city. 

How: Schedule online here.

Where: Multiple sites in SF.

Who: Asymptomatic testing for those who live or work in SF.

PAMF and Kaiser — Established primary care patients at PAMF or Kaiser can be tested at their specific drive-through locations with approval by a visit with their PAMF or Kaiser primary care MD.

**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**

(Jennifer Abrams, MD, October 19, 2020)

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The Great Barrington Declaration was authored and signed October 4th by a team that came together at an economic policy think tank in Massachusetts to suggest a public health approach very different from current COVID-19 policies. The authors include Martin Kulldorff, a Harvard Medical School professor of medicine, Sunetra Gupta, a University of Oxford professor of theoretical epidemiology, and Jay Bhattacharya, Stanford University professor of medicine. The authors subsequently presented their ideas to Dr. Atlas (President Trump’s new pandemic advisor) and the Health and Human Services Secretary in Washington, so the message was widely spread quickly. As of last week, organizers say 35,000 doctors and scientists have signed the declaration that supports working towards herd immunity.

The declaration calls for a change to a method of controlling Coronavirus called “focused protection,” which the document states “is the most compassionate approach that balances the risks and benefits of reaching herd immunity, [by allowing] those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk.” The authors argue that “current lockdown policies are producing devastating effects on short- and long-term public health,” and that “keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.” 

The proposal suggests that public health responses should more directly be targeted at the vulnerable populations, but that those who are young and not high risk “should immediately be allowed to resume life as normal,” including opening schools, resuming sports, opening restaurants and businesses and resuming cultural activities. This plan aligns with their goal to “minimize mortality and social harm until we reach herd immunity.” Importantly, the declaration does not mention masks, social distancing, avoiding crowds and indoor environments, or any of the other recommendations pushed by most government and scientific experts. 

Thus, as expected, this declaration has been met with criticism and has been called “dangerous.” Dr. Anthony Fauci, has dismissed the declaration as unscientific, dangerous and “total nonsense.” Notably, the declaration does not present any data nor does it have specific suggestions as to how to implement the change. The main argument against a public health policy with the goal of achieving herd immunity is that it may not be possible without a vaccine. Herd immunity occurs when enough of a population is immune to a virus that it is no longer able to pass from person to person- current estimates are that 10% of the population are currently infected, which is far from the 60% that most scientists believe need to be immune for herd immunity to be effective at preventing disease spread. 

Opponents say that attempting to achieve population-level immunity without a vaccine could result in many tens of thousands of preventable deaths. In the opposition paper,  titled the “John Snow Memorandum” (named after a legendary epidemiologist) — eighty expert authors call herd immunity “a dangerous fallacy unsupported by scientific evidence.” The other trouble is that we don’t yet know that having COVID-19 provides long term immunity, which makes the idea of counting on herd immunity to protect you even less promising.

“There are a lot of communities around the world that have tried to take the approach of ‘let it spread and we’ll do minimal separation and social distancing’ and [those communities] have seen bad outcomes,” Dr. Jeff Smith, executive officer of Santa Clara County said. He argues that the restrictions are needed to protect the vulnerable because the virus can be spread by people who don’t know they’re infectious. 

As of now, while the current administration generally supports the ideas stated in the Great Barrington Declaration, there are no new national policies, but rather the public health policies regarding restrictions and lockdowns still remain in the hands of the states. Given the recent upward trend in cases and deaths across the US, it seems that now is probably not the best time to drastically change policies, but of course it is always important to consider different approaches as many would argue that we have not found the appropriate balance just yet.

Source: https://www.sfchronicle.com/health/article/Why-is-a-Stanford-doctor-promoting-herd-immunity-15648639.php


Jackie Phillips, MD, October 20, 2020

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As we head into months 8 and 9 of our collective newness that is living in the age of COVID-19, we are starting to find new rhythms to sustain us. The uncertainty is still around us but many have streamlined their work-from-home set up and developed new workout routines and, of course, routines around distance learning.  

There is another important tool to build resilience and that is ritual. I know for my own family, October is always a busy month. We have several family birthdays, an Indian dance festival called Navratri and the start of the Indian New Year Diwali, and Halloween! In regular times we mark these events with parties and get-togethers, dancing and eating — and of course, pumpkin-spiced lattes are a hallmark of October.  

Anthropologists have long known that celebrations and rituals give us predictability, a sense of control and connection. As hard as it is to believe, singing “Happy Birthday” again and again reduces anxiety. The repetition of cutting a cake, dancing, and even decorating and pumpkin carving lets us exercise the parts of our brain where we know what to do. It feels easy and joyful.

This study from Harvard shows that rituals improve performance and decrease anxiety. 

Birthdays are an important milestone for many and for children it usually holds an added bonus of a party and presents. It is important to remember that if this is something your family has traditionally celebrated, doing your best to mark the day will go a long way in creating happiness. The feelings carry over for months and the connection to family and friends on a sidewalk or or driveway will create meaningful memories. 

Reimagining and reinventing family traditions can be fun, so be sure to hang on to those as we head into another season. If it means decorating with spiderwebs and goblins for Halloween or making a nice warm spiced cider, plan on doing the same this year. I would like to share one of my family’s favorite recipes for this time of year,  pumpkin chocolate chip muffins.   

Improvise and enjoy!

Prerana Sangani, MD, October 19, 2020

Choosing costumes, decorating pumpkins, and getting special treats brings joy to many children at Halloween. Some Halloween traditions may look different this year to keep everyone safe during the COVID-19 pandemic. However, there are still plenty of ways families can have fun while avoiding the scare of being exposed to or spreading the virus.

Most importantly, keep doing what you have been doing: avoiding large gatherings, keeping a distance of six feet from others, wearing cloth face coverings (think superhero!), and washing hands often. Some ideas for ways to keep safety steps in place while celebrating:

Virtual costume parties & parades

Use video chats for an online party with friends and family and show off costumes and play games. Have fun with it! In cold climates, this may be the first time your child can wear a costume that isn’t buried under a parka! Outdoor costume parades are another option, if it is possible for everyone to stay at least 6 feet apart and wear cloth face coverings.

Remember: a costume mask is not a substitute for a cloth face covering unless it has multiple layers of breathable fabric and covers the mouth and nose snugly. 

If children plan to use their cloth face coverings as part of their costumes, they should not paint them since some paints contain toxins .

Spooky movie night

Celebrate with a movie night and dress as your favorite characters. Do this as a family at home or consider letting your child watch with their friends while video chatting, with everyone starting the movie at the same time. For tips on finding age-appropriate movies for your child, read more here.

Decorating pumpkins

This is one Halloween tradition that’s as safe and fun as ever. As always, just be careful to avoid pumpkin carving injuries. Children can draw a face with markers. Then parents can do the cutting. When the carving is done, consider putting a battery-operated light rather than an open-flame candle inside. Roast the seeds from the pumpkin for a healthy snack!

Halloween-themed treats

Make some fun Halloween treats as a family. Decorate a pizza with toppings in the shape of a jack-o’-lantern, for example, or make tangerine pumpkins (peel the tangerine and stick a thin slice of celery on top to look like a stem). Make sure the treats are not choking hazards if you have children under age 3.

Outdoor community events

Look for community events focused on safe ways to have fun. These may include programs offered by a park district, arboretum, zoo or other outdoor venues in your area. Stay away from crowds and clusters, and follow safe distance rules even when outdoors.

Avoid indoor events such as haunted houses. A local haunted forest or corn maze may be a better option, as long as cloth face covering use, physical distancing and one-way walk-through is enforced. If you think there may be screaming, leave extra distance to lower the risk of spreading respiratory virus. If you go to a pumpkin patch or apple orchard, also use hand sanitizer before and after touching what you pick.

If your children will be outside, mark their costumes with reflective tape. Remind them to be careful around cars, as drivers may not see them. Make sure shoes fit well and costumes are short enough to prevent tripping or contact with flames.

 If there is trick-or-treating in your community…

Trick-or-treating may be discouraged or cancelled in some areas this year. A family scavenger hunt for treats in your home or yard can be a fun alternative. If trick-or-treating is still on in your neighborhood, avoid large groups or clustering at doorsteps or anywhere else. If you hand out treats, consider sitting outside and lining up individually pre-packed treat bags for families to take (don’t forget to wear your own mask!) Non-edible treats are a good option, especially for children who suffer from food allergies.

How much touching objects spreads the COVID-19 virus isn’t clear. But if your child collects treats from a few, socially-distanced neighbors, you may want to wipe the packages or let them sit for a couple days before giving them to your child. And, of course, good hand hygiene like washing hands or using hand sanitizer before and after trick-or-treating is always a good idea!

Remember

Halloween during the COVID-19 pandemic is a chance for you and your children to get creative, and maybe even invent some new traditions for your family! It’s also a great opportunity to model flexibility and a positive spirit. If you’re excited and make it fun, your kids will have fun, too.

More importantly, this is a good time to teach children the importance of protecting not just themselves but others, as well. The decisions we make on this one day can have a ripple effect beyond our own families. Finding safe ways to celebrate can create magical memories.

More Information

Adapted From: healthychildren.org 2020-10-05

Source American Academy of Pediatrics (Copyright © 2020)

The information contained in this article should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Sky Pittson, MD — October 20, 2020

 

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 ever growing 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

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Paradox Valley

From a friend from our days at Sacred Heart Prep:

“My son Rod Cardamone dropped a new song today called Paradox Valley. The song is named after a valley in Colorado in which the Dolores River crosses the divide between two cliff walls. Roddy learned about that valley about the same time as he read the speech RFK gave in Indianapolis the night that MLK was killed, in which RFK quoted Aeschylus: “Even in our sleep, pain which cannot forget falls drop by drop upon the heart until, in our own despair, against our will, comes wisdom through the awful grace of God.” Indianapolis is the only major US city that did not erupt in violence that night. This song is the result of Roddy’s pondering all that in this complex time.”

Check it out here. Enjoy.

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…