CV🦠News, Week of October 26, 2020 – The Village Doctor

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CV🦠News, Week of October 26, 2020

 

 

Electoral greetings, friends and patients of TVD!

By the time you read next week’s newsletter, it will be November already, and what I might argue is the most consequential national election of our lifetimes will be just behind us.

So my message for this week is simple, and important: #VOTE!

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, I continue with this secondary, but also important message: Hands. Face. Space.

✅ Wash your hands

✅ Wear a face covering

✅ Make space

✅ Vote

The first three things make a difference. 

Your vote makes a difference. 

Spread the word, encourage your kids, friends, and neighbors, and please get out there and vote.

 

Eric Weiss, MD, October 26, 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.

 

Last week, the CDC changed their definition of what it means to be a “close contact” to reflect a surprising case that was contracted in a Vermont correctional facility. Simply put, the definition changed such that you are now considered a “close contact” if you have been within 6 feet of an infected person for 15 minutes CUMULATIVELY in a 24 hour period rather than necessitating that the 15 minutes be CONSECUTIVE. The timing of exposure to the “infected person” includes being in close contact with them starting from 2 days before their symptom onset (or 2 days before testing) until the time the patient is isolated.

As mentioned, the revision was inspired by a case that occured in a correctional facility. A corrections officer interacted briefly with incarcerated individuals who were asymptomatic, but later found to be COVID-19 positive. In total, he spent 17 minutes within 6 feet of infected patients over his 8 hour shift. For the most part, he was wearing a mask, gown, goggles and gloves, and the infected people were wearing masks, but there were some brief unmasked exposures as well. He was not considered a close contact and thus continued to work, but 7 days later, he unfortunately developed COVID-19.

So, as cases increase at an alarming rate across the country and globally (the WHO reported a new record high for global weekly incidence for the sixth consecutive week), it’s important to take this new definition into account. Presumably the officer contracted the virus in one of the interactions where he wasn’t wearing a mask, so it’s a good reminder to wear a mask if you are going to be spending time near anyone that is not in your household. Per the CDC, there continue to be other factors to consider when defining close contact including “proximity (closer distance likely increases exposure risk), the duration of exposure (longer exposure time likely increases exposure risk), whether the infected individual has symptoms (the period around onset of symptoms is associated with the highest levels of viral shedding), if the infected person was likely to generate respiratory aerosols (e.g., was coughing, singing, shouting), and other environmental factors (crowding, adequacy of ventilation, whether exposure was indoors or outdoors).” 

If at any time you do meet the criteria to be defined as a close contact, the safest thing to do is quarantine for 14 days. For information on testing after exposure, please see our FAQ “If I’ve been exposed, how soon should I be tested for COVID-19?” 

Jackie Phillips, MD, October 27, 2020

 

Children spend more time than ever staring at digital screens—on computers, tablets, TVs, smartphones, and other devices. All that screen time can take a toll on children’s wellbeing, including how their eyes may feel.

Research shows that children begin zooming in on digital media devices, such as their parents’ tablets or smartphones, as young as 6 months old. By their teens, studies have found, kids spend nearly 7 hours a day using screened-based media, watching TV, playing video games, and using social media. Especially if they’re having fun, children might keep playing and watching to the point of eye-rubbing exhaustion.

This doesn’t include additional time spent using screens at school and for homework.

COVID-19 & online learning: watch children’s eye health 

With COVID-19 and a shift to online learning by many schools​, children are spending even more time looking at screens. Screen time limits are also being increased in many families to help children stay entertained and socialize with friends virtually, as they spend m​​ore time at home to prevent the spread of the virus. All of this makes it especially important to take steps that can help prevent tired, sore eyes in children.​​

Why screen breaks are important

Staring at a screen for long stretches without taking breaks can cause symptoms such as:​

  • Eye fatigue. Muscles around the eye, like any others, can get tired from continued use. Concentrating on a screen for extended periods can cause concentration difficulties and headaches centered around the temple and eyes. Children may also use screen devices where lighting is less than ideal, causing fatigue from squinting.
  • Blurry vision. Gazing at the same distance for an extended time can cause the eye’s focusing system to spasm or temporarily “lock up.” This condition, called an accommodation spasm, causes a child’s vision to blur when he or she looks away from the screen. Some studies also suggest computer use and other close-up indoor activities may fuel rising rates of myopia (nearsightedness) among children, although this is not yet proven. More time playing outside may result in healthier vision development in children. 
  • Dry eyes. Studies show that people blink significantly less often when concentrating on a digital screen, which can leave eyes dry and irritated. Desktop and laptop computer use can be especially tough on children’s eyes, because they’re usually situated higher up in the visual field than a book, for example. As a result, the upper eyelids tend to be open wider—speeding up evaporation of the eye’s tear film.

What parents can do

  • Monitor screen time. The American Academy of Pediatrics (AAP) family media use plan and related reports target issues ranging from obesity to sleep problems linked with too much screen time. Although children’s screen time will understandably increase during the COVID-19 pandemic, the AAP encourages parents to do their best to help keep some balance between the digital and real world. Two especially important aspects of this are making sure screens don’t cut into:
    • Sleep. Not getting enough shut-eye leads to tired, sore eyes. The AAP recommends children not sleep with devices in their bedrooms, including TVs, computers and smartphones. In addition, the AAP recommends avoiding exposure to screens for 1 hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can interfere with sleep. Studies also suggest the blue light given off by screens might also make it difficult to sleep. 
    • Exercise. Putting down the device or stepping away from the computer or TV can help avoid eye and vision problems from too much screen time. The AAP recommends children age 6 years and older get at 60 minutes of physical activity each day. Active play is the best exercise for young children. Outside play can also be a great “workout” for children’s vision—giving them a chance to focus at different distances and getting exposure to natural sunlight.
  • Take frequent breaks. Children frequently get so absorbed in what they’re doing that they don’t notice symptoms of eye strain. Remind them to take breaks. The American Optometric Association recommends the 20/20/20 rule: look away from the screen every 20 minutes, focus on an object at least 20 feet away, for at least 20 seconds. In addition, children should walk away from the screen for at least 10 minutes every hour. A simple timer can help your child remember, and there are even software programs that can help by turning off the screen at regular intervals.
  • Remember to blink. Research published in The New England Journal of Medicine says staring at a computer can cut blinking rates by half and cause dry eyes. Encourage your child to try to blink extra, especially when they take breaks. Your pediatrician or eye doctor may recommend moisturizing eye drops or a room humidifier if your child continues to be bothered by dry eyes.
  • Screen positioning. Make sure the screen on your child’s desktop or laptop computer is slightly below eye level. Looking up at a screen opens eyes wider and dries them out quicker. Some experts suggest positioning device screens based on the 1/2/10 rule: mobile phones ideally at one foot, desktop devices and laptops at two feet, and roughly 10 feet for TV screens (depending on how big the screen is). Adjusting the font size—especially on smaller screens—so it’s twice as big as your child can comfortably read may also help reduce eye fatigue.
  • Spotlight on lighting. To cut down on glare and eye fatigue, a study published in Journal of Ophthalmology & Research says the level of lighting in a room when using a computer or other screen should be roughly half what it would be for other activities such as writing on paper or working on crafts. Try to position computers so that light from uncovered windows, lamps and overhead light fixtures aren’t shining directly on screens. Decrease the brightness of the screen to a more comfortable level for viewing. Some optometrists recommend special computer glasses with orange lenses that may also help reduce glare. Children who wear prescription eyeglasses may have an anti-reflective coating added, as well. Computer monitor hoods or shades that attach to the screen may also be an option.
  • Get regular vision screenings. If your child is having blurry vision or similar eye problems, he or she may not speak up. That’s why regular vision screenings are important. The American Academy of Ophthalmology and the AAP recommend children have their eyes checked by a pediatrician at well-child visits beginning at birth. If a problem is found during one of these routine eye exams, your pediatrician may refer you to a pediatric ophthalmologist.

Does my child need blue-light filtering glasses?

You may have heard about special glasses that help filter blue light given off from computers and other screens. Especially with more online learning during the pandemic, many wonder if t​​hese glasses should be on their child’s back-to-school supply list. Although there is no evidence that blue-light is harmful to the eyes, it can make it harder for children to fall asleep and contribute to eye strain, However, turning screens off an hour before bed, using the 20/20/20 rule and the other tips above can help prevent this—no purchase necessary!​

Remember

Children, especially younger ones, will likely need help and reminders to use digital screen devices in an eye-friendly way.

If you have any questions about keeping your child’s eyes and vision healthy, talk with your pediatrician.

More information

Source American Academy of Pediatrics (Copyright © 2017)

[Taken from this healthychildren.org article]

The information contained on this website 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 28, 2020

 

10/26/20 Note: Result turn-around times seem to have increased slightly this week. LabCorp Pixel is now taking 48-72 hours for results. Stanford lab seems to be taking 24-48 hours.

**We recommend the options starred below for their combination of relative convenience and reliability. We are actively monitoring testing options and are continuously adding to this list.

**San Mateo County Testing / Curative – PCR saliva test for kids and families. Same-day, drive-through test readily available M-F 1pm-8pm at the San Mateo County Event Center location.

How: Schedule online through the Curative website where appointment slots are easy to see before any screening is required. See FAQs for testing procedure.

Where: At the San Mateo County Event Center and several other San Mateo County locations.

Who: All San Mateo County residents with children ages 5 and older are eligible for no-cost testing. Asymptomatic or sympomatic.

**Stanford Express Care — PCR testing, now mostly nasal swabs (nasopharyngeal still used if you have symptoms or an upcoming procedure). 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 s given to those who are symptomatic or were exposed to confirmed or suspected COVID-19 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 — PCR test of nasal swab sample collected at home. This is convenient and a fairly quick turn-around.

How: Order online through the link above, filling out the questionnaire. The kit is sent by FedEx Express (next day), picked up from your home by FedEx Express 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).

**Quest Direct — PCR test of nasal swab sample collected at home.  Ordered online through Quest Labs’ Quest Direct program.

How: Order online through the link above, filling out the questionnaire. The kit is next-day mailed to you and you next-day mail it back. Results available within 48 hours of receipt by the lab.

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-19 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 take longer 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. Meets the State of Hawaii’s pre-travel testing program requirements.

How: Sign up for your kit on 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: Adults and children (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.

San Mateo County Testing / Project Baseline  — PCR nasal swab drive-through test (no video visit or doctor’s order required) available for scheduling up to 7 days in advance. For this test, the county public health system is operating through Google’s company Verily.

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

Where: The San Mateo County Event Center is open Tu-Sat 8am-3pm and there are several other rotating mobile testing sites.

Who: Adults (age 18 or older) who live or work in San Mateo County. Asymptomatic or Symptomatic.

San Mateo County Testing / Curative – PCR saliva test for kids. Same-day, drive-through test reliably available M-F 1pm-8pm at the San Mateo County Event Center location.

How: Schedule online through the Curative website.

Where: Several San Mateo County locations.

Who: Children age 5+. 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, San Francisco (in the Castro), Mill Valley, Oakland (in the Piedmont area).

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-19 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-19 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.

Walgreens — PCR test of nasal swab. Some sites also have rapid test available.  Drive-through testing by appointment only. Local sites include Cupertino and Daly City.

How: Complete the screening survey on the website to determine eligibility and sign up at the website.

Who: Adults and children (website says age 3+)

Note: Website says results available in 3 days.

Albertsons/Safeway — PCR test of saliva sample collected at home. Kit can be picked up from Albertsons/Safeway or mailed to you. You send it back via Fedex (drop it in a FedEx dropbox, or at a FedEx location, or schedule same-day pick-up). Samples should not be collected on Friday or Saturday.

How: Fill out an online questionnaire and have your test picked up by a designated person or delivered to your home

Who: Adults and children (no age restrictions, but child needs to be able to produce enough saliva to fill to the line on the tube provided)

Where: Available at several local Albertsons/Safeway locations, including Menlo Park, Redwood City, Palo Alto.

Note: Website says results will be delivered to you via text or email within 72 hours. The COVID-19 test does not currently meet the requirements for pre-travel testing to Hawaii. Tests are $139.99. They do not directly bill insurance for the test, but you may be able to submit your receipt to your insurance company for reimbursement.

Costco — PCR test of saliva sample collected at home, coordinated through AZOVA.  **Kits with ($139.99) and without ($129.99) video observation are available.

How: After ordering online, the kit is delivered next-day when you submit your registration on the Azova website by 10:30am MST M-F.  Drop off kit at UPS.

Who: Age requirements not listed.

Where: Website states the kit is only available to order online.

Note: Results are available in 24-48 hours with video observation, 72 hours without.  Note some travel requirements require video observation. They do not directly bill insurance for the test, but you may be able to submit your receipt to your insurance company for reimbursement.

IGeneX — PCR test of nasal swab sample collected at IGeneX headquarters in Milpitas (must be done there, in-person). Same-day and 24-hour results available.

How: Ordered online through their website at least one day in advance.

Where: IGeneX headquarters, 556 Gibraltar Dr. Milpitas, CA 95035. Appointments are available every 10 minutes, M – F, 8:30am – 10am.

Who: Age not specified.

Notes: Choose between the C100-24 test, which provides results in 24 hours, for $250, and the C100-6 test, which provides results on the same day, for $400.

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 26, 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

Girls in the Window

Love this. See full image here.

“In 1960, while a construction crew dismantled a row of brownstones right across from my own brownstone studio on East 58th Street, I was inspired to, somehow immortalize those buildings. I had the vision of 43 women in formal dress adorning the windows of the skeletal facade.

We had to work quickly to secure City permissions, arrange for models which included celebrities, the demolition supervisior’s wife (third floor, third from left), my own wife (second floor, far right), and also secure the Rolls Royce to be parked on the sidewalk. Careful planning was a necessity as the photography had to be accomplished during the workers’ lunch time!

The day before the buildings were razed, the 43 women appeared in their finest attire, went into the buildings, climbed the old stairs, and took their places in the windows. I was set up on my fire escape across the street, directing the scene, with bullhorn in hand. Of course I was concerned for the Models’ safety, as some were daring enough to pose out on the crumbling sills.

The photography came off as planned. What had seemed to some as too dangerous or difficult to accomplish, became my fantasy fulfilled, and my most memorable self-assigned photograph. It has been an international award winner ever since.

Most professional photographers dream of having one signature picture they are known for. “Girls in The Windows” is mine.”

Girls in The Windows. Ormond Gigli, 1960.

https://ormondgigli.com

 

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…