SPECIAL INTERVIEW WITH DR. RICE ON COVID-19
Thank you Lisa Liguori for this insightful Q & A on what we need to know and how not to worry.
Flattening the curve---are we there yet?
Encouraging data from the San Diego Department of Health has shown that fewer new cases of COVID-19 have been identified the past few days. Officials are encouraged by this data, but say it is too soon to know if this trend will hold for the long-term, and when we can expect to return to a semblance of our former lives. We aren't there yet.
So why are we so fixated on flattening the curve? When we refer to flattening the curve, we are referring to the decline in new cases of COVID-19, not the total number of active cases. To really be in the clear and return to our jobs, socializing, gym time, surfing, and shopping, there needs to be a significant decline in the total number of cases, not just new ones. In addition, we have not had testing available to the masses in order to identify asymptomatic carriers of COVID-19, as well as symptomatic cases. A key feature of this virus is that it can be actively spread by seemingly healthy people--without any symptoms. Until we see total cases of COVID-19 decline to levels that indicate it is no longer a significant threat, begin testing to identify asymptomatic carriers, discover a cure, vaccine or successful treatment modality, we still need to maintain social distancing measures. That includes good hand-washing, maintaining a minimum of 6 feet from others, and wearing masks when outside or in close proximity to other people. If you missed Dr. Parker's recommended reading on New Guidelines for Exercise and Social Distance in our last newsletter you can view it here--if you exercise outside, you'll be glad you did.
Theoretically, after infection with the virus that causes COVID -19, patients develop antibodies in their blood to fight off the virus. These normally take 7-11 days after initial exposure to the virus to be detectable, and can be measured in a patient’s serum. Initially IgM antibodies form, indicating current infection. As these fade, a second IgG antibody forms which is a marker for a past infection and can indicate some degree of immunity for future infections with the same virus.
Due to the urgency of the situation, the FDA allowed many companies to begin marketing tests for IgG and IgM antibodies without the normal, thorough process of having first to prove through extensive studies that their tests are indeed highly accurate and reproducible. Unfortunately, it has now been shown that there are many false positive and false negative test results – so much so that the results cannot be counted on to provide useful information regarding the presence or absence of past infection and assurance of any degree of immunity.
So while it was hoped that these tests would be widely available and very helpful in helping us sort through the issues of safe “return to play” by documenting resistance to re-infection, in reality they have just added another layer of confusion to an already overly complex problem. One of the largest of these companies offering drive-by testing and rapid results was just shut down due to lack of compliance in demonstrating testing reliability and quality. But don’t give up hope. As the legitimate companies refine their methodology and meet reliable standards of excellence, accurate antibody testing will proved a valuable tool for determining who has been infected. Eventually (just not yet) we will know how the presence or absence of these antibodies relate to potential immunity. It still needs to be discovered how much antibody formation reflects what degree of immunity, and for how long. Based on how antibodies have related to immunity for similar types of coronaviruses in the past, we can make projections. But it will all still be theoretical for now. Bottom Line: Current testing will be informative, but not definitive, and won’t help us a ton right now to recommend action items based on the results. We need more information to determine WHICH companies offer the most accurate test results. Beware of potential scams.
Just how important are masks?
This short video shows how far droplets are aspirated during speech both with and without a mask.
Chloroquine: A double-blind research study found it to be so dangerous at high doses the trial was shut down after six days. The study, conducted in Brazil, found one-quarter of the patients taking the anti-malaria medication developed potentially deadly changes in the electrical system regulating their heartbeats. While a small and imperfect study, it highlights the compelling need for more rigorous data. The American Heart Association found in a study that the combination of hydroxychloroquine and azithromycin caused an increase in heart failure and chest pain with twice the risk of cardiovascular mortality in the first month. Bottom Line: A drug previously thought by many to be a savior, now looks not so much like the answer we had hoped for.
Remdesivir: Back in February, the World Health Organization said remdesivir showed potential against Covid-19. In a new study, it was reported Thursday that patients have been recovering quickly, with most going home in days. The patients taking part in a clinical trial of the drug have all had severe respiratory symptoms and fever, but many were able to leave the hospital after less than a week of treatment. "The best news is that most of our patients have already been discharged. We've only had two patients perish," Dr. Kathleen Mullane, an infectious disease specialist at the University of Chicago who is leading the clinical trial, said in a video with colleagues. However, the trial does not include a control group, so it will be difficult to say whether the drug is truly helping patients recover better. Gilead is sponsoring tests of the drug in 2,400 patients with severe Covid-19 symptoms in 152 trial sites around the world. It's also testing the drug in 1,600 patients with moderate symptoms at 169 hospitals and clinics around the world. Gilead said it expected results from the trial by the end of the month. Bottom Line: Remdesivir is potentially a winner. We should be able to judge better in two weeks.
Now something a little on the lighter side with this coronavirus parody. You will want to turn up your speakers if you are a Les Miserables fan. Thank you, Phyllis Epstein for some much needed humor.
Our LWI Family in action for COVID-19
We are so thankful and proud of our LWI family for their generous and kind spirits. Below are just a few things our family members are doing to help others through this challenging time. Thank you on behalf of those receiving your gifts, and thank you for uplifting us all with your amazing hearts.
Young Bryce Hamlet has purchased and donated 1000 KN95 masks to San Diego Sports Medicine and Family Health Center (including Lifewellness Institute) to protect physicians and staff. Bryce is a HERO. Thank you Bryce!
James Brennan, CEO of Suja Juice, has personally been donating and distributing cases of his nutritious juices to hospitals and First Responders in San Diego County. James is a perineal philanthropist in times of crisis. We are blessed and grateful to have James in our community.
Dene Olive and Elizabeth Oliver, additional frequent angels in our community, have donated significant funding for COVID-19 testing to UCSD Healthcare. Thank you Dene and Elizabeth for this forward thinking gift.
Ben and Bryan Wood, of B. Wood Insurance for the precious support of families dealing with childhood cancers through the Emilio Nares Foundation, and championing the San Diego Food Bank for the food insecure. Thank you for reminding us of those who are often forgotten in times like these.
Are you an undercover angel? Do share! It gives us all a boost of much needed good news. It can help connect our LWI family in ways to support one another and our community.
Nutrition Zoom meeting
with Linda Illingworth, RDN
Wednesday April 22, 11 am
The Importance of Plant Centered
Eating for Immune Health
Mexico, which early on looked like it may not suffer from the type of numbers of COVID-19 patients seen in the U.S., has now become a hotbed of infection. Of particular concern is Baja California. One week ago, it was reported that Tijuana emergency rooms and hospitals were overrun with COVID-19 patients. Health care providers are working double and triple shifts without adequate PPE. They lack staffing and ventilators. President Andrés Manuel López Obrador has conceded that the system does not have the number of doctors and nurses that it needs as the epidemic begins to ramp up in Mexico. Nurses described the situation inside Hospital General in Tijuana as “desperate” and “very grave” and some have described the hospital situation being akin to a “war zone”.
My concern is with people that travel back and forth across the border and the potential they have to spread new infections in the U.S. – knowing that many infected patients will be unaware of their infection for up to 14 days prior to development of symptoms. Bottom Line: Baja California is in the logarithmic growth phase of COVID-19. We should be very careful with how we protect ourselves and our families from this new source of potential infections by being careful to follow the CDC recommended isolation and hygiene measures when appropriate.
Now is the time to continue to abide by our stay at home, wear our masks, wash our hands and continue social distancing as Dr. Fauci has advised.
We HAVE flattened the curve! ☺ NOW, we need to DEFLATE it. Please KEEP IT UP, for all of us.