Month: April 2020

So this question was posed on the live session on Monday April 20, and has been being asked across the nation. I didn’t really have time to delve into a full articulate response, but I do think I hit on some points I’d like to expand and clarify here.

1. This is likely a factor of our being the likely to have other risk factors such as metabolic diseases (diabetes, hypertension, BMI > 30). When you have a population that is much more affected by the other risk factors, you expect to see that population much more affected.
2. This is something that is systemic, and predates the COVID-19 pandemic. In the medical community, we have been discussing social determinants of health for some time now, and this is something that largely affects the health of our black and brown communities.
3. To further elaborate on the above comment, unfortunately, you also find that there is less access to testing in black and brown communities at this time. What we know is that without testing, we find it difficult to contain any pandemic.
4. There is historical mistrust between the African-American community at large and the medical community. And it has been earned. With a history like experiments on those at Tuskegee and others like it, within past 100 years no less, it’s sometimes hard for the African-American community to trust that the information that is coming out is best for them. In this case, it can lead to ignoring sound health advice, and spread of illness, or worse course of illness.
5. Many of us could not self quarantine. When you look at those who are not socioeconomically well off, they are disproportionately black and brown. Many of us were given the choice of working or not getting paid. Many of us lost our jobs and can’t afford masks and hand sanitizer. These are the things that affect outcomes.

So what can we do about it?

We can’t fix systems overnight. But we can do some things to try to make sure we are helping our communities tip the scales a bit. One thing is to donate to organizations that are specifically trying to reach those who are underserved and get them the tools to protect themselves—masks, hand sanitizer, etc.

Another—believe us when we say to remain socially distant and act accordingly. Do not go to your nail salon if they don’t come back into business with appropriate measures in place. Don’t get your hair done if your stylist isn’t protecting his/her clients by taking the financial or temporal hit to socially distance clientele and sanitize appropriately. Don’t start having parties and gatherings that violate social distancing too soon. It’s not more important than our health as a community.

Ultimately, as well, I believe we have to start focusing on our overall health. We must start educating ourselves on better eating choices and exercise, and stop glorifying diets that kill us. Eating more fruits and vegetables is good for your immune system, but also, in the long term, eating more plants and moving more, means less metabolic disease. We have to continue to fight for improved systems so that everyone has access to healthful foods and safe places for exercise. Because in the middle of a pandemic is too late to change a broken system, we have to remember the lessons and fight for change for the next time.

See links below for other discussions on this topic.

Associated Press Article

Previous Surgeon General Weighs In

It is an encapsulated RNA virus. That means it can not replicate on its own, and needs our bodies to do the work. It invades the cell, uses its machinery to replicate, and ultimately kills the cell.

When it has killed enough cells, it causes an immune response, which causes the initial symptoms you will begin to feel. It really likes the cells in the respiratory tract. In severe infections, it can also be detected in the kidneys, and we have detected virus in feces as well. At this point, it doesn’t seem to be blood born.

Most of the symptoms you have are from your body’s immune response, including what happens in severe illness causing ICU care.

This amazing picture from JAMA was found in the article linked below. It illustrates what the virus does to the body.

What Coronavirus Does to the Body

• Age > 60: our immune systems get weaker as we get older. They are also weaker when we are very young (younger than 2) but for some reason, this virus hasn’t affected that population quite the same
• Metabolic syndrome: hypertension, diabetes, obesity (BMI > 30): these things weaken our immune systems. Hypertension is turning out to be a bit less of a risk factor, while uncontrolled diabetes and BMI >40 are turning out to be significant risk factors for severe disease.
• Coronary Artery Disease or Heart Failure–they are in pro-inflammatory states, and the illness tends to attack the heart.
• active smokers and vapers–damages the lungs, and this illness really likes the lungs
• males?: some thinking that it may be due to the fact that the immune function is on the X chromosome, and males only have one.
• Immunocompromised: cancer patients on chemo, those with autoimmune illnesses on certain medications, patients with severe kidney disease, particularly those on dialysis, end stage liver disease.
• African-Americans, Hispanics, and Native Americans-This is extremely multi-factorial, and goes back a long way. It’s more systemic than genetic–and I did a completely separate post to try to do the subject justice.
• Chronic lung disease?: It is still being considered a risk factor, although there are clear differences between COPD and asthmatics in the data.

For someone with mild symptoms, there are no approved medical treatments. It’s the same as a cold—eat well, rest, treat symptoms. The medications that the President has suggested, or that you see being discussed on social media—those are for people who need hospitalization, when it’s possibly worth the harm these medications can cause, and these patients can be appropriately monitored. Additionally, most of these medications are experimental in even these populations, so you need to be enrolled in a study.

I did a previous post on some medications were were beginning to investigated. There have been SOOO many more investigations added since I did that post, and I will try to update when I have a chance, but at this point, for the average person, at home, the therapy is supportive. For those who are extremely interested, I have linked the JAMA article reviewing the current experimental treatments here.

Not sure I can answer this question well. Those who had mild disease can recover like recovering from a cold. Those who had severe disease and ICU stays have a much more significant process and potentially lasting damage to their lungs and other organs. It looks different for everyone, but the important thing to remember is that many, many people recover.

It does remain important to try to avoid becoming infected, because as we learn more and more about this illness, we find that the recovery can really take a while, even for those with mild disease.

One great resource to how testing works, where the testing sites are located and how each of them should be accessed is here. It is updated on a regular basis and has the numbers for screening for most of the testing sites.

For patients who are uninsured, there are options with the city and county. They are offered 6 days weekly: M-W in precincts 2 and 4 in the county and Th-Sa in pricints 1 and 3. They are mobile pop up sites, which means they change locations to try to meet the needs of where they are finding the concentration of need for testing.

If you live inside city limits you should call 832-393-4220 between 9 a.m. and 7 p.m. If you are outside city limits, but inside Harris county, you should go to the website for a code for testing. They ask questions about being symptomatic because of false negatives, so they are prioritizing symptomatic patients. However, at this point, both the city and the county will test anyone who want to be tested if they have capacity, although they are prioritizing those with symptoms. The code is for line control, and the line is staffed by law enforcement officers to keep things flowing nicely.

At the county pop up sites, you drive through, you roll down your window halfway, and a nurse uses the swab to collect the sample.

There are also two stationary sites at Baytown and Katy for the county, and two city sites (locations will be researched). These sites are self swab sites, and you will be given the testing media, and instructed in collecting the sample yourself.

As recently as Friday, there are also screening sites at Walgreens locations; these will be self-swabbing sites as well.

All are free, not asking immigration status, not taking copayment.

There is a great deal of information on the covid website.

Test results take 3-5 days.

Contact Harris health if unsure if you feel you need to be evaluated: the county’s triage line is available from 9am-7pm at 713-634-1110, and they prefer you call so that you can be appropriately triaged before arriving at a hospital, and the hospital can be prepared for you, even if you need hospital care. The county hospitals (Ben Taub and LBJ) are equipped to handle COVID-19 patients.

Map of Drive Through Testing Sites

Harris County Symptom Check

Harris County COVID-19 Site

At this point, the public testing sites are testing anyone who wants to be tested. However, I would caution against this slightly, for two reasons:

1. When you are asymptomatic, you may test negative, but actually be too early in the infection to test positive. This may give a false sense of confidence, and you may spread the infection to others in that time.
2. In some of these public sites, you are walked through a self swab. The swabbing process is particularly important and affects the accuracy of the test. Again, getting a negative test when you actually have the virus can be dangerous.

I think we should be testing as many people as possible, but I also think our results should be as accurate as possible if we’re going to really be able to contain the spread.

So with my patients, I test if they have a constellation of symptoms that sound like COVID-19, OR if they have even one symptom with a known contact. I do tend to wait for symptoms because it makes it less likely the test will be negative when they actually have the virus. I always recommend that if they’ve been in high risk contact with someone with the virus that they behave as if they have the virus for 2 weeks (meaning self quarantine) regardless of symptoms. Ultimately, this should be a conversation between you and your doctor.

*****UPDATE*****

Things have changed significantly, but I have left the above, because there is important rationale there. Now, there are populations that it is important to test as often as possible as we re-assimilate into normal life. This will help us assure less asymptomatic spread, and help contain the virus. There are many caveats when considering when to test–for instance, if you are about to go visit loved ones and want to ensure you aren’t carrying asymptomatic infection, it may be a good time to be tested. I maintain that a conversation with your primary care doctor or an infectious disease specialist is the best way to go to decide when to get tested–it’s can get pretty complicated.

Unequivocally yes!!

It should have been done sooner, and the numbers show that we have absolutely saved lives by doing so. It’s also realistic that we won’t be able to live this way forever—the mental health implications alone are difficult to ignore. However, there should be no “getting back to normal.” This is not a situation you can slap a bandaid on and pretend didn’t happen. There will have to be significant changes to the way we operate as we try to reopen things and maintain some social distancing until we have the situation fully under control. If we don’t, we will absolutely see a much worse second spike.

• Hand washing, clean surfaces, and social distancing!
  • These are the single most important tools you have at protecting yourself and preventing the spread of this virus.
  • remember, 30 seconds of hand washing or sanitize your hands with alcohol based sanitizer, before and after eating, any time you’ve entered your home from outside, after touching any packages from outside, after interacting with others at work (if you are still working), after touching items in a wallet or purse, etc.
  • Wipe down surfaces that are touched frequently on a regular basis: door handles, steering wheel, refrigerator door, computer, cell phone, etc.
  • Remove shoes (leave them outside or in a mudroom), change, and shower when you get home.
  • Continue to remain distant, even as our business begin to open. THIS IS IMPORTANT. We have seen the curve flatten, but we are far from out of the woods, and we will absolutely see a worse second spike if we do not do this. Do not go back to hugging, kissing, shaking hands, sitting in groups. I’ll include an image (that isn’t mine, but I’m not sure of it’s origin) to help drive this point home:

• Masks:
  • what we have seen is that wearing masks in public does seem to prevent the spread of illness.
  • It is imperative that you wear them correctly, and DO NOT TOUCH THEM while you are out and about.
  • You should also know how to appropriately take it off so that you don’t accidentally infect yourself while taking it off: wash or sanitize your hands, remove it from the point furthest from your face (from the ear loop or from behind your head, not grabbing the portion covering your mouth), and then dispose of it or immediately prepare it for sanitizing (if reusable or cloth) and wash your hands. Removing protective equipment is one of the times you are most likely to infect yourself, and part of the reason it wasn’t initially advised for the general public.
• NOT GLOVES:
  • Most people do not know how not to cause cross contamination when wearing gloves.
  • Have you ever noticed how many times you see your doctor change gloves if they are performing a long procedure? Or do you notice that they don’t glove until they intend to touch the things they want to touch while clean and then immediately re-glove if they have touched something outside of that field? That’s because there is nothing about gloves that makes them inherently germ free.
  • Gloves are only clean as long as they haven’t touched a dirty surface. The minute they’ve touched a dirty surface, they are the dirty surface, and they are spreading germs, just like dirty hands.
  • Don’t wear gloves, and wash your hands frequently. You are less likely to feel a false sense of security, more likely to do what is correct and prevent the spread of illness.
  • *don’t forget to click the hyperlink*
• Healthy diet
  • A healthy diet is essential to a healthy immune system. Supplements are wonderful, but our body REALLY likes to see things naturally, from foods. That’s how we were meant to get our nutrients. Not from pills. So it’s best to eat a diet that is rich in plants and varied in color to ensure you’re getting the vitamins, minerals and antioxidants your body is craving.
• Exercise
  • If you know me at all, you know I say EXERCISE FOR EVERYTHING!! From diabetes and hypertension to weight management to anxiety and depression to dementia…exercise can be my non-pharmacologic prescription for all of it. And guess what–there’s some evidence it can help boost your immune system and help protect against deadly complications in COVID-19 infection. So you know I had to include it in the list, right?!. Click the hyperlink on the main bullet for the main article and click here for my previous post on staying healthy during the pandemic.
• Vitamin c? Zinc? Other supplements?
  • In the medical community, you’re seeing mixed feelings about using these things to try to help prevent and treat the viral illness. You guys know how I feel about them from previous posts. I also discussed elderberry, specifically in COVID-19 here.