The Dangers of Antibody Testing

SARS-CoV-2 antibody testing has been touted as the holy grail – the get-out-of-COVID-jail free card. Because there are many asymptomatic carriers, some are understandably hoping: “if I’ve already had it and was asymptomatic, I could be immune!” and then can indiscriminately resume their pre-pandemic lifestyles. I want that too! But bad news, friends – antibody testing is not the key to that door.

To put it simply, antibodies are Y shaped proteins launched forth by your immune system which latch onto an antigen (in this case, the SARS-CoV-2 virus) to render it inert and/or destroy it. Pretty cool, right? The problem is, SARS-CoV-2 comes from a family of viruses called the coronaviruses, of which there are almost 100. The antibody test does not discern between the types of coronaviruses, so it won’t tell you if you’ve had the common cold (which doesn’t kill you), or SARS-CoV-2 (which very well could). So, you could’ve had the sniffles last year and your Antibody test will be positive. You’ll be led to believe you are immune to COVID-19, but you’re actually just immune to the virus that caused your common cold.

So you could go around traveling and loving life again… going out to bars, sharing drinks, not wearing a mask, not maintain a 6 ft distance… and you would still be susceptible to contracting the virus, and developing the frighteningly lethal infection that is COVID-19. It just takes seeing one person suffering from COVID-19 to scare you enough to do everything you can from getting it. It’s a terrifying disease.

I know that all this misinformation has created an information quagmire. But try to stick with trusted resources based on science (the FDA has a really good list of approved/not approved tests re: COVID-19), and for the meantime, until we get more and better tests, it’s better to maintain safe practices for yourself. Wash your hands, don’t touch your face, stay 6 ft apart, and for goodness sakes, please wear a mask. In sum, antibody tests are not specific for COVID-19. It will just tell you if you’ve had one of the 100 coronaviruses. So, it gives no answers against your immunity and safety against COVID-19. Thanks for sharing.

Love, Dr. Yang

If you aren’t in over your head, how do you know how tall you are?

“If you aren’t in over your head, how do you know how tall you are?” ― T.S. Eliot

The LA Times featured my hospital system, and specifically my hospital, Sharp Memorial, in a photo journal. It was surreal seeing the hallways and wards that I walk through on a daily basis pictures in such a vivid and prolific manner. The second photo is in an ER bay that I walk in almost every day I’m at work to admit patients.

In this strange time and place where every aspect of medicine has been affected by the virus, making clinical decisions for our patients has arguably never been harder. When I look back on this time of my career 20 years from now, I know we’ll be proud of our strength, our sacrifice, our courage… and our friends. The friends who helped us clean and doff our PAPRs in the ED, the friends who laughed and cried with us as we attended COVID-19 treatment update meetings on Zoom, the friends who had pizza delivered to the wards because they know that will be the only thing you have time to eat that day, the friends who held the hands of our dying patient in the ICU. As I witness each act of friendship, I’m learning just how enormous and significant kindness and love can be, and that makes me immeasurably proud to be even just a small part of your lives.

Photos by @yamphoto of the @latimes

Some words of caution as we lift shelter in place orders…

As of yesterday, San Diego fully entered Phase 2b, which means restaurants and retail businesses can have in-person customers with modifications to operations.

I wanted to offer some words of warning as we begin to venture out.
We have entered that stage of the pandemic where we’re just tired. Tired of working so hard and so long. Tired of the loneliness, for ourselves, for our loved ones. But remember, we have met with a novel virus that is causing disease unlike anything we have ever seen, during an era of scarcity that we have never before encountered, in a time of rapidly unfolding science and ever-changing information… and misinformation. In this time where every aspect of our lives has been affected by the virus, letting exhaustion affect our decisions will be detrimental. My only plea? Don’t let boredom or fear create a monster so scary that you start to believe that he’s real.

Please remember that we were sheltering in place so as to not overwhelm our health care system.

If you become ill with COVID-19 and you have to go to a hospital, you are overrunning the hospitals and potentially taking ventilators away from people with cancer or involved in major trauma. A child with cystic fibrosis or debilitating asthma can’t control the exacerbation of her disease, but you can exert some semblance of control as to whether you contract COVID-19. In the last 2 months, I have taken care of plenty of COVID-19 patients in the hospital, sure, but the majority of my patients are those with end-stage cancer or severe kidney/liver/cardiac disease. They need to be hospitalized or they will die, and we need to save beds for them. So, can we bear another surge, with potentially more cases? No, we need to save beds and ventilators for innocent, compromised patients, not for those that want to go to bars and play beer pong.
I feel impatient as well. I want to get back to life as much as anyone else. I want to travel and embrace my family. I want to see my best friend’s new baby. But I remember that we have a greater purpose and it’s to make space for the people that need us. For my cancer, my liver, my trauma patients. Thanks for sharing.

Love, Dr Yang

Why you should wear a mask, explained.

Why should I wear a mask? Here’s why:

Masks provide “source control”—blocking the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection. A study published in Nature showed that surgical masks are effective at blocking 99% of respiratory droplets. Double-layered cotton masks, the kind most of us have been making at home, can block droplet emissions as well. And the Sars-CoV-2 virus doesn’t last long on cloth; viral counts drop 99% in 3 hours. A recent review of the research suggests that if at least 60% of the population wore masks that were just 60% effective in blocking viral transmission (i.e. a cloth mask), the epidemic could be stopped. Read that again. If just 2/3 of us would wear masks, COVID-19 COULD BE STOPPED.

I don’t think this is asking a lot. If you have to wear pants in public, it is not much more burdensome to wear a mask.

Cloth and surgical masks don’t fit tightly, so it is hyperbole to say you can’t breathe. Maybe it is not as comfortable, but you can breathe air coming in around the sides. They are designed to safeguard others, not the wearer. The basic logic is: I protect you; you protect me. Benefit to the wearer may be limited, but it’s not insignificant: surgical masks reduce inhalation of respiratory-droplet-size particles by about 75%. Two-layer cotton masks filter about half as much, though a good fit can improve that considerably. Masks also prevent wearers from touching their noses and mouths.

Evidence of the benefits of mandatory masks is now overwhelming. Our hospital system would not be able to stop viral spread without them. So yes, you should wear a mask. I protect you and you protect me. We’re in this together, let’s beat this virus together. Thanks for sharing this info and wearing a mask! .

Thanks also to @atul.gawande for providing the majority of these statistics! .

We are not less productive, we are just less frantic

I had the loveliest facetime catch up with my amazing friend Diane today. She is not just a deeply knowledgeable and heartfelt yoga teacher, but also a wise and connected human and friend. We were talking about social isolation, as many of us do today, and I jokingly posed the question to Diane: “Why am I so much less efficient now when I have so much more time, than I was before social isolation?” She laughed and answered, “Maybe you’re not less efficient, just less frantic.” And there it is. I let out a sigh of relief and realized how incredibly right she is. I am not getting any less done that I used to be. I’m still going to the hospital and taking care of sick patients. I’m still preparing for the publication of my next book. I’m still cooking, and caring for the dog, and cleaning the house, and sending out emails. But all this is done in a setting that is so much less frantic.

I’m no longer running myself ragged on my days away from the hospital – trying to see friends, go to the store, and get to a yoga class. Now I get to practice the same yoga class at home. Now, instead of rushing from event to event, or packing for trips, I am taking my time planning meals for myself and my partner, and taking the dog on long walks.

So today, instead of mourning the loss of “all the things” that kept me frantically busy, I will celebrate the freedom of a less frenetic way of being. Instead of rushing through my chores or my workouts, I will languish in the spaciousness. Instead of being frustrated that the dog interrupts my yoga session, I will giggle that she wants to be support this emotionally exhausted frontline worker and restart the posture sequence.

We’re doing all the same things – we are just less frantic.  Thanks, Diane. Thanks for sharing your wisdom with me, and with all of us. Let’s all find a little more perspective and space within our less-frantic socially-isolated lives.

Keep your pulmonary system healthy with this technique of diaphragmatic breathing

Did you know that we have pulmonary vagal irritant receptors? Irritant receptors lie between airway epithelial cells and are stimulated by noxious gases, cold, and inhaled dusts. Once activated, they send action potentials via the vagus nerve leading to bronchoconstriction (which can lead to cough) and increased respiratory rate. When stretched, these receptors also increase production of pulmonary surfactant, which allows our alveoli in the lungs to be more flexible and compliant. Our treatment, when these irritant receptors are activated is supplemental oxygen and airway clearance. You can do this yourself! Just take a long, deep, deliberate breath – right now! That brings in more oxygen into your lungs (supplemental oxygen), and helps to clear your airway with the prolonged exhalation.

Keep your pulmonary system healthy, avoid cough, and your vagus nerve toned during these times in the pandemic with this technique of slow, diaphragmatic breathing. Keeping the pulmonary vagal irritant receptors inactivated and at rest!

How meditation helps me cope with COVID-19

Now, more than ever, I have called upon my meditation practice to help me through each day. Every morning, whether I’m headed to the hospital or self-isolating at home, I find my way to my meditation pillow for 30 minutes. This is a very stressful time for a physician. There is no question that I love my job, and I thrive in stressful environments. However, these times are unprecedented. No doctor has trained for this. But my mindfulness practice has guided me through the stressful hospital days and has helped me navigate the challenges with dignity, grace, and compassion.

I remember when I first started meditating; I was living in NYC, 9/11 had just occurred and I felt stressed about everything. I could hardly sit still for even 5 minutes. But regardless of how hard it was (and it was hard!), I would practice every day. Even for just 5 minutes. Eventually, I started to notice the benefits — I was no longer ruled by my concerns about the future or dwelling in the past — I felt more present in my daily life, and consequently, more free.

My meditation practice really took flight during med school. I was filled with so many feelings of inadequacy and self-doubt. How could I ever have the knowledge and healing instinct that seemed to come so easily to my mentors? But when I committed to the practice, I found it inside me — that sense of knowing… the confidence and self-love that it took to believe I could be all the things I set out to be. It motivated me to study harder and work longer hours. It took years of practice, and some days are harder than others. But it’s in those moments, I know I must go back to my practice. In moments of doubt and fear, I sit– to stay grounded and centered. In times of discomfort I call upon meditation for comfort and guidance — and it has never failed me. In these times of the

COVID-19 pandemic, I practice meditation daily. And without it, I would be a very different person. Who knows, I may have let the stress get to me. But because of the support of meditation, I know myself better, and I can summon the courage needed to take on these difficulties ahead, and step up to the plate the way my patients need me. You can too.

How long do Coronaviruses remain infectious on surfaces?

Many of you have asked how long the SARS-CoV-2 virus (the virus that causes the Covid19 infection) lasts on surfaces. Here is a good guide. Reminding you about my two golden rules: 1) don’t touch your face, and 2) wash your hands well and often.

Love, Ingrid