When will life be back to normal?

Let’s face it. We are tired. I am tired too. I’m tired of not embracing my friends. I’m tired of not going out and only eating the food I cook myself. I’m tired of not traveling or not conducting work meetings in person. The sacrifices are worth it, but it has been demoralizing for all of us, and let’s be honest – it feels like it’s been FOREVER. But it hasn’t been forever. Just a half a year of soul-searching and character-building. But it helps to have an end in sight. So, when WILL this end? Here’s my messy, but hopefully realistic, estimate:

Based on the information we currently have (keeping in mind, the information is always changing), we hope to have a vaccine by December of this year. It is then projected that we will have about 700 million doses by April 2021 of said vaccine. It will likely be that many people will not want the vaccine right away due to trust issues (more on this in a future post about the safety of vaccines). So, even if we could vaccinate everyone within the first few months, due to delay by many skeptics, we likely will not have the required amount for herd immunity until the 3rd quarter of 2021.

Therefore, in reality, by the time enough people are vaccinated so that there will be enough impact to start thinking about nearing normalcy will be in the 3rd or 4th quarter of 2021… and that is pending availability of a vaccine by December of this year.

So… time will tell. This is just my best estimate (not a medical opinion, just an anecdotal estimate), based on the data (that is always changing!) on when we may get back to a sense of normalcy. How long will the immunity (and thus, normalcy) last? This will be addressed in a future post!

But for now, having an estimate helps me cope… knowing that this won’t go on forever. Sure, it may not be as soon as I want, but waiting until next year is *not* forever. And until then, let’s continue doing what we know works: socially distancing, washing our hands, and wearing masks. And when the time comes, we will be well-positioned to take on our 2021 normalcy with good health and embrace our friends with strong, COVID-free arms.

Love, Dr. Yang

“At the still point of the turning world… there the dance is.” T.S. Eliot

This past week I participated in a yoga nidra immersion. I have felt a lot of vata energy, and the immersion helped me feel grounded amidst the chaos that has been life these last few months. Next week, I will be participating in a week-long yoga nidra retreat (all online, of course), and I am looking forward to it. More chaos, change and unrest will come… and I hope to be grounded in my nervous system before it all makes me dizzy. I am learning to dance with the turning world, feel its rhythms and ground my soul. What are you doing settle into your heart and spirit?

With COVID-19 causing us to stay indoors, we tend to sit more, exercise less, and thus, use our lungs less efficiently. To get your lungs into better shape, your go-to option should be regular old physical activity — the kind that gets your heart rate up. Anything that makes you breathe faster is basically a breathing exercise, whether it’s biking for 20 minutes, swimming, walking, or practicing pranayama (yogic breathing exercises).

Staying active is especially important because lung function will decrease with neglect. Without use, the muscles that support your breathing become weaker and your lung tissue will lose elasticity. Studies (and common sense) have shown that exercise boosts lung function.

So, what should I do? Aerobic activity! It helps air get into the deepest parts of your lungs. And if there are any pollutants you’ve inhaled, aerobic activity helps you clear them out and decreases your risk of infection or pneumonia. Aerobic fitness also helps your body obtain oxygen from the environment and use it in the most efficient manner. So, if you happen to get COVID, and you’ve been doing cardio, that’s going to help you.

What’s important for lung health is to exercise at an intensity that quickens your breathing rate. Many of us don’t like the discomfort of heavy breathing, but when we push ourselves just outside of our comfort zones, we achieve the largest gains. That includes our lung health too.

Aerobic activity is also great for your muscles and weight maintenance. Sometime in the near future, this pandemic shall pass, and when it’s no longer acceptable to wear pajamas all day, it will feel good to put on those old jeans and leave the house. We’ll get through this, friends!

My last piece of advice? Mix it up! Just running every day will wear at your knee and hip joints, so make time to stretch, strengthen, and work on your range of motion! I participate in a different activity each day whether it is running, a HIIT class, biking, yoga, or a brisk walk. It’s all good for you and cross-training helps to preserve your joints.

So, get out there! Today! And strengthen your lungs, body, and spirit!

Love, Dr. Yang

“What lies behind us and what lies before us are tiny matters compared to what lies within us.”― R.W. Emerson

COVID lies behind us, before us and with us. And while I’d argue that the pandemic isn’t “tiny,” as the days and weeks and months roll on, I’ve become increasingly convinced that what lies within each of us is greater than the virus… especially when we stand together. Thank you for the fortitude to continue to socially distance, wear masks, and be kind to those around you.

Love, Dr. Yang

Last week, July 26th, 2020 was the 30th anniversary of the passing of the American Disabilities Act. This historic federal legislation enhanced and extended civil rights to millions of Americans. Shortly before the act was passed, disability rights activists with physical disabilities coalesced in front of the Capitol Building, shed their crutches, wheelchairs, and other assistive devices, to pull their bodies up all 100 of the Capitol’s front steps. As the activists did so, many of them chanted “ADA now”, and “Vote, Now”. Jennifer Keelan, a second grader with cerebral palsy, pulled herself up the steps, using mostly her hands and arms, saying “I’ll take all night if I have to.” This direct action is reported to have “inconvenienced” several senators and to have pushed them to approve the act. The ADA improved access to public services, the built environment (e.g. sidewalks with curb cuts and accessible pedestrian signals), understanding of the abilities of people with disabilities, established a right to equal access to public services and has demonstrated the contributions which people with disabilities can make to the economy and society as a whole. Disparities still remain in employment, earned income, Internet access, transportation, housing, and educational attainment, and so much more, and the disabled remain at a disadvantage with respect to health and health care. We have so much more work to do. As a former rehab doctor, I saw firsthand these inequities and wanted so badly to level the playing field in some way, in the ways I know how. Thus, this book. Because yoga isn’t about fitting into our western paradigm. It is not about about making people fit yoga. It’s about yoga fitting people. Real people. All people. Because yoga IS for every body. I hope this book does justice to those that have fought for equal rights and equal access. I hope this is a book that Jennifer Keelan would be proud of. I hope that this book teaches people to do yoga who never thought they could before. Happy anniversary to the passing of the ADA. Look out for the book in November. Yoga is for every body. Yes. I mean it.

Have you considered practicing yoga in a studio during the pandemic? Is staying 6 feet apart and wearing a mask really enough? Read my interview with Entrepreneur Magazine on the science and safety behind practicing yoga in a studio during the time of Covid-19!

Photos by @cr9gaze while I practice pandemic yoga. Mask on. Fanny pack with hand sanitizer. Is the stress worth it to you?

This story is getting old, but seems like it still needs to be told over and over again. I just admitted a COVID patient who is young (early 30s) and has no medical problems who went from room air to requiring HFNC (remember the equipment I said was running frighteningly LOW in my post last week?!) and is now on the brink of intubation within the 8 hours since I admitted her. This could be you.

So let’s reiterate the points: 1) COVID-19 is not just a “bad flu”, 2) Today I can use an anti-virals, steroids, and other experimental therapies to help COVID-19 patients navigate more safely through their disease course. I didn’t have any of these options 3 months ago. I hope this patient will survive because of these new discoveries. What other tools will we have to fight COVID 3 months from now? Delay getting this disease as long as you can – we will have a better chance to cure you and get you through this terrible disease.

Thanks for listening and spread the word.

Love, Dr. Yang

**Radical art and mural by @austinzart

Read my advice in the Martha Stewart Living Magazine!

Every person wants to think they are a good person. But when you willfully defy the good, hard-earned advice from scientists just because you “don’t like” something, you have to question the “good person” goal. People try to bend the rules :“well if I’m outside, talking at the open window-counter inside to the person 2 feet away, it’s ok to not wear a mask right?” People try to have their parties “no matter what,” or because they are simply tired for trying so hard. This is not how it works. We have to follow the evidence. And the evidence says, make no exceptions. Socially distance. Cancel your parties. Wear. A. Damn. Mask.

I can promise you that in no way did your country or anyone else conspire to exacerbate a pandemic just to control you and force you to wear a tiny piece of cloth on your face. Please just wear the mask. If not for you, for all of us. So we can open back up and resume our lives.

Are you a good person? Do you want to be? Prove it. Make the right decision, over and over again. And eventually it will become habit to be kind to others and unselfish in your actions. Habits create lifestyle. And it can be your lifestyle to be a good person AND survive this pandemic.

Love, Dr. Yang

Cartoon by the hilarious @theawkwardyeti

Last week while on service in the hospital, one of the respiratory therapists said: “We are out of High flow nasal cannulas.” This struck fear in my heart. Let me explain what that means and why this is so terrifying. For me, for you, for everyone you know.

In the past 3 weeks, COVID19 admissions in my hospital have risen, and the majority of those patients requiring oxygen, and sometimes intubation, have been between 30-50 years old. For my followers, that’s probably you.

The equipment in which we use to support a person’s oxygenation range from nasal cannula (#1 on the graphic) to intubation (#6). You want to try to avoid #6 at all costs because there are, more often than not, long-term consequences to having a tube placed down your airway for even a few days. And we want to avoid the risk that the tube will never come out at all.

In the graphic, notice that HFNC (high flow nasal cannula) is #4. That means that, because supplies are running low or are out altogether, we are losing one of the most important intermediary steps to supporting patients who cannot breathe without oxygen support. In sum, you are one step closer to intubation and death from COVID-19 without the intermediary step of HFNC.

My hospital has since replenished our stores, but we are still running low. The whole country is running low because we have so many Covid19 patients that are using them. And if infections keep rising at this rate, we may not have one for you or your loved one when you/they are hospitalized, whether with COVID-19 or another illness. This, to someone who wants to be able to save you, is terrifying.

But don’t panic. There is a solution. Save the high flow nasal cannulas. Save your body from being intubated. Wear a mask. Wash your hands. Socially distance!

Thanks for listening and I hope you stay safe and healthy.

Love, Dr. Yang