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! .

National Doctor’s Day

It’s March 30, 2020, and it’s national doctor’s day. But this year is unlike any other. It has been trying times recently for physicians. Even before the pandemic, burnout was 46% and the physician suicide rate is the highest of any profession. Physicians have been frustrated trying to shuffle paperwork, and serve hospital systems and insurance companies when all we really want to do is take care of patients.

Now our situation has shifted. In a pandemic, we no longer have time to worry about our failing American health system—we have to act. And physicians everywhere are acting. They are stepping up to take care of the surges of people with COVID-19 in our communities.

As a hospitalist on this Doctor’s Day, I start a string of shifts caring for patients infected with COVID-19. Every physician I know caring for COVID-19 patients is experiencing higher levels of stress ever (and we know stress). But we also feel more alone than ever as we distance ourselves from our families, friends and colleagues in order to protect them.

What can you do to support physicians for Doctor’s Day 2020?
1. Just reach out and connect. It means so much to us to hear from you, and to remember we are working for YOU.
2. Donate PPE if you have any. We can’t take care of you if we are ill ourselves.
3. Stay home. PLEASE. I am literally begging. The chant “We go to work for you. Please stay home for us” are just as much for as it is for us. There are only so many beds. Don’t make us choose who gets them.
4. Remember all of this when it’s over. Because this will end… and after the pandemic has subsided, please remember that physicians were there. Despite personal anxiety and concerns for our own safety and our families, we keep showing up to take care of you. So sometimes we have bad days too. We, like you, are human, and we’re doing our very best.
As for me, I will approach Doctor’s Day more seriously than ever. Some of my colleagues have died from COVID-19, and we will lose more before we’re through. I will continue to use Doctor’s Day as a time to reflect on my place in this calling. I hope we all remember—not just on Doctor’s Day—the sacrifices physicians make. . . . .

Happy Women Physicians day

 

Today, a dear friend reminded me that today is National Women Physician’s Day. I am honored to celebrate this day as both a member and admirer of physicians. By 2050, women will consist of more than 50% of the physician workforce… while still being mothers, sisters, daughters, caregivers, side-gigers, philanthropists, volunteers, activists, friends, badass multi-taskers, and so much more. This profession is not just a job, it is a calling. In my late 20s, I changed the direction of my life to pursue this calling. From attorney to physician, it was the best decision I could have ever made. I am now one of those rare people that can say she absolutely loves her job. And with the hard work and sacrifices that came with this life change and the grueling medical training, I can now say I live my life in complete alignment with my values. The journey was wrought with seemingly impossible obstacles and turbulent waters. Time after time, challenges arose that caused me to doubt myself and my journey. And they still do. But I keep coming back. To the patients. To the humanity. To the inspiration that I gain day after day in this work from my colleagues and patients. I am proud and blessed to be doing what I love. To be part of this community of caregivers who work hard day after day. Not just to study and improve for the sake of their patients. But who maintain open hearts and thin skin — so that compassion and love can continue to permeate. So that each individual patient is a human, and not a number. So that we always know and remember the value of human life and human emotion. Because healing is not just about prescriptions, but about the openness of your heart and the depth of your gratitude. And I am grateful.  Happy Women’s Physician Day!!