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?” ― 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
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 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! .
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.
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!
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.
*The beaches are closed. The parks are closed. But our hearts must stay open.*
Today, the US now has more confirmed COVID-19 cases than any other nation. That is over 82,000 confirmed infections across the country. And this is despite having performed a paucity of testing. Without question, there are tens of thousands (if not, hundreds of thousands) more cases that were not reported simply because we were not prepared to test this many people.
Slowly, each state is enacting Stay Home orders… But I am so fearful we have done too little, too late. Each day’s delay in stopping human contact creates more hot spots, none of which can be identified until about a week or two later, when the people infected start falling ill. The weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy and our lives to restart. The death toll in the U.S. has quadrupled over the last week and I am devastated. And this will only get worse from here. Please, let’s do your part in slowing this virus down. Taking what feels like extreme actions now will allow us to have a quicker recovery when this crisis is over.
We are one day shy of a week into our compulsory stay at home order in California. The beaches are closed. The parks are closed. But our hearts must stay open. We are all in this together.
I know this has been hard – on all of us. I talk a lot about how connection is what defines us as humans. And this severing of physical connection has worn us all down. But I ask you to stay strong. Start to enjoy your alone time, because soon enough, it will be busy again. Spend this time reflecting on your life, your goals, the connections you want to continue to cultivate in life. The ones that are meaningful to you. This is a novel virus, and also a novel time. Enjoy the novelty of your solitude and time for reflection. Embrace it – you never know how long it will last; and if it is like anything else in life, it will be fleeting.
“When ‘I’ is replaced with ‘we,’ even illness becomes wellness.” – Malcolm X
Getting antsy during your self-isolation? It’s time to roll out the yoga mat that you bought at Target 8 years ago! (that may or may not still be in its original wrapping)… During this period of isolation, this is your chance reconnect with the physical and mental exercise that for thousands of years have hooked yoga practitioners around the world. Stretching is essential because it helps maintain flexibility. And if anyone of us need anything right now to stay sane, its flexibility in our bodies and our minds. The Mayo Clinic recommends that stretch at least two to three times a week. And you should hold each stretch for 30 seconds for most areas and up to 60 seconds for sore or problem areas. The beauty of yoga, specifically, is that it stretches the body, the mind, and the heart. I think we all need to open our hearts in this moment and make them bigger. We all could make space in our hearts for those that are suffering. Whether you are young or old, overweight or fit, yoga has the power to calm the mind and strengthen the body. Yoga really is for everyone. So in this time of self-isolation, find some space to connect back with yourself through yoga. Maybe find more space and openness if your heart for love. And send it out there. Love, great love. The world is indeed full of peril, and in it there are many dark places; but still there is much that is fair, and though in all lands love is now mingled with grief, [love] grows perhaps the greater.” ― J.R.R. Tolkien
Community in Immunity.
Just a reminder to keep up your immunity up by exercising and eating right. I made myself a green juice with lots of ginger. Whether or not ginger actually boosts my immune system, it made me happy. And there’s plenty of scientific evidence that the happier you are, the more robust your immune system. So, do what makes you happy. Go outside. Get some exercise. You can take care of yourself in COVID-19 isolation.
Trying to preserve some sense of normalcy is really important for your wellbeing. Maintaining a routine like getting up and getting dressed, can positively affect mental health. *And good mental health promotes good physical health.* For me, exercise is my catharsis in times of stress. Every little bit of movement counts, so even when confined to our homes, the key is to move. The American Heart Association recommends adults engage in at least 150 minutes (2.5 hours) per week of moderate-intensity aerobic activity, or 75 min/week of vigorous activity. So, next time you watch TV, do some squats during the commercials. Heel raises when you’re washing dishes. Lunges when you’re doing laundry. Knock out some push-ups when you’re waiting for water to boil. Dancing is also a great way to move your body. Turn on some music and boogie with your partner or kids.
A good rule to follow is to make sure you get your heart rate up, multiple times a day. Stairs can be your cardiovascular best friend and if you have access to stairs in your home or apartment, going up and down those stairs is a great way to get your blood pumping.
We are following shelter in place orders here in California, but you can still go for a walk or run if you stay close to home, as long as you’re able to maintain a reasonable amount of distance and you’re being good about hand hygiene. What counts is that you’re moving your body.
So get up. Go for that run. Do some squats. And stay strong for our community in immunity! I’ll be back tomorrow with some yoga stretches and exercises to keep that immune system strong!