Opportunities and Antibodies

To Our Dear Spring Center patients:

As I was contemplating this email blog to you today, I wanted to share my immense gratitude for you all and the opportunity that this pandemic is providing us now.  The staff of the Spring Center and I are so grateful to all the healthcare workers, doctors, nurses, paramedics and first responders, grocery store workers, pharmacy staff, and all other essential workers who are risking themselves and helping so many others to function in this strange world.  I was also thinking about how much worse it could be.  We still have heat and electricity and running water and internet! A few years ago, I began preparing for the next big earthquake.  I bought several weeks worth of freeze-dried food, emergency preparedness kits, a first aid kit, large containers for drinking water.  Fortunately, we haven’t had to use any of those things.  And this virus, although terrifically deadly in some people, pales in comparison to some movie depictions; like Outbreak, Contagion, 12 Monkeys, or even real life scenarios like an Ebola outbreak or the MERS epidemic with a near 35% fatality rate.  Yes, this is unprecedented. Yes, this is causing hardship and great financial strain.  And it also is an opportunity for growth, transformation and change for the better in numerous areas of our lives.  So, how do we want to use this precious time that we have?  Here are some suggestions. And, as always, I would love to hear your feedback and suggestions as well.
This time is a pause from life as we knew it. It is a break from the busyness of life, from hectic schedules and outer focus.  We have the choice to get upset, to fight against this, to maintain our external focus OR we can begin to look within, to reflect and to restructure our lives in alignment with what is truly important to us.  And in order to do so, we need to determine, what IS REALLY important to us. This time offers us opportunities at different levels.  As individuals, families, communities and even as a global community, each level has aspects to consider.

Individual opportunity

In terms of the individual opportunities we have in this time of isolation, my encouragement for you all would be to consider HOW do you want to spend this time? What do you want to learn, explore or do that you may have never made the time for in the past? How about learning a new language? Learning how to cook, dance salsa? Or take up yoga? Learn a musical instrument? Write a book? There are so many options and platforms for learning. What about learning meditation

or starting a garden? I have been doing about 15-20 minutes a day of DuoLingo app learning Spanish for over 2 years now. It has really made a difference in my comprehension and appreciation for the language. My dog Buddy and I are going on walks twice a day and my cat often sits with me while I’m working at the computer.

It’s been comforting to spend quality time with my critters.

But perhaps you want to share a gift or skill you have? Perhaps this is the time to get your online business off the ground. There are so many options for all of us. Take the time to look inside to dream and to create the life you have always wanted for yourself.

This is also a great time to get really serious about your health. I spoke with a patient the other day who has been struggling with her weight for years and since this Stay-At-Home order, she has cleaned up her diet and lost 25 pounds! If you are thinking about doing a Cleanse or ramping up your Detox, now is a fabulous time for that as well. For those of you who have been contemplating an exercise program, or a re-commitment to your healthy diet and supplements, I would strongly encourage you. The time is now! I’ve been using my elliptical my husband got me for Christmas and aiming for 10,000 steps a day, as well as using my sauna and doing yoga more regularly. What are some of your goals for yourself? If you need some direction or support, please contact the office to schedule to discuss your specific situation.

This time can also be challenging psychologically. In fact, for some, this could be the “Dark Night of the Soul”. This phrase refers to the spiritual crisis in the journey towards union with God or Spirit. No matter what your spiritual beliefs are, this time may bring up for you, material that demands to be processed. How are you coping with your mental health? Are you reaching out to loved ones? Are you communicating with therapists or psychologists? Many therapists are also doing telehealth and are available to help. Some many even be covered by insurance. If you need more support in this trying time, please reach out for help.

Family Opportunity

Whether you are in quarantine alone or with family, there is opportunity in this time for connection, communication and hopefully, healing of relationships. Now is a great time to turn off the television and be present with one another, to have conversations either in person or via FaceTime or skype to share authentically about how you are really doing in these

circumstances. It is when we are willing to be vulnerable with one another that true intimacy can emerge.
I’m sure some families are overwhelmed with so many responsibilities, parents trying to work and home-school and put food on the table. We can allow ourselves to be stressed out, or we can choose to respond differently, with compassion for ourselves and others. We can choose to be kind to one another and to practice gratitude for each other.
Reach out to old and possibly estranged friends and family members. We don’t really know what these next few weeks or months will bring. Time is precious. Don’t wait. Connect now.

Community Opportunity

We are sheltering at home for a reason. To flatten the curve, to reduce the spread of this infection, to save lives of those most vulnerable, to lessen the surge of critically ill people requiring hospitalization and mechanical ventilation. It appears to be working, but this is far from over. New information about the virus is presented daily. Perhaps it is more prevalent than previous thought. Patients with the virus are having neurological symptoms. Recovering patients are testing positive again. Are they re-infected, or it can become a chronic condition, like EBV and Chronic Fatigue Syndrome. The truth is we still know very little about this disease. Some countries like Sweden are not closed down. Some states are clamoring to open up again. Time will tell which choices prove to be the best course of action.

  • In the meantime, what are your opportunities in your community?
  • How can you be of service?
  • How can you participate?

Wear your masks and gloves when you go out to the stores.

Be Kind. Be courteous.

If you are in a position to do so, consider how you can help.
There are so many people in need and opportunities to help. Consider how your skills and interests might align for the good of your community. Perhaps sew masks or help an organization with food donation and delivery. Please share ideas with us if you have them so we can share them with others.

Global Opportunity

Perhaps this is our collective “dark night of the soul”, an opportunity to deeply consider what is happening.  My colleague and friend, Neil Nathan, MD discussed this in his recent blog.
Whether this virus has naturally “jumped” from bat to human or is from a man-made source, the end result is that some people are getting very sick and dying from this virus.  It does appear that African American and Latinos are dying in higher percentages than other ethnicities.  Why?  The Guardian article describes how communities of color are disproportionately dumping grounds for pollution. They have more air pollution, which has been shown to worsen outcomes in COVID19.  Additionally, they are medically underserved and have less access to healthy food. Less access, often less education translates into higher rates of diabetes, obesity, heart and lung disease. These toxicants in the environment, get into all living organisms in the area, which then contribute to underlying inflammatory states and predispose to poor outcomes.  The cytokine storm probably already exists on a low level in these folks, and the Coronavirus adds fuel to a smoldering fire.
There is also evidence to suggest a correlation of 5G EMF exposure and increased COVID19 outbreaks. As an environmental medicine physician, we can choose to acknowledge that our Mother Earth is angry at how we have treated her and do something about it.
Additionally, we need to start paying attention to what happens next.  Have you begun to consider what the world will look like when we emerge from quarantine?  Governor Newsom has suggested we will all be wearing masks and gloves and maintaining social distancing.  And that may be true, but what about antibody testing, will that offer some hope?  What about vaccines?
What comes next? Hope for increased Antibody testing.

Antibody testing and Prevalence

As many of you may have seen recently in the news, a Stanford Study looked at Antibody testing in Santa Clara County and found that prevalence rates were much higher than previously assumed. Prevalence in epidemiology is the proportion of a particular population found to be affected by a medical condition at a specific time. It is calculated by comparing the number of people found to have the condition with the total number of people studied. Incidence refers to the rate of occurrence of new cases and conveys information about the risk of contracting the disease. A link to the full paper is available in the references section. The study states that the prevalence might be 50-85 times higher than thought, between 3-4%. And as much as I would love to believe this, it is controversial and may not be accurate. (and if the original predictions of 80% of the population is expected to become infected in the coming months or years, we still have a LONG way to go to reach that milestone!)
Statistics are not my forte, but the author, Balaji S. Srinivasan, of the Medium.com article below cites a variety of issues with the study, including the high reported false positive rate and sample recruitment bias as problematic. (link below) Additionally problematic with the prevalence study is the idea that this infection is wildly contagious but with a very low infection fatality rate of 0.12-2%. I think it is too soon to tell, especially when we look at previous outbreaks.
Another article cites that previous influenza pandemic outbreaks in the Unites states have had multiple waves. The figure below illustrates the two waves for H1N1 in 2009. It took 12+ months to infect 11-21% of the world over multiple waves. I think that this COVID19 pandemic is very far from over.

I did want to share some incidence resources also.  John Hopkins University of Medicine has a world and USA map for COVI19.  https://coronavirus.jhu.edu/map.html

 

Antibody testing

The test that have been used so far to determine if someone is sick is a nasal and pharyngeal swab that uses technology called PCR to identify RNA from the virus.  The availability of this test has been frustratingly limited.  Additionally, it appears to have challenges with its accuracy.  Perhaps even has high as 30% false negative rates.  If the swab wasn’t deep enough, if the timing of the swab isn’t in the correct window if infectivity, it can be negative.  Without repeat testing and access to adequate testing, identifying who has COVID19 so far has been challenging.
An antibody test which measures immunoglobulin response to the presence of the virus is the next phase of testing.  This will identify who has been exposed and has now made immune proteins, IgM and and IgG to the virus.  The IgM antibodies are usually made in the beginning of an infection and indicate a current and active infection.  The IgG antibodies are created later and then are maintained as immune memory, to that if the body “sees” this infection again, it can quickly and effectively mount a response so that the person won’t get sick again.
A USC study of LA county just announced today that it appears that the rates of infection are higher in LA county as well.  The research team estimates that about 4% of the adult population has an antibody to the infection.  This translates into 28 to 55 times higher than the confirmed COID19 cases reported in the county at the time of the study in early April.  This study has not yet been peer reviewed.
Some challenges to consider, is the test really reflecting infection with CoVID19 or could there be cross reactivity with other Coronavirus infections?  And other considerations, does having antibodies confer immunity?  And if so, how long will that immunity last?  Is it total or partial immunity?  These are questions for which we don’t yet know the answers.
At this time, I am actively looking for a reliable, accurate, inexpensive antibody test for COVID19.  It seems that every lab company in the country is aggressively working on a test kit. And although there are many potential options, I want to make sure that when I do select a company’s test, you all can feel confident in the results.  Please stay tuned.
Please know you are all in my thoughts and prayers that each of you are safe and healthy.
Blessings and Virtual Hugs,
Dr. Kelly
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