Physician and Patient.

I wear two hats. That of a physician and that of a patient. It’s a tall order, especially during this pandemic. The two roles often feel in opposition to each other. While the healer in me wants to be “out there” working in the front lines she also says the same thing she would say to another person in the same position: “No, don’t do that. You are part of the vulnerable group most likely to have a severe case of COVID-19. Do what you can from the sidelines. There is plenty of healing work to be done that doesn’t involve exposure.”

The Doctor

I became a doctor because I love helping people. I’m a healer at my core. The fact that there is no way to save people from the brutality of COVID-19 is a difficult one to accept. We are all dependent on our own immune systems to fight the battle and there is no treatment proven to be effective. Scientists are working faster than ever before but a solution is not there yet. Right now it is nature or nothing as a healing entity.

The Patient

So I do exactly what others are doing. I am sheltering and working from home. I am doing all I can to keep myself healthy and my immune system strong. That means good sleep, outdoor exercise daily (socially distanced of course), good nutrition, and recommended supplements such as Vitamin D, Vitamin C, and Zinc. I keep in touch with friends and family by Zoom, phone, and text. I listen to podcasts and I also participate in group therapy designed to help the group cope with the huge amount of grief and frustration that COVID-19 has brought to our world.

The Risk

The illness that puts me most at risk with COVID-19 is Sarcoidosis. Most people haven’t heard of it. It’s a chronic immune disorder that most frequently affects the lungs, as it does in my case. So I’m very careful about social distancing. Mask and gloves when going in stores. Social distancing outside. Lots of time at home. I GET that it sucks to withdraw from social occasions and the workplace. I’m frustrated like everyone else that we need to do this. But I also have confidence that we will get past it in time.

If I didn’t have an increased risk for this disease I might not understand the need for social distancing.  So if you are staying at home and don’t feel you need to I offer you a big THANK YOU for caring enough about others to respect the need for social distancing.  It might just be that you helped save some lives.

It is challenging to keep up with evolving information on a day-to-day basis, perhaps even more so during a pandemic. The goal of this post is to provide you with a resource that can help you understand the risks associated with the environments you frequent. Erin Bromage, PhD, from the University of Massachusetts Dartmouth, has written a series of posts that put the science of the COVID-19 pandemic into lay language. Here is some content from his posts that I find the most useful in terms of understanding the risk associated with various situations.

Where do people become infected?

We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.

Where do people get the virus in the community?

Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint.

How much exposure do you need to become infected?

In order to get infected you need to get exposed to an infectious dose of the virus…. it appears that only small doses may be needed for infection to take hold. Some experts estimate that as few as 1000 SARS-CoV2 infectious viral particles are all that will be needed. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 infectious viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.

Successful Infection = Exposure to Virus x Time

Where are the personal dangers from reopening?

It all relates to population density and air exchange within the space. IE the number of people, the size of the space, and the degree to which air can flow through the space.

When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers – all day; customers – an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes more risky.

Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floorplan office, you really need to critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk.

If you are sitting in a well ventilated space, with few people, the risk is low. If I am outside, and I walk past someone, remember it is “dose and time” needed for infection. You would have to be in their airstream for 5+ minutes for a chance of infection. While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed. Please do maintain physical distance, but the risk of infection in these scenarios are low.

Airline travel during this time seems worrying, and before going ahead you have to assess all factors into determining whether you fly or not. If you are in the high risk group for developing severe COVID-19 symptoms, then despite all the precautions you and the airline can take, it is unwise to get on a plane.

What is the role of asymptomatic people in spreading the virus?

Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.

Remember the Formula: Successful Infection = Exposure to Virus x Time

As we are allowed to move around our communities more freely and be in contact with more people in more places more regularly, the risks to ourselves and our family are significant. Even if you are gung-ho for reopening and resuming business as usual, do your part and wear a mask to reduce what you release into the environment. It will help everyone, including your own business.

Thank you to Erin Bromage, PhD, for sharing this information to the public.

Reference

https://www.erinbromage.com/

The world is changing dramatically, and we must change along with it.  Medicine has changed in two very important ways that reflect the demands nature and society have placed on it. 

TELEHEALTH IS NOW

First, Telemedicine is no longer the wave of the future.  It is NOW.  Like social relationships that have transitioned to online meetings, so have medical services.  Dr. Larson holds telemedicine appointments using a HIPAA compliant connection through her Electronic Health Portal.  She was a pioneer in telemedicine, having used teleconference technology for several years over several platforms. 

Not all video connections were created equal.  They each have their pros and cons.  Variations in connection reliability, portability, and security make the choice of platform important.  When considering what kind of connection you want to have with your provider remember that unless it is compliant with the Health Information Portability and Accountability Act (HIPAA) the privacy of your health information may be compromised. 

PERSONALIZED MEDICINE IS NOW

COVID-19 has brought to our attention in a dramatic way that while we are all the same, we are also different.  Our vulnerability to infection and severity of disease varies with age, health status, and variables we have not yet discovered.  People are aware of their individuality and want medicine that delivers to their unique needs.  This pattern has been developing for some time but is now a driving force for change. 

Dr Larson’s Functional Medicine practice offers a path to personalized care through cutting edge testing and attention to the specific needs of individuals.   Those needs are uniquely expressed in an individual’s DNA.  The new science of Genomic Medicine expands the opportunities for individualization in medical decision making beyond what can be accomplished with even the cutting edge Functional Medicine tests.  To learn more about Personalized Medicine and Genomic Medicine contact Dr. Larson.