June 13, 2020 Newsletter: Understanding the confusion of COVID-19, Diabetes care, Don’t Ditch Your Mask Yet, Introducing Lifewellness Institute, Working From Home–Ergonomically

Unraveling COVID Confusion and the WHO Statements on Coronavirus:

In the past few days, you may have read conflicting information about how asymptomatic carriers may or may not be contagious or able to transmit COVID-19 to others. At a June 7 media briefing WHO lead investigator, Dr. Maria Van Kerkove made a statement that came under much scrutiny from the scientific community. At the media briefing Dr. Van Kerkove said,

"We have a number of reports from countries doing very detailed contact tracing. They are following asymptomatic cases. They are following contacts and they are not finding secondary transmission onward. It is very rare."

The next day on June 8, the WHO held a live event to answer questions about the above statement. At about the 3:00 mark in the video Dr. Maria Van Kerkove explains her comment giving more facts about what we do know about COVID-19 transmission and says that,

"It would be a misunderstanding to state that globally, secondary transmission is rare", adding that data from models suggests, 'transmission rates from asymptomatic carriers to be about 40%.'

On June 9th, Dr. Eric Topol, the Director and Founder of Scripps Translational Institute at Scripps Research released the video below in which he details findings that most in the scientific community seem to endorse. Dr. Topol discusses that 40-45% of COVID-19 asymptomatic carriers may transmit the virus.

Confusing, right? Yet, conflicting statements as confusing as they might be, are each very important to consider. Public policy affecting population health as well as economic prosperity depends on the accurate interpretation of conflicting data with critical potential outcomes hanging in the balance.

Let's daydream for a minute. If completely asymptomatic carriers of the virus are truly not able to transmit COVID-19 to someone else, where would you be right now? In Bali? Playing sports, going out to dinner or a movie? Social distancing would look much different and businesses and schools could open with more confidence. Now think about walking through a mall and knowing everyone that looks healthy could be a COVID-19 carrier and almost half of them could give you the virus. If this is true, then we have been following the right path with social distancing measures. Dr. Topol points out that asymptomatic people can be invisible and the actual number of asymptomatic carriers is largely unknown at this point. In the second media briefing Dr. Van Kerkove also seemed to concede that we really don't yet know all the facts.
Why is it so confusing? Let's first look at the term 'asymptomatic'. As the science of transmission continues to emerge, terms like asymptomatic or asymptomatic carrier appear to have different meanings to different authors. Here are some examples:

  • Test positive for COVID-19, without any symptoms and remain so
  • Test positive for COVID-19 without symptoms as the disease incubates then develop symptoms--also called pre-symptomatic
  • Test positive for COVID-19 with only minor symptoms

Additionally, the science of transmission is studied in a variety of ways. Research findings from viral studies in the lab tend to look very different from data obtained from studying population trends.

Why are these details so important? When an individual is exposed to a large enough contagion (usually thousands of viral particles) the virus finds the most vulnerable locations in the body to invade healthy host cells. In the case of COVID-19 that location is in the back of the throat and the airways including deep within the lungs when the virus is inhaled. The virus then begins to quickly replicate during the early phase of disease called incubation. As this process takes place the host’s (a person) immune surveillance system recognizes the invader and begins to mount an immune response by developing antibodies. The host immune response is dependent on many factors such as good general health versus the presence of co-morbid conditions such as obesity, diabetes, chronic lung and heart disease or those taking medications that impair immunity. During this incubation period the host is asymptomatic (has not yet developed clinical symptoms) but is able to transmit the disease to others through the spread of respiratory droplets. It also appears that some people who have been previously exposed to other types of Corona virus (many common colds are caused by Corona viruses) have some immunity to the COVID-19 Corona virus and never develop clinical symptoms. Others may have been exposed to a very small contagion (small number of viral particles) resulting in the development of antibodies without developing clinical disease. These are additional examples of how a person may be able to spread the disease to another host while never actually developing symptoms themselves. You can learn more about antibodies in our May 29 Newsletter.

Whom should we believe? The sheer volume of research pouring out of laboratories and from population health studies all over the world is astounding. There are thousands of scientists working around the clock to understand how to interfere with COVID-19, mitigate symptoms, and develop vaccines to help prevent further suffering. As scientific data is disseminated by people of various backgrounds through various platforms it is important to find reliable expert sources to read, digest, and interpret all the confusing and somewhat contradictory information. It will take many more months to fully understand this disease but rest assured, the scientific community is working very hard to discover everything there is to know about COVID-19 and effectively communicate this to the public. The physicians at SDSM are following the data and will continue to update our patients as our knowledge of COVID-19 grows.

Why do answers change? The very premise of science is discovery. The process of discovery involves theory, observation and experimentation. Discovery takes time and the truth is that the answers to our questions change as new information presents. Unfortunately, initial statements made by governmental and community leaders under extreme pressure to produce policy in the public interest may prove to be false or deemed inaccurate as new information emerges. Our leaders are not immune to overstatement, miscommunication, or oversimplification leading to criticism and distrust. It's important for the public to realize there are many determinants for what information is communicated, which studies to cite and who is to be trusted within the scientific community. It is wise to keep an open mind and avoid rapid judgement.

You can learn more about antibodies in our April 17 Newsletter, and learn more about the coronavirus from the Scripps research team in the links below.
COVID-19 Antibody Testing: April 17 SDSM Newsletter
About Coronavirus, how it's spread, how it affects the body, and long term consequences

Diabetes: Staying On Top of Your Health

People with diabetes are at increased risk of infections including influenza and related complications. A major concern during the coronavirus pandemic has been for people with diabetes and their ability to fight off the virus and the risk of a secondary bacterial infections, such as pneumonia. Diabetic patients have an impaired immune-response to infection. Poor sugar control, high blood pressure, decreased kidney function, and obesity provide additional challenges making it difficult for the body to regulate the immune response. In coronavirus infections, an over-responsive immune system can create a cytokine storm which can lead to tissue damage in an already stressed system. Even in good health, we recommend routine lab work and important preventive care for people with diabetes.

Labs:

  • A1C: This test measures long term blood sugar control by assessing the amount of glucose in your red blood cells. Red blood cells live for about 90 days so we can use them as an indication of how high or low glucose levels have been averaging in the past 3 months. In a diabetic patient, A1C tests should be performed every 3-6 months depending upon how well you have maintained healthy blood sugar in the past and if you have been changing medications or your routine exercise and diet.
  • Blood Lipids: Various types of cholesterol such as LDL, HDL, and triglycerides should be checked once a year at least. Poorly controlled blood lipids increase the risk of cardiovascular disease. Diet, exercise, and medication should be assessed regularly to best manage elevated lipids. People with diabetes may benefit from the additional anti-inflammatory actions of a statin medication.
  • Kidney tests: Creatinine in the blood measures how well your kidneys are filtering the blood. Microalbumin in urine indicates that protein is leaking out into the urine and the kidney is unable to keep this protein in the blood where it belongs. These blood and urine tests need to be drawn at least annually to monitor the health of your kidneys.

Exams:

  • Eye health: Diabetes is one of the leading causes of blindness. Your eyes should be examined every year. Let us know the name of your eye doctor and date of your last exam. We are happy to refer you to an eye doctor if needed.
  • Foot care: People with diabetes are more likely to get foot infections. Nerves that allow you to feel pain can be damaged by high blood sugar. Injuries and infections can be easily overlooked since they may not cause any discomfort. You should check your feet every night before going to bed, and feet should be examined in the office each year by your physician to help avoid severe infections/ulcerations.
  • Mental health: Chronic diseases like diabetes can increase the risk of depression and anxiety. Exercising daily and eating well are very important to be able to handle stress successfully. We can help you with that.
  • Immunizations: Up-to-date immunizations are important for people with diabetes. Gather any immunization records you have and bring them in so we can identify any gaps in immune protection.

Medications:

  • Avoid NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) as they can be hard on your kidneys, especially in diabetics.
  • Tylenol is the pain medicine of choice particularly for patients with diabetes. Reviewing all of your prescription and over the counter medications and supplements is crucial to keep your kidneys healthy.
  • Aspirin: Studies on aspirin have yielded conflicting results. Call us to schedule your physical so we can go over the new studies and your own personal risk assessment of what is best for you after getting your labs done in advance.

Abandoning Your Mask? Please Read On.

Much of the nation seems to be experiencing COVID fatigue, but that pesky virus isn't going away anytime soon. Wearing a mask is STILL recommended and the best way for you to protect others. If you've missed our prior discussions on how micro-droplets travel, the 40 foot slipstream from heavy breathing cyclists, and how micro-droplets recirculate in confined spaces, let us assure you that wearing a mask is still necessary to curtail the spread of the virus. A new study from scientists at Britain’s Cambridge and Greenwich Universities suggests that if 50% of the population wear masks that we could effectively flatten the curve and lessen the possibility of future lockdowns. In addition, the June 9 San Diego County Health order requires that everyone over 2 years of age be in possession of a mask in public.So here's a quick review on how to wear a mask, keep it clean, and do your part to stop the spread:

  • Face coverings or masks should cover your mouth and nose--especially when you are speaking, coughing, laughing, sneezing, etc.
  • Wash your hands before putting on your mask.
  • Don't touch your mask while wearing it---you can transfer virus from your hands onto your mask making it more likely for the virus to reach your nose or mouth.
  • Keep it clean. Masks and cloth face coverings should be changed regularly. At minimum, wash your cloth mask or face covering daily. Paper masks should not be washed, but replaced with a new mask.
  • Allow masks or face coverings to dry thoroughly. Wet masks do not filter as well as dry ones. Your breath will also dampen your mask giving you another reason to change it more frequently.
  • Avoid masks with respirator valves even if it's an N-95 mask. The valve allows your micro-droplets to flow out potentially exposing others to COVID-19. Masks must contain your micro-droplets to be effective.

    The World Health Organization has additional information on safely wearing a mask in this infographic.
    Encourage your friends and family to wear a mask and always have one with you. Be prepared for an unexpected chat or a venue with more people than you anticipated, and stay safe!

    SDSM Pilates is now open!
    Come prepared to work and get that pilates body back in shape! Pilates physical therapy, back rehab class, and our general Pilates fitness program are in full swing and our instructors are excited about getting back into class to help you. You can find the class schedule here but do call for an appointment--some class times may be changed to accommodate social distancing measures. As in all of our clinics, you can expect proper social distancing measures and disinfection of equipment between each class to ensure your safety. Looking forward to seeing you in class!
    Call to schedule: 858-793-7862

    Introducing Lifewellness Institute

    In January of this year, SDSM purchased Lifewellness Institute in Point Loma. Lifewellness Institute is a family and sports medicine practice specializing in lifestyle medicine, founded by Dr. Lee Rice.

    Lifestyle medicine is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. Understanding how to practice key lifestyle habits is foundational to treating and preventing diseases like heart disease, diabetes and cancer. Our interdisciplinary team at Lifewellness can help you adopt healthier lifestyle habits related to exercise, nutrition, sleep, healthy relationships, alcohol and smoking cessation.

    For more information on programs at Lifewellness Institute visit the website or contact us at [email protected]

    Working From Home: What a pain in the neck... and back!

    The COVID-19 pandemic that is currently gripping the world has changed numerous parts of all of our lives, from the grocery store to youth sports, to home schooling our children to our commute, or lack there of. Working from home has been one of the most drastic changes for most of us and one that we have had to adjust to rather abruptly.

    This abrupt change in our work environment resulted in cobbled together, make shift desks and work spaces. We have gone from sitting or standing at desks or work stations to sitting on the couch or at the kitchen table. Our laptop has replaced our desktop computer. A track pad has replaced a mouse. In general these are not drastic changes, neither are they terrible ones. However, all together with a 40+ hour work week, multiplied by two and a half months, the results are not good. The neck and lower back are the first two casualties. Sitting for hours on soft “comfortable” surfaces like the couch and looking down at a tablet, phone or laptop compromises our posture and spinal mechanics. The couch is made for relaxation, to be enjoyed a few hours a day, it was not designed for a 40 hour work week.

    If working from home is the new standard for your work life, the time for change is now. For starters, set up a dedicated work station. Consider having a screen, keyboard and mouse that plug into your laptop or use a wireless keyboard and mouse so you can improve the position you sit and work in. Attempt to replicate your work space at the office. Be aware of the position you are sitting in. Be aware of any pain or stiffness; these symptoms are your body sending you an “alarm” message that something is not right or needs to change. Below is a list of Do’s and Don’ts to help you make a change and feel better.

    Do:

  • Sit at a table/desk
  • Sit on firm chair with a back rest/support
  • Try to type and mouse at the level of your lap
  • Try to have your screen at eye level
    Don’t:

  • Sit on a couch or bed
  • Look down at your screen
  • Type at the level of your shoulders
  • Slouch for extended periods

    Still have questions? Our Physical Therapists can help. Call us to discuss how we can help you work pain free.
    Stay safe San Diego.

    SDSM continues to be available to help you. With telemedicine or an in-person visit, we can meet your needs for general physicals, annual health assessments, management of chronic conditions, and treatment of injuries. You can trust that we disinfect between each patient interaction and ongoing throughout the day. Cold/flu/COVID-19 symptoms and patients at increased risk of complications from COVID-19 are still best addressed through a convenient telemedicine appointment, as are on-going treatment assessments and check-ins with your provider.

    Please call us if you feel ill, especially if you have diabetes, asthma, COPD, heart problems, impaired immune function, difficulty getting enough sleep, or are experiencing high levels of stress. Working together, we can help you to stay healthy and thrive.

    Yours in health,

    The Physicians and Staff of San Diego Sports Medicine and Family Health Center