Month: April 2020

Tomorrow is the first day of Phase 1 for reopening our state. We have flattened the curve in Smith County – three Covid-19 related deaths in our population of 233,000 since our first case on March 13. The purpose of the stay-at-home order was to slow the spread of the virus and we have done that. Whether we will need to shut down again will depend on how responsibly we come out of this one.

It is inevitable that we will have a second wave of cases when we start reopening things, no matter how late or cautiously we open. We must be prepared for this not just medically, but also psychologically. If we panic at a small rise in cases or deaths and rush to close down again, then we will have a third wave when we reopen again and so on. The goal is to keep the number of new cases manageable through phased reopening and social distancing so we avoid shortages in hospital resources and can minimize the number of deaths.

Norway has already opened up nursery and kindergarten schools, thus exposing its least vulnerable group to the virus first so they can start building immunity safely. Next will be adolescents and young adults.

We need to come out of our homes with caution. We must not rush to normalize things or we will pay a steep price that will force us to shut down again. High risk people should continue to take steps to protect themselves as low risk people are slowly exposed.

If you don’t feel ready to come out, then don’t. If you are ready, then please do so responsibly.

I will be doing a series about how to minimize risks to yourself and others as we slowly come out of our homes. Remember the risk will never be zero unless you’re in a containment chamber with sterile food and air piped in! You can only reduce it.

I’m going to address questions that are asked by neighbors, friends and family.

𝗖𝗮𝗻 𝗜 𝗽𝗹𝗮𝘆 𝗴𝗼𝗹𝗳?

Living in Hideaway, this might be the single most important question!!

I spent Sunday morning with Andrew as he played golf. I had a lovely time even though I do not play – I got to be outdoors in the fresh air and the brilliant sunshine, smelling the honeysuckle in the woods while watching him hit the ball.

Playing golf is one of the safest ways to get exercise and give your mood a boost during the pandemic. For people in Hideaway, it also gives a sense of returning to some level of “normalcy”. You’re not touching balls handled by others like in tennis, volleyball or basketball. You just touch your own ball (you know what I mean!). You’re well separated from other players and can still get in some socialization by waving across the green or stopping for a conversation while social distancing.

Our fabulous Hideaway golf club has already put some great safety measures in place to prevent crowds from gathering in close quarters. No more than 10 people are allowed on the driving range and each player is separated by a lot more than 6 feet. They have removed sand bottles and rakes and have asked people to avoid touching the flags. They’re disinfecting all carts thoroughly. So if you want a break from your usual walk, now’s the time to get out your golf clubs.

I plan to “play” golf with Andrew once a week with social distancing so we can have our nerdy chats even when we’re not working and can exchange some friendly waves with other players. It’s amazing how much I look forward to those waves these days! They lift my spirits instantaneously.

[Fulbright podcast transcript]

Hello everyone, this is Sue Royappa, I am a physician specializing in internal medicine and global public health. I was a Fulbright researcher in India for 9 months in 2017-2018.

I am amazed by the miracle of modern science and technology. There’s been significant erosion of trust in science the world over, I’m hoping this pandemic will open the eyes of people to how different their lives would have been if not for science and technology. Within a matter of weeks, scientists were able to sequence all the different strains of Covid-19 and share it with the entire medical and scientific community. This would have been impossible even just a couple of decades ago. In the past, I would have had to wait for months and possibly a couple of years for the information to be discovered, for it to be published and for the library to have a copy of this journal, which would most likely have a months long waiting list to check out. But now this same information is at my fingertips almost instantaneously. It is equally incredible that human trial for vaccines have already begun and there is real hope that we can vanquish this disease forever. Thanks to supercomputers, researchers screened 8,000 compounds in a matter of days and identified 77 potentially beneficial compounds that can treat the virus. Several clinical trials are already underway for using our existing drugs while others are looking for new ones. I fervently hope that effective treatments and vaccines  will help restore the faith in medicine and science that many seem to have lost and that some actively deny.

And finally, I am inspired by how ordinary citizens in India (the country where I did my Fulbright research) have successfully used technology to help the elderly, the disabled and the vulnerable such as the migrant workers, again with little regard for their own safety. Within a day of India announcing their total lockdown, regular folk started Caremongers India on Facebook and Whatsapp, now with tens of thousands of volunteers, reaching out to people in need. These are the people that we cannot forget. These are the stories that we need to share.

𝗪𝗵𝗮𝘁 𝘁𝗵𝗼𝘂𝗴𝗵𝘁𝘀 𝗱𝗼 𝘆𝗼𝘂 𝗵𝗮𝘃𝗲 𝗳𝗼𝗿 𝘆𝗼𝘂𝗿 𝗳𝗿𝗶𝗲𝗻𝗱𝘀 𝘆𝗼𝘂’𝘃𝗲 𝗺𝗲𝘁 𝗮𝗿𝗼𝘂𝗻𝗱 𝘁𝗵𝗲 𝘄𝗼𝗿𝗹𝗱?

I am a very realistic and practical person, so I understand the gravity of what is happening and the massive way in which our lives will be changed. But I am also eternally optimistic and a believer in the goodness of humanity. So I want to tell my friends in India and around the world to not despair. We will all get through this together.

𝗪𝗵𝗮𝘁 𝗯𝗼𝗼𝗸𝘀, 𝗼𝗿 𝗺𝘂𝘀𝗶𝗰, 𝗼𝗿 𝗮𝗿𝘁, 𝗼𝗿 𝘄𝗵𝗮𝘁𝗲𝘃𝗲𝗿 𝗮𝗿𝗲 𝗵𝗲𝗹𝗽𝗶𝗻𝗴 𝘆𝗼𝘂 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝘁𝗵𝗶𝘀 𝘁𝗶𝗺𝗲?

I have to say that Psych reruns on Netflix have been my savior. I can take my mind off the pandemic and can blissfully and obliviously laugh for an hour. Don’t know if any of you have watched it, a show about a fake psychic detective – very Hollywood and totally delightful.

Also, my acrylic paints and canvases have come out to keep my sanity – I’m painting cherry blossoms right now, I should have been in DC earlier this month among the cherry blossoms, of course I had to cancel my plans, but I’m reliving my visit there last year and bringing the memories to life on canvas.

For now I am trying to stay informed, stay positive and reach out to my community. Wishing everyone who’s listening good health and good spirits. Thank you for listening.

My physician colleagues have patients that were so terrified of getting the coronavirus that they did not go into the hospital with signs of a stroke or heart attack. They either died or were left with severe disabilities like paralysis. Hospitals around the nation are reporting a 40-50% reduction in admissions for heart attacks and strokes. Surely, there has not been a coincidental dramatic decrease in these conditions!

Before we engage in risk reduction behaviors, we need to be aware of the magnitude of the true risk to us, and not be led simply by our perception of it. There are people who get into a car everyday without a second thought but won’t get on a plane because they think their risk of dying in a plane is higher. This is a misperception of risk, because in reality, you’re more likely to die in your car. Even when we know the true risk, different people have different levels of tolerance for risk. Some are perfectly happy parachuting out of a plane, while others won’t even get on one.

We need to ask ourselves how far we are willing to go to reduce our personal risk from coronavirus – the answer will be different for each individual. The risk will never be zero.

I’ve seen social media memes about virus positive persons infecting every person that they come in contact with. There are also memes of infected people leaving a cloud of virus trailing behind them, as though this cloud is infecting every person that walks through it. These are misleading, because we have a fairly good idea that this is not what happens. On average, one infected person causes 2.5 secondary infections.

Just because a surface is contaminated with the virus, doesn’t mean that you will automatically get infected by touching it. Just because you passed by someone who had the virus, doesn’t mean you are going to get infected by them. You need to get enough of an infectious dose for that to happen. A larger dose means a greater chance of getting infected and likely more severe disease as well.

So while it is dangerous to minimize the risks of coronavirus by saying it’s no different from the flu, it is also dangerous to overstate the risks and get people paranoid about it. Please don’t ignore other risks in your zest to reduce your exposure to the coronavirus. For some of you, the risk of dying from those other conditions may actually be higher than that of dying from the “c”.

I am so disappointed to read about unreliable Covid-19 antibody tests hitting the market. Since the FDA relaxed guidelines for confirming whether a test is actually valid, more than 70 companies have registered to sell their kits. It appears several of these tests are completely useless. This is more harmful than having no test at all.

This is a warning sign of what happens when we relax rules in an effort to speed things up due to panic and hysteria – we want that drug now, we want that test now, we want that vaccine now! Tests, drugs, vaccines – these are the keys to ultimately defeating this pandemic. We want them ONLY after they meet our established standards for quality, reliability, effectiveness and safety. Let us all demand this!

We’re talking about population level here. Obviously, in individual cases, experimental treatment protocols are all we have now.

Please don’t get mail-order, in-home tests. You must go through your doctor. It is not as simple as having a red “positive” line on a random rapid test. There are lots of nuances and interpretations surrounding immunity.

It is my fervent hope that we learn from our mistakes and work diligently to rectify them.

If you have not read Part 1, please read it first, otherwise this will appear one-sided. I’m aiming for a balanced look from the middle. https://www.facebook.com/sudhasue.royappa/posts/10158027271274631?

Continuing from Part 1, where we discussed the importance of long term Social Distancing..

Prolonged stay-at-home orders in the hope of virtually eliminating all risk would require everyone to stay at home for many months, maybe even years. But for most people, this is not a viable option. They won’t have money for medications or doctors’ visits to manage their chronic diseases like heart disease, diabetes and depression, and they are going to start dying from them sooner. They won’t have money to buy food, pay rent or utilities. There are already reports of increased child abuse and domestic violence from people being forced into prolonged close-quarter living in less than ideal situations.

That being said, we should not come out of stay-at-home orders in an irresponsible way, without social distancing, losing all that we gained in the past weeks. Neither should we stop living while being alive, allowing panic and hysteria to drive our feelings, thoughts, behaviors and decisions. We have always been willing to accept some level of risk as a society so that we can continue our activities of daily living. So we need to now accept that some people are going to get sick and die from the coronavirus just like people die from car accidents, flu, and other things. We will have to first allow the lowest risk groups, people younger than 20, to start developing immunity through exposure, then stagger exposure of higher risk groups as treatments become available. We must protect our elderly and most vulnerable for as long as possible until effective vaccines are available since they have an unacceptably high risk of death from this virus.

Social distancing allows us to minimize risks while still carrying on with many aspects of our lives. We may not be able to go to large parties, sporting events and concerts, but many of us will still be able to go to work with precautions and judiciously socialize in smaller groups. Some hard hit states like NY may need to continue stay-at-home orders until the danger of running out of health workers, beds and ventilators is past. However, for the rest of us, in the long run,  we need social distancing, not stay-at-home orders.

Based on questions that I’m getting from people, there appears to be a fair amount of confusion about stay-at-home orders and what to expect when these orders are lifted. I am breaking this post into two parts.

The main purpose of stay-at-home orders for a few weeks is to reduce the rate at which sick people come into the hospital. Let’s say 1000 really sick people were going to come to the local hospital in 1 week with Covid-19. This could lead to unnecessary deaths from lack of medical staff and equipment. By staying at home, we spread those out over one month instead. This way we have the required doctors, beds and ventilators to properly care for all of them, thus reducing the number of deaths.

Many people are under the false impression that when stay-at-home orders are lifted, we can just resume life as normal, and we will miraculously have fewer cases and deaths from Covid-19.  Conversely, an equal number of people feel that we should all stay home until “the virus is gone”. Although I understand both viewpoints, neither is realistic. A middle path is necessary in the long run  to balance the risk of Covid-19 with other physical, mental and emotional health issues. This middle path is Social Distancing. We cannot fully return to normal in the next few weeks, neither can we be in stay-at-home mode for months to years.

𝗦𝗼𝗰𝗶𝗮𝗹 𝗱𝗶𝘀𝘁𝗮𝗻𝗰𝗶𝗻𝗴 𝗶𝘀 𝗻𝗼𝘁 𝘁𝗵𝗲 𝘀𝗮𝗺𝗲 𝗮𝘀 𝗮 𝘀𝘁𝗮𝘆-𝗮𝘁-𝗵𝗼𝗺𝗲 𝗼𝗿𝗱𝗲𝗿. It is avoiding gatherings of people from different households where you cannot maintain a 6 foot separation. So you can get together with friends in your backyard, with chairs six feet apart. You can play golf as long as you can stay six feet away from the other person. But two high risk people with unknown Covid-19 status may not want to play tennis together as they are touching the same ball multiple times. So you would have to analyze each situation individually.

In order to drastically reduce the number of cases and deaths, we would need to practice social distancing for several months to possibly two years, until these things happen:

𝗪𝗶𝗱𝗲𝘀𝗽𝗿𝗲𝗮𝗱 𝘃𝗶𝗿𝗮𝗹 𝘁𝗲𝘀𝘁𝗶𝗻𝗴 so people with Covid-19 infection can be isolated to prevent spreading it to others.

𝗪𝗶𝗱𝗲𝘀𝗽𝗿𝗲𝗮𝗱 𝗮𝗻𝘁𝗶𝗯𝗼𝗱𝘆 𝘁𝗲𝘀𝘁𝗶𝗻𝗴 so we can allow people who have recovered from previously undiagnosed Covid-19, and are now immune, to mingle with others safely. We don’t know for how long they will be immune, experts say anywhere from 6 months to 8 years, only time and repeated testing will tell. A good test is one that has few false positives, so people don’t mistakenly think they are immune when they’re not.

𝗣𝗼𝘀𝘀𝗶𝗯𝗹𝗲 𝗿𝗲𝗱𝘂𝗰𝘁𝗶𝗼𝗻 𝗶𝗻 𝘃𝗶𝗿𝘂𝘀 𝗮𝗰𝘁𝗶𝘃𝗶𝘁𝘆 due to heat, but the jury is still out on this one.

𝗗𝗲𝘃𝗲𝗹𝗼𝗽 𝗲𝗳𝗳𝗲𝗰𝘁𝗶𝘃𝗲 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁𝘀, first for really sick people that are hospitalized and then for people in the community before they become very sick. We cannot treat a large number of people based on one doctor or hospital’s experience with a particular drug or set of drugs. We can do that for severe cases when we have nothing left to lose. For treating large groups, we need randomized, controlled trials, which take time.

𝗗𝗲𝘃𝗲𝗹𝗼𝗽 𝗮 𝘀𝗮𝗳𝗲 𝗮𝗻𝗱 𝗲𝗳𝗳𝗲𝗰𝘁𝗶𝘃𝗲 𝘃𝗮𝗰𝗰𝗶𝗻𝗲. If you want a safe vaccine, you cannot rush it. The minimum time to get it fully tested is one year, likely closer to 18 months. It will take several months after the vaccine is tested and approved, for it to be mass produced and made widely available, and to finally have widespread public participation.

Part 2 coming soon.

I initially planned to send this for my monthly HAWL newspaper column, but I think it will be more useful right now, rather than a month later.

Originally published in the Hideaway Lake News on April 1, 2020

In an effort to minimize all risk from the “c”, I’m concerned that many of us may forget that we are more likely to have problems from our other medical conditions like heart disease and diabetes, if we don’t take care of them in the coming weeks to months.

My own lunch, one day last week, was a bag of Doritos, Andy’s concrete and a McD’s apple pie. Shameful, I know, but one day of such behavior is going to do no harm. However, I can see how it can be easy to slip into bad eating habits while hanging out at home in our PJ’s wallowing in self pity. So I would like to motivate you to get dressed in the morning and stick to your daily good habits of eating healthily and exercising. Make sure you stay in touch with loved ones virtually and with appropriate social distancing in person.

Many primary care doctors are open for restricted hours and urgent patients only, or are working via telemedicine during the pandemic. If your regular appointment was cancelled, please don’t just blow it off. Make sure you learn how to get set up on telemedicine. Your doctor won’t be able to provide the same level of care as they can in person, but it is far better than not going in at all. Even if your appointment is not for another month or so, get registered on their tele site so you can visit them remotely if you are a high risk person or if something urgent pops up.

Remember, since your doctor may be working from home, they may not have access to your full chart which may be in their office. Not all doctors have electronic medical records that are in the cloud. Here’s how to prepare for your next chronic care telemedicine visit:

On the day before your appointment, check that your webcam or phone camera, as well as your audio, are working properly. Also make sure you can get on the telemedicine site and connect correctly with your doctor’s office.

Type out a list of all your medicines with doses ahead of time.

Keep your blood pressure, sugar and any other data record readily available, if you were asked to keep track of them.

Have your most recent blood test results handy if you have them.

Make a list of things that you need to speak with your doctor about. Keep it to three items or less, otherwise there won’t be enough time to thoroughly address all of them.

Make sure you FIRST address any important symptoms such as chest discomfort, difficulty breathing, nausea or dizziness. This allows your doctor to spend the most time evaluating them.

Our lives are going to be quite different in the coming months. These are uncharted waters for us all. The doctors and nurses need time to figure out this telemedicine thing. Let’s be patient, kind and understanding with those who are caring for our health. Practice deep breathing, prayer and meditation to help keep tempers down and anxiety in check. Sometimes anxiety can manifest as irritability, anger or frustration. We all need an inordinate amount of patience right now as we show love and kindness to everyone struggling to get it right, including ourselves.

Good health and good spirits to all!