Month: August 2020

Originally published in Hideaway Lake News on August 28, 2020

You’re doing everything you can to not get the virus – washing your hands, staying six feet away from people and covering your face. But what if you do get it anyway, what can you do to reduce your risk of severe COVID-19 disease? If you are overweight or obese, you can lose weight. If you’re at a healthy weight, you can maintain your weight. It has become clear that obesity is a major risk factor for developing severe illness from the virus, leading to a greater risk of hospitalization and being placed on a ventilator or breathing machine. 

Obesity is a risk factor independent of other health problems such as diabetes, high blood pressure and heart disease. This is especially true in younger patients in whom these diseases may not have yet developed. So even if you have no medical problems other than obesity, you should consider yourself high risk and behave like someone with diabetes or heart disease, when it comes to COVID-19. One study found that morbidly obese COVID-19 patients were 60% more likely to die or require a ventilator, compared with people of normal weight.  This is because increased fat tissue compromises lung function, leading to greater need for pulmonary support. Fat tissue also promotes inflammation and blood clots, two things that have been closely associated with severe COVID-19 disease. 

Boris Johnson, Prime Minister of the UK, was hospitalized for more than 2 weeks, including 3 days in the ICU with COVID-19. He acknowledged that his weight was a significant factor in the severity of his illness. Since his release from the hospital, he has lost more than 14 pounds. He also started an anti-obesity campaign for severe coronavrius disease prevention, encouraging Brits to lose weight. 

This risk is particularly relevant for us because about 40% of Americans suffer from obesity, compared to 6% of people in China and 20% in Italy. The pandemic, with its stay at home orders, means that many of us are eating more, eating less healthily, spending endless hours in virtual meetings and not exercising much. Most of us have stopped going to the gym and playing group sports. Many of us are drinking more alcohol, often forgetting about the extra calories that adds to our daily intake! Before we know it, we have packed on the pounds. 

If you are already at borderline weight, those few pounds may be just enough to push you into the high risk category. It has been several months since the first case in China and it is likely that the virus will be around for at least a couple more years in the best case scenario, possibly longer if vaccines are not terribly effective or if many people refuse to get them. So we’re in this for the long haul. There’s enough time for us to actually lose weight, reducing risks of complications and death, if we do become infected despite all precautions. Those that don’t need to lose weight can still get back to a healthy regimen of smaller portion sizes, nutritious meals and regular exercise to maintain a healthy weight. 

Best of health – physical, mental and emotional – to us all!

Originally posted on August 5, 2020 in https://cityofhideaway.org/docs-corner/f/how-can-we-help-fight-covid-19

Our community and our lives have been drastically affected in the past few months by COVID-19. The biggest challenge in fighting this pandemic has been the lack of knowledge about the virus. In order to gain insight into how COVID-19 is spreading, the CDC is testing people for antibodies in multiple cities across the nation. Since Hideaway is not one of those selected cities, we have applied for a grant through the Coronavirus Relief Fund for our own testing program. This program will be undertaken by the North East Texas Public Health District (NET Health). We will start recruiting about 300 volunteers in mid August. Participants will be tested sometime in early September and the same group will be tested again in December. This will show how many new positives occurred in three months and how many people who tested positive in September continue to maintain their antibodies into December. 

If you volunteer and become part of the program, a sample of your blood will be drawn from a vein by a medical professional in the same way a sample is drawn when your doctor orders “blood work”.  Your blood will then be shipped to a lab for analysis. The results will be shared with you and no one else without your authorization. We plan to set up blood draw sites here in Hideaway for your convenience.

The most accurate antibody test available will be used. The test can show if you had a past infection with COVID-19. It does NOT test for active infection with COVID-19. It does NOT confirm protection from the virus. All it tells you is whether you developed antibodies as a result of exposure to the virus at some point in the past. The antibody test is currently not of significant value to an individual, but when used in large groups of people, it can provide valuable population information. This study, along with studies from other cities, has the possibility of increasing our knowledge of how this virus is spreading and how we can slow it down. A positive or negative test will not change your life in any way at this point, it will simply provide data for the scientists. Most recently, the University of Texas Southwestern Medical Center announced such a study for the Dallas-Fort Worth area.

We have received our allotment of the Coronavirus Relief Fund from the State of Texas to conduct this program. Once the dates and locations of testing have been confirmed, we will launch the website and start recruiting participants. We hope to have many volunteers in Hideaway eager to help our city and our nation slow and eventually stop the pandemic.

Thank you for supporting our initiative to study COVID-19 in our community!

Sue Royappa, MD, MPH

Originally Published in Hideaway News on July 31, 2020

We all expect our medical information to be kept confidential by health care providers, hospitals and public health entities through HIPAA. Similarly, our medical information with our employers is protected by the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). Even outside of these settings, most of us in the US have a reasonable expectation of privacy regarding various matters, including our health information. But these are special times when there is real worry and fear of getting and spreading the virus, and we might think that there is a case for breaking medical confidentiality. However, before we do that, we should look to science and the health authorities to determine the following:

Is revealing the identity of someone who is COVID-19 positive truly going to protect us and reduce the spread of the virus to others?

The CDC has made it very clear that the only people who need to be informed are CLOSE contacts, those who were closer than 6 feet from you for at least 15 minutes in the 2 days prior to symptoms. This exposure is regardless of whether either party was wearing face coverings. It says that the person just needs to be informed that they are a close contact without disclosing the identity of the positive case. It has also made it very clear that employers should inform workers and persons that came in close contact with the positive person, again without revealing their identity, as provided in the ADA. Close contacts will be asked to follow CDC guidelines pertaining to them. 

So if you have not been notified by NET Health, your employer, the affected person or their family that you were a close contact of a positive case, then you don’t need to do anything different from the average person. And you don’t need to know their identity.

Having had casual contact with a waiter at a restaurant, being handed groceries, delivery boxes or food, going through the checkout counter at the golf shop, talking to someone for five minutes at the beach, being handed a bill after someone mowed your yard… these are all NOT examples of close contact and should not cause you undue concern. People with such contact do not need to be informed that they were exposed, do not need to be quarantined and do not need to take special precautions. They simply need to do what the rest of us are doing – watch for symptoms, and call their doctor and get tested if they have symptoms. 

The person testing positive has a reasonable expectation of privacy. They should not be made to feel guilty if they don’t want to disclose their medical status to everyone. They should not feel coerced into revealing their status to anyone but their close contacts. There is no risk reduction to the person who had casual contact with the positive case and no benefit to our community at large in terms of virus spread by actually knowing their identity.

On the other hand, “outing” someone with COVID-19 could be potentially damaging to a person’s life, professionally, economically and socially, well after the isolation period. There have been instances of people losing their jobs and being verbally or physically attacked because someone felt that they should not be out, even though it had been weeks since they recovered. Stigma from COVID-19 can persist, causing isolation and depression from ostracization. So let us be very cautious about going down the slippery slope of invasion of medical privacy if there is no health benefit to anyone in the community. If however, someone chooses on their own to publicly share that they tested positive, let us be compassionate and not judgmental. 

The best thing that each and every one of us can do right now to prevent the virus from spreading in our beloved community is to continue to social distance, wear face coverings when that is not possible, wash hands and avoid large gatherings.

Wishing us all the very best of health!

Sue Royappa, MD, MPH

Chief Health Officer

City of Hideaway

 Originally published in Hideaway News July 31, 2020

Every person that I have spoken with who has tested positive for COVID-19 has agonized over how they could possibly have got it and whether they passed it on unwittingly to someone. “I thought I did everything right! Did I get too close to someone? Did I forget to mask up one time? Was I wearing my mask properly? Did I wash my hands enough? Did I wipe down surfaces sufficiently? Did I infect someone else unknowingly? Are my co-workers upset with me for having possibly exposed them to the virus? Are they mad at me because they now have to quarantine themselves for 14 days?”  And the questions go on, tormenting them with doubts of when they might have done something wrong to get this virus and how they might have affected someone else’s life.

Some people are judgemental of those who test positive. “They must have been careless. They must not have worn masks. They probably had their mask hanging below their nose. They didn’t stay home enough. They must have not washed their hands or cleaned their homes properly.” Such thoughts and comments are not helpful and often add to the guilt and anxiety that they are already feeling.

Someone could have taken all appropriate precautions and still have got the virus. I know of cases where the person masked up everywhere, social distanced with their own family, washed hands and disinfected everything obsessively and still got infected. Some may hear of this and say, “Well what’s the point of doing all of that if I’m going to get infected anyway, I’m not going to do any of it.” Another may hear the same case and say, “Oh my, if all of that was not enough, maybe I should also wear a gown, a respirator and shoe covers.” I believe the practical and prudent response is somewhere in the middle. There are very few things in life that are truly risk free, and it is impossible to reduce risk to zero. We can minimize risks, but we can’t eliminate them. The only thing we can do is try our best to take reasonable precautions while still living life responsibly and safely. We can’t constantly worry about things we have no control over.

Some may have been super vigilant and others a little lax taking precautions. But we are all human, and however good our intentions, it is hard to stay vigilant 24/7 for months at a time. So if you test positive, give yourself a break, stop torturing yourself with endless questions and be kind to yourself. Instead, redouble your efforts to reduce spread of the virus from yourself to others in the community. Isolate yourself according to CDC guidelines and identify all your close contacts. Encourage others in your family and social circle to avoid large gatherings, practice social distancing, wear face coverings when social distancing is not possible, and wash hands often.  If you know someone who tested positive, please be kind to them and don’t judge them.

If your positive test is making you suffer from worry, fear, guilt, sleeplessness or agitation, or if you are feeling lonely, isolated and sad, please get help early. Make sure you reach out to friends and family and share your thoughts and feelings with them. Having someone to talk to is sometimes all you need. If that is not enough, talk to your doctor about a tele-visit with a counselor, therapist or psychologist. The pandemic has made access to tele-health services much easier. Do not hesitate to use them. Above all, in addition to being cautious, stay hopeful. Even though some people may have serious complications or even die, most people have mild symptoms and recover without complications. Even if you are considered high risk, it is very likely that you will come through just fine. Best of health to all!

To read Dr. Royappa’s blog as the Chief Health Officer of Hideaway, please visit Doc’s Corner at www.cityofhideaway.org.