Author: sroyappa

COVID-19 paralyzed the world and changed our lives drastically within a matter of months. As our state slowly moves towards a new “normal”, each one of us has a different emotional response. Some feel like they can finally breathe and start living again, while others feel like everything is opening up too fast and are not ready for any kind of normal yet. We need to realize that both of these emotional responses are valid. Every person is unique in their ability to tolerate risk, each person is in a different place when it comes to their physical and financial health, family and community support and philosophy on how to live life. We owe it to each other to respect these differences and treat each other with kindness as we all figure out how to move forward.

As we reopen our state, we should keep in mind that our precious community is somewhat different when it comes to risk of hospitalization and death from the virus. Our median age is 65 years, almost twice that of the state, which is 34 years! So what is prudent for the rest of the state may not be so for us. Our older population with more underlying medical conditions would still have to be more cautious than the average population. Continuing to wash hands frequently is a given. Social distancing with people from other households and wearing cloth masks where social distancing is not possible are both crucial to minimize risk, especially in high risk folks.

Here are some other tips to help you reduce your risk while still enjoying your favorite activities:

Gatherings of smaller groups are always lower risk than larger groups.

Try to break up group activities into more sessions with smaller groups.

Go out to dinner or the park in smaller groups.

Meet at large restaurants where you can get larger tables for smaller groups so people can sit further apart.

Outdoors is always lower risk than indoors.

Try to move your favorite indoor group activities outdoors if at all possible. This may be difficult in the heat of the summer, but maybe it will be more feasible in the fall.

Practice social distancing even when you are outdoors by picking the largest possible space for your event.

Exercise outdoors when possible. You have to be careful in the summer heat that you don’t get dehydrated or suffer from heat exhaustion. If you can work out indoors at home in the summer, that would be perfect. But if you do have to go to the gym, try to find times when it will be least crowded.

Children are at the lowest risk of complications and death from the virus. This should be comforting to parents. But they should be aware that children can potentially transmit the virus to grandparents and other older folk who may be at a higher risk. It is challenging to teach little ones to social distance and each family will have to decide how far they’re willing to go to maintain that distance with older relatives. There is again no right or wrong answer, just a different one for each family.

Some of us may need to realize that things are not quite normal yet and maybe need to curtail some of our usual activities a bit, some of us may need a little more time to come out of our homes and some of us may not be ready to leave home at all for a long time yet because we feel we are at too high a risk due to our age or our medical problems. Let us all give each other the time and kindness to move towards our new “normal” at our own pace.

Heart racing a bit, palms a little sweaty, sitting in the parking lot still wondering if I should do what I was about to do. No, I was not sitting in the parking lot of my local airfield before my first parachute jump, I was sitting in the parking lot of my hair salon before my first haircut since the pandemic started!

What I was about to do was step into a smallish room and get within less than 6 feet of a human being other than my husband for the first time in the last two months.

I am vain about many things, but my hair is not one of them. I often go for months with a shabby pixie, frequently using a straight razor to chop some strands off my eyes and asking my husband to clean-up my neck with his electric razor. So why did I choose to go get it cut at the salon now of all times?

It started a few weeks ago when I began seeing posts from hairdressers in my community about how much they were suffering from the shutdown. Then I got an email from my hairdresser last week saying she was back at work and would really appreciate my business. The salon had a really well thought-out plan for cleaning, disinfecting and minimizing risk to customers. I would wait in my car until my hairdresser was ready for me. I could skip shampooing and blow drying to minimize time in the salon. She would be wearing a mask, I could wear a mask attached to my ears. She would just need to take my mask off momentarily to clean-up around my ears.

The risk-averse voice started niggling in my head – her cloth mask is not going to protect you from aerosolized particles that leak as she cuts your hair, talking, laughing and breathing, you really don’t want to do this. And what if you have the coronavirus and unknowingly give it to her – not a good idea at all! Then the scientist brain took over and said – wait a minute, don’t make an offhand decision based on your fear, make a calculated and educated decision. And that’s what I did.

My hairdresser has a young family and recently bought a home for which she would need to make monthly payments. It would be very difficult for her to do that without a paycheck and she might lose her home. Then the nervous brain asked me, but what if she dies from the virus that you gave her because you didn’t know you had it? Is that not a lot worse than losing her home? But then the scientist brain took over again – how likely is she really to die from the virus based on her age and where she lives? Is she at greater risk of dying in a car accident while driving into work? After I did all the math, it became clear that her risk of dying on the way to her workplace from home was higher than that from coronavirus.

According to the NY numbers, 815 people in my age group, and 85 people in my hairdresser’s, died of the virus out of a total of 19.5 million people. Now this is NY, the hardest hit of all our states, with a likely 20% prevalence of the virus. I live in rural East Texas, our city has had 1 case and 1 death which happened in mid March and the salon is also in a city with exactly one coronavirus death. So my risk of death from the virus is minute, hers even less so since she is in her 20s.

After I looked at the numbers, I could not help but wonder why I was more scared of the coronavirus than many other things, say TB, which is rampant in India. The time I spent a whole year there doing research, more than 400,000 people died from TB alone! I happily spent hours everyday that year in hospital wards, outpatient clinics, slums and other crowded areas without giving it a second thought. And now I was scared to get my haircut at a rural Texas salon in a city where one death has occurred from COVID-19 since the pandemic came to the US?!

I don’t know why I feel this way – maybe it’s TV news, maybe it’s Facebook. But whatever the reason, I’m sure I do not want to live in unfounded fear for the next several months to years. I won’t be stupidly taking high risks for myself or selfishly putting vulnerable people at high risk of death, but neither will I cower in fear over a minuscule risk. I want to return to being that person who made rational, not fear-driven choices. Finding that person again has been a slow and difficult process. The trip to the salon was an important baby step in the right direction.

What I love most about Hideaway is the connection with the wonderful people who live here. The pandemic has sadly destroyed most of our activities. I dearly miss my Friday coffee club meets at the grill, Garden Club, Art League, Book Review Club, park parties, boat rides with friends on the lake, and dinner and dance at the clubhouse.

We are looking at a very different life going forward, as we social distance to protect the vulnerable. But we desperately need to find  ways to safely resume human contact, if not with physical touch, then at least from 6 feet away.

As a doctor and a public health professional, my goal is to look out for the overall well-being of my patients and loved ones. Well-being of not just our bodies, but our minds and spirits as well. To that end, I am starting to connect again safely with my friends and neighbors in Hideaway and am encouraging others here to do the same if possible.

Beginning next week, Andrew and I will invite a couple from Hideaway to join us for lunch every Tuesday and Thursday. Since we normally work from home, we are continuing to do that during the pandemic, and don’t want to stress over “guests” for lunch. So we’re asking the couple to bring a sandwich or whatever they normally have for lunch and join us while we eat our own simple lunch.  We can enjoy each other’s company and banish some of this isolation without the stress of having to entertain. We hope to see old friends and make new ones along the way.

We will take an extended lunch break from 12-2. It will be outdoors on our deck where we will set up two 6 ft banquet tables side by side, so we can adequately social distance. This should minimize our risk significantly. Our deck is surrounded by trees, so it is relatively cool and the bugs don’t seem to be out yet, fortunately!

We plan to then start cooking for people, one couple at a time, maybe every Saturday. We’ll  have to entertain more often since we can only invite one couple at a time for now. If I’m going to do this, I’ll have to let go of having a “perfectly” cleaned and decorated house, a “perfect” menu and a “perfect” whatever. I need to simply revel in the joy of human connection.

I hope this motivates others to start safely socializing towards a new “normal”.

Originally posted on KevinMD.com

In the past month, I find myself going from making videos telling people to stay home to slow the spread of Covid-19, to videos telling patients not to be so terrified of the virus that they die from other serious conditions like MIs and strokes. I fear that I, and other physicians, in our efforts to warn people about the dangers of Covid-19 may have caused the pendulum to swing too far in the other direction. I believe we did not effectively convey the actual risk to patients as more data became available, and we now run the real risk of people unnecessarily suffering from the severe consequences of ignoring other serious conditions because of unrealistic fear of Covid-19. Perhaps we did not convey this to our patients because many of us ourselves have not paid attention to the data, but have instead been ruled by our emotions and our wish to protect our patients, our loved ones and ourselves at all cost.

In the beginning, when we had so little data and were faced with the possibility of unimaginable mortality and morbidity from a novel respiratory virus with no treatments or vaccines, it was prudent to take all possible precautions, including shutting down the nation to flatten the curve and wait for data. But now, after we have done exactly that, many of us seem to have forgotten the original purpose of stay-at-home and shelter-in-place orders. Most now want to keep these orders in place for prolonged periods, long after the curve has been flattened, to stop the virus, and not just slow it down to avoid overwhelming our healthcare system. We all know in our minds that we cannot stop this virus until we have an effective vaccine, good treatments for early disease and massive testing, but many of us are following our hearts in wanting to somehow eliminate or nearly eliminate this virus with stay-at-home orders.

We wanted to flatten the curve, we’ve done it in most places. If we want to eradicate the virus, we know in our minds we can’t do that by all of us just staying home for another week or month. That would take several months to possibly even years, and none of us can or need to stay at home for years given what we already know about how this virus behaves.

Smith County, Texas, where I live, has had a total of 3 deaths (county population 233,000) since our first case on March 13 (one of whom was a 91 year old with multiple medical problems). Our hospitals are sending healthcare staff home because hospital traffic is so low, there is no danger of acute shortages of ICU beds, vents or PPE. So I was surprised to see so many physicians react with hate and rage to the Texas governor introducing a reasonable and cautious plan to reopen the state in measured phases while taking all social distancing precautions to ensure that we do not overwhelm our system as we reopen. This was despite him taking pains to repeatedly stress that his actions were guided by doctors on his Strike Force. Social media was ablaze with healthcare workers bashing the state for reopening too soon. I acknowledge that his plan is not perfect and things are not ideal in terms of full restoration of supply chains, but we are in a far better place than we were when this started. If all the data say that we have more than flattened the curve in the state, what reason, other than unfounded fear, do we have for not reopening carefully? I would understand some of the panic, and I would be joining in it, if the governor had announced that we would just open everything up all at once and  go back to life as usual, but he did not.

So let’s take a step back, acknowledge our fears as human beings, and then let’s rationally look at the data as the professionals that we are and make decisions for the overall wellbeing of our patients, not just preventing them from getting Covid-19.

If you are over 80 or have multiple medical problems, you are the highest risk group, so please don’t even think of doing this right now. Wait for the lower risk people to go out first. If you are 60-80, you are still high risk, and will have to decide what level of risk you are willing to take.

For the rest of us, here are some tips to minimize risks to yourself and others if you choose to dine-in at one of our local restaurants. Several have opened at 25% capacity with social distancing as part of Phase 1 of our state reopening plan.

1. Make use of any outdoor seating in a covered patio or lawn. Being outdoors greatly reduces the infectious dose.

2. Eat at restaurants with larger dining rooms where there is at least 6 ft separation between seated tables.

3. Avoid sitting with people from different households at the same table, even though the state allows groups up to six. This is because you are about 2-3 feet away from others at the table for an extended period, talking, laughing and eating. Most of us won’t be able to wear masks while eating! So the exposure dose could be relatively high.

Below, pumpkin grits with sauteed spinach and ground turkey at Chez Royappa. Yummy topped with grilled-shrimp too. And yes, I eat pumpkin “off-season”!

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

We have been bombarded by health news for months, fueling fear in some of us and denial in others, both of which can be dangerous. Headlines like those below are meant to simply catch our attention, and most of us will read just those, the headlines.

“Treatment for coronavirus virus found!”, “Grim news about treatment for coronavirus“.

Coronavirus vaccine will be ready this summer!”, “We will never find a vaccine for coronavirus”.

“Coronavirus is a hoax!”, “Coronavirus will kill us all!”…

It is impossible to know what to believe by just reading the headlines.

Here are some tips to make sure that you are getting the whole truth:

Read beyond the headlines!

Do not form an opinion before you read the entire article. Preferably read multiple articles on the same issue from different news sources to make up your own mind. Do not get all your news from one source, there will always be bias.

Determine whether the headline is a fact or an opinion.

If it is a fact, then try to find the source of this fact. Health facts should come either from established health organizations like the CDC or from peer reviewed medical and scientific journals like the New England Journal of Medicine or the Lancet. If the headline is an opinion, then find out something about the author to establish their credibility. Do they have the knowledge and experience to intelligently comment on the issue at hand?

Be extremely wary of “facts” propagated via social media.

Fake news and memes are rampant on social media. Before you believe something you read, type the headline or some key phrases into a website like snopes.com, whose sole purpose is to research the truth of information being shared on social media outlets.

Remember that headlines can be manipulated to play with your emotions.

One headline may read “Coronavirus deaths in children have quadrupled in the last three months.” Sounds ominous does it not? We were manipulated into alarm even though the truth may be that just one child died in the first month, and in the three months since, four total children died. It is true that the deaths quadrupled, but the headline no longer has the same effect on your psyche as it first did. Not only can such headlines cause panic, some can exaggerate positive news as well. For example, “Risk of toenail cancer reduced by 50% with new procedure!” – wow, that sounds great, but not when you get the whole story that while you can die from it, toenail cancer is very rare, so a 50% reduction is really not that momentous, especially if the procedure involves preventatively amputating your toe! These are of course extreme examples where the manipulation is very obvious, but often it is more subtle and you must be prepared to do some digging to learn whether the news is actually meaningful for your own health.

So the next time you come across a sensational health news headline, take a step back and work a little harder to get at the real truth, you will be able to care for yourself so much better.

Wishing you good health – physical, mental and emotional!

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”.