Relax (Don’t Do It) – May 1, 2020

Within the next few days, 31 states will relax their social distancing regulations. I get it – we’re all tired of sheltering-at-home and the economic implications are so epic, it’s almost hard to wrap our brains around them. But in the famous words of Frankie Goes to Hollywood, I am pleading with you: if the rules relax, still don’t do it. Don’t run to the mall unless you absolutely need that pair of underwear, and even then, think about online ordering. Don’t resume daily grocery shopping. Don’t converge in droves on the beach or community pool or hair salon or whatever else happens to be open. Yes, there exist valid arguments touting the relative risks of shutting down and sheltering-at-home, covered by pieces like this one from Bloomberg. My bottom line, though, remains this: relax spiritually and psychologically, easing the grip of fear. But don’t rush to do life as you did two or three months ago, because that will just put us all on a fast track to another quarantine.

Now to the science, starting with the new theory in town. Scientists are floating the idea that coronavirus does not primarily attack the lungs, but rather it targets the blood vessels. Reports over the past few days from both Europe and the US have identified coronavirus-positive kids with inflammatory syndromes similar to Kawasaki’s disease. The cause of Kawasaki’s has never been identified, but it is thought to involve an infectious trigger that tells the immune system to attack blood vessels (the medical term is vasculitis), especially along the entire gut and within the heart. Kawasaki’s was first described in the late 1960s, so it long predates the new circulating coronavirus. But it is very possible that there is a similar mechanism at play with COVID-19.

You may also have heard about a new phenomenon called COVID toes. This discoloration of one or several toes – seen most frequently in kids and young adults with no other coronavirus symptoms – is thought to be a byproduct of the same vessel-focused inflammatory response described above. It looks like frostbite… except people in balmy weather shouldn’t have frostbite. Doctors seeing patients with apparent COVID toes are now routinely checking them for coronavirus, and many are swabbing positive.

Even though there’s mounting evidence that COVID involves vessel inflammation, still the virus clearly interrupts normal lung activity by interfering with the interface of oxygen and the bloodstream. When you breathe in, oxygen flows down to tiny sacs at the very end of the airways (more doctor vocab today: these sacs are called alveoli). The blood flowing through the lungs passes by the alveoli, soaking up that oxygen. This piece from the NY Times suggests that rather than waiting for coronavirus symptoms to worsen with increasing shortness of breath and cough thanks to all of this inflammatory gunk in the alveoli, we ought to be monitoring our oxygen saturation levels using a simple monitoring device called a pulse oximeter. A pulse ox (now you’re even getting medical shorthand!) fits over one finger, digitally reading out your heart rate and oxygen saturation. These devices are cheap and non-invasive. I like the advice in this article with one giant caveat: just like any other monitor – from a home baby monitor to a heart monitor in an ICU – false alarms and mis-readings are common. So, if you heed this advice and buy one, just play around with it for a while in order to understand its quirks. My pulse ox (yep, I own one) sometimes reads my heart rate at half its actual speed, and my oxygen level can fluctuate widely depending upon which finger I use and how warm or cold I am because microcirculation impacts the reading big time. I know how to interpret these rogue results (I ignore them), but some people may become very stressed out and think they are sick or in need of emergency care when they are, in fact, absolutely fine. Home-based monitors can be a blessing and a curse.

The rush to do something good but inadvertently creating mayhem is not limited to montiors. When coronavirus started to spread like wildfire, there was a run on hand sanitizer. So everyone and his mother jumped into the hand sanitizer production business. Now there’s evidence that some products are not safe. Read on to learn about the brewing battle between the FDA and ethanol companies.

Meanwhile, there may be a new diagnostic test on the horizon thanks to dogs who can sniff out coronavirus infection, literally. The University of Pennsylvania is training a group of golden retrievers to become a “canine surveillance corps” for the virus, which shouldn’t be any great surprise because dogs already do this for bombs, drugs, and yes illnesses like cancer and malaria, too. So, sniffing for COVID doesn’t seem like such a longshot.

For those who live in Los Angeles, a couple of items especially for you. First, our mayor Eric Garcetti announced this week that we will be the first major city to offer coronavirus testing for anyone who wants it. This huge news for our city will provide a model for the entire country. And second, the XX Fund, a giving circle co-founded in 2015 by Amy Wakeland (coincidentally, Eric’s wife, though a mover and shaker in her own right to be sure), is working to help LA women on the frontlines of coronavirus. The stats are daunting: 2/3 of minimum wage or part-time workers in Los Angeles are female; more than 3/4 of healthcare workers, too; and during shelter-at-home there has been a 40-80% increase in domestic violence against women. The XX Fund is mobilizing to address all of it, and you can help.

That’s a lot for today. You deserve a new health and safety poster for your WFH “office.”