There is an App for That: The US is amassing an Army of Contact Tracers to Contain the Covid-19 Outbreak.

Why contact tracing may be a mess in America

High caseloads, low testing, and American attitudes toward government authority could pose serious challenges for successful efforts to track and contain coronavirus cases.

Alaska, California, Massachusetts, New York, and others are collectively hiring and training tens of thousands of people to interview infected patients, identify people they may have exposed, and convince everyone at risk to stay away from others for several weeks.

Contact tracing is a proven tool in containing outbreaks of highly infectious diseases. But this particular virus could pose significant challenges to tracing programs in the US, based on new studies and emerging evidence from initial efforts. Stubbornly high new infection levels in some areas, the continued shortage of tests, and American attitudes toward privacy could all hamstring the effectiveness of such programs.

The chief challenge with this coronavirus is its potential to spread exponentially: absent containment measures, every infected person on average will infect two or three others, according to most estimates (although some studies find it could be higher).

A team in any given region would have to detect at least half of new symptomatic cases, and reach at least half the people they were in close contact with and encourage them to stay away from others, in order to reduce the transmission rate by 10% or more, according to a new model.

 If they successfully detected 90% of symptomatic cases and reached 90% of their contacts—and tested all of them regardless of whether they had symptoms—it could reduce transmissions by more than 45%, the researchers found.

In other words, if social distancing in a given region had reduced infections per person from 2.6 to 1, this level of contact tracing could push it down to .55. Or the region could ease distancing measures by about half and keep infection levels constant.

Will technology help? Smartphone apps are playing a role in many countries but not the U.S.A.

The American psyche

Successful contact tracing efforts also require people to accept calls and heed advice from complete strangers.

Unfortunately, years of robocalls and telemarketing have conditioned many Americans to ignore calls from numbers they don’t recognize. Jana De Brauwere, a program manager with the San Francisco Public Library who is working with the city’s contact tracing task force, says that at least half the people she calls simply don’t answer. Others hang up once she starts asking for personal information, like addresses and dates of birth.

Americans pride themselves on privacy and freedom, another hindrance to gathering public health information, as well as conspiracy theorists.  In a Twitter thread earlier this week, Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford, argued that public health officials are underestimating how much US attitudes toward government authority could undermine national testing and tracing programs.

Americans have already defied the orders of health officials in several prominent incidents, including assaults on store workers who asked people to wear masks, armed demonstrators protesting stay-at-home restrictions, and businesses that have reopened before their local government gave the go-ahead.

Public health orders work only when there’s a public that will abide by them.

The US is amassing an army of contact tracers to contain the covid-19 outbreak. But they'll face major challenges. | MIT Technology Review

Alphabet Verily is launching an antibody research study for Covid-19

Verily is adapting its existing clinical trial technology, Project Baseline, to the coronavirus. 

Its initial focus will be to study antibody testing. 

There are still many unknowns when it comes to antibody tests. 

And there’s a wide variation in the accuracy of the tests.  

Alphabet’s life sciences company, Verily, is launching a research project with an initial focus on understanding how the human immune system responds to the coronavirus. 

The company is adapting its existing study, Project Baseline, which aims to use the latest technology for longitudinal health care research, to support the pandemic. Its first initiative, Baseline Antibody Research, offers serology testing to those who have already received a nasal swab test from Verily’s testing program.

Verily, which spun out of Google Life Sciences, has already rolled out testing sites across various sites in California for those who suspect they might have the virus. 

A serology test is designed to detect antibodies, which circulate in our blood to help fight off infections. Researchers see some potential in using antibody testing to understand how prevalent Covid-19 is in a community, and studies are already underway.

But there are wide variations in accuracy across the various test markers. These tests are producing a lot of false positive and false negative results. For that reason, many public health experts are wary about overly relying on antibody testing for so-called “immunity passports,” as we don’t yet know whether a positive result means there’s conferred immunity. 

In a blog post Verily elaborated on Antibody testing

Verily’s Baseline Platform: Investing in Security and Privacy

An Alphabet/Google study designed as a Project Baseline is the quest to collect comprehensive health data and use it as a map and compass, pointing the way to disease prevention.  Project Baseline is partnered with Stanford Medicine, Duke University School of Medicine, The American Heart Association is already studying numerous other diseases and is enrolling participants for ongoing studies in heart disease, skin disorders, gastrointestinal diseases, sleep disorders and mood disorders.  

The Covid-19 Pandemic adds a new sense of urgency for Verily's project.

As a Project Baseline member, you can...

Choose to contribute through clinical research, surveys, focus groups and more

Be the first to know when studies matching your preferences open.

Test new tools, technologies, and treatments and shape the future of healthcare.

Get exclusive access to updates, thought leaders, and community events.

Ultimately, learn about your own health and help improve health for all.

COVID-19 Research Project

Verily COVID-19 Pathfinder.  If you want to learn more Click here.

Automated support for frontline teams

Verily is developing digital tools to support health systems, hospitals, ACOs and others on the front lines of the COVID-19 pandemic.

Verily COVID-19 Pathfinder is an easy-to-embed tool that provides information about the virus, helps patients understand symptoms and their possible severity, and guides them to the most applicable information based on their inputs -- all from your website. Information is sourced from public guidance from the CDC, WHO, Johns Hopkins Medicine, the American Lung Association, the American Heart Association and the American Diabetes Association. 

Designed by Verily, this tool can be customized based on your organization and available resources. We want to streamline management on the front lines so your teams can focus on delivering care.

COVID-19 Pathfinder features:

Customize the tool to blend seamlessly into your website and incorporate local contact information 

Implement quickly and easily with a small embeddable code snippet 

Collaborate with Verily’s team of technologists and clinicians to inform future tools and development 

Automatically provide access to content that’s sourced from official public health organizations like the CDC and updated regularly by Verily 

Verily COVID-19 Pathfinder FAQs

Who is this tool intended for?

This tool is designed for health systems, hospitals and other organizations delivering care during this pandemic. We want to relieve some of the burden on staff managing thousands of inquiries from their communities, and re-deploy them to deliver care.

How can our system get access to the Verily Covid-19 Pathfinder?

Fill out this brief form and our team will reply as soon as soon as possible. 

What technical capabilities are needed to implement this tool?

We make it easy to deploy our tool with simple cut and paste code. We’ll work with your team to customize the tool with your branding, local contact information or your requests to your community for supplies.

Alphabet Verily is launching an antibody research study for Covid-19

Why Medical Writing is Essential to Medicine

I wasn’t as happy as I expected to be when I walked out of the hospital on my last day in medical school. But then again, there was little to celebrate — my last few patients had terminal cancer, a stroke, and end-stage liver disease from alcoholism. I signed off my patients to my resident, and so, my medical school career came to an unceremonious end. I thought to myself that I was finally done with my schooling.

How many times have we told ourselves that we reached the last milestone — that it’d be smooth sailing from now on? I remember telling myself that I was done with medical school when I finished my first board exam. Then, I repeated those words to myself when I finished my second board exam. And then again when I finished my last residency interview and once more after Match Day.

But it’s never done. The reality of being responsible for patients slowly took shape during these past few weeks. Maybe that’s why my last day of medical school came and went without any fanfare — even eventually with an MD after my name, nothing will have really changed. I’ll still be learning and taking care of patients just as I’ve done over the past year.

Some special aura appears around you when you don a white coat. Suddenly to outsiders, you’re seen as a healer and sometimes a last resort. Magically, you possess the backstage pass to delve into the lives of strangers and hear about their most intimate details. I’ve had patients tell me many times about their joys and worries, their relationships and vices, and even their sex lives, all unprompted. There is no other relationship comparable to that between a doctor and the patient — at least not one that can form so swiftly and built on blind trust and confidence.

The clarity of a clean white coat soon becomes less distinct as time passes. With time the title 'doctor' loses some of it's brilliance.  The early thrill of hearing Doctor Smith diminishes as time passes as I carry more responsibility and automatically make decisions with less time thinking about them than when I was a wet behind the ears healer. The clean pristine white coat would become altered, much like my own sense of worth.

Still, there hangs a thick and opaque curtain between us — patients know so little of what goes inside our heads, and we devote so little of our time to figuring out what their thinking and feeling. That’s why medical writing is essential to medicine. The goal of my columns over these last four years was never to persuade, or to convert, or to proselytize. After all, you can’t do that in a 600-word monthly column — you can’t change anyone’s opinion these days even if you handed them a thick binder filled with scientific facts.

Instead, the goal was simply to teach, to inform, and to reveal. To let patients know that their doctors cared for them and are invested in their lives, even if they manage to see them for only 15 minutes after an hour of sitting in the waiting room. These pieces intended to tell patients that we know that being a patient not easy, but neither is being a doctor.

Every patient and doctor have untold stories that deserve to be exchanged. My columns were a collective attempt to build a two-way bridge between those who were being cared for and those who cared for them.  

California's Governor Newsom Proposes Painful Cuts to Health Care Programs to Close Budget Shortfall

Disaster is coming to some patients on MediCal.   Despite the recent restoration of some MediCal benefits in January 2020, before the Covid-19 pandemic, Governor Newsom now reports a major shortfall in California tax revenues that support many Medi-Cal benefits.  

Unfortunately this reduction in benefits falls most heavily upon those least likely to be able to afford it.

The number of Medi-Cal recipients increased. With so many Californians losing jobs and health insurance because of the pandemic, the state estimates 2 million more people will sign up for Medi-Cal coverage this year, bringing the total caseload in the health care program for low-income Californians to 14.5 million people.

To pay for the increase in enrollment, Gov. Gavin Newsom wants to cut back on some of the benefits patients will receive and the rates doctors will get paid to see them. 

Services like vision care, hearing aids, speech and physical therapy,

podiatry will no longer be covered by Medi-Cal under the Governor's 

revised budget.   

Other items projected are a decrease in senior citizen benefits (another reduction on those who can least afford reductions, since most are on fixed budgets from social security, and are at most risk from the Covid-19 pandemic. 

Doctors groups, which spent millions to help pass the tobacco tax, say this cut to reimbursement rates will create more pressure and uncertainty on physician practices at a time when many are already facing big drops in revenue because of canceled surgeries and appointments. Doctors say this could force them to limit the number of Medi-Cal patients they see. 

There are many items in the California budget, sent to the legislature, which could be eliminated or put on hold to save our low income population from disaster. Our representatives need to do a line by line analysis and make their recommendations, and not blindly stamp an approval on Newsom.s proposals.  Read the link here

 

Governor Proposes Painful Cuts to Health Care Programs to Close Budget Shortfall | KQED

The Hunt for Covid-19 The secret to why some people get so sick from covid could lie in their genes |

23andMe is searching for genetic clues to why some get sick from Covid-19 and others don't even have symptoms.

by Antonio Regalado

GETTY Image

While it is known that older people and those with health conditions such as diabetes are most at risk, there could be hidden genetic reasons why some young, previously healthy people are also dying.  

23andMe operates a large gene database with more than 8 million customers, many of whom have agreed to let their data be used for research. The company has previously used consumer data to power searches for the genetic roots of insomnia, homosexuality, and other traits. 

In April the company, based in Sunnyvale, California, sent covid-19 questionnaires out to a swath of its members. So far, says a company spokesman, about 400,000 have enrolled, including 6,000 who say they have confirmed cases of the pandemic disease.

The 23andMe gene hunt will complement efforts from university researchers to obtain genetic profiles of covid-19 cases and pair them with detailed medical records, says Andrea Ganna, who coordinates the Covid-19 Host Genetic Initiative. The international consortium is sharing genetic data on covid-19 cases from Italy, the UK, and the US and regularly making results public. 23andMe has an enormous database of genomic information at it's command.

Scientists hope to find a gene that strongly influences, or even determines, how badly people are affected by the coronavirus. There are well-known examples of such genetic effects on other diseases: for example, sickle-cell genes confer resistance to malaria, and variants of other genes are known to protect people from HIV or to norovirus, an intestinal germ.

According to Ganna, however, an initial peek at the genes of 900 covid-19 cases turned up no significant genetic hits. His consortium is now preparing an analysis of twice as many cases, which could improve their chance of spotting an association.

Over the counter testing company Ancestry  has recruited 250,000 participants from its own database for the same evaluation.

In the meantime the search for The Vaccine is ongoing.  Click on link below:

SARS-CoV-2: A New Song Recalls an Old Melody.  lin   

The secret to why some people get so sick from covid could lie in their genes | MIT Technology Review

IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

CEO and founder Tim Fitzpatrick is leveraging the latest in neuroscience research and VR filmmaking to radically improve health education and patient confidence. 

Kidney disease is a large and growing health challenge, in the United States and globally, thanks in part to rising rates of diabetes and high blood pressure. A full 37 million Americans (15% of the adult population) suffer from kidney disease, according to the National Kidney Foundation, and in 2016, more than half a million people had to be put on dialysis at least 3 times a week just to survive. 

This represents a huge cost to Medicare ($114B in 2016) and efforts are now underway to transition dialysis patients to in-home care, a cheaper and more comfortable alternative. This need for this transition to home became even more acute during the COVID-19 pandemic, but how can resource-strapped dialysis clinics — which currently only spend a few minutes on patient education through paper pamphlets — safely and efficiently transition hundreds of thousands of patients to home care?

Levin is a former CEO of Time Warner

It has been said that necessity is the mother of invention. Jerry Levin, ex CEO of Time-Warner shares his own personal experience with dialysis. Following a severe injury from a fall, with multiple injuries he eventually was placed on hemodialysis while rehabilitating in a skilled nursing facility.  The experience was an eye-opener and less than optimal for his condition and many others.

The Centers for Disease Control and Prevention has also provided specific guidelines to address a similar deathtrap: dialysis centers, due to their comparable high volume of older patients (50% of all dialysis patients are over 65) and their history of infections are a very high risk for heightening the spread. More than 725,000 Americans suffer from kidney failure, otherwise known as end-stage renal disease (ESRD). Of these, at least 500,000 individuals are on dialysis.

Receiving home dialysis treatments in a nursing home is not something that is only available to people like me (former CEOs). It could be provided to any patient who needs it. Unfortunately, right now it’s not available to many, which is mainly a function of the red tape and bureaucracy in healthcare. Our current system is characterized by slow decision making, limited willingness to try new and innovative therapies, and stubborn adherence to the status quo of where and how healthcare should be delivered.

But there is a safer way to administer this lifesaving care, and we must urgently make plans to deliver dialysis within nursing home and long-term care facilities, and further to accelerate the provision of dialysis for those able to do it in their home. We must save our elderly and our broader population from this deadly blind spot.

Say Hello to IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

Covid-19 The Risks - Know Them - Avoid Them

People are hoping and anticipating a return to some form of normalcy.  I have been reading and sourcing many opinions.  I found a well written colloquial article by Professor Erin Bromage. If you are about to venture out into the world with or without the permission of the 'experts' this may give you some guidance. A precautionary Waiver.  I  provide this as information only and not my recommendation to do so.

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That's what's going to happen with a lockdown. 

 As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I've said before, if you don't solve the biology, the economy won't recover. 

 There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained. 

So throughout most of the country we are going to add fuel to the viral fire by reopening. It's going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk. 

Where are people getting sick?   We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.   But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks.... are these places of concern? Well, not really. Let me explain.

In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with MERS and SARS, some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

How much Virus is released into the environment?

 

A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk. 

 A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds. 

A cough at 6 meters (18 feet)

A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).

Speaking: increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose. 

If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.

 A breath: A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled. 

 Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don't have a number for SARS-CoV2 yet, but we can use influenza as a guide. We know that a person infected with influenza releases about 3 - 20 virus RNA copies per minute of breathing. 

Remember the formula: Successful Infection = Exposure to Virus x Time. In other words if you have to go somewhere, do not linger.   Have a list for grocery shopping and plan your visit.  Do not  "window shop'.

Air filters may offer additional protection. Hospitals use them all the time, especially in the ER, ICU, and Operating Rooms.  Air Cleaning Technologies An Evidence-Based Analysis

How coronavirus attacks the entire body — damaging the brain, kidneys and more

Modes of transmission of virus causing COVID-19

 

COVID-19 Superspreader Events in 28 Countries: Critical Patterns and Lessons

Understanding Your COVID-19 Test Result

The Risks - Know Them - Avoid Them

Covid Restrictions rescinded in Riverside CA

Good morning, it is 8 AM  Saturday morning on the "Left Coast".  Our restrictions are being loosened, however we are all still wearing masks.  Personally I like it as it gives me a false sense of security, however it reminds me of how close we cam to an even worse disaster with far more deaths that we already have suffered.  It also should remind us it is not over by a long shot.  Numerous predictions about the long term outcome vary greatly from utter destruction of world economics, to it will rebound quickly.  The. stock market seems to have largely ignored the pandemic, after showing an initial decline.  Perhaps no one is working at the NYSE. (Was it determined to be non essential?). It makes a few very rich, and no longer reflects real value of a company.  Social media has more predictive value. The stock market is like a horse race, all bets are off, and chances are the odds are worse in the stock market, and better at the Kentucky Derby where there are less than 20 horses.  You have a far better chance of. picking a winner out of a field of twenty than hundreds of stocks. 

Nothing will be the same? Yes, it will

Where are we this morning?  

Riverside County officials vote to rescind all local coronavirus public health orders.    reported by the LA Times

 Woman wearing a MAGA hat (near exit sign)

With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered.

The Board of Supervisors voted to lift the closure of vocational and higher-education schools, end the restriction on golf courses, eliminate limitations on short-term lodging, and remove the requirements to wear face coverings and engage in social distancing.

Comments from the Supervisors.

Officials also voted for the use of face coverings to be “strongly recommended” by the county, instead of being mandated as Kaiser implemented last month. The use of masks is only a recommendation on the state level.

During the meeting, 5th District Supervisor Jeff Hewitt said that he didn’t feel he needed to wear a mask, citing conflicting evidence of its benefits, but that he would continue to do so if certain businesses require it.

Like his colleagues, 4th District Supervisor V. Manuel Perez, the board chair, called the guidelines unattainable and impossible for Riverside County and any other urban counties with large populations.

When 1st District Supervisor Kevin Jeffries said the county didn’t have the power to revoke Newsom’s orders, Hewitt countered: “The funny part is we do all the enforcement, so his power is powerless if you don’t enforce it.”

Sheriff Chad Bianco had said Tuesday that he would not be enforcing any of the county’s restrictions, which he believed to be unreasonable. During public comment on both days, many protesters voiced their support of him.

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Kaiser about potentially amending the mask requirement.

On Tuesday, Kaiser said his position hadn’t changed, and he credited the county’s lower-than-expected COVID-19 cases and deaths to the strict orders. (conflicting statistics from the Los Angeles Times) (see below)

"With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered. He was not available for comment Friday night, and it was not clear if his position had changed, though he apparently plans to sign the recission orders."

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Cameron Kaiser M.D., County Chief Public Health Officer, about potentially amending the mask requirement.

Comment from an octogenarian

A 78-year-old man, who spoke in support of rescission, agreed with Hewitt said that he wears a mask only when he’s around people who are afraid. “I’m not afraid.... People get old and they die.”

https://www.domesticpreparedness.com/journals/march-2020/

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

"This is one of the first antibodies known to neutralize SARS-CoV-2."

According to a new study by an international team of researchers, antibodies found in the blood of llamas were able to stave off coronavirus infections.

“This is one of the first antibodies known to neutralize SARS-CoV-2,” Jason McLellan, from the University of Texas at Austin and co-author of the study, said in a statement.

The researchers built on previous research from four years ago in which they found that the antibodies from a then 9-month-old llama named Winter were able to neutralize both SARS-CoV-1 and MERS-CoV viruses over six weeks.

Luckily, the antibodies from Winter — who’s now four years old — also staved off SARS-CoV-2, the virus that causes COVID-19. Winter is a 4-year-old chocolate-colored llama with spindly legs, ever-so-slightly askew ears and envy-inducing eyelashes. Some scientists hope she might be an important figure in the fight against the novel coronavirus.  “Vaccines have to be given a month or two before infection to provide protection,” McLellan said in the statement. “With antibody therapies, you’re directly giving somebody the protective antibodies and so, immediately after treatment, they should be protected.”

The Llama and the Nanobody

The molecule the team produced, and for which they obtained a structure, represents only the extracellular portion of the spike protein, but it is enough to elicit an immune response in people, and thus serve as a vaccine.

“The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.She is not a superpowered camelid. Winter was simply the lucky llama chosen by researchers in Belgium, where she lives, to participate in a series of virus studies involving both SARS and MERS. Finding that her antibodies staved off those infections, the scientists posited that those same antibodies could also neutralize the new virus that causes Covid-19. They were right, and published their results Tuesday in the journal Cell.

Surprisingly, this isn’t the first time llamas have been used in antibody research, as The New York Times reports. Llama antibodies have been used in work related to HIV and influenza, where they helped discover promising therapies.

This is a 3D atomic scale map, or molecular structure, of the 2019-nCoV spike protein. The protein takes on two different shapes, called conformations—one before it infects a host cell, and another during infection. This structure represents the protein before it infects a cell, called the prefusion conformation.

Thanks to the llamas’ antibodies’ small size, they can connect with different parts of the virus more easily.  “The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.

“The binding of this antibody to spike is able to prevent attachment and entry, which effectively neutralizes the virus,” Daniel Wrapp, Dartmouth Ph.D. candidate and co-author, explained in the statement.

Scientists are hopeful a treatment plan for the newly infected in the form of antibody therapies is particularly promising.

Scientists Say Llama Antibodies Could Be Key to Defeating COVID:

Emotional Well-Being During the COVID-19 Crisis for Health Care Provider...

Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic

Providing care to others during the COVID-19 pandemic can lead to stress, anxiety, fear, and other strong emotions. How you cope with these emotions can affect your well-being, the care you give to others while doing your job, and the well-being of the people you care about outside of work. During this pandemic, it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.

Mechanisms in neurobiology which help physicians and caregivers to deal with covid-19 patients.

Recognize the symptoms of stress you may be experiencing.

1. Feeling irritation, anger, or denial
2. Feeling uncertain, nervous, or anxious
3. Feeling helpless or powerless
4. Lacking motivation
5. Feeling tired, overwhelmed, or burned out
6. Feeling sad or depressed
7. Having trouble sleeping
8. Having trouble concentrating

Tips to cope and enhance your resilience.

Communicate with your coworkers, supervisors, and employees about job stress.
Talk openly about how the pandemic is affecting your work.
Identify factors that cause stress and work together to identify solutions.
Ask about how to access mental health resources in your workplace.
Remind yourself that everyone is in an unusual situation with limited resources.
Identify and accept those things which you do not have control over.
Recognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the resources available.
Increase your sense of control by keeping a consistent daily routine when possible — ideally one that is similar to your schedule before the pandemic.
Try to get adequate sleep.
Make time to eat healthy meals.
Take breaks during your shift to rest, stretch, or check in with supportive colleagues, coworkers, friends and family.
When away from work, get exercise when you can. Spend time outdoors either being physically activity or relaxing. Do things you enjoy during non-work hours.
Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting and mentally exhausting, especially since you work with people directly affected by the virus.
If you feel you may be misusing alcohol or other drugs (including prescriptions), ask for help.
Engage in mindfulness techniques, such as breathing exercises and meditation.
If you are being treated for a mental health condition, continue with your treatment and talk to your provider if you experience new or worsening symptoms.

Stress and Coping

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

Self assessment and inventory.

People who may respond more strongly to the stress of a crisis include

Older people and people with chronic diseases who are at higher risk for severe illness from COVID-19

Children and teens

People who are helping with the response to COVID-19, like doctors, other health care providers, and first responders

People who have mental health conditions including problems with substance use

Pre-existing conditions

High risk categories...age, chronic illness, emotional wellness

Note: Self assessment can be very difficult. Due to peer pressure, shaming and self esteem issues it is very easy to be in denial.  Ask for help when you feel overwhelmed and/or inadequate.  Others are experiencing these feelings as well. Sharing is caring.

Hopefully this post will help those on the front lines of the covid pandemic.

Please consult with a trusted professional before acting on information in this post.

Stay safe !

The Golden State Awakens

According to Guidelines from the CDC and Governor Gavin Newsom California will begin to stir on Friday from it's self-induced coma.   Restarting the economy will be a great challenge rivaling the shortage of PPE and ventilators.

Perhaps some background music will help us all

After weeks of waiting, some California businesses can reopen Friday. But it's complicated. Here are 5 things to know about the reopening.

California will move into the first new stage of its reopening plan at the end of this week, and some retail businesses will be allowed to open back up for customers as early as Friday — assuming they comply with new health guidelines, Gov. Gavin Newsom announced Monday.

The state has made enough progress in its efforts to contain, trace and test for the new coronavirus to allow retailers to reopen for curbside pickup, Newsom said. The businesses able to reopen this week include clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday, the governor pointed out.

Manufacturers and other logistics companies that make up retail supply chains will also be able to reopen, he said. On Thursday, the state will announce guidelines that the reopened businesses must follow to ensure social distancing. In the past, Newsom has said those requirements may include temperature checks at the door and fewer tables inside.

This step means that California is entering Stage 2 of its gradual, four-part reopening plan, which Newsom laid out last week. The timeline for moving into each stage will depend on the state's ability to ramp up testing for the coronavirus, begin widespread contact tracing of people who've tested positive, and protect vulnerable residents, Newsom said.

Here are five things to know about Monday's announcement: 

This graphic from the governor's office shows the metrics that officials will use to decide whether the state is ready to lift more restrictions. (Office of Gov. Gavin Newsom)

1) Some businesses can reopen.

The only businesses allowed to reopen Friday are "low-risk" retailers that can open for curbside pickup, to minimize person-to-person contact. This includes clothing stores, bookstores, music and toy stores, sporting goods stores and florists — which will be able to open in time for Mother's Day on Sunday

Manufacturers and other logistics companies that make up retail supply chains can also reopen, Newsom said.

2) Many more cannot.

Offices, shopping malls and dine-in restaurants will not be permitted to open this week, even though they were included in Stage 2 of the initial reopening plan.

Higher-risk venues like gyms, hair salons and churches, which include more person-to-person contact, won't reopen until the state enters Stage 3 of its plan.

And mass gathering places like concert venues and sports stadiums will stay closed until the state has access to drugs that treat COVID-19 — a development that may take months or longer.

3) Some counties can lift orders sooner. Others can keep theirs stricter.

Some California counties, which have seen relatively mild outbreaks of COVID-19, can now develop their own containment plans in which they lift restrictions sooner than the rest of the state, Newsom announced Monday.

These counties, some of which had already started defying the statewide order, can move further into Stage 2 by allowing restaurants and other hospitality venues to reopen. But the counties' plans must be certified by the local health officer and county supervisors, Newsom said.

On the other hand, regions like the Bay Area, which have stricter stay-home rules than the statewide order, are free to keep the stricter limits in place.

4) Stay-home orders could come back.

Reopening the state doesn't mean the virus will no longer be a threat. Hospitalizations have stabilized, and the state has expanded its health care capacity enough to treat a surge of patients, but people will keep getting sick until there's widespread access to a treatment for COVID-19.

That means stay-home orders could be reimposed if virus cases spike again, Newsom said Monday. Last month, he described this as a "toggling back and forth between more-restrictive and less-restrictive measures."

It's one of many reasons why life after the crisis will look much different than before. Restaurants will reopen but may have temperature checks at the door, along with fewer tables inside, officials have said. Face masks will likely remain common. And mass gatherings won't happen for the foreseeable future.

5) More testing and tracing are coming.

One reason for cautious optimism: state officials say they have ramped up their ability to trace and test for COVID-19 — two metrics considered among the most important for containing the disease.

California is now testing 30,000 people each day for the disease — exceeding its goal of 25,000 by the end of April, Newsom said Monday. It eventually hopes to test 80,000 people each day.

Meanwhile, the governor announced a new program that he said will train 3,000 tracers per week, adding to an existing workforce of more than 2,800 tracers who work in 22 counties across the state. The "academy," developed in partnership with UC San Francisco and UCLA, will open Wednesday and aims to eventually train at least 20,000 contact tracers.

As the state considers when to further lift restrictions, officials will keep an eye on a number of metrics, including the rate of COVID-19 hospitalizations, the availability of personal protective equipment for health workers, the health care system's ability to handle a surge in patients, and the ability to continue tracing and testing for the virus