The SHIFT Medical team continues to monitor the progression of the coronavirus and will pass along meaningful updates when they arise. We continue to stay well connected to the High Consequence Infectious Disease teams at Northwestern, Lurie, RUSH, and University of Chicago that focus exclusively on preparedness efforts for rare pathogens of high clinical and/or public health significance. These teams monitor epidemiology of coronavirus daily and get debriefings from the Chicago Department of Public Health and the CDC weekly. These teams will communicate important updates to SHIFT promptly as needed, and all pertinent info will be passed along to our SHIFT members as well.
Our number one priority is to keep our members, families, and co-workers safe. By doing the above, we are confident that we can continue to provide safe, effective, and compassionate care, even during an infectious diseases outbreak.
In Real Health,
Dr. Brian Hollett and Dr. Ari Levy
As physicians, striking the proper balance in sharing information is akin to determining the proper therapeutic dose of a novel medication. If we provide too much (either in quantity or complexity) you may become overwhelmed; provide too little information, we risk causing you confusion. Today we hope to deliver the proper therapeutic dose of information as it relates to the current status of, and our experience with, the COVID-19 pandemic.
Situational Overview of COVID-19 (7/21/2020):
- The COVID-19 virus is not significantly limited by warm or humid climates.
- Cases are surging nationwide. It will take at least a month for us to understand how these surging case counts will affect daily death counts.
- The COVID-19 pandemic remains very much alive in Chicago. Expect surges, additional business closures, and increased tensions as people continue to navigate their daily lives.
- Are you curious about what sources of information we review as physicians to stay informed about COVID-19? See a list of sites here: COVID-19 Dashboard.
- With research continuing to question the notion of herd immunity with COVID-19, a vaccine is the most likely path to lead us out of the pandemic. However, all those pursuing vaccines, whether private industry or through government agencies, require time to conduct research, perform trials, and track response. Numerous trackers exist, e.g. New York Times and Milken Institute.
- While some look optimistically at vaccine development and deployment in late 2020, a more realistic expectation is late 2021. In the meantime, it is important to stay safe by avoiding exposure as we await a potential vaccine.
- COVID-19 has mutated, and the new strain with a D614G mutation (meaning that the 614th amino acid is now a glycine rather than aspartic acid) is being hypothesized to be more contagious but less lethal. This is based on cell-culture models in petri dishes though, so don’t change your behaviors just yet. In the best-case scenario, COVID mutates back to the common cold in the next 9 months. This is unlikely but not impossible. We await additional research publications to deepen our understanding about the clinical significance of this new mutation.
- A mutation can have numerous implications on vaccine development, testing efficacy, and treatment response rates. As far as we know today, this new mutation is not known to have any serious negative effects on testing, treatment, or vaccine development
IFR (Infection Fatality Rate)
- According to a recent article in the New York Times, “more than six months into the pandemic, the coronavirus has infected more than 11 million people worldwide, killing more than 525,000. But despite the increasing toll, scientists still do not have a definitive answer to one of the most fundamental questions about the virus: How deadly is it? The figure, usually called the infection fatality rate, could tell health officials what to expect as the pandemic spreads to densely populated nations like Brazil, Nigeria and India.” The article goes on to say, ”On Thursday 7/9, after the World Health Organization held a two-day online meeting of 1,300 scientists from around the world, the agency’s chief scientist, Dr. Soumya Swaminathan, said the — which means that the risk of death is less than 1 percent.” There are also more individualized data coming out of cities such as Geneva, Switzerland depicting the variability of IFR observed in an individual city based on age, showing that the overall IFR may be more than a 50-fold overestimate for specific age-groups.
- Before you throw caution to the wind, keep this in mind, a large percentage of people experience lingering symptoms, such as ongoing fatigue, breathlessness, joint pain, and chest pain for weeks after they have “recovered” from the acute viral infection. As we only have months rather than years of data, it is unknown just how long many of these symptoms will remain. At present, the long-term effects of COVID-19 also remain largely unknown.
- R0, pronounced “R-naught,” is a mathematical term that indicates how contagious an infectious disease is. It tells the average number of people who will contract a contagious disease from one person with that disease.
- For example, if a disease has an R0 of 7, a person who has the disease will transmit it to an average of 7 other people. Without action, arborizational replication will continue repeatedly if no one has been vaccinated against the disease or is already immune to it in their community.
- What do R0 values mean?
- Three possibilities exist for the potential transmission or decline of a disease, depending on its R0 value:
- If R0 is less than 1, each existing infection causes less than one new infection. In this case, the disease will decline and eventually die out.
- If R0 equals 1, each existing infection causes one new infection. The disease will stay alive and stable, but there won’t be an outbreak or an epidemic.
- If R0 is more than 1, each existing infection causes more than one new infection. The disease will be transmitted between people, and there may be an outbreak or epidemic.
- See current R0 values of COVID-19 by state here: https://rt.live/
- Three possibilities exist for the potential transmission or decline of a disease, depending on its R0 value:
FINAL TAKEAWAYS FOR TODAY:
The world’s top scientists need time—time to build new vaccines, time to validate new treatments, and time to understand more deeply the numerous facets of this new challenge our society is facing. Do your part to buy scientists some time. You have the ability, through your behavior each day, to impact directly how quickly (or slowly) this virus spreads near you. Masks, strong hygiene practices, and social distancing all matter…still. Take it upon yourself to be part of the solution.
We want to thank you all for sharing how much these periodic updates have meant to you. We aim to continue to keep you all well informed and well ahead of the curve in this continually evolving pandemic.
After several weeks researching and developing a clinical testing protocol for our Members, SHIFT, in partnership with RUSH Medical Center, is proud to announce the launch of the SHIFT COVID-19 Asymptomatic Testing Protocol. This testing protocol is a longitudinal series, which includes two (2) rounds of testing for each participant, that will detect the presence of both antigen (“do I have COVID-19?”) and antibodies (“was I previously exposed to COVID-19?”). By leveraging the laboratory capabilities of RUSH Medical Center, SHIFT can offer what our research indicates is the highest quality testing at scale for our Members and their families.
Non-Members, please contact email@example.com to inquire about testing for you or your business.
Even before COVID-19 hit our nation, media outlets began offering a torrent of messages that were confusing, conflicting, and often misleading. The endless stream of news and (mis)information has provoked a range of emotions in us all, frayed our nerves, and, importantly, not satisfied our natural and fundamental desires for certainty and a single, informed voice of reason. In the meantime, we have all been forced to live in the grey and to formulate our own ideas and opinions with scant definitive information. It has been and is still difficult, we know.
In turn, our objective is to stand above and apart of the fray so that we may continue to provide you with highest quality information, recommendations, and services you deserve and expect. To do this, we have been occupied with rigorous evaluations of scientific data, assessments of trusted medical reports, and communication with leading experts to ensure we have the best information available about the nature, transmission, risk, prevention, testing, and treatment of COVID-19. In that work, we hold ourselves to a high standard and consider your health and wellbeing to be as important as our own and that of our family members. We do not have all the answers we need just yet, but we are very close to having them. As soon as we know, you will know.
At present, the SHIFT Team is working on a clinical testing protocol to provide you access to the best COVID-19 testing available. We are collaborating daily with experts and health systems to ensure that we offer access to a testing protocol that is not just clinically excellent in terms of accuracy and sequencing, but also as manageable as possible logistically for our Members. We hope to launch this proprietary testing methodology within the next 7-14 days.
There has been a lot of buzz in the news recently about antibody testing for COVID-19.
The state of emergency declared by the Department of Health and Human Services (HHS) on February 4, 2020 enabled the rapid development and deployment of numerous testing modalities for the SARS-CoV-2 virus, which causes the illness COVID-19. This has enabled over 70 companies to provide a rapid influx of new testing modalities, albeit without the meaningful FDA oversight that it typical. This lack of FDA oversight has created a mess, and the media hype around these tests has further worsened the current state of confusion. There are many tests currently being offered without any meaningful testing data pertaining to the quality of the test itself, and many claims being made by those delivering these tests that are not supported by science.
A deeper clinical testing workflow is needed rather than a single antibody test alone. At SHIFT, we are working to finalize a meaningful clinical workflow that will not simply deliver a single test but also a sequence of tests and a heightened level of insight – both at a point in time and longitudinally.
In doing so, SHIFT will be working daily with other prominent institutions as we seek to answer:
- How long do antibodies to SARS-Cov-2 last?
- Do survivors of COVID-19 have long-lasting immune responses to the virus?
- Does the presence of antibodies indicate that someone cannot be reinfected by SARS-CoV-2?
- Are antibodies the ultimate measure of immunity? Are there other cells involved?
- What are the minimum amounts of antibody necessary for protection?
- Are all antibody levels protective against SARS-CoV-2 reinfection, or is there potential for worsened disease?
- How important is herd immunity to stopping the COVID-19 pandemic?
What do I do now?
Sit tight for the moment. Reach out to your SHIFT physician if you are feeling ill, but do not yet rush out to get antibody testing done on your own. The SHIFT algorithmic pathway will be a multifaceted approach to testing that will address administration of testing at scale for our SHIFT community, foster coordination and connectedness in the process, and deliver communication and support along the way.
Based on new information and developments regarding COVID-19 and in the interest of the safety of our Members, staff, related vendors, and the broader community, SHIFT has determined out of an abundance of caution that ALL Group fitness classes, 1:1 individual training sessions, and open gym hours will be cancelled effective tomorrow, March 16, 2020 until March 31, 2020. Please be advised that these time frames may change when new information becomes available.
This decision is made after careful consideration of new information and clear evidence that the viral spread of coronavirus precedes symptoms and, as such, there is no known way to screen for or protect everyone with certainty. SHIFT will continue to provide you with medical care during this time, but we ask that all Members having any medical need whatsoever first call SHIFT or one of its physicians. We appreciate your understanding during this period as we seek to fulfill our duty to care for and protect all people.
For any Members with an upcoming scheduled annual visit, please note that all Annual Assessments will continue to be conducted.
Please stay tuned as we will continue to provide you with new updates about COVID-19 and our response.
Protecting Your Health during COVID-19
General Health Needs / Signs and Symptoms
If you are not feeling well in any way, have any medical need, or are experiencing any symptoms (COVID-19 symptoms or other), PLEASE contact Brian or Ari, directly first by phone or email and we will respond as soon as possible.
Again, for those experiencing any symptoms possibly indicative of having contracted COVID-19, SHIFT is working in coordination with Rush University Medical Center and its Coronavirus Command Center and has established a direct access point for SHIFT Member care in response to COVID-19. If you are determined to be at risk, our team will work in coordination with Rush to begin your testing and evaluation process and support you as move through it.
While there currently is no vaccine to protect against COVID-19, the best way to prevent the illness is to avoid being exposed. The CDC recommends the following preventative measures to help prevent your risk of illness:
- Wash your hands with soap and water thoroughly, and especially when returning from trips outside where you may have had contact with others;
- If soap and water are not available, use alcohol-based hand sanitizer (at least 60%);
- Disinfect frequently touched objects and surfaces;
- Avoid contact with people who are sick;
- Avoid public transportation and non-essential travel to the greatest extent possible;
- Stay home when you are sick;
- Avoid touching your eyes, nose and mouth; and
- Cover your cough or sneeze with a tissue (and then throw away the tissue)
Stay physically active. This means doing what you can do with what you have. Exercise is extremely helpful to our efforts to manage stress and to boost short- and long-term immunity. Remember in these current conditions you want to pursue mild to moderate exercise, not overly challenging and over–the–top workouts.
Continue to focus on fueling your body with high quality nutrients. Strive to maintain a balanced plate at meals, with ½ of the plate being fruits and veggies, ¼ lean proteins, and ¼ complex carbohydrates. Continue to maintain optimal hydration (consuming ½ your weight in pounds in ounces of water. Example: If you weigh 200 pounds, strive to consume 100oz of water daily). Think of proper fueling and hydration as a foundational building block for your immune system. Continue to fuel your body well so that it has the solid foundation to fully power your immune system.
Your Mental Health
During this time, you might find yourself experiencing some mental health challenges and feeling more anxious that usual. This may be brought on by the high volume of news about coronavirus, feeling panic in yourself or from others, and being in close quarters with your family for extended periods. To combat these challenges, it is important that we have at the ready various coping mechanisms. Below please find a few suggestions, and please also know that Brian and I are here to help provide support and recommendations, as needed.
Recommendations: Limiting any screen time for certain periods, yoga, meditation, deep breathing exercise, short walks outside, reading, gratitude practice, doing what you can and letting go of those things that are outside of your control. In addition, this is not the time to limit your sleep; in fact, if anything, we should be looking to increase sleep slightly. Aim for 8-10 hours of sleep per night if possible (these are the same recommendations given to pro athletes in weeks prior to competition, as bountiful sleep maximally allows the body to repair, defend, and sustain).
Following the increasing spread of COVID-19 and its classification as an international pandemic, we want to make sure that you have the information and support you need to be healthy during this time. To stay connected, we will update you with the facts we have when we know them in the coming days and weeks.
- In coordination with Rush University Medical Center and its Coronavirus Command Center, SHIFT has established a direct access point for SHIFT Member care in response to COVID-19. If you are experiencing any symptoms or are feeling ill (COVID-19 symptoms or other), PLEASE contact Brian or Ari, directly first by phone or email and we will respond as soon as possible. If you are determined to be at risk, our team will work in coordination with Rush to begin your testing and evaluation process and support you as move through it.
- The current global approach to COVID-19 is about containment, slowing the spread of the disease, and ensuring that the US healthcare system can handle patient volume. We are in regular communication with the High Consequence Infectious Disease teams at Northwestern, Lurie, RUSH, and University of Chicago that focus exclusively on preparedness efforts for rare pathogens of high clinical and/or public health significance. These teams monitor epidemiology of coronavirus daily and get debriefings from the Chicago Department of Public Health and the CDC These teams will communicate important updates to SHIFT promptly as needed, and all pertinent information will be shared with SHIFT Members.
- SHIFT will remain open for business as usual and does not have a known case of COVID-19 at this time. We want SHIFT to continue to remain an extension of your lives in the safest ways possible.
Our number one priority is to keep our members, families, and co-workers safe. At SHIFT, we are following infection control procedures, have stepped up cleaning and disinfecting protocols for all areas and equipment, and have reinforced best practices during an outbreak with SHIFT Team members. We will continue to provide safe, effective, and compassionate care as this virus takes its course.
At present, here are our continued recommendations:
- Everyone can do their part to help us respond to this emerging public health threat:
- Individuals and communities should familiarize themselves with recommendations to protect themselves and their communities from getting and spreading respiratory illnesses like COVID-19.
- Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness.
- Please contact us by phone if you:
- If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, call us and tell us about your symptoms and your exposure. We will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home.
- If you are a resident in a community where there is ongoing spread of COVID-19 and you develop COVID-19 symptoms, call us and tell us about your symptoms.
- For people who are already ill with COVID-19, but are not sick enough to be hospitalized, please follow CDC guidance on how to reduce the risk of spreading your illness to others. People who are mildly ill with COVID-19 are able to isolate at home during their illness.
- If you have been in China, Italy or another affected area or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement and activity. Please follow instructions during this time. Your cooperation is integral to the ongoing public health response to try to slow spread of this virus.
Please contact SHIFT at 312.566.4210 during business hours, or if after hours reach out to Ari or Brian directly if you have questions, concerns, or believe you have or may have COVID-19.
We will continue our rigorous preparedness efforts and keep you informed as this public health issue evolves.
What is Coronavirus Disease 2019 (2019-nCoV aka COVID-19)
Coronaviruses are a large family of viruses that typically cause a mild illness like the common cold. From time to time new coronaviruses emerge and have the potential to cause severe disease and global epidemics. Coronavirus Disease 2019, or COVID-19, is caused by a new respiratory virus, which is also sometimes referred to as SARS-CoV-2. This virus is different than SARS and MERS that caused previous outbreaks of respiratory illness. This virus was first identified as the cause of an outbreak in Wuhan, Hubei Province, China and has subsequently spread to more than 30 countries on several continents. Early cases were believed to be animal-to-human spread linked to a large seafood and animal market, but it is now known that person-to-person spread is occurring. The new coronavirus has resulted in more than 80,000 cases throughout mainland China. More than 2,000 additional cases have been identified in other countries, including several, mostly travel-related, cases throughout the United States.
What are the symptoms of COVID-19?
Symptoms of those confirmed to have COVID-19 include fever, cough and shortness of breath. While most cases are relatively mild, some patients have had a severe respiratory illness. Severe respiratory disease is more common in the elderly and patients with medical co-morbidities. It is believed that symptoms may appear in as few as 2 days or as long as 14 days after exposure.
How does it spread?
Coronaviruses generally spread through respiratory droplets via:
- Coughing or sneezing
- Close personal contact such as touching or shaking hands (within about 6 feet)
- Touching a surface with virus, then touching your mouth, nose or eyes before cleaning your hands
- There is potential for airborne spread if an infected person undergoes an aerosol-generating procedure, such as endotracheal intubation, receipt of nebulized medicines, or undergoing nasal swabs.
How dangerous is COVID-19?
COVID-19 is spreading from person to person throughout mainland China. Community transmission has been identified in several countries in Asia, as well as in Italy and Iran. Currently, the virus is not spreading in the community in the US. Thus, the general risk to those living in the US and Chicago remains low. The severity of illness of COVID-19 and risk of dying is less than other epidemics of new coronaviruses (SARS and MERS) over the past 20 years. Children and immunocompetent adults are particularly likely to only have mild disease. However, reported cases of COVID-19 have already surpassed the prior SARS and MERS epidemics. Fewer than 3% of patients have died because of COVID-19, mostly those older than 70 years and those with chronic medical conditions. As of late February, there have only been 60 cases in the US, mostly in travelers. To put it into perspective, so far this flu season in the US there have been 29 million infections and 16,000 deaths from influenza. Because your risk of influenza and an influenza-related death is substantially higher than COVID-19, those who have not yet been vaccinated this season should see their providers for a flu shot, which can prevent and/or minimize severity of influenza and protect against influenza-related deaths.
With several cases in the US, how can I keep myself safe?
Currently, the virus is not spreading in the community in the US. Thus, the general risk to those living in the US and Chicago remains low. Thus, we advise to take general measures that are effective for preventing all causes of respiratory viral illness, including:
- Wash hands with soap and water often. When soap and water is not available, use alcohol-based hand sanitizer.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid close contact with individuals who are sick.
- Stay away from public places such as work, school and daycare when sick.
- Cover your cough and sneeze.
- Clean and disinfect frequently touched objects and surfaces such as phones, tables and doorknobs.
How is COVID-19 diagnosed?
At this time, laboratory diagnostic testing for COVID-19 is being conducted at the IDPH laboratory. The COVID-19 strain can only be detected at a public health laboratory.
How is COVID-19 treated?
There is no current antiviral treatment recommended for COVID-19 infection. However, scientists and public health officials are assessing whether certain antivirals and monoclonal antibodies can be effective treatments. Individuals who have been infected with COVID-19 will receive supportive care to help manage symptoms.
What should I be aware of if I am planning international travel?
As community transmission of COVID-19 is being identified in countries outside of China, the CDC is continually updating travel advisories and classification of high-risk areas. At this time, both China and South Korea have Level 3 travel advisories (avoid all non-essential travel) and are considered highest risk. Level 2 travel advisories are in place for Iran, Italy, and Japan; nonessential travel should be avoided for those at higher risk of complications from COVID-19. Level 1 travel advisory is in place for Hong Kong. Other destinations currently with risk of community spread include Singapore, Thailand, Taiwan, and Vietnam. We anticipate this will continue to change rapidly over the next several weeks to months. Thus, it is possible that travel and return-to-work restrictions may be expanded to other countries in the future. If you anticipate any future international travel, please stay abreast on travel advisories here: https://wwwnc.cdc.gov/travel/notices.
What steps should I take if I, or a household contact, have returned from other international travel (outside of China and South Korea)?
To optimize safety in the setting of a rapidly evolving public health issue, if you have travelled internationally anywhere outside of North America, South America, or the Caribbean in the past 14 days and develop fever or respiratory illness, please DO NOT report to work. Additionally, if a household contact has travelled internationally (outside of North America, South America, or the Caribbean) AND becomes ill with fever or respiratory symptoms, also please DO NOT report to work. If these situations occur, please then call SHIFT at 312.566.4210 during business hours or reach out to Ari or Brian directly after hours.
What is SHIFT doing to prevent spread of COVID-19?
Our number one priority is to keep our members, families, and co-workers safe. SHIFT is staying well connected to the High Consequence Infectious Diseases (HCID) teams at Northwestern, Lurie, RUSH, and University of Chicago that focus exclusively on preparedness efforts for rare pathogens of high clinical and/or public health significance. These teams monitor epidemiology of coronavirus daily and get debriefings from the Chicago Department of Public Health weekly. This information is crucial for rapidly modifying policy and clinical practice recommendations in real time. These teams will communicate important updates to SHIFT promptly as needed, and all pertinent info will be passed along to our SHIFT members as well. By doing the above, we are confident that we can continue to provide safe, effective, and compassionate care, even during an infectious diseases outbreak.
We will continue our rigorous preparedness efforts and keep you informed as this public health issue evolves.