• Dr. Tania Dempsey, Armonk Integrative Medicine

Coronavirus in NY: Westchester County: A Doctor's Perspective

Updated: May 20


A medical perspective on coronavirus from a doctor in private practice in Westchester County

The reality we are in right now is that the coronavirus is probably pretty widespread in terms of exposure. It's hard to imagine that it isn't because of how quickly people get infected with this virus. The transmission of this virus seems very easy from what I have seen. It has a longer incubation period and people remain asymptomatic for a long time.

I'm guessing that the first people in New York that were exposed to COVID19 were somewhere around two or three weeks ago. So, we're going to start to see the uptick now in cases and I think this could go on for months. We need to be prepared that this is not just going to die down when spring comes and that is a key difference between coronavirus and the flu. We don't know about the seasonality of this virus, whereas we know with the flu to some extent.

As doctors, we know we can predict that there's going to be a time when there will be less flu around. There's always flu in the air. I've had patients who have had the flu in spring, but generally speaking, it starts to die down and there are less and less cases.

We don't know that about coronavirus. The other issue and the reason there has been a lot of fear circulating in the media is because we haven't been able to test well for COVID19 in New York up until Monday or Tuesday when some changes were made at the government level to get proper testing and to allow people to be tested more efficiently and in larger numbers. People weren't being screened.

So, there could have been a lot of spread of COVID19 in the Westchester County community (and beyond) without us knowing it.

You could only request the health department test your patient for coronavirus. You had to beg them to approve the test. I’ve been talking to doctors who are on the frontlines, working in hospitals and taking care of patients and having difficulty even trying to test them.

If we had tested them weeks ago, because we had access to the testing, and didn't have to restrict it, we would be at a very different place then we are at today.

There are a lot of reasons why it had to be restricted. But if we did that, we might have known at this point where the situation is and how bad the situation is going to get. With the flu, we at least have some treatment and something we can give to people that might shorten the course of their illness.

With coronavirus, we have no treatment for it. There is nothing really that can be done except for supportive care. For medical professionals, that's very scary. The coronavirus does seem to have more lower respiratory symptoms and greater risk of pneumonia than the flu even though the flu has a high risk and the death rates are different.

I've heard a lot of numbers being thrown out there in terms of what the mortality rate is from the flu versus coronavirus.

It is important to note that we don't have all the numbers.

Particularly in China, I don't think we have half the answers that we need. If you look at the numbers, they are estimating somewhere between 2% and 3% mortality rate for coronavirus.

To put that in perspective, the flu mortality rate is 0.1% maybe up to 0.2% depending on the season versus 2% to 3%. So, in other words, coronavirus has a higher rate of mortality, meaning that it's killing people at a higher rate than the flu is.

It's very hard to imagine that they are even being compared. We don't understand everything about this virus. For other viruses, we say wash your hands and drink a lot of water and you'll get through it.

That is simply not the case here with COVID19.

I want to reassure people because there's a good chance that if you're reading this today you're going to be fine and that you may not be exposed and you may not have an issue. However, I think that we have to be more realistic and a little more honest with the public so that they understand that yes, they need to wash their hands, but they need to wash their hands better than they're washing their hands now, because clearly people are not washing their hands for 20 to 30 seconds and you have to sing Happy Birthday, the full song, before you rinse your hands. People are not doing that. So could that help? It could, but it can't hurt.

But the problem is the transmission of this virus seems beyond that. The thought is that there may be microscopic droplets in the air that may be suspending in the air from coronavirus that if a person with coronavirus leaves the room and you walk into that room, those air droplets could still be infectious. So in that case, washing your hands won't matter. You could breathe it in so the challenge is that we have a big issue on our hands and we don't have the information that we need to truly protect people and that's my biggest concern as a medical professional. I have patients who have canceled their vacation plans for next month with the anticipation that this could be an issue. So, the question is, what should you do? If you have a chronic illness, are immunosuppressed or have chronic lung problems, you should probably lay low. If you're healthy and you have a good immune system, you might be okay. However, I can’t give any medical advice around this and many other medical professionals can’t either until we have more data. There does seem to be a discrepancy between who is getting sick from COVID9. I don't believe that anyone is immune to the coronavirus.

But I think that in general, there are some people who absolutely *should* be a little bit more careful.

Children do seem to be less affected from the numbers that we're seeing. But I'm not 100% sure about that because I'm not sure I believe all the numbers. But if we go by what some of the experts are saying that kids are not as vulnerable, then theoretically the schools might not be as big of an issue. Now, on the flip side, a kid could have coronavirus and not be as sick, not get tested because they have what looks like a cold, maybe they stay home from school for a day or two. But they are still potentially contagious and still spreading coronavirus into the Westchester County community.

That's the fear and that would be the reason why you would want to close a school, not because the kids themselves are getting sick, but because they're potentially spreading it to those in the community who are really immunocompromised.

I wouldn't be surprised if we start seeing some school closures if coronavirus continues to infiltrate into the Westchester County community, which I am predicting it will. I think it's the wrong attitude to say, you are young and you don't have to worry about coronavirus, because how many of us have people in our families who are not young and who are susceptible?

This could touch a lot of people. And even if you get coronavirus, you may not be as sick, but you're still potentially also spreading it. We know that 30-year old’s can get coronavirus and can spread it, they just won't be nearly as sick as a 65-year-old.

But that doesn't mean it's still good. COMMUNITY SPREAD OF COVID19 IN WESTCHESTER COUNTY, NY

Many of the Westchester County coronavirus cases do not fit the typical risk factors that we're seeing in that they didn't travel to the areas where we know were hit first. So, the question is, how did how did this Westchester County lawyer pick it up?

It must be in the community and it must have been in the community for some time.

And so again, we go back to, this has been going on for longer than we initially thought. It seems that coronavirus is extremely contagious. For example, if you take the flu, which is very contagious, and you have a family, sometimes one person gets the flu and brings into the family and everybody gets sick. I have families that I take care of that happens to. I also have families that one or two people get sick. Some of the other family members don't get sick, their immune system was better, or they wash their hands more. The point is, not every single person in the family gets it. In this case, this gentleman was exposed to coronavirus, got the virus and got sick, and every single person in his family tested positive for it. So if that's the case, and the transmission is 100%, if you think about it, then it's inevitable that the numbers are going to skyrocket within the next week or two. I think we're really just a couple of weeks away from seeing coronavirus become a little more widespread.

In my opinion, we're on our way to a pandemic. I don't know if we're theoretically meeting the definition of pandemic, but I think it's just a matter of time, given the numbers that we're seeing. If you look at the map and the countries every day we’re hearing more countries that have new cases. They have confirmed cases now in the Ukraine, Romania, Saudi Arabia, Belgium, Austria, Argentina, and a few others, so as it starts to hit all the countries, we are almost there. SELF QUARANTINE

A quarantine is where you isolate and you're separated from people. So, self-quarantine means that you do it on your own. It's not as voluntary. You're not required and you stay in your home. You don't go out to the store, you don't go out and pick up stuff. So, yes, being prepared is smart. A lot of people have gone out and started getting supplies. Initially, it was looked at as this fear of running through the Westchester County community, everyone's crazy going shopping and buying things.

I don't think it's crazy. There should be some supplies in the house in case you can't leave including water, extra food and things like that.

People are being quarantined until they are deemed not infectious anymore. There will be a number of tests that have to be done I believe to qualify as being removed from quarantine. If you have been told to self-quarantine, please stay home. It's not fair to others who are in a different position whose immune system is different, who might not be able to continue working while they're sick, or people who go out to the store and infect other people.

Coronavirus is a deadly virus. It looks like it's deadlier than the flu. And I understand the flu is bad too, but you just risk hurting other people.

And this is a time when you really have to take care of yourself and take care of others and you have to isolate. I think it's selfish not to do that. But I understand that impulse if you have commitments and you don't feel that bad yet. You kind of think I'll push through it.

But unfortunately, this is not that type of virus to fool around with.

If you have things to do you have to do it. If it's something that is for pleasure, maybe it's optional. Maybe those are the opportunities that you sort of say okay, I'm going to It, but if you have important meetings that you have to go to and you're not sick, be cautious.

WHAT TO DO IF YOU ARE WORRIED YOU MAY HAVE CORONAVIRUS If you are worried you may have coronavirus, call The Health Department or call an emergency room at one of your local hospitals in Westchester County, NY and make sure that the hospital can test for coronavirus. That hospital might suggest that the person come in for testing because right now we're at that stage where they want to test people to get a sense of who was affected and the hospitals are trying to be as prepared as they can for their exposures that they're getting there. You need to find out if the hospital can test and then go to the hospital.

MASKS People should have masks at home, particularly not because the mask is not going to protect them from somebody else. But if they get sick themselves, putting a mask on can be protective to other people. So they put a mask on so they can go to the hospital they put a mask on so they can get the help that they need. I don’t think it's useful to wear the mask particularly because these masks are not designed to really filter out the COVID19 virus and you have to have the right mask and that is a whole other story. I don't recommend people walk around with masks.

What I recommend is having masks so that if you are sick, and you're home with your family, you put your mask on to protect you from your family and to protect you when you go to the hospital and protect them from you.

You're not helping yourself; you're helping other people around you. PRECAUTIONS

Be cautious and avoid touching your face and putting your fingers in your eyes and your mouth. Wash your hands frequently and use antibacterial which may kill some of the viral particles. There are ways to make hand sanitizers that have essential oils and can be a little bit safer than alcohol, but I don't know their efficacy against this virus. We know that alcohol-based hand sanitizers do kill the virus. I'm of the opinion that if we have some research that says that's working, why change it? I want patients to stay hydrated. You want your mucous membranes to not be dry. You are more likely to pick up the viruses through your respiratory tract if you are dehydrated, so drink lots of water. I would also urge you to avoid sugar at all costs. Sugar lowers the immune system and makes it more difficult to fight infection. Eliminating sugar and as many simple carbohydrates as possible can only help the immune system. Eat quality protein to help the production of your antibodies that fight things like that. There are so many things in our bodies that come from protein, so you need to eat enough protein to maintain that process and good fats. Do your best, it's not going to be 100% effective, but it will help. There are things that can be helpful for viruses including zinc, elderberry, vitamin C, vitamin D, vitamin A, etc.. These are all great but it doesn't mean that you should go buy them all and start taking them. You do need to have some medical guidance beyond what you are seeing on TV. FINAL THOUGHTS

As medical professionals, we have a problem. Things are flying off the shelves. it's going to be harder to get food and it’s going to be harder to get medical supplies and even cleaning supplies.

As medication becomes less available, we're going to see people reacting more things.

You do something to help one issue and you cause more problems on the other end. This is just going to keep going and I think we need to be prepared for that. That's the bottom line.

We can't be surprised that this is going to happen. We're going to hear more and more cases of coronavirus in our communities everywhere, even beyond Westchester County, NY.

And we're going to be as safe as possible and hope in the interim that we have people who are studying and finding things that we can use to shorten the duration of the illness to stop the illness and prevent the illness. I know a lot of people are looking at vaccines. I'm not sure that the vaccine is the right route. But I'm not certainly not the expert there. I definitely would want drugs and antivirals that could help this disease get resolved quicker and more safely. We are at the tip of a big iceberg and we need to be prepared. It is going to get worse until it gets better. It's going to affect more people and there are going to be more people who are going to know people who are affected by COVID19, especially in Westchester County.

We have to understand that this is different than other diseases that we've been affected by and we can't just lump it with the flu.

This is different and we have to be respectful of that fact.

We are going to see this transpire in a way that we've never seen anything transpire.

ABOUT THE AUTHOR

Dr. Tania Dempsey, MD received her MD degree from The Johns Hopkins University School of Medicine and her BS degree from Cornell University. She completed her Internal Medicine Residency at New York University. For more information on coronavirus, check out the podcast episode below. Coronavirus in Westchester County: What you need to know.


MD PODCAST ON CORONAVIRUS: LISTEN HERE

FACEBOOK LIVE ON CORONAVIRUS: WATCH HERE

NEWS 12 SEGMENT ON CORONAVIRUS: WATCH HERE

NEWS 12 SEGMENT ON COVID-19 (PART TWO): WATCH HERE

COVID19 #FLATTENTHECURVE SOCIAL MEDIA CAMPAIGN

I am proud to participate in the Ruby Media Group #flattenthecurve COVID19 Coronavirus social media campaign. Here are the 5 things I am doing to help flatten the curve. What are you doing to help flatten the curve?

IMMUNE BOOSTING SUPPLEMENTS

The top 3 Supplements to boost your immune system

What supplements should I take for COVID-19 prevention?

Can supplements protect against coronavirus? While I wouldn’t go so far as to say that a single supplement can prevent coronavirus, the following three supplements are strong supplements to boost your immune system, regardless of a specific virus or infection.

Here are the top three supplements to consider.

1. ZINC.

Zinc is a mineral that is involved in so many enzymatic processes in the body and is important for the immune system.

The media has been talking about sucking on zinc lozenges or taking various zinc over the counter preparations because of the belief that zinc may be protective against COVID-19.

While there is no direct evidence of this, research on zinc and its effects on the common cold have shown that it can shorten the duration of a cold. There was a small study that showed that zinc stopped the replication of a similar coronavirus, SARS-CoV-1 (from the 2003 outbreak), so it is assumed that it would be equally effective against SARS-CoV-2 (CODID-19).  

Interestingly, zinc deficiency can cause the loss of taste and smell, which also happens to be an early symptom of COVID-19 in a subset of patients.

2. VITAMIN D.

Vitamin D is the most important vitamin to take because there's no question that vitamin D (which is really a hormone, not a vitamin) acts on just about every cell in the body. It is involved in modulating the various parts of the immune system and a deficiency in vitamin D has been shown to increase susceptibility to infection.  It can even lead to the development of autoimmunity.

I am a big proponent for supplementing with Vitamin D3, particularly in the winter, to prevent illness or to help the immune system during an illness.  95% of my patients with MCAS tolerate vitamin D if they find the right formulation.

3. VITAMIN C.

Vitamin C, or ascorbic acid, is an essential vitamin, which means that since the body cannot produce it, it needs to be taken in from food or supplements. It acts as a cofactor in many cellular processes including collagen and neurotransmitter production and also acts as an antioxidant.  Vitamin C helps to stimulate the production and function of white blood cells in the immune system.  In 1970, Dr. Linus Pauling, the noble prize-winning chemist and peace activist wrote in his book, Vitamin C and the Common Cold, that increasing the daily dose of vitamin C could help the immune system fight off respiratory infections.  

It was recently reported that a hospital in New York City started giving Intravenous Vitamin C to ICU patients with COVID-19, which looks promising.  While we don’t have clear data about the effects of Vitamin C on COVID-19, there are currently trials underway in China and in The United States. 


*This post does not mean we are using vitamins to treat any medical condition. This is a personal opinion post.


*This is not medical advice, and you should see your personal physician or healthcare provider for any supplement suggestions.


COVID 19 ANTIBODY TESTING


Antibody testing is absolutely critical to restarting the economy. It is becoming more evident that there is a significant portion of the population who were exposed to COVID-19 but remain asymptomatic.


These patients remain in isolation concerned about their exposure to this dangerous virus when, in fact, these patients have antibodies indicating they have already had the infection and have immunity now to it.


These are the people who could go back to the workforce without the fear of getting infected. This would be a tremendous improvement over our current situation and would really help keep some or even most industries in business.


There are various hurdles to overcome regarding testing. First, the test needs to be made readily available at hospitals and commercial laboratories in order for it to make an impact on the economy.


Large numbers of people needs to be screened. Medical insurance companies would ideally need to cover the testing as the cost may be prohibitive to some patients.

In addition, doctors will need to interpret the tests and help patients understand whether it is safe for them to re-enter the workforce.


Companies would need to understand which employees can return to work.

These are all resolvable issues, however, with the right team of scientists, doctors, human resource experts, and economists.


**********************

COVID-19 also know as SARS-CoV-2, has proven to be an elusive virus. It seems that every week or even every day, we find out something new or unexpected about it. What we understood as a truth about the infection last week, may be disproven this week. This is particularly true of our understanding how our immune system mounts an immune response to the virus.


We have known, for instance, that when our immune system gets exposed to a virus such as Epstein-Barr, our acquired immune system, the part that makes antibodies, kicks in pretty quickly and starts to produce acute antibodies, also known as IgM antibodies. A few weeks later, the immune system will start to produce a variety of chronic antibodies, known as IgG antibodies, to various Epstein-Barr virus (EBV) proteins.


Once someone has had EBV, they can’t get re-infected with the virus because they have antibodies to protect them. The Epstein-Barr virus, however, doesn’t go away completely as it lays dormant in our cells. It can reactivate at any time and when it does it can cause similar symptoms to the initial infection or worse. There are plenty of viruses like EBV and we often make assumptions that viruses behave similarly.


For the past few months, it was thought that patients who were infected with COVID-19 developed an antibody response first with acute antibodies and then with chronic antibodies and that these antibodies would protect them for getting re-infected.

Now that more and more patients are getting antibody testing done, mostly in the setting of research protocols to determine if they can be plasma donors for sick COVID patients, it is becoming clearer that the antibody response might not be as rigorous in a subset of patients.


These patients might only have low levels of antibodies or none at all and this is concerning because it is possible that this means that these patients can get re-infected. It also might mean that the virus can re-activate and become infectious again in some patients.


Just when we thought we were on our way to herd immunity, we might not be. Without the presence of enough people in our communities with immunity, the more likely this virus will continue to circulate. And taking it one step further, it also means that a vaccine might not be effective, because if patients can’t build up an immune response to the active virus, they are unlikely to do so against an inactivated virus.


Given some of this new information, it is actually more important than ever to do antibody testing in as many people as possible so that we have a better understanding of whether SARS-CoV-2 will continue to plague the world and whether we have to brace ourselves for SARS-CoV-3.


TELEHEALTH


Do you provide Telehealth (Virtual) appointments?

Yes, due to the Covid-19 pandemic, Telehealth Service laws are changing rapidly to accommodate the needs of patients who are unable to travel.


We offer Telehealth appointments in every state and Internationally for all our patient follow-up visits.

For new patients, we have a rapidly expanding list of states which both Dr. Dempsey and Dr. Afrin are able to provide Telehealth appointments. To see what Telehealth options are available to you in your state, please contact our office directly (914-730-7390) as this list changes frequently.

You may also email us your information at info@armonkmed.com and we will contact you within 48 hours to discuss the options available in your state. In your email, please be sure to provide the following information:


Name  

State

Best contact number

We are continuing to look at new innovative telemedicine options and new ways to practice medicine.


Do you really need to stay in your house indefinitely?


There is a lot of talk lately about loosening restrictions on quarantining, but it is not clear if we are ready for this. It has to happen eventually, however, it would be best if we had solutions in place, like the right treatment protocol and assuring adequate personal protective equipment (PPE’s) in hospitals.


Staying home is the safest plan right now no matter what. Everybody needs to self-quarantine and stay home regardless of if they’re at increased risk or not for coronavirus. At this point, it’s not clear that anyone will be spared from coronavirus.

The issue is that nobody in The United States (or the world) has any immunity against this new virus unless they have had this before.


Whatever their underlying issues are, everyone needs to protect themselves the best they can. For anyone with specific underlying health issues, staying home becomes even more crucial. If you have the additional layer of chronic infections, like tick-borne infections, or have immune dysregulation, you need to be more cautious.

If you need supplies, somebody else should get food supplies for you or deliver it to your house. I would prefer you to not leave your house because I don’t think you can protect yourself adequately, even if you are just going out for essentials.

LYME DISEASE AND CORONAVIRUS

If I have Lyme Disease, does it make me more susceptible to COVID-19?


It is not known whether a person with Lyme disease is more susceptible to contracting the new coronavirus but the concern is that once they have been infected that they may be more susceptible to severe disease due to their dysfunctional immune system.


There is a distinction between those who have “recovered fully” from Lyme disease and those that have battled the chronic versions of Lyme disease. People who have had Lyme disease and have recovered fully and have had no long-term consequences are probably at the same risk as the general public. But people that have had chronic infection or who have underlying autoimmune diseases and other conditions as a result of Lyme or co-infections are probably at increased risk. It is important to note that this is all conjecture at this point because we don’t actually have any data to support that.

If I have an autoimmune disease, does it make me more susceptible to COVID-19?

It is critical to self-quarantine and stay at home to avoid people coming and going from your house if you are immunosuppressed. It’s vital for people with a history of immune system disorders to discourage people delivering items directly into your house. You don’t know who is exposed and who is a carrier of COVID-19. Coronavirus has a very long incubation period. It could be 14 or more days before people show symptoms and in the meantime they think they’re fine while simmering the infection inside. Others don’t even know they have been infected and will never show symptoms but can spread the disease to others.

I think that everyone, whether they have an autoimmune condition, mast cell activation syndrome, or chronic Lyme disease, has to act as if they do have a condition that makes them more at risk because the reality is we don’t know for sure. It is better to act safe and protect yourself the best you can.

MCAS AND COVID-19

If I have MCAS, does it make me more susceptible to COVID-19?

It is not known (that is, it has not been studied) whether having MCAS makes somebody more susceptible (as compared to somebody who does not have MCAS) to getting infected by the COVID-19 virus.  For MCAS patients who are concerned about Coronavirus, we do not yet know how COVID-19 coronavirus impacts MCAS patients differently than how it impacts anybody else.

My best guess is that the virus is so infective/contagious even in people who don't have MCAS that it's hard to imagine how having MCAS could make somebody more susceptible to getting infected by this virus.  It is *possible* (but, again, has not been studied) that people with severe immunodeficiencies or severe lung diseases *might* be more susceptible than other people to getting infected by this virus, but MCAS generally does not cause severe immunodeficiencies or severe lung disease.

What to do if you have been around someone with COVID-19


If you have been in proximity to somebody with known COVID-19 infection, or somebody who is being investigated for possible COVID-19 infection and you begin to develop symptoms of COVID-19, you should:


(1) Immediately begin avoiding contact with others as much as possible (including staying home from work or school, not leaving your residence except to visit your doctors, and using separate hygiene/cooking/sleeping facilities/areas from those being used by others in the household, i.e., quarantining yourself so that others don't come into your proximity and don't contact any materials/surfaces you have recently used)


(2) Contact your local county health authorities for further guidance and assistance (such as getting tested to see whether you truly do have the infection).

If I have an autoimmune disease, does it make me more susceptible to COVID-19?

It is not known (that is, it has not been studied) whether having an autoimmune disease makes somebody more susceptible to getting infected by the COVID-19 virus.  My best guess is that the virus is so infective/contagious even in people who don't have autoimmune disease that it's hard to imagine how having autoimmune disease could make somebody *more* susceptible to getting infected by this virus.  It is *possible* (but, again, has not been studied) that people who have autoimmune disease *and* who consequently must take medications which cause severe immunodeficiency (i.e., severe suppression of their immune systems) *might* be more susceptible than other people to getting infected by this virus, but the management of autoimmune diseases in most of those who have such diseases does not require "severe" immunosuppression.






#coronavirus #covid19 #coronavirusWestchestercounty

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