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Stay on Top of Your Heart Health During COVID-19, Part I

Posted on Aug 27, 2020 in California Pacific Medical Center, Scroll Images, Wellness

The pandemic has understandably transformed many of us into housebound creatures, oftentimes moving less and eating more.

“It’s created the perfect storm for developing high blood pressure. For those who are already hypertensive, their blood pressure can get out of control,” says Michael X. Pham, M.D., M.P.H., chief of cardiology with Sutter’s California Pacific Medical Center in San Francisco.

People may be exercising less, can be generally feeling more stress, and may lack the normal outlets to decompress, including time with family and friends, travel, attending sporting events or going to the movies.

“People are also eating less healthy,” says Dr. Pham. They may be ordering takeout more often or eating processed foods because they last longer and require fewer trips to the store.

But there’s hope for our hearts! Dr. Pham says healthy eating and exercise can help prevent, manage, and stave off high blood pressure. “Even small changes can make a difference,” says Dr. Pham.

Blood Pressure Basics

Blood pressure readings have two numbers—systolic and diastolic. For example, a blood pressure number would be written 118/78 mm Hg. The top number (systolic) accounts for the pressure when the heart beats. The bottom number (diastolic), accounts for the pressure between heart beats.

A person will be diagnosed with high blood pressure if their systolic blood is 130 or higher and their diastolic is 80 or higher. A blood pressure reading of 120/80 mm Hg or lower is considered normal.

“If a patient’s blood pressure is high or borderline, it’s a warning sign,” says Dr. Pham.

High Blood Pressure Puts Your Heart at Risk

A person’s blood pressure rises and falls throughout the day, but, if it stays high for a long time, that person may have the medical condition of high blood pressure, also known as hypertension.

Hypertension can cause heart disease or kidney disease—and may lead to heart attack, stroke or even death.

“High blood pressure doesn’t usually cause symptoms—it’s a silent disease. Most people don’t know they have it until they go to their healthcare provider for a routine visit,” says Dr. Pham.

Safe Care Sites

For hypertensive patients, regular blood pressure checks allow your care team to monitor your treatment plan and the effectiveness of your medications. For those whose blood pressure is under control, preventative care is still important.

Sutter Health’s integrated network has convenient care options available to help you stay on top of your health.

In-person: Sutter care sites have implemented safety measures to help reduce the risk of COVID-19 exposure. These include, but are not limited to: extra cleaning, screenings before entry, and mandatory masking.

Online: Sutter care sites also offer convenient access to video visits for those who don’t want to come into an office environment and don’t need direct contact. Video visits allow your doctor to see, hear and talk with you as they would during an in-person visit.

COVID-19 and Wildfire Smoke: Doctor Answers Masking Questions

Posted on Aug 20, 2020 in Alta Bates Summit Medical Center, Safety, Scroll Images

OAKLAND, Calif. –Wildfire season is suddenly upon us and thick smoke from multiple wildfires around Northern California, coupled with hot weather and the COVID-19 pandemic, has led to some confusion about masks: when to wear them and what type is best.

Now Ronn Berrol, M.D., medical director for Alta Bates Summit Medical Center’s emergency department in Oakland, offers tips to help you and your loved ones stay healthy in the Q & A below and in this KTVU interview.

Q: It’s so hot and smoky out! Do I need to wear a mask?

A: Yes! It’s important that everyone who can medically do so continues to wear a mask when they are in public to help reduce the spread of COVID-19. Between the heat, the smoky air and COVID-19, the virus still poses a significant risk.

Q: Does it matter what type of mask I wear? Will a homemade mask protect me or do I need an N95 mask?

A: With respect to COVID-19, for most people it’s probably more important that you wear a mask whenever you are in public than the type of mask you wear. This is because the COVID-19 virus is transmitted to others by droplets that people produce when they exhale—and especially when they cough, laugh, sing or speak loudly. By wearing a mask, you help protect the people around you.

If you have a lung condition such as asthma, emphysema or COPD (Chronic obstructive pulmonary disease), that makes you more susceptible to wildfire smoke, the type of mask you wear becomes more important. This is because tiny particulates and chemicals in the smoke can cause inflammation or difficulty breathing. And homemade cloth masks or surgical masks are not very effective at filtering out harmful particulates and chemicals from the smoky air. To filter out these particulates, an N95 mask is preferred. However, N95 masks can be more difficult to breathe through and lead to more overheating when it’s hot out.* So my advice is to stay indoors, keep doors and windows closed and use air conditioning and an air purifier, if you have them. I also recommend changing your home’s air filter and running the air conditioner in your car on recirculate so you’re not pulling outside air in.

Q: What else can I do to protect myself from the heat and the smoke?

A: It’s always a good idea to keep hydrated –when you are well-hydrated, your body can better respond to infectious challenges and the mucous membranes in your nose and lungs are better able to protect your body from environmental insults like smoke particulates. If you have asthma, emphysema or other respiratory illness, use your maintenance inhalers as directed by your doctor and be sure to carry your rescue inhaler with you if you do have to leave your home. Contact your doctor if you experience symptoms such as asthma, difficulty breathing or chest pain.

Read more about wildfire smoke and its effect on lung health here.

Read more about Sutter’s respiratory care clinics here.

*Important note: Some N95 masks have valves in them that vent exhaled breath without any filtration. Though they may be helpful to filter out wildfire particulates, these vented N95 masks will not provide protection for nearby individuals in the event the wearer has COVID-19.

Air Quality + COVID-19. What Does This Combo Mean for Our Lung Health?

Posted on Aug 20, 2020 in California Pacific Medical Center, Safety, Scroll Images, Wellness

SAN FRANCISCO – Wildfires burning across Northern California coupled with extreme heat and dryness has the air quality in the unhealthy range. All of this is sparking concerns for people with respiratory issues, especially those with COVID-19. Dr. Vinayak Jha, a pulmonologist affiliated with Sutter’s California Pacific Medical Center, says the best way to protect ourselves from the virus and poor air quality is to stay indoors and wear a mask or face covering when outside.

Jha says elderly people, children and individuals with respiratory illnesses are particularly susceptible to elevated air pollution levels. With smoky air blanketing much of the Bay Area and the Sacramento and Central Valley regions, these at-risk populations should take extra precautions to avoid exposure.

Know before you go: View a list of Sutter Health facilities temporarily closed due to the effects of wildfires in Northern California.

Signs Wildfire Smoke May Be Affecting You

Breathing in wildfire smoke can have both immediate and long-term health impacts. In the short term, wildfire smoke can irritate the eyes and airways, causing coughing, a dry scratchy throat and irritated sinuses. Elevated particulate matter in the air can also trigger wheezing in those who suffer from asthma, emphysema or COPD (Chronic obstructive pulmonary disease).

Contact your provider if you experience any of the following symptoms:
• Repeated coughing
• Shortness of breath or difficulty breathing
• Wheezing
• Chest tightness or pain
• Palpitations
• Nausea or unusual fatigue
• Lightheadedness

What happens when a virulent virus is added to the mix? In a recent article by the San Francisco Chronicle, Jha explains that people are already concerned about catching the COVID-19 virus and becoming ill. And the situation becomes more complicated when smoke from wildfires is combined with the unusually high temperatures we’ve experienced in Northern California. This trifecta is not ideal for those with respiratory conditions.

Jha says the early science is revealing. “There are growing reports out of China, Europe and the U.S. that the more air pollution there is, the more COVID deaths and cases there are. There’s some reason for concern that wildfire smoke, besides being bad for people in general, may affect people’s susceptibility to getting the virus, too.”

Recovering from COVID-19? Living with a respiratory illness? Here’s what you should do if wildfire smoke becomes a problem.

As this fire seasons heats up, Jha recommends COVID-19 patients keep in close contact with their health care providers and avoid exerting themselves, especially if they are at the beginning of the illness.

“Continue to socially distance, and continue to wear a mask in public,” says Jha. He encourages people to check the Air Quality Index (here), check their own home air purifying system to make sure the filters are clean, and have a plan in case you need to leave the area.

Pulmonary Care

In the Sutter Health network, pulmonary specialists have deep expertise in treating acute and chronic lung conditions, including asthma, bronchiolitis, emphysema and pneumonia. They offer treatment for interstitial lung disease, advanced COPD, pulmonary nodules and pulmonary hypertension.

In light of COVID-19, Sutter Bay Medical Foundation stood up respiratory care clinics (RCCs) to prepare for increased patient demand. These exam experiences keep potentially contagious people distanced from those that aren’t, while allowing all who need in-person care to receive it.

Read more about Sutter’s respiratory care clinics here.

Sutter Health is committed to your health and safety. If you need care, make an appointment today. Our care teams are ready to serve you, either in person or by Video Visit.

Learn more about getting care during COVID-19 here.

An Immune Boost Toward COVID-19 Vaccines

Posted on Aug 18, 2020 in Affiliates, Innovation, Quality, Research, Scroll Images

Microscopy image of the novel coronavirus, COVID-19

As the COVID-19 pandemic continues to persist worldwide, few features of the human body have figured as prominently on center stage as the immune system.

How does the immune system respond to viruses?
One function of the human immune system is to inhibit viruses, and prevent them from causing illness. The body has two types of immune response to accomplish this function: innate immunity, which starts within hours of an infection, and adaptive immunity, which develops over days and weeks.

A virus causes an illness by infecting cells in the body and taking control of their genetic material. The virus then instructs these infected cells to reproduce the virus’s genetic code and replicate more viral “soldiers” that fight against our immune system.

The body’s adaptive immune response consists of two types of white blood cells—called T and B cells—that can detect “signals” specific to the virus and assemble a targeted response to it.

T cells identify and kill cells infected by a virus. B cells make antibodies—a kind of protein that blocks viral material from entering our cells and prevents the virus from reproducing.

In case the body may need to fight the same virus again, the body stores T and B cells that helped eliminate the original infection. These “memory cells” help provide us with long-term immunity. How long is long-term? Antibodies produced in response to a common, seasonal virus last for approximately one year. But the antibodies generated in response to a measles infection, for example, can provide lifelong protection.

Antibodies, a critical component of the human immune system

The human immune system and vaccines
Vaccines provide immunity, or protection against a disease without causing the illness. They are made using killed or weakened versions—called antigens—of the disease-causing virus. For some vaccines, genetic engineering is used to make the antigens included in the vaccine.

If you’re administered a vaccine to prevent viral infection, your immune system responds to the vaccine in the same way it would if exposed to the actual virus, by: recognizing the proteins and other components of the vaccine as foreign; making antibodies to “attack” the vaccine, as if it were the actual virus, and; remembering the foreign invader and how to destroy it. This response means if you are exposed to the disease-causing virus again, your immune system can intervene before you get sick.

The science on COVID-19 vaccines
Worldwide, scientists are studying more than 165 vaccines against COVID-19. Thirty are being tested in clinical trials in humans, and three of those are in Phase 3 studies.(1) Vaccines typically require years of research and testing before reaching the marketplace or clinic, but scientists are attempting to develop a safe and effective COVID-19 vaccine by next year if not sooner.

Each of the COVID-19 vaccines being tested use a different method to “attack” the virus and engage the immune system to fight infection. But to date, there are a few common approaches being studied in clinical trials:(1, 2)

1. Genetic vaccines use one or more of the COVID-19 virus’s genes to provoke an immune response, using genetic material called messenger RNA (mRNA) or DNA to produce viral proteins in the body.
2. Repurposed vaccines rely on vaccines already being used to protect humans against other diseases (e.g., tuberculosis) that may also be effective in protecting against COVID-19.
3. Viral vector vaccines use a virus to deliver COVID-19 genes into cells and provoke an immune response. These vaccines typically use viruses that infect animals such as chimpanzees or monkeys to act as the “carrier” that prompts an immune response against COVID-19 in humans.
4. Whole-virus vaccines use a weakened or inactivated version of COVID-19 to spark an immune response.
5. Protein-based vaccines use a COVID-19 protein or its pieces to invoke an immune response against the virus.

Sutter Health anticipates studying a COVID-19 vaccine being tested in humans through a Phase 3 clinical trial. Stay tuned for more news next month! Curious about other research at Sutter? Learn more.

References:

  1. World Health Organization. Accessed Aug. 11, 2020.
  2. The race for coronavirus vaccines: a graphical guide. Nature news feature, April 2020.

Caring for a Newborn in a Pandemic

Posted on Aug 17, 2020 in Carousel, Palo Alto Medical Foundation, Pediatric Care, Quality, Safety, Scroll Images, Uncategorized, Women's Services

This article was written by Anita Mantha, M.D., pediatrician with the Palo Alto Medical Foundation for the August 2020 issue of Bay Area Parent magazine. 

Raising a newborn has never been easy. Nighttime feedings, coping with your own body’s recovery and the constant worry that comes with keeping your little bundle of joy safe are all part of being a new parent. In the midst of a pandemic, that job may be even more challenging. In the era of COVID-19, how do we keep our newborn baby safe, while enjoying the beautiful journey ahead?

If a mother is suspected or known to have COVID-19, how do doctors care for the newborn?

This is an evolving topic, as we learn more about this virus. Many hospitals are currently testing pregnant women around the time of their delivery for COVID-19. You can check with your obstetrician and the hospital team to find out if and when this test is being done if you have questions.

If you do test positive, do not panic. Hospitals have policies and procedures in place to help keep you and medical staff protected. While your care team may look a bit different than you imagined – gowns, face shields, masks and gloves – they will still work hard to support you during your delivery.

Once your baby is born, your care team will likely recommend that you wear a mask and practice good hand hygiene. Your baby may also be tested. Your care team will likely discuss additional precautions around topics such as physical distancing and feeding. Please remember not to put face coverings on children less than 2 years of age.

Can I still breastfeed my baby if I have COVID-19?

The benefits of breast-feeding have been long documented. One of the benefits is that breastmilk has antibodies that help protect the body against bacteria and viruses, potentially making it all the more important to breast feed your newborn now. In limited studies, COVID-19 has not been detected in breast milk. However, we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk. 

What we do know is that it’s important to practice good hand and breast hygiene while pumping. Also, consider having a caregiver in good health offer bottles of your milk. If you have tested positive for COVID-19, you and your care team can discuss when and how to nurse your baby directly. 

What are the symptoms of COVID-19 in a newborn?

Newborns can have a wide range of symptoms including fever (defined as a temperature greater than 100.4F), poor feeding, being very tired, coughing, congestion, runny nose and/or breathing difficulties. The tricky part about newborns is that these symptoms can be caused by a variety of things, so it is important to discuss any concerns with your care team. The good news is that most children (including newborns born on time) with COVID-19 are asymptomatic or have mild symptoms. Prior to going home with your newborn, consider having a thermometer at home and being comfortable taking a rectal temperature, which is the most accurate temperature reading in newborns. Having your physician’s advice line number on hand is also important in case questions arise.

Can I let family members visit the baby? How do I keep my newborn safe from COVID-19?

Aside from COVID-19, we recommend caution, especially in the first month of life, to prevent your baby from catching an infection. Your newborn has an immature immune system and is at risk for serious bacterial infections. For these reasons, a fever is considered an emergency, and you should seek care for your child right away if it happens.

Now, more than ever, try to limit visitors in the first month of life. Anyone who visits should practice careful hand hygiene, practice physical distancing and wear a mask as much as possible. Please remember, even in the midst of a pandemic, normal newborn concerns still exist: jaundice, weight checks, etc. Please keep all regularly scheduled newborn care appointments and inform your care team if you or your baby are symptomatic prior to these visits so they can determine next steps.

I know moms can go through “baby blues.” Won’t physical distancing only make this feeling of isolation worse?

With all that is going on, it is natural for new mothers to feel as if they are on an emotional roller coaster. The important thing is, even though you may need to physically distance yourself to keep your newborn safe, you do not need to emotionally distance. Make sure to connect virtually with friends and family as much as possible. Connecting with other parent friends via video or phone calls can be helpful as well. La Leche League (llli.org) also provides great support to new parents.

What can I do to help my postpartum worries?

Make sure to take time for yourself and try to maintain a bit of a routine to help feel more balanced. Try to avoid frequently checking the news or social media, as this can lead to more stress. Consider some time for meditation, spending time outdoors or anything else you find enjoyable. Postpartum blues can turn into something more serious such as postpartum depression or anxiety, so please seek help if you are feeling that your mood is making it difficult to function. There are many resources to help, so do not wait to reach out. As things are constantly changing, please check with your healthcare team for updates on the care of newborns in this challenging time. The CDC also offers helpful information here.

How To Keep Your Kids Safer in the Water

Posted on Aug 10, 2020 in Affiliates, Eden Medical Center, Safety, Scroll Images, Sutter Delta Medical Center, Sutter East Bay Medical Foundation

As parents scramble to find ways to keep their kids active during the pandemic, water safety is even more important

ANTIOCH, Calif. –When the weather’s hot, it’s natural for kids to be drawn to water — a pool, lake, river or ocean. Water is sparkly and refreshing, a place to have fun.

But now more than ever, experts are warning parents and families to be sure to take the right safety precautions around water.

Late summer and early fall raise special concerns in the Bay Area—especially in the inland areas like the Delta and the Tri-Valley, where warm weather is typical as late as October. Because of the pandemic, community centers that once offered supervised swimming pools may be closed. And schools are again providing instruction remotely, so kids are spending more time at home and possibly more time around a swimming pool or taking end-of-summer-vacation trips to rivers, lakes and other natural bodies of water. Add to this that many parents are working from home and may be distracted, and the potential for danger increases.

“Many people think about pools as fun and not necessarily as a hazard, but I always ask parents what steps have you taken to keep your child safe around the pool,’’ said Geri Landman, M.D., a pediatrician based in Berkeley with Sutter East Bay Medical Foundation (SEBMF), part of the Sutter Health integrated network of care.

Drowning is the leading cause of injury-related death for children 1 to 4 years of age, and at least one in five drownings are children ages 14 and younger, according to the Centers for Disease Control.

William Francis, M.D., an emergency room doctor at Sutter Delta Medical Center in Antioch, said he has treated several children for water-related injuries since the pandemic started.

“There’s an explosion of above-ground pools and spas, and part of that is because people start to look at what they can do around their house and there’s a rush to install equipment,” Dr. Francis said. “We have to remember that when a pool is installed – either above ground or in the ground – children need to be supervised 100 percent around water.”

Pediatricians with SEBMF say they counsel parents on safety measures and may also remind them that accidents around pools, even drowning, are a reality.

“Counseling is important during well-child visits and it’s important to remind parents it doesn’t take much for a child to for a child to drown,” said Susan Adham, M.D., an SEBMF pediatrician based in Antioch. “If necessary we remind parents that this continues to happen in our communities. Kids can get into trouble so quickly.”

To help kids stay safer in the water, clinicians at Sutter Health recommend:

  • When young children are in or around water, an adult should be supervising at all times. If adults are in a group, appoint a “water watcher’’ who will pay close attention to the children, and avoid distractions like talking on a cell phone or drinking alcohol.
  • Pam Stoker, a trauma injury prevention specialist at Sutter’s Eden Medical Center in Castro Valley, encourages parents to follow a protocol for active supervision that includes:

    Attention – focusing on your child and nothing else because anything that takes your attention away increases your child’s injury risk.

    Continuity – constantly watching your child. For example, don’t leave your child by the pool to go inside and get a towel.

    Closeness – stay close enough to actually touch your child. If you are out of arm’s reach of your child, your ability to prevent injury goes down significantly. While it is impossible to actively supervise your child 24 hours a day, it is important to do so during activities that are high risk to your child’s safety.
  • Pools should be fenced on all sides with a 4-foot fence that kids cannot climb. The fence should have a gate with a lock that kids can’t reach.
  • When using inflatable or portable pools, remember to empty them immediately after use. Store upside down and out of children’s reach.
    Consider installing a door alarm, a window alarm or both to alert you if a child wanders into the pool area unsupervised.
  • Don’t rely on water wings or noodles as flotation devices. They are fun toys but no substitute for a Coast Guard-approved life jacket. A life jacket is particularly important in natural bodies of water that may be murky because the bright color stands out and is an effective way to locate children.
  • Teach children to swim. They can start swimming lessons as young as 1 year.
  • Learn CPR. Check for resources on first aid training at a local fire department, American Red Cross or American Heart Association.