Frequently Asked Questions

COVID Update 11/18/2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Possibly the Best News Besides the Performance of the Pfizer and Moderna Vaccines

      There are an increasing number of studies suggesting that immunity to COVID after infection may be long lasting for most people. While antibody levels in the blood decrease over time (a normal finding for most infectious diseases) the B and T cell immunity appears to persist. The expectation now is that nearly all persons recovered from COVID will have sufficient immune memory to prevent them from having reinfection bad enough to hospitalize them.

      This is compatible with the finding that the survivors of SARS, the first novel coronavirus in 2002-2003, still have enough immunity to fend off reinfection with the SARS even now, almost 20 years later. The observation that the SARS-CoV-2 virus that causes COVID is typically slow to do harm also gives the immune system time to kick into gear.

      This is all very good news for anybody who has already had COVID and supports the hope that immunity due to vaccination may also be durable.

Thursday’s PCR Test is Not a Green Light to Saturday’s Party

      Everybody is looking for more freedom and many are trying to be safer in their choices. It is a mistake to think that a negative PCR test one day becomes a passport to carefree socialization in the following days. You can get a negative PCR result when you are already infected with COVID if that test is done before the virus multiplies enough to be detected. You can also acquire infection after your test is collected and have a short incubation period with the result that you have enough virus to infect others within 1-3 days.

     Adults ages 18-29 are currently the largest proportion of newly diagnosed COVID in L.A. County followed by adults ages 30-45. To walk our case rates back from the edge of disaster while we wait for vaccines, we must recommit to the basic preventive measures of masking, physical distancing, avoiding gathering with persons outside of our household, staying home when sick and hand washing. As Dr. Ferrer of L.A. County Public Health puts it, “this isn’t like we don’t know what to do, this is about getting back to what works”.

A Promising New Test of Prior COVID Infection and Possibly a Measure of Vaccine Durability

      We know that immunity to COVID is not only a function of antibodies but also the T and B cells of the immune system. It is not ready for commercial release but Adaptive Technologies is working on streamlining a test for measuring T cell receptors that recognize parts of the virus that causes COVID. Looking for these COVID specific T cell receptors may allow us to more accurately identify people who have had prior COVID infection and may also provide a way for vaccine manufacturers to track the durability of T cell response to their vaccines.

Extra Steps to Making Thanksgiving Safer

      In terms of COVID risk, it seems that the timing of Thanksgiving couldn’t be worse. We know that small gatherings are fueling much of the current steep rise in cases.

      Ventilation in your home may be the single largest factor to address to reduce risk. Most houses by design are poorly ventilated – it helps them achieve energy efficiency for summer cooling and winter heating. The air in typical homes changes every one to two hours but the World Health Organization recommends at least 6 air changes per hour to reduce viral spread.

      Be grateful you live in Southern California and throw open multiple windows. That alone can increase the ventilation to as much as 3 air changes per hour. Adding portable air cleaners and turning on stove and bathroom exhaust fans can also help. If possible, move some or all of the meal outside. Run your HVAC system to pull air through that high MERV filter to trap viral aerosols. Think about adding a humidifier to push the indoor humidity up to 40-60% where your nose and upper airways may better resist the virus and viral aerosols may be cleared more quickly.

      The highest value intervention for Thanksgiving is to reduce the number of persons present, and if possible, to include only those persons in your household so that more of us can live to celebrate Thanksgiving after the pandemic. When not eating, masks should be worn; avoid sharing serving utensils and keep your gathering short.

Wednesday Funny

      Adapted from: https://www.pinterest.com/janismeixsell/my-inner-t-rex/

Wednesday Not Funny

      Adapted from: https://twitter.com/Vaccinologist/status/1327708210749448195

Basic Preventive Measures

      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twindemic” by getting a flu shot with choices including:

  • Almost every pharmacy, often free if you have insurance; the lowest cash price we found was under $20 at Costco (and you don’t have to be a member to use the pharmacy)
  • A. County Public Health Clinics this link is contact information from January 2020, call and ask about flu shots/cost
  • Other L.A. free/low-cost vaccination clinics this link is contact information from 2018, primarily for children ≤18 but some can vaccinate adults also, call and ask about flu shots

Quick Links to Resources

Clinic Physician: Ann Walker, MD


COVID Update 11/11/2020

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services (SHS) continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Flu: Protecting Yourself and Others - Join Us!

      Do you have questions about the flu? Have you heard any myths surrounding the flu shot? Please join Student Health Services live on YouTube on Tuesday, November 17th at 12 noon to get answers! All are welcome to participate.      More information can be found through Student Health’s social media (Facebook, Instagram, Twitter, and YouTube): @PCCHealthWell

Thinking Ahead About Thanksgiving

      The U.S. is headed up the steep side of a third wave of COVID cases. For the week ending 11/7, the U.S. is now averaging 102,000 new COVID cases every day. If you have decided to resist giving in to pandemic fatigue, now is the time to think about how you want to approach the winter months and holidays to reduce the risk of infection for yourself, your household, and the community around you.

      Our northern neighbor Canada celebrated Thanksgiving on October 12th. Canada’s cases per 100,000 persons per day had been at or under 1 through July and August and had risen to 3 cases per 100,000 persons per day by the end of September (2 weeks before their Thanksgiving). Currently, at 3 weeks after their Thanksgiving, the rate has nearly tripled again to 8.6 cases per 100,000 persons per day based on World Health Organization data.

      The U.S. is now less than 3 weeks away from its Thanksgiving. The U.S. had 24 cases per 100,000 persons per day as of the week ending 11/7 and the number for L.A. County is 17 cases per 100,000 persons per day. If our experience is similar to our northern neighbor, the U.S. will be looking at 238,000 new COVID cases every day in the week before Christmas and Los Angeles’ share of that will be 5,200 cases per day. If you don’t like the looks of where we are headed, now is the time to double down on masking, distancing, and redirecting any large family gathering you may have hoped to have, into a distanced event that protects you and the people you care about the most.

A Nasal Spray to Prevent COVID While We Wait for a Vaccine?

      There is a preprint article about a nasal spray that prevents COVID in ferrets. Ferrets are used by scientists to study flu, SARS and other respiratory diseases because ferrets can catch viruses through the nose just like humans. The study at Columbia developed a spray containing a lipopeptide – a cholesterol particle attached to a chain of amino acids. In this case, the chain of amino acids matches a stretch of amino acids in the spike protein of the COVID virus. This is a stretch of amino acids that we already know mutates only rarely.

      When the lipopeptide latches onto its matching portion of the spike protein, the virus is no longer able to use the spike protein to fuse to the wall of the cell. Without fusion, the virus cannot inject its RNA into the cell, a necessary step in initiating infection in the cell.

      Ferrets treated with the lipopeptide spray did not become infected with COVID when caged with an infected ferret but the ferrets in the same cage who got the placebo spray did become infected. We still need toxicology and human studies before we will know if this spray could be used to protect people but, the guess is that it can be inexpensively produced as a freeze dried powder which would not need refrigeration. When dispensed, it could be remixed to produce a nasal spray. Low cost and ease of handling/administration would make it a much more feasible option for the world than the expensive monoclonal antibody preventives.

More on Animals and COVID

      We have already discussed that dogs and cats get infected with COVID but so far have not been found to transmit the virus back to humans. Any species that can be infected with COVID and transmit it back to humans could become a reservoir for the virus. If there is a reservoir for the virus, it would provide an opportunity for the virus to mutate with the chance of developing more transmissible or more lethal strains of COVID.

      The mink industry in Denmark is being wiped out as we speak and northern Denmark is on lockdown because transmission from minks to humans has been proven and we also know that the virus has mutated within the mink population (as it does in humans) with one of the variants being less responsive to antibodies.

When the Immune System Goes Astray

      There is more evidence that some patients with COVID end up developing autoantibodies, antibodies that target proteins or genetic material from the patient’s body instead of the virus. This may happen, in part, due to a pre-existing defect in the immunity cells known as “B cells” but an immunologist at the University of Washington in Seattle says that any time you have a combination of inflammation and cell death, there is the potential for autoantibodies and autoimmune disease to emerge.

      The good news is that we already have some tools for modifying autoimmune processes. Only time will tell whether the autoantibodies in COVID survivors represent a temporary or permanent change in the patient’s immune system.

Why Every Day Feels Like Blursday

      Do you find yourself having trouble remembering the day of the week? Does it feel like three years since the lockdown in March? Monotony, chronic stress and isolation are destroying our sense of time.

      In the absence of the familiar holiday celebrations, typical workweek commuting, vacations, and gatherings, the brain has a harder time processing and cataloguing memories. Monotony has the ability to warp time and tangle memories. On top of monotony there is a crushing collection of worries: a killer virus, political chaos, increasing difficulty meeting basic needs for shelter and food, ongoing systemic racism and quickening environmental change to name a few. It leaves many stuck in a lousy present with little sense of (or hope for) the future.

      Isolation itself can distort the shape of days, weeks, and months. When we are isolated, we lack the psychological anchors in time and space that other people provide for us.

      How to respond? With an unknown number of months remaining in which we still need to hide from the virus, we need to focus on creating our own safe seasonal celebrations, our own stress reducing tools, and safe milestone celebrations that can push back against the monotony, crises and isolation of our current life as the calendar pages flip.

Wednesday Funny

Adapted from https://thehoneycombers.com/bali/funny-coronavirus-memes/

Basic Preventive Measures

      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands.       Help avoid a “twindemic” by getting a flu shot. The free flu clinics appear to be done but if you have insurance, it should be free. If you don’t have insurance, the public health and low-cost clinics below may be an option:

 

Quick Links to Resources

Clinic Physician: Ann Walker, MD


11/4/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Leading Story this Week – Get Your Flu Shot! Here Are Some FREE Sites:

More on the Flu and COVID “Twindemic”
      The last thing our strained hospitals need this winter is people sick enough to need care for an illness that could have been prevented or made significantly milder by timely vaccination. If you are thinking maybe you can skip the flu shot because you know that the 2020 flu season in the Southern Hemisphere (their winter is June-August) was so mild, think again. The Southern Hemisphere did have phenomenally low rates of influenza infection for this most recent season but there are several variables to consider. Looking at Australia, they had stronger than usual flu vaccination rates. They also had social distancing in place for COVID prevention (works against both viruses) and have what many describe as onerous restrictions on entering the country. Influenza typically spreads around the globe and within countries based on travel patterns.
      By contrast, only 45% of American adults got a flu shot in 2018-19. Currently accelerating COVID case numbers are evidence of our currently less than sufficient social distancing (locally and nationally) and compared to Australia, we have few travel restrictions internationally and internally.
      If you are still teetering on whether or not to get a flu shot, please contact us through medicalSHS@pasadena.edu and give us an opportunity to try to answer your questions.

Lower Death Rates for COVID Patients – It May Not Last
      It has been a grim year with COVID. Who can forget the refrigerated trucks parked on the streets of NYC as overflow morgues? It is truly good news that the rate of death from COVID has fallen from a high of 25-30% of hospitalized patients in March to 3-7% in the summer even though those lower numbers are still much higher than we see for flu or other respiratory diseases.
      Before we let the good numbers make us complacent, there is NO evidence that the virus is less deadly than it once was. Some of the drop is due to the shift in hospitalizations to younger adults; by the end of August the average patient age was under 40. Some of it is due to heightened community awareness and patients seeking care before they become desperately ill.
      A likely significant factor is we have learned a lot about managing the disease. We know better when to use steroids (initially considered unwise based on early reports from Wuhan, China and Italy), prone positioning and anticoagulants (to avoid COVID induced clotting problems).
      Undoubtedly, backing off on the crushing load of patients during those early months in New York has also helped reduce mortality rates. We have an easier time keeping up with staffing, stamina and equipment when hospitals are not packed to the gills.
      We will lose that last advantage if our case rates continue to increase. The number of hospitalized patients across the country has increased by 40% over the last month. Hospital administrators in Idaho, Utah and Kansas City, Missouri have warned they are already close to capacity. In the words of Tom Inglesby, director of the Center for Health Security at Johns Hopkins University, “if hospitals that aren’t prepared for large numbers of people have to deal with a large influx of COVID patients, or small hospitals get pulled into it, we should expect that mortality could change”. 

Wednesday VisualTessa shows us how to wear a mask!

Adapted from  https://www.yourcentralvalley.com/news/local-news/how-to-wear-a-face-mask-by-tessa-the-fresno-fire-dog/ 

Basic Preventive Measures
      Besides getting a flu shot, these are STILL the tools at your disposal:

  • social distance
  • wear a mask
  • choose outside or increased ventilation
  • isolate/quarantine when indicated
  • wash your hands

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 


 

10/28/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Surfaces + COVID = Wash Your Hands!
In the beginning of the pandemic, packages and mail were put into quarantine and packaged groceries were wiped down with disinfectants. We didn’t know how the COVID virus spread and lab studies were showing that it was still detectable for hours on cardboard and for days on plastic and steel. Those initial studies were not wrong but it appears they did not ask the right question. The fact that you can detect virus on a surface does not tell you whether it can create infection. In lab studies, virus samples are deposited on surfaces within synthetic substances or blood serums specially designed for stability studies. Those surfaces are then maintained in environments that do not necessarily reflect real world conditions. Those surfaces were then sampled over time to see if virus is still detectable. It is not surprising that the virus recovered was still capable of growth in a cell culture, a measure of infectivity. In contrast, more recent studies of samples gathered from highly contaminated surfaces (COVID hospital wards and COVID quarantine hotels) revealed abundant virus by diagnostic testing but no viable culture and reproduction of the virus that was collected.
      There are likely several factors responsible. Lab conditions can be far different from “normal life”. Saliva is normally part of the aerosols and respiratory droplets that can result in virus deposited on surfaces, but saliva also has enzymes designed to denature viruses (one of the challenges of saliva-based testing strategies).
      Low risk is not zero risk and prudence dictates that high touch surfaces merit disinfection. At the same time, it is important to avoid having attention to low risk exposures exhaust your ability to focus on things that matter more. 

The truly simple solution when it comes to COVID and surfaces boils down to frequent handwashing.

New Collaboration
      To address disinformation about COVID, the World Health Organization (WHO) has collaborated with Wikipedia. As one of the world’s 10 most consulted sites with ~175 languages, Wikipedia will have free use of published information, graphics and video from WHO. The staff of 6 people at WHO responsible for digital content management will have the assistance of the 200+ volunteer editors on WikiProject COVID-19 to monitor changes made to WHO information. In time, this collaboration will include live links which will update global case and death numbers on Wikipedia as they are posted by WHO. 

Two Vaccine Trials Restarted
      The FDA lifted the 6-week clinical hold on the U.S. arm of the Oxford/Astra Zeneca phase 3 viral vector vaccine trial. The unofficial account is the FDA did not directly tie the vaccine to 2 cases of transverse myelitis but did advise Astra Zeneca to alert study volunteers about symptoms like weakness and numbness that might be present with a mild case of transverse myelitis.
      Johnson and Johnson had paused its phase 3 viral vector vaccine trial for 11 days to evaluate a “serious medical event” in one trial participant before resuming on 10/23 after determining there was no evidence that the vaccine caused the event. This conclusion was reached without the evaluators knowing whether the participant received the vaccine or the placebo which helps remove bias from the process of evaluating the event.
      In typical vaccine development, none of this information would have been released until after the phase 3 trial was completed. Adverse events are not uncommon in large-scale vaccine trials. In some cases they are caused by the vaccine but usually they are coincidental, simply a matter of chance. 

A More Accurate Measure of Death Due to COVID
      You might think that death due to COVID is easy to count but it is not. Some of what we miss is because of the times and places that testing has not been available. Some are deaths that are not COVID infection but are deaths that would not have occurred without the societal, economic and healthcare changes that are a result of COVID. Consider inability to seek timely care because of fear of infection and loss of healthcare coverage due to COVID related job loss to name two causes.
      When you have historical data for comparison, you can determine if the overall death rate is higher than similar matched time spans, looking for “excess deaths”. The CDC looked at weekly deaths from January 26th to October 3rd in 2020 and compared those numbers to the corresponding weeks for 2015 through 2019. The estimated “excess deaths” for that period in 2020 is 300,000 with ~198,000 directly attributable to COVID and ~100,000 to other causes.
      One of the surprising findings is that the percentage increase in deaths was highest in the 25-44 year olds (26.5%) compared to the 65-74 year olds (24%) and the 45-64 year olds (15%). Not surprisingly, the percentage increase in deaths by racial groups showed many of the same inequities as seen with every other COVID statistic, 54% in Hispanics, 37% in Asians, 33% in Blacks, 29% in Alaskan/Native American and 12% in Whites.

Wednesday Funny

https://imgflip.com/i/4ff91x

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

  


 

10/21/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

App for Estimating COVID Risk of a Single Event
      Brown University Lifespan Center for Digital Health has released an app to estimate the risk of COVID infection for a single event based on variables including geographic location, number of people, setting (indoors vs outdoors), duration, mask compliance etc. In future versions they hope to be able to address the cumulative risk of multiple activities over a stretch of time. The risk scores range from very low (less than 1 in 10 million) to very high (five or more out of 100, roughly the infection risk of caring for a family member with COVID). You can read more about this app and its limitations. The app can be downloaded at https://www.mycovidrisk.app/.

Increased Fear to Combat Pandemic Fatigue?
      Are you looking for extra motivation to re-commit to the basic preventive measures and get your second wind for the marathon that remains to get to the other side of this pandemic? You may need to look no farther than the personal accounts of the growing numbers of post-COVID patients reporting “brain fog”.
      Brain fog (episodic memory loss, confusion, difficulty focusing, struggling for common words) varies widely and includes people who were only mildly physically ill with COVID and had no previous medical conditions. Leading theories are that it arises when the body’s immune response to the virus doesn’t shut down or when there is inflammation of blood vessels in the brain. The episodes may represent persistent immune activation after the initial infection subsides. The scariest part? It’s too early to know how much these symptoms will improve (much less resolve) and how long that improvement/resolution will take.

Another Look at Reinfection with COVID
      So far there have been four published cases of confirmed reinfection with COVID with another twenty cases in the scientific review process. The good news is that these numbers are so small compared to the 40+ million cases worldwide so far. Even better news – only three of those 24 had a more severe course with the second infection compared to their first.
      Between the scarcity of testing early on (at least in the U.S.) and the mild to asymptomatic nature of most second infections found so far, we know that we are not finding all cases of reinfection. On the upside, people with more severe symptoms on a second infection are more likely to present for care and if reinfection were common, we would have found thousands of cases.
      The take home message is to continue masking and distancing even if you have recovered from COVID. There are reasons to believe that vaccine-induced immunity should perform better than natural immunity. 

A Fundamentally Different Trial of Vaccines
      Imperial College of London is preparing to do a human challenge trial to compare the performance of a handful of COVID vaccines though the vaccines have yet to be picked. This approach involves purposefully exposing trial participants to the virus, all of whom have been previously vaccinated with one of the 3 to 4 vaccines being compared. Those participants are held in a medical isolation unit and evaluated for development of disease.

   Some of the upsides of this approach:

  • You select healthy 18-30 year olds whose overall risk of severe disease is lower
  • You can control the dose of virus to which participants are exposed
  • When you see signs of infection you can start remdesivir
  • You get information faster than waiting for “natural” infection

    Some of the downsides of this approach:

  • Studies in young, healthy patients doesn’t reliably translate to outcomes for older persons with preexisting conditions
  • With rapid treatment intervention we will have less information about vaccine efficacy for preventing severe disease
  • Squirting virus in a person’s nose is not the same as how people get infected in the real world and it’s hard to know the importance of that difference
  • Knowing that both unexplained cases of severe illness and also long-term consequences with a yet unknown duration occur in healthy young people demonstrates the risks of this approach

Cold Symptoms? COVID Testing? No Easy Answers
      There is a diversity of opinions regarding COVID testing in people whose symptoms would be quickly attributed to the “common cold” in any year other than the present. Only occasionally will the tip-off symptoms of loss of taste or smell be present. It’s easy to insist on diagnostic testing for those with fever, cough and shortness of breath but how about congestion, headache and sore throat? The article linked above helps illustrate why the answer of when to test is not always straight forward.

Wednesday Funny

Adapted from: https://twitter.com/Tburgeswatson/status/1318259532993355776 

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 

 


10/14/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

Dodging COVID as “Winter” Comes
      We all know crowded enclosed spaces are riskier. Here are some tips if you are indoors more to avoid wildfire smoke or cold and rainy weather or, in our case, those blistering hot and dry Santa Ana winds.
      If a member of your household has confirmed or suspected COVID, Isolation Instructions from L.A. County Public Health will tell you many things to do to reduce the risk of spread to you and other household members.
      Other simple measures include:

  • Wear your mask indoors even if you are more than 6 feet apart from other people (those aerosols can really travel)
  • Opening a window can dramatically increase air exchange rates which can help clear out virus*
  • Passengers in your car? Wear a mask, turn off “recirculate” and crack the windows*
  • Don’t put a sick person in front of a fan with other people downwind
  • Portable, plug-in HEPA air filters chosen to match a room’s size can help
  • HVAC air filters do make a difference; most home systems can handle a MERV 11 filter; go with the MERV 13 if your system can handle the “pressure drop”. Change those filters on schedule – being dirty creates more work for your HVAC. See the blog on secondnature.com for an easy intro to understanding MERV and filter performance for particles sized 0.3 to 10 microns which covers the viral aerosols you want to remove
  • Simple humidifiers may keep your nasal passages moist which may reduce your risk of infection

DON’T USE

  • Exotic air cleaners claiming to use “bipolar ionization” to break down coronavirus; they generate ozone and hydroxyl radicals which are harmful when inhaled
  • Fumigation with bleach or hydrogen peroxide or other chemicals; the concentrations you need to kill coronavirus would also be toxic to people
  • UV light; professionally engineered and installed UV systems help in hospitals but that’s not what you will be getting in portable filters; UV light can burn the skin and damage eyesight

 *Look at the Air Quality Index (AQI) before you open windows, if the AQI is <100, it is probably okay to open up. If the AQI is >150, it may be better to keep windows shut and use other measures to reduce virus; with an AQI 100-150, it depends on medical issues for those breathing the air versus virus risk.

The Aftermath of Severe COVID
      Even after surviving COVID, many patients who were critically ill face long and arduous recoveries. The problems they collect include muscle atrophy, kidney damage, reduced lung capacity, post-intensive care syndrome, fatigue, confusion, peripheral nerve damage from proning, and cognitive/psychological issues to name a few.
      With the estimate of public health experts at Harvard that millions of Americans could require intensive care before the pandemic is over, the number of COVID patients needing rehabilitation could become another public health crisis. And care delayed is care denied; the sooner COVID patients begin pulmonary rehabilitation after leaving the ICU, the faster they improve in mobility, lung capacity and muscle strength and the better their overall recovery.

COVID and the “Long Haulers”
      A long recovery is not limited to COVID patients who had severe disease. The guess is that as many as 10% of people who have had COVID could be classified as “long haulers”, experiencing prolonged symptoms (weeks, months, more?). Many of these people were never “sick enough” to need hospitalization, much less intensive care and ventilation.
      We have more questions than answers but SARS-CoV-2 may trigger long lasting changes in the immune system and perhaps in the autonomic nervous system. Dr. Fauci has noted that the brain fog and fatigue complaints of long haulers are “highly suggestive” of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There are support groups out there for long haulers that in addition to support are trying to spur research. They include “Body Politic COVID-19”, “Long Haul COVID Fighters”, and the “COVID19 Survivor Corps”.

Wednesday Funny

Adapted from a cartoon by Adrienne Hedger, www.hedgerhumor.com 

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:


Quick Links to Resources

Clinic Physician: Ann Walker, MD

 


 

10/7/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry during our business hours.

The Unintended Effects of Compassionate Use on Clinical Trials
      Trump was given Regeneron’s monoclonal antibody treatment for COVID as a result of a compassionate use request. This is not something the general public can expect to get for their COVID illness. In part, there’s not that much monoclonal antibody to go around. The main way to get this treatment at this stage in its development is to qualify for entry into a clinical trial, realizing that you might get the real drug or might get the placebo. In theory, anybody can apply for compassionate use of an investigational drug, and in fact, the 2018 Right to Try law sends those requests directly to the manufacturer and sidesteps the FDA approval that used to be required first.
      There is a downside to broad access to compassionate use. In the spring, the FDA set up a large access program for convalescent plasma and Trump promoted the treatment’s benefits. Since then, researchers have found that they have increasing difficulty enrolling participants in the clinical trials that are needed to assess its efficacy. Perhaps those potential participants didn’t like their 50-50 odds of getting the “real thing” when they can apply for compassionate use.

Failure of a Test-Only Strategy
      Beyond highlighting the limitations of testing as a sole preventive strategy, you need to know that neither the Abbott ID NOW rapid polymerase chain reaction (PCR) test (first used by the White House) nor the Abbott Binax NOW rapid antigen test (that they may currently employ) is being used in compliance with the Emergency Use Authorizations for these tests. BOTH tests are designed to be used with symptomatic people suspected of having COVID in the first 7 days of symptoms, NOT for screening asymptomatic people.
      When it comes to analytic sensitivity, the limit of detection (LoD) of these tests (i.e., the smallest number of copies of a virus in a milliliter of specimen that they can reliably detect) are orders of magnitude higher than the LoD of commonly used PCR diagnostic tests. These commonly used PCR diagnostic tests have a LoD of 100 to 7,000 copies per milliliter. The  Abbott ID NOW rapid PCR test has a LoD of 300,000 copies per milliliter. The Abbott Binax NOW rapid antigen test reports its analytic sensitivity as TCID50 which represents a viral load at which 50% of exposed cells become infected. The guess is that this translates to a LoD of ~1,000,000 copies per milliliter if the number crunching Deaconess Hospital researchers did to translate the Sofia rapid antigen test TCID50 into a LoD can be used with the Binax NOW rapid antigen test.
      The bottom line on all those numbers? You need to have a much higher concentration of virus to be found positive on the rapid tests the White House has been using. Suffice it to say, a person with a negative ID NOW test or negative Binax NOW test can already be (or go on to be later in the day) infectious even if these tests fulfill all their performance characteristics. The false negative rate may be as high as 20-50% based on those LoDs.

Obesity and COVID
      We know obesity is a risk factor for doing poorly with COVID. We know that some of this can be due to the correlation between obesity and other medical problems like high blood pressure and diabetes. We also know that obesity disproportionately affects Blacks and Latinx who are disproportionately subject to a number of other socioeconomic determinants of health such as limited access to medical care, higher representation in low wage jobs with increased exposure to the public, food deserts, crowding and a host of other inequities tied to systemic racism.
      But there also appear to be some more direct effects of obesity on physiology. From a purely mechanical standpoint, you will work harder to breath when there is more weight on your chest. Obesity also seems to increase the risk of clotting and appears to delay the immune system’s initial response and then possibly increases the chance of that response slipping into overdrive. There is also the concern that the ongoing low level of inflammation associated with fatty tissue may reduce the immune system’s ability to generate the long-lived population of “memory” cells for lasting immunity.
      The more pernicious effect of obesity on health is the tendency of healthcare providers to be more dismissive of patients with obesity, more ready to brush off worrisome symptoms as “irrelevant” side effects of their weight.

Our Fur Babies
      We have more data that cats and dogs can be infected with COVID, at least in a laboratory setting. Neither animal is likely to get sick. There is NO evidence that cats and dogs can infect humans although cats do shed the virus and have been demonstrated to infect other cats. Infected dogs do not appear to shed virus.
      On the other hand, there is very strong evidence of multiple, independent mink-to-human transmission events from a mink farm in the Netherlands.

Wednesday Funny

Created by Paul Schantz, CSU Northridge

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD


 

9/29/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.

Part of Why COVID Usually Appears Mild in Children?
      When you are young, most every infectious agent is a new experience and a child’s immune system relies primarily on a flurry of immune activity called an “innate immune response” that is fast and overwhelming. As you age and fewer viruses are new, the “adaptive system” predominates, remembering and fighting familiar threats. It is very good at what it does, but it moves more slowly, so viruses have more time to do damage before the adaptive response gets the upper hand. And it appears that as we age, our ability to mount an innate immune response diminishes.  

The Latest Word on COVID Antibody Prevalence
      Stanford University looked at 28,500 dialysis patients across the U.S. and found that on average ~10% had COVID antibody levels. The New York metro area had values up to 25% and the western U.S. was <5%.
      While dialysis patients may have been motivated to be more careful about exposure, the CDC is due to release their own study this week based on data from commercial labs. Their study also found a ≤10% COVID antibody prevalence nationwide.

Delivery Logistics for the Genetic Vaccines
      Pfizer and Moderna both have messenger RNA vaccines in phase 3 trials. Because genetic vaccines must be shipped and stored frozen, there is a lot to prepare. Moderna’s vaccine only needs negative 20°C which is in the range your home freezer can achieve, the same as other frozen vaccines we already routinely handle. More challenging is the negative 80°C needed for Pfizer’s vaccine.
      FedEx and UPS are stocking up on freezers capable of reaching these temperatures. Pfizer has designed a special box, like a large cooler equipped with GPS enabled thermal sensors, making it possible to know where the boxes are and how cold they are so dry ice can be added as needed (somebody will have to do the babysitting).
      Corning was awarded a contract to quadruple capacity at its plant in New York to produce glass vials capable of withstanding negative 80°C and start a new plant in North Carolina as well. The dry ice needed to keep everything chilly in transport is in short supply, so UPS and FedEx are looking into making their own.
      Of course, those ultra-low temperatures needed by Pfizer’s vaccine probably means it won’t be the go-to vaccine for community clinics and mom-and-pop pharmacies.

J&J Shares its Blueprint
      J&J started its phase 3 trial for its viral vector vaccine on 9/21 and like Moderna, Pfizer and AstraZeneca earlier, they released their clinical protocol.
      Some of the pluses:

  • 60,000 participants (and will include people >60 with certain stable chronic conditions)
  • Likely a one dose vaccine (as opposed to the 2 doses for Pfizer, Moderna and AstraZeneca)
  • It needs refrigeration, not freezing, making distribution easier
  • Based on the adenovirus Ad26, used in 100,000 people without serious side effects for Ebola, HIV, RSV and Zika vaccines
  • Mild and asymptomatic COVID infection are not primary endpoints

      The reasons for caution:

  • First interim analysis at 20 cases of COVID, then weekly re-looks (see last week’s update for why frequent looks is a concern)
  • Their primary endpoint is prevention of moderate to severe/critical COVID but their definition of moderate is a positive PCR plus either shortness of breath or any 2 other symptoms of COVID; this allows for some apparently tame combinations of symptoms to count as moderate disease; What we really want to see is the reduction of severe/critical disease.

Wednesday Funny

Image Adapted from: https://i-am-fert.tumblr.com/post/626373223855112194/halt-traveler

Basic Preventive Measures
      You know the drill: social distance, wear a mask, choose outside or other increased ventilation, isolate/quarantine when indicated and wash your hands. Help avoid a “twin-demic” by getting a flu shot; the free options we know about so far are:

Quick Links to Resources

Clinic Physician: Ann Walker, MD

 


 

9/23/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

     During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.

This week it’s all about the vaccines!

The Quick Recap on Vaccines in the Race
      There are 27 vaccines in phase 1 trials, 15 in phase 2 trials and 9 in phase three trials. Those phase three trials include:

  • 2 with mRNA vaccines – Moderna and BioNTech/Pfizer/Fosun
  • 3 with viral vector vaccines – AstraZeneca/Oxford, Gamaleya Institute and CanSinoBio (though CanSinoBio just made the change from a one-dose to a two-dose trial)
  • 3 are inactivated virus vaccines – Sinovac, SinoPharm/Wuhan and SinoPharm/Beijing
  • 1 is a trial of BCG (an old preventive for Tuberculosis)

A Trust Building Exercise?
       Moderna and BioNTeech/Pfizer/Fosun released roadmaps for how they plan to evaluate the safety and efficacy of the vaccines they have in phase 3 trials, followed by similar information from AstraZeneca/Oxford and there are some potentially important differences. This information is usually released only after trials have been completed but these companies appear to be feeling the need to get out in front of the public concerns over safety in the setting of accelerated development and political pressure.
     All three companies know the total number of COVID infections that must occur in the study population in order to determine with statistical accuracy that their vaccine produces at least a 50% reduction in infections (the goal set by the FDA for emergency approval of a vaccine). The power of studying tens of thousands of people is that it will take only ~150 COVID cases to reach statistical significance and possibly fewer if a vaccine is more effective than 50%. All three companies plan interim analyses of their data: AstraZeneca will do it once at 75 cases, Moderna will do it twice at 53 and 106 cases and Pfizer plans four interim analyses, the first at 32 cases. The norm in vaccine development is one interim analysis. 
     While this atypical transparency by the vaccine manufacturers is appreciated, it raises some questions. Multiple interim analyses of the data increases the odds of finding the appearance of safety and efficacy that might not hold up and can increase the risk of missing rare side effects that could be significant once the vaccine is given to millions of people if the decision is made to stop a trial early based on good interim results. There is also concern that Moderna and Pfizer intend to include relatively mild COVID cases in their case counts. Any vaccine’s efficacy would be more compelling if we knew that it reduced moderate to severe cases. It is important to not let perfect be the enemy of good, but we need to agree on what constitutes “good enough”.

Trust Building from the Government as Well?
      The FDA is reported to be days away from issuing stricter guidelines for emergency authorization of any coronavirus vaccine. Release depends on passing review by the White House Office of Management and Budget but these guidelines may include:

  • A median of 2 months follow-up of participants in late-stage trials after receiving their final dose of vaccine before emergency authorization could be considered
  • Requiring at least 5 cases of severe infection in the placebo group to assess whether vaccination lowers the risk for severe infection
  • More thorough safety follow-up of anyone receiving vaccination under emergency authorization

Waiting for the Other Shoe to Drop
     It doesn’t lessen public concerns about safety that there has been less than full information about the case of “serious neurologic illness” that briefly halted the AstraZeneca phase 3 trial earlier in September. This was the second halt – the first occurring in July when transverse myelitis was diagnosed in a study participant after her first dose of vaccine. Further study of that first case determined that the participant had previously undiagnosed multiple sclerosis as the cause of her transverse myelitis, unrelated to the vaccine, and the trial resumed.
     An anonymous source reported that this second case of “neurologic illness” has also been identified as transverse myelitis and occurred in a participant after her second dose of vaccine. Transverse myelitis can occur on its own but it is rare. Scrutiny will clearly be much more intense if a third neurologic illness develops. The FDA will not resume the US arm of the phase 3 trial without a more complete accounting of the data that led AstraZeneca and the independent data and safety monitoring board in the UK to decide that it was safe to resume.
     It is also disturbing that AstraZeneca did not “promptly” alert the FDA about the pause. Reportedly, the neurologic illness did not become known to the FDA until it was leaked after an AstraZeneca chief executive spoke with investors. If true, this does not build confidence.

Basic Preventive Measures

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT - links for free flu shot clinics we are aware of so far:
    o   City of Pasadena
    o   Huntington Hospital


Quick Links to Resources

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD


9/16/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Case and Testing Numbers for L.A. County
      L.A. County is still in tier 1 (widespread transmission) with the Blueprint update on 9/15/2020 which reflects cases and testing from 8/30-9/5. Our adjusted cases per 100,000 persons is 8.1 which is what keeps us in tier 1 for now. The Blueprint calculation of test positivity is 3.2% for L.A. County and county hospitalization numbers continue to improve. On the downside, the average daily COVID-19 deaths for the most recent week based on L.A. County dashboard numbers is 37, not our worst number but still high.
 
How Bad is That Air?
     COVID-19 has been the front-page story for months now but for the recent days, the destructive, deadly fires, and the air pollution they create have been front and center. There is a lengthy Q&A from the L.A. Times that addresses many issues, among them:

  • If you can see or smell smoke, it is better to stay indoors as much as possible.
  • Consult the Air Quality Management District (AQMD) current air quality index map to see numbers for your area; readings of 150+ mean everybody should avoid outside activities; some weather apps use a different index so be careful which numbers you compare!
  • AirNow.gov lets you put in your zip code and get the most recent air quality readings for your area.
  • While exercising early in the day or near the ocean are usually safer with respect to air quality, that isn’t really true in the current circumstances.
  • If you have window or wall air conditioning units, you want to make sure they have the best possible filter if you are using them at this time; the air in your home is cleaner than the outside and window/wall units draw air from the outside.
  • Don’t have a central air system to help clean your indoor air? There is a DIY answer for that using a box fan and a furnace filter.
  • If you are driving, put your air on recirculate; if your car has a cabin air filter (most cars within the last 10 years do), you can get a HEPA grade replacement filter and most are easy to self-install.
  • If you must be outside, masks of any kind can help but only so much.
  • The air outside isn’t good for pets either; if possible, turn them into indoor pets with short potty breaks and wipe any visible ash off their fur with a damp cloth.

     
      There is evidence that air pollution creates inflammation in the lungs (for everyone) which makes you more susceptible to COVID-19 infection. There is also evidence that after bad fire seasons, flu seasons are significantly worse. We have been pushing people to be outdoors as much as possible to reduce their risk of COVID-19 transmission but that will need to pause until the air quality is better.

Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION (but not with unfiltered outdoor air until the air quality improves)
  • GET YOUR FLU SHOT – more information about free flu shot clinics coming soon!

Quick Links to Resources

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD


 

9/9/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Blueprint for a Safer Economy
     
The new state plan for reopening released on 8/28/2020 had its first numbers update on 9/8/2020. There are a lot of details about how counties can move between tiers, how to count cases and how to adjust those numbers for testing activity. There is also more to be developed for addressing health outcomes and assessing the ability to address the most impacted communities within a county. Follow the link on the Blueprint homepage for “learn more about tier assignments” for these details and a link to current adjusted numbers for counties. The state is using 10,257,557 as L.A. County’s population.

COUNTY RISK LEVEL

Adjusted cases/day/

100,000 persons

# of adjusted new cases for L.A. County/day

% positive

Tier 1 Widespread

Many non-essential indoor businesses closed

>7

>718

>8%

Tier 2 Substantial

Some non-essential indoor businesses closed

4-7

396-718

5-8%

Tier 3 Moderate

Some indoor businesses open with modifications

1-3.9

103-395

2-4.9%

Tier 4 Minimal

Most indoor businesses open with modifications

<1

<103

<2%

COVID-19 and College Towns
      There are 203 counties in the U.S. where college students make up ≥10% of the population. Half of those counties have had their worst weeks of the pandemic since August 1st and half of those have new infections peaking now.
      Makes me wonder about the ~100 counties NOT having their worst weeks since August 1st. Are they all in NY, NJ, Florida, Texas and California which peaked earlier?
 
Buckle your Seat Belts, It Could Be a Bumpy Ride
      We won’t know for ~3+ weeks which direction COVID-19 case counts in L.A. County will go and how far following Labor Day weekend. Did the beastly weather drive more gatherings inside to escape the heat making transmission easier? Was Redondo Beach a one-off or was it the face of Southern California?
      There are lots of factors that will affect where LA County cases are in the next weeks besides the Labor Day weekend but at least our average case count now is about 1,000/day lower than prior to July 4th. Let’s see where we go from here.
 
Vaccine Manufacturers Pledge
     Pfizer, Moderna, Johnson & Johnson, GlaxoSmithKline, AstraZeneca, BioNTech and Sanofi have signed a joint statement that they will not submit vaccine candidates for FDA review until their safety and efficacy is shown in large clinical trials.
 
Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation
     

Wednesday Funny

Image adapted from: https://www.pinterest.com/pin/397161260859093423/
 
Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD


 

9/2/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Welcome back to the Fall term, week 2!
 
      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.
 
General Information on COVID:
      Please see the campus wide email from Bob Blizinski from the morning of 8/28/2020 that describes how employees, students and guests can access an online questionnaire to be cleared to come on campus. For any employees, students or guests who will be on campus for work, class, picking up materials or any other purpose, this self-review should be done before leaving your home.
 
     If you report:

  • A diagnosis of suspected or confirmed COVID within the last 10 days, or
  • Close contact with a confirmed or suspected COVID case in the last 14 days, or
  • Symptoms of fever, chills or sweating, new or worsening cough, sore throat, whole body aches or vomiting/diarrhea, or
  • extreme shortness of breath, blue lips or face, chest pain or discomfort, severe dizziness or lightheadedness (these can be symptoms of COVID requiring emergency evaluation)

you will receive a red stop code from the questionnaire and be advised to get medical advice instead of coming to campus. Otherwise you will receive a green clearance code. Both codes are time-stamped and dated.
 
      Even if you are not planning to come to campus, we encourage all employees and students to do a self-review for COVID symptoms daily.  In addition to the events and symptoms mentioned above, the CDC, L.A. County DPH and PPHD include fatigue, headache, new loss of taste/smell and congestion/runny nose as potential symptoms of COVID.
 
      If you have fever with cough or shortness of breath, you are presumed to have COVID and need medical advice about testing and isolation. If you have any of the other symptoms listed above, or any symptoms that are not on the list that concern you, you need medical advice. If you have been diagnosed with suspected or confirmed COVID or have had close contact (within 6 feet for 15 minutes or more) with a suspected or confirmed COVID case, you need medical advice about when your isolation or quarantine is finished.
 
      For medical advice:

  • Students can contact their medical provider, an Urgent Care, the L.A. County COVID Medi-Nurse line at 877-409-9052 (24/7), or contact us at medicalSHS@pasadena.edu for assistance.
  • Employees can contact their medical provider, an Urgent Care, or the L.A. County COVID Medi-Nurse line at 877-409-9052 (24/7).
     
    COVID Testing Options:
          There are several COVID-19 testing options if you have new symptoms, have been told you are a suspected COVID-19 case or have been told that you had close contact with a suspected or confirmed COVID-19 case. They include but are not limited to:
    • Your medical provider
    • https://covid19.lacounty.gov/testing/ (for free testing sites, walk-up and drive-up by appointment)
    • Carbon Health Urgent Care: https://carbonhealth.com/locations (make appointments online)
      600 E. Colorado Blvd, #120, Pasadena (other locations on their website)
      They have confirmed that they can bill all private insurances (including Kaiser), MediCal and Medicare and can bill the State CARES Act for persons with no insurance resulting in no charges for the patient being evaluated and tested. See https://carbonhealth.com/insurance-pricing (scroll down for pricing). This billing information may be the same at other Urgent Care facilities, but you should ask to confirm.
       
            If you have been told that you need to isolate or quarantine, see the links for L.A. County Public Health Isolation and Quarantine Instructions below. You should continue to isolate or quarantine until you have been told that it is safe to stop by a medical professional. If you need to isolate or quarantine and there is no way to do this in your current living situation, you may be eligible for L.A. County medical housing (call 211).


Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources     

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation
     

Wednesday Funny


Image adapted from: https://boards.bordercollie.org/topic/41700-bc-working-from-home/
 
Warmest Wishes for a Safe and Successful Fall term!
 

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD


8/27/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Welcome back to the Fall term!
 
      During the current campus’ limited access, Student Health Services continues to offer Tele-Health/Triage services to students. Please contact us at medicalSHS@pasadena.edu  or call us at 626-585-7244 (messages only). We will respond to your inquiry in a timely fashion.
 
General Information on COVID:
      We encourage all students to do a self-review of COVID symptoms daily. For any students who will be on campus for class, picking up materials or any other purpose, this self-review should be done before leaving your home. If you have any of these symptoms or answer “yes” to either of the two questions below, you should not come to campus and should seek further evaluation as described below.

  • Fever (≥100F/37.8C) or chills
  • Cough
  • Difficulty breathing
  • Fatigue
  • Muscle pains/aches
  • Headache
  • New loss of taste/smell
  • Sore throat
  • Congestion/runny nose
  • Nausea, vomiting, diarrhea
     

This list comes from the CDC. That page on the CDC also lists the symptoms to prompt emergency care. 

There are two questions you should ask in addition to the self-review of symptoms:

  1. Have you been told that you need to isolate because you have suspected or confirmed COVID-19?
  2. Have you had close contact (within 6 feet for 15 minutes or more) with a person with suspected or confirmed COVID-19 or have you been told that you need to quarantine based on close contact with a suspected or confirmed COVID-19 case?


      If you have fever with cough or shortness of breath you are presumed to have COVID and need medical advice about testing and isolation. If you have any of the other symptoms listed above, or any symptoms that are not on the list that concern you, you need medical advice. If you answer "yes" to either of the questions about isolation and quarantine, you need medical advice about when that isolation or quarantine is finished.
 
      For medical advice, students can contact their medical provider, an Urgent Care, the LA County COVID Medi-Nurse line at 877-409-9052 (24/7), or contact us at medicalSHS@pasadena.edu for assistance.
 
COVID Testing Options:
      There are several COVID-19 testing options if you have new symptoms or have been told you are a suspected COVID-19 case or have been told that you had close contact with a suspected or confirmed COVID-19 case. They include but are not limited to:

  • Your medical provider
  • https://covid19.lacounty.gov/testing/ for free testing sites, walk-up and drive-up by appointment
  • Carbon Health Urgent Care: https://carbonhealth.com/locations (make appointments online)
    600 E. Colorado Blvd, #120, Pasadena (other locations on their website)
    They have confirmed that they can bill all private insurances (including Kaiser), MediCal and Medicare and can bill the State CARES Act for persons with no insurance resulting in no charges for the patient being evaluated and tested. See https://carbonhealth.com/insurance-pricing (scroll down for pricing). This billing information may be the same at other Urgent Care facilities, but you should ask to confirm.

 
      If you have been told that you need to isolate or quarantine, see the links for LA County Public Health Isolation and Quarantine Instructions below. You should continue to isolate or quarantine until you have been told that it is safe to stop by a medical professional. If you need to isolate or quarantine and there is no way to do this in your current living situation you may be eligible for LA county medical housing (call 211). 
 
Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)

Quick Links to Resources   

  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

Warmest Wishes for a Safe and Successful Fall term!

Director of Student Health Services: Quinn Tang, DHSc., DACM, PA-C
Clinic Physician: Ann Walker, MD


8/19/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Encouraging Evidence Suggesting Lasting Immunity After COVID-19 Infection
     
Protection against reinfection cannot be fully confirmed until there is proof that people who encounter SARS-CoV-2 a second time are able to fight it off. The good news is that we now have more evidence that the memory T and memory B cells essential for durable immunity are produced by persons who have had COVID-19 and even in those with mild to asymptomatic cases.
 
Smoking Gun for Aerosol Transmission of SARS-CoV-2
      A University of Florida research team succeeded in isolating culturable live virus from the air in a room for 2 patients in a ward dedicated to COVID-19 cases. Neither patient in the room had been subject to any medical procedures known to produce high levels of aerosols. The volume of virus collected was small but knowing that it was collected at 7 and 16 feet away from the patients and in a room with all the engineering enhancements to eliminate the virus (6 air changes/hour, efficient filters, UV irradiation and more) makes an even stronger case for “keep your mask on indoors”
 even if you are more than 6 feet away from others who are not part of your household.
 
A Breakthrough in PCR Testing?
   
   Yale University was given an EUA for their SalivaDirect test that was developed in part with funding from the NBA and the NBA Players Association. They recognized that SARS-CoV-2 in saliva did not require preservatives or specialized collection tubes and that processing the specimens with a simple proteinase and heat treatment eliminated the need for more expensive and time-consuming nucleic acid extraction techniques. Plus using saliva meant no more uncomfortable nasopharyngeal swabs. So SalivaDirect offers cheap and easy specimen collection and preparation but you still have to pay for it to go through the polymerase chain reaction (PCR) testing process.
 
Could the Answer be in the Sewer?
     
How much COVID-19 does a community have? If you are trying to answer this by testing individuals, you need to test a lot of people – asymptomatic as well as symptomatic – and you may want information from multiple points in time to track the rise and fall of the virus.
      Sewage Chemical Information Mining (SCIM) is a technology that is already used to estimate community levels of opiate use, tobacco and pesticide exposure. Looking at levels of SARS-CoV-2 in the “sewersheds” of communities may be another way to track prevalence of disease.


Basic Preventive Measures are Still the Tools You Have to Make a Difference

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK
  • ISOLATE/QUARANTINE WHEN INDICATED
  • CHOOSE GREAT VENTILATION
  • GET YOUR FLU SHOT (MANY PHARMACIES HAVE IT NOW)


Quick Links to Resources

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up testing sites, all by appointment: https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
               ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
               ph.lacounty.gov/covidisolation

 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


 

8/12/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Rate of Asymptomatic Infection
     
In another large study from South Korea, there is more data to suggest that persistently asymptomatic COVID-19 infections may be more common than we originally thought. There were 303 people isolated at a community treatment center after testing positive for SARS-CoV-2 by PCR. Of those people, 110 were asymptomatic on admission and 89 of that 110 (29% of the 303) continued to be asymptomatic throughout their stay. All persons had multiple PCR tests and were not released until they had a negative test. There was also no significant difference in the viral load of the symptomatic and asymptomatic persons (as evidenced by equivalent cycle thresholds for PCR tests).
      Since asymptomatic people are not coughing and sneezing, you can hope that they might infect others less frequently. The flip side is that because they don’t feel ill, they will continue their usual activities, producing respiratory droplets and aerosol particles with breathing and talking that can transmit SARS-CoV-2. This reinforces the need to wear your mask, social distance and wash your hands no matter how normal you or the people around you feel.
 
 
Indirect Evidence that Masks Reduce Viral Dose Which May Reduce Severity of Illness
     
We know from previous studies of influenza virus that even simple masks can reduce the dose of virus inhaled and that the dose of influenza virus exposure makes a difference in severity of illness. Nobody would agree to do the same dose-of-exposure trials for SARS-CoV-2 virus in people but there are animal studies and indirect evidence that masks reduce infection rates and that lower exposures may result in milder disease.
      Regarding milder disease as a result of lower exposure, of the 634 persons on the Diamond Princess cruise ship in February with a positive PCR test, 80% were symptomatic whereas of the 128 PCR positive passengers on an Argentinian cruise in March, only 20% were symptomatic. The passengers of both cruise ships were quarantined in their cabins when illness was recognized but the Argentinian passengers were also given masks to wear after the first person became feverish. With what we know now, no one could in good conscience do a randomized trial of mask versus no mask.
 
 
When the News is About How the Numbers are Reported, You Know that Isn’t Good
    
  Nobody wanted to hear last week that there were an unknown number of COVID test results in the California Reportable Disease Information Exchange (CalREDIE) that haven’t been reported due to a computer “glitch” of unknown duration. Labs processing tests send reports to the state and then the state sends numbers to the counties. Dr. Mark Ghaly, California’s Health and Human Services director was quoted on 8/10/2020 saying the glitch involved 250,000 to 300,000 test results and that the problems are fixed, and the backlogged data has been shared with county health officials. But when you look at the L.A. County COVID dashboard on 8/11, they say they are still waiting to hear about backlogged results. Apparently the CalREDIE runs on technology that was as antiquated as the systems used in the DMV and Employment Development Department.  
 
 
What We CAN Say About the L.A. County Numbers
     
We won’t know until later how many of those backlogged tests are cases in L.A. County but at least the numbers we DO have are showing slow improvement with daily average new cases of 2,364 for 8/5-8/11. Sadly, our case positivity rate for 8/5-8/11 is still a depressing 11.3%. The percentage change in hospitalization and ICU numbers for L.A. County and the state are definitely improving (at low and near double digit rates over the past week) and the numbers of hospitals reporting that data has almost stabilized after reporting was switched from the CDC to the federal Health and Human Services Department in mid-July.
 
What We All Want to Be Able to Say

Image adapted from: https://makeameme.org/meme/goodnight-moon-goodnight-9a0861b903

Basic Preventive Measures
     
In an article about how the U.S. has gotten to where it is with COVID-19, Dr. Thomas R. Frieden who ran the New York City Health Department and the CDC. for a combined 15 years observed, “This isn’t actually rocket science, we know what to do, and we’re not doing it.” The things we know we can do include:
        WASH YOUR HANDS                              MAINTAIN SOCIAL DISTANCING

 
             WEAR A CLOTH FACE MASK                   ISOLATE/QUARANTINE WHEN INDICATED
 
                      CHOOSE GREAT VENTILATION                GET YOUR FLU SHOT
 
 
Quick Links to Resources

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up   testing sites, all by appointment: https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
         ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
         ph.lacounty.gov/covidisolation


 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


 

8/5/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Faster, Cheaper Testing
     
We know that PCR testing has been the diagnostic test of choice and we know that nasopharyngeal specimens have been the specimen of choice. We know that the limit of detection (which translates to sensitivity) of PCR tests can vary a lot. We have known for months that people do not like the collection process for nasopharyngeal specimens. We continue to be painfully aware of the challenge of keeping up with the supply of swabs, reagents and PPE for collecting and running these tests and the overall cost of PCR testing. And everybody knows that days spent waiting for results invariably results in increased transmission unless people are willing and able to fully isolate.
     
Columbia University is working on a saliva-based test that can produce results in 30 minutes that has a sensitivity and specificity comparable to good PCR tests using a modification of the loop-mediated isothermal amplification process (LAMP) that doesn’t require special equipment. A test like this could be inexpensive enough to do every day to identify people (many of them asymptomatic) who need to isolate. Let’s hope it moves from pre-print to reality soon.
 
Children and COVID
     
There is some preliminary evidence that children under 5 may have up to 100 times the viral load of adults. It was only a small study and detecting virus by PCR is not the same as proving that it can infect others (something this study was not designed to address) but along with the South Korea study documenting transmission in children, it will move the needle of opinion about COVID and children.
      In the category of better to learn from the experience of others, an overnight summer camp in Georgia opened up on 6/21/2020 with 363 campers and 261 staff. Everybody had a negative coronavirus test no more than 12 days before arriving at camp and there was enhanced cleaning, physical distancing outside of cabins, staggered use of communal spaces and staff were required to wear cloth face coverings when with campers. The campers were not required to wear masks (this was Georgia), windows and doors were not opened in buildings to increase ventilation and, as usual, the camp experience included a lot of loud singing and cheering. One teen staffer left sick on 6/23/2020 and had a positive COVID test on 6/24/2020, some campers were sent home sick by 6/24/2020 and the camp was closed on 6/27/2020. Results of COVID testing were available for only 344 out of the total of 624 campers and staff but 76% of those tests were positive.
 
A Peek at Colleges and Universities
      The New York Times has launched an attempt to gather outbreak information from colleges and universities, something that has not been presented as separate data on county/state/federal dashboards. They have started small (public 4-year plus private 4-year schools either in Division 1 sports or a member of the Association of American Universities). They hope to expand the data base over time and include other 4-year and 2-year colleges. The data shows 6,600 COVID cases linked to U.S. colleges (before fall classes). Perhaps most disturbing is how many of the colleges contacted so far said that they were either not tracking COVID cases or declined to share aggregate, anonymized data. You can see a list of the schools that provided case information that plan to have fall classes “primarily or fully in-person” includes 7 colleges reporting 50 cases or more.
 
Basic Preventive Measures We All Still Need
     
WASH YOUR HANDS                              MAINTAIN SOCIAL DISTANCING

 
          WEAR A CLOTH FACE MASK                   ISOLATE/QUARANTINE WHEN INDICATED
 
                        CHOOSE GREAT VENTILATION                GET YOUR FLU SHOT
 
 
Quick Links to Resources  

  • If you have had close contact with a suspected/confirmed case of COVID-19 or are having symptoms of COVID-19:
    o   Check with your healthcare provider about testing
    o   If you don’t have insurance, use this interactive map to find drive-up and walk-up testing sites, all by appointment - https://covid19.lacounty.gov/testing/
  • If you are looking for a test because you had close contact with a suspected/confirmed case or because you have symptoms, you need to quarantine/isolate. L.A. County updated their isolation instructions on 7/27/2020 – use the link to get up-to-date instructions:
    o   Short URL for home quarantine instructions webpage with multiple languages:
              ph.lacounty.gov/covidquarantine
    o   Short URL for home isolation instructions webpage with multiple languages:
              ph.lacounty.gov/covidisolation

 
 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD
   


 

7/29/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Waning Antibodies After COVID-19 Do Not Necessarily Mean Risk of Re-infection
     
Don’t let the King’s College of London report of quickly waning COVID-19 antibodies convince you we are doomed. There’s more to immunity than antibody levels alone. We haven’t been measuring the T helper, T killer, memory T and memory B cells that are potent factors in on-going immune response.
      What about those reports of people diagnosed with COVID-19 seeming to recover only to later develop new symptoms and a positive PCR test? They appear to be anecdotes without confirmation of reinfection, as evidenced by the lack of recoverable live virus or transmission to others.
    
When We Get a Vaccine, Who Gets it First – Part 2
     
In the 7/15/2020 COVID-19 Update we discussed the demographic factors being considered in how to equitably distribute the initially limited supply of vaccine.
      We are getting a trial run of achieving equity in the distribution of a scarce commodity with remdesivir which has been identified as a promising treatment for COVID-19. Its supply is far outstripped by the number of COVID-19 patients that might benefit from its use. The University of Pittsburgh developed a weighted lottery to prevent haphazard and inequitable distribution of their limited supply of remdesivir. They added weight for patients from disadvantaged communities and for essential workers and subtracted weight for patients expected to die within a year from a chronic end stage condition. Because allocation of the drug within the subgroups identified by the weighted factors is randomized, it becomes possible to follow that subgroup as a randomized controlled clinical trial and make measurable assessments of the benefit of remdesivir for that subgroup, something that was not possible in the prior clinical trial of remdesivir.
 
We’ll Take Improvement Where We Can Get It But Will We Be Able to Keep It?
     
The numbers in L.A. County were better this past week in that the average number of new cases per day is 2,467/day compared to 3,108/day in the preceding week. Unfortunately, some of this drop in cases may be related to a concurrent drop in testing. With 116,000 tests in the past 7 days (a 30% drop from the ~170,000 tests per week in the two weeks prior) the percent positive rate is 14.9%. You want that number well below 8% and closer to 3% if you are trying to flatten and then bend the curve of COVID-19 infection. The hospitalization data for L.A. County appears to be improved, though with the changes made in reporting, there is data missing on both the county and state level.
 
Basic Preventive Measures
    The fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING – as many as half the people who can “give” you COVID-19 won’t look sick
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge that is form fitting under the chin
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case
  • CHOOSE THE OUTDOORS OR ROOMS WITH GREAT VENTILATION in addition to social distancing and masks when with people outside of your household
  • GET YOUR 2020-21 INFLUENZA VACCINE when it becomes available later this summer

Quick Links to Resources

 
 
Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


7/15/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

An Update on the Vaccine Race
           
There are  4 vaccines that have started phase 3 (efficacy) trials: the viral vector vaccine from Astra Zeneca, the killed virus vaccines from Sinopharm and Sinovac, and the “repurposed” BCG vaccine being studied by Murdoch Children’s Research Institute. Moderna is still expected to get phase 3 trials of its messenger RNA vaccine going in July.
 
When a Vaccine is Available, Who Gets it First?
           
It will take time to make enough vaccine for everybody who needs it. Normally the CDC makes recommendations about the use of a new vaccine and state/local public health decide whether to follow those recommendations. The Advisory Committee on Immunization Practices (ACIP) routinely advises the CDC regarding implementation of new vaccines. ACIP has started discussing how underlying conditions, living environments, occupational risks, ethnicity and race should be weighed in allocating the initially limited supply of vaccine. They anticipate public meetings later this summer and involving communities being considered in its deliberations.
 
If We Have a Vaccine, Will People Accept It?
           
All the talk of accelerating vaccine production along with societal wrangling over COVID-19 is likely to make many people less confident in choosing to accept a vaccine when it is available. The BIPOC (Black, Indigenous and Persons of Color) communities have experiences that support distrust of American government, society, healthcare and medical research. Dr. Phoebe Danziger, a pediatrician at University of Michigan summarizes it well in saying “sufficiently widespread vaccination will be possible only if the values and goals of a vaccine program are discussed explicitly, transparently and early, and if that discussion includes the full range of voices that have been telling us for years that trust in the American institutions and systems responsible for vaccines is broken”.
 
Who Will Be in those Phase 3 Trials?
            The communities at increased risk of infection and death from COVID-19 will need to see their communities reflected in all phases of vaccine trials to help address the questions of safety and efficacy for their communities. The COVID-19 Prevention Network (CoVPN) is a merger of four existing NIAID (National Institute of Allergy and Infectious Disease) funded clinical trials networks to leverage existing infrastructure and engage communities to secure the thousands of volunteers needed for late-stage clinical trials of promising vaccines. “Centralizing our clinical research efforts into a single trials network will expand the resources and expertise needed to efficiently identify safe and effective vaccines and other prevention strategies against COVID-19” (Dr. Fauci). People interested in participating in vaccine trials can get more information at www.coronaviruspreventionnetwork.org.
            Human challenge trials deliberately expose participants to infection, in order to study diseases and test vaccines or treatments. www.1daysooner.org is recruiting volunteers for COVID vaccine challenge trials. Before you dismiss this approach, you should look at the estimate of benefits and risks presented on this web site.
 
Basic Preventive Measures
The fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case
  • Let’s add CHOOSE THE OUTDOORS OR ROOMS WITH GREAT VENTILATION when with people outside of your household
  • And don’t forget to GET YOUR 2020-21 INFLUENZA VACCINE when it becomes available later this summer

  
Quick Links to Resources

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 


 

7/8/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Watch Out for Methanol-Based Hand Sanitizers
Los Angeles Health Alert Network passed along advice from the CDC to avoid using methanol-based hand sanitizers, some of which is manufactured by “EskbiochemSA de CV”. While methanol most frequently causes death and blindness by swallowing it, repeated application to the skin also appears to be dangerous. The signs and symptoms of methanol poisoning include headache, blurred vision, blindness, nausea, vomiting, abdominal pain, loss of coordination and decreased alertness. There is a list of products that have been recalled.
 
Thinking About Air Travel?
If you are thinking about flying inside the U.S., be aware that many states have travel restrictions in place requiring a 14 day quarantine for not only international travelers but also domestic travelers. If you have your heart set on a trip to Europe, you should think twice. The U.S. State Department advises U.S. citizens to avoid all international travel and as of July 1, residents of the U.S. are not on the list of persons allowed to enter the European Union unless they qualify for an exemption.
 
Home Testing for COVID-19?
What if testing for COVID-19 was easy like a home pregnancy test AND cheap? With cost estimates of $1-$5 per test, there is a clear financial incentive. The devil, as always, is in the details. These rapid antigen tests (both home and outpatient office) detect proteins of the SARS-CoV-2 virus with results in approximately 15 minutes. They are less sensitive than the molecular polymerase chain reaction (PCR) diagnostic tests so a negative rapid test in a person with symptoms should be followed by a PCR test. For a cautionary review of these tests, read what the Association of Public Health Laboratories has to say.
 
Weighing the Risks of an Activity?
You are trying to make good decisions, trying to weigh the risks and benefits of your actions. But what you need to know is that the deck is stacked against you when it comes to evaluating your personal risk. Knowing more about optimism bias, confirmation bias, exposure therapy and the confusion created by high levels of public disagreement may help you keep things in perspective.
 
Wednesday Comic
 
Image adapted from: https://www.stairwaytoevan.com/drawing-1
 
 
Basic Preventive Measures
Boiling it down to the fundamentals:

  • WASH YOUR HANDS
  • MAINTAIN SOCIAL DISTANCING
  • WEAR A CLOTH FACE MASK when out in public; if you physically can’t wear a mask, wear a face shield preferably with a drape along the bottom edge
  • ISOLATE if you have confirmed or suspected COVID, QUARANTINE if you have had close contact with a known or suspected COVID case


Quick Links to Resources

  • Interactive map showing 63 drive-up and 29 walk-up testing sites, all by appointment; if you are looking for a test because you had a risky exposure or because you have symptoms, you need to quarantine/isolate until you have your results:

          o   https://covid19.lacounty.gov/testing/

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


7/1/2020 Coronavirus Update


Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

The “Read’em and Weep” Numbers and Words
          L.A. County averaged 2,211 new cases per day over the past 7 days; that number was 1,281 for the period of 6/3-6/9 and 799 for the period of 5/6-5/12.
          The percentage of tests done over the past week that were positive was 12.1%; you want to see 8-10% if you are trying to “flatten” the curve (mitigation) and ≤3% if you are hoping to bend the curve back to zero (suppression).
          In the past 7 days there was a 19% increase in suspected and confirmed COVID hospitalizations and an 8% increase in suspected and confirmed COVID ICU patients compared to the preceding week.
          The only California County Variance Criteria L.A. County is meeting in the past 7 days is in numbers of tests per 1,000 persons per day but before you start feeling too good about that, I recommend you read an article about the total number of tests California needs to be doing based on current infection rates to flatten (mitigation) or bend (suppression) the curve of COVID cases according to Harvard Global Health. When you are done with that one, read the one from The Atlantic about how the U.S. is once again outstripping its testing supply just when surging cases mean that testing really needs to increase dramatically further.
 
Isolation and Quarantine, When Do They End?
          Last week we referred you to the L.A. County Department of Public Health instructions for Isolation and Quarantine. Follow this week’s links to see that you can choose from 13 languages for a pdf version.
          The second page of the Isolation Instructions has boxed information for when your isolation period ends.
          Defining the end of quarantine is more nuanced. If you have a positive nasal or oral swab test OR if you develop symptoms compatible with COVID-19 during your quarantine, you switch to the isolation instructions. The quarantine instructions cover five different scenarios for calculating an end to quarantine (at the end of the document). If you are still uncertain about when your isolation or quarantine can end, ask your local Public Health Department.
          At the current rate of new cases, more of us will likely end up in isolation or quarantine and knowing how to do it correctly (and quickly) will be the only way for our community to emerge from the hole we are digging.
 
Some of the Story Behind “Toilet Plume” and Fecal SARS-CoV-2
          People studying infectious disease have known about “toilet plume” at least since 1950. A review article from 2012 tells how toilets create an eruption of bioaerosols with flushing that can remain suspended in air for hours and how subsequent flushing continues to produce the same bioaerosols even if no further bacteria has been added. It won’t make you feel better when they tell you that “the most significant toilet plume airborne infections are likely to be due to viruses”. When you follow the lead to read about the SARS outbreak in the Amoy Gardens apartment complex in Hong Kong in 2003 (if nothing else, read the discussion at the end), you will realize that you want to know more about the SARS-CoV-2 virus that has been detected in the stool of some COVID-19 patients.
           The best review of the potential for fecal transmission of SARS-CoV-2 that we found reminds us that it is only a subset of COVID-19 patients who have had virus detected in their feces. Detecting the SARS-CoV-2 virus in feces is not the same thing as documenting the ability to infect other people. The 14 studies summarized are hampered by varying combinations of small numbers, methodology and short follow-up. There were only three reports of virus that could be grown among these 14 studies.
          Before you vow to never use another shared restroom, the overwhelming evidence is that respiratory droplets are the primary route of transmission for SARS-CoV-2; that delightful group meal in a restaurant or that drink in a bar with three of your closest friends is hands down the easiest way for you to get COVID-19. Still, this review prompts us to push for:

  • Wear your cloth face mask when using shared restrooms, it doesn’t stop everything but it is definitely better than nothing.
  • Continue aggressive public health messaging about hand washing.
  • Frequent cleaning for touch surfaces in shared restrooms.
  • Great ventilation in shared restrooms.
  • Lids for our toilets and the presence of mind to close them prior to flushing.
  • If there is a drain in a restroom floor, make sure the water trap has water in it.
  • A lot more data about how long and in whom infectious virus appears in the stool to make the necessary recommendations about the use of shared restrooms.
     

Basic Preventive Measures
Amazingly, these are still the tools you can use to protect yourself and others:

  • WASH YOUR HANDS; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you or they are sick; disinfect high touch surfaces frequently; MAINTAIN SOCIAL DISTANCING.
  • WEAR A CLOTH FACE MASK when out in public until the CDC, state and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine. 


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD
 

 

 


 

6/25/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Update on Testing to Diagnose COVID-19 in L.A. County
          To diagnose COVID-19 based on test results, you need a Polymerase Chain Reaction (PCR) test done on a nasal or oral swab specimen. The preferred approach to diagnostic testing is to get it done through your insurance/primary care provider so that you are already hooked up with someone to help you interpret the results and advise you on next steps. If you cannot contact your provider or do not have health insurance, there are ~98 sites for testing in L.A. County that you may be able to use. Some of these (22) are operated by L.A. City and County, some are OptumServe sites set up by the state (8), some are associated with Project Baseline, a project of Verily (3) and some are part of the growing list of CVS pharmacies, various community health centers and city level testing (e.g. Baldwin Park, Carson, etc.) and other providers (65 sites).
          All of these sites offer free testing to persons who meet the criteria for testing. If you have insurance, these sites will collect information to bill your insurance to collect reimbursement with no co-pay or deductible costs for you. If you do not have insurance, the state will be billed for the test and you will not have any expenses. Some of these sites are drive-up only, some walk-up only and some do both. All of these sites do testing by appointment only. If you are using the interactive map to find testing sites, there are test site addresses, phone numbers and links for making an appointment.
          Have family in California outside of L.A. County? There is a state level interactive map that includes OptumServe sites, Verily sites and a long list of community sites.

Information You Need if You Have Been Tested or Are Considering Testing
          If you are doing PCR testing because you have had symptoms (fever, cough, shortness of breath, chills, muscle pain, headache, sore throat or new loss of taste or smell), you should follow L.A. County Isolation Instructions while you arrange for testing and wait for results.  If you are doing testing because you were told you had close contact (within 6 feet for 15+ minutes) with a person with confirmed or suspected COVID-19, you should start following the  L.A. County Quarantine Instructions at the time you are told that you are a close contact.
          These instructions include information about when your isolation or quarantine can end. If you are on quarantine, a negative PCR diagnostic test does NOT mean that your quarantine can end sooner. Too much is still unknown about antibody testing for it to modify isolation or quarantine instructions.

The Word on Masks From the California Department of Public Health
          If you missed it, the California Department of Public Health published statewide guidance for the use of face coverings on 6/18/2020. That guidance calls for cloth face coverings anytime you are away from your home unless you are outside and can count on being able to stay more than 6 feet away from other people who are not part of your household. Notice that if you are unable to wear a cloth face covering due to a medical condition and your job puts you in regular contact with other people, you should wear a face shield with a drape on the bottom edge if physically able. 


Basic Preventive Measures

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC, state and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD

 

 


 

6/17/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Review of Vaccine Development for COVID-19
          The race has been on since January to develop vaccine(s) for COVID-19. Ideally, there will be multiple successful vaccines to make widespread production easier and to hedge our bets when it comes to the ongoing safety and efficacy. As of early April, there were at least 60 vaccine candidates being developed around the world and that number is probably closer to 120 now. There are five vaccine candidates currently being expedited with financial support from the U.S. being developed by Moderna, Oxford/Astra Zeneca, Janssen (J&J), Sanofi and Merck.

    There are basically four different categories of vaccines.

  • Whole virus vaccines to stimulate the immune system to produce antibodies to attack live versions of the virus in the future, with either a killed or a live attenuated virus.
  • Protein-based vaccines to produce antibodies in the same way that whole virus vaccines do but only require introducing a protein, not the entire virus. Sanofi is developing a recombinant protein vaccine.
  • Viral vector vaccines use a virus that enters cells easily to deliver a gene to produce a COVID-19 protein (usually the spike protein) to illicit an immune response; the vector virus is either harmless or has had its genes modified to eliminate its multiplication inside the cell. Oxford/Astra Zeneca, Janssen (J&J) and Merck are developing viral vector vaccines.
  • Genetic vaccines deliver DNA or messenger RNA (mRNA) to produce a COVID-19 protein to illicit an immune response without the use of a vector virus. Moderna and Sanofi are developing mRNA vaccines.

       Each of these four types of vaccines have their own strengths and weaknesses. A significant caution with genetic vaccines is the fact that this is a totally new method of vaccine production without a history of prior use to illuminate pitfalls.

       Vaccines go through several phases of development. They all have a preclinical phase that ends with animal trials and leads to the clinical trials:

  • Phase 1 – Small scale human trials to assess safety and dosage of the vaccine relative to immune response.
  • Phase 2 – Larger human trials to assess efficacy and side effects.
  • Phase 3 – Human trials with hundreds to thousands of persons across multiple sites to evaluate the efficacy under natural disease conditions.
  • Phase 4 – After a vaccine is licensed and introduced, on-going surveillance is done to look for rare side effects and assess long term efficacy.

        The usual timeline for development of a new vaccine is 4+ years minimum. Multiple steps are being taken to attempt to compress this timeline. We know from previous SARS, dengue and HIV vaccine trials that rarely, viral vector vaccines can trigger antibody-dependent enhancement, which makes recipients more susceptible to infection rather than less. You can try to speed up the vaccine research with “challenge trials”. Normally, it is unethical to challenge someone with a disease for which there is no cure (as with COVID-19) but the counter argument is that a challenge trial may be more ethical than leaving large populations vulnerable for a longer time.

        Mass production of successful vaccines is the next bottleneck. American vaccine plants typically produce 5 to 10 million doses of routine vaccines per year. For SARS-CoV-2, the U.S. may need 300 to 600 million doses of vaccine, syringes, alcohol wipes, glass vaccine vials, etc. The U.S. is attempting to build the manufacturing capacity in parallel to the vaccine development and to put the Defense Department in charge of logistics. When the vaccine is available, the only ethical choice is to make it available to all regardless of insurance or ability to pay.

Dose of Exposure Matters
          The number of viral particles in an exposure appears to be key in the likelihood of successful transmission of COVID-19. While large respiratory droplets fall to the ground quickly, the much smaller aerosol particles created with breathing, speech and coughing remain airborne longer and have been shown to contain viral particles which can remain viable and infectious. We don’t yet know how many viral particles are required for infection, but the SARS-CoV-2 virus is similar to the SARS virus for which the estimated infective dose is just a few hundred particles. Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow, and timing. Increasing ventilation reduces risk and while surgical masks are only ~30% effective at reducing aerosol particles inhaled by the mask wearer, they are much better at reducing the aerosols generated by exhaling and speaking.

  • If you are in a room with people not from your household, in addition to keeping 6+ feet distance, you should continue to wear your mask to reduce sharing aerosol particles.
  • You should choose rooms with as much ventilation as possible when with persons outside your household or go outside in addition to maintaining social distancing.

Basic Preventive Measures
These are still the tools you can use to protect yourself and others:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


6/11/2020 Coronavirus Update
 

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

A Mask to AVOID if You Care About Others
         For the sake of those around you, watch out for those masks (N95 or other) with non-filtering one-way exhaust valves in the front. Not only do they fail to filter out the droplets and aerosols created by the wearer speaking and exhaling, but the funnel effect of the exhaust valve likely means that those unfiltered droplets and aerosols are propelled with even greater velocity (and stay airborne further and farther) than if there was no mask at all.

Pasadena Public Health Department Guidance
          Pasadena Public Health has released written guidance for colleges and universities for the return of students to campus in Stage 3 but they continue to develop their Reopening Protocol for Office Workspace which includes measures to protect those who work on campus during Stage 2 while students are still remote.

L.A. County by the Numbers
          The average daily new COVID-19 cases fell for the first time compared to the previous four weeks to 1,281 new cases/day for the week ending 6/9 (average 1,360 new cases/day for the preceding week) but L.A. County is still far above the cutoff of 180 new cases/day set by the 5/18 County Variance Criteria. With 10.3% of tests positive for the week ending 6/9, L.A. County also failed to meet the <8% cutoff for the alternative method of satisfying the criteria regarding new cases. It is difficult to know how much each of these changes are due to the 31% drop in numbers of tests performed compared to the previous week or rising prevalence of disease or both.
          There were 1.23 tests/1,000 persons/day in the week ending 6/9 which no longer meets the variance criteria of 1.5 tests/1,000 persons/day.
          COVID-19 hospitalizations in L.A. County are unchanged for the week ending 6/9 while they had been dropping 2-3% in each of the two preceding weeks. COVID-19 ICU patient numbers are down 3.5% over the previous week.
          We are hoping that testing volume returns to the sort of numbers that will allow us to assess the presence of infection more accurately.

Basic Preventive Measures
These are still the tools you can use to protect yourself and others:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


 


 

6/3/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Dose of Exposure Matters
          The number of viral particles in an exposure appears to be key in the likelihood of successful transmission of COVID-19. While large respiratory droplets fall to the ground quickly, the much smaller aerosol particles created with breathing, speech and coughing remain airborne longer and have been shown to contain viral particles which can remain viable and infectious. We don’t yet know how many viral particles are required for infection but the SARS-CoV-2 virus is similar to the SARS virus for which the estimated infective dose is just a few hundred particles. Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow, and timing. Increasing ventilation reduces risk and while surgical masks are only ~30% effective at reducing aerosol particles inhaled by the mask wearer,  they are much better at reducing the aerosols generated by exhaling and speaking. This sort of data leads me to think that:

  • if you are in a room with people not from your household, in addition to keeping 6+ feet distance, you should continue to wear your mask to reduce sharing aerosol particles.
  • you should choose rooms with as much ventilation as possible when with persons outside your household or go outside in addition to maintaining social distancing.
     

Crises Exacerbate Inequities

          The COVID-19 pandemic, like all crises, amplifies longstanding inequities in housing, employment, transportation, income and healthcare access that go on to function as multipliers resulting in higher rates of infection and/or death in communities that experience those inequities. In California, this is most apparent for African Americans and Latinos.


L.A. County Numbers Compared to 5/18/2020 State County Variance Criteria

          The average number of new COVID-19 cases has been rising over the last four weeks, 1,360/day for the week ending 6/2 and 1208, 940 and 799 for the three preceding weeks. Despite these high numbers of cases, L.A. County still meets the County Variance criteria based on testing numbers that result in a percentage of positive tests of 7.5%, below the 8% cut off. This is up from 5.4% the previous week.

          There were 1.8 tests/1,000 persons/day in the week ending 6/2, down from 2.2 the previous week, but still better than the 1.5 tests/1,000 persons/day criteria. 

           COVID-19 hospitalizations in L.A. County declined 2% over the previous week. Hospitalizations and deaths tend to lag behind cases by 2-3 weeks.

Basic Preventive Measures

These are still the tools you can use to protect yourself and others:    

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


5/27/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Contact Tracing
        As society re-opens, we will need to continue our basic preventive measures to reduce the transmission of COVID-19. The only way it will be reasonable to continue re-opening is if we can manage to have at least stable, if not ideally, steadily decreasing numbers of new cases – something that has not happened in L.A. County yet. In the absence of a preventive medication or an immunity generating vaccine, decreasing cases will happen only if we are diligent about finding new cases (that’s the role of abundant testing), isolating new cases to prevent spread to others and rapid identification of close contacts of cases for testing and quarantine.
         For an in-depth look at contact tracing, consider reading Tomas Pueyo’s third installment of “Learn to Dance”. If your brain is already hurting knowing that it is a 40 minute read, here is a 1,500 word summary that hits the high points.
         If you look at Wuhan style manual tracing at its fastest, the guesstimate is that it takes about 5 person-days per case (one person working 5 days to assess one case or 5 people working 1 day to assess one case). If you were attempting to get 70-90% of the contacts for all of each day’s new cases contacted and quarantined within 2 days and you were working with 180 new cases each day you would need 450 people in L.A. County working extraordinarily hard doing contact tracing 7 days a week.
         Why are we suggesting 2 days to assess a case? Because that is the minimum speed needed to reduce transmission. Why are we saying 180 new cases each day? Because that’s the target of the 5/18/2020 County Criteria for L.A. County. For the past week, L.A. County is averaging 1208 new case per day. For those numbers, you would need over 3,000 contact tracers working 7 days a week. This manual approach is heavily dependent on the cooperation and memory of the initial infected person as well as the accessibility and cooperation of the contacts of that infected person.
          There are ways to make contact tracing faster, easier and more accurate but it takes being willing to access GPS data, mobile phone location data, credit card location data and closed circuit TV. And it could include Bluetooth identification of contacts. This only helps if most people keep their Bluetooth enabled device with them and turned on and don’t opt out. People can argue about privacy but if you are trying to avoid a reapplication of “The Hammer” in order to control disease you might decide the trade-off is worth it.

California Connected
          Hot off the presses, Governor Newsom announced “California Connected” on 5/26/2020, a plan to put 10,000 trained contact tracers to work across the state. Their job will be to “connect with individuals who test positive for COVID-19 and work with them, and with people they have been in close contact with, to ensure they have access to confidential testing, as well as medical care and other services to prevent the spread of the virus.” They do not ask for financial information, social security numbers or immigration status. Additional information is available at California Connected.
          If California Connected is trying to reach you, you should see “CA COVID TEAM” on your caller ID, your text message, or your email.

Answer your phone, email and text messages if you see CA COVID TEAM is reaching out!

Basic Preventive Measures
Everything you have been doing all along is still important:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


 

5/20/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

New state criteria for moving forward in reopening
The Regional Variance Criteria announced on 5/7/2020 by Governor Newsom have been revised as of 5/18/2020. Some of the changes seem clearly necessary (zero deaths from COVID-19 over 14 days would have been unachievable for a long time in L.A. County) and some seem like deciding to move the goal posts when you are unhappy with your current position.  The revised County Criteria cover many of the same issues in the Regional Variance Criteria but is longer and introduces some new measurements in assessing a county’s readiness to reopen sectors and spaces that are part of the State’s plan for Stage 2. Reopening colleges and universities is part of Stage 3 which these criteria are not intended to address. Here’s what we can tell you about the similarities and differences between the Regional Variance Criteria and the revised County Criteria and what the L.A. and Pasadena numbers look like at this time: 

5/7/2020 Regional Variance

5/18/2020 County Criteria

Cases

≤1 case/10,000 persons/14days

 For L.A. County that is 1010 cases/14 days
For Pasadena that is 14 cases /14 days

≤25 cases/100,000 persons/14 days 
(which is ≤2.5/10,000 persons/14 days)

For L.A. County that is 2,525 cases/14 days
For Pasadena that is 35 cases/14 days

Or less than 8% testing positive in last 7 days

L.A. County had 12, 629 cases for the 14-day period of 5/5-5/18.
L.A. County had 9.4% of tests positive for 5/11-5/17.
Pasadena had 250 cases for the 14-day period of 5/5-5/18.
No testing data for Pasadena. Unable to calculate % of tests positive.

Testing

≥1.5 test/1,000 persons/day

≥1.5 test/1,000 persons/day and disclose avg daily testing volume for past 7 d or make case that less testing is indicated AND testing available for 75% of residents within 30-min drive time (private and public testing)

L.A. County had an average of 0.98 tests/1,000/day for the week of 5/11-5/17.
PPHD does not post testing numbers, only cases, deaths and demographics of cases and deaths.
It is unclear whether L.A County currently or in the future will have testing available to 75% of residents with ≤30 minute drive and L.A. County Public Health has suggested that the regional free testing sites will be shut down by fall.

Deaths

No COVID deaths in last 14 days

Stable hospitalizations of COVID on 7 day average with <5% change                     
                   -OR-
No more than 20 COVID hospitalizations on any single day in the past 14 days

L.A. County had 611 deaths for 5/6-5/19, Pasadena had 13. It looks like the revised criteria will use hospitalizations instead of deaths. We haven’t been tracking the hospitalization numbers but we will start

July 4th as a goal for being more open in L.A. County
The L.A. County Board of Supervisors meeting on 5/19/2020 announced a goal of being more fully open by July 4th (free subscription for COVID news) where "more fully open" most likely means being farther into Stage 2 of reopening. Dr. Barbara Ferrer was quoted as saying "...we are going to really aim to get there as quickly as possible but we are going to pay attention to the data and science". Public Health follows the "R" for infectious diseases which represents how many new infections will occur for each identified infection (aka the effective transmission rate). The R for COVID-19 was 3.5 in March before the stay-at-home order and the R is now at 1 with the stay-at-home order. Time will tell us whether our R number stays low as we move about more.

How to get a test
We have said it before but it bears repeating, if you don't have health insurance you can still get free diagnostic testing in L.A. County by going to corona-virus.la. Higher priority if you are symptomatic but they will test asymptomatic persons.

What can you do to get more of life open sooner?
Do your part to reduce transmission of COVID-19 and keep our R at or below 1. That means:

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantine. 

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 


 

5/13/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

On 5/7/2020, Gov. Newsom issued criteria for counties that want to move farther and faster into Stage 2 of Reopening.

L.A. County DPH posted their Roadmap to Recovery PowerPoint. We have reviewed the first 4 of 7 Regional Variance Criteria that counties must meet in order to move quicker through Stage 2. Our comments about the readiness of L.A. County are in italics.

Regional Variance Criteria
Epidemiologic stability

  • No more than one case per 10,000 people in the last 14 days
    Based on the L.A. County population of 10.1 million, that’s 1,010 cases over 14 days or approximately 72 per day. As of the last two weeks, it takes L.A. County only 1.2 to 1.3 days to hit 1,010 cases.
  • No COVID deaths in the past 14 days
    L.A. County has had an average of 43 deaths per day as of the week of 5/6 to 5/12; even if increased testing means more mild cases detected, it seems unlikely that our deaths would fall to zero over a 14 day stretch if we are still “allowed” to have 72 new cases per day.

Testing capacity

  • Minimum daily testing of 1.5 per 1,000 residents
    L.A. County averaged 1 test per 1,000 residents per day for the week of 5/6 to 5/12 – that’s the highest rate of testing over the past 4 weeks.

Protection of Stage 1 essential workers

  • Ability to support employees when sick or exposed
    How easy will it be for health care professionals to get tested for free? Do those free diagnostic tests have a 30% false negative rate that we have heard anecdotally? Will support include a space to isolate when that employee has no way to safely isolate at home? Help with childcare or other home responsibilities if needed while isolated?
  • Availability of disinfectant supplies and personal protective equipment (PPE)
    Where does L.A. County stand with PPE? We sure can’t get any. Are the hospitals still operating under the CDC contingency strategies? CDC crisis strategies? Analysis suggests that  approximately 45% of infections come from exposure to infected people in their pre-symptomatic stage making it clear that you need effective PPE for all close contact of greater than 10 cumulative minutes.

Containment capacity

  • At least 15 contact tracers per 100,000 residents
    That’s 1,515 contact tracers for L.A. County. Speed is essential in isolating cases and quarantining contacts to reduce transmission.
  • Ability to temporarily house at least 15% of county residents experiencing homelessness
    L.A. County had 58,936 homeless persons in 2019. The 2020 numbers are not out until May/June. 15% of the 2019 count is 8,840 persons. We have no clue how many homeless persons L.A. County is currently able to temporarily house.

What do we do to keep moving forward?

Basic preventive measures are still the most important contribution each individual can make to reopening.

  • Wash your hands; avoid touching your eyes, nose and mouth; cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently; maintain social distancing.
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise.
  • If you have symptoms suggestive of and/or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding testing, isolation and quarantining.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


5/6/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Testing numbers and availability

  • As of 5/1/2020, California was averaging 25,000 tests per day. This met the state’s testing goal to start Stage 2 of reopening. Ultimately California has a goal of being at 60-80,000 tests per day.
  • 60,000 tests per day in California would be 153 tests per day per 100,000 persons which would meet the Harvard Global Health goal referenced in previous updates. For comparison, L.A. County is 69 tests per day per 100,000 persons for L.A. County on average for the past week.
  • For the past week, L.A. County has extended free COVID-19 diagnostic testing to persons without symptoms. Go to https://corona-virus.la/ to sign up for a test. They still prioritize people with symptoms, increased risk of severe disease and people with increased risk of exposure but they will do testing without these factors.

Which symptoms to prompt you to think of COVID-19?

  • It really depends on who you ask. The CDC lists fever, cough, difficulty breathing, chills or shaking chills, muscle pain, headache, sore throat and new loss of taste or smell. This same list appears on the free testing website for L.A. County mentioned above.
  • LAC DPH has expanded their list from fever, cough and difficulty breathing to more closely mirror the CDC list.
  • The Pasadena Public Health Department’s list of symptoms to consider when reporting to work in an essential business also includes sneezing, runny nose, stomach cramps, diarrhea and not feeling well.

How long does virus remain detectable after COVID-19 and can it still infect others?

Test kits are still a precious resource. The end of isolation is usually determined by the  time-since-onset-of-symptoms method. The recently revised guidelines of 10 days since the onset of symptoms and 3 days after the resolution of fever and improvement of other symptoms is supported by research that shows virus that is able to copy itself has not been successfully cultured more than 9 days after onset of symptoms. A virus has to be able to copy itself to infect new people. Some people continue to test positive for virus for weeks to months after their illness, but we currently think they cannot infect others.

What do we do now?
Basic preventive measures will continue to be important indefinitely.

  • Wash your hands, avoid touching your eyes, nose and mouth, cover your coughs; stay away from other people when you are sick; disinfect high touch surfaces frequently
  • Maintain social distancing
  • Wear a cloth face mask when out in public until the CDC and local Public Health tell us otherwise
  • If you have symptoms suggestive of or exposures that increase your risk of COVID-19, follow the advice of your local Public Health regarding isolation and testing

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD 


4/29/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Testing
Evaluating adequacy of local testing capacity

  • Based on currently available information, L.A. County has averaged 30-70 diagnostic tests per 100,000 people per day over the last 5 days, better than before but still short of the Harvard Global Health goal of 150 discussed last week.
    https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html?referringSource=articleShare
  • Newsom announced on 4/22/2020 that 100,000 test swabs would arrive in California that week and another 250,000 the next week. For perspective, 100,000 swabs would last about 6.5 days if they were all used in L.A. County at a rate of 150 tests per 100,000 persons per day.
  • The percentage of positive tests in L.A. County is still running high, 13-15% (from daily press releases at http://www.ph.lacounty.gov), compared to the World Health Organization recommendation of <10%.
  • The curve of new cases in L.A. County is flattening but it is far from dropping – the new cases per day ranged from 440 to 1081 over the last 5 days.

Immunity
A few words on “herd immunity” (aka “community immunity”) https://www.cdc.gov/vaccines/terms/glossary.html#commimmunity

  • Herd immunity doesn’t mean that someone who lacks immunity to a disease can’t get sick, it only means that their risk of getting sick is lower when more members of their “herd” are already immune, either by virtue of having had the disease and having immunity that lasts or by virtue of an effective vaccine.
  • The more people who are already immune, the less chance that the disease will continue to spread because it has more trouble finding the next person to infect – this is especially important to people in the “herd” who are either especially likely to do poorly with the disease they are trying to avoid and those unable to be vaccinated because of medical issues when a vaccine becomes available.
  • Every little bit of reduction in transmission helps but for comparison, we already know that for Measles we need vaccination rates (as a proxy for immunity since we don’t routinely test these antibodies) above 95% to prevent outbreaks of Measles from sporadic imported cases.
  • As horrifying as the sheer numbers are for people infected with and dying from COVID-19, even when we are done with this first wave there will likely be less than 5-10% of the U.S. population will appear to be immune and only time will tell us if that immunity will last.

Other Information

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


4/22/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Another look at what it will take to move from Stay-at-Home to Reopening
Governor Newsom has pledged that decisions for California will be guided by health outcomes and science and has identified six key indicators that will be considered before modifying the state’s stay-at-home order.
https://www.gov.ca.gov/2020/04/14/governor-newsom-outlines-six-critical-indicators-the-state-will-consider-before-modifying-the-stay-at-home-order-and-other-covid-19-interventions/

Here are some thoughts we have on what these indicators look like for LA:
Cases:
A sustained reduction in new cases for at least 14 days would go a long way to protecting our community

Testing and Surveillance:

  1. Increased diagnostic testing will be key to monitoring and protecting our community
    •  Enough to test everyone with symptoms, do surveillance testing of frontline  
        healthcare workers, do testing of contacts of new cases, and to do some
        surveillance testing in the population at large – The L.A. Times online reported on
        4/21/2020 that California has approved testing for asymptomatic persons
        working in prisons and nursing homes and in some high risk households.
    •  Harvard Global Health Institute suggests a minimum of 150 test per 100,000
        people per day – California as a state was at 35 per 100,000 people on the day
        of 4/15/2020; LA County has been doing 15 to 45 tests per 100,000 people per
        day over the past week.
    •  When the portion of positive tests in a day of testing is greater than 10% of the
        total, the message is that you need more testing – the daily testing in L.A.
        County has been running 11 to 15% positive each day over the last week.
        https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html?referringSource=articleShare
     
  2. Testing to identify people who may be immune to COVID-19
    •  Everything we said last week about the issues with antibody (aka serology)
        testing still applies.
    •  The Center for Health Security at Johns Hopkins University gives a simple
        description of the three general types of antibody testing being developed and
        twice a week they update their site with the companies that have completed the
        Emergency Use Authorization process with the FDA. All of these tests have
        limitations and it will take using them to assess their reliability and usefulness
        and they will have the same problems with scaling up to the numbers of tests
        that are needed that has been experienced with the diagnostic testing
        processes. 
        https://www.centerforhealthsecurity.org/resources/COVID-19/serology/Serology-based-tests-for-COVID-19.html
     

Public Resources:

  1. Adequately resourced Public Health agencies
    •  Just looking at the people needed to trace contacts of new cases, there are
        currently 2,200 people between the CDC and state and local health departments
        for this work.
    •  China hired and trained 9,000 contact tracers in Wuhan alone; an equivalent
        response in the U.S. would be 300,000 contact tracers according to Dr. Tom
        Frieden, a former director of the CDC.
    https://www.nytimes.com/2020/04/18/health/coronavirus-america-future.html?referringSource=articleShare
    •  Although Apple and Google are teaming up to develop and roll out their contact
        tracing application in the U.S., questions related to privacy, accuracy and public
        acceptance remain unclear.
     
  2. The ability to support continued physical distancing in public as stay-at-home relaxes
    In order to have adequate physical distancing when in-person classes resume we may need:
    •  continued increased on-line course offerings compared to pre-pandemic
        offerings to avoid crowding on campus.
    •  a blend of in-person and on-line attendance (synchronous and/or asynchronous)
        in courses with enrollment that exceeds the available room capacity when
        factoring in physical distancing.
    •  continued easy access to hand washing and sanitizer supplies.
    •  use of masks may continue to be needed for an extended period.
    •  continued adherence to stay-at-home with symptoms of even mild illness and
        consideration of temperature screening for entry to campus.
    •  continued physical distancing in dining, athletic, and recreational areas.
     
  3. Hospital capacity and equipment to safely treat people sick with COVID-19
    •  Thanks to some combination of luck, density, and social distancing, our hospital
        capacity has not been exceeded; if we are not cautious, we can lose that
        advantage.
    •  Personal protective equipment is still insufficient; if we had enough, Newsom
        would not be making a billion dollar deal for more from China; you have seen the
        same stories we have of health care workers being threatened with firing for
        speaking out about lack of personal protective equipment.
     

These and other measures will be needed to dampen surges of infection and to protect the many in our college community who will continue to be at increased risk of severe disease while we wait for effective treatment and vaccine.

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


4/15/2020 Coronavirus Update 

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

Some Good News to Start

  • It promises that decisions will be guided by health outcomes and science.

Another way to look at the numbers

The antibody tests are coming…BUYER BEWARE!

After being criticized for being slow in approving diagnostic tests for COVID-19 (the “are you infected now” tests), the FDA has given states permission to implement and manage their own antibody testing, AKA serology testing (“are you immune” tests) without FDA input. In an FDA statement made on 4/7/2020 statement, they note that 70+ test developers have already notified the FDA that they have antibody/serology tests available.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-serological-tests

Some things to keep in mind:

  • Even once we start having results from antibody/serology tests, we won’t know the level of antibodies needed to protect us from re-infection or how long that protection will last until we can do surveillance testing (periodic “are-you-infected” testing) on people with antibodies, especially when individuals return to work and social events. We can hope to get some useful information from the countries that are ahead of us in this process.
  • Cellex is the only company that has gone through the EUA (emergency use authorization) process with the FDA for a clinical laboratory rapid test (not a home test.)
  • For now, if you see an ad offering to sell you a serology/antibody test at home, you should ask a lot of questions; no company has an “FDA approved” test (the Cellex EUA is not the same as “FDA approved”) and there could be a lot of companies coming after your money.

Apple and Google want to help

What are we supposed to do now? THE VERY SAME THINGS WE HAVE BEEN DOING SO FAR!

  • Wash your hands, cover your coughs and sneezes, wear a mask when you go out to grocery shop or might pass near other people, and don’t touch your face.
  • Stay more than 6 feet away from anyone who doesn’t live in your home
  • Isolate yourself if you are ill.
    http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

A parting thought….

This came to us attached to an email from a colleague. Like that colleague, we wish we could tell you the author’s name but it is still worth reading:

When you go out and see the empty streets, the empty stadiums, the empty train platforms, don't say to yourself, "It looks like the end of the world." What you're seeing is love in action. What you're seeing, in that negative space, is how much we do care for each other, for our grandparents, for the immuno-compromised brothers and sisters, for people we will never meet. People will lose jobs over this. Some will lose their businesses. And some will lose their lives. All the more reason to take a moment, when you're out on your walk, or on your way to the store, or just watching the news, to look into the emptiness and marvel at all of that love. Let it fill and sustain you. It isn't the end of the world. It is the most remarkable act of global solidarity we may ever witness.

Resources with Updated Information


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


4/8/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

KEEP IT GOING: DON’T LET UP YET ON SOCIAL DISTANCING

The Good…The Bad… And Keep Staying at Home  

  • New cases in L.A. County were dropping from a high of 711 new cases on Saturday 4/4, 663 new cases on Sunday 4/5 to 420 new cases on Monday 4/6. New cases on Tuesday 4/7 went back up to 550. Only time will tell us when we resume a downward trend. Everyone needs to do their part by following the "Safer at Home" recommendations by Mayor Garcetti.
  • Free testing is becoming more available in L.A. County. It is still focused on symptomatic people but without age and/or underlying conditions restrictions.

⇒See https://www.latimes.com/california/story/2020-04-06/all-l-a-residents-can-now-get-coronavirus-tests-as-restrictions-are-lifted-garcetti-says for more information
⇒Go to https://corona-virus.la/ to apply for testing at one of the 13 L.A. County sites 
⇒Although access to testing has improved, they can’t test everybody at once; there is still a priority on who gets tested first

For friends and family who think COVID-19 isn’t in their area
Disease modelers at University Texas Austin have found that:

  • Counties with even a single confirmed case of COVID-19 have a better than 50% chance of already having sustained, undetected transmission.
  • That probability rises to 95% with 10 confirmed cases.

You can read a summary of their study (Inside this summary you can follow the link to the actual study which is very interesting):
https://www.nytimes.com/interactive/2020/04/03/us/coronavirus-county-epidemics.html?referringSource=articleShare

How do we get out of where we are?
To do it safely we will need AT LEAST:

  • Even better availability of testing than currently exists:
    https://www.theatlantic.com/ideas/archive/2020/03/we-need-1-million-tests-week/609154/
  • A sustained reduction in new cases for at least 14 days (even as increased testing identifies more cases)
  • Adequately resourced and supported Public Health agencies with surveillance as well as symptom driven testing to find new cases and staff to follow those cases and trace contacts
  • Healthcare resources that are no longer stretched to the limit and imperiled by lack of protective gear so that the people who do get critically ill have the best chance to recover
  • Reliable testing to identify who may already be immune (not available yet in the U.S.) – those are the first people for whom to consider reducing restrictions

A lot of the above comes from https://www.nytimes.com/2020/04/06/upshot/coronavirus-four-benchmarks-reopening.html. Another interesting read is https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56.

Still your best protection

  • Stay at home – don’t even go out for groceries unless your cupboard is truly bare, and the next food delivery option is too far away – it’s time to eat up the things we have been passing over!
  • The key steps are still:

1.  If you are ill, start with the assumption that you have COVID-19 and isolate    
     with these instructions  
     http://publichealth.lacounty.gov/acd/docs/HomeisolationenCoV.pdf
2.  Wash your hands,
3.  Don’t touch your face,
4.  Wear a cloth mask if you must go out,
5.  Don’t touch the outside of your mask,
6.  Wash your hands again when you take a mask off.

PCC Helpful Resources

Resources with Updated Information


Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


4/1/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

DON’T STOP HANDWASHING AND SOCIAL DISTANCING,
THEY ARE STILL THE MOST POWERFUL TOOLS WE HAVE

Keeping those numbers in perspective

  • According to the World Health Organization (WHO), on 3/31/2020, the U.S. leads the world in confirmed cases with 140,640. The number of cases is ahead of Italy at 101,739, Spain at 85,195 and China at 82,545.
  • If you look at cases per 10K of the 2019 population, the U.S. currently has 4.27 cases/10K (compared to Italy at 16.8/10K and Spain at 20.93/10K).
  • Our numbers will get worse before they get better but keep doing that social distancing thing to keep the numbers as low as possible.
     

Where are those plentiful and easy to get tests that we needed 6-8 weeks ago?

Time for some good news - early indications that social distancing is helping in California

Who should we assume has COVID-19?

  • About a week ago, the L.A. County changed how it views respiratory illness and states that ambulatory patients with symptoms of a viral respiratory illness should be presumed to have COVID-19. If we each start from the perspective of thinking we have COVID-19 and focus on what to do to avoid sharing it, maybe that will help. Safety first, protect others by protecting yourself--that's the take home message.
     

What can we do besides wash our hands and stay away from each other?
After no public comment since a 3/9/2020 media briefing, Dr. Robert Redfield, CDC director,  gave an interview on 3/31/2020:https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us?referringSource=articleShare
     The take home messages from this interview include:

  • As many as 25% of infected persons may remain asymptomatic – we don’t know who these people are and we don’t know if and how much virus they can share because we haven’t been able to do any surveillance testing
  • An infected person’s ability to share the virus probably starts 48 hours before the onset of symptoms in that person
  • When we get through the first surge in hospitalizations and deaths that will occur in April and May, 95% of Americans will still have no immunity to the virus
  • We can hope this virus behaves like influenza and that transmission decreases as weather warms, but we should expect to see it back by early winter
  • Any talk of letting up on social distancing will have to be focused on geographic areas where we have enough data on community transmission. That will necessitate surveillance testing which we are not currently able to do.

Dr. Redfield was asked if the CDC was looking at changing its mask recommendations. He was only willing to say that it is being “aggressively reviewed”. Until the CDC gets finished with its aggressive review, Student Health Services recommend that everyone should wear a mask when out in public.

If you live with someone who is at risk for severe illness with COVID-19, maybe you should look at the L.A. County self-isolation/quarantine PDF files in previous updates and consider what you want to do to reduce the risk of exposing your loved one in case you have asymptomatic infection.

Mask Information:

Is there something more you can do?

Calling all nursing students, RN, LVN, and CNA, who thought in January that they would be graduating soon. California wants you and will pay you to work. The anticipated time of need is now to June 30th. It is possible this work could be counted as clinical training missed under stay-at-home orders keeping nursing students on track for graduation. The call includes all healthcare providers, behavioral health professionals and health care administrators. The website is:https://covid19.ca.gov/healthcorps/

There is more information in Governor Newsom’s briefing on 3/30/2020:
https://sacramento.cbslocal.com/video/4497336-governor-newsoms-daily-press-conference-3-30-20-announces-establishment-of-california-health-corps/

And now, the care and feeding of the right side of the brain (videos and comics for your enjoyment):

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


3/25/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have any questions, contact Student Health Services.

SYMPTOMS TO CONSIDER

WONDERING IF YOU NEED A COVID-19 TEST

  • The “Situation” section of the 3/25/2020 health alert by the Los Angeles health Alert Network (LAHAN) provides some guidance: http://publichealth.lacounty.gov/eprp/lahan/alerts/LAHANCOVID032520.pdf
  • DO NOT test symptomatic patients that can be managed at home with these instructions: http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf
    • If you can safely self-isolate, that is what you should do.
     
    DO NOT test asymptomatic people, EVEN IF THEY MAY HAVE BEEN EXPOSED. L.A. County and San Bernardino County DPH define “exposed” as persons with close contact of a known/suspected case of COVID-19 (within 6 feet for more than 10 minutes) or having handled bodily fluids of that person without appropriate protective gear starting on the first day that the known/suspected case was symptomatic and extending until that case has been released from isolation. People who know they have been exposed by those criteria should be told to self-quarantine following the home quarantine instructions: http://publichealth.lacounty.gov/acd/docs/COVHomeQuarantine.pdf

HOW LONG TO ISOLATE COVID-19 CASES AND PEOPLE IN CONTACT WITH THEM?

NEW TESTING RESOURCES FOR THE CITY OF LOS ANGELES

  • The City of L.A. is offering COVID-19 testing to city residents who meet one of three criteria for testing. They hope to extend testing to L.A. County residents in the near future. To see their current criteria for testing and apply for a test, go to: https://lacovidprod.service-now.com/rrs  

EFFECTIVE CLEANING AGENTS
For proper disinfection of SARS-COV-2, the virus that causes COVID-19:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

  • The EPA “N list” has the products considered effective
  • They are listed in ascending numerical order of their EPA registration numbers, the first two sections of which describe the active ingredients
  • If the product you are using has the same first two sections as a product on the N list, then your product is also effective
  • The N list also tells you how long the item needs to stay wet (wet contact time) with each cleaning product

CLEANING ADVICE

REMEMBER: PREVENTIVE MEASURES ARE STILL OUR STRONGEST TOOLS

  • Stay 6 feet away from others; learn to love virtual socializing
  • Wash or sanitize your hands frequently
  • Avoid touching your eyes, mouth and nose
  • Cover your coughs and sneezes 
  • Stay away from other people when you are ill
  • Clean your work areas with an EPA approved cleaning product
  • Consider using gloves when working outside of the environment you can clean. It might at least remind you not to touch your face

STUDENT HEALTH SERVICES and PERSONAL COUNSELING SERVICES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


3/18/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES
The trend in numbers of COVID-19 cases continues to change on a daily basis. Please refer to the links in the Resources section listed below for the current numbers of cases.

PREVENTION
The most impactful means of reducing transmissions of COVID-19 are the basic preventive measures (social distancing, groups less than 10, handwashing, isolate when ill, etc.) Paying attention to these measures can allow us to slow down the spread of disease in hopes of keeping medical care needs within the bounds of available medical human and equipment resources. Persons at increased risk of poor outcome with COVID-19 by virtue of age and/or underlying illness should be especially vigilant.

REMOTE ASSISTANCE TO STUDENTS
Though campus is closed to students and the public, Student Health Services will continue to address medical concerns of students. Students with medical questions are asked to contact SHS by email at:

medicalSHS@pasadena.edu

They should include their full name, lancer number, enrollment status, their question and a phone number where we can reach them, if needed. We intend to reply within 24-48 hours during our usual working hours of 8:00a-4:30p Monday-Thursday and 8:00a-12:30p Friday except for weekends and holidays.

FACULTY/STAFF
Faculty and staff are encouraged to take their medical questions to their medical providers. The SHS web site includes a list of low cost medical services in the area: https://pasadena.edu/campus-life/student-health-services/community-referrals.php

TESTING
Testing for COVID-19 is still a limited resource at this time and requires that a medical provider determine that either you meet your local Public Health Department criteria for free testing or that you have insurance or other resources to cover the cost of testing. There are several avenues through which we hope testing will expand in the near future. We will provide updates as it becomes available.

The California Department of Public Health has launched a new website which covers all the basic preventive measures as well as information about state case numbers, testing, unemployment, family leave and disability benefits: https://covid19.ca.gov/

RESOURCES

⇒ Home Isolation Instruction: 

http://publichealth.lacounty.gov/acd/docs/HomeisolationenCoV031520.pdf

⇒ Home Care Instructions for Mild Respiratory Illness:

http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

⇒ Travel Notices:

https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html#travel-1

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


3/12/2020 Campus Update: Classes Cancelled Monday 3/16 and Tuesday 3/17

As PCC continues to take additional steps in response to the coronavirus outbreak, I am writing to let you know of two important updates:

  • In consultation with the Academic Senate and the Faculty Association, Dr. Endrijonas has decided to cancel all face-to-face classes on Monday and Tuesday, March 16 and 17, so that faculty, deans, and classified staff can continue the important work of implementing our transition to remote instruction. All administrative and business functions will continue as normal – the college is open for business. Courses and support services will begin moving online as soon as they are ready. It is our expectation that every possible course will meet through remote methods beginning Wednesday, March 18. For more information, contact your instructor.
  • Following a decision by the California Community College Athletic Association, all spring sports games and practices are suspended indefinitely.

Additional information you may find helpful in the days and weeks to come:

  • This morning Dr. Endrijonas held a video briefing for college faculty and staff. You can view the video here.

    In her remarks, Dr. Endrijonas summarized the recent actions the college has taken to address the coronavirus pandemic. These include moving all possible courses to remote instruction during the period of March 18 to April 20; cancelling or postponing all college and community events during that same time period; and curtailing all district-sponsored travel through April 30. We also provided information on how Student Health Services is assisting students, how Facilities Services is cleaning and sanitizing our physical plant regularly; and how you can stay in touch with the college and let your concerns and questions be known.
  • Counseling Resources for Students: Counselors are accepting virtual appointments through this link. Counselors can help you understand your options during this transition and also update your educational plan.
  • PCC Personal Counseling and Social Services: Students who may be in need of support or resources should visit these offices to learn more. There is a referral guide produced by Personal Counseling that will be of assistance and Social Services information is available online.
  • Q&As: Please keep your questions and comments coming! We are continually updating our FAQ page and tomorrow we will be updating our Health Updates page so you can more easily find important information quickly.

Thank you for your continued engagement. We are reading your messages and making an effort to respond wherever possible. Your feedback helps us know what our community is facing during this challenging time.

Thank you for your patience and understanding as we navigate this emergency.


3/11/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES
As of 3/11/2020:

  • 27 confirmed cases in L.A. County

  • The college has no indication that the individual who has tested positive for coronavirus in Pasadena has interacted with people or facilities at the college. We are working with public health authorities to monitor and respond to the situation.

  • We will continue weekly updates as well as emergent briefings as needed.

  • With increasing numbers of cases in the U.S., the CDC has transferred responsibility for setting criteria for COVID-19 testing to state and local Public Health Departments. Pasadena Public Health Department is using the L.A. County Department of Public Health clinical criteria for testing.  

WHAT YOU SHOULD STILL BE DOING NOW

  • Continue basic preventive measures – Wash your hands; avoid touching your face; cover your coughs/sneezes; stay away from sick people; replace handshakes and hugs with elbow bumps or verbal greetings; get the flu shot if you have not earlier this flu season.

These basic preventive measures are our best tools for slowing the spread of this virus. Slowing the spread of the virus makes it more likely that medical resources will be sufficient to meet the medical needs of the people who need help.

  •  Stay home if you are sick

1. If you are sick, have a fever ≥100°F (≥37.8°C), or have a spewing productive cough that is difficult to contain, stay home and away from other people until your temperature has been below 100°F for 24 hours without having to use fever reducing meds to get it there and you can manage your cough/other symptoms.

2. The faculty has been asked to adjust their absentee/missed work approaches to better accommodate students who should stay home because they are ill.

3. L.A. County DPH has some advice for people who need to stay home for mild illness and are not felt to need testing for COVID-19: http://publichealth.lacounty.gov/acd/docs/COVHomeCare.pdf

  • Identify your medical provider and how to contact them – When we start to have community transmission locally, telephone consultation will help protect you and others.

  • Update your Emergency/Earthquake plan – Have enough of the medications you usually take and fever reducing medications if you can use them; food for people and pets, toilet paper, feminine products, kitty litter, basic first aid supplies including a thermometer, cleaning supplies and a communication plan with your family. CDC has some preparation advice for home, school, and work: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html?deliveryName=USCDC_2067-DM21103 

ADDITIONAL INFORMATION

  • If you or someone in your family is identified as a COVID-19 case and well enough to be managed at home, you will be given self-isolation instructions by Public Health. http://publichealth.lacounty.gov/acd/docs/COVHomeIsolation.pdf (also available in Chinese).

  • If there is sufficient local transmission, Public Health, in consultation with school administration could advise closing the school. PCC has an Airborne Transmissible Disease (ATD) Plan that is being updated on an ongoing basis for the current situation. You can see this document at https://pasadena.edu/campus-life/student-health-services/latest-health-updates.php. If you have questions for which you cannot find answers among the updates clicking on “send us your feedback” takes you to a form to submit questions by email.

RESOURCES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


3/10/2020 – Coronavirus Response: Update 

The following message was sent to faculty and staff:

March 10, 2020

Sent on behalf of Superintendent/President Erika Endrijonas

Dear colleagues:

In order to limit the transmission of coronavirus (COVID-19) on campus, and in an abundance of caution for the health and safety of our students, faculty, and staff, I am writing to let you know of specific actions the college will be taking over the coming days and weeks. Please note that there are no confirmed cases of coronavirus on our campus at this time, and the college is not closed for business.

The changes listed below will be in effect from Wednesday, March 18, through the end of Spring Break, April 20. Any change to this timeline will be made at a later date, in response to information gained from public health officials.

  • By March 18, PCC will convert most in-person classes to offer temporary remote instruction wherever possible through Canvas, Zoom, and other modalities. No changes will be made to courses that require face-to-face instruction; these courses will continue to meet on campus as scheduled. Examples of courses in this category include performing arts, lab courses, and physical education. Faculty should contact their dean for further clarification.
  • From March 18 through April 20, college events with a projected attendance of more than 100 people will be cancelled or postponed. Sporting events will be conducted wherever possible without spectators, while college arts performances will be postponed until later in the semester. Community events will be cancelled or postponed.
  • To help facilitate this transition, the agenda for PD Day will be reconfigured to allow faculty, staff, and managers time to prepare for these changes. Breakfast and lunch on Thursday (March 12) will proceed as planned in the Piazza, as will the streamed message from Dr. Endrijonas at 9 a.m. sharp. Faculty, staff, and administrators should plan to tune in to the stream to learn more about our ongoing response to the coronavirus outbreak. The special classified morning event and all afternoon breakout sessions have been cancelled. More information about how preparations will unfold within Academic divisions and student services and other departments will be forthcoming from the Office of Professional Development and your supervisor or dean.
  • The college is not closing. College facilities will remain open, and many operations will continue normally. Unless they are actively sick, employees should report to work as normal. Facilities Services has been increasing cleaning and sanitization efforts, and increased supplies of hand sanitizer, soap, and other cleaning products are being distributed. More information will be provided through your supervisor or dean as it becomes available.

A separate email with this information has been sent to students. 

These changes may cause some stress and uncertainty. If you notice someone who has been impacted by this emergency, please remind them that help is available. One option is PCC’s Employee Assistance Program, which provides confidential, complimentary counseling and other assistance to employees and their dependents. Please contact Human Resources if you need additional guidance with this resource.

This emergency will continue to have impacts, and we will continue to respond accordingly. Throughout this emergency, we have been balancing our educational mission with our imperative to protect the health and safety of our students, faculty, and staff. As more information about this outbreak has become evident, these actions represent prudent steps we can take to respond effectively to a rapidly changing situation. We appreciate your flexibility, commitment, and professionalism as we navigate this challenging time together.


3/5/2020 Pasadena City College and the Coronavirus outbreak

Posted by Pasadena City CollegeAs you may have seen, yesterday the LA County Department of Public Health announced that there are additional confirmed cases of the Novel Coronavirus in Los Angeles County. As a precautionary measure, both the county and the city of Pasadena declared a public health emergency in their jurisdictions. It is important to note that there are no confirmed cases of coronavirus transmission in Pasadena at this time, and PCC is open for normal operations.

Current events may cause surprise and worry, so I want to share information about what Pasadena City College is doing to keep our community healthy and safe. There are a number of things we can all do to help reduce the likelihood of this illness impacting our lives, and to also help public health authorities effectively manage this outbreak.

What can I do?

  • Practice good hygiene: 
    • Wash your hands frequently
    • Avoid touching your eyes, nose and mouth
    • Cover your coughs and sneezes, and then wash your hands again
    • Stay at least 6 feet away from sick people
    • Replace handshakes with elbow bumps or verbal greetings
    • Get the flu shot if you haven’t in order to reduce the number of opportunities to become ill.
  • Stay home if you are sick:
    • If you have a fever of 100°F or greater, along with a cough, sore throat, or shortness of breath, it is important that you stay home and away from other people. Once your temperature has been below 100°F for 24 hours without medication, and your other symptoms are not causing problems, you should return to the college.

      We understand that staying home can present challenges to work, home, and daily life. The college is prepared to accommodate reasonable absences in light of this public health crisis. If you have any concerns, please direct them to your supervisor or area vice president and they will work to find a solution.
  • Identify your medical provider and know how to contact them:
    • Our medical system is expected to be under high demand during this time. While you should only contact your medical provider if its services are needed, now is a good time to know what numbers to call so you’re prepared in the future.
  • Help the college maintain order and remain calm:
    • As with any emergency, new details are emerging every day and it’s difficult to know what is fact and what is rumor. While it is totally normal to have fears and worries during this time, it’s important to remember that we speak from authority when interacting with other members of our community – particularly students. If you know of someone who is experiencing severe stress during this emergency, it may be helpful to share the simple steps and facts contained in this message. If you are asked a question and you don’t know the answer, please refer to statements by public health officials or law enforcement agencies, rather than repeat what might be trending on social media. Some helpful websites include:

What is PCC doing?

Beyond these individual actions, the college is taking steps to respond to this emergency. PCC staff are in regular contact with local law enforcement and public health officials, and we are constantly evaluating our operations to see if any changes are necessary. Custodial staff are installing and updating handwashing, sanitization, and cleansing wipe stations around our campuses. Faculty and administrators are exploring alternative methods of coursework – including online and remote classes – so that classes can continue if in-person attendance is problematic. This information is being communicated to deans and faculty as soon as it becomes available. The college has a response plan and is using it to address developing events. Remember, courses and public events are still ongoing, and the college will only limit its activities if it is absolutely necessary. 

How can I stay informed?

During any emergency, it’s important to know how to find trusted information. There are a couple of key ways you can stay informed as this outbreak continues to develop:

If you have a question or concern that you would like to share, please send it to us and we’ll be able to help.


3/4/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

CASES

  •  As of 8:30am 3/4/2020, by the announcement made by the L.A. County Board of Supervisors and the L.A. County Department of Public Health, there are 6 new COVID-19 cases confirmed in L.A. County in the last 48 hours. Each of these cases has a known presumed source of illness so there is still

No evidence of community transmission yet

daily update radio briefings

ph.lacounty.gov

  • We will continue weekly updates as well as emergent briefings as needed.

  • L.A. County Board of Supervisors and the L.A. County Department of Public Health are declaring a Local Health Emergency to enhance coordination and implementation of activities to protect the public. Pasadena Public Health and Long Beach Public Health expect to do the same (no confirmed cases in those two areas). There are no closures or changes to public events at this time.

  • If you want to see the CDC numbers for the U.S. (that are now being updated each week day): https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

  • CDC guidelines for who to test continues to evolve: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. The decision to test is made by the Public Health Department for the geographic area of the candidate for testing.

WHAT YOU SHOULD BE DOING NOW

  • Continue basic preventive measures – you know the drill! Wash your hands, avoid touching your eyes, nose and mouth; cover your coughs and sneezes; wash your hands again if you used a tissue to do that last one; stay 6 feet or more away from sick people; replace handshakes with elbow bumps or verbal greetings; get the flu shot if you haven’t in order to reduce the number of opportunities to become ill.

  • Stay home if you are sick – fever ≥100°F (≥37.8°C) or a spewing productive cough that is difficult to contain are two of several good reasons to stay home and away from other people until your temperature has been below 100°F for 24 hours without having to use fever reducing meds to get it there and you can manage your cough/other symptoms.

  • Identify your medical provider and how to contact them – when we start to have community transmission locally, telephone consultation will help protect you and others

  • Update your Emergency/Earthquake plan – (you DO have one, right?) Thankfully we probably WON’T lose power, water and communication channels but a lot of the other issues are the same; have enough of the medications you usually take and fever reducing medications if you can use them; have enough shelf/freezer stable food for people and pets, toilet paper, feminine products, kitty litter, basic first aid supplies including a thermometer, cleaning supplies and a communication plan with your family. CDC has some preparation advice for home, school, and work: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html?deliveryName=USCDC_2067-DM21103

ADDITIONAL INFORMATION

  • If you or someone in your family is identified as a COVID-19 case and well enough to be managed at home, you will be given self-isolation instructions by Public Health. Here is what L.A. County Public Health Department says: http://publichealth.lacounty.gov/acd/docs/HomeCarenCoV.pdf (also available in Chinese).

  • If there is sufficient local transmission, Public Health, in consultation with school administration could advise closing the school. PCC has a Pandemic Preparedness Plan that is being updated for the current situation and will be distributed to the appropriate individuals who will assist with enforcing the plan, if needed.

RESOURCES

Director of Health and Wellness: Quinn Tang, DHSc., PA-C
Clinic Physician: Ann Walker, MD


2/26/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

Cases:

  • U.S. cases reported by the CDC as of 4 pm 2/25/2020:

                12           travel related
                  2           household contacts or travel related cases
                  3           repatriated from Wuhan, tested by CDC
                42           repatriated from the Diamond Princess, tested by CDC
               59         TOTAL CASES

  •  Still no new cases in L.A. County 

Travel:
CDC provides travel advice regarding COVID-19 at https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html As of 2/25/2020, CDC recommends the following (refer to the above CDC link for detailed descriptions related to each of the following categories):

  • Avoid all nonessential travel based on widespread community transmission in:

o   China
o   South Korea

  • Practice enhanced precautions based on sustained community transmission in:

o   Iran
o   Italy
o   Japan

  • Practice usual precautions based on multiple instances of community transmission in:

o   Hong Kong

  • Other destinations with risk of community spread:

o   Singapore
o   Taiwan
o   Thailand
o   Vietnam

Keeping Your Work Area Clean:
Surface cleaning solutions that are Environmental Protection Agency (EPA) registered for use in hospital and healthcare settings are effective for killing the virus responsible for COVID-19.  You must achieve the wet contact time--letting the surface dry on its own, after cleaning with the product. This could be 2 to 10 minutes or more depending on the product. Check each product for specific recommendations.

Protection:
AS A REMINDER: Your best protection is still

  • Frequent hand washing
  • Avoid touching your eyes, nose and mouth
  • Stay >6 feet away from people who are sick
  • Stay home when you have a fever until your temperature is under 100°F/38°C for 24 hours without the use of fever-reducing medicines
  • If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with your sleeve, scarf, or clothing items (e.g. T-Shirt)
  • Get the 2019-20 seasonal flu shot while limited free doses are still available for students at Student Health Services

2/19/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services.

  •  As of 2/19/2020, the CDC is still reporting 15 identified cases in the U.S. This number does not include persons being brought back to the U.S. for treatment/quarantine from the Diamond Princess Cruise ship.
  •  There continue to be no new cases in California and in L.A. County.
  •  If you are an asymptomatic traveler who returned to the U.S. on or after 2/3/2020 and who had traveled in China within the 14 days before your return to the U.S., please review the recommendations posted on the 2/12/2020 update.
  •  REMEMBER: Your best protection is still

o   Frequent handwashing
o   Avoid touching your eyes, nose and mouth
o   Stay >6 feet away from people who are sick
o   Stay home when you have a fever until your temperature is under 100°F/38°C for
     24 hours without the use of fever-reducing medicines
o   If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with
     your sleeve, scarf, or clothing items (e.g. T-Shirt)
o   Get the 2019-20 seasonal flu shot; there are still some free doses for students at
     Student Health Services

Resources on COVID-19:

Pasadena Public Health: https://www.cityofpasadena.net/public-health/news-announcements/local-information-and-guidance-for-novel-coronavirus/

LA County Public Health: http://publichealth.lacounty.gov/media/Coronavirus/

CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html


2/12/2020 Coronavirus Update

Below are the most recent Coronavirus updates. If you have questions, contact Student Health Services. 

  • COVID-19 is now the name for the 2019 novel Coronavirus infection that started in Wuhan, China
  • As of 2/12/20 afternoon, there are 14 identified infections in the US with 8 of those being in California and still only one in LA County
  • The advice has changed for asymptomatic persons who:

1. have traveled in Hubei Province or elsewhere in mainland China in the past 14 days and
2. have arrived in the US on or after 2/3/20 and
3. have no other known risk factor for exposure to COVID-19 other than travel

Asymptomatic individuals meeting the guidelines in bullet point #3 above—who traveled in Hubei Province, should be actively monitored by their public health department on a daily basis with no public activities until symptom free for 14 days. Of note, day 1 is the day after departure from China. Please contact your local public health department for specific directions.

Pasadena Public Health: https://www.cityofpasadena.net/public-health/

Los Angeles County Public Health: http://publichealth.lacounty.gov/

Asymptomatic individuals meeting the guidelines in bullet point #3 above—who traveled elsewhere in mainland China, should do self-monitoring with supervision by their local public health department and avoid congregate settings (e.g. schools, concerts, etc.), limit public activities and practice social distancing until symptom free for 14 days (day 1 is the day after departure from China).

Transit through an airport in Hubei Province or mainland China without time outside the airport is generally not considered to be an exposure.

At this time, Hong Kong, Macau and Taiwan do not have widespread transmission of COVID-19 and are not considered part of mainland China for this guidance.

  • REMEMBER: Your best protection is still

o   Frequent handwashing
o   Avoid touching your eyes, nose and mouth
o   Stay >6 feet away from people who are sick
o   Stay home when you have a fever until your temperature is under 100°F/38°C for
     24 hours without the use of fever-reducing medicines
o   If you are coughing or sneezing, wear a mask or cover your coughs/sneezes with
     your sleeve, scarf, or clothing items (e.g. T-Shirt)
o   Get the 2019-20 seasonal flu shot; there are still some free doses for students at
     Student Health Services

For additional information on the Coronavirus and other health news, please refer to the Student Health Services webpage: https://pasadena.edu/campus-life/student-health-services/latest-health-updates.php

Resources on COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Coronavirus+Colleges+Guidance+2_11_20.pdf


2/11/2020 Measles Update

There is a recent outbreak of measles sites mostly in West Los Angeles back in late January early February.

Suspected measles cases have:

  • Fever and Generalized Rash
  • Had exposure to measles within the last 3 weeks

 http://www.publichealth.lacounty.gov/hea/library/topics/measles/CDCP-IP-0012-01.pdf


2/7/2020 Update 

In response to a steady stream of questions relating to the Coronavirus outbreak, Student Health Services have developed the following Q&A. If you have questions contact Student Health Services. 

PCC Q&A on the Novel Coronavirus (nCoV)

Answers to frequently asked questions are below; additional helpful information is available at the Centers for Disease Control and Prevention (CDC) FAQ website https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Faculty’s instructions to students: Individuals with a fever greater than 100.4 °F or 38°C or who are unable to contain coughing or sneezing, should refrain from attending classes or work until their symptoms are controlled. Inform the student to go home. Faculty should work with the student to make up class work and instructions, rather than penalizing the student for missing class.

Students’ instructions: You should consult your primary doctor or contact Student Health Services (626-585-7244) if you are unwell.

Do not assume, on the basis of appearance, in the presence of flu-like symptoms that they have coronavirus. 

Patients with confirmed 2019-nCoV infection have reportedly had mild to severe respiratory illness with symptoms of:

    • fever (>100.4 °F or 38°C)
    • cough
    • shortness of breath

Many cases appear to be mild. Individuals who are elderly, have weakened immune systems, or have other underlying health conditions appear to be at risk for more severe disease.

Local public officials will conduct a “contact tracing” measure with identified patients and proactively contact any individuals who might have had an exposure. They will work with any individuals who may be affected to monitor if any symptoms develop.
Coronaviruses, including the 2019-nCoV, are considered airborne transmissible diseases.

The college is taking extended measures to ensure a hygienic environment, including regular cleaning of common areas, and refilling of soap and hand sanitizers. 

Flu and other serious respiratory illnesses are commonly spread by cough, sneezing, or unclean hands.

    • Covering your nose and mouth when coughing or sneezing prevents the spread of a virus.
    • Handwashing (with soap and water) for 20 seconds reduces risk of infection. (https://www.cdc.gov/handwashing/videos.html).
    • Avoid touching your eyes, nose, and mouth. Avoid close contact with someone who is sick. Please refer to the most recent email blasts on updates, distributed 2/5/2020.
Isolation and Quarantine are not currently recommended for asymptomatic individuals.
Anyone seeking evaluation based on symptoms plus travel/exposure in the last 14 days should make their first contact by phone (Public Health Department, Student Health Services, or Primary Care Provider) to limit the exposure of other people until a decision can be made over the phone about the need and location for testing. If testing is recommended, you should isolate yourself to avoid exposing others. Cover your mouth and nose with a mask, scarf or other fabric if you are told to leave self-isolation for testing.
In the event of a PCC student testing positive for the 2019-nCoV, the patient would receive appropriate medical attention and would be under monitoring of Public Health officials. The Public Health officials will determine which other persons should be evaluated as close contacts. 
It's hard knowing people you care about are in the middle of a very scary situation far away. We know that this has been a difficult time for many members of our college family. Please know we are here for you and encourage you to reach out for support. If you want to meet with a counselor, please call 626-585-7273.

You can also help your family back home by letting them know you are taking good care of yourself. The best advice for not getting sick is to practice frequent handwashing and staying out of close contact with people who might be sick. Let them know you are well, and it may comfort and reassure them. As opportunities to assist become available, we will share these with the community. 
No, the flu shot is formulated to match influenza viruses expected to be circulating in the United States during the 2019-2020 flu season (Los Angeles County is currently seeing a rising number of cases, so please get a flu shot if you have not already done so). The influenza virus is a different virus from the coronavirus. The coronavirus has many genetic variants, including the “common cold” that generally does not present serious adverse health risks.
Students coming to Student Health Services with fever, cough, or shortness of breath will be given a mask to wear. Cover your mouth and nose with a scarf or other fabric, if you do not have a mask.
Wearing face masks routinely is not recommended for people who are not sick. Masks help sick people reduce spread of illness to others but are not very effective protection for well people.
Remember that hand gel does not replace handwashing with soap and water; handwashing is a more effective way to reduce the spread of infection.
There are no dietary restrictions related to viral infections.
The most updated current information on the 2019 Novel Coronavirus, as it presents in the United States, will come from the federal public health agency, the Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/index.html. If we receive additional local advisories for California or Los Angeles County, we will provide updates to our campus community in electronic forms.

For reliable information, go to:

Additional Resources, go to:


2/5/2020 Update

This is intended as an update to the information posted on 1/31/2020 to enrolled students, faculty, and staff.

To date, there are no new cases in LA and Orange County. There are 4 new cases in/near the Bay Area bringing the California total to 6 cases. As of 7pm on 2/4/2020 there are 11 cases total in the US.

If you have a fever, cough or shortness of breath AND have traveled from China or been exposed to a confirmed or suspected case of 2019-nCoV in the last 14 days, you need to be evaluated and should do so as soon as possible. Faculty and staff should consult their primary doctor or the Public Health Department for their residence. Students should consult their primary doctor or the Public Health Department for their residence or Student Health Services (626-585-7244). 

GeoBlue has added new free services for covered international students. See the attached documents about how to access their Global TeleMD service for telephone medical consultation as well as their Global Wellness Assist telephone counseling. 

Anyone seeking evaluation based on symptoms plus travel/exposure in the last 14 days should make their first contact by phone (Public Health Department, Student Health Services, or Primary Care Provider) to limit the exposure of other people until a decision can be made over the phone about the need and location for testing. If testing is recommended, you should isolate yourself to avoid exposing others. Cover your mouth and nose with a mask, scarf or other fabric if you are told to leave self-isolation for testing.

If you have traveled from China or have been exposed to 2019-nCoV and have no symptoms, please watch for symptoms for 14 days after travel or exposure. There is no reason to isolate you or refrain from usual activities. 

As stated before, the best way to avoid acquiring or spreading all viral infections is to:

  • Wash your hands frequently; soap and water for 20 seconds are more effective than hand sanitizer
  • Avoid touching your eyes, nose and mouth
  • Stay >6 feet away from others if you or they are sick
  • Cover your nose and mouth when coughing or sneezing with your sleeve or a mask, change masks when they are wet and if you use a tissue, throw it away after use and wash your hands

Masks help sick people reduce spread of illness to others but are not very effective protection for well people.

If you haven’t gotten the 2019-2020 seasonal influenza vaccine yet, we recommend that you do. Influenza can be prevented or reduced in severity by vaccination.

For reliable information, go to:

Additional Resources, go to:


1/31/2020 Update

Coronavirus Info Sheet

There is only one identified case of 2019-nCoV in LA County and one in Orange County, neither with any known connection to PCC. The local public health officials (Pasadena Public Health for issues in Pasadena and LA County Department of Public Health for all other parts of LA County) conduct "contact tracing" with all identified cases in their coverage area, and proactively contact any individuals who might have had an exposure. They follow individuals who may have been exposed and do testing if needed.

There are only 6 confirmed cases of coronavirus in the US as of 1/30/2020. There has been a FAKE LETTER claiming an outbreak in Carson in addition to multiple inaccurate social media posts. If you want reliable information go to:

If there are new cases in Pasadena or LA County, the relevant Public Health Department will issue a press release.

If you have fever (>100.4°) or cough or shortness of breath AND have traveled from China or have been exposed to a suspected or confirmed case of coronavirus in the last 14 days you should be evaluated. The location of greatest concern is Wuhan but the decision to do testing may be expanded to Hubei Province and other parts of China in the near future.

If you have traveled from China or been exposed to a suspected or confirmed case of 2019-nCoV case in the last 14 days but have NO symptoms, your job is to watch for symptoms. There is no reason to isolate you or refrain from your usual activities.

If you believe you meet the criteria for evaluation, you should wear a mask and call your medical provider before you show up so that they can make preparations for the evaluation that limits the exposure of other persons. Students can call Student Health Services at 626-585-7244 during the hours we are open. Faculty and staff should contact their medical provider.

It may be appropriate to seek evaluation at an Urgent Care or Emergency Room if your primary medical provider is unavailable and any of the following apply to you:

  • your fever does not go below 100°, even temporarily, despite the use of fever reducing medicines within 48 hours
  • you have an underlying illness such as diabetes, asthma, emphysema, immunosuppression, etc., that put you at risk for more severe illness
  • you are increasingly short of breath with minimal exertion

The best way to reduce your risk for acquiring or spreading ALL VIRAL INFECTIONS is to:

  • wash your hands frequently; soap and water for 20 seconds is more effective than sanitizer
  • avoid touching your eyes, nose and mouth
  • stay >6 feet away from people who appear to be ill
  • cover your nose and mouth when coughing or sneezing with your sleeve; if you use a tissue, throw it away after use and wash your hands

Masks help sick people reduce spread of illness to others but are not very effective protection for well people.

Like many other viral illnesses, the primary treatment for infected persons is supportive care (plenty of fluids, rest, avoid sharing a room with others whenever possible). The vast majority of people with 2019-nCoV will not need to be hospitalized and there is NO ROLE for antiviral medications in ambulatory patients at this time.

If you haven't gotten the 2019-2020 seasonal influenza vaccine yet, now's the time to do it. As of the week ending 1/11/2020 the CDC was estimating 13 million cases of flu, 120,000 hospitalizations for flu and 6,600 flu-related deaths in the US. Those numbers are far beyond what we have any reason to expect to see with 2019-nCoV based on what we currently know. We will provide updates as they become available.

Clinic Physician:  Ann Walker, MD
Director of Health and Wellness: Quinn Tang, DHSc., PA-C