Today, after weeks of "radio silence", I have finally added the following banner to the Coronavirus pages of my website:
PLEASE NOTE, DUE TO MANY INCONSISTENCIES IN THE INFORMATION AVAILABLE ABOUT THE VIRUS (INCLUDING INFORMATION FROM THE OFFICIAL SOURCES AND FROM THE SCIENTIFIC STUDIES), I HAVE DECIDED NOT TO SHARE ANY ADDITIONAL DETAILS ABOUT THE VIRUS FOR THE TIME BEING.
I WILL RESUME AS SOON AS SOLID DATA BECOMES AVAILABLE.
THANK YOU FOR YOUR UNDERSTANDING!
IF YOU HAVE ANY SPECIFIC QUESTIONS, I AM STILL OFFERING INDIVIDUAL CONSULTATIONS:
HERE ARE SOME OF THE REASONS I STOPPED WRITING ABOUT THE VIRUS IN A Q&A FORMAT:
Q: Is the information we hear on the news accurate?
A: Not always. (This includes "right", "left", "conspiracy", and "independent" news sources.)
Q: Is the information coming from the WHO and CDC accurate?
A: Not always. This is my conclusion after reading the actual scientific studies that WHO and CDC are using to make their guidelines. Many of the SARS-CoV-2 guidelines have been inherently flawed.
Q: Is the information from the White House accurate?
A: Not always. With that said, I believe that it is important to pay close attention and to read between the lines, since in addition to WHO, CDC, and the experts, the White House also relies on intelligence sources. PS: It takes a calm and neutral mind to read between the lines, so I believe it's essential to stay open-minded and apolitical if we want to HEAR anything.
Q: Are there fake profiles on Facebook and other social media that propagate misinformation?
A: Yes. I've come across them personally. It is important to point out, that the fake profiles are not specific to any one camp - they are present across the board. So just because someone's post aligns with most of what we believe or want to believe, it might not be real and had been simply set up to propagate fear and the division in our society.
Q: Are there any scientific studies that are published to propagate a specific agenda?
A: Yes, I believe so.
Q: Have you been blocked by Google when searching for COVID-19 treatments used in other countries?
Q: Have you been blocked by Google when searching for SARS-CoV NIH research grants from the mid 2000s?
Q: Have you video captured being blocked?
A: Yes, I have. That video has been blocked.
Q: Have any of your neutral, unbiased, posts with apolitical information about Coronavirus been blocked or deleted by Facebook?
Q: Has Facebook prevented you from adding this website to your FB page?
Q: Has any of the Coronavirus data you've published been misrepresented and then praised while being falsely inflated by the media?
Q: Has the same exact information been misrepresented and then discredited by the experts interviewed by the media?
Q: Have you been falsely quoted by the media (by journalists who never spoke to you or contacted you in any way)?
Q: Have you come across fake doctor profiles on Facebook that proliferate fear in our society, including among other physicians?
A: Yes, it appears that some physician profiles in some of the Facebook COVID-19 doctor groups are fake
Q: Have you uncovered any disturbing information about the virus and about the pandemic?
A: Yes. I do not feel comfortable sharing a lot of it, but some of this information is beginning to surface on its own.
Q: So are the conspiracy theories true then?
A: Some parts of what's considered to be "conspiracy theories" might actually be true, yes.
Are you worried that you could be discredited as a doctor if you continue sharing what you are discovering?
A: Yes. When I started writing about the Coronavirus, my goal was to share unbiased medical and scientific facts with the public and with the healthcare providers. It has become progressively more challenging to discern truth from fiction. The information keeps changing on a daily basis, and I certainly do not wish to share something today that will end up being incorrect tomorrow. I do not wish to add additional confusion in a setting of a wide-spread disinformation. I believe that it is wiser to review what we discovering over time and then to form a scientific/medical view that can be shared. I am taking this time to reflect and to form a more informed opinion. I will share more with you, as I uncover more of the solid facts.
SO WHAT CAN WE DO IN THIS CHAOS?
Have questions? Can't find answers? I can try to help - I am still offering individual virtual consultations:
THINGS HAVE BEEN PRETTY BAD FOR A WHILE...
Scroll down to a section in blue below to read one doctor's experience.
Thousands are doctors around the country have their hands tied by their hospital administrators. General public is largely unaware or non-medical professionals impact patient care.
Doctors have been facing and reluctantly complying with growing impositions from a wide range of sources. Here are some examples:
- insurance companies limiting the ability of doctors to prescribe medications that would be ideal for an individual patient and many insurance companies pay doctors laughable amounts for the work they do (trust me on that)
- medical coding system (each diagnosis and procedure has an assigned number, and many of the diagnostic code names make very little clinical sense
- electronic medical record systems (the vast majority of which have completely altered the normal physician workflow and how we gather, process and share information with each other)
- legal field (there is always a possibility of being sewed even if you did ABSOLUTELY NOTHING wrong)
- hospital systems that work their doctors to death (if you don't know many doctors, that's because they are probably always at work and only socialize at the expense of sleep or some other vital necessity)
- ridiculous board exams, which in no way correlate with whether or not a doctor is knowledgeable and does an amazing job at caring for his or her patients (these exams take many weeks of study of random information we rarely use in real life, and take us away from patient care; not to mention, most of them are over $1,000 each (+ a few thousand for a prep course + $1,000 if you have to retake it) and have to be taken every 5-10 years.
For at least a few decades, doctors have been working on fumes (most work 60+ hours/week, many even more - I personally have regularly worked 100+ hours per week). We do not get enough sleep. We often don't have time to eat. I can't tell you how many times nursing staff would sneak in a plate of food in front of me while I was documenting patients histories patient charts, because otherwise I would not eat at all in the 9+ hour shift. I simply did not have time (trust me it was not by choice!). I can't tell you how often, as I was leaving work, I would realize that I have not had time to go to the bathroom. At all, in a 10 hour day! All of this is so wrong and unhealthy, but for many of us, it's our reality. Sadly, I am not an exception... Many doctors around the country will tell you similar stories.
The sad part is that things have been getting worse and worse every year. It's true that we now have work hour limitations have been placed onto resident and fellow physicians (doctors in their first years of working as physicians - no more than 80 hours/week and 24 hr/day of patient care [not including charting, lectures, etc, etc]. So yes, resident and fellow physicians do work a little bit less now than before, but as soon as you are done with residency or fellowship, this rule no longer applies. So yes, it's madness.
Going back to my point. Things are getting worse every year. Doctors are too busy taking care of patients, simply don't have time to fight the overwhelming force of external forces that ultimately impact how we care for our patients. Thus far, we've been able to adjust, each of us figuring out was to "work around" the system in order to deliver the best possible care to our patients.
Today, these major external forces have surpassed every boundary. Today, during this tragic pandemic, doctors are literally being forced to do the wrong thing! Many are threatened by being fired if they don't comply. I literally see hundreds of horrifying posts from doctors in private Facebook groups every day. The vast majority can't do ANYTHING to fight this!
Doctors are in a horrible position because they have an obligation to their patients, and even when hospital administrators do not provide doctors with proper masks, doctors are still going in because they can't let their patients die!
It is wrong for non-medical professionals to dictate how doctors should do their job. You want doctors, not administrators making medical decisions.
It is obvious. It is common sense. And yet, now more than ever, we have reached an unprecedented level of admitrators controlling patient care.
Please read one doctor's story below. Please share it.
WHAT'S HAPPENING NOW. A DOCTOR'S EXPERIENCE.
"Mostly venting. And physically sad/angry/upset at my hospital’s response to COVID. Here’s my two specific examples. (I’m FM) [Family Medicine Doctor]
1. Radiology is being told by administration that they can’t use the word COVID in their reports. It’s “scaring staff”. So they can’t say in a CXR [Chest X-ray] report “patchy bilateral infiltrates consistent with COVID,”. They just have to stop at “patchy bilateral infiltrates.” Same for CT scans, which to my knowledge, can be nearly diagnostic of COVID. We do not do this for other diagnoses. We would not hesitate on a mammogram to describe a breast lesions and say “highly suspicious for malignancy” or describe the pancreas on CT and say “consistent with pancreatitis.” Also, if/when our patients get transferred to outside hospitals, and only the imaging report goes, not the images, the receiving doctors will need to read between the lines.
2. There are two small hospital systems in my entire county. On Friday, the media reported that my county had the first positive confirmed case. The two hospitals released a joint statement saying that The case was not at either one of the hospitals. This confused me. Then my Hospital went out of his way to make another statement on Saturday again reiterating that the case was not at our hospital. However, I know that my hospital like we has four or five pending cases. I’m angry that my hospital system is either trying to deceive the public, downplay the situation, or make it look like we are still a safe place to come because COVID “is not here”. Or maybe there’s another tactic that I don’t understand. But I don’t like it.￼￼￼￼￼"
Family Practice physician
(Publishing anonymously per doctor's request)
Administrators can’t tell us how to do our jobs. If the radiologists stop using the phrase “consistent with...” it may potentially affect clinical decisions that other doctors will be making (those who provide direct patient care based on on the the radiology reports). Which means, if radiologists comply with what hospital administration demands of them, it may cost people’s lives.
Our primary obligation as doctors is to our patients, we all gave a “do not harm” oath. This obligation is much stronger than any other duty we have to our employers, or others who impede good patient care. We have never in our careers had to experience such a discrepancy between what we are told to do and what is right. On top of that, doctors who are trying to do the right thing, are being threatened with being fired.
Here is the thing. It's not that doctors are afraid to lose their jobs. No, they are not thinking about themselves. Doctors are concerned about patients and who will take care of them if the doctors are not there. They do not want to be forced to abandon their patients because the hospital administration is making wrong decisions.
That's why doctors find all this to be so overwhelming. They are stuck between a rock and a hard place.
As you read these words, I hope you can understand the tough position the doctors are in right now.
If doctors don't have the right masks or other protective equipment, they should not be treating patients potentially exposing them to the virus. Please refuse to be seen by a doctor (or any healthcare provider) who is not properly protected.
Doctors should not be told by their hospital administrators how to their job. Doctors should not be risking their jobs if they are doing what's right.
Don't let some bureaucrat decide your fate and the fate of your doctor.
Please help your doctors. They are there to help you. They put their lives at risk to help save yours. Ask your doctor what you can do to help.
If you see something like this happening in your community, please talk to the press! The doctors can't help themselves right now. They need you to help them take care of you the right way.
Please share! People have to know!
CHEETOS AND GLITTER
Now that the State of California is officially on "Lockdown", many people are trying to figure out how to stay home and how to get everything delivered.
Although many California residents have been able to switch to various restaurant and grocery delivery services, the majority of us is still having a hard time figuring out how to handle the "sterilization" procedures for all the "incoming goods". How do you even order a pizza these days?
We have to wash our hands every time we come in contact with something that has been potentially contaminated, but in a practical sense, how do we go about doing it?
It is certainly a conundrum!
There are so many questions that come up. Is it safe to eat the food? What about cash tips? What needs to be disinfected? How? Of course there is a million points of view on the internet, but in reality, no one really knows exactly!
So here we are... Welcome to the 2020! (Everyone kept saying last year, "Oh, 2020 is going to be so much better!" I really don't know where they get their information, by people really need to start using better sources!)
But I digress... Back to the pizza delivery challenge... (Sorry, for another tangent, but have you ever thought that you would have to consult multiple experts before ordering a pizza? You have to admit, it is a little bit humorous!)
So what should we do?
Imagine you get some food delivered. If you come in contact with the person who is delivering your food or grocery items, try to keep a distance of at least 6 feet. My advice would be no cash tips or paper receipts. Hopefully, the service that you use will have better alternatives. Yes, may feel awkward and uncomfortable, but these are the times we live in. It's not easy, but we can still smile at each other and wave, it's a matter of being smart, not fearful.
I am going to compare our current situation to being at risk of exposure to glitter or cheetos (disclaimer: I love both), and if you have ever come across either one of those, you know exactly what I am talking about! Have you ever received a glittery holiday card or overindulged in Cheetos? You know that you had to keep washing your hands to get the glitter or the cheetos dust off - same is true now, we need to keep washing our hands - it is as if the whole out there, everything outside of your home, was covered with Cheetos and glitter! If you keep that in mind, it might help you figure out how to handle your deliveries, and especially the importance of washing your hands and keeping them clean.
So let's say your items have been delivered in bags or in a cardboard box. How would you unpack it if it was covered in glitter and you didn't want it in the house? I can tell you, the CDC does not have an answer! So you just have to use common sense.
Jokes aside, here is some information that you might find helpful.
From what we know as of right now, SARS-CoV-2 (the coronavirus that causes COVID-19) can stay around on various surfaces for some time:
So be mindful of that.
Personally, I set my non-food deliveries aside to be opened later - for at least 24 hours or longer depending on the contents. You certainly don't want to wait for days when you are getting your food delivered - so for food and perishables, be prepared to do some extra handwashing and extra disinfecting, followed by more handwashing.
As far as the food itself, based on what we know now, you cannot contract the virus by eating something. We will know more over time, and I will continue sharing information with you if anything changes.
In the meantime keep washing your hands for at least 20 seconds after you touch anything from outside (or use 60%+ alcohol-based hand sanitizer if you don't have access to soap and water).
Hope this helps :)
Please stay safe!
- Dr. Danilychev
PS: Just for laughs: "Cheetos interrogation"
PPS: I miss Cheetos!
EXPERT VIEW ON VIRUS TRANSMISSION
I spend hours going through all the available data on SARS-CoV-2, the virus that is causing current pandemic, I also communicate daily with front-line physicians and experts, who understand this disease better than all of us.
Many of these frontline physicians are not able to share their experiences publicly out of the fear of retaliation from their hospitals' administration and also out of concern about the reaction of the public. In the end, this important information needs to be shared so that the people can make educated decisions about how to protect themselves and how to help protect their healthcare providers:
Below is a letter from one of the doctors, whom I consider to be an expert :
A LETTER FROM AN EXPERT
"I have debated whether to post about my suspicions regarding airborne transmission of SARS-CoV-2 and COVID-19, whether I’d be causing unnecessary panic over something we can’t do a whole lot about. I think it’s time.
There is much I can’t say in public that’s scaring the crap out of me and keeping me up all night. Those of you who know me well, know that I research exhaustively and am very logical and data driven. The data is bad.
I am the lead author of several publications on aerosol deposition in the airway. So when I talk about aerosol inhalation, I have more in depth understanding of this than most physicians. Not all—some know a lot more than I do. But most.
Airborne vs droplet precautions are archaic.
Airborne precautions require healthcare workers to don previously fit tested N95 masks or PAPRs (powered air purifying respirators), in addition to eye protection, gown, and gloves. Fit testing, which must be done before a healthcare worker can safely use N95 masks, ensures no air can be inhaled through gaps between the wearer’s skin and the edge of the mask. This is critical. Droplet precautions require a regular surgical mask, gown, eye protection, and gloves.
Airborne transmission relates to an infectious agent’s ability to infect others at a significant distance through aerosols. Aerosols are small particles of potentially infectious material generated by coughs and sneezes.
Aerosols remain suspended in the air for some time. They don’t immediately fall and land on surfaces like the larger particles, droplets, do.
Aerosols suspended in the air can infect others in close proximity, even if a disease is not classified as “airborne.”
We know the coughs of a healthy person generate aerosols. not just droplets. We know viral infection (specifically influenza) can increase the percentage of small aerosols generated by a cough. We know small aerosols penetrate deep into the lungs. This is thought to be a mechanism by which influenza enhances its transmission from host to host. SARS-CoV-2 might be able to do the same. We just don’t know yet.
Small aerosols <= 5 micrometers reach the lung alveoli when inhaled. That means the deepest lung tissue, where gas exchange occurs.
SARS-CoV-2 remains viable in the air for hours, at a minimum, when aerosolized in vitro. And it is postulated that the method of transmission on cruise ships may include true airborne, through the ventilation systems.
A regular surgical mask doesn’t protect the wearer against aerosols. It only helps to protect against droplets, for those in close proximity to expelled airway secretions. It also helps to keep the wearer’s own droplets in, to protect others and to maintain sterility. But it won’t stop anyone from inhaling aerosols
Asymptomatic and mildly symptomatic people are contagious, as are their coughs. They probably don’t know they have COVID-19, and probably aren’t socially isolating. The cases we know about are just the tip of the iceberg. You’re probably breathing the virus in from someone’s cough, even if you don’t know it, as well as contracting it through contact with droplets, contaminated surfaces, and possibly the fecal-oral route. If people don’t start DRASTICALLY socially isolating, we have no hope of flattening the curve.
HEALTHCARE WORKERS NEED N95 OR PAPR DEVICES NOT TO DIE. Please help by contacting your local, state, and national representatives, as well as philanthropists, to make them aware of the urgency of our need. And please, please stay home and stay away from others. Your life, the lives of those in close proximity to you, the lives of those you meet in passing, the lives of healthcare workers who may treat you, and their families’ lives, depend on it. Thank you."
Anonymity preserved per doctor's request
As of 03/20/2020 we still don't know enough about Coronavirus transmission.
From my personal extensive analysis of the available data (references are available on this page) it is clear to me that the virus can be transmitted in the following way:
Additionally, it appears that SARS-CoV-2 (the Coronavirus responsible for this pandemic)
Check out a litter from an expert on the subject of transmission. It is really eye-opening...
CLICK HERE to view the blog post with the letter.
Please take the time to read the letter. It is important. Please share it as well.
WHAT IT MEANS FOR YOU
Be conscientious about your own hygiene and take active measures to protect yourself and others:
I know this is a lot to take in, but it will save lives.
I am sorry if the information keeps changing all the time! I will do my best to continue keeping you updated.
With love and care,
Dr. Maria Danilychev, MD
P.S.: Below are some images that may help makes sense of all the PPE (personal protective equipment)
PERSONAL PROTECTIVE EQUIPMENT
When around people outside of your home:
To protect yourself from droplets in case some coughs or sneezes on you (and to protect the others from your own accidental cough or sneeze), you can use a scarf if you are not sick and a mask if you are (PS: please don't go in public if you are sick):
PPE for healthcare workers
If you are sick at the hospital with a respiratory infection, you want all your doctors and care providers to look like the BEST photo above in the ideal case scenario.
Which masks are currently provided to healthcare workers? Very few get PAPRs, many do not have access to N95s, some healthcare workers don't even have enough regular masks, any many are instructed by their hospital administrators to wear suboptimal protective equipment to avoid "scaring" the public. Honestly, I would be more scared of a doctor who is unprotected and may be passing germs around, then the one who is fully "suited up".
Please do whatever you can to help! You don't want people in the front lines to start getting sick and dying. Who is going to help the rest of the people?
Physicians are notorious for being really bad at advocating for themselves. I've been asking everyone how is not adequately protected by their healthcare organization to speak up, but very few people are doing it. It will take a public outcry to for this horrible situation to change.
I am doing everything I can to increase public awareness of this issue which is largely hidden from the public eye and which is not being adequately addressed.
Please spread the word! Please find ways to contribute PPE to healthcare workers near you!
A MESSAGE OF ENCOURAGEMENT
I just wanted to tell you just how happy I am that I am able to contribute to your lives with the information on my blog and this website.
Every day I review scientific literature and communicate with doctors who are treating the disease and try to piece it all together for you. I hope that it helps you make sense of this confusing virus and the disarray that it has created in our lives.
What started out as one simple blog post about this pandemic, has now taken over my whole website :) It's amazing that I've been able to gather so much information - I never expected for it to happen!
Since my site grew so rapidly, I am reorganizing it a little bit - to make it easier to find information. So if you notice that some of the pages look a little different or being moved around, that's why it is happening.
I am sure you've come across a lot of conflicting information in the media. It's not surprising - this particular Coronavirus in only a few months old, and we know very little about it.
Most doctors who are on the front lines dealing with the disease are working day and night and don't really have much time to publish their results. In fact, it's a miracle that this much data is becoming available. I am going through hundreds of pages of information every day and try to find the most accurate details for you.
These are confusing times, and we are all learning how to deal with this virus as we go along.
Epidemiologists are trying to help us contain it.
Governments are trying to balance scientific advice with somehow salvaging collapsing economy as well as preventing chaos without infringing on people's essential freedoms.
Doctors are trying to figure out how to treat it.
Healthcare organizations are trying to deal with the rush of new patients while protecting healthcare workers from getting sick, and managing limited supplies of testing kits and equipment.
All of us, humans, are trying to figure out how to live in the new crazy world! The world, in which everything became so different practically overnight! It's trial and error time!
This pandemic is quite overwhelming for most people. In spite of that, there is a certain lightness in the air. Talented people who used to be in the shadows are stepping up, shy folks who went along with what they didn't agree with are speaking up, people are helping each other, making each other laugh, many people are feeling more connected regardless of being more isolated - a spiritual transformation is happening in the world!
I believe that something magical will come out of it all. After the pandemic is behind us, from all the chaos we will re-emerge as more thoughtful, kind, and caring human beings, and our beautiful Earth will feel healed.
So I just want to send you some encouragement.
We are going through tough times, but we are doing it together. You are not alone. You are loved. Stay informed. Stay safe. Follow all the social distancing and hygiene rules, and simply take it day by day.
This is our time to pause, to reassess, to find inner calm, to see the beauty in ordinary things.
With compassion and love,
- Dr. Maria Danilychev, MD
THE INFORMATION ABOUT CORONAVIRUS KEEPS CHANGING VERY RAPIDLY AND BECOMES OUTDATED LITERALLY EVERY DAY. SO I AM NO LONGER UPDATING THIS BLOG POST. INSTEAD, WHAT YOU ARE LOOKING FOR CAN NOW BE FOUND ON THE HOMEPAGE OF THIS WEBSITE
ORIGINAL BLOG POST (NO LONGER UP-TO-DATE)
Disclaimer: I am sharing this for informational purposes, anything in this blog it is not meant to diagnose COVID-19 or offer treatment advice. Please contact your doctor if you are sick.
WHERE DID THIS VIRUS COME FROM?
There are many coronaviruses in nature, most cause infections in animals and humans (generally respiratory infections). This particular coronavirus is "novel" (new) - it was not known until December 2019 when it caused the first outbreak of a respiratory infection in Wuhan, China.
It appears that this particular virus comes from an animal (the exact source is uncertain), but it also appears that at this point, the virus is transmitted exclusively between humans.
WHAT IS THIS CORONAVIRUS ACTUALLY CALLED?
This new coronavirus is called “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2).
The disease that this virus causes is called “coronavirus disease 2019” (COVID-19)
Note, that most people may call the virus and the disease “coronavirus”, but the medical terms are SARS-CoV-2 and COVID-19 respectively.
WHAT ARE THE SYMPTOMS?
This particular coronavirus causes respiratory symptoms, fatigue, and not feeling well in general:
If you or someone you know have the following symptoms, those are symptoms to be concerned about:
The symptoms above are most typical, but other symptoms may also be present. Please consult a doctor for diagnosis.
HOW IS THIS DIFFERENT FROM A COLD OR A FLU?
Symptoms-wise, neither common cold, nor flu would normally give you shortness of breath.
Also, this coronavirus supposedly does not cause nasal congestion or sneezing - so if you have those symptoms it’s unlikely that you have the virus.
But it's not just about the symptoms. Please continue reading, and it will make sense.
WHAT SHOULD I DO IF I AM SICK?
CALL IN FIRST to your doctor's office or a designated phone number in your town/city/region. Don't go to see your doctor directly until after you call in. It will allow the clinic to take appropriate precautions.
If you are severely ill, Call 911 (or a specific coronavirus-designated emergency number in your area).
CLICK HERE for official recommendations from Centers For Disease Control.
HOW SEVERE ARE THE SYMPTOMS?
Most cases are mild. In mildest forms of the disease there are minimal to no symptoms.
In more severe form, the disease causes a serious lung infection / pneumonia that may be life-threatening to the point of requiring life-support in intensive care unit.
According to the World Health Organization, 1 out of every 5 infected patients requires hospital care.
HOW LIFE-THREATENING IS IT?
The exact mortality rates from COVID-19 may vary from country to country, but overall, the mortality rate is somewhere between 3 and 4% (out of 100 people infected with the virus, around 4 people may die).
Officially, as of 03/13/2020, World Health Organization is estimating the overall mortality rate at 3.4%. However, this number will depend on many factors - it will vary by region based on the overall health of the population, and on the preparedness of the local healthcare system. So far no children under age of 10 have died. I will keep this section updated as more information becomes available.
Time from first symptoms to death may be as short a few weeks.
Mortality tends to be higher in the older patients (age >70), smokers, people with multiple underlying health problems such as heart disease, diabetes, chronic lung disease, high blood pressure, cancer, and obesity among others. Mortality appears to be slightly higher in men comparing to women.
WHO CAN GET SICK FROM CORONAVIRUS?
Any person can potentially get sick from SARS-CoV-2
Based on the information available today (03/16/2020), our animals, including household pets, are not susceptible to this virus and should be safe.
HOW LONG DOES IT TAKE TO SHOW SYMPTOMS?
Symptoms may begin anywhere between 1 day to 2 weeks (and possibly even longer) from the time of being exposed to the virus.
In most cases, it takes about 5 days from the time one contracts the virus till the symptoms appear. In some cases it can take just a few days; however, it is possible for it to take longer to develop symptoms.
In 99% of people will have the symptoms appear in less than 14 days from the exposure. During this period of time (“incubation period”) the infected person may have no symptoms but may still be contagious infecting others.
There have been cases reported of symptoms developing even three-four weeks after known exposure; however, it is possible that this was due to double exposure, meaning that people were exposed twice during those three weeks.
Currently, anyone who has been exposed to the virus, should be in a 14-day-long quarantine/isolation in order to prevent potential spread of the infection.
HOW DOES THE VIRUS SPREAD? WHAT CAN I DO TO PREVENT THIS?
The virus spreads through cough, sneezing (so if someone is sick they should wear a mask to protect others).
When the virus lands on surfaces, it can be contagious through touch (if a person with the virus touches something, that object may be contagious for hours after). So if you touch the object with this virus on it, and then touch your face (eyes, nose, mouth), you can get the virus. That’s why it’s important to take various precautions such as hand washing, using hand sanitizers, and keeping everything clean - disinfecting surfaces. Also, it's important to avoid touching your eyes, nose or mouth.
So basically, it is important to use all the normal precautions that we should be using anyway in our everyday lives but often don’t. AND don’t touch your face! (which is easier said than done)
As far as hand washing it should be with soap and water and for at least twenty seconds (sing the “Happy Birthday” song twice for good timing). When soap and water are not available, use hand sanitizers with at least 60% alcohol.
You can use bleach-based disinfectants on surfaces, but NOT on your body.
WHAT SHOULD I DO IF I DON'T HAVE SYMPTOMS?
If you don't have any symptoms and have not been exposed to the virus as far as you know, and if you live in a region where there has been at least one case of COVID-19 (basically, if you live anywhere in the world), I would recommend the following:
Yes, this sounds extreme, I agree, but not only this would lower your risk of getting infected, but it will also slow down the spread of the disease in the community.
In Italy, people felt the same way (were not taking the virus too seriously), until the government finally put the whole country on lockdown. Unfortunately, it was a few weeks too late.
Let's learn from the mistakes of others.
Our governments have a tough job at trying to control this emergency - they are trying to prevent panic and may have other reasons to suggest only mild and partial restrictions at this time.
We, global citizens, don't have to wait for our governments to take extreme actions too late, we need to take responsibility, and do the right thing NOW to help slow the spread of this virus.
PLEASE DO THE ABOVE! TRUST ME ON THIS!
Don't worry about work, meetings, bills, birthday parties, credit cards, business, etc. - we are talking about hundreds of thousands of deaths that could be prevented if we do this before our governments have to force us to do it weeks from now.
PLEASE DO THIS NOW.
WHY SHOULD WE CARE ABOUT THIS VIRUS?
The issue with the virus is how fast it spreads, that we don’t have immunity to it, and that there is no treatment or vaccine available at this time.
Unfortunately, as a global community, we have missed a chance to prevent the spread of the virus. The prevention challenge lies in the fact that people with no symptoms could be infecting others and unless an extremely strict quarantine is followed (like they’ve eventually done in China and now in Italy) there is no way to monitor or control the disease outbreak.
The other challenge in the US is that until 03/12/2020 very few test kits and labs that can run the tests. So only sick patients who had either known exposure or known travel history to high-risk countries were tested, which likely means that many patients who did contract the virus but didn't travel and didn't have a known exposure were not diagnosed and were in the community as everyone else, potentially exposing others to the virus.
The other challenge is that most societies will not be able to create the environment where all citizens will stop contact with each other. Each government will have to make difficult choices regarding this and find a nearly impossible balance between several critical aspects of this pandemic:
CAN I BE TESTED FOR THE VIRUS?
As of 03/16/2020, in the US, testing for Coronavirus depending on test kit and lab availability.
Testing is done similar to a flu test - by using a long q-tip type swab in the back of the throat and deep in the nose (it may be a little uncomfortable but not painful). The swab is then placed in a test tube and sent to a laboratory for diagnosis.
Drive-through test centers are being established throughout the country.
www.CORONATESTMAP.com is a free private website that will be adding new drive-through centers daily. Please check them out, and spread the word (Please contact them if know of a location that they haven't listed yet.)
If a person tests positive by the local laboratory, it is called "presumptive positive". The test must be then confirmed by the CDC, at which point if it becomes "confirmed positive". (Based on the information available to me at this time, CDC no longer requires confirmation from local test sites; however, I do not know whether it is universally true across all of the United States.)
If you feel sick, please call your doctor's office (for severe symptoms/illness call 911.)
WHAT ELSE CAN I DO TO PREVENT THE SPREAD OF THE VIRUS?
In addition to washing hands, using efficient hand sanitizer, not touching your face, and disinfecting surfaces, I would highly recommend avoiding places with many people (especially enclosed spaces). In fact, minimize all nonessential contact. In fact avoid any contact as much as possible.
When greeting people, do not hug or shake hands - wave instead. (All touch contact should be minimized to decrease the risk of spread of the disease. This may sound extreme, but keep in mind, the disease is mild in the vast majority of cases, but we just need to do our best not to infect someone who might not do so well.)
Additionally, although I’ve seen a wide range of recommendations on how far to stay away from people who have respiratory symptoms. It appears that there is a possibility to get the virus even at a 6 foot distance of someone (please note that most precautions recommend only a 3 foot distance). Personally, I would recommend a 6-foot distance, if possible. So if you or someone is coughing or sneezing keep at least 6 feet away.
SHOULD I WEAR A MASK?
Wearing a facemask/surgical mask is mainly useful if you yourself have symptoms, but it does not fully protect you from others who are sick. So if you don't have any symptoms, you do not need to wear a mask unless you are taking care of someone who has COVID-19.
WHO SHOULD BE IN ISOLATION?
If someone has been exposed to the virus and is asymptomatic, it makes sense to quarantine (be isolated from other people) for at least 14 days.
If someone has tested positive for coronavirus, based on what I’ve read in the scientific studies of the virus, I would lean towards a longer quarantine - around 6-7 weeks. The authorities of each region and country will determine what's not only scientifically sound but also feasible and realistic based on how the pandemic is unfolding.
In my opinion, every attempt at minimizing contact with other people is essential in slowing the spread of the disease. Remember, people who have contracted the virus may be infectious to others without showing any symptoms. I believe that in addition to avoiding sick contacts and staying home if we have any respiratory symptoms (and being tested for the virus when appropriate and possible), we should do everything in our power to minimize any potential virus transmission. Many places, local governments have requested cancellations of large events (250 people or more); however, this may not be adequate. The longer we wait to self-isolate the more people will end up dying.
IS IT AS BAD AS IT SOUNDS?
Unfortunately, yes, it is. We are underreacting, not overreacting.
On March 11th, 2020, World Health Organization has called it a pandemic - a major global disease outbreak
As of the morning of March 12th, 2020, World Health Organization is still being hopeful that we can contain the pandemic. Personally, I believe that we are past that based on the slow response from the authorities in different countries, including the U.S. The challenge now is not to “prevent” the pandemic - we are already there, to slow down the spread as much as possible so that the healthcare system doesn’t get completely overwhelmed and so that hospitals are not overflowing with patients.
In Italy they are running out of intensive care and hospital beds and other resources to the point that doctors have to decide who they are going to treat and whom they will let pass (so those with low chance of survival are no longer treated). As far as I know, there is now a major shortage of doctors in the North of Italy, so they have to work even if they themselves are infected with the virus and only mildly ill. Note, that there are fewer doctors per capita in the US than in Italy - so will might be facing the same scenario (if not worse) in the US in the upcoming weeks (fortunately that’s probably not the case here in San Diego, but we need to be prepared).
No need to panic about any of this, but each person must do his or her part in minimizing the spread of the virus. It’s is critical that we do this (it will save many lives).
Epidemiologists estimate that if the virus continues to spread at current rates, that what we are seeing now is only a tip of the iceberg. From what I’ve read and the from the graphs I’ve seen in terms of infection rates, it would not be surprising that this pandemic will continue into 2021, and I would expect a rapid increase in cases in the upcoming weeks. I am not an epidemiologist, but from what I understand, these types of pandemics that have not been contained from the beginning (such as this one) only subside after a large percentage of the population has been infected at which point we will begin to build up immunity. The fall in the infection rates will begin at that point. So it will get worse before it gets better.
Again, no need to panic. Just prevent, prevent, prevent. As much as we can!
Please use the resources that are available - websites of World Health Organization and CDC, local healthcare and government organizations, your doctor and local clinic. We are all in this together. We should try to support each other.
HOW MANY PEOPLE ARE SICK?
As of 03/16/2020 people in 172 countries have been affected by the disease.
The issue is not how many people are sick right now, but how quickly the disease is spreading - the numbers of infected and dying are rising exponentially every day. That's why it is such a concern and that's why we cannot approach like we would a cold or a flu.
The data below reflects total cases and total number of deaths. Please note, a better way of looking at this information is by looking at the number of cases/10,000 of the population of each country as opposed to the total number of cases. But in any case, if you are following this blog, you will see how rapidly the numbers are going up and it is a HUGE concern.
WORLD: 216,994 cases (15,744 new). 7,965 (817 new deaths).
CHINA: 80,84 cases (13 new). 3,237** deaths (11 new)
ITALY: 35,713 cases (4,207 new). 2,978 deaths (475 new)
IRAN: 17,361 cases (1,192 new). 1,135 deaths (147 new)
SPAIN: 14,746 cases (2,920 new). 638 deaths (105 new)
GERMANY: 12,327 (2,960 new). 28 deaths (2 new)
FRANCE: 9,134 cases (1,404). 264 deaths (89 new)
S.KOREA: 8,413 cases (93 new). 84 deaths (3 new)
USA: 8,055 cases (1,644 new). 127 deaths (18 new)
. . .
* Countries are listed by total number of cases (top 8)
** The number of deaths in China which I posted on 03/16/2020 was incorrect. I apologize for the error. Current data is accurate.
*** I am doing my best to report the numbers as accurately as possible, but the actual numbers may be different based on testing availability and reported data, but this is as close as we can get. Source of data is Worldometer. Numbers last updated on 03/17/2020 at 11:50 AM PST. (TBA = to be announced)
WHAT DO THESE NUMBERS REALLY MEAN?
These numbers mean the following:
WE ARE ONLY DAYS BEHIND ITALY!
Based on the available information about the rate of spread of the virus, experts believe that the United States is only 16 days behind Italy.
Take a look for yourself using this Online COVID-19 lag tracker tool.
When we connect the dots in the graph below, we can see that the pattern of the spread of the virus is the same in the US as Italy and other European countries.
If we follow the path of the graph, we can see that the number of cases is rapidly going up! Look at the numbers in italy, and your will see where we are going to be in a few weeks.
No need to panic, but it's important to know the reality and to take appropriate actions.
Approximately 2 weeks ago, the number of cases in Italy were more or less what they are today in the USA.
If everything continues as is, in approximately 16 days, we will have similar numbers of new cases and new deaths as Italy does now!
The Italians are sharing with us what they should have done - more drastic measures and sooner. We can't ignore this, if we want to prevent as many avoidable deaths as possible!
Time is running out!
WHAT IS A GROWTH FACTOR?
Growth Factor is an important number which tells us how things are going - whether the infection is on the increase or the decrease. Growth factor should be less than 1 and eventually 0.
This is how growth factor is calculated Growth Factor = new cases each day / new cases the day before. For example, if yesterday there were a 100 new cases, and today there are 150 new cases, the growth factor is 150/100 = 1.5.
We want the number of new cases to be less each day than the day before.
You can calculate the growth factor for your region to know whether to be relieved or concerned.
Based on how [slowly/inadequately] the governments around the world are responding to this crisis (I am sure to the best of their abilities), I would expect that the growth factor will be above 1 for several months around the world with an exception of only a few regions, unless drastic containment measures are instituted world-wide immediately.
P.S.: I am sharing this in an effort to raise awareness and yes, concern, but not panic. The more aware the people are, the more we can do to contain the virus as humanity. Worry has never helped anything.
Let's work together to contain this! Please do your part! Minimize contact with others, wash your hands, if you are sick self-isolate and see a doctor.
COVID-19 NEWS IN CALIFORNIA
California: officially 598 cases, 13 deaths.
Current official data from 03/17/2020 06:00 PM PST from State of California Department of Public Health.
On 03/15/2020, California Governor Gavin Newsom has urged people with chronic health conditions and senior citizens over 65 years of age to isolate themselves.
There is an online COVID-19 screening survey which is intended to help California residents find out whether or not they need further testing (in an attempt to expand access to screening). Thes tool is currently available to residents of Santa Clara and San Mateo Counties: https://www.projectbaseline.com/study/covid-19/
I will continue keeping you updated!
COVID-19 NEWS IN SAN DIEGO
San Diego County Residents: 51 cases, 0 deaths
San Diego Federal Cases (at Miramar Base): 5 cases, 0 deaths
Non-San Diego County Residents in San Diego: 4 cases, 0 deaths
TOTAL: 60 cases, 0 deaths.
This is current official data is from 03/17/2020. San Diego County updates the official numbers of its website daily around 4pm.
Testing for COVID-19 is available in San Diego. Although the exact testing criteria may differ slightly between different institutions, one can most definitely be tested if he or she has typical COVID-19 symptoms and has had travel history to the "hot zones" such as China, Italy, or Iran.
Turn-around for test results can be as few as 4 hours for inpatient location, and up to 48 hours or more for most outpatient locations (clinics, doctor's offices).
SAN DIEGO BREAKING (GOOD) NEWS
From San Diego County News Center:
"To slow the spread of COVID-19, the following guidance is being issued and is effective from March 17 through March 31, 2020:
WHEN WILL THIS VIRUS GO AWAY?
Unfortunately, based on various predictions from the experts on pandemics, most likely the virus will continue its "disruptive work" into 2021.
Most definitely, it will not be "just a month or two".
WHAT ABOUT A VACCINE?
You can come across social media posts that claim that a vaccine against the virus has been found. In my opinion, those statements are entirely false.
It takes many, many months to develop a new vaccine. I highly doubt that we will have a vaccine before 2021.
SHOULD I STOCK UP ON THE ESSENTIALS?
The idea is to isolate yourself from other as much as possible. If you are standing in line to get toilet paper "just in case", chance are you could be exposing yourself to the virus.
In my opinion, it is wise to get the basic essentials, but conser doing it without major exposure to crowds of people who are trying to do the same. Realistically, chances are, most basic needs of the population (at least in the USA) will be met during this pandemic. So don't panic.
Here is what San Diego County recommends to help prepare for the pandemic.
ARE TRAVEL BANS HELPFUL?
Limiting travel is most definitely helpful. However, partial travel restriction will not solve the problem.
I would recommend NO travel, local and domestic, even if it is not restricted by the government.
Keep in mind, the government has to keep a balance between what's necessary to contain the virus vs. what's realistic. So we, the citizens of the world, can take on some of the burden off our governments' shoulders and self-restrict travel as much as possible.
Let's stop the spread of this virus!
NON-HEALTH "SIDE EFFECTS" OF THE VIRUS
Sadly, there are several predictable, and distasteful non-health-related "side effects" of this virus:
Please be mindful of this, and please help those who are not email or online new savvy avoid these traps.
WHAT ABOUT ALL THE CONSPIRACY THEORIES?
At this point it does not matter where the virus came from or who was responsible. At this point the only thing we should worry about how to contain it. Plain and simple. So don't add this extra worry to your plate. I am sure your plate is full as it is!
We can come back to this subject after the pandemic is controlled.
ARE THERE ANY POSITIVE NEWS ABOUT THIS VIRUS?
There are several positive things that are indeed happening in the world.
For one, China's outbreak appears to be more or less contained at the moment. That's a relief. So we know - quarantine and testing definitely work.
In Italy, where the virus has spread like wildfire, and extreme measures of nearly complete isolation of the entire country has been ordered, the people are creating new coping strategies. According my Italian friends, many people have been creating virtual social gatherings with friends like daily virtual happy hours or virtual workout parties. Also there are numerous balcony-singing flashmobs - people in different towns sing and playing musical instruments on their balconies, often creating beautiful neighborhood performances singing together from their windows.
Also, our pets appear to be safe :)
WHERE DOES ALL THIS INFORMATION COME FROM?
Everything above is my summary opinion based from what I’ve learned from the official sources, extrapolation from the available scientific research data, and from some of the perspectives of epidemiologists/experts in the field. Personal accounts come from communication with people I personally know in the "hot zones" (Italy).
WHERE CAN I LEARN MORE?
WHO (World Health Organization) - WORLD primary source of information
CDC (Centers for Disease Control and Prevention) - USA primary source of information
Worldometer (statistical website run by an independent company) - additional information
CDPH (California Department of Public Health) - CA primary source of information
San Diego County official government website - local information. In San Diego you can also call 211.
INTERVIEW WITH AN EXPERT - DR. BRUCE AYLWARD
HAVE OTHER QUESTIONS?
Please click on the "Comments" below to add your question or comment. Feel free to share as well!
This is a quote from a doctor from Rockport, Maine.
This physician's viral post in a Facebook Group for medical professionals fighting COVID-19 has received hundreds of "ME TOO!" replies from around the country within hours.
The doctor has agreed for me to share her outcry with you, requesting to be anonymous to avoid potential retaliation from her hospital administration.
It may be one person's voice but it saying what's on the minds of so many!
This is real. Please read.
I am starting to feel so confused. Too many questions, too little evidence based data, too many rapidly changing “guidance”, too many hypothetical answers. No PPE*, horrid non existent access to testing. We give and sacrifice so much for this job, this calling, this privilege of being a doctor, a job we love and now.... we are left out here vulnerable and abandoned. I just can’t wrap my head around it. So many of us exposed, maybe exposed, likely exposed. Our kids sick, family members sick, our patients sick and we have NO GD ANSWERS. So if my kid has a 104 fever what do I do? Go to the hospital, don’t go to the hospital? Ask for a test? Get a flu test? Yes you can be coinfected, but maybe not. Only this age or that age. No freakin actual facts. Good luck, sorry doc. You don’t meet the “criteria”. Your kid doesn’t meet “criteria” your patient doesn’t meet “criteria”. The magic fvcking criteria made up by people NOT on the front lines. So what do you do? Stay home, go in, possibly expose more people? Stay home for 3 days, 10 days, 14 days? Repeat test, oh wait no test done. So don’t repeat test. Wear a respirator, wait no surgical mask ok. It’s probably airborne and probably droplet. Use an N95 until you have the results of the test you can’t order. Really?!?!WTGDF !? It’s like a bad Vietnam War movie. The guy 1000 miles away from the gunshots is making all the decisions and he doesn’t really care if you live or die. This can’t be the reality.
I feel like I’m losing my mind. For $10 I’d put my family in the car, drive off into the woods and camp for the next 6 months. It’s all too much. Someone has to do something! Meanwhile people across the country- some my family and friends! Out in bars, out having fun without a care in the world. Not a shred of reality. And we will be resuscitating them and passing it- this amorphous unknown unpredictable motherfvcker of a virus to ourselves and our families. Why?!! I’m just totally lost."
* PPE - Personal Protective Equipment (like facemasks, etc.)
DOCTORS' HANDS ARE TIED
Although some hospitals are doing an excellent job with COVID-19 reponse, it appears that many doctors are forced to work without proper protective equipment. Many doctors feel that their hands are tied by hospital administrators.
Here is what this doctor had to say about the situation many physicians are facing. (Reposting with the doctor's permission):
"When exactly did physicians lose control of our profession?😢
I’ve read all the posts in this group, and am sensing such powerlessness and despair: story after story by my physician colleagues all across the country, of “ADMIN” * mandating things during this COVID19 crisis that we as physicians know are unethical and unsafe. They sit in their safe offices telling us that even though we have inadequate PPE** , we must make do and continue to work, reuse PPE and ask permission to access N95 masks*** that they’ve locked away. They’re refusing to “allow” us to cancel non-urgent routine appointments and surgeries -we have to wait for admin to decide. They’re refusing to “allow us” to test patients we know should be tested. They’re forbidding us from publicly posting about the crisis because we are “inciting panic.” They’re threatening our jobs if we don’t comply.
We are afraid to speak out because we don’t want to lose our jobs. We’re afraid to refuse to see patients without adequate PPE, both because of “admin” and a misguided sense of duty.
Every one of us that are working without PPE are at high risk of infection, and will become super-spreaders. We’ll be passing it along to subsequent patients during our asymptomatic period, and bringing it home to our families, before we then become infected patients ourselves. Won’t we end up infecting more people overall than if we refused upfront to see pts without adequate PPE?
We have no union, most of us are employees following the direction of people with half the education and intelligence than us. They’re the kings sitting on horses directing us lowly soldiers at the front line to charge, without swords and shields.
When did we become so powerless? And when this crisis is over, is anything going to change? Sorry for the rant and I actually don’t have the answers, just felt the need to vocalize what so many are feeling. God protect us all 🙏🏽
(ETA to be fair: I must say on a personal note that my organization has been overall very responsive to the concerns of its PCPs****, received our constructive feedback/suggestions and started instituting changes within the last week like 90% telemedicine, remote work for high risk PCPS...mainly because it is PHYSICIAN led. This is also why we need to #takebackmedicine.)"
* "ADMIN" - referring to hospital administration in this case
** PPE - personal protective equipment, such as face masks
*** N95 masks - the masks healthcare workers should be using to be protected from Coronavirus
**** PCP - primary care physician/provider
MY LETTER TO HUMANITY
"Dear friends. My fellow humans. Please share.
I don’t know what to do. I literally want to cry right now because so many people I know are taking what’s happening with coronavirus too lightly.
We are on the brink of a preventable global catastrophe due to this pandemic.
We only have a few days left to help the situation and in one very simple way.
PLEASE STAY HOME!
Yes, it’s that simple. Don’t go anywhere for a few weeks unless it is necessary for your survival.
I know it sounds extreme, but there are lots of asymptomatic carriers in the community who haven’t been diagnosed with COVID-19 yet and who are unknowingly spreading the disease.
Every time you leave your home, not only you are exposing yourself, you are potentially exposing EVERYONE you come in contact with for up to 4 weeks of getting the virus! (It’s less than 2 weeks in 99% of cases, but there is that 1% that’s also very real.) Even if your own symptoms are mild to none, you can infect others!
By leaving your home you could unwillingly contribute to someone’s demise. I know you don’t want that.
It doesn’t matter if you are young and healthy. If you are around other people, you may still get the virus which could be deadly to you or to someone you care about.
I’d like to make a parallel. It might sound shocking perhaps. I want to compare us leaving our homes right now to drunk driving. We can all agree that drunk driving puts people’s lives in danger. Imagine if every time you left your home you were at risk of returning completely intoxicated and accidentally hurting someone close to you. And that each time you left home, it could lead to several new drunk drivers who could kill someone? And that each of those people would create their own “set” of deadly drunk drivers and so on, like a domino effect? Can you imagine?
This is exactly what this is like, but worse! Experts in pandemics have extremely grim predictions of what will happen with COVID-19 and with the devastation that it will bring to the world. Millions will die, and it’s not science fiction. It’s reality.
Please. I am begging you. Try to hear what I am trying to say. Let’s make those predictions wrong by doing what no scientist could predict! By being kind, thoughtful, and responsible human beings - by staying home. Every single one of us!
In a few weeks, when we start seeing the aftermath of our careless decisions, it will be too late!
Don’t wait until a mandatory quarantine is instituted.
Stay home now!
By doing this you will be preventing the virus from spreading, and will help save hundreds of thousands of lives!
I don’t know how to help people understand just how critical this is, and how important it is for it to happen TODAY, NOW!
I don’t know if you can hear me, but I hope you do.
If it saves even just one life, it’s worth it.
Writing to humanity in desperation on March 15th, 2020 from San Diego, California.
With love and gratitude, Dr. Maria Danilychev, MD"
ADDRESSING VENTILATOR SHORTAGES
Off-label use of one ventilator to save multiple lives.
USEFUL LINKS FOR HEALTHCARE PROFESSIONALS
THIS SECTION IS CURRENTLY UNDER CONSTRUCTION - ADDITIONAL LINKS TO BE ADDED
MAP - Coronavirus interactive map
WHO - online training
CDC - for healthcare professionals
Stanford coronavirus study - please share
THIS SECTION IS CURRENTLY UNDER CONSTRUCTION - ADDITIONAL LINKS TO BE ADDED
Dr. Maria Danilychev, M.D., is a San Diego based medical doctor with 20 years of experience and board-certified in Internal Medicine, Geriatrics, Hospice/Palliative Medicine, and as a Hospice Medical Director. Dr. Danilychev also conducts clinical trials and was one of the first responders during 9/11.