Posts by Doctor Sophia

One of our hidden doctors. Pathologist, author and seeker of truth in medicine and life.

How coronavirus changed the world

The coronavirus pandemic entered quietly into our spaces without any warnings as many other natural disasters. And it forever changed our reality and normalcy. Actually, there were some warnings, but we underestimated its potency and downplayed it by saying “it’s just another flu, thousands of people die with flu every year.” This silent and deadly enemy cannot be seen; we cannot shoot a virus by enlisting military forces to honor our heroes amongst the army, navy and air force. In fact, this formidable enemy crosses all boundaries of countries, red and blue states, all races, religions, genders, ages, education, and economic status, a true definition of An Equal Opportunity. In fact, this coronavirus hijacked our lives without our consent. We are consumed with news regarding the coronavirus attacks locally, regionally, nationally and internationally. No other news was emphasized from March of 2020 till now, almost 3 months straight by this brainless and incompetent packet of DNA and RNA strands which has changed and captured the human enterprise.

As of today, there have been more than 5.1 million infections with the virus and a death toll of more than 335,000 globally. Just within the US, confirmed deaths caused by the coronavirus surpassed 95,000. The negative impact caused by the virus is not just the death rate but the accompanying collateral economic damage with 23 million unemployed Americans as of mid-April which translates to an unemployment rate of 14.7%, and growing every week, approaching the highest level since the Great Depression in 1929, 10 years after the influenza pandemic.
In 1918 during the worst influenza pandemic, the final global death toll ranges from 17 million to 100 million, depending on the way victims are counted. Almost 700,000 people are thought to have died in the U.S., equivalent to more than 2 million people today as a proportion of the population. The predominant population who died were young males, soldiers. 
In 2020, the coronavirus pandemic largely, but not entirely, spares the young, and targets the older population, testing how much contemporary U.S. society values the elderly.

This virus changed every aspect of our culture, society, politics, business, economy, and life attitudes. In fact, it permeated through so many levels, we cannot even fathom. 
The culture is changed in fundamental ways, for example, by the way we greet each other; we recoil from handshaking, even elbow bumps to keep the distance of 6 feet away from each other.  The greetings have now altogether become a no-go, not even smiles hidden under the mask.

Politics have changed; no campaign events with a large crowd, travels to every state by candidates, and voting may change entirely to mail. The blaming games for faulting others in delayed response to the pandemic has not changed, however. The Americans also became better at several things; cooking, being more homebodies and accustomed to be more introvert due to limitations going out to restaurants and bars.

Education has changed. Most classes are by website or zooming.  Students without computers will be left out in the dark which creates lack of access and opportunities in learning for the poor. “Tele schooling” is now becoming more of a norm affecting at least 55.1 million students impacted nationwide.

Traveling, entertaining, vacationing, and hotel businesses have been halted by the virus. Instead, on-line ordering from Amazon, Walmart, Costco and groceries has been doing well, some with price gouging to follow the fundamental economic rule, “as consumer demand increases, the price increases.” Delivery truck drivers’ job security has been increased since they are now the lifeline to many.

Our hygiene requirements and habits have been changed; we wash our hands more frequently, something we should learn from obsessive-compulsive patients who have perfected this art. Americans also became hoarders of hand sanitizer, disinfectant, toiletry and tissue products. In lieu of high fashion clothing, more colorful designs of facial masks are selling better. The definition of personal hygiene has shifted. Both men and women’s hair length are increasing, including some of the governors who are showing up every day on the television monitors. The people with sign language also stepped up and are more visible than before.

What about the attitude? American people naturally tend to focus on two desires, safety and freedom. Hyper-individualism shouting, “keep me safe and leave me alone.” But we now know that these two desires are inter-related and even conversely related. One cannot be safe unless you do your part in the four pillars of our strategy—hygiene, distancing, screening, and masks. Who would have thought someone (index patient zero) from Wuhan China can affect the entire global world like today? Can one person change the world? Absolutely. Freedom? Yes, we want that too, but not when it affects other people in such a detrimental way. What we do today is intertwined with how we affect others tomorrow more than we can possibly imagine. 

We lost our innocence in the trust of being together socially. Hugging, handshaking, talking and singing together, touching and holding hands to comfort others, and even breathing the air in an enclosed space has become risky. Every causal contact has become a calculated risk as if it is a sexual encounter. The question of who and where have you been with recently crosses our mind before welcoming someone into our boundaries. The comfort of being in the presence of others has been replaced by the comfort of being alone. All the things extroverts flourish in have become a thing of the past. 

Nobody can predict when is the end and the full consequences of the coronavirus pandemic. History repeats itself and we can learn a great deal of knowledge by studying past experiences. Key points from observing the epidemiology of past influenza pandemics in 1918 may provide insight into the COVID-19; the length of pandemic will likely be 18 to 24 months, as herd immunity gradually develops in the human population. Given the high transmissibility of coronavirus, in order to halt the pandemic, an estimate of 60% to 70% of the population may need to be immune to reach a critical threshold. One thing we can predict with confidence is that it will take time to get back to the normalcy we once used to know. We will soon forget what the pandemic was like—our memory is short-lived and amnesia is guaranteed, but the history will repeat itself again by having another pandemic. The way the pandemic with COVID-19 will end is most likely by our exhausted energy and fading memory in dealing with it before the actual virus pandemic will be over.  

The only sure things in life are death, paying taxes and perpetual mutation in viruses. Currently, the pandemic is far from over. Despite a still rising coronavirus infection rate worldwide, America will open the businesses and resume the usual domestic air travel starting 5/25, the special train to transport migrant workers on 6/1, and 200 general passenger trains across the country. Slowly and surely all the businesses, essentials and non-essentials will open, tip-toing the balance of sacrifices from the health care workers who actually take care of the residual contagious and sick population.  There will be spikes of COVID-19 back into emergency rooms and intensive care units. The government will calculate how many bed capacities are available, rather than how many doctors, nurses, EMT, janitors and other allied health care workers are risking their own lives and their loved ones in their family. Most health care workers did not sign up to be enlisted as military personnel, understanding one’s own life may be endangered by the duties, but they simply want to help others who are sick. They did not sign up to risk their lives every day as if we are going to the battlefield on the frontline. As the pandemic prolongs, the glory and honor of the jobs being heroes, albeit involuntary, will be soon forgotten and diminish. The price of paying one’s own sacrifice needs to be thought through, weighing the benefits and risks, as we now see many early retirements from health care workers. The younger generation will pick up the tune of, “for the whom the bell tolls,” and we may face severe shortages of health care workers in the future. 

At the peak, we are witnessing COVID-19 crisis overwhelm the hospitals, and we are in dire need of physicians and health care allies on the frontline. However, in the midst of all of this, hospitals had to furlough thousands of employees, cutting their pay, requesting volunteer staff, and yet failing to provide adequate PPE while demanding that staff risk their lives. Some nurses and doctors are speaking out on the reality of lacking adequate PPE and over-working their shifts to 15 hours, but some hospital administrators are punishing those that spoke up against the system. Some other hospitals are laying their employee off. Even worse is that these same CEO’s, administrators, and executives were being compensated with million-dollar salaries or more.  It is very perplexing how health care workers could be fired, furloughed, or asked to take pay cuts as they put on PPE to care for critically ill patients at great personal risk.  

Life goes on as death goes on. More recently, news media rarely covers how many deaths occur daily by regions any longer, as if 50 dead are not important as 800 dead. As media coverage dissipates, so will be our reality in COVID-19. The tail end of the mess, perpetual chaotic reality that virus left will be cleaned up by the unsung heroes just like the Vietnam veterans with amputated extremities, still with mental and physical scars.

Dealing with pain

Blog #6
I wrote this 3 years ago when I had my right femur fracture. This still pertains to how I see the world today.

COVID-19, The questions of what is this all about creeps in.
Why is this happening? How long will this go on? Am I going to become infected? If so, what shall I do with the remainder of the days on this earth? Where do the dead people go? Is there anything beyond this life? Is God there? Why do we have to go through all this? Why is God silent in pain and pandemic? What is the meaning of pain? What is the meaning of life anyway? Why do bad things happen to good people? Why so much suffering and pain in this life? How can a loving God permit so much calamity?

There is a strange story in the Bible about a man named Job. He lived in the land of Uz. He was a man of complete integrity, and blameless. He feared God and stayed away from evil. He was, in fact, the richest person among all the people of the east. Everything he did was honest, and righteousness covered him like a robe. He served as eyes for the blind and feet for the lame. He fed the hungry people, clothed the poor, and looked after orphans and widows. New honors were constantly bestowed upon him. People listened to his advice. They were silent as they waited for him to speak. And after he spoke, they had nothing to add, for his counsel satisfied them. They longed for him to speak, as people long for rain. They drank his words like a refreshing spring rain. When they were discouraged, he smiled at them and they felt accepted. His look of approval was precious to them, and like a chief, he told them what to do and they obeyed. He lived like a king among his people and comforted those who mourned. He also had many family members and friends who supported him and made him feel proud. Job is a “picture perfect” and ideal person who had power, respect, honor, wealth, and he was a person filled with justice. This is a kind of life everyone would desire to live.

Job 1:
One day the members of the heavenly court came to present themselves before the Lord, and the accuser Satan came with them. The Lord asked Satan, “Have you noticed my servant Job? He is the finest man in all the earth. He is blameless, a man of complete integrity.” Then Satan said, “You have always poured a wall of protection around him and his home and his property. You have made him prosper in everything he does. Look how rich he is! But reach out and take away everything he has, and he will surely curse you to your face!” God replied, “All right, you may test him. Do whatever you want with everything he possesses, but don’t harm him physically.” This was the conversation between God and Satan. It is hard to believe such things are recorded in the Bible.
God is fully aware of every attempt by Satan to bring suffering and difficulties upon Job. The first attack was on Job’s possessions, his oxen, donkeys, sheep, camels, farm hands, shepherds, and servants. The second attack was on Job’s children; his sons and daughters died from a powerful wind collapsing their house.
After all these calamities, Job tore his clothes, shaved his hair and fell to the ground to worship God and said “I came naked from my mother’s womb and I will be naked when I leave. The Lord gave me what I had, and the Lord has taken it away. Praise the name of Lord”. In all this, Job did not sin by blaming God. He acknowledged and loved God for who He is and not what He gives. His emotions of his loss and grief were expressed to God.
The members of the heavenly court came again to present themselves before the Lord and the Satan came also. God said that Job has maintained his integrity even though Satan harmed him without the cause. Satan replied “skin for skin, a man will give up everything he has to save his life. But reach out and take his health and he will surely curse you to your face”. The Lord said then do as you please but spare his life. Then Satan attacked Job a third time, with physical ailments—Job was with terrible boils from head to toe and Job scraped his skin with a piece of broken pottery as he sat among the ashes. Job’s wife gave the fourth attack, humiliating Job by saying “Are you still trying to maintain your integrity? Curse God and die.” Job replied “You talk like a foolish woman. Should we accept only good things from the hands of God and never anything bad?” So, in all this, Job said nothing wrong and had not sinned against God. The final attack was from his three most trusted friends who came to comfort and console Job. Their names were Eliphaz, Bildad and Zophar. They were from different regions. When they saw Job from a distance, they scarcely recognized him. They sat on the ground with him for 7 days and no one said a word for they saw that his suffering was too great for words. After 7 days, his friends, one by one accused Job with harsh words by saying that he must have sinned enough to deserve such suffering.
Loss of power, possessions and love ones are sad enough, but he was getting further humiliation by younger people mocking and abusing him, adding insult to injury. Job said “But now I am mocked by people younger than I. A lot of good they are to me. And they mock me with vulgar songs! They taunt me! They despise me and won’t come near me, except to spit in my face. For God has cut my bowstring. He has humbled me, so they have thrown off all restraint. They block my road and they do everything they can to destroy me. They know I have no one to help me. My honor has blown away in the wind and my prosperity has vanished like a cloud. And now my life seeps away. Depression haunts my days. At night my bones are filled with pain which gnaws at me relentlessly. I cry to you, O God but you don’t answer. I stand before you, but you don’t even look. You have become cruel to me. You use your power to persecute me. My heart is troubled and restless. Days of suffering torment me.” (Job 31).

This agonizing voice of Job crying out to a silent God is faced by most of us at some point in our lives. The pain and suffering that we are facing at times do not seem “fair.” Why is this happening to me when others are seemingly happy and carrying on with their lives with uneventful mishaps? At times, life is so cruel that not existing seems better. Despising life and desire to die at times are so strong. In Job 10, he said “I am disgusted with my life. Why did you deliver me from my mother’s womb? Why didn’t you let me die at birth?”

This principle of good things should happen to good people and bad things should happen to bad people are a prominent thinking and somehow natural ways of thinking we all have. “Life should be easy” is also a common and natural expectation, but life is never easy. None of these expectations are written in the law of life or in the Bible. We intuitively know that life is indeed difficult, and we face tragedies and turmoil at times but when they actually come, we are often surprised as to why. Initially, friends and family members sympathize with the acute difficulty for the loved one but with a little time, it is not unusual to question perhaps previous sins of the loved one has caused one to have such difficulties and deserve such sufferings. Assumption regarding others to suffer due to their own fault or previous sin is not correct. It is not “eye for an eye” principle that God reacts to one’s sin.

There are four different reasons why we may suffer in life that I can see:
1. One reason why we may suffer is due to the consequences of bad decisions we have made. For example, if one drinks a lot and becomes an alcoholic, there are a number of bad consequences one may have to face, which may include broken relationships, loss of job, financial problems and physical illness such as liver cirrhosis. This is a direct consequence of acts that one causes by choosing and continuing to live with bad decisions. Most often, a person knows that he or she made sequences of bad decisions and hence deserves such suffering. This might be a root to our common philosophy that the wicked shall be punished and live in pain and the righteous shall live upright and prosper. God will give prosperity to those who truly believe in Him and live happily—this is a dangerous way to think.

2. The other reason why we might suffer is to bring healing and restoration. God is trying to teach and instruct specific things in one’s life to “give a lesson,” so to speak. This kind of suffering is not meant to punish us as much as it is meant to correct and restore us to keep us on the right path. This is why we constantly ask questions such as “what must I learn from this experience?” “What was it that I am supposed to gain from this lesson?” or “Is God telling me something?” Although maturity can be established by thinking through this way, it is still somehow tied to sin and that your imperfection is getting refinement.

3. The other reason why we might suffer is to benefit others. I was afflicted with polio on my right leg at a young age. This is what I believe why I constantly suffered throughout my life with my physical disability. Without my own pain, I would not know others who go through lives with pain and physical limitations. I understood this very well when I saw a patient who lost almost half of her face due to head and neck cancer. She was severely disfigured and shocking to see. She lived in fear that people would look at her with disbelief and disgust. She was in pain and shame. When she unwrapped her face and revealed her scar, she was crying after I held her hand. She knew that I had my own sets of physical limitations and I had gone through emotional and mental pain. There was unspoken language of understanding and compassion to each other. We had a special bond at that moment and there was a mutual understanding of enormous burden we each carried in our daily lives. This kind of human understanding needs no words but is felt between people who went through certain amount of pain. This experience taught me though I still suffer with my physical disability, I am somewhat comforted knowing that my pain has some purpose.

4. The final one is that pain has no identifiable reason. This is unexplainable pain and suffering, similar to what Job went through. God negotiated and discussed with Satan in heavenly meetings and God allows certain things to happen to Job. There is nothing a human can explain or even attempt to understand. The Creator of the universe is carrying out His plans. The only thing that I can say is that ultimately God always blesses the one who suffers with this kind of cause.

(Job 38-42) When Job challenged God by asking why God has done all these things to him when he was upright and fearing God, God spoke to him but not directly answering him. God asked Job a series of questions pertaining to earth’s nature which no human can fathom to answer. God asked “Where were you when I laid the foundations of the earth? Who determines its dimensions? What supports its foundations? Who kept the sea inside its boundaries? Have you ever commanded the morning stars to appear and caused the dawn to rise in the east? Have you made daylight spread to the ends of the earth, to bring an end to the night’s wickedness? Have you explored the springs from which the seas come? Have you explored their depth? Do you know where the gates of death are located? Where does light come from and where does darkness go? Have you visited the storehouses of the snow or seen the storehouses of hail? Where is the path to the source of light? Where is the home of the east wind? Who creates a channel for the torrents of rain? Who laid out the path for the lightening? Who makes the rain fall on barren land, in a desert where no one lives? Who sends rain to satisfy the parched ground and make the tender grass spring up? Who gives birth to the dew? Who gives birth to the frost from the heavens? Can you direct the movement of the stars? Can you direct the sequence of the seasons? Do you know the laws of the universe? Can you use them to regulate the earth? Can you shout to the clouds and make it rain? Can you make lightening appear and cause it to strike as you direct? Who gives intuition to the heart and instinct to the mind? Who is wise enough to count all the clouds? Who can tilt the water jars of heaven when the parched ground is dry and the soil has hardened into clods? Can you stalk prey for a lioness? Who provides food for the ravens when their young cry out to God and wander about in hunger? Do you know when the wild goats give birth? Have you watched as deer are born in the wild? Do you know how many months they carry their young? Are you aware of the time of their delivery? Who gives the wild donkey its freedom? Who untied its ropes? Will the wild ox consent to being tamed? Will it spend the night in your stall? Can you hitch a wild ox to a plow? Will it plow a field for you? Have you given the horse its strength or clothed its neck with a flowing mane? Did you give it the ability to leap like a locust? Is it your wisdom that makes the hawk soar and spread its wings toward the south? Is it at your command that the eagle rises to the heights to make its nest? Do you still want to argue with the Almighty? You are God’s critic but you do not have the answers? Will you discredit my justice and condemn me just to prove you are right? Are you as strong as God? Can you thunder with a voice like his?” After all these questions God asked to Job, he simply responded “I know that you can do anything and no one can stop you. I was talking about things I knew nothing about, things far too wonderful for me.” And then Job repented, taking back everything he said to God.

No one can fathom God’s knowledge and power to explain his creation and common events in nature. How can we possibly understand God’s intention in our pain? God himself is the standard of justice and we cannot put fairness or justice as a higher standard than God. If nature is beyond grasp of understanding, how could we possibly know God’s purpose in pain? One thing we do know is that the principle that suffering is God’s judgment for sin is not always true. In fact, this is a dangerous road to take. Certain people believe that if you are a true “Christian,” then you will prosper and always be a winner. It is equally not true to think that suffering always brings discipline and refinement. Satan was also wrong in that people only believe and worship God when they are prospering and not suffering. Though people are friable and weak at times, the desire to seek out the creator and relying on God in all circumstances, especially in pain, is deep rooted in our heart.
“I know the road that I take with the Lord and when I am thru, I will come out as gold,” said Job. This is the trust, the faith in God which is the only thing required in living. Perhaps God’s view on suffering is that it will cause us to trust God for who he is and not what he does. Amidst undesirable outcome, even the death will be acceptable if we believe that God is under control. This faith is the only thing that can provide any hope.
The blessing may be disguised in death. We cannot fathom how death can be a blessing. The only fact that is true is that there is death after birth. Life here on earth is always numbered and no one escapes from the death. But without death, there is no resurrection. We only know what this life is about and death seems dark, lonely, and unknown. It is like a fetus in the woman’s womb, cozy in the warmth of its own fluid, not breathing but moving around in a tight space. The fetus would never even imagine what it will be like in the outside of the womb. But when the womb broke its contents and the baby comes out into this new world and takes the first breath filling the lungs with air, there is a new life with new experiences. Death may be the same, something to experience outside of this limited world in which we live. The space beyond this life may be even greater than where we are. There will be an end to pain, physical limitations, and confinement to the body and emotions.
This is where I am differing in thoughts. I have hope even in death because the faith I have in Jesus. For all those who are battling with cancer diagnosis, COVID-19 infection, or severe mental pain, do not lose your heart. When you are nauseous, vomiting your gut out and feeling like there is no meaning in life, keep talking to God. God did not have to show up to Job and justify his actions but God did show up and spoke to Job because he cared and loved him. Throughout the Bible, all God talks about is how He showed up and cares for us. And even if God is silent, keep praying. Your God did show up 2000 years ago, broke the history in BC to AD through Christ. He came humbly as a baby through a woman’s body, cleansing the cursed name of “Woman” with His deity, spilled out his blood as a sacrificial lamb for the atonement of our sins, underwent extreme humiliation and mockery from his own creatures, emptying his glory, laid down his life to be forsaken and to save us from the eternal death, rose again victoriously from the death so that we may have hope, sat on the right hand side of Father God and He promised us “He will lead them to springs of life-giving water. And God will wipe every tear from their eyes.” (Revelation 7:17).

Why do we suffer? It is for the glory of God. The glory which we cannot fathom today but in time, God will reveal to us. Rejoice in pain and wait patiently. God will show up and lift you up in His glory.

COVID-19 battle: Health or Wealth?

April 16, 2020 #5 blog: 

COVID-19 battle: Health or Wealth?
Today, President Trump is expected to spell out when to “open up the US.”  Two impending priorities demand a battle: Health or wealth? Which is more precedent now? Contagious COVID-19 infection causing overload of hospital capacities and resources and death; or, economical suffocation due to unemployment increasing by the day.

For the medical personnel like myself, it is obviously health over wealth but to perhaps a majority of Americans, immediate needs such as shelter, food and clothes to wear are becoming more significant, even though we as a nation then gamble and play the odds of prolonging the contagious virus. 

There are a number of issues we need to sort out during the pandemic in my humble opinion. As news media said, “we are in this together” fighting the silent and deadly enemy. And because this virus is novel, no one can predict, and prepare for the best scenario when unknowns are stacked against our odds. This was manifested by unpreparedness in our most powerful country and medical experts. Medicine is truly practiced at this time.

  1. Americans are saying we need more robust testing.

Here are the current estimated numbers:

RegionTotal population# infected cases% infection# Death% Death
CA40 million  27,2260.07%    8930.002%
US328.2 million657,2300.2%29,9080.009%

– The deaths out of the total number tested is not a true percentage of the death rate caused by coronavirus. It is easy to mistakenly calculate as such.

– These statistics are not the actual numbers because testing is done only in the high risk people where COVID-19 infections are suspected following specific guidelines.

– Even in the current ER admission, unless met with specific symptoms and signs, nasal swab test is not being done.

– Drive-thru testing sites are open in many areas but one needs to have high risk criteria such as immunosuppressed states, diabetics, high blood pressures, etc.

– Even doctors and nurses and health care allies are not given the option for testing because we simply do not have availability of test kits and labs to run the test.

  • No tests currently conducted are “FDA approved.” 
    – No sensitivity and specificity studies are done; if the test result is negative, it does not necessarily mean one did not get infected. 
    – Sensitivity of nasal swab which is a PCR method (most common) and it is expected to have a 70% accuracy rate, which means 3 out of 10 tests may be a false negative result. 
    – Each test requires Sensitivity and Specificity analysis. Sensitivity test is the ability of a test to correctly identify those with the disease (true positive rate). Specificity test is the ability of the test to correctly identify those without the disease (true negative rate).
  • Many labs including commercial, individual hospital labs, and government labs are currently coming out with new rapid tests. None are FDA approved. Each lab test has different sensitivity and specificity rates. There is no national standard check point to validate the accuracy of the test given from each site.
  • Blood testing for antibodies against COVID-19 is the newest and entirely different test that Dr. Fauci talked about. The US FDA recently granted an “emergency use authorization” for this test. In Italy, politicians want to use antibody status to determine which people will get back to work. This test will be able to detect those “asymptomatic COVID-19 infected people” and it has a potential to reveal the true % of coronavirus infection rate. However, in order to do that, we will need to test all people. In the US, a collaborative multiyear project is underway which aims to provide a prevalence of nationwide antibody. The first phase is to collect samples fromblood donors in 6 major urban areas. This will be in combination of 3 national surveys of donors, supported by CDC in this fall and in the fall of 2021. Notice that this study involves blood donors, not entire regional areas, state or the US. How can we ever find out the true infection rate from these data?
  • The antibody test has many presumptions.
  • Influenza (flu), poliovirus and Varicella-Zoster (chicken pox) infections induce antibodies and not only tells who was infected, but provide protection that will be near universal, and have long-lasting resistance. Vaccines against these also provide a life time protection against re-infection. The immunity is permanent.
  • HIV infected people will often have large amounts of antibodies but it does nothing to prevent or clear the disease.
  • Hep B vaccine, Mumps, Measles, Rubella and Closterium (bacteria) which causes botulism need to have regular booster shots even if antibodies are detected in blood.  
  • The presence of coronavirus antibodies may not bring a long-lasting resistance as chicken pox. At this early stage of understanding, we simply do not know yet what it takes to be effectively protected from this infection, how long do coronavirus antibodies remain in the blood and do they protect against re-infection.
  • Do we really know how long asymptomatic coronavirus infected persons can actively transmit to others? It is recommended to be quarantined for 14 days (some say 10 days) but do we really know after these 14 days, it is contagious-free?
  • It is estimated that we will eventually have approximately 5% of the population in the nation to be infected which means 95% are free of infection, and needing vaccine. If we are thinking about re-opening the economy, wouldn’t it make sense to send the people to work who are not infected?
  • In some profession such as medicine, the majority may be exposed to COVID-19. If COVID-19 or antibody test results are positive, does that mean they cannot go back to work and for how long? Who then will remain in the hospital to attend to the sick?
  • COVID-19 Vaccine in works.
  • As of 4/8/20, there are 115 vaccine candidates and 73 are currently at exploratory or preclinical stages. Even though the scale and speed of the global vaccine research and development is at the highest focus, there is an indication that vaccine could be available in early 2021 (which is a disappointing timeline). To expedite the process, tremendous funding, strong international coordination and cooperation between vaccine developers, regulators, policymakers, public health bodies and government are needed.
  • Here is the summary of current vaccines in the pipeline:
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  • Current potential treatment: Recent JAMA paper is included for your review:

Go to Jamanetwork.com,

Pharmacologic Treatment for Coronavirus Disease 2019 (COVID-19) by James M. Sanders. 

If China indeed had spilled out COVID-19 from Wuhan Lab (albeit accidently), surely, they should have antidote for this virus and the time to release it is now. 

After I spilled out my thoughts regarding COVID-19 which is all gloomy (I am sorry), I want to say I look for my comfort and peace in God who is called The Son of Man, The First and the Last, The living One, The Son of God, The faithful and true witness, the Lion of the tribe of Judah, the Heir of David’s throne, Lamb, Shepherd, Christ, the Word of God, King of all kings, Lord of all lords, the Alpha and Omega, the Beginning and the End, the bright morning star, Rock of Ages, Redeemer, Bread of Heaven, Living water, our sure foundation, good, fairest of ten thousand, Savior, Mediator, our Advocate, Almighty, the stone the builders rejected, wonderful counselor, friend of sinners, great physician, Anointed one, healer of broken hearts, prince of peace, blessed hope, our atonement, mighty fortress, shelter, the narrow gate, Lord of grace, God of all comfort, Word of life, Rose of Sharon, lily of the valley, Glorious, Immanuel, Living word, chief cornerstone, Creator, Ancient of Days, the eternal One, finisher of our faith, resurrection and life, the way, the truth and the life, everlasting Father, captain of the Lord’s army, strong tower, Yahweh, our defender, our friend, our comforter, the One who prays for us, the Most High Priest, and the most High…

These are just a few names and references for Jesus whom I trust, worship and give thanks to. It is indeed a miracle that we each have breaths today and live life as a gift from God.

How did I change?

How did I change?
April 13, 2020 Blog #4 : US National Parks

In this “Lock Down” state during the COVID-19 in California, I find myself enjoying the time to reflect, quieting the mind, prioritizing and recognizing what is really important in my life, and “truly living in the moment”. To top it off in my selfish and delectable enjoyment, it comes with a guilt-free package and no obligations to please others by socializing and being hospitable. It is a safe-haven for an introvert like myself. Recent news tells me that a lot of folks are experiencing “cabin fever” but I am secretly experiencing such a pleasure staying home, and found myself so busy that I had to regulate my schedule into some routines to discipline my time to include exercises, piano practice, cooking new recipes and watching Netflix for entertainment.  During quieting of the mind, my thoughts are in traffic jams and I have to discipline myself to tell one story at a time in this blog. And today, I decided to share about our two US National Parks trips which are one of my “bucket list” activities. 

The first US National Parks trip took place on 9/30-11/7/2016, a total of 39 days through the northern routes of America. We drove 7,223 miles from Los Angeles to Washington D.C., slept in 23 different hotels with no reservations and saw 11 National Parks, a few state parks, waterfalls and national monuments. I saw how beautiful and blessed this country was. Large cities with bright lights, proud tall buildings with bustling people busy minding their own business, practicing their constitutional rights in the pursuit of happiness, to the endless grasslands with perfectly arranged piles of hay without a single person in sight for miles. Small farm houses with red roof barns, cattle roaming around peacefully in the green grass fields punctuated by scattered scenic lakes, ponds and rivers adding to the richness in beauty. Philadelphia and Washington D.C. showed our proud constitution based on the faith of God who we trust with the founding fathers who formulated our government based on human rights, values and equality. We had an extra bonus in seeing colorful foliage during the fall season. This northern route was mostly middle class income houses with Trump supporters displaying their signs in the front yards and it was easy to predict who might be the next president.

The southern route of the National Parks trip was on  1/4 to 2/19/2020, a total of 45 days. We drove 7,477 miles from Los Angeles to Florida, saw 11 National Parks and stayed at 23 different hotels and vacation rentals. I was saying to Hal, “we will be changed people when we are done with the trip.” Unlike the northern route, in the South (especially parts of Texas, LA, MS, AL and parts of Florida), we saw cruelty in poverty amidst muddy brown water swamps, houses with partially blown roofs due to repetitive hurricanes, holes in the walls, miserable hot humid air even during the winter months which made me imagine the unthinkable misery in the summer time with annoying mosquitos in the crowded, and barely covered shacks. The notable things throughout the South are the crawfish Cajun style eatery billboards, but we were not traveling in April, which is the season for eating crawfish. On this trip, I was struck by how divided our country really is socioeconomically; the poor are so poor and the rich are so rich. The costal parts of Pompano Beach and West Palm Beach in Florida displayed incomprehensible and spectacularly expensive estates lived in by a few Caucasian people with their unobstructed view of the Atlantic Ocean. In my opinion, it is not the education, race, gender, different nationality, or languages that divides the American people but the socioeconomics; most of the blacks are in poor, crowded neighborhoods with one McDonald’s, and an old, decrepit, half empty sugar cane factory for the entire community to work in, and without many schools or resources to even dream what to dream to for reprieve from the poverty. The natural disasters always have much more profound devastation on the poor. The residues of hurricanes still remain: Ripped-off roofs, flooded cities, businesses and houses boarded up and never to open again. Just like the current COVID-19 pandemic, the African-Americans die more frequently and it is no surprise why that might be. Crowded spaces, poverty, lack of hospitals to go to, lack of opportunities for work that provide health insurance, and perhaps cultural differences in seeking medical help until too late. To match this realization, the 2020 Oscar winning movie from Korea “Parasites” confirmed my perspectives on the division of the classes by the economic status. The rich are oblivious to the basic human needs of the poor and naïve toward the calamity that is about to come from the poor that will ultimately affect their lives. The poor people live in the same country of “equality” and yet never taste what that really means. My heart aches for the poor but my body demands luxury.

White Sands National Park, NM
Big Bend National Park, TX
Big Bend National Park, TX
South Texas Cafe
South Florida

Having seen most of America including Hawaii, and Alaska, I am blessed to say that still, America is a beautiful country.  If I had to choose where is the most beautiful National Park, I have to say Yosemite in California and Big Bend in Texas.  The most beautiful and scenic state to drive thru is Alaska.

Yosemite National Park, CA

How did I change? For one, I am grateful that our parents who came to this country giving up their comforts and familiarity and became proud to be a citizen in this beautiful country. Secondly, I am grateful to Hal, my husband who is not only my companion, friend and lover but supports and prepares every step of the way to ease the discomfort of my physical disability, being my own legs to explore beyond the door of the house. Thirdly, I am grateful for the faith I have in Christ to have the courage beyond my imagination to explore the whole country with my polio stricken leg. Despite my physical disability, God took me and lets me see His creation in Nature and His people throughout the U.S. and I dare to travel trusting God is good all along the way. Fourth, through seeing the whole country, it gave me the perspective on who I am and what is important in life. My identity is not just defined by the work I do. Life is much more than that. Having a balanced life, knowing the purposes and meanings found in God, having the end in mind but fully present and mindful of the breaths I take today and not consumed with worries of tomorrow is good. The time passes ruthlessly never asking my permission. This moment too passes, and never returns. No one knows when I will die. The COVID-19 reaffirms the fragile nature of the life. Indeed, it is a time to reflect, know what’s really important, lay down the pride and humble myself to God. We came into this world alone and naked and we die alone. Tomorrow is never promised. And therefore, rejoice in God, praise and pray to Him one more time today while I still have breaths. In Matthew 6:19, Jesus said, “Do not store up for yourselves treasures on earth, where moth and rust destroy, and where the thieves break in and steal.” In Luke 12:39, Jesus also said, “Be sure of this, that if the head of the house had known at what hour the thief was coming, he would not have allowed his house to be broken with.”

“Go back to your home!”

Yesterday I watched a painful scene of an Asian woman getting slandered with unwelcome and unkind words by a a few white Americans on TV. The words spoken are “It’s your fault that we are getting sick! Go back to your home!” These young male Americans were not only vomiting toxic words but eye were also throwing garbage or stones at the woman. She started to run away from them and they gave chase. The news clip stopped and we do not know whatever happened after that.

I remember our mayor in LA, Gil Garcetti, meeting not to discriminate against Asians or to destroy businesses owned by Asian people. Twice in his daily debriefings spoke on this at the 5:00 televised briefings which began soon after the COVID-19 outbreak in our nation. I appreciate Mr. Garcetti for his effort to communicate the updates on the COVID-19 each day and I was especially struck by his comments about the racial slander against Asians that are happening ay this already difficult time. As our nation faces overwhelming amounts of people with COVID-19 infections and the death toll increases everyday, t is easy to get numbed by the news. As of today, 946,234 COVID-19 confirmed cases and more than 47,858 people have died worldwide. And in the U.S., we have 214,461 confirmed cases  with 4,841 deaths. As of yesterday, our nation is facing whether recommend wearing of facial masks for everyone.The entire news, very hour and days filled with the COVID-19 stories. I this environment it is natural for the people to fear, especially when people cannot trust our leaders in government, medical experts, and even the entire infrastructure and social systems.  We place some level of trust in the medical experts who should know how to advise people—whether we should wear masks or not. One day they say “no,” and another day, “yes”. Whatever the reason may be, the trust should not change. The medical experts should have come out and recommended that the entire population should wear masks. But we do not have enough medical supplies and therefore we should give the PPE to medical personnel and others who are on the front lines facing sick patients. It appears all leaders are changing their stories and recommendations “flying by the seat of their pants” depending on the circumstances. If we had known what’s coming tomorrow, we would have done a few things differently to prevent this infection, and leaders would have prepared better to protect the nation, but we are all humans and now, it is what it is. In the meantime, fear among the general population increased, manifested by stockpiling food and toilet paper and attacking Asian-Americans who most likely lived in America for a long time, like fellow Americans who live in this beautiful country and yet they are getting singled out for an outpouring of anger from other races. It is frustrating to have this COVID-19 crisis which originated in Wuhan, China. It must have been started by an individual person recklessly tasting an exotic food for his/her curiosity and pleasure which is now resulting in the loss of so many lives. It is easy to blame others because it is one of our coping mechanisms, but it is a cowardly way to deal with the current circumstances. As an immigrant Korean-American person, and a physician who takes some risk going to work during this crisis, I cannot help toffee sympathetic to other Asian-Americans who face racial discrimination during this painful time. Misery usually compounds, yet this touches me personally. The unfairness compounds since I am not Chinese, but because an “Asian face is an Asian face,” all Asian nationals are a target for the blame by ignorant people in America. 

Recently Americans were told our death and infection rate may peak in two weeks, which means even the current situation is not the worst. The worst is yet to come. Loss of jobs, lack of money to pay the bills, hunger, sickness, fear and loss of mind and lack of judgment will increase to the degree we have not seen in America. The blaming game which is the original sin form Adam and Eve times will spike to the level when Adam said “It was the woman you gave me who gave me the fruit, and I ate it.” Eve said, “The serpent deceived me. That’s why I ate it.” Neither of them claimed responsibility but fingered someone else or something else for their actions. This blaming game fractures relationships in the marriage, families and nations. At a different time in the history of the US, different types and races of people get the blames. Now, the COVID-19 era unfolds and blame targets the Asian race, similar to the World War II era when Japan invaded Pearl Harbor. All Asians suffered in America. Rather than blaming others for our calamities, it is time to turn our focus toward our creator God who is allowing such a time as this in our nation. In Psalm 110: 5-6,  the text states “He will strike down many kings when His anger erupts. He will punish the nations and fill their lands with corpses. He will shatter heads over the whole earth.”

Maybe God is doing something globally and we need to figure out what that is. In the meantime, we need to fill the needs of the people, stepping up to help out our neighbors and not be among the numbers who spread this deadly disease to others. It is my hope to cease the easy route of blaming, and come together in prayers to pass this unprecedented time together as stronger Americans. Discrimination is a cop-out, a cowardly act, and it gains nothing. In Psalm 110, it reveals who is the Messiah and says, “He will be victorious”. Later in Matthew 22:41-46: “Then, surrounded by the Pharisees Jesus asked them a question. ‘What do you think about the Messiah” Whose son is he?’ ”  They replied, “He is the son of David.” Jesus responded, “then why does David, speaking under the inspiration of the Spirit call the Messiah, My Lord? For David said, “The Lord said to my Lord, sit in the place of honor at might hand until I humble your enemies beneath your feet”. Since David called the Messiah my Lord, how can the Messiah be his son?” No one could answer him. And after that, no one dared to ask him more questions.”

This Jesus is our Lord who sits at the right hand of our Father God, and won the victory over evil.

Education on COVID-19

March 28, 2020

As I read more about Coronavirus, I wanted my family and friends to know about a few things and to call out to God in prayer. 

The definition of pandemic means a disease is prevalent over a whole country or the world. The definition of epidemic is a widespread occurrence of an infectious disease in a community at a particular time. The coronavirus started as an epidemic in Wuhan China and became a pandemic. Coronaviruses are a large family of viruses that cause common colds in people but they also infect other animals and different species. Throughout history, we know that viruses mutate constantly and at times they can become highly infectious and virulent. Corona means the upper portion or crown of a part, as of the head as appears in the electron microscope. This is an example diagram of Coronavirus from Google.

The Severe Acute Respiratory syndrome COronaVirus 2 (SAR-COV-2) and the disease it causes, Coronavirus disease 2019 (COVID-19) is known to have initiated from Wuhan China in December, 2019. The most common symptoms are reported as fever, dry cough and shortness of breath. The test is by polymerase chain reaction (PCR) from a nasopharyngeal swab. The New York Times Coronavirus dashboard as of today reported more than 606,200 people are infected and at least 28,050 people have died. The US Coronavirus cases and the number of deaths are continually rising. On 3/1/2020, New York Times headline reported “How prepared is the US for a Coronavirus outbreak?” and now merely within a month, we know we were not prepared. 

According to the Center for Disease Control (CDC) records, flu season in the US which runs from October through May claims 29,000 to 59,000 lives, with most common cause of death from complications such as pneumonia, heart attacks and strokes. Last year, an estimated 80,000 Americans died of flu which was the highest death toll in at least four decades. The death rate from influenza (flu) is generally a fraction of 1% (0.1% to be exact) but the Coronavirus induced death rate is over 1%, (reaching 4.7% today worldwide),  so it is at least 10 times more than seasonal flu.

In 1918, a flu pandemic caused by an H1N1 virus which lasted nearly 2 years killed more than 50 million and infected 500 million (1/3 of the world’s population). It is reported that H1N1 virus originated from genes of avian (bird) origin. In that era, there were no vaccines, antibiotics and medical facilities with ventilators like today and the only way to combat the pandemic was by isolation, quarantine, good personal hygiene, use of disinfectants and limitations of public gatherings; non-pharmaceutical intervention.

In 1957-58, a new influenza (H2N2) virus emerged in East Asia spreading a pandemic (Asian Flu). This virus was first reported in Singapore in February of 1957, Hong Kong in April of 1957, and in coastal cities in the US in summer of 1957, according to the CDC records. The estimated death numbered 1.1 million, with 116,000 of those in the US. This virus originated from Avian Influenza A.

In 1968, Pandemic H3N2 virus comprised a new mutated Avian influenza A. And again in 2009 a novel (new) influenza A (H1N1) virus (H1N1)pdm09 virus, otherwise known as swine flu arose, implicating its origin from swine, occurred in the spring.

The current COVID-19 is thought to have arisen from smuggled pangolins used for both food and medicine. Another possibility is bats, because these two animals have similar genetic codes as in coronavirus. Exactly how the virus jumped from a wild animal to other animals or humans remains a mystery.

According the recent publication in JAMA, the mechanisms leading to death by coronavirus is by filling the lungs with fluid as seen in congestive heart failure symptoms. Human lung is like a tree branching with the end of the tree twigs having grapes with empty sacs. These sacs have a thin membrane which transports oxygen molecule, which is absorbed into the blood flow to provide life to all cells within the body. With COVID-19 infections leading to death, all these grape-like sacs are filled with fluid which leads to inability for oxygen transport. By imaging, the radiologists describe the condition as the “ground glass opacity”. The ventilator is the only way to deliver some oxygen by pushing positive pressure into the lungs. The strong pressure can cause these sacs to “pop” (causing atelectasis) which will damage to the lung permanently. More chronic consequence is the fibrosis/thickening of sac membrane. COVID 19 infection causes this kind of dire situation very fast (within 1-3 days). As in all flus, the most devastating effects are seen in elderly, diabetes, immune deficient populations and other pre-existing medical conditions. 

Knowing these facts, and the history of pandemics, what can we deduce from then and what do we do now? We wait for the specific vaccine against COVID-19. Until then, we go back to what we do know in how to combat the virus; non-pharmaceutical intervention. As we are changing the life style of norms, it is perhaps easy to blame others-governments, organizations such as CDC, WHO, the people of Wuhan China, the President, by saying “only if… “ Strangely, we are so connected by a few people in Wuhan China; their business of what they eat and do are no longer just their business but we are so intimately affected. Their business is now our business whether we like it or not. So, shall we blame the Chinese? What if the next strain of virus comes from a small town in the US? 

When one thinks like the virus, the success depends on the reproduction, increase in potency and easy transport by new and clever mutation of genetic codes and it has nothing to do with the boundaries, races, ages, genders etc. The question we need to ask is when is the next pandemic, and not if. 

As we fight against with this virus today, the only logical way is to distance from each other to stop the spread which will cause less burden to our health care workers and their resources. Most of the health care workers are prepared to fall and are ready to die for the sick. It is their dedication to sick people and promise to the professional Hippocratic oath.

There are always two perspectives and we can choose to see one way or another. One good thing is we have the social media, a technology to connect to the ends of the earth through your phone. We are not alone and thank God for this.

The other thing we can do together is to pray the prayers David had in Psalm 86, 1-3,11-13.

Bend down, O Lord and hear my prayer, answer me for I need your help. Protect me, for I am devoted to you. Save me, for I serve you and trust you. You are my God. Be merciful to me God, for I am calling on you constantly.

Teach me your ways, O Lord that I may live according to your truth. Grant me purity of heart so that I may honor you. With all my heart I will praise you, O Lord, my God. I will give glory to your name forever, for your love for me is very great. You have rescued me from the depths of death.