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To overcome the catastrophic coronavirus (COVID-19) pandemic at hand, it’s important to recognize the positives. One beacon is selfless service. Countless acts by organizations and individuals alike are minimizing the lasting damage. This hard work isn’t only done by the ER doctors, nurses, and first responders constituting our last line of defense. It’s also the good Samaritans doing thankless work next door. We raise our glasses to all the local heroes on the front lines—from all the hospital workers to the grocery stockers, postal workers, small business owners, plus those delivering goods to the elderly and at-risk, #weoweyoudrink.
This week, we got the chance to chat with Santa Monica-based artist/muralist/designer Ruben Rojas. As the co-founder of @beautifyearth, Ruben’s mission since 2013 has been spreading a massive message of love through his art, murals, and speaking engagements across the world. From Paris to New York to Florida, Ruben’s messages of love can be found in urban environments with the intent to simply inspire people to love one another, not only during times of crisis, but every single day.
Photo: Courtesy of Ruben Rojas
Name: Ruben Rojas Title: Artist, Muralist, and Designer Location: Santa Monica, CA Years on the Job: 6 years
MJ: How has your work changed in the last two months?
RUBEN ROJAS: When the pandemic first hit work changed overnight. Many approved jobs with signed contracts were canceled indefinitely and with that, money stopped. Rather than focus on that, I continued my mission and my work, painted murals across town as inspirational reminders to be safe and stay distant.
Two of these murals were, “Love Is Standing Six Feet Apart” and “You Can’t Quarantine Love”—simple reminders for people as they pass by. These murals are a part of history forever and as an artist I’m creating culture and spreading awareness that this is real.
What is the greatest challenge at-hand right now?
Keeping up the momentum that I have created, continuing to grow and scale with limited resources, and trying not to worry about the potential recession or looming financial crisis.
Do you feel at-risk/threatened?
I do not, and I am taking this very seriously being as safe as possible. I also do not see this as a “me” problem or an attack on my liberties, this is a human problem when people are being careless and gathering it does upset me. I get a little sad for them.
Do you see signs of hope?
I see tremendous amounts of hope and positivity that will come from this. Life, as we know it, will drastically change and I am excited to see where we head as a society and I am rooting for us to get closer to our basic humanity.
Should people be working? How can folks help right now?
Of course, essential workers are different. If you can work and be safe, then absolutely, but if you cannot be safe and are putting yourself at unnecessary risk stay home and protect yourself and your family. Ultimately, I believe that staying indoors when possible, wearing a mask when you’re outside around others, and staying away from crowds is about self-respect and self-love. Maybe you have it maybe you don’t, but definitely don’t give it to someone by being careless.
The new study included 770 hospital patients who hadn't previously been diagnosed with coronavirus infection. Of those, 30 tested positive for COVID-19. Of those who tested positive, 22 had no symptoms -- meaning the rate of positive tests among asymptomatic women was 2.9%.
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For months, the coronavirus pandemic forced hospitals to delay elective surgeries as doctors turned their attention to treating COVID-19 patients, but the spigots on non-urgent procedures are about to reopen.
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What should you do if you get a call from a contact tracer letting you know you’ve been exposed to someone who tested positive for COVID-19? Even our best efforts to stay well — by maintaining distance, washing hands often, restricting the size of our social circles, and wearing masks — may not keep the virus at bay as cities and towns lift restrictions.
That’s why many experts recommend three combined approaches to help prevent a dangerous resurgence of illnesses, hospitalizations, and deaths from COVID-19:
continued mitigation efforts, which includes preventive strategies like those described above
prompt access to testing, with quick turnaround on results
contact tracing.
What is contact tracing and who does it?
Generally, contact tracing means locating and testing people known to have been in close contact with a sick person, to prevent an illness like COVID-19 from spreading to an ever-widening circle of people. This strategy works best when case numbers are low — not high or rising fast, as they did in hot spots like New York and California in late March and early April. After the peak passes, contract tracing is feasible. It’s proven effective in countries such as Germany, China, and South Korea.
Just how can we make contact tracing work in the US? Public health authorities are trying to figure that out, even as cities and towns recruit people to train as contact tracers. In some places, contact tracers are volunteers; others are paid. And they have a variety of backgrounds, including public health workers, retired healthcare professionals, furloughed hospitality workers, and students. Being able to speak the language and understand the culture of those who will be called are major advantages. So is a healthy amount of empathy.
Three steps in contact tracing for COVID-19
While local processes vary in the US and around the globe, the World Health Organization recommends these three steps for contact tracing programs:
Identify close contacts. After someone tests positive for the COVID-19 virus, they should first receive appropriate medical care and take measures to isolate themselves. Then, a contact tracer can interview them to get a list of people with whom they’ve spent significant time. According to the CDC, this list should include intimate partners, household members, and anyone coming within six feet of the infected person for at least 15 minutes starting 48 hours before the symptoms that led to testing. Other factors, such as whether the infected person was coughing or wearing a mask, also affect infection risk. Checking calendars and social media communications can help people retrace their steps and refresh their memories about who they might have exposed.
Contact close contacts. The contact tracer will call or text each person considered to be at risk for infection. This is tricky. If the call is unexpected, the contact might be distrustful, skeptical, or even uncooperative with the caller.
If you receive a call, advice will vary depending on the exposure: for a minimal exposure to someone who wasn’t coughing, the recommendation may be to just monitor symptoms and call back if any develop. For more intense exposure, you may be advised to self-quarantine for 14 days. Testing may be suggested if you have symptoms, but may not be necessary otherwise.
Follow-up. After a number of days, the contact tracer should call back to confirm that no symptoms have developed, and answer any questions that have come up. If you test positive for COVID-19, your contacts are called and the process starts over.
How cellphones can help with contact tracing
Researchers and tech companies quickly realized that cell phone technology could help determine who an infected person has come into contact, with and the status of a person in quarantine. For example, apps exist (or are in development) that can
alert you if a person you’ve been near tests positive and lists you as a potential contact
store location information over a period of time that can be readily retrieved if anyone you’ve been near tests positive
automatically text contacts of an infected person every few days to ask if symptoms have developed.
Cell phones have also been used to enforce quarantine in a few countries, although some measures taken may not be acceptable in the US due to concerns about privacy and personal freedoms. But as we enter the “new normal,” requests for our cell phone number when entering a restaurant, supermarket, or other business may become more common. Later, if a worker or other customer has a positive test, knowing who has been there and their phone numbers can make it much easier to notify those who could have been exposed.
Using cell phone technology for those who agree to participate will allow contact tracers and public health workers to allot more resources to those who don’t have a phone, or who are unwilling to share information by phone.
Challenges to contact tracing
Formidable challenges include:
Trainees and cost Current estimates suggest that we’ll need between 100,000 and 300,000 contact tracers nationwide. Recruiting, training, and paying them will require significant resources.
Support services If a contact is advised to quarantine, they may need help getting food, medications, child care, or other services. The contact tracer can help with this only if such support systems are in place.
Testing availability Contact tracing requires ready access to testing and prompt reporting of results.
Acceptance As long as participation is voluntary, a contact tracing program can only be effective if there is widespread cooperation and acceptance by the infected person and their contacts.
Privacy concerns and scammers Whenever personal medical information is requested, safeguards are needed to prevent accidental or inappropriate sharing of that information. The Federal Trade Commission has some helpful recommendations for avoiding scams that have already surfaced. For example, a legitimate contract tracing program may text to tell you to expect a call, but shouldn’t ask you to click on a link or request personal information, such as your social security number or any financial information.
And there is debate about whether data should be stored centrally (for example, by a government agency), whether sharing one’s medical information should be mandatory, and whether individuals should be able to opt out of tracing programs.
The bottom line
Hopefully you and those around you are doing everything possible to limit the risk of becoming infected with the virus that causes COVID-19, and you’ll never be called by a contact tracer. But if you do, don’t be alarmed. What they are doing is a vital part of safely reversing the stay-at-home orders and restrictions made necessary by the pandemic.
Follow me on Twitter @RobShmerling
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
Linda Cardellini, the co-star and a producer of Netflix’s Dead to Me talks about dating your friends, her lifelong love of game shows, and the likelihood of a Freaks and Geeks reboot.
Men’s Journal: Dead to Me is about grief, friendship, and what we’re willing to forgive. Your character hits it off right away with Christina Applegate’s, and they become inseparable. Do you find friendship to be that intense in real life?
Linda Cardellini: I think it’s representational of female friendship. Female friendship is messy. That best friend is the first to tell you you’re messy, but also, if somebody else calls you crazy or messy, they’re the first to defend you. I think female friendships are like family. We’re pretty open about crying, we’re pretty open about anger, and that open communication is what any relationship relies on.
Do you feel the same way about friendships with men?
With a male/female relationship, there can be some guarding going on. I do love my male friends, though, because I can run anything by them and get a different perspective. They’re good at looking at all angles of the situation. I still have the friends I’ve had since kindergarten. Even my significant other—I’ve known him since I was 10.
How did it go from friends to romance?
I don’t really dabble with my male friends because you’ve got to be careful—it will get serious real fast. This seemed like something worth crossing that line for. So we did, and I thought, Well, this is good. This is serious. This is it.
You’ve had an unusual career arc: You’re in your 40s but are just now starting to be cast in leading roles. What’s that been like?
This is the golden era of TV and streaming content, so there are roles that weren’t explored before. When I first started, people would say, “Once you’re a certain age, over 30 or over 40, there’s nothing there.” That’s terrifying. But the business has changed—because there is more content, there’s more room for underrepresented voices and roles that aren’t just for the bright, new, shiny object.
I LOVE WHAT I DO AND CONSTANTLY WORK HARDER TO BE BETTER AT IT—IT’S AS IF IT WERE A SPORT.
Your big break was on Judd Apatow’s cult favorite Freaks and Geeks more than 20 years ago. What do you think has kept you working, versus struggling the way many other child performers have?
I love what I do and constantly work harder to be better at it—it’s as if it were a sport. A lot of it has to do with resilience and perseverance, which is an interesting mix for a creative person. You have to be vulnerable in so many ways, but you also have to have a thick skin, and those two things are in contrast to each other.
Where do you fall on that vulnerable-versus-thick skin continuum?
As a child, I was always told that I was overly sensitive. But the thing that I thought was wrong with me actually became the thing that made me capable of doing what I love. I have learned that sometimes your weakness can actually be a strength.
Reboots and reunions are so popular right now. Could you see reuniting for a Freaks and Geeks where-are-they-now?
Never say never, but it would be a hard one to revisit because so much of that show was about the bittersweet discomfort of being in high school. Once you’re beyond that moment, you realize all those things that you thought were so important aren’t that important, and that the world is so much bigger than your small school. But if everybody signed on, I would love to get back together.
I can’t let you go without asking about this: You once won a fireplace on The Price Is Right?
The first thing I did when I got to Los Angeles was to wait outside all morning to be on The Price Is Right. I was so nervous, but I won a gas fireplace mantle. I was in college living in a dorm, and I didn’t need it at all, but I chose that over the cash value. I had it for years and years, but the funny thing is, I actually lost it in a fire at my storage facility. So yeah, I lost my fireplace in a fire. But I love The Price Is Right—I still watch it. I also watch Wheel of Fortune and Jeopardy! I like a good gamble.
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As reviewed in “Vitamin D Level Is Directly Correlated to COVID-19 Outcomes,” there’s compelling evidence to suggest optimizing your vitamin D level can reduce your risk of COVID-19 and other viral infections such as seasonal influenza.
A number of different scientists are calling for people and governments to prepare for a second wave of COVID-19 come fall, both in the U.S. and abroad.1 Considering SARS-CoV-2 has been shown to be responsive to temperature and humidity, with infectiousness increasing with lower temperatures and humidity levels, we’re likely going to see a reemergence of COVID-19 infections in the fall, during normal influenza season.
REALLY IMPORTANT: Optimize Your Vitamin D Level Before Fall!
What this means is you now have a known “deadline” for optimizing your vitamin D level. To improve your immune function and lower your risk of viral infections, you’ll want to raise your vitamin D to a level between 60 nanograms per milliliter (ng/mL) and 80 ng/mL by fall. In Europe, the measurements you’re looking for are 150 nanomoles per liter (nmol/L) and 200 nmol/L.
Historically, December typically has highest flu activity in the U.S.,2 but it would probably be good to aim for October, or maybe even earlier depending on your location. Optimizing your vitamin D is particularly important if you have darker skin, as darker skin places you at higher risk for vitamin D deficiency — and serious COVID-19 infection.
COVID-19 Racial Disparity Rooted in Vitamin D Deficiency
As reported by The Guardian,3 the COVID-19 mortality among black Americans is three times higher than that of whites, and researchers have long known that blacks cannot achieve optimal vitamin D levels from sun exposure at any time of the year in Northern America.4
Research5 posted April 28, 2020, points out that vitamin D insufficiency is prevalent in severe COVID-19 cases and that “Emerging health disparities data regarding African-American and homeless populations suggest that vitamin D insufficiency (VDI) may be an underlying driver of COVID-19 severity.” Importantly, this study6 found 100% of COVID-19 patients under the age of 75 admitted to intensive care units had vitamin D insufficiency.
A letter to the editor,7 published in the Irish Medical Journal, also points out the many links between vitamin D deficiency and factors known to play a role in COVID-19, such as male sex, acute respiratory distress syndrome (ARDS) and comorbidities like obesity, diabetes and heart disease, and presents data from an in-hospital review of 33 male COVID-19 patients’ vitamin D levels.
The 12 patients who progressed to ARDS had a mean vitamin D level of 27 nmol/L (10.8 ng/mL), whereas those who did not progress to ARDS had a mean level of 41 nmol/L (16.4 ng/mL).
It’s worth noting that 16.4 ng/mL is still grossly insufficient, as 40 ng/mL (100 nmol/L) has been established as a minimum level of sufficiency for general health and disease prevention by GrassrootsHealth.8 The same goes for the elderly, as you tend to lose the ability to convert vitamin D from sun exposure as you age.
Step 1: Measure Your Vitamin D
So, how do you go about optimizing your vitamin D level? First, you need to find out what your base level is, which is done using a simple blood test. An easy and cost-effective way of doing this is to order GrassrootsHealth’s vitamin D testing kit.
Once you know what your blood level is, you can assess the dose needed to maintain or improve your level. Again, the ideal level you’re looking for is above 40 ng/mL, and ideally between 60 ng/mL and 80 ng/mL (European measurement: 100 nmol/L or, ideally, 150 nmol/L to 200 nmol/L).
The easiest way to raise your level is by getting regular, safe sun exposure, but if you’re very dark-skinned, you may need to spend about 1.5 hours a day in the sun to have any noticeable effect.
Those with very light skin may only need 15 minutes a day, which is far easier to achieve. Still, they too will typically struggle to maintain ideal levels during the winter. So, depending on your situation, you may need to use an oral vitamin D3 supplement. The next question then becomes, how much do you need?
Step 2: Assess Your Individualized Vitamin D3 Dosage
The reason you do not want to get fixated on arbitrary dosage recommendations is because the required dose can vary greatly depending on several factors, including skin color, weight and other nutritional deficiencies. As explained by GrassrootsHealth:9
“One of the main factors contributing to this variability is a person’s weight. Therefore, we also calculated a dose-response curve adjusted to an individual weighing 150 pounds (68 kg), shown below.
Indicated on the chart are supplemental dose amounts that ensure a specific proportion of the population achieves particular vitamin D levels. For example, 55% of participants achieved at least 40 ng/ml with 2000 IU/day and 94% of participants achieved at least 40 ng/ml with 8000 IU/day. This chart can be used as a guide to select your starting dose.”
While this chart provides a starting point, you can fine-tune your dosage further by taking into account your baseline vitamin D level. To do that, you can either use the chart below, or use GrassrootsHealth’s Vitamin D*calculator. To convert ng/mL into the European measurement (nmol/L), simply multiply the ng/mL measurement by 2.5.
How to Calculate Your Vitamin D From Sun Exposure
To calculate how much vitamin D you may be getting from regular sun exposure in addition to your supplemental intake, consider using the DMinder app,10 created by Dr. Michael Holick, author of “The Vitamin D Solution: A Three-Step Strategy to Cure Our Most Common Health Problems.” The free app is available for iPhone and android in the Apple store and Google play respectively. As explained by imedicalapps.com:11
“The app attempts to calculate a patients’ vitamin D level based on demographics imputed when first opening the app and then updates the level based on either actual lab draws or data from the app. The app even uses the phone’s GPS and clock to determine the ‘best’ time of day for a patient to get the required sun exposure for vitamin D skin conversion.”
Step 3: Retest
Next, you’ll need to re-measure your vitamin D level in three to six months, to evaluate how your sun exposure and/or supplement dose is working for you. As explained by GrassrootsHealth:
“The only way to know how much supplemental intake you need is to test your levels. This will tell you whether the dose you are taking is the right dose for you to reach optimum nutrient levels. It is also important to check your nutrient levels at regular intervals because lifestyle changes may create a need for dosing adjustments.”
What Is the D*action Project?
Aside from the DMinder app, another helpful tool is the myData-myAnswers online tracker created by GrassrootsHealth. You automatically have access to this tool when you buy their vitamin D testing kit and enroll in the D*action project.
You can track any given supplement with this tracker (not just vitamin D). By tracking exactly how much you take and when, you can get a clearer picture of your personal requirement to reach and maintain an ideal level.
When you buy the GrassrootsHealth testing kit, you agree to enroll in the D*action project, an international field study aimed at solving the vitamin D deficiency epidemic.
By sharing your test results and anonymized personal health data with GrassrootsHealth researchers, you will enable them to determine the details of how vitamin D impacts health. As explained by GrassrootsHealth:
“You may choose to enroll 1-time to test your levels with an extended health questionnaire or you may participate for the full 5-year project where you provide your health information each 6 months for the 5-year period. The participation fees are based on the tests chosen; additional tests can be added to fit your individual needs.”
While I make these testing kits available in my online store, I do not make any profit from their sale. All proceeds go directly to GrassrootsHealth. If you prefer, you can also obtain the kit directly from their website.
Share and Inform Your Community
I urge everyone to share this information with friends, family and community at large, so that we can minimize a second outbreak. For example, you could speak to pastors in churches with large congregations of people of color and help them start a program getting people on vitamin D. Doing so could help save many lives; far more than any vaccine program.
Additionally, if you have a family member or know anyone that is an assisted living facility, you could meet with the director of the program and encourage them to get everyone tested or at least start them on vitamin D.
