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The curious case of the SF doctor whos been coronavirus-positive nearly 90 days and counting – San Francisco Chronicle

Dr. Coleen Kivlahan knew what the result of her coronavirus test would be the moment she stepped outside her San Francisco home and sensed she was smelling a forest fire, a symptom that can accompany loss of smell.

Then that persistent cough kicked in. Those are two of the lasting symptoms. So it was no surprise that she tested positive on Wednesday. The surprise was that it had been at least 85 days that she has been infected with the coronavirus and 62 days since she first tested positive. That she is both alive and still has symptoms may be some kind of record for longevity for suffering the disease without hospitalization.

I belong to the very small club of persistent positives, said Kivlahan, who is executive medical director for all primary care at UC San Francisco. She has seen some 60 UCSF colleagues come down with the coronavirus, almost all going through a miserable few weeks and then test negative and be allowed to return to work.

For Kivlahan, the worst of the symptoms are over. She narrowly avoided hospitalization and the dreaded intubation. She is able to get out of bed and even enjoy the luxury of walking up a flight of stairs. But she has lived essentially in isolation with her husband at their home in Crocker-Amazon since March 6, 10 days before the citywide shelter-in-place order, and has no idea when it will end.

We dont know why I am persistently positive and when I am going to turn negative, she said in a phone interview following her test on Wednesday. Im anxious to join the world again.

Dr. Peter Chin-Hong, an infectious disease specialist at UCSF, does not know Kivlahan and is unfamiliar with her case. But this is the first time he has heard of a patient still testing positive for the coronavirus nearly three months after infection. Within eight days of the onset of symptoms, the virus is normally dead.

I would be shocked if that is live virus, he said of Kivlahans positive test this week. My gut sense is that it is persistent fragments of the virus. This patient may be the exception, but no one really knows.

Chin-Hong said there are not enough data yet on COVID-19 survivors, but with other viruses there have been survivors who develop chronic symptoms like the ones Kivlahan cannot shake.

This is a club, she says, that I dont want to be in.

Kivlahan, who is 66 and in otherwise excellent health, is not sure when she joined the club. It was either Feb. 25 or March 3, the last two days she took time away from her administrative and faculty duties to work in the urgent care clinic at UCSF Parnassus.

On both days she wore a face mask and so did her patients, but there was no coronavirus test available to UCSF patients at that time, and on either day she was examining patients with the standard COVID-19 symptoms of fever and a cough.

I spent a lot more than 10 minutes closer than 6 feet with each patient, she said, so I was a direct hit.

As head of the clinical services side of primary care, Kivlahan oversees hundreds of doctors and thousands of patients, of all ages. She was among 100 UCSF leaders to attend the first strategic meeting on dealing with the coming pandemic, on March 6, three days after she had seen patients in the clinic. The meeting took most of a day, and late in the afternoon as she was hearing about the symptoms to recognize in patients, she started feeling them chills and a fever. She got home just in time for her first cough.

It sounded just like the cough I had been hearing in the clinic, she said. I was having trouble breathing. I knew something was very bad.

She rested through the weekend and on Monday morning she went to UCSF for a nasal swab test and it came back negative, for both influenza and COVID-19. She was sent home to rest and began work on a meticulous medical diary that may serve as a case study some day.

Ive had malaria three times for my work overseas, she said, and I knew there was something severe about this virus.

The journal details her temperature, pulse rate and oxygen level any time she felt symptoms. It also details how, on March 11, her husband, Dave, developed the same symptoms. He also tested negative for the coronavirus but positive for human metapneumovirus, an upper respiratory infection known as HMPV.

Suddenly, we were both quite ill and had to figure out how to get food and medicine, and isolate from each other while being each others only caregiver, she wrote.

On March 15, Kivlahan tested negative for the coronavirus for the third time, but positive for HMPV and bronchitis.

She was given a 12-day course of steroids, and her symptoms waned. Her husband recovered, and she felt well enough to resume working while in bed as shed done all along. But she was hit with a second wave on March 25. She lost her voice, and by nightfall the cough had taken over. She had alternating chills and night sweats so bad that she changed the sheets twice.

The next morning, March 26, she made one of her now too-frequent visits to the UCSF Respiratory Care Clinic. It was one of lifes small strange victories that she finally tested positive for the coronavirus.

I felt relief actually, she wrote. I knew it had been hiding away, under the banner of HMPV, and waiting to take hold of me.

Within a few hours of the diagnosis, she lost her sense of smell and taste for food, which have been revealed in studies to be telltale symptoms. Neither one has come back.

I have a fake smell of smoke from forest fires all around me, she said. It always got worse around 6 p.m. with fever, burning eyes, headaches, nausea. By nighttime shed be so short of breath I couldnt get out of bed to go to the bathroom, and usually I walk 5 miles a day.

But by morning she would feel that she was on the mend, until it started up again. Through it all, she was determined not to go to the hospital and did not want intubation.

For elderly people who are intubated, the mortality rate is high, she said. I was not confident that that was how I wanted to die.

She had the advantage of being able to constantly test herself with a digital thermometer, plus a device that measures the oxygen in the blood and a pulse cuff to measure her blood pressure.

They let me know where I was on the continuum, she said. I prayed that I would be conscious and cognitively clear enough to make a good decision to stay at home until I could not stay at home anymore.

That came on March 31. Her temperature spiked to 102.1, and the dry cough was so bad she packed up for the hospital. Dave was ready to drive her to UCSF.

I said, Give me one more hour, she recalled, and it slowly stabilized.

One of the mysteries is why Dave caught HMPV but it never advanced to COVID-19. He and Kivlahan have joined a UCSF study on couples, one of whom tests positive and the other doesnt. Chin-Hong said she is a model candidate for a second UCSF study being mounted called LIINC (Long-term Impact of Infection with Novel Coronavirus) being set up at San Francisco General Hospital.

How nice, she says, another club to belong to.

One of the first studies on survivors was published by the JAMA Network on May 22. Researchers at Hunan Normal University in China tracked 60 adult patients who had recovered from COVID-19 and been released from the hospital. After 14 days of home quarantine, they were tested again. Ten of the 60 still tested positive for up to 24 days after discharge. An earlier study suggested that patients could test positive up to 30 days after recovery.

But all of those patients were symptom-free. Kivlahan still has the lingering dry cough, tightness in her chest and an elevated heart rate. She still has not regained her sense of smell or taste. Saturday will make at least 88 days since she was infected.

What makes me unusual, and I share this with a small group of people throughout the world, is that my COVID nasal test remains positive this far out from my illness onset, she said. Thus we are in limbo trusting that we are not infectious and that maybe we have antibodies that protect us if exposed ... or maybe not.

Sam Whiting is a San Francisco Chronicle staff writer. Email: swhiting@sfchronicle.com. Twitter: @samwhitingsf

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Black Doctors From the University of Virginia Create Children’s Book To Explain Coronavirus Pandemic – The Skanner

(L to R) Dr. Webb, Dr. Hilton, Illustrator Ashleigh Corrin Webb. (Photo Courtesy of The Get Well Company, Good Stock Consulting, AALBC.com)Two Black doctors from the University of Virginia decided to create a book to help explain the coronavirus pandemic to children,NBC29reports.

Dr. Leigh-Ann Webb, Dr. Ebony Hilton, and illustrator Ashleigh Corrin Webb teamed up to write a childrens book that would explain the pandemic to younger children as well as the dangers for children of color during this time.

Were Going to be O.K.tells the story of Parker, a young Black boy adjusting to his new normal of schooling from home as a result of the coronavirus pandemic. The story gives tips on how to stay safe, as well as advice on physical health and mental wellness during COVID-19.

I think that the enemy of fear is information, Dr. Hilton said.

Dr. Webb agreed, adding that there were questions that young people might have that needed to be addressed. How do you try to stay social? Share the good work that youre doing while maintaining a safe distance away from other people so that you dont get sick? Little Parker does that really well in the book, but I think the overall message is little things can make such a big impact, Dr. Webb said.

Dr. Hilton is an anesthesiologist, critical care physician, and medical director atGood Stock Consulting, a company that focuses on empowering leaders, engaging underserved communities to drive change, teaching and strengthening organizational capacity, and cultivating trust between orgs and the communities they serve. Dr. Webb is an emergency medicine physician and the founder ofThe Get Well Company, an organization focused on [using] empathy, innovation and collective action to promote equity and revolutionize the illness experience. To illustrate the book, the two brought in 2020 Ezra Jack Keats award winning illustrator and designer,Ashleigh Corrin Webb.

The group felt the book was the best way to merge their expertise and enroll children in the process of keeping themselves safe during the COVID-19 pandemic. We know that health literacy is important for longevity so we try in this book to literally talk about COVID-19 from a scientific point. It literally says, this is what COVID-19 means. This is what this virus looks like. This is where its now taking us as far as day-to-day living, Dr. Hilton said.

She also added that the implications of the book are far reaching, and hopefully even inspires children to pursue careers in the medical field. I think the impact that I hope it has is that it engages children early to be curious about science.

"Hopefully this makes some scientists and doctors for the future, she said.

The book has already received national recognition, winning the Emory Global Health Institutes 2020 eBook competition. It is also completely free and includes printable workbook pages, including a feelings chart, a gratitude exercise and a list of free resource links.

To get your copy ofWere Going to be O.K.,clickhere.

This story was originally published on BecauseOfThemWeCan.com.

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Black Doctors From the University of Virginia Create Children's Book To Explain Coronavirus Pandemic - The Skanner

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Here is how alkaline water boosts immunity – The Indian Express

By: Lifestyle Desk | New Delhi | Updated: May 31, 2020 11:22:59 am A lot of people have taken to talking about immunity-boosting measures, along with Actor Anushka Sharma. (Source: Getty/Thinkstock Images)

Ever since the coronavirus has impacted the world, immunity boosters have become the buzzword. A lot of people have taken to talking about immunity-boosting measures, along with actor Anushka Sharma who has been sharing tidbits from her lockdown days along with husband and cricketer Virat Kohli.

Alkaline water has a ph level 8 to 10 against the pH level of 6.5 to 7.5 for drinking water. This gives a measure of how acidic or basic a substance is on a scale of 0-14. Generally, regular drinking water has a ph of 7 making it neither acidic nor alkaline. Alkaline water has antioxidant properties and helps to fight free radicals.

There are quite a few studies which highlight the benefits of drinking alkaline water. According to one published in Evidence-Based Complementary and Alternative Medicine, alkaline water provides higher longevity in terms of deceleration in ageing as it increases survival functions. In another study published in the Journal of the International Society of Sports Nutrition, a significant difference was observed in the whole blood viscosity of participants after consuming alkaline water as opposed to drinking regular water after a vigorous workout.

A study published in Alternative Therapies in Health and Medicine indicated that drinking alkaline water may prevent osteoporosis and protect pancreatic beta cells with its antioxidant effects.

How does alkaline water boost ones immunity?

An excess amount of toxic compounds in the body means it will have to work extra hard to maintain its biological functions. This may lead to weakness. On the other hand, alkaline water neutralises these toxic compounds present in the body. Moreover, alkaline water is more easily absorbed by the body. This allows your body to use the water you drink effectively, and toxins and harmful substances are flushed out of your system more easily.

Drinking alkaline water regularly can improve the performance of your circulatory system, says Dr Suresh Sisodia, Sr. Vice President, Havells India Ltd. It alters the quality of blood in such a way that more oxygen is carried to vital organs. All benefits of alkaline water work in tandem to make the immune system stronger in order to fight foreign pathogens and infections.

Due to its basic nature, alkaline water neutralises the acidic content in the bloodstream, lowers the Oxidation Reduction Potential (ORP) resulting in the antioxidant nature of water while introducing a variety of natural minerals to regular drinking water. Drinking alkaline water has umpteen number of health benefits such as supporting digestion and assimilation, strengthening of bones, weight reduction, better hydration for skin and body alongside other benefits such as anti-ageing and detoxifying properties, etc.

Further, it also relieves acid reflux, which affects people who eat cuisines that tend to be spicy. Additionally, alkaline water has antioxidant properties that help to prevent the growth of cell-damaging free radicals, which can accelerate the ageing process.

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How to live longer: The best diet hailed by health experts to increase life expectancy – Express

The Western diet and lifestyle which includes consumption of processed foods such as burgers and little to no exercise are often viewed as two of the main contributors to rapid ageing and disease.

Vegans and vegetarians live longer and have lower mortality rates.

They also tend to have healthier gut profiles with a reduced abundance of pathogenic gut bacteria and greater abundance of protective species.

Those who followed this way of eating also had lower blood pressure, lower incidence of heart disease, lower overall cancer incidence and have a lower risk of developing diabetes.

Vegan, vegetarian and plant-based diets eliminate all animal-based foods including meat, dairy and eggs.

This usually results in a diet which is rich in fruits, vegetables, whole grains, legumes, nuts and seeds.

Numerous researches suggest that diets loaded with these plant foods help to increase life expectancy.

Moreover, these diets tend to pack plenty of fibre, plant protein and antioxidants.

Diets rich in these nutrients are believed to safeguard against obesity, diabetes, cancer and heart disease which in turn promote increased life expectancy.

In a study with the National Library of Medicine, cardiovascular disease mortality and cancer incidence in vegetarians was analysed.

The study noted: The objective of the present analysis was to investigate cardiovascular disease mortality and cancer incidence among vegetarians and nonvegetarians.

Participants were from the UK, Germany, USA, the Netherlands and Japan.

The study concluded that all-cause mortality in vegetarians was 9 percent lower in nonvegetarians with the mortality from ischemic heart disease being significantly lower in vegetarians than in nonvegetarians.

Our results suggest that vegetarians have a significantly lower ischemic heart disease mortality and overall cancer incidence than nonvegetarians, it added.

Vegan, vegetarian and plant-based diets contain the best types of food to eat.

Fruit and vegetables contain protective bioactive compounds such as antioxidants, polyphenols, fibre, vitamins and minerals.

Whole grains are rich in phytochemicals, trace minerals and protein with whole grains helping to lower blood pressure and reduce the risk of cardiovascular diseases.

Plant-based proteins such as beans, legumes and pulses help to lower LDL'bad'cholesterol which reduces cancer risk and nuts and seeds contain a variety of vitamins and minerals which reduce risk of cancer mortality.

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Quanterix Expands Menu of Ultra-Sensitive Neurology Assays with Simoa P-Tau181 V2 Kit for Improved Detection and Study of Alzheimer’s Disease -…

BILLERICA, Mass.--(BUSINESS WIRE)--Quanterix Corporation (NASDAQ: QTRX), a company digitizing biomarker analysis to advance the science of precision health, today announced that it will expand its robust menu of ready-to-use Simoa kits to include tau phosphorylated at threonine 181 (p-tau181), a highly specific biomarker for the study of Alzheimers disease pathology, in cerebral spinal fluid (CSF), serum and plasma. A growing body of research, including work published recently in The Lancet Neurology, suggests that the biomarker could prove critical to predicting Alzheimers disease progression and differentiating the disease from other neurodegenerative disorders. Moreover, an ultra-sensitive, blood p-tau181 assay may hold the key to advancing preventative care for the disease in clinics and via homecare sampling through a simple, cost-effective blood-based screening that can deliver an early, objective diagnosis. These findings and details on how researchers can gain early access to Quanterix new commercial assay through the Simoa Accelerator Laboratory, will be discussed during an upcoming Powering Precision Health (PPH) Think Tank Webinar taking place at 10 a.m., EDT on June 3, 2020.

Biomarkers continue to play an invaluable role in understanding how neurological diseases manifest, progress and respond to treatment, said Kevin Hrusovsky, Chairman, Chief Executive Officer and President, Quanterix. Building on years of innovation and a proven track record for successfully commercializing ultra-sensitive assays that disrupt markets and drive innovative breakthroughs forward, our p-tau181 version 2 assay kit offers researchers unrivaled visibility and specificity into this revolutionary marker in serum and plasma. The exquisite sensitivity of Simoa uniquely positions us to deliver on the promise of p-tau181 to pave new pathways in Alzheimers disease exploration, just as our neurofilament light chain (Nf-L) assay has transformed research for other neurological diseases. In particular, the impact of a high-definition, blood-based Simoa assay that rivals traditional CSF or PET scans could be revolutionary, with material potential for home sampling to enable early detection and development and approval of drug therapies desperately needed to improve outcomes for the millions of people living with Alzheimers disease today. This biomarker advance fits perfectly in our vision to transform reactive sick care' into proactive asymptomatic precision healthcare.

While deaths associated with other pervasive diseases such as heart disease have declined between 2000 and 2018, Alzheimers disease-related deaths have increased by 146 percent, according to the Alzheimers Association. Importantly, there is no objective test to diagnose the disorder, leading many physicians to rely solely on subjective cognitive assessments. As a result, many patients are not diagnosed until late in the diseases progression, after symptoms of cognitive decline, such as memory loss, begin to present. Even then, the disease can often be misdiagnosed for another neurodegenerative condition, such as frontotemporal dementia (FTD).

For years, researchers have studied the utility of biomarkers for understanding, detecting and monitoring Alzheimers disease. These efforts have been accelerated in large part by the PPH network, which has grown into a global epicenter for biomarker-enabled innovations to not only detect and treat, but ultimately, prevent disease. Resulting studies demonstrate the vast utility of proteins such as total tau and Nf-L. Researchers, doctors and pharmaceutical companies are now harnessing these biomarkers to see the disease earlier, monitor its progression and inform clinical decision making more effectively, and assess the viability of experimental therapies. Quanterix ultra-sensitive immunoassay technology, Simoa, which empowers single- and multi-plex detection of key biomarkers with 1000 times greater sensitivity than competing enzyme-linked immunosorbent assay (ELISA) solutions, is the driving technology behind much of this research. Among the most notable is a 2019 Nature Medicine paper that used Simoa to see signs of Alzheimers disease 16 years before symptoms through the high-definition detection of Nf-L. The technology has powered hundreds of similarly peer-reviewed journals over the years that demonstrate the potential for blood-based detection of the disease with equal or greater sensitivity as compared to CSF or PET biomarkers. Collectively, these studies create an influential body of research that advances the preventative care paradigm envisioned by PPH at its inception by supporting the utility of a non-invasive and easily administered blood test to detect Alzheimers disease before symptoms.

Today, emerging research suggests that p-tau181 could hold even greater diagnostic promise for Alzheimers disease, as it has proven capable of differentiating the condition from other forms of dementia with greater specificity than total tau. Leaders in the field of neurodegenerative disease research, such as the authors of The Lancet Neurology paper Professors Henrik Zetterberg, MD, PhD, and Kaj Blennow, MD, PhD, of the University of Gothenburg, believe blood p-tau181 has the potential to revolutionize Alzheimers disease research and patient care in much the same way that serum-based Nf-L has for multiple sclerosis (MS).These concepts further progress PPHs mission and vision to harness biomarkers for true precision health, with myriad implications that include improving understanding of the condition, enabling earlier diagnosis and intervention, informing more accurate long-term care, identifying clinical trial candidates earlier in the disease cascade and, subsequently, accelerating promising new therapies to market.

The latest installment of the PPH Think Tank series of webinars, entitled Novel p-tau181 Blood Immunoassay and the Future of Alzheimers Disease Research, will explore the vast opportunities associated with p-tau181 to revolutionize the way we approach disease and administer care. Specifically, the discussion will detail how an innovative immunoassay to measure p-tau181 in blood could accelerate efforts to establish a clinically relevant routine Alzheimers disease diagnostic test, and the potential high-definition detection via small volume blood samples creates for homecare precision health. Hrusovsky, together with Professors Zetterberg and Blennow, will break down the findings from the recent paper in The Lancet Neurology and examine how Simoa is powering exploration into uncharted territory as it pertains to Alzheimers disease detection, monitoring, treatment and prevention.

Were on the cusp of what could be an incredible new era for Alzheimers patients and those with a genetic predisposition to the disease, said Zetterberg. The ability to see dementia asymptomatically and moreover conclusively distinguish it as Alzheimers disease-induced could forever change the face of this condition. P-tau181 shows immense promise in this regard, which is augmented considerably when harnessed by a leader in detection like Quanterix.

Early findings from our work with p-tau181 are very encouraging, said Blennow. The biomarker is proving to be an exceptional new tool in our arsenal against Alzheimers disease. While CSF p-tau181 has been recognized as a highly valuable biomarker in Alzheimers disease pathology, the greater clinical benefit will come from our ability to effectively harness the marker in blood. The unprecedented specificity of p-tau181 paired with a highly sensitive technology like Simoa promises to broaden our knowledge of this devastating disease considerably, with monumental implications for patients and caregivers.

To register for the webinar, click here.

To learn more about how you can take advantage of our early access program for p-tau181 through the Accelerator Lab or pre-order your commercial kits, visit https://www.quanterix.com.

For more about Quanterix Simoa technology, visit https://www.quanterix.com/Simoa-bead-technology.

About Quanterix

Quanterix is a company thats digitizing biomarker analysis with the goal of advancing the science of precision health. The companys digital health solution, Simoa, has the potential to change the way in which healthcare is provided today by giving researchers the ability to closely examine the continuum from health to disease. Quanterix technology is designed to enable much earlier disease detection, better prognoses and enhanced treatment methods to improve the quality of life and longevity of the population for generations to come. The technology is currently being used for research applications in several therapeutic areas, including oncology, neurology, cardiology, inflammation and infectious disease. The company was established in 2007 and is located in Billerica, Massachusetts. For additional information, please visit https://www.quanterix.com.

About Powering Precision Health

Powering Precision Health is the world's first independent, non-profit organization dedicated to bringing the world's leading physicians, scientists, innovators, investors and patient advocates together to unveil their latest research on new biomarkers that are revolutionizing precision health. Founded by Kevin Hrusovsky, a widely acclaimed thought leader and visionary in life sciences and personalized medicine, Powering Precision Health is a movement that represents the intersection of new technological capabilities with the latest medical research. Its rooted in the science of precision medicine, which shows personalized treatments to be an increasingly more effective way to maximize drug efficacy and minimize toxicity. In addition to the impact environmental and lifestyle factors can have on minimizing disease triggers, precision health marks an evolution in the way we approach disease and aims to inspire a full healthcare transformation, from philosophy to approach to outcome. In an industry often plagued by skepticism and marred by false promises, PPH puts science first and brings together stakeholders that span from fundamental research to clinical practice, investors, policy makers, patient advocacy groups, and anyone who embraces the vision of Powering Precision Health. Featuring a distinguished keynote lineup of dignitaries, the Summit unveils groundbreaking approaches to prevention, early diagnosis, and next-generation treatments. Powering Precision Health is supported thanks to the generous contributions of sponsors from a wide range of companies and organizations committed to advancing precision health.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as "may," "will," "expect," "plan," "anticipate," "estimate," "intend" and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) are intended to identify forward-looking statements. Forward-looking statements in this news release are based on Quanterix expectations and assumptions as of the date of this press release. Each of these forward-looking statements involves risks and uncertainties. Factors that may cause Quanterix actual results to differ from those expressed or implied in the forward-looking statements in this press release are discussed in Quanterix filings with the U.S. Securities and Exchange Commission, including the "Risk Factors" sections contained therein. Except as required by law, Quanterix assumes no obligation to update any forward-looking statements contained herein to reflect any change in expectations, even as new information becomes available.

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Curious case of SF doctor who’s been COVID positive nearly 90 days and counting – msnNOW

Dr. Coleen Kivlahan knew what the result of her coronavirus test would be the moment she stepped outside her San Francisco home and sensed she was smelling a forest fire, a symptom that can accompany loss of smell.

Then that persistent cough kicked in. Those are two of the lasting symptoms. So it was no surprise that she tested positive on Wednesday. The surprise was that it had been at least 85 days that she has been infected with the coronavirus and 62 days since she first tested positive. That she is both alive and still has symptoms may be some kind of record for longevity for suffering the disease without hospitalization.

I belong to the very small club of persistent positives, said Kivlahan, who is executive medical director for all primary care at UC San Francisco. She has seen some 60 UCSF colleagues come down with the coronavirus, almost all going through a miserable few weeks and then test negative and be allowed to return to work.

For Kivlahan, the worst of the symptoms are over. She narrowly avoided hospitalization and the dreaded intubation. She is able to get out of bed and even enjoy the luxury of walking up a flight of stairs. But she has lived essentially in isolation with her husband at their home in Crocker-Amazon since March 6, 10 days before the citywide shelter-in-place order, and has no idea when it will end.

We dont know why I am persistently positive and when I am going to turn negative, she said in a phone interview following her test on Wednesday. Im anxious to join the world again.

Dr. Peter Chin-Hong, an infectious disease specialist at UCSF, does not know Kivlahan and is unfamiliar with her case. But this is the first time he has heard of a patient still testing positive for the coronavirus nearly three months after infection. Within eight days of the onset of symptoms, the virus is normally dead.

I would be shocked if that is live virus, he said of Kivlahans positive test this week. My gut sense is that it is persistent fragments of the virus. This patient may be the exception, but no one really knows.

Chin-Hong said there are not enough data yet on COVID-19 survivors, but with other viruses there have been survivors who develop chronic symptoms like the ones Kivlahan cannot shake.

This is a club, she says, that I dont want to be in.

Kivlahan, who is 66 and in otherwise excellent health, is not sure when she joined the club. It was either Feb. 25 or March 3, the last two days she took time away from her administrative and faculty duties to work in the urgent care clinic at UCSF Parnassus.

On both days she wore a face mask and so did her patients, but there was no coronavirus test available to UCSF patients at that time, and on either day she was examining patients with the standard COVID-19 symptoms of fever and a cough.

I spent a lot more than 10 minutes closer than 6 feet with each patient, she said, so I was a direct hit.

As head of the clinical services side of primary care, Kivlahan oversees hundreds of doctors and thousands of patients, of all ages. She was among 100 UCSF leaders to attend the first strategic meeting on dealing with the coming pandemic, on March 6, three days after she had seen patients in the clinic. The meeting took most of a day, and late in the afternoon as she was hearing about the symptoms to recognize in patients, she started feeling them chills and a fever. She got home just in time for her first cough.

It sounded just like the cough I had been hearing in the clinic, she said. I was having trouble breathing. I knew something was very bad.

She rested through the weekend and on Monday morning she went to UCSF for a nasal swab test and it came back negative, for both influenza and COVID-19. She was sent home to rest and began work on a meticulous medical diary that may serve as a case study some day.

Ive had malaria three times for my work overseas, she said, and I knew there was something severe about this virus.

The journal details her temperature, pulse rate and oxygen level any time she felt symptoms. It also details how, on March 11, her husband, Dave, developed the same symptoms. He also tested negative for the coronavirus but positive for human metapneumovirus, an upper respiratory infection known as HMPV.

Suddenly, we were both quite ill and had to figure out how to get food and medicine, and isolate from each other while being each others only caregiver, she wrote.

On March 15, Kivlahan tested negative for the coronavirus for the third time, but positive for HMPV and bronchitis.

She was given a 12-day course of steroids, and her symptoms waned. Her husband recovered, and she felt well enough to resume working while in bed as shed done all along. But she was hit with a second wave on March 25. She lost her voice, and by nightfall the cough had taken over. She had alternating chills and night sweats so bad that she changed the sheets twice.

The next morning, March 26, she made one of her now too-frequent visits to the UCSF Respiratory Care Clinic. It was one of lifes small strange victories that she finally tested positive for the coronavirus.

I felt relief actually, she wrote. I knew it had been hiding away, under the banner of HMPV, and waiting to take hold of me.

Within a few hours of the diagnosis, she lost her sense of smell and taste for food, which have been revealed in studies to be telltale symptoms. Neither one has come back.

I have a fake smell of smoke from forest fires all around me, she said. It always got worse around 6 p.m. with fever, burning eyes, headaches, nausea. By nighttime shed be so short of breath I couldnt get out of bed to go to the bathroom, and usually I walk 5 miles a day.

But by morning she would feel that she was on the mend, until it started up again. Through it all, she was determined not to go to the hospital and did not want intubation.

For elderly people who are intubated, the mortality rate is high, she said. I was not confident that that was how I wanted to die.

She had the advantage of being able to constantly test herself with a digital thermometer, plus a device that measures the oxygen in the blood and a pulse cuff to measure her blood pressure.

They let me know where I was on the continuum, she said. I prayed that I would be conscious and cognitively clear enough to make a good decision to stay at home until I could not stay at home anymore.

That came on March 31. Her temperature spiked to 102.1, and the dry cough was so bad she packed up for the hospital. Dave was ready to drive her to UCSF.

I said, Give me one more hour, she recalled, and it slowly stabilized.

One of the mysteries is why Dave caught HMPV but it never advanced to COVID-19. He and Kivlahan have joined a UCSF study on couples, one of whom tests positive and the other doesnt. Chin-Hong said she is a model candidate for a second UCSF study being mounted called LIINC (Long-term Impact of Infection with Novel Coronavirus) being set up at San Francisco General Hospital.

How nice, she says, another club to belong to.

One of the first studies on survivors was published by the JAMA Network on May 22. Researchers at Hunan Normal University in China tracked 60 adult patients who had recovered from COVID-19 and been released from the hospital. After 14 days of home quarantine, they were tested again. Ten of the 60 still tested positive for up to 24 days after discharge. An earlier study suggested that patients could test positive up to 30 days after recovery.

But all of those patients were symptom-free. Kivlahan still has the lingering dry cough, tightness in her chest and an elevated heart rate. She still has not regained her sense of smell or taste. Saturday will make at least 88 days since she was infected.

What makes me unusual, and I share this with a small group of people throughout the world, is that my COVID nasal test remains positive this far out from my illness onset, she said. Thus we are in limbo trusting that we are not infectious and that maybe we have antibodies that protect us if exposed ... or maybe not.

Sam Whiting is a San Francisco Chronicle staff writer. Email: swhiting@sfchronicle.com. Twitter: @samwhitingsf

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Curious case of SF doctor who's been COVID positive nearly 90 days and counting - msnNOW

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