Elder Letters from Dr. Ryan Gross


Excerpts from Dr. Ryan Gross’s letters to his Elder Group regarding the coronavirus

 

May 2, 2020

Greetings, y’all!

You have by now seen Governor Inslee’s plan for “reopening” Washington state gradually, and many are discouraged by the long timeline.  The rainy weather doesn’t help.  Perhaps like me your mood waxes and wanes.  How long, O Lord?

Now that the Governor has given us something of an outline, the pastors, Session, and Diaconate will begin drawing up tentative plans as well.  As I mentioned last time, we are forming a little “COVID-19” subcommittee which will meet (virtually) soon.  The pastors are in the process of roping a couple of our fine deacons into this work.  As soon as we have something for you that is more substantial than “well, maybe this…or maybe that” we will let everyone know.

I have been pondering Pastor Nicoletti’s sermon Sunday evening on the pandemic as revelation/apocalypse/uncovering, and the idols which are revealed.  I have also heard our current situation referred to as an “acid test” which is a similar idea.  An acid test is an idiom originating in metallurgy, in which acid is used to dissolve away all that which is not gold.  The gold is left behind, revealed by the corroding power of the acid.  Whatever else is true, this virus is revealing much, and Christians must think and act wisely about it.

We know very little right now about this particular coronavirus.  Over the past century much has been learned about viruses in general.  You might (or might not) be intrigued to know that there are 13-16 separate RNA virus “families” (of which coronaviruses are but one) and 7-8 different DNA virus families which are known to cause human disease.  In each family there are many separate viral diseases, some familiar (polio, influenza, rabies) and some not (Marburg, Lymphocytic choriomeningitis virus, Sandfly fever Sicilian virus).  But of this newly recognized coronavirus, we know little and must extrapolate from what is known of other members of the family.

Does SARS-COV2 spread fast and easily like the common cold coronaviruses (coronaviruses HKU1, NL63, 229E and OC43, if you are scoring at home…)?  Does it cause severe pneumonia and death like the coronaviruses SARS-classic and MERS?  So far, the answers to both questions appear to be YES.  Do we know what symptoms SARS-COV2 causes?  Well, yes.  And no.  Maybe usually, but not always.  Some people have no symptoms.  How many?  We have only educated guesses (at this point).  When will we know more?  Tomorrow, and the day after that, as well as 6 months from now and 5-10 years from now.

And so the acid test burns away our pretensions and reveals the immensity of our ignorance, not only of the medical/biological/epidemiological details of just one viral disease, but also of the economic and political crises that will follow.  What should the wise Christian do, and where do we look for the gold?

I have been discouraged, but not surprised alas, to see many (including many Christians who should know better) coalescing into the usual social media groupthink categories, expressing certainties about this or that aspect of the crisis, criticizing and disparaging others and looking for the usual dark conspiracies of choice.  Surely God’s Word does not commend such behavior to us.  In the face of such a calamity, and such ignorance and uncertainty, surely the wise Christian embraces humility both in public and in private.  In us, this acid should corrode away all that does not leave humility.

Likewise, have you wondered why this acid test hasn’t revealed more of us Christians on our knees pleading for mercy?  I know that for myself that I do not take the Lord nearly as seriously, nor fear Him as the righteous Judge, as I ought.

Humility is gold, repentance is gold, and prayer is gold.  There must be many others, but enough for now.  I have been reading lately Charles Spurgeon’s Lectures To My Students, a collection of his talks and advice to ministerial students.  There is a chapter devoted to ministers suffering under severe circumstances, and it is applicable to us as well:

“Even if the enemy’s foot be on your neck, expect to rise and overthrow him.  Cast the burden of the present, along with the sin of the past and the fear of the future, upon the Lord, who forsaketh not His saints.  Live by the day—ay, by the hour.  Put no trust in frames and feelings.  Care more for a grain of faith than a ton of excitement.  Trust in God alone, and lean not on the needs of human help… Any simpleton can follow the narrow path in the light:  faith’s rare wisdom enables us to march on in the dark with infallible accuracy, since she places her hand in that of her Great Guide.  Between this and heaven there may be rougher weather yet, but it is all provided for by our covenant Head.”

I pray that, most of all, this acid test may reveal and strengthen our faith in our Great Guide.

Ryan

 

April 19, 2020

Greetings, and Happy Lord’s Day to one and all!  An update for those interested…

Paul Darby and I, with the pastors and Derek Whaley (administrator), have been asked by the Session to serve as a sub-committee to advise about how to resume operations when the time eventually comes.  Unfortunately, I think it likely that large group meetings will be slow to resume.  I can give you at least a sense of why I think that, and what follows below are just a few of the basics of the situation medically.  Skip it if not of interest to you personally.  On the other hand, if you are the kind of person who wants me to drone on endlessly, then this is for you:

On Coronavirus:

  1. As you undoubtedly know, here in western Washington the numbers of new cases are declining, as are hospitalizations and deaths, gradually.
  2. The virus likes humans in high density (cruise ships, aircraft carriers, meat packing plants, public transportation, nursing homes, prisons, urban areas, homeless shelters).  No surprise.
  3. The virus disproportionately harms and kills the most vulnerable among us (the elderly, chronically ill, the poor, and all who work in high density situations, often minorities and immigrant populations).  There may be some genetic reasons why certain races are significantly more vulnerable, but that is not known currently.  However the virus itself is most commonly found in the young.  In Washington, about 2/3 of all detected cases are people under age 60, and in fact about a third are under age 40, while 92% of the deaths are in folks 60 and over.
  4. You will hear much in coming weeks about opening up society and about testing, particularly the nasal swabs and antibody testing.  A few basics might help you navigate what you see in the media.
  • All medical tests have specificity (a positive test actually diagnoses the disease) and sensitivity (a negative test actually rules out the disease).  An “ideal” test would have 100% specificity and sensitivity.  However, in real life there are NO ideal tests!
  • The nasal swab (a collection of snot placed in preservative and then frozen, if I may be indelicate) used for COVID-19 has an uncertain specificity, although it is presumed to be near 100%, because the test actually amplifies the genetic material of the virus when it is present in the snot collected on the swab.  So, a positive result indicates the virus is present almost every time (but says nothing about whether the symptoms are bad or not).
  • The sensitivity of the swab however is POOR, perhaps just 70%, maybe as low as 60%, so negative does NOT mean the virus isn’t there for sure since we may miss it 30-40% of the time even when it is present.  A negative nasal swab does NOT “rule out” coronavirus infection, which obviously is a huge problem.
  • The antibody tests you are hearing about right now are analogous to pregnancy tests, basically they look for IgM and IgG antibodies in a finger stick drop of blood and give you a “plus” or “minus”, present or absent.  Usually, when the body mounts an antibody response to a virus, you first make IgM (immunoglobulin type M, for anyone who has read this far and is still conscious!) antibodies and later IgG type antibodies.  When an infection occurs, those tests tend not to become positive until over a week has passed (for IgM) and a few weeks (for IgG).
  • So these initial “plus/minus” antibody tests might have some usefulness in certain situations, but in general aren’t going to be a breakthrough just by themselves.  At my office, we considered purchasing these tests, but ultimately decided they were not helpful enough to invest money and time in.
  • What we really need are blood tests that measure the amount of each antibody present, and we need to know whether those antibodies provide immunity, and for how long.  We don’t know any of that today and can’t know that for some time.  The blood tests are coming soon, though, within weeks I think, and will add considerably to our knowledge.
  1. A vaccine is NOT guaranteed, many viruses have defied attempts at vaccine development in the past, it is possible this one will as well.  It will take time to know.  Remdesevir looks promising so far, hydroxychloroquine does not, as of this weekend.  Stay tuned.  Lots of other drugs are being tested.  Viruses are almost always hard to treat.
  2. We DON’T know all sorts of things about this disease.  We don’t know how many people will be left with permanent lung damage, permanent kidney damage, permanent neurological damage.  We don’t know if the virus is seasonal, if it recurs in a previously infected individual, or if it will mutate to a less virulent or more lethal form.  We DO know it is highly transmissible, much in the way the common cold is.  But unlike the common cold, it causes serious illness in a significant percentage, sends a lot of people to the hospital, results in lots of folks on oxygen, and large numbers of folks simultaneously have respiratory failure.  Pray this pestilence ends soon.

Blessings to all, let us hear from you as you are able.

Ryan

 

March 21, 2020

March 21, 2020

Greetings and our Lord’s blessings to all as we isolate and learn new ways of communicating.  Some of you were formerly in Elder (Emeritus) Hannula’s group, so a particular hello to you (and an extension of sympathy should you be, quite understandably, disappointed!).

MEDICAL ADVICE YOU DIDN’T ASK ME FOR UPDATE:  I started medical school 36 years ago in the early stages of the HIV/AIDS epidemic.  Suzan and I both did our Internal Medicine residency training at the height of that epidemic, and we watched a lot of young folks suffer and die with various infectious diseases, some of them quite exotic.  HIV has now been turned into a chronic and controllable condition for nearly everyone infected with it.  We have subsequently seen various epidemics come and go over the past many years, and those of us who are students of medical history have worried particularly about “the big one”.  15 years ago SARS (another coronavirus) looked like it might be, but aggressive containment and the virus’ own lethality (9%) limited spread.  COVID-19 appears to be the big one we have worried about, a virus that combines significant infectivity with a high percentage of severe illness and death.

COVID-19 has been in our community for two months now, spreading mostly silently among younger healthy folks with cold and flu (or no) symptoms, and now reaching into nursing homes, homeless shelters, prisons and other places of close confinement.  The news media, generally, has focused on the number of positive tests and how many people have died.  Now they, and our political leadership, finally have understood that the more important numbers are how many people are sickened enough to wind up in the hospital, and how many have respiratory failure and need ICU care.  What is happening in northern Italy is terrifying.  Pray for the Lord’s mercy there and in other areas of very high population density, because our major cities could have the same scenario, one after another.  New York City right now is in real trouble.

All this to say:  take it seriously.  Keep even your youngsters apart from others and away from the elderly or otherwise vulnerable.  And if your hands aren’t as chapped as mine are, you aren’t washing enough!

If you are interested in a reliable medical authority in this crisis, may I suggest the now well known and ubiquitous Dr. Fauci to you.  Dr. Anthony Fauci has been THE authority on infectious diseases for the entirety of my medical life for 36 years, and is very careful in what he says.  He is one of the long term editors of Harrison’s Principles of Internal Medicine (one of our two standard textbooks).  You may, almost always, chisel his words in granite.  If a Facebook post says one thing and Dr. Fauci another, go with Fauci!

May God be with us all,

Ryan