Robert Angotti, Lic. Ac. Herbalist

“I am wondering if you have any suggestions for boosting an immune response to the vaccine?”

Your question about the herbs and vaccinations is a good one. Here are my recommendations. The vaccines contain the molecule which carries instructions for the production of the “spike” protein on coronavirus. This spike protein is essential for the coronavirus to enter our cells and begin replication of itself. The current vaccines encourage our body to produce this protein without the attached replicating virus. The increasing proliferation of the protein after vaccination then allows our body to begin building antibodies to the that protein. This is the process by which we create some immunity.

Chinese Herbs with Vaccines

There is growing research indicating that among the actions of Chinese herbal anti-virals is some disruption of this spike protein. Therefore I am concerned that anti-viral herbs may target the vaccine’s production of the spike protein. If these herbs do compromise the production of this protein, they may inhibit the immune response we are looking for from the vaccine, at least to some degree. It is important for me to point out that this is speculative. Nevertheless, my advice is to stop taking anti-virals just prior to and in the first two weeks after vaccinations.

Antiviral Remedies by Name

These remedies (and their varied names) are:

Cold Stop 1

Cold Stop 2

Yin Qiao Wan 

Gan Mao Ling

Initial Defense

Wu Han Formula

Immune Enhancement

Conversely, research indicates that some Chinese herbal remedies enhance the immune system function in part through the increased production of antibodies. Among the formulas most notable for this is the classic remedy know as Yu Ping Feng Wan. It is my suggestion that taking this formula in advance of, and during the vaccination phase could potentially enhance the immune response to the vaccine and thereby increase ones immunity to the coronavirus. 
I must say clearly here that I haven’t seen specific studies that would support this conclusions. For instance, I have seen no study where antibody production post vaccination was evaluated in two control groups. One group taking the immune enhancing herbs and the other not. Nevertheless, my recommendation to patients is that taking the Yu Ping Feng Wan formula is likely beneficial during the vaccination phase. 

Immune Enhance Remedy Names

Yu Ping Feng Wan

Yu Ping Feng San

Jade Windscreen

Immune Enhance

Immune Tonic

Other Remedies

Please contact me directly if you have questions about your herbal remedies.

The post Chinese Herbs and Vaccinations: Patient Questions appeared first on Red River Health.

Robert Angotti, Lic. Ac.

We have endured a great deal over the past 12 months. A pandemic has taken over 440,000 American lives and nearly 2.2 million lives across the globe. Old wounds in our country have been torn open and left bleeding. Silos of disinformation have pulled families and friends apart. Economic hardships have impacted millions of households. And despite all of this the evidence indicates that the greatest challenges of COVID are still to come.

The Biggest Surge

I have made a habit of following news regarding epidemiological specialists and their assessment of the pandemic this past year. I don’t envy their labor. Experts have tried to speak frankly to a weary population. Often these experts need to tell us bad new. Moreover, the insights and recommendations of these specialists have frequently been ignored. Many Americans have falsely associated bad news about the pandemic with politics, or threats to their individual liberties. Regardless of these distractions, we need to know what lies in the COVID waters ahead. Moreover, we need to re-imagine how we can navigate this surge together.

The Race Against an Evolving Virus

In this transcript of an interview with Dr. Michael Osterholm you can find a helpful synopsis of our current challenge. I will try to summarize it here. Dr. Osterolm is predicting that the greatest COVID surge is yet to come. Yes, vaccinations will be essential in protecting the population from COVID. The rollout of vaccines is well underway, and in they arrived to us record time. However, our human herd immunity is based upon combining the number of those vaccinated with the number of those who have been infected. This combination isn’t anticipated to reach a level higher than 40-50% within the next 6-8 weeks. Therefore, our country won’t have a significant immunity barrier any earlier than the fall.

Meanwhile, the US is averaging 150,000 new cases every day. Although this number has reduced by 50% since the Jan. 8th peak, it remains very high. Simultaneously, newly mutated strains of coronavirus are circulating through the population. Some of these strains are both more contagious and more destructive. Additionally, we still have an enormous disruption in the flow of information within the population. Millions of citizens continue to see this pandemic as a hoax and will not likely participate in vaccinations. This same section of the population is less likely to participate in the social distancing required for slowing the spread. Finally, it remains unclear how long our immunity will last or if it will benefit us when confronted by these mutated strains of the novel virus.

Dr. Osterholm anticipates that over the next 2-3 months, this convergence of circumstances will result in the greatest swell of cases we have seen. Consequently, our only means of protecting the most vulnerable, our medical workers, and our essential workers is a co-operative effort to slow the spread.

The “Greatest Generation”

Last weekend I watched the film Greyhound. I recommend it. The film is a reminder of the sacrifice behind the moniker “Greatest Generation.” We once had enemies outside of our national boundaries that defined our collective purpose. I couldn’t help but contemplate this as I watched the film. Many scenes were wonderful metaphors of the great common challenge before us now. I will share some of these thoughts hopefully without spoiling the film for you.

An Ocean of Death

The story of Greyhound is the story of a fleet of of American destroyer ships providing protection to a convoy of soldiers and supplies headed across the Atlantic. Based upon a true story, this fleet provided essential materials to European allies in the war against the Germans. However, the region they must pass through was known as “The Black Pit”. This area of open ocean was outside of the protective reach of military air cover. The German navy took great advantage of this vulnerability through stealthy submarine attacks on the convoy. As I absorbed the circumstances faced by these sailors I began to see the selfless sacrifice they engaged in collectively. To step on those ships was to step into a vast endless ocean and into the uncertainty of war. Death at sea would most likely take the form of being submerged in frigid water with no land in sight. Much like the deaths of so many COVID victims, death at sea would be suffered alone, cold and unable to breath.

The Solemnity of War

“His enemies are not demons,
but human beings like himself.

He enters a battle gravely,
with sorrow and with great compassion,
as if he were attending a funeral.”

~Tao Te Ching, Lao Tzu

The Greyhound film provides a look into the great anguish of leadership in horrendous times. We see the war through the eyes of the ships Captain. As the story unfolds, it’s soon made clear that nearly any choice would involve death.

After a particularly harrowing event, while the sailors rejoice in staying alive, the Captain clearly has no time for exaltation. As the men applaud the death of some 50 German soldiers intent on killing them all, the Captain reminds us, they were “50 souls.”

When lives become numbers, when deaths become statistics, we fail to mourn. When we fail to mourn, we fail to honor life and we begin to slide into a world where compassion is abandoned. Once we reach this place common purpose is lost. Yesterday, January 30th, 2021 we lost 2,641 American souls to this virus. We lost grandparents, mothers, fathers sons and daughters. Honoring that truth is important if we are to prevent more death.

The Death that you See Before you is a Death you Can’t Accept

In the film, the Captain faces a series of no win decisions. One situation involves a moment where the German assault is ravaging the allied fleet from various positions. A cargo ship within his view has been struck and countless sailors overboard are visible in the churning water. Meanwhile, a nearby destroyer is taking heavy fire. The vulnerable destroyer requests assistance from the Captain and his ship’s arsenal. Lives are moments from being lost in either direction. Which lives would you choose to save? Once you make that choice you also choose the death of others.

One of the great tragedies of this pandemic is how we have failed to bear witness to its price. Most of us aren’t in the churning water of this war. Many of us can isolate comfortably and weather this crisis while streaming movies. Most of us aren’t seeing the sailors flailing for life in the water below us. Those that are bearing witness to the toll of this pandemic walk the halls of hospitals and morgues. We need to seek out and share their stories and the stories of those we have lost. Preparing for this next surge will require that we willingly and collectively see those in need of protection. Our choice to save lives is our path of common purpose. If we fail to make that choice we simultaneously continue to chose the deaths of others.

“Friendly Fire”

The final image from this film that I will share with you is the most poignant for me. The advantages of the German submarines is their maneuverability and their ability to submerge the ocean depths. Slipping below the water’s surface keeps them beyond the view of the larger freight ships and destroyers. Like a virus, the submarines can hide in plain sight.

Consequently, forcing the German warcrafts to the surface is essential for assuring a counter assault. This is the naval wartime equivalent of coronavirus testing. Testing is our only means of confirming the presence of the virus in our community.

In the film two American destroyers surround an enemy submarine. With deft action the crew of both ships forced the submarine to the surface. However the German vessel was is in the water between the ships. To take aim upon the submarine inevitably meant firing towards one another. Realizing this horror, the Captain demands a cease fire. However, without a continued assault the German boat is likely to return to the depths and attack again. For the Captain, the killing of fellow soldiers through “friendly fire” would be an irreconcilable tragedy.

The coronavirus lies in the water between us all. We now have the ability to bring its presence to the surface. Testing allows us to take measure of its destructive force. We have made enemies of one another long enough. This virus has set its radar on the DNA of humanity. This virus can bring us together in common purpose or it can tear us apart. I found this film to be an inspirational reminder of how we have been a people capable of common purpose and collective action in our recent past. We may need this reminder now.

The post The Final COVID Surge and Our Common Purpose appeared first on Red River Health.

Two important interviews on the pandemic

Robert Angotti, Lic. Ac.

I am posting two interviews regarding the pandemic. This first is a New York Times interview with Dr. Anthony Fauci. It is a retrospective discussion regarding the pandemic management in the early months.

The second interview is a focus on the management of the pandemic moving forward. In this interview Dr. Vivek Murthy addresses many of the successes and challenges that we still face with the coronavirus. Dr. Vivek is the new surgeon general and the co-chair of President Biden’s coronavirus task force. This interview can be very helpful if you have remaining questions about getting vaccinated.

The post Vaccines, Viral Mutations, and Leadership appeared first on Red River Health.

Robert Angotti, Lic. Ac.

Last week I started the process of determining if I was eligible for the vaccination. I will share that story but first let me explain why I wanted to get vaccinated.

Why should we get vaccinated?

The coronavirus vaccines are the quickest and safest path out of this pandemic. Exactly one year ago the United States saw its first case of COVID. We have now seen nearly 25 million cases. The number of daily deaths from COVID will decrease as the number of vaccinated citizens increases. There have been over 400,000 COVID deaths in the US as of today. Meanwhile, we are seeing around 4000 new deaths every day.

Epidemiologists suggest that we will need around 75% of the population immune through vaccinations or infections before we can return to normal social behaviors. The current estimates are that we have about 30% of the population immune. Those numbers are very hard to determine, however. It is also difficult to assert the “durability” of that immunity (I will address this point later).

Why did I get vaccinated?

Since the onset of the pandemic it has been clear to me that I simply can’t provide assurances to my patients about my risk to them. I have never know if I might be a carrier, and this disease could be very hard on some of my patients. Keeping the clinic open has been a risk and your support through that risk has meant a great deal.

Throughout the pandemic I have studied and administered Chinese herbal protocols for the prevention and treatment of COVID. I’m pleased to say these protocols have proven to be effective and helpful for patients. Nevertheless, my ability to treat COVID doesn’t reduce my risk of causing symptomatic spread. I chose to get the vaccine in order to remove a potential host for the virus and thereby reduce the risk I pose to my clients and community.

The many unknowns

Currently, virologists and epidemiologists don’t know if those vaccinated are less likely to carry the virus. My understanding is that the greater the virus load in a host, the greater the chances of cross infection to those exposed. It’s therefore likely that a vaccinated person carries a very small viral load and is minimally infectious. However, we simply haven’t had enough time with vaccinated people in the population to know if they still serve as potent carriers of the virus. Once vaccinated, we should continue to practice distancing at least until we learn that we are not carriers or until we successfully corral the spread.

Likewise, we don’t know how durable (long lasting) the vaccine immunity is. Some vaccines provide a lifetime of immunity. Others need boosters or modifications as viruses mutate. It will take time for us to learn the durability of the COVID vaccines and each vaccine may vary. Until we know how long our immunity lasts we will need to keep up with safe protocols to slow the spread even once we are vaccinated.

There are currently multiple strains of this virus circulating. The strains have unique codes used to label them but they are also being named based upon the location in which they have proliferated. For example there is a “UK” strain, a “Brazil”, a “South Afirca” strain and it sounds as if there is also at least one “California” strain. Scientists don’t know if the vaccines provide immunity to all these different strains. However, we are seeing that several of these strains are significantly more transmissible. Scientists also point out that the more people that become infected, the more the virus has a chance to mutate and adapt.

Finally, we don’t know the long term risks associated with the vaccines. Side effects to date have been minimal and mimic what would be expected from the flu vaccine. A reaction from the body such as a slight fever or soreness at the shot location indicates the bodies defenses are activated. This response is they way that we acquire immunity and is a sign that the immune system is reacting. Nevertheless, it will take months or maybe even years for us to know the long term effects of the vaccine, if there are any. For me, the risks of further deaths within the population and the economic fallout of a prolonged pandemic outweigh any risks of potential long term effects.

My vaccination experience

As a healthcare worker, I knew I was on the list for receiving the vaccine early. Nevertheless, I felt that there were many ahead of me that needed the vaccine more than me. To reduce unnecessary deaths health care workers, the elderly and our more vulnerable citizens should be vaccinated first. However, it was brought to my attention that vaccines were available at some area locations but the supply was greater than the demand. I have also heard stories of vaccines going unused in other areas of the nation. Meanwhile, as of today, there is national shortage of vaccines disrupting the roll out.

I started to pursue the vaccine by calling the ND department of health, which then directed me to the Fargo Cass Public Health Department. I was able to speak with someone through that contact who confirmed my eligibility. The county representative asked for my email contact information and explained that I would be contacted soon.

Then next day I received an email from Fargo Cass Public Health. In that email I was offered several vaccination dates as options. Selecting a day loaded a registration website where I entered the relevant information and choose a time of day for the vaccination. This all went smoothly and took no more than 10 minutes.

I arrived for my appointment and found only one other person in line ahead of me. Within minutes I was directed into the area where shots were being administered. A vaccinating nurse was available to me immediately. She asked a few questions and then administered the shot . The shot was painless and I was asked to sit in a nearby area for 15 minutes just to be certain there were no adverse reactions. There were none. While I waited I registered my cell phone number for daily check-ins from the CDC. I was in and out in 20 minutes.

The CDC texted me for a report of symptoms which I provided over the next two days. The site of the shot was achey for the first day, less so the next day and had no issues the third day. My next shot is 21 days after the first.

The closing innings

Dr. Osterholm has been using the metaphor of baseball game to describe his view on this pandemic’s lifespan. I have been listening to his podcast regularly and he seems to have stopped using the metaphor a few months back. At that time we were still in the middle innings.

Baseball doesn’t have a game clock. The time doesn’t run out. Baseball also doesn’t have tie games. The game is played for as long as it takes to determine a winner at the close of a full inning.

For what it is worth, I see us in the later innings of this game. However, the likelihood of extra innings is increasing because of these new strains. Our participation in the vaccination and our social distancing efforts will be essential in providing the defense we need to close this game out. The pandemic has provided our generation its greatest opportunity to work together, mourn together, and celebrate success together. Stay well!

The post My First Vaccine Dose appeared first on Red River Health.

Robert Angotti, Lic. Ac. Herbalist

Many people really look forward to this time of year. There is a reason our ancestors started bringing trees into the home and placing lights around them during these darkest days before the solstice. Our souls call for life and light in this season. This is the time of year we need hope, companionship, comfort, and rest. And this year, we need it more than ever.

The reports on vaccines are promising. First line medical staff should be getting doses soon. Following that, we should be able to start providing vaccines for the most vulnerable. By late spring, we should see a steady administration of vaccines for the general population and with that a return to more familiar patterns of socialization by summer. I can address this later, but if you are wondering how I feel about the vaccine, let me summarize it this way. The experts I trust believe it is safe, and they believe it is the quickest way to end the death, illness and economic destabilization.

Tough Days Ahead

Nevertheless, the indications for the next two months are concerning. Heading into the Thanksgiving weekend, our local population was breaking global records. North Dakota registered with the highest per capita rate of infection at any point and in any location on the planet since the start of the pandemic. If 10 people gathered for Thanksgiving in the state, statistically speaking, one of those people would have been infected. Although public health officials were trying to encourage citizens to stay home for the holiday, numerous families didn’t get that message, or, they choose to ignore it. Over the next three weeks, we will start to measure the results of those choices in positive case increases. Weeks after that we will measure those choices in lost lives.

I have the pleasure of communicating with a local doctor working at an area hospital. Her rural location is overrun with cases. Our local Sanford hospital is too overwhelmed to take them. Many patients will simply not be given access to medical care because we don’t have the space or the staff. We need to be clear about what that means. We need to be honest with ourselves about our choices. People have been choosing their individual freedom over choosing to save lives. Is this who have we become?

The doctor added the following. “I have really done a lot of soul searching lately. Because I may be sacrificing my life and our family’s well-being for people who can’t even bother to try.”

The Circle of Spread and a Long Feedback Loop

I have been trying to find ways of explaining just how this virus uses our desire to be social as an advantage. Somehow, I am stupified by the fact that nearly 300,000 deaths have not managed to change our behavior.

There are a couple critical facts regarding spread that may bear revisiting. I have found two diagrams to help communicate some of the basic, important facts.

We know this virus spreads when we gather but the virus also prevents us from getting direct feedback on our role in its spread. The long incubation period has undermined our ability to witness the spread directly within our own lives.

Thinking differently

Let’s do a thought experiment. Imagine that the moment you were infected you suddenly had labored breathing. In this imaginary scenario, the only difference between this virus and coronavirus is that the onset of symptoms is immediate for those that will have symptoms. Rather than taking up to 10 days for the onset of symptoms, those who do experience symptoms will have those symptoms immediately; thus they will know right away that they have contracted the disease, Meanwhile asymptomatic carriers would still be oblivious to their condition as is the case with coronavirus.

Now, let’s also imagine that the death rate from this hypothetical virus is identical to COVID, and that the infection rate (charts above) is also the same as COVID. In other words, in the case of this imaginary virus, you have the same likelihood of infecting people and the same likelihood of dying from an infection as we do now with COVID. Moreover you have the same number of asymptomatic carriers. The only difference is that, if you are a person who has symptoms, you immediately know when you are infected because the symptoms show up the minute the virus takes hold in your body.

In this scenario everyone would have the ability to know with a much greater level of certainty who is an actual carrier. Anytime you would be in the company of others, there would be a chance of witnessing someone getting infected. Many people would end up having direct first hand experience of the spread.

Having firsthand experience would dramatically alter behavior. Seeing the spread actually occur would change our relationship with socialization. Any time we witnessed someone becoming sick we would be concerned that we might be responsible, or that we might be on the verge of sickness. Imagine how that would change our behavior. We would go out less and we would be much more willing to use inhibitory measures such as masks if we had to go out.

In this scenario you can imagine how having direct experience with transmission of the virus would effect spread. People who witnessed transmission episodes would be telling others. The experiences and the story of the experiences would be vivid reminders of our vulnerability and the contagious character of the virus. In this scenario, the spread is more apparent, evident, and obvious. We wouldn’t need to try and imagine what it might look like because we would either see it directly or we would see it through others’ eyes. We wouldn’t be as dependent on trusting experts or politicians to tell us the risks because the risks would be more apparent. In a culture like ours where the perception of independent freedom is paramount this subtle difference would likely save tens of thousands of lives.

A Failure of Imagination

I genuinely think that if people are given the right information, they generally make the most ethical choice. The problem with COVID is that it has successfully hidden that information from us.

One of the great challenges with this virus is that it is hard to see. Few of us know someone who has died from it or even become quite ill from it. Most of us would be able to survive it, and many of us will have no direct feedback of the threat it poses. The only effect COVID has had on most of us is personal inconvenience. However, for our medical personal working long days back to back, witnessing the most serious cases, the effect is much more apparent.

We are on our way to seeing 500,000 people die from COVID within a year. The only path to lowering that number is by taking individual responsibility in slowing the spread. To achieve this we will need to begin imagining the celebration of Christmas and other gatherings differently.

New Christmas Traditions

We are a creative species. Even though we need to separate ourselves from loved ones, that doesn’t mean we need to stop practicing how we love them. The truth is, trying to find creative ways of connecting may lead to some of the more genuine moments of connection with loved ones in years.

Here are some “off the cuff” ideas for alternatives to Holiday gatherings.

• Write a letter. Pick a loved one and share your thoughts with them. Letters are a dying art and we need to return to long forms of communication. Tweets, tags and texts just don’t seem to be capturing all the varied texture of life. Truth and meaning seem to exist much more often between the black and white of life. Short forms communication seem to be enabling some of our more rash communication instincts.
• Send some food. Make your favorite holiday treat and drop some off or ship some to family. Save some for yourself and then make a plan to enjoy it at the same time while talking over the phone or through Zoom. (I do not have an advertising contract with Zoom by the way, I just don’t know if other forms of video gathering yet.)
• Make a video. Zoom can be glitchy and sometimes awkward. With large groups it can inhibit spontaneity and sincerity (there goes my potential advertising contract with Zoom). Recorded video is a great way to express yourself creatively and it gives the viewer a chance to watch it in their own time. Christmas carols, poetry readings, dance are just a few potentially rich video opportunities.
• Record an interview. I have always wished I had some recordings of the elders in my family to share with the younger generation. Think of a list of questions you might have for grandma or grandpa and record the conversation. What is your first Christmas memory Grandpa?
• Share artwork. Some of us love to talk, but others us prefer different forms of communication. Spending some time with expression through artwork could be therapeutic for you and inspirational for others.
• Play Zoom games. The article does the talking for me here.
• Meaningful conversations. As long as I can remember there has been a pop culture admonishment about family gatherings. “Avoid conversations about politics or religion.” What I find interesting about this social rule, however, is that these are the two areas of our lives where our most sincere values are oriented. If we cant find ways to talk about difficult things, our relationships won’t have the opportunity to become more-than-superficial. And if we settle for safe but surface-level relationships, how will we find the collective courage to face the challenges of our times? I have been working on a template for meaningful, civil conversations. I am calling the template, “America, we need to talk.” It may be pretty pie in the sky thinking but I’m hoping the Christmas spirit can help! Have a merry Christmas.

The post Our COVID Christmas appeared first on Red River Health.

Robert Angotti, Lic. Ac., Herbalist

“He (President Trump) has been trying the same things for months. Always saying the US is turning the corner to the virus disappearing, to a miracle cure, to a vaccine, but if you keep turning corners you are actually going in circles.” Garry Kasparov

In the attached podcast interview, renowned chess champion, Garry Kasparov sheds light on COVID, the election and democracy.

The post Chess Grandmaster Garry Kasparov shares his thoughts on COVID management in the United States appeared first on Red River Health.

Robert Angotti, Lic. Ac., Herbalist

This week I had a few more patients with COVID cases that were hitting closer to home. One patient presented with symptoms that showed a strong likelihood of COVID positivity. Without news of a test, I chose to error on the side of caution and shut the clinic down until I knew more. My apologies to those who were effected.

I spent that afternoon looking ahead and consulting public health. I had a long phone conversation with the MN department of health the assisting nurse explained some of the difficulties that public health officials are facing. For example, one of the most challenging requirements for a sustained slowing of the COVID spread is the quarantining of suspected “first circle” contacts. If you are exposed to someone who shows signs of COVID symptoms and/or tests positive for COVID, you should quarantine for 14 days in order to prevent spread as an asymptomatic carrier. “People have a hard time understanding prevention”, the public health representative said. The importance of prevention is further complicated by strategies such as what the state of North Dakota has implemented. Recently, the ND state COVID management department said you would not need to quarantine if you had been in close contact with someone with COVID-19 but you and the contact had both been wearing a mask. Dr. Michael Osterholm of CIDRAP was stupefied by this suggestion saying there is absolutely no research to support that claim.

React or Over-react

Success with COVID will almost always look like an overreaction. I have probably written this multiple times in prior posts. However, the more time I spend observing our culture struggling to wrap its head around prevention, the more I realize that the ethical orientation that physicians and public health representatives bring into this situation may be uniquely influenced by their profession. Hippocrates’ famous code of ethical orientation for physicians bears repeating. “First, do no harm.” For public health physicians in the midst a pandemic this means doing everything possible to limit unnecessary death. Until death, disease and economic hardship are close enough to effect most Americans directly, corralling this virus through prevention will continue to be a challenge for us.

I bring this up because I am witnessing leaders in our community, and among citizens in our community who have grown suspicious of public health and in some cases have actively advocated for undermining their efforts. To be fair, pubic health has not been free from mistakes. Early in the pandemic the CDC’s website advice for masking was clearly contradictory. Nevertheless, mistakes are inevitable, especially when dealing with an unknown pathogen. We are learning more about COVID every week. However, as a collective body, we are still learning how to work together to prevent its spread. North Dakota and South Dakota are leading the nation in numbers of cases per capita. Minnesota’s Clay county has the 7th highest rate of infections per capita in the state. Cass county has the highest number of active cases in ND.

Changes at the Clinic to Keep us Safe

Due to this increased COVID-19 risk level, I will be making the following modifications at my clinic. I want to continue providing care for as long as possible during this “High Risk” phase in our area.

1. Please email your answer to the following questions when you get your reminder email.
   1. If you have the ability to check, what is your current temperature?
   2. Have you been exposed (within 6ft for 15 minutes or longer) to anyone who has tested positive to COVID-19 in the past two weeks?
   3. Have you been exposed to anyone who has shown symptoms of COVID-19 in the past two weeks?
   4. Are you practicing diligent social distancing?
2. Please sanitize your hands upon arrival at the front door.
3. Please stay six feet from the lobby desk. 
4. Please prepare for contactless payment if possible.

Thank you all for your support during these times. This will be a very challenging winter but we can get through it together! I highly recommend having the COVID Combo on hand for treatment of wither COVID-19 or the standard flu.

The post “People have a hard time understanding prevention” appeared first on Red River Health.

Robert Angotti, Lic. Ac. , Herbalist

I have something of a routine at my clinic. When I first meet with a patient I try to explain the stages of treatment. I explain that the first stage of treatment is designed to assess, “Is the treatment helping?” The second stage is then aimed at determining, “How much better can this get?”. And finally, the third stage is, “What do we have to do to maintain those benefits?”

In previous posts, I compared our collective therapy against COVID-19 to the kind of therapy I would administer for a single patient using the three stages as a framework. Back at the outset of this pandemic, my practice was shutdown, (Stage 1 treatment) and I had more time to write. Once we entered Stage 2, with more opening of society, and a slow return to normal at the clinic, I found less and less time for writing. However, we have hovered in stage two through the summer and several areas of the country had to return to stage one in order to stop the rapid rise in cases in their region. Unfortunately, it seems that our upper midwest area is headed in the same direction.

“Right here in the upper midwest we are on the road to following what happened in Georgia, Florida, Texas and parts of California.” ~Dr. Micheal Osterholm

Since the second surge of cases that started in July, I have heard more and more about “cases with faces”. In other words, I have heard of people who know people that have tested positive. My patients, my students, and my family members all now know others that have been infected. Two members of my own family came down with COVID and are slowly recovering. I don’t point this out for emotional impact. Rather, I point it out in order to demonstrate that infections are increasing around us, pushing us closer to a scenario of spread which becomes harder to manage. That spread puts people, schools and businesses at risk.

While the summer surge was happening, the debate over masks continued, along with protests, and the increase in large gatherings such as in Sturgis, South Dakota. Clearly, these things have enabled the spread of COVID, and with schools resuming we can already see a rise in cases.

In my own family, I have seen my boys become more active in social activities, and sports. My oldest son is now in quarantine after only one week back in session at Concordia.

All of these things point to the inevitable oncoming third surge in cases and the importance of highlighting once again what will be required for us to prevent unnecessary death and economic hardship over the next several months.

Surrounded in Cases

When patients and I first enter into the second stage of treatment, things are usually looking pretty good. Patients are pleased to see that the acupuncture works and/or that the herbs are helpful. In some cases they can also see some benefit from lifestyle adjustments we have agreed upon. Generally, things are looking up.

However, my clinic experience usually leaves me prepared for some peaks and valleys in progress as we enter stage two. Often, my suggestions for some of the lifestyle recommendations become harder to get traction on. When I bring those things up, patients aren’t as enthusiastic about engaging in them. When I suggest limiting their use or exposure to some of the problem aggravators, many patients give only half hearted indications that they have heard me. Therefore, I wasn’t surprised that as we entered stage two with COVID back in May, the essential commitments for continued progress against the pandemic were not being embraced nationally. When I see this happening with patients, I usually like to review our goals in treatment. It seems that we should be doing this regularly with regard to COVID both nationally and locally.

COVID-19 Treatment Goals

1. Limit unnecessary deaths. It is interesting to me how we seem to have lost site of this. Nearly every day in August 1000 Americans died of COVID. Just imagine how many bombs we would have dropped on some foreign country if this were the daily death total from terrorist attacks. Imagine the outrage and the patriotic lust for vengeance if our 190,000 dead civilians had been lost at the hands of an enemy we could take up arms against. We must acknowledge, honor, grieve and protect against this tragic loss of life. I have imagined creating a place where those lives are no longer just numbers. Until we see faces, or until we experience the pain directly we may not be able to understand the need for sacrifice. This link serves that purpose.
2. Protect our medical personnel. We have lost over 900 medical providers to COVID0-19. People are showing up to work daily and risking their lives in order to give others a chance at survival. Why we are not honoring that service and instilling a national commitment to self-sacrifice in tribute to these heroic efforts is beyond me. It speaks to the tragic loss of consideration, concern and a shared truth that underlies our struggle with this pandemic.
3. Assure the educational opportunities of our children. Unfortunately, we will likely see area schools return to distance learning within the next months as cases rise. The depth of the effect this will have on families may last decades. Many parents will be forced to either stay home and leave a job, or stay at a job and leave children unsupervised. I have heard from educators for months discussing how hard it is to provide quality education online, and how many young people may not have the nutrition, emotional support, or even broadband access necessary for an online education. I wish more government officials had been considering these consequences when bars were opened back up in May and June.
4. Preserve the economic foundation necessary for a post COVID recovery. Many people weigh the economy against the above criteria and come to a conclusion that protecting the economy must be the primary goal of treatment strategies during stage two. However, this is like the tennis player that comes to see me so that they can keep playing tennis. Sometimes you have to take a break and let the body heal or you will just be back again and again as the unresolved underlying dynamics go unaddressed. We are one of the wealthiest nations in the history of the world. We can afford to put the brakes on the economy for a few months now in order to avoid having to do it haltingly again and again over the next 9-12 months. The economic consequences of the later are likely much more dire.
5. Return to normal. Stage three of treatment is aimed at maintaining progress and resuming normal activities. However, much like a patient that has made it through to stage three of treatment, we won’t necessarily return to the old “normal”. Instead will have to redefine a new normal based upon all that we have learned. I will write more about this when it looks like we have a chance to get there.

Essential treatment during the stage two resurgence

Below I have compiled a list of “treatment strategies” for each of us to embrace individually over the next several months. All indications are that we will be dealing with COVID well into next year. A vaccine may be ready much sooner than expected. Hopefully, no short cuts will be taken on safety evaluations and we will see the administration of a vaccine beginning sometime early next year. Nevertheless, the availability of a vaccine will take many months for most people, and still others will deny getting it. Therefore, we need to prepare for at least another 9 months of challenges with COVID.

1. Limit your exposure to strangers. It’s important that we assertively restrict our social circle. Now that the weather is making outdoor activities less appealing we need to remind ourselves of the danger of enclosed spaces. Being with large groups of people, or varied and unpredictable groups of people is not recommended. Limiting group size slows the spread and assists in tracing positive cases.
2. If exposed – quarantine for 14 days. The importance of this step can not be overemphasized. Nothing is harder than staying away from people and your responsibilities when you are well. Commitment to the importance of this step will be the difference between seeing regional deaths in the hundreds over the next months or deaths in the thousands. We need to publicly honor and celebrate this sacrifice if we are to succeed.
3. Wear masks and make sure you know how to wear them properly. Make whatever case you want about this. Let the science bear it out somewhere down the line if you need to. But.. come on America! If we can’t take on this little inconvenience in order to potentially save lives, what American ideal are we really fighting for. Think about the American’s before us who sacrificed life, comfort and wealth to preserve the ideals of liberty and freedom that many anti-mask folks find offensive. We are better than that. We are more willing to sacrifice for others than that. We just seem to have forgotten it.
4. Trust experts and trust that they are still learning. One of the biggest challenges with COVID-19 is that if we do the right thing, it will look like we over-reacted. I have settled in on listening to a few experts in the field in order to assess the risk for my patients, my family and the community. In addition to the charts and graphs I share here, I listen to national reporting and specific podcasts on the topic including the one with Dr. Osterholm above. The predictions of these experts, or those reporting on them, have proven consistently accurate. I am not an expert. I don’t even really have the time needed to necessarily consider myself a well informed citizen. However, many in our nation believe this pandemic is a hoax. The consequence of this thinking is that the pandemic will only appear real when you, or someone you love becomes sick or dies. It is time to find a shared truth and a shared purpose.

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Dr. Michael Osterholm, CIDRAP

“We are in a period where it’s not one local area… this is now widespread.”

Please take the time to listen to and share this information about the spread of COVID. I have found Dr. Osterholm to be consistently accurate in his assessments and predictions regarding this ongoing pandemic.

https://www.cidrap.umn.edu/covid-19/podcasts-webinars/episode-15

The post A Huge Coronavirus Forest Fire appeared first on Red River Health.

Robert Angotti, Lic. Acupuncturist, Herbalist

Some of the images and graphs in the clinic newsletter didn’t make it through to publishing. I am inserting those details here for your information.

We are into our 5th month with this virus and unfortunately, we still have plenty to learn. Although the science on masks is in process, it is clear that masks are essential for our protection. By wearing a mask in public places, we can help protect ourselves and our loved ones, but we can also protect people we may never have contact with. Over 670 healthcare workers have died from COVID-19! If each of us does our part to slow the spread by wearing masks in public places, we can protect those essential workers, and we can protect many other more vulnerable members of our population.

New cases of COVID reached their highest levels on Wednesday and are expected to continue rising over the next several days and weeks. At best, we are heading into only the 3rd or 4th inning with this pandemic (borrowing a metaphor from Dr. Michael Osterholm) and it seems that we are once again facing the strongest part of our opponents lineup. We need to ready ourselves defensively again. I have found the website chart below to be helpful for tracking the case surge in our area and comparing to the rest of the nation. 

I also appreciate checking on how things look in our local counties on a per capita basis as shown in this graph. In this chart, hot spots are in yellow.

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