Tag Archive for: coronavirus

Mental Health Update: Fall 2020

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As I write this, I just got back from working out. I went to my gym for the first time since it opened last Wednesday after closing in March. Everyone wore masks. Everyone cleaned up their equipment, but that’s the standard anyway so that wasn’t surprising. Nobody fainted from lack of oxygen. Everybody just worked out, cleaned up after themselves, and went on their way. No big deal.

But it’s a big deal to many people who have been anxious over the closures in their states, including their gym. That can lead to depressive symptoms. If you follow social media, that can hurt considerably: comments suggesting the virus is one big scam or people are too concerned. In fact neither is true; spending less time on social media might be the single best thing you could do for your mental health. I go back to what I wrote several months ago: don’t let yourself be immobilized by fear of this virus, but show it the proper respect.

On top of that, the political climate is a mess. There are no longer any discussions, just arguments that can be vicious. The anger is palpable. When you lose contact with family and friends you care about because of political differences, that also leads to anxiety and depression. Throw in unemployment, concern about finances, keeping a roof over your head, and more, and it seems our mental health is taking a beating.

But is it? I’ll take a look at the research this week.

Reminder for all Insiders: our monthly Conference Call is tomorrow night at 9 p.m. ET. One topic I’ll be discussing is a remarkable study done on COVID-19 and genetics by a supercomputer. You don’t want to miss it. If you’re not yet an Insider, you have until 8 p.m. to join and still participate live.

What are you prepared to do today?

        Dr. Chet

Why Riley Went to School This Week

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Tuesday was Riley’s first day of kindergarten in the classroom. One of the reasons I haven’t written memos for two weeks is because Paula and I were attending online kindergarten with Riley four times a day; that gave Jamie some time to spend with her sister, who has a serious illness (and we’d appreciate your prayers for Nicki).

Riley’s school gave each child a Chromebook already loaded with all the apps they would need for class, and he figured it out in no time. (One day we were both dismayed and proud to find him watching a Sonic the Hedgehog movie, but Paula is still more proficient than he is and blocked a few sites.) Online school for people who can’t read was interesting to say the least. I thought getting adults to mute themselves was challenging! But it didn’t take long for most kids to get it and respect the teacher and other students in class.

While we’ve been anticipating getting Riley into a classroom, it’s slightly scary; we don’t want him to get sick or bring anything home to the rest of us. The district, staff, and teachers in his elementary school have done what they could to be safe: masks, hand-washing stations and sanitizer, and social distancing to the extent possible with five-year-olds. They’ve explained how people will look and what they will do to help students. The students know they will wear masks and that they should wash their hands to the ABC song. Everyone is ready, especially Riley, who was very eager to go to school after his pre-K days were cut short.

Riley needs this; he is the most social person I know. We think it will be easier to keep him focused when he’s surrounded by other students who are paying attention rather than just looking at a screen. He could continue online, but as a family we agreed it’s worth the risk, given the advantages versus the precautions taken; if he were several years older, we might have decided to stay online, as our neighbors with older children did. Our little people-person needs the interaction with his teachers and classmates for as long as it lasts. School districts in the state that opened with in-school classes lasted about a week. Let’s hope Kentwood Schools last longer.

I’ll keep you posted on how things are going. Oh, and don’t forget, while you’re washing your hands, sing the ABC song so you make sure you wash long enough to really get rid of those germs.

What are you prepared to do today?

        Dr. Chet

COVID-19: What We Don’t Know

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I’m sure you’ve heard the expression “What we don’t know could kill us” and that’s truer today than at any other time. While we may argue about masks and social distancing, there’s just still too much we don’t know about the novel coronavirus. The critical factor is that because of what we don’t know, we aren’t able to work on treatments that can be administered to more people sooner once they’ve been diagnosed.

The Microbiome

You’ve heard me repeatedly say that the immune system starts in the gut; I don’t think many healthcare professionals would debate that anymore. That’s why knowing how the microbiome deals with COVID-19 is critical to establishing prevention and treatment programs. I don’t mean preventing people from catching the virus—I mean preventing them from getting a very serious form of the infection that results in hospitalization and severe treatments such as intubation and respirators.

We know that the digestive system is full of ACE2 receptors as I’ve written about before. What we don’t know is how to specifically make the microbiome more robust. What specific foods should we eat? What specific strains of microbes should we ingest to help immune function?

If we should eat more vegetables, should they be raw or can they be cooked? There are 6,500 different microbes that we know of at this point with multiple strains; if we’re supposed to take specific microbes, which strains are the most effective? We just don’t know enough to make our personal immune system stronger. We should still do the things that we’re doing by eating more vegetables, taking fiber and probiotics, but we could do better if we had more specific information.

Genotype and Phenotype

We know that age is a risk factor for a serious case of COVID-19; we also know that conditions such as heart disease, hypertension, and type 2 diabetes are also associated with a serious COVID-19 infection. And that’s about it for right now. Let me give you three questions that may or may not be important but certainly have to be checked out.

Does race have an effect? In addition to the observations about co-morbidities and healthcare opportunities, there may be some impact related to race that hasn’t been examined yet. Or instead of race, maybe it’s ethnicity. Think about it; from an ethnic perspective, what was different between the people of Italy and Spain, where there were significant deaths, from those who lived in Norway and Denmark? What about male pattern baldness? What about familial hypercholesterolemia? Could either of those be a genetic risk factor?

What about phenotype? Are people who are ex-smokers at greater risk than those who never smoked? We would think so, but nobody’s studied it. What about people who’ve lost a significant amount of weight and maintained it? What about people who exercise regularly compared to those who never exercise? All those traits would be associated with a healthier lifestyle, but we haven’t tested their impact of the risk of COVID-19. Lifestyle can impact the expression of your genes. And in some ways, once genes are expressed or turned on, they may not be downregulated or turned off. That could be important.

Do supplements help? It’s easy to say massive amounts of vitamin C and vitamin D and turmeric will help, but do they help everyone? What if you already have adequate vitamin D levels? Could adding even more be counterproductive? The same is true for vitamin C. We know that vitamin C is an antioxidant, but in high quantities, it may act as a pro-oxidant and increase free radical damage. How much is the right amount? Think of all of the supplements that we all take. It would be nice to know which are the key supplements to help our immune function against this virus and which ones just help our bodies in our day-to-day activities. At this point, we don’t have enough information.

Better Treatments

The whole point of treatments for COVID-19 is to force the virus to back off long enough to allow the immune system to do its job. There are no medications that I’m aware of that can target the virus and kill it; that means it’s up to the body to do the killing, and even after a vaccine is available, that will still be the case. We need better treatments that can neutralize the impact the virus has on the body so that the immune system can, in effect, clean up the mess.

There have been a lot of debates about some medications such as hydroxychloroquine. There are hopeful additions that include steroids, although they have issues as well. We may even find out that specific types of diets including fasting may be beneficial. Or they may be disastrous. We need more research to find better treatments, and we need that research now.

As it relates to a vaccine, we really don’t know if there ever will be one or how effective it will be. Even if one is developed, the logistics are just incredible. How are we going to get 330 million doses of a vaccine ready for administration when we still don’t have enough tests available or enough gloves and masks for healthcare workers? Early testing means early treatment. But if you can’t test people to begin with, and you can’t get the results to them quickly, using better treatments could end up being too little too late for any given individual.

The Bottom Line

The novel coronavirus will be with us for a while longer. Maybe indefinitely. As I wrote a couple months ago, we don’t have to fear it; we have to respect it. Your job is simple: take care of your body the best that you can with diet, exercise, supplements, and reducing stress. If you’re going to venture out of your home, wear a mask, social distance, and wash your hands frequently. That’s our job. And know that there are people who will keep trying to find the answers we need and still more people who will help us if we get sick. We can give them time to work and lighten their load if we do our part.

What are you prepared to do today?

        Dr. Chet

COVID-19 and Obesity

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Obesity may be a contributing factor to the severity of symptoms for those who get COVID-19. The best explanation I’ve found why that may be true is in a paper in Nature Reviews Endocrinology published in April. There are several reasons in addition to the cardiovascular and endocrinological co-morbidities associated with obesity.

Just a reminder, by definition obesity is a Body Mass Index (BMI) greater than or equal to 30.0 kg/meters squared; it’s a measure of surface area. You can check yours at the Health Info page on the Dr. Chet website; it also includes the info to determine if you’re really big boned, because that has an impact.

The increased risks associated with obesity are driven by the respiratory system:

  • Impaired respiratory mechanisms
  • Increased airway resistance
  • Impaired gas exchange
  • Low lung volume
  • Low muscle strength

In effect, the greater the obesity, the more difficult it is to breathe deeply and when deep breaths are taken, the resistance within the airway and the actual exchange of oxygen and carbon dioxide are impaired. If required, intubation is more difficult. The greater the degree of obesity, the more difficult it is to provide regular patient care if someone is hospitalized with the virus. Add to all that the co-morbidities of the cardiovascular and endocrinological systems, and it makes recovery very difficult. More research is needed, but it’s a serious issue in a country where over 40% of all adults are obese.

I’ll wrap this up on Saturday with some thoughts about what we don’t know that could be impacting the development of treatments for the COVID-19 virus.

Facebook Messenger

I try to make myself as accessible as possible, and Insiders and Members have quicker access. My website contains a way to email me if you have a question. One way I’m no longer going to accept questions is via Facebook Messenger, so please use one of the other avenues.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews Endocrinology volume 16, pages341–342. (2020)

COVID-19 and Blood Type

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This week we’ll examine reports about comorbidities and other factors associated with the severity of the COVID-19 virus. We’ll begin with a question from a long-time reader and family member who shares DNA with Paula: her brother, Steve. Both have blood type A, which has been in the news as a factor in the severity of COVID-19.

The study that got the most attention was published in the New England Journal of Medicine. It was an observational study, which is important. They didn’t select a group of people with specific genetic mutations for the ACE2 gene and the ABO gene, which determines blood type, and then give them the virus; no ethics committee in the world would approve that study. Instead they collected patient data from the hardest-hit areas in Spain and Italy, including tissue or blood samples. They had limited historical data on the patients, especially known comorbidities such as heart disease, high blood pressure, and type 2 diabetes. They also knew the severity of the disease for each patient, including who was on oxygen and ventilators. It should be noted that about 80% of the most severe cases were people with comorbidities.

The researchers analyzed the entire genome of each patient and the control subjects, people from the same geographical area who didn’t get the virus. That worked out to 1,600 with the virus and 2,200 controls. To analyze every gene with potential mutations requires an average of 8.5 million combinations per person. They found two mutations or SNPs (single nucleotide polymorphisms) that seemed to increase the risk of a severe case of the virus: one area was responsible for blood-type proteins and the other for specific proteins use by the ACE2 receptor. They found that people with blood type A were 45% more likely to get a severe case of the virus requiring oxygen or a ventilator; people with type O blood had a 35% lower risk of the same response. They don’t know yet what the ACE2 protein area SNPs mean.

What does that mean in the real world? As this research continues, they may be able to determine a profile for a person most at risk so that they can get preventive treatment (if one is developed) and early treatment upon diagnosis. What I don’t think it means is that those with blood type A are at greater risk of catching the virus or type Os are at less risk of catching the virus, but I’d recommend that blood type A people should be even more diligent in reducing their exposure, and if they suspect they are infected, seek treatment earlier, rather than later.

Insider Conference Call

The Insider Conference Call is tomorrow night at 9 p.m. Eastern Time. Besides answering questions, I’ll report what I’ve learned about a Texas physician who claims to have found the “silver bullet” to cure COVID-19. You can become an Insider up through 8 p.m. and still participate live.

What are you prepared to do today?

        Dr. Chet

References:
1. https://bit.ly/3gX1Bmh
2. NEJM. 2020. DOI: 10.1056/NEJMoa2020283.

The Bottom Line on Masks

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To satisfy my own curiosity, I wanted to do a run/walk to see how wearing a mask might impact my performance. This is tricky for someone with a scientific background; trying to duplicate everything with the exception of the one variable, the mask, is difficult when you’re outdoors. But the weather has been pretty stable: overnight lows in the mid 60s, rising to 90 degrees almost every day with little humidity.

I decided to run the half-mile loop in my neighborhood six times just like I normally do. Five days before I ran it with the mask, I had run it faster than I had in a couple of years; I’m not setting any speed records here, but my knee appears to be getting stronger and I’m able to open the jets a little bit. I ran the same six laps at the same time of day and at the approximate same temperature. The only variable was the mask.

Before I tell you the results, I have to say that I spent way too much time thinking about the mask instead of just running or walking. At this point, I’m running for one minute, and walking for 90 seconds. I maintained that with no real problems once I stopped thinking about the mask. I also must say then I decided to bulk up the day before by over-eating some great tasting pasta I made. I was four pounds heavier than last week. Five days before, I ran the six laps in 40:52. This time I ran it in 41:20—28 seconds slower.

Did I have any trouble breathing? Not really other than thinking about it too much. Did it affect my ability to run? I don’t think so. I intentionally tried not to make it a race, but just to go out and run/walk the best that I could. I didn’t feel like I was breathing any harder while walking or running. My recovery from the run seemed about the same. So I would have to overall say that wearing a two-layer, cloth mask (just like in the picture) didn’t have any impact on my ability to exercise.

Should Everyone Wear a Cloth Mask?

No. The Centers for Disease Control does not recommend cloth masks for:

  • Children younger than two years old.
  • Anyone who has trouble breathing.
  • Anyone who is unconscious, incapacitated, or otherwise unable to remove the cloth face covering without assistance.

They also list some pragmatic concerns for those who must travel in populated areas but cannot wear a mask. They do not qualify what “trouble breathing” means, but certainly respiratory issues as well as cardiac issues would probably be included. Of course, if you have heart trouble or respiratory problems, taking chances with your health doesn’t seem like a smart choice; I’d recommend staying home as much as you can.

The Size of a Pea or the Size of a House?

For those of you who think size matters, let’s talk about the relative sizes of the various items under discussion when we talk about masks.

Viruses are so small they’re measured in nanometers; a nanometer is one millionth of a millimeter. There are about 25 millimeters in an inch, so take one twenty-fifth of an inch and divide it into a million: that’s a nanometer. A human hair is around 75,000 nanometers. So here’s what you need to know:

Oxygen molecules are one-third of a nanometer; carbon dioxide is a carbon molecule with oxygen molecules on its right and left, so it measures about one-third of a nanometer by one nanometer.

Coronaviruses are 125 nanometers.

Droplets vary from 2,000 nanometers to 100,000 nanometers.

By definition, an N95 mask blocks 95% of particles of 300 nanometers.

Cloth varies so much it’s hard to determine the size of the comparative spaces between fibers, so it was hard to find any info at all. The best I could find is that it’s in roughly the same size range as the droplets; used, folded, tightly woven cotton has about 20,000 nanometers between fibers.

It’s hard to visualize the comparative sizes when we’re talking about a unit of measure that’s so incredibly small. Let’s transform everything into familiar sizes by changing nanometers to inches:

Oxygen would be about the size of a pea, and carbon dioxide would be three peas pushed together.

A coronavirus would be 10.5 feet tall, so it probably wouldn’t fit in your house.

An N95 mask blocks particles equivalent to 25 feet or more.

Droplets start at the size of a 12-story building (167 feet) up to almost 600 stories (over 8,000 feet).

So you can see how a cloth mask that stops droplets from getting through would allow plenty of oxygen and carbon dioxide to pass freely.

But how does a mask stop a 125-nanometer coronavirus if it filters out particles of 300 nanometers? It’s important to know the virus isn’t floating around by itself—it’s hitching a ride on the droplets of moisture we breathe out, and a mask definitely stops those.

Final Research Paper

Here’s a quote from the 2013 paper I used as a basis for the effectiveness of cloth masks:

“In the questionnaire on mask use during a pandemic, six participants said they would wear a mask some of the time, six said they would never wear a mask, and nine either did not know or were undecided. None of the participants said that they would wear a mask all of the time. With one exception, all participants reported that their face mask was comfortable.”

That seems to be where we are today during this pandemic, seven years after that study was published. Only today it’s reality, not answers to a questionnaire.

The Difference in Lives

If none of that convinces you to wear a mask, maybe this will: a new model by the University of Washington predicts more than 208,000 Americans will die from COVID-19 by November.

But if 95% of the population wears a mask in public from now until then, that number would drop to 162,808—a difference of more than 45,000 lives. Let’s bring that home. The U.S. has 3,141 counties; would you wear a mask to protect 14 people in your county?

The Bottom Line

This week I’ve reviewed some of the major objections that people have to avoid wearing a cloth mask, and the research doesn’t support the objections.

The final objection is that people are willing to take their chances that they will get only a mild version of the virus; it seems their freedom to enjoy life supersedes the safety of those around them. Maybe like Gus in Lonesome Dove, they’ll take their chances with an infection and die with their boots on. I challenge those people to do some research on long-term consequences of COVID-19.

It’s no longer a safe assumption that your local hospital will make everything okay if you get ill. Every area with a COVID-19 spike has seen hospitals at capacity, healthcare workers at or beyond the breaking point, and the necessary supplies running short, including PPE. All respect to healthcare workers, but they’re human and at some point mental, emotional, and physical exhaustion sets in and they’re not going to be able to give their best. Maybe you could wear a mask for the sake of the people you know in healthcare, like our daughter-in-law.

What are you prepared to do today? Wear the damn mask!

        Dr. Chet

References:
1. https://bit.ly/3gvDH0J
2. Disaster Med Public Health Preparedness. 2013;7:413-418.

Facts About Masks: Which Material?

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If one considers the elemental purpose of a mask, it’s to provide a barrier to reduce the spread of exhaled, potentially virus-containing, droplets. Many opinions on social media cover the size of the viruses, droplets, and the fabric density of masks. I’m not going to do that because it’s the wrong argument. Instead, I’m going to review studies that have examined the potential blocking ability of various types of manufactured and home-made masks.

In a study published in 2013, researchers tested different masks in a series of experiments using a bacteria and a virus. The surgical mask was by far the best choice blocking up to 90% of the virus with the least drop in breathability. Home-made cloth masks made up of single layer of cotton blend were 70% effective against viral transmission.

In a study published in April of this year, researchers tested a variety of masks for blocking ability of an avian flu virus. The N95 mask was best at 99.98%, the surgical mask was second with 97.14%, and a double-layer cloth mask was 95.15%.

In a study that’s currently in the peer-review process, researchers tested 10 different fabrics compared to the typical surgical mask for blockage and breathability. The surgical mask blocked 96.3% with the best breathability. Single-layer, cotton and polyester blend fabrics blocked 90.1% with a comparable breathability (in the photo above, my mask is the least effective). A used dish-cloth blocked 97.9% with acceptable breathability. They also found that doubling and tripling the cloth fabric increased the amounts blocked and still allowed for good breathability, so Paula and Riley are better prepared than I am.

Masks, even those made of cloth that can be found in most homes, can be effective in reducing the amount of droplets spread. What about wearing a mask during exercise? I’ll give you my results and wrap this up on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Disaster Med Public Health Preparedness. 2013;7:413-418.
2. DOI: 10.1002/jmv.25805.
3. https://www.medrxiv.org/content/10.1101/2020.04.19.20071779v1.full.pdf

Info on Our Masks
• Riley’s mask is available from Cincinnati Zoo in several breeds (he chose the hippo); proceeds help support the zoo
• Paula’s mask is made by Humans In Action, which provides work for displaced garment workers in Guatemala; many colors available with ties instead of earloops
• Dr. Chet’s mask is from Sports Fan Island, which also sells other types of face masks for sports fans

The Facts About Masks

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When I finished last week’s Friday Memo with “Wear the damn mask!” I knew it wouldn’t be the last of it. I spent the weekend reading the research about what masks could and could not do to limit our exposure to the COVID-19 virus. The primary goal of wearing a mask is to prevent you from spreading the virus to others. If everyone were to wear a mask, that could reduce our potential exposure in social settings.

Before I cover that, two things that seem to travel social media. First, people avoid masks because they don’t want to continually re-infect themselves. This took no research at all: if you’re infected with COVID-19 or any other respiratory virus, you’re infected. Period. You can avoid spreading it to others by wearing a mask, but you can’t reduce any hazard to yourself because you already have the infection. If you aren’t carrying the virus, you can’t infect yourself by breathing into your own mask. That should be pretty clear.

Second, people are concerned that the carbon dioxide levels building up in the mask, but it’s not as simple as oxygen in and carbon dioxide out. The air you breathe in is 21% oxygen and 0.4% CO2 and what you breathe out is 16% oxygen and about 4% CO2. The rest is nitrogen. Due to the proximity of your nose and mouth to the mask, there’s limited exposure to CO2; if there were a significant amount of room for the carbon dioxide to build up with no air flow within the mask, that could be an issue. In a human breathing normally, the air will constantly change to high oxygen and low carbon dioxide.

We’ll take a look at mask materials on Thursday; what is best?

What are you prepared to do today?

        Dr. Chet

COVID-19 Attacks the Whole Body

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Our look at diseases associated with COVID-19 continues in this pre-4th of July memo. Let’s turn to diabetes. We know, based on prior reports, that people with type 2 diabetes as well as other comorbidities are susceptible to getting the worst symptoms of COVID-19. But now, there are also some reports that COVID-19 infections may cause diabetes; people diagnosed with COVID-19 with minor symptoms have developed type 1 diabetes later.

How could that happen? The first way may be a direct attack on the pancreas because it also contains many ACE2 receptors. Or it may be that as the virus stays in the body, it triggers an autoimmune response. Or it may somehow stimulate other dormant viruses due to the inflammation and immune response.

One of those is the Epstein-Barr virus; almost 90% of us have been exposed to it. Epstein-Barr impacts the nervous system in a significant way. Perhaps the challenge to the immune system somehow triggers the activation of Epstein-Barr to cause neurological dysfunction from mild to severe.

In doing the background research for these Memos, I found that scientists are looking at every organ for potential consequences of the COVID-19 virus infection. We already knew of cardiovascular problems as well as kidney damage; lung damage was significant whether the patient was on a ventilator or not. The impact on blood vessels, which are full of ACE2 receptors, are the root cause of many of the problems. With the loss of taste and smell, it may be that the virus causes the death of enough of those organelles that we are permanently impacted. We’re learning some patients develop problems in their brains such as strokes, psychosis, and altered mental state, and we’ll discover more conditions that are impacted by the virus as time goes on. And we haven’t even begun to discuss the microbiome.

The Bottom Line

As I wrote several weeks ago, I don’t want you to fear this virus but you’d better respect it. That means you do your best to avoid getting it and avoid spreading it.

This is the beginning of the major holiday of the summer. Being restricted in what we can do and where we can go has worn on people, perhaps even you. So let me leave you with two thoughts.

First, if getting into a pool is part of your holiday plans, go ahead. The chlorine in a well-maintained pool or hot tub will kill the virus and sunshine helps, so have some fun; but if you’re just socializing while wet and not social distancing, wear a mask.

Second, I’ll finish where I began this series: with wearing a mask in public. You don’t have to like it. Who does? Science clearly shows it reduces the risk of catching or spreading the virus which, as we’ve seen, has far more implications then just a little fever and cough. So if you’re going into public places, do what I do and wear the damn mask. Please.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. 2020. doi: 10.1038/d41586-020-01891-8.

COVID-19 and the Small Intestine

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With the ACE2 receptor implicated in the long-term side effects of COVID-19, let’s begin with the digestive system. The gastrointestinal distress such as cramping, pain, and diarrhea are obvious, but there are reports that some people have had to have their entire small intestine removed due to damage from the COVID-19 virus. How could that happen?

One of the characteristics of these specific cells that contain the ACE2 receptor is that they function to absorb nutrients. If the virus interferes with absorption of nutrients by cells, the first cells that will be impacted are in the small intestine; it could literally starve to death. Second, a significant blood supply goes to the digestive system. We know that the COVID-19 infection can cause unusual clotting; if the blood flow is restricted to the small intestine, that could also cause cell death.

While we’re not done with this topic yet, I think it should be clear that we don’t know as much as we need to about the long-term effects of COVID-19. That’s why it’s so important for research to continue and for all of us to be vigilant in protecting our own health and the health of everyone we encounter.

Because of the holiday weekend, we’ll complete this tomorrow, but the discussion is far from being over as more research reveals more issues from exposure to this virus.

What are you prepared to do today?

        Dr. Chet

References: www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified