Tag Archive for: COVID-19

Does Exercise Reduce COVID-19?

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I’ve written about fitness and COVID-19 before, but a recent post by a colleague got my attention. I had never been able to find any research that suggested people who are fitter would have less serious cases of COVID-19 or any upper respiratory infection for that matter. I thought maybe the scientific paper he used might provide an update. In addition, there were a couple of statements in the paper that caught me by surprise. Here’s what I found.

Exercise and Fatty Lungs

The paper suggested that if a person were overweight or obese, there could be an increase in fat cells in the lungs. As such, that could increase the available components such as fatty acids that could contribute to the cytokine storm in extreme cases of infection. I’d never heard that fat cells were found in the lungs, so I decided to dig deeper.

The paper referenced an article that talked about risk factors for severe cases of the COVID-19. They cited two studies. The first was a study on overweight diabetic rats. However, we’re not rats so we can’t assume the same applies to humans. The other article dealt only with obesity. The paper said that in a small study on humans, fat cells were found in the lung parenchyma where gas exchanges occur in the lung tissue.

I decided to check out that paper as well. It was a post-mortem examination of the lungs of normal-weight and overweight subjects who died from asthma and non-respiratory conditions. Researchers found fat cells in the cell walls of large structures greater than 6 mm in diameter but none in smaller areas. There was an increase in the fat cells and immune response cells in the fatal asthma cases in obese subjects. While interesting, it does not support the original article indicating fat cells in the lungs to any significant degree, because some obese subjects had none in their lung tissue.

Exercise and COVID-19

The rest of the paper discussed the benefits of exercise as it relates to weight loss, reducing cardiovascular disease, and improving metabolic systems, especially as related to type 2 diabetes. They talked about how every type of exercise improves the body enough to reduce comorbidities, and reducing comorbidities may lead to a better outcome if you get COVID-19.

The only misstatement was that exercise is a way to reduce a significant amount of body fat. It’s not; you also have to reduce your caloric intake to do that. But exercise can improve every organ system to respond better to challenges. That may help if one catches a severe case of COVID-19, so they got that right.

The Bottom Line

Exercise has been described this way: it would be the most prescribed medication in the world if it were in pill form. Based on this paper and the sum total of all the research on exercise and health, exercise can help you reduce your risk of a severe case of this or any virus, maybe not directly, but in helping you reduce your comorbidities. Move more and start today!

What are you prepared to do today?

        Dr. Chet

References:
1. Front. Physiol. doi.org/10.3389/fphys.2020.572718
2. Diabetes Metabolism. 2020. https://doi.org/10.1002/dmrr.3325.
3. Eur Resp J. 2019. 54:1900857; DOI: 10.1183/13993003.00857-2019

Research Update: COVID-19 on Surfaces

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There are hundreds of papers published every day on the COVID-19 virus. The range of topics borders on the incredible, so I decided to provide two updates based on a couple questions that I’ve gotten. The first is a simple one. How long does the virus live on surfaces? When does it become unable to infect us?

Using standardized procedures that exposed the surfaces to identical amounts of viable COVID-19 virus, researchers tested surfaces under a standard temperature of 68 degrees F and 35-40% humidity. They found the virus was detectable up to seven days on nitrile gloves, four days on chemical-resistant gloves, 21 days on plastic face shields and N95/N100 particulate respirators, and 14 days on stainless steel. All very nice, but how about what appears to be argued about most of the time: cotton masks? The viability of the virus on cotton was reduced within four hours of drying and by 24 hours, was not detectable at all. For a full explanation on the facts behind masks, check out the free Health Info on drchet.com: Cloth Masks: What the Research Says.

The researchers want to check out other materials used in personal protection devices, but the masks are most relevant to you and me. If we can’t wash them between uses, which will kill the virus, letting them dry completely overnight renders the virus unable to infect us. They will continue to protect others as long as we wear them. Respect.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.matt.2020.10.006

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