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COVID-19 Update #10

            No matter how prudent a lockdown may have been as a precautionary measure, COVID-19 isn’t going away and smarter ways of living with the virus will have to be used.  A continued lockdown of activity only moves the country toward economic collapse.  Without economic activity businesses bankrupt, retirement savings disappear, and eventually, governments collapse.

            Fortunately, a depression is not where we have to be headed although fear-mongering by the news outlets may have you believing that endless lockdowns are the only answer.  The repeated dissemination of information in the most sensational way with the least possible context has not been helpful.  Why we have more cases of COVID-19 than most other countries should not be a mystery.  Claiming we have 3x or 5x as many cases as countries like Spain or France is simple fear-mongering.  We are a very large country and probably collect data better than all but a few.  Around the world, many countries lack the ability to collect data. Complicating data collection is the fact that even in normal times, ascertaining the exact cause of death is challenging.  For example, a person with the flu may have heart problems, lung problems, and diabetes.  Given that only one cause goes on the death certificate, why waste time deciding. For a definitive answer, an autopsy is usually needed.  Are the numbers of deaths from COVID-19 accurate? Not likely.

            Based on news reports you might think there were two different viruses out to get us.  On one hand, there are a few people in which we see a disturbingly high death rate, on the order of 1%-3%.  For most, however, the virus is more like a wave that washes through unnoticed or with minor effects.  These waves will continue to slosh about until we have widespread herd immunity.  Fortunately, each time the wave washes through, there will be less disruption and less harm for numerous reasons.  We have learned a lot about caring for patients with COVID-19. Many can be safely treated at home. We have also learned that far fewer ventilators are needed and that some patients were harmed by being put on ventilators too early. We now understand that blood clots are contributing to morbidity and have tested treatments to compensate. In general, we know more about many nuances of treating high-risk patients. As a society, we are more aware of the benefits of social distancing and hygiene to help prevent infection. And, we are more aware of how to protect our nursing homes. The biggest reason that it won’t be as bad again is the ever-increasing number of infected people that have gained immunity. While this is certainly a positive view on average, this doesn’t mean that everyone is in the clear.  The problem, of course, is that in any successive wave, people with medical conditions remain at an increased risk of getting sick. As the Center for Disease Control (CDC) routinely reminds us, among the most common underlying conditions placing people at risk will be diabetes; chronic lung disease, including asthma, COPD, and emphysema, and cardiovascular disease.

            The path forward needs to be one where the most vulnerable remain isolated and the rest of us return to our usual activities with adjustments as needed to slow the spread of the virus when new outbreaks occur.  This would have been the most sensible approach in the first place.  Unfortunately, the ‘experts’ used flawed models to project how many would become seriously ill.  In many areas of the country, the overreaction sent the economy off the tracks unnecessarily.

            Thus far, I have no patients that have been diagnosed with COVID-19 and local hospitals have admitted few patients with COVID-19.  Of the few that died, you may wonder how many died because of COVID-19?  Without an autopsy, you might get three different answers from three different doctors.

            Many had hoped that testing for the virus would provide a more efficient way to control the spread of the virus.  The problem is that the number of positive cases found does not predict the number that will become critically ill or the number of deaths.  Until the models and the tests improve, additional testing appears to have limited value.  For more about the limited value of additional testing, read “COVID-19 – Why We Can’t Test Our Way Out of This” by Anish Koka, MD. If still pondering why it would be that more testing is unlikely to help, the discussion of test sensitivity and specificity by Dr. Peter Attia in “COVID-19 Update #6” helps unravel the mystery.

            On a positive note, worries about COVID-19 have reduced the number of smokers and vapers. It seems that both the smokers and vapers are getting the message that their habit no longer takes 40 years to kill them.  A study in Great Britain indicates that 300,000+ people have recently quit smoking.  For a country the size of America that would translate to about 1.5 million Americans stopping smoking.  As odd as it might seem, such an outcome could have COID-19 being a net positive for the country given that smoking is a serious health concern.  Now, if we could get a similar message across to people living on the Standard American Diet (SAD) about COVID-19! That alone would save millions from heart attacks, strokes, cancer, etc. In Dr. Michael Greger’s book “How Not to Die” he covers the 15 most common causes of death.  With the exception of two, the 15 ways all point to lifestyle as the greatest threat we face.

            There is more encouraging news.  Several drugs have been used with success to reduce the severity of COVID-19 and better ventilator protocols have been developed. In some hospitals, changes in these protocols have significantly reduced deaths.  Every week, a positive new discovery is reported.  Between the ever-expanding herd immunity that is developing and many new medical treatments, COVID-19 looks to be a disease we can beat.  Still, many wonder how a single strand of RNA managed to outsmart our 46 chromosomes. Perhaps half of our chromosomes are republicans and half are democrats.  That would explain it.

            I’m looking forward to the “old normal” and far less COVID-19 news.  For now, I will continue to offer virtual office appointments as needed, but will increasingly be recommending office appointments when appropriate.  While some types of social distancing may be with us for quite a while, in time, that too will pass.  On a positive note, our social consciousness has been inoculated and should we face another virus, we know the drill.  For now, we will follow the “Safer at Home” rules from the State of Alabama.  If during the transition you have questions or concerns about our COVID-19 office arrangements, please feel free to call.

            As I mentioned in the first COVID-19 Update, the virus will probably be with us for years to come. At present, the earliest a vaccine could be made available in large quantities is expected to be in 18-24 months.  This should not be confused with news reports that vaccine trials are already underway.  Quite likely, you will soon see advertisements seeking participants for local COVID-19 vaccine trials.  Because of the time required to make safe and effective vaccines, now is the right time to work on defensive lifestyle measures to protect your health.  If unsure about the best way to get started, let’s have a talk.

            Nancy Neighbors, MD

Amended Safer at Home Order

            In Alabama, a new order goes into effect on May 11, 2020, and remains in place in place until May 22, 2020.

            Click here for a summary.

            Click here for the official order from the State Health Officer

            Click here for an AL.com article about the new Safer at Home order.

How Protecting Yourself from Cancer
Can Also Protect From COVID-19

The COVID-19 pandemic has made it clear that we need to keep ourselves in the best health possible.  The good news is that lifestyle changes that help defend us against cancer also help defend against COVID-19 and contribute to a longer healthspan.  If unsure how you can make the right changes, the following three interviews will give you plenty of ideas to work with. Click here to begin the three presentations described below.

  • “The Ultimate Cancer-Kicking Diet” by Kristi Funk, MD (51.22 Min.) From Dr. Funk, you’ll find out about genetics, soy, sulforaphane, resveratrol, wine, mushrooms, coffee, and how you can eat to kick cancer to the curb while loving your life.  Dr. Funk practices as a breast surgeon at the Pink Lotus Breast Center in Los Angeles, where she is an expert in minimally invasive diagnostic and treatment methods for all types of breast disease.
  • “How to Eat to Beat Cancer” by Chris Wark (48.49 Min.) Chris provides stories and his lessons learned for fighting cancer.   Chris’s mission is to inspire people to take control of their health and show them how simple diet and lifestyle changes can have a huge impact on cancer prevention and survival.
  • “Eat for Life” by Joel Fuhrman MD (49.14 Min.) Dr. Fuhrman explains what’s wrong with most “healthy eating” recommendations. Dr. Fuhrman is a board-certified family physician and a researcher that specializes in reversing disease through nutrition.

Does Blood Type Affect the Severity of COVID-19?

            The incredible amount of research that COVID-19 has stimulated has greatly increased our understanding of the virus.   With this level of research, it was only a matter of time before discoveries were made that could explain a genetic susceptibility to the new coronavirus and the severity of the disease it causes.  For more about the relationship that genetics and blood type have on COVID-19 read “Do Your Genes Predispose You to COVID-19?”

Reduced Cancer Screening Are a Concern

            For several months, the majority of patients that were scheduled for cancer screenings have not been accessing healthcare because of the COVID-19 pandemic.  It now seems likely that the result of this lapse in care will be increased deaths due to cancer. Estimates now indicate there could be 34,000 excess deaths in the United States in the following year.  For more about this expected trend, read “Excess Cancer Deaths Predicted as Care Disrupted by COVID-19.” 

            In a separate analysis, extrapolated data from claims histories suggests that there could be 36,000 missed or delayed diagnoses of breast cancer 18,800 missed for colorectal cancer, 22,600 missed for prostate cancer, etc.  Fo more about these projections read “Three Months of COVID-19 May Mean 80,000 Missed Cancer Diagnoses.”

A Reality Check

            Had we been told that a space rock 50 miles in diameter had painted a bullseye on earth, widespread panic would be expected. No doubt the economy would grind to a standstill as all resources were reallocated to space rock defense.  On the expected day, as the speeding rock unexpectedly just misses the earth, Monday morning quarterbacks would be asking, “Why did we waste all this effort?”  Well, regardless of how we got to our own version of panic, the data is in and it’s time to move on.  Click here for more about why it’s time to stop the panic.

            If you were one of many that felt like our area of the country was overreacting, you will find a companion to commiserate with, in the voice of Dr. Pamela Popper.  In a May 7, 2020 video blog Dr. Popper offers her thoughts in the video blog “More COVID-19 Data and Information from Dr. David Katz – a Voice of Reason” in which she reminds us that Dr. David Katz was the adult in the room that policy leaders should have been listening to. I believe most would agree.  Earlier, in April, Dr. Popper along with many others began protesting that the predictions for disaster were flawed.  For more about the issue, view the April 16, 2020 video blog “COVID-19: The Models Are Wrong.”  In hindsight, Dr. David Katz and many others from the American College of Lifestyle Medicine were spot-on for the correct course of action. For anyone that missed Dr. Katz March 20, 2020 article titled “Is Our Fight Against Coronavirus Worse Than the Disease?”, it’s well reasoned and well worth reading.

What a Difference Another Week Makes

As the virus that causes COVID-19 moves through the population, the number that can be infected is reduced by the number that has recovered.  In New York, the virus went through densely populated areas like wildfire.  Still, the virus seeks new host, just more slowly since there are fewer people left to infect. As shown in the table below, two weeks ago, Alabama had a 25 times lower death rate than New York.  Then a week later the rate was only21 times lower.  Now, two weeks later (5/10/2020) Alabama’s death rate per million is only 17 times lower than in New York.

 Deaths/Million
State4/25/20205/3/20205/10/2020
Alaska121214
Arkansas162729
Texas233338
Tennessee273335
Alabama446180
Florida516880
Georgia88121132
Michigan329415456
Connecticut520714822
New Jersey6608951042
New York1,11712711378

                From Worldometer

While Alabama still looks pretty successful in managing COVID-19 compared with the Northeastern states, given time we may yet have to call it a draw.  Then perhaps, our open spaces and the sunny climate are more protective.

Internationally, similar trends can be observed.  For example, a week ago Spain had a death rate of about three times that of the United States but a week later only about 2.6 times greater. Then, two weeks later, on 5/10/2020, Spain’s rate is only 2.3 times greater.

 Deaths/Million
Country4/25/20205/3/20205/10/2020
Taiwan0.30.30.3
China333
S. Korea555
Germany708390
USA166211243
Sweden217274319
UK305423469
France350386404
Italy441481505
Spain496544569
Belgium612684747

From Worldometer

            While services like Worldometer probably report the data they receive accurately, the reliability of the data sources remains questionable.  In some countries, it appears that relatively few are allowed to officially die from COVID-19.  Then, the way data is reported varies by country from daily reports to sporadic reports.  Often a spike in reported infections and deaths means little in the most recent report.

As We Move About, Let’s Do It Right

            Social distancing is still recommended even outdoors.  Staying 6 ft apart, not gathering in groups, and wearing a mask correctly is still prudent.  When you can, enjoy the outdoors.  Huntsville’s many parks and greenways make a nice getaway this time of year.  Early mornings are spectacular (cool and bug-free.)

            As a side note from history, there is evidence that being outdoors is good medicine.  During the 1918-1919 Spanish flu, there was an interesting experiment in the beneficial effects of light therapy (heliotherapy.)

The Government erected emergency hospitals – one of which, the Camp Brooks Open Air Hospital in Massachusetts, had the unique distinction of being an outdoor recovery unit. The mortality rate for patients there fell from 40% to 13% when they were moved outside. Was it the sterilizing effect of UV light, or was it the increased vitamin D3 levels in the patients? Probably both.  Although the President was recently criticized for suggesting UV as a possible way of countering COVID-19, his suggestion had a historical basis.

            As you return to stores and other public venues, some places may require facemask.  No doubt some will see this requirement as an infringement on their right to choose.  If you should feel this way, consider the analogy of driving a car.  No one tells you where you can drive but they do have the right to expect safe driving.  Wearing seatbelts saves lives and reduces costs to the public (lower insurance rates for all) and, of course, driving under the influence similarly drives up the cost for everyone.  These rules for safety are intended to help everyone.  In essence, we have the right to many freedoms so long as the way we use them doesn’t bring harm to others.  If feeling some displeasure with the rules, I suggest helping others around you feel safer. It won’t kill you and perhaps you won’t kill anyone else. Wherever we go in the public spaces, there will be some that are immune-compromised or vulnerable in ways we can’t know.  A little more help from each of us can make it safer for everyone. If it’s any consolation, this too will pass.

The Potato Story Revisited

            If you have had reservations about plant-based whole food diets, you may find some reassurance from the story of Andrew Taylor, an Australian that lived for a year on potatoes, lost 121 pounds, and regained his health.  This is not a recommendation to follow a potato only diet.  Rather, it’s a lesson about the amazing nutrition available from plants.  Later, Andrew discovered that he could have gained more benefits from a diet that included a variety of plant foods. The magic wasn’t unique to the potato – it was the magic of nature’s plants. Some two years ago, I shared this story in an article titled “A Potato Story.”  It’s an entertaining sidelight on plant-based whole foods and if you missed it a story you are sure to find intriguing.

            Hopefully, the story will also intrigue you enough to try a couple of recipes from Andrew Taylor’s web site. Oh, and don’t let the recipe titles fool you.  Andrew is all about potatoes.

Broccoli Cheddar Soup

            Inspirational You Tuber, ‘High Carb Hannah,’ shares one of the recipes that saw her lose over 31kg (68 pounds)! Best of all, despite the title, no cheese needed to make it.  Click here for the recipe.

Rainbow Jungle Curry

            Adam Guthrie, a heart attack survivor, professional chef, and founder of the ‘I Feel Good’ program, shares his delicious Rainbow Jungle Curry.  Click here for the recipe.

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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