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COVID-19 Update #3

            Based on recent information, COVID-19 is not the apocalypse. Granted, it’s a serious infection that could, in the short run, outpace the capacity of our hospitals.

            The good news is that in China, where the problem emerged, new cases have fallen to a small number per day.  Unfortunately, this was after a significant loss of life.  By all indications, the rate of infections peaked several weeks ago. In South Korea, the infection rate has now dropped to around 3%.

            More about what we face can be gleaned from the experience of the Diamond Princess cruise ship.  The initial infection occurred in a person between January 21 and January 25.  The next person to show symptoms of illness occurred on February 3rd. In this community of people in close contact, 712 of 3711 passengers and crew tested positive, and seven died (all elderly). That means the death rate of infected patients was about 1%, and the likelihood of surviving an epidemic within close quarters was about 98.8%.  Not having to be confined this close to others with the virus, we should do far better.

            In a recent statement from the Academy of Physicians for Clinical Research (APCR), drugs and vaccines that show promise are rapidly being evaluated.  There are currently 16 antivirals with effectiveness against COVID-19 in vitro (laboratory conditions, before human trials). Many are already starting clinical trials, and vaccines testing will soon begin. It’s possible that COVID-19 may be largely medically mitigated after these antivirals and vaccines complete clinical trials.  This is not the apocalypse.  However, this is the time for everyone that possibly can to isolate themselves – especially the elderly and vulnerable.

            The next few weeks will be difficult.  As we have learned from international reports, how hard the medical system will be challenged depends on how willing communities are to quarantine. As we have observed, Hubei province in China was poorly prepared. In contrast, Singapore, South Korea, and Hong Kong brought their cases to manageable levels.  It remains to be seen how responsibly Americans can act. If the Diamond Princess represents the worst-case scenario, that would translate into about 700,000 lives lost to COVID-19.  Our challenge in mimicking the success of South Korea and Singapore is that our leaders have been slow to issue blanket quarantine orders.  Shortages of Personal Protection Equipment (PPI) and testing supplies compound the difficulty of slowing the virus.  While our freedoms give us many benefits in normal times, they may not be the ideal complement to a pandemic.  Still, there is reason for optimism.  America is a resourceful country, and many will rise to the occasion with hard work and creativity.

            For now, don’t expect kids to go back to school this year. As you have likely noticed from the national news, hospitals are starting to look like a scene from M*A*S*H, with tents outside and lines of people waiting for testing.  Of course, hospitals are greatly restricting visitors and all non-essential operations are postponed.  If you should see an infectious disease doctor, don’t be surprised if he/she is walking around wards in what looks like a spacesuit. In some areas, Intensive Care Units (ICUs) are already in short supply, even at this early stage.

            This is not the time for our ‘invincible youth’ to party.  Scenes from Florida of youths at the beach are worrying. Many of them will pick up the virus and bring it back to their friends and families. This is one of many reasons that a lockdown at this time is essential.  Granted, a statistic like 1% may not sound so bad.  The problem is that the 1% could include your parent or grandparent being denied a place in an ICU.

You may be wondering, “How do I know I’m infected?”  Well, in the first few days of infection, you probably won’t know you have it.  Unfortunately, during this time, you will be leaving a trail of viral particles at home, on counters, doorknobs, on elevator buttons, at the grocery store, and wherever else you travel. In general, airborne droplets, skin contact, and surfaces seem to be how the virus is transmitted.  A surface touched by someone else could infect you for several days after someone has contaminated it.  Droplets from breath probably hang in the air for at least 30 minutes before falling to the ground.

The first signs of illness will likely be fever, dry cough, fatigue, or muscle ache. For a few, it will begin with gastrointestinal distress.  Here is what generally happens.

  • 83% to 98% experience a fever
  • 76% to 82% develop a dry cough
  • 11% to 44% experience fatigue with muscle aches.

The symptoms tend to mimic those of colds and flu that cause mild to moderate upper-respiratory tract illnesses.  With COVID-19, about 81% are expected to have mild symptoms and fair well with self-care. For about 14% of people, the symptoms will be more severe and may require some medical attention. For the remaining 5%, critical care may be required.

Although symptoms may begin like the common cold, you won’t be sneezing.  Soon, you may have a dry, raspy throat and maybe a headache. Within a few days, you may feel like you’ve got the flu, with a high fever and some aches.  In more severe cases, pneumonia may develop along with difficulty in breathing.  In the most severe cases, the virus can attack the heart, kidney, gut and even the lining of blood vessels.  A great deal depends on the body’s ability to mount a defense.

Current expectations are that 75% of us will have COVID-19 before a vaccine becomes available.  Ultimately, we will reach a point called “herd immunity.” That happens when enough people have become infected and developed a resistance to COVID-19.  In essence, when enough people have become immune to COVID-19, there will be so few left to infect that the healthcare system can easily respond to critical needs. When that happens, the virus becomes manageable and, optimistically, is on its way to disappearing as a threat.

            Nancy Neighbors, MD

A Voice of Reason

            In a sixteen minute video, Dr. Michael Klapper offers encouraging thoughts about how to get through these challenging times along with what we need to do as a society to keep diseases like COVID-19 from happening so frequently.  If stressed, take a few minutes to enjoy Dr. Michael Klapper’s perspective in the video, “Pandemic – How to get through these challenging times.”

Why Now

            Within the last 20 years, there have been three coronavirus outbreaks (SARS, MERS, and COVID-19) that emerged from animal to human transmission.  In each case, the globally connected world rapidly helped these viruses spread.  Why they are emerging now and not previously is not certain, but theories include greater human-wild animal contact for food, increased production of meat (chicken, beef, pork, and fish) in densely populated facilities, and climate change. There is more about this problem at the end of Dr. Michael Klapper’s video, “Pandemic – How to get through these challenging times.”

How to Protect Your Immune System

While physical distancing, frequent handwashing, and not touching your face are important for slowing the spread of the disease, you can further improve your chances of avoiding COVID-19 or at least minimizing the effects by adhering to the following recommendations

  • Diet/Nutrition – A plant-based whole food diet will provide the best health and, consequently, the best immunity to disease.  In particular, eat lots of leafy greens, vegetables, and fruits across a rainbow of colors.  This will help develop a healthy gut microbiome, reduce inflammation, and give you the micronutrients needed to maximize health.  An animal food-based diet high in saturated fat and cholesterol accelerates viral disease progression according to research results reported in the Journal of Infectious Diseases.
  • Physical activity – While still healthy, get daily exercise – at least 30 minutes of moderate activity per day.  Make sure that you work up a sweat. This virus has the highest impact on people’s hearts and lungs, so you want to make sure they are in the best condition possible before you get the virus. If in need of ideas for exercise, try FitnessBlender.com. They have hundreds of free exercises and exercise programs you can view on YouTube.  Best of all, it’s free and no gym or equipment is needed. If you missed joining the Silver Sneakers program before the local gyms closed, you can still access many of the Silver Sneaker’s online workout videos. Just enter the search term “SilverSneakers + YouTube” in your web browser.  For those that have a Medicare Advantage Plan, be sure to take a look at what your free Silver Sneakers gym membership has to offer.
  • Sleep – Sleep is essential for your immune system to operate at peak efficiency. For most, this means 7-8 hours of sleep nightly.  Routine sleep time is best. Go to bed at a regular time.  Avoid screens at least an hour before bedtime.  You may find that it helps to develop a wind-down ritual, like listening to soft music, writing in a journal, or reading a book.  Finally, make sure your room is cool, dark, quiet, and comfortable. 
  • Reduce stress –Reducing stress reduces cortisol levels, which in turn helps your immune system.  Mindfulness practices, meditation, and breathing exercises can all help reduce stress. If you find that your stress is becoming unmanageable, seek help. Being outside helps reduce stress.  You can walk with a friend and still maintain a physical distance of six feet.  When possible, walk in the sunshine for a dose of vitamin D.
  • Relationships – This is an important time to be supportive of friends and family. Listening to each other and feeling safe to express your feelings is the place to begin.  When possible, help neighbors or others who may need a hand. If quarantined, use some of the time to reconnect with friends and family by video chat.
  • Substances – Avoid smoking, vaping, or inhaling any substance that is toxic to the lungs.
  • Meaning and purpose –If you are religious, use the power of prayer.  Otherwise, use what works best for you.  For many, a list of affirmations provides reflection along with a reminder of their purpose. Think about the many things you are grateful for.  Also, practice smiling and laughing. Your immune system will thank you.

Mindfulness Training

The Alabama Institute for Mindfulness invites you to participate at no cost in their online stress reduction classes. This is an online community gathering, and everyone is welcome.  For the Wednesday afternoon virtual meetings at 5:00 pm, you will need to register in advance.  For the Saturday morning meetings at 9:00 am, register in advance using this link. After registering, you will receive a confirmation email with information about joining the meeting.  For more information, feel free to contact Leila or Beth at mindfulalabama@gmail.com

More Community News

All stories on AL.com connected to COVID-19 are now free to read and share. Also, the digital replica, or eNewspaper, is free for all to read at al.com/ReadHT.  A full one-year archive of past issues is also available when accessed through a web browser.

Local, state, and national information is also available from:

More About Hand Washing

Can’t find any hand sanitizer? Check out this quirky video by Alton Brown and learn why soap is better than hand sanitizer, if you do it right.  Of course, when you are out and about at the grocery store or have to hold the gas pump, soap and water aren’t going to be available.  In these situations, hand sanitizers are the way to go.

            If the stores continue to be out of hand sanitizers, click here to learn how to make your own.  The World Health Organization also offers ideas for making hand sanitizers. However, beware of using denatured ethanol sold as a solvent in the paint department, or that sold for alcohol burning stoves. It is denatured with methanol alcohol, which is poisonous and can be absorbed through the skin.

More Thoughts from Dr. Attia

            You may be wondering why America is struggling to make COVID-19 testing available to large numbers of people and why this is important.  The videos below tell the story along with an explanation of why you should stay the course with your current prescriptions unless your doctor advises otherwise.  In Video 9, Dr. Attia reminds us, by way of current data, why each community can experience the effects of COVID-19 in greatly different ways.

Video 5 – Why we are behind the curve on testing

Video 6 – The importance of testing 

Video 7 – More about how the virus spreads 

Video 8 – What about blood pressure drugs 

Video 9 – A lesson from Italy and New York

            The following three articles are more technical and recommended to medical professionals.  None of the recommendations offered are appropriate without your doctor’s personal assessment of your condition.

Pharmaceutical update 3/19/2020

Medication Interaction update 3/18/2020

General guidance update 3/12/2020

More About Diet From

Physician’s Committee for Responsible Medicine

Eating a low-fat, plant-based diet may help give the immune system a boost. The immune system relies on white blood cells that produce antibodies to combat bacteria, viruses, and other invaders. People that eat a plant-based whole food diet have been shown to have more effective white blood cells when compared to those eating animal-based foods due to a high intake of vitamins and low intake of fat.

Eating a low-fat diet may also be protective. Studies have shown that limiting dietary fat helps strengthen immune defenses. Research also shows that oil may impair white blood cell function and that high-fat diets may alter the gut microbiota that aid in immunity.

Maintaining a healthy weight can also benefit the immune system. Excess weight has been linked to increased risk for influenza and other infections such as pneumonia.  Plant-based diets are effective for weight loss because they are rich in fiber, which helps fill you up without adding extra calories. Fiber can also lower BMI, which is linked to improved immunity. A plant-based diet has also been shown to reduce inflammatory biomarkers.

Quick Chickpea Bolognese

Got a few minutes and want something delicious and totally nourishing for dinner? Try this quick vegan chickpea bolognese sauce over your favorite pasta! Chopping the chickpeas gives the sauce a finer texture that’s easier to eat with noodles. Feel free to leave this step out, however, if you’d rather eat them whole. This bolognese is completely plant-based and loaded with veggie goodness to make you feel awesome. Imagine that after eating a big bowl of pasta!  Click here for the recipe.

COVID-19 Reality Check

            COVID-19 is the third reminder in less than 20 years that using animals for food comes with extreme risk when grown at the scale needed to feed a world with almost eight billion people.  Fortunately, COVID-19 was not the beginning of a super-pandemic with the potential to kill billions, but it could have been.  In the face of these future possibilities, it is important to understand that while the ability to quickly create new vaccines is possible, testing for effectiveness and safety can still take months and sometimes years.

            For the foreseeable future, reducing our dependence on animals for foods may be the only way to avoid future pandemics.  The good news is that animal-based foods aren’t necessary and for most lead to a shortened lifespan and shortened healthspan.

            While stockpiling supplies for future pandemics may be the solution most talked about, not having a future pandemic would be a far better plan.  Fortunately, we don’t have to wait for an excellent solution.  A plant-based diet can greatly eliminate the transmission of diseases from animals to humans, provide better nutrition along with improved healthspan, significantly reduce healthcare cost, and significantly reduce greenhouse gasses.

The information presented is provided for educational purposes only. It is not intended as a substitute for personalized diagnosis, treatment, or advice from a qualified, licensed medical professional.

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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