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Germs Public Health

COVID-19 Update #7

            As the days in quarantine go by, there is one question on everyone’s mind; “When will it be safe to return to something close to normal life?”

            Unfortunately, the answer depends on data that, for now, can only be guessed.  Many estimates have been made; however, without accurate and widespread testing, the range of estimates gives policymakers little useful guidance. Some estimates show the number of people infected range from 0.1% to 10% of the population. Estimates of the infection fatality rate also vary widely.  Even the doubling time for infections has widely varying estimates. In each of these numbers, small variations make significant differences in how we should respond. To more fully appreciate how challenging it has been to get good data read, “In Pursuit of Real Coronavirus Numbers.”

            In the best of all worlds, we would not have come to this pandemic predicament in the first place.  Of course, now that we are here, the finger-pointing has begun.  Did the Chinese cause the problem?  Was the problem amplified by mismanagement?  Should we blame WHO and CDC?  While there were missteps, the most important cause was the failure of the public to remember history.  Faulting our leaders would be convenient, except for the fact that we elected them to solve other problems.

            The German philosopher Georg Wilhelm Friedrich Hegel (1770-1831) wrote, “The only thing we learn from history is that we learn nothing from history.”  In more recent times, Pogo creator Walt Kelly reminded us, ”We have met the enemy, and he is us.”  To suggest that important lessons from the past were forgotten would be an understatement.  The good news is that how we prepare for future pandemics will change.

            Many warning signs suggested that human civilization had overstepped its welcome with the natural world.  While no one could have predicted the timing of the current pandemic, the expectation of a serious event had been on the minds of many epidemiologists and fellows of my medical specialty like Dr. Michael Greger.  In part, my involvement in lifestyle medicine, along with an emphasis on plant-based diets, was motivated by an understanding that we must change our lifestyle and in particular, our relationship with animals as food to survive. Quite simply, we are not living in the same world we were in 50 years ago, much less 100 or 1000 years ago.  With over seven billion humans and more than 70 billion food animals, humans are closer to animals than ever before. As a result, we are ever more exposed to animal diseases.

            As a reminder of lessons long forgotten about why we face the current pandemic, why a pandemic was predictable, and what we must do to avoid future pandemics, I strongly encourage you to watch the video “Pandemics – History and Prevention” (57 min) by Michael Greger, MD.  This may be the most important history lesson to remember for the survival of our species.  For those that have followed my articles over the years, Dr. Greger will be a familiar name. What you might not have expected is that though the video was recorded over ten years ago it remains quite relevant today.

            If interested in learning more about Dr. Greger, visit my blog at DocNeighbors.org and enter the search term “Greger.”  You will also find a video summary of highlights from Dr. Greger’s book “How Not to Die” at DocNeighbors.org.  As many have discovered, Dr. Greger’s website, NutritionFacts.org, is the gold standard for information about nutrition in a format that’s science-based and easily understood.

            You may be thinking, didn’t philanthropist and Microsoft co-founder Bill Gates warn us about the likelihood of a pandemic?  As it happens, Bill Gates did offer a warning in a TedTalk titled “The next outbreak? We’re not ready” about five years ago on April 3, 2015.  Having been viewed millions of times, I’d say at least a few had been warned.

            Getting back to the news of the week, plans are being worked on to take the country out of quarantine.  The gradual nature of the plan is due to recognition of the many unknowns.  To ease the uncertainty of how reopening can be managed, far more testing for COVID-19 is needed.  Understanding what’s happening at the community level is the key part of dealing with this pandemic.  Importantly, we need to appreciate that we don’t know how far along we are in resolving the pandemic.  Ultimately, how the country is reopened will depend on balancing a wide range of interest.

            Epidemiologists tell us that COVID-19 can still spread exponentially until about 50% of the population has been infected.  While it’s nice to have a target to work toward, knowing how many have been infected is still a guess. For now, there is reason to believe that in even the hardest-hit communities, less than 14% have been infected.  In most communities, a range of 1% to 10% is more likely. By any of these estimates, we have quite a way to go before achieving herd immunity.

            Reports from around the world remind us that when quarantine restrictions are relaxed, the virus can spread quickly.  This tells us that no country has 50% of the population infected. Until more accurate and more extensive testing is available, our leaders have challenging decisions, and some may prove wrong in hindsight.  Thus far, no country has beaten COVID-19.  Countries that managed to flatten the curve early on now see the virus threatening to roar back.  Fortunately, there is some good news later in an analysis from Dr. Peter Attia.

            For now, it’s impossible to know when any region of the country will peak.  For the good quarantines have done, there is little verifiable data about how they have been implemented.  As a result, quarantines have further complicated analysis by epidemiologists.  This uncertainty underlies the cautious advice to State Governors for easing restrictions first for regions with low transmission of COVID-19.  Ideally, this process will lead to gradually building herd immunity without overrunning the capacity of hospitals.  One recent study predicts that intermittent social distancing may be required until 2022.  Perhaps facemask will become the next must-have fashion accessory.

            As part of exploring a path to normal, Suzzane Clark, President of The US Chamber of Commerce, interviews Dr. William Hanage, an infectious disease epidemiologist at Harvard’s Chan School of Public Health.  The interview is in the video, “A RoadMap to Reopening (43 min).”  For a quick read of the key points from the interview, the Competitiveness Enterprise Institute provides “A summary of the Roadmap to Reopening. (3 min read)”

            Again, I encourage you to watch the video “Pandemics – History and Prevention” by Dr. Greger. The story Dr. Greger shares is one we must not forget.  Be sure to pass it along.

            Nancy Neighbors, MD

Innate Immunity vs. Adaptive Immunity

            If unsure about the difference between innate immunity and adaptive immunity, you can learn the basics from the video, “5 Ways to Boost Your Innate Immunity and Lower Your Risk for Viral Infection.”   In the video Cyrus Khambatta, Ph.D. and  Robby Barbaro, MPH, two super nice people, both living with type 1 diabetes, explain what immunity is all about.  Robby and Cyrus are admirable guys that walk the talk when it comes to living a healthy lifestyle. 

            The message Cyrus and Robby share is for almost everyone, regardless of whether they have been diagnosed with diabetes or not.  Quite simply, the lifestyle that makes diabetes manageable and of minimal consequence is the same diet that improves almost every health condition.  If you happen to have a diagnosis of diabetes and need extra encouragement in adopting a healthier lifestyle, you may find the services offered through Mastering Diabetes worth considering.

Do You Know Where Viruses Come From?

            All human viral infections are believed to originate in animals.  To understand COVID-19 and other deadly viral outbreaks, it’s important to understand their history and evolution if we expect to prevent future pandemics. We have to take lessons from the past. For example, how did we successfully beat back SARS? Why is it more difficult with COVID-19? What do we have to do to slow the pandemic today before there is a vaccine?  These are topics Dr. Michael Greger recently covered in a four-hour webinar and summarized in a quick read titled “Takeaways from My Webinar on COVID-19.”

Have You Missed the Library?

            Quarantine doesn’t mean all is lost. The library continues to provide quite a few remotely accessible resources.  When certain restrictions have been lifted, the library will be offering curbside service.

Missing school field trips?  While you may not be able to travel right now, there are great virtual tours on the Internet. Here is what the library staff picked for you.

For kids, DOGOnews has fun articles on current events, science, sports, and more! There are lots of stories, pictures, videos, quizzes, and vocabulary games.  To access DOGO,click here.

While the library is temporarily closed for physical access, you can still access a remarkable number of resources through its website.

Perhaps there are a few places you can’t wait to get back to.  Matt Wake breaks down the 20 places many can’t wait to get back to (hint: the library is one!)

A Reality Check

            Pandemics like COVID-19 remind us how precious life is.  Interestingly, the greater threat that we face every day has not been declared a pandemic.  That threat is chronic diseases resulting from lifestyle choices. According to the CDC, 20% of the deaths in the US in 1990 were related to chronic disease. Today, that number has risen significantly. When COVID-19 passes, we must refocus our attention on the pandemic of dietary and lifestyle-related diseases. You may ask, why wait? Unless still looking for an excuse, there may be no good reason.

Thai Rice Salad Bowls

            This impressive rice salad recipe from Forks Over Knives is surprisingly easy to make and works with white or purple cabbage. A creamy-tangy dressing, featuring almond butter and lime juice, pulls everything together. Prep time 15 minutes. Ready in: 50 minutes.

This impressive and satisfying rice salad is surprisingly easy to make. Hands-on time is minimal, and it’s served in individual bowls with no chilling required. A creamy, tangy dressing pulls everything together. Click here for the recipe.

Free Plant-Based Cookbook

            The Physicians Committee for Responsible Medicine (PCRM) has an offer you can’t refuse.  To help you improve your immunity during the COVID-19 pandemic, they have a free plant-based whole food cookbook you can download.  To get your free copy click here.  If you aren’t familiar with PCRM, you may be familiar with Neal Barnard, MD, an advocate for plant-based whole foods.  Dr. Barnard’s books and articles have been the inspiration for numerous articles I’ve written over the years.  To learn more about PCRM and Dr. Barnard, visit DocNeighbors.org, and enter the search term “Barnard.”

The Pandemic – WHO Dunnit?

            COVID is here. A little strand of RNA that used to live in bats has found a new home in humans.  New York has been overrun with new cases.  Detroit, New Orleans, Miami, and Philadelphia await an inevitable surge of their own.  With the amazing technology that could have been brought to bear on the problem, how did COVID-19 get ahead of us? In an opinion piece Anish Koka, MD, offers an answer in “The COVID Pandemic –  WHO Dunnit?”  It’s far too early to write the full story. For now, consider Dr. Koka’s views the first draft of chapter one.

Need A Positive Perspective?

            Chef AJ has adapted to the quarantine by producing daily interviews with a wide range of people with views about healthy foods. These interviews include doctors, researchers, nutritionists, athletes, and others with a wide range of interesting perspectives.  Chef AJ’s positive perspective is refreshing.

Did We Over React
With Social Distancing?

(For Nerds Only)

            Dr. Peter Attia speculates that COVID-19 doesn’t look nearly as catastrophic as it seemed in mid-March. The numbers of new cases and new deaths seem to be plateauing and even declining (slightly) in hotspots such as New York City.  So now we are at a fork in the road. Do we continue the lockdowns in hard-hit parts of the country, to halt the further spread of the disease? Or do we begin to open up parts of the population (and economy), and inch back towards something resembling normal? For more about Dr. Attia’s perspective, read “COVID-19: What’s wrong with the models?

Coronavirus Immunity Challenge

            From the Seventh Day Adventist in Uchee Pines, Alabama, we are offered the Coronavirus Immunity Challenge. This is an opportunity to strengthen your immune system and be prepared for what the pandemic may bring. This free, 10-day event will run from April 26 to May 6. In this 10-day challenge, you will receive daily practical tips about habits that are important for strengthening your immune system. You will also receive a number of immunity-boosting recipes. And, there will be thoughtful reflections to make sense of the crisis we are passing through and gain hope for the future. The challenge is free. All you need to do is sign up at this link.

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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