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COVID-19 Update #8

When the potential effects of the COVID-19 pandemic became widely understood, a near worldwide decision was made to “flatten the curve” as a strategy for keeping the health care systems from being overwhelmed.  Although the total number of infections was expected to ultimately be the same either way, the health care system could hopefully meet the demand with the most vulnerable having an opportunity for care.

If the curve is now flattening then pushing on to create herd immunity at a safe pace should be the next step.  Unfortunately, there remains some uncertainty about how to relax social distancing and along the way the situation became a political wedge issue.  Complicating matters, the course of action chosen by a physician, an epidemiologist, an economist, a person out of work, and a politician would all be different.

Having gained some experience with COVID-19 in the United States, there is a growing belief that we can handle the remaining surges by gradually relaxing social distancing requirements.  Even the hardest-hit areas like the New York City metropolitan area seems to have weathered the storm.  Curiously, in well-managed areas of the country, there remains considerable disagreement about how to move forward.  Some are upset with Georgia for relaxing social distancing restrictions and California for not relaxing restrictions.

You may wonder why Alabama, along with many other regions of the country, has had far fewer COVID-19 infections than expected.  From the table below, it’s clear that the outcome has varied quite a bit from state to state.  For the date shown on the table below, Alabama had achieved an almost 25 times lower death rate than New York.  In contrast, Alaska’s death rate was about one-fourth of the rate in Alabama.

StateTotal DeathsDeaths/Million
Alaska912
Arkansas4816
Texas64123
Tennessee17827
Alabama21344
Florida1,05551
Georgia90788
Michigan3,274329
Connecticut1,862520
New Jersey5,863660
New York21,9081,117

From Worldometer 4/25/2020

Interestingly, states that have done as well as Alabama in flattening the curve may have reduced all-cause mortality below what it would have been without COVID-19.  With fewer people driving, there have been fewer auto accidents.  With social distancing, there are fewer flu infections, etc. On the other hand, deferred routine health care could soon result in more deaths than COVID-19.

It’s likely that between the reduced deaths from traffic accidents, reduced deaths from seasonal flu, and a few other social distancing related factors that Alabama has gained a net positive if you discount damage to the economy.

There are several theories for why Alabama has controlled the virus better than other states.  The most likely explanation is the relatively low density per square mile of people in Alabama compared with a state like New York.  Other possible reasons for why we have been spared (so far) are offered in an article that describes three reasons why the COVID-19 curve seems to be plateauing.

On a country by country basis, the differences in how the curve was flattened are remarkable. Most notably, both Taiwan and South Korea have had wakeup calls from viral pandemics in recent years, learned important lessons, and responded extremely well.

Few countries were prepared.  As shown in the column titled “Deaths/Million”, the United States has done remarkably well compared with countries that had not experienced unusual viral epidemics in the last few decades.  More about what went wrong in many of the unprepared western countries is explained in the article, “COVID-19: the Italian Drama – Four avoidable risk factors” by Ernesto Burgio.

CountryTotal DeathsDeaths/Million
Taiwan60.3
China4,6323
S. Korea2425
Germany5,88470
USA54,941166
Sweden2,194217
UK20,732305
France22,856350
Italy26,664441
Spain23,190496
Belgium7,094612

                                From Worldometer 4/25/2020

Until we change our relationship with animals, current events may only be a wakeup call for what could be a recurring event.  Viruses easily mutate and like the flu have the potential to revisit in succeeding years in more virulent forms.  Next time around will we be prepared like Taiwan and South Korea or again drive our economy to a standstill because it’s the only option available?  As we have been reminded, unless prepared, most last-minute choices have a very high cost.

In our current dilemma, we have switched resources away from many other serious illnesses to take on the problems of COVID-19. If this continues, there is little doubt that cancer mortality will increase along with the possibility of even more worrisome diseases that can kill millions if worldwide vaccination rates decrease.  Hopefully, we are nearing the end of the current pandemic and our country will implement solutions based on the lessons learned.

If unsure about the most important lessons learned, my fellow ACLM member Dr. David Katz sums it up in a short video.  You will find a link to his video at the end of the section titled “A Reality Check.”

            Nancy Neighbors, MD

A Thought About Epidemics

            Epidemics are not new phenomena.  They only seem less frequent until they strike close to home.  For a list of major epidemics since 1200 BC click here.

            Before the middle of the last century, diseases like whooping cough, polio, measles, Haemophilus influenza, and rubella struck hundreds of thousands of infants, children, and adults in the U.S. Thousands died every year from them. As vaccines were developed and became widely used, rates of these diseases declined until today most of them are nearly gone from our country.  For more about the importance of vaccines click here.

Alabama Tiptoes Back toward Normal

            Alabama Gov. Kay Ivey announced that she will allow retailers, some businesses and state beaches to reopen on Thursday.

            In view of the low but still increasing number of COVID-19 cases,  Ivey said she will not extend the stay-at-home order but will issue a new “safer at home” order that encourages, but doesn’t require, people to stay home.

            Businesses may reopen if they follow sanitation and social-distancing guidelines.  However, higher-risk businesses will have restrictions. Gyms, theaters, bowling alleys, night clubs, will remain closed. Retail stores will be able to open at a 50 percent occupancy rate.  Restaurants, bars, and breweries will remain limited to take-out, curbside, or delivery.

            Beaches will reopen, but gatherings of more than 10 people or more are banned and people must stay at least six feet apart.  There is more information in the official order from the State health officer.

            Our State leaders seem to have concluded that the cure was getting worse than the disease.  Before judging their actions, be sure to read the following section titled “A Reality Check.”

            What hasn’t changed is the need for everyone to keep social distancing, wearing a mask, and handwashing until we are clearly in the safe zone.

            Now that we have our marching orders, let’s see if we can make it work.  Imagine the reward – The NY Times and the Washington Post having to report Alabama is #1.

            For an update on how Alabama is doing over the next few weeks, check with the Alabama Coronavirus Data and Mapping Dashboard for an overview of the situation.

            For now, COVID-19 testing remains limited and doesn’t provide a comfortable estimate of how far the virus has spread.  Each week, testing expands and each week we expect the estimates to get better.  In a situation like this, an alternative method for estimating how far the virus has spread is to poll large numbers of physicians.  While no one physician could know how far the virus has spread, the average opinion may be the best barometer for now. Below is the opinion of physicians about whether their country has reached the point of peak infections.  Unfortunately, this poll did not provide estimates for individual states.

CountryReached Peak
Mexico3%
Russia15%
Canada24%
Great Britain28%
USA37%
Germany41%
France68%
Italy85%
Spain86%
China94%
Japan96%

How to Protect Your Immune System

The COVID-19 pandemic has made it clear that we need to keep ourselves in the best health possible.  This reminder is not all bad news.  For the 85% of people that have been ignoring their health, this can be a welcomed wakeup call given that thousands of medical studies tell us that a change in lifestyle can improve our health.  From cancer to heart disease, and from type 2 diabetes to Alzheimer’s, the key to prevention is lifestyle, and most importantly the food on our plate.  The good news is that the same foods that help defend us against COVID-19 are the same foods that boost our immunity to diseases and contribute to a longer healthspan.  If unsure how you can make the right changes, the following three interviews with leading experts should give you plenty to work with. Click here to begin the three presentations described below.

  • “Health and Love in the Time of COVID-19” by Matt McCarthy, MD  (53.58 min) You’ll hear from one of the world’s top infectious disease specialists on how you can take action to support your health and safety while caring for your loved ones and our world.
  • “Food, Health, and the Coronavirus” by Michael Klaper, MD  (53.23 min) A global pandemic raises many questions, including how much do healthy food choices really matter? You’ll discover which foods optimize immune function, and which ones increase the risk factors associated with viral infections like COVID-19.
  • ‘It All Starts in Your Gut” by Zach Bush, MD (48.32 min) You’ll learn about how your food, lifestyle, and environment shape your brain, mood, immune system, and life expectancy.

The Silver Lining

If living in quarantine you may feel like the days are running together.  In case you’ve lost track, today is Blursday.  It’s not quite that disorienting in my world – yet.  With fewer patients to see in the office, I often get away by 5:30 pm.  With the days getting longer, I’ve found time in the late afternoon to clean out the flower garden and even spend some time in the backyard helping along the parsley, radishes, and lettuce.  With luck, in a few months, there will be tomatoes, cucumbers, and more.

Like many of you, I’m getting more accustomed to virtual work, church, conferences, birthdays, school, etc.  While it gets us by, virtual is no substitute for actual community and seeing people in person.  Some predict this experience will change the way we interact in the future.  I’m hoping they are wrong.

            While I am still enjoying the “silver lining” of time at home in the afternoons, I know this comes at a high price to many with illness, lost jobs, and uncertainty about their future.  This has been a sobering reminder that having the best health possible is what carries us on to a better day.

            If in doubt about why we have foregone our usual habits in favor of social distancing, this animated story explains the gift of distancing.

Why Protecting Ourselves Begins
With Protecting the Planet

In this time of social distancing and global lockdown,  it may feel like there’s very little we can do. However, in this seven-minute snippet of Dr. Stoll’s hour-long lecture titled “The Power of the Plate“, he shares just how powerful the choice of what we put on our plates each day can be to impact not just our human health, but also the health of the planet.

Will Antibody Tests For COVID-19
Change Everything?

As with most new technologies, there are signs that the promises of COVID-19 antibody tests have been oversold, and their challenges underestimated. Kits have flooded the market, but most aren’t accurate enough to confirm whether an individual has been exposed to the virus.  And even if tests are reliable, they can’t indicate whether someone is immune to reinfection.  Antibody tests are being used by researchers to estimate the extent of infections at a population level, which could be quite valuable.  Read more in “Will Antibody Tests For the Coronavirus Really Change Everything?

The Next Global Pandemic?

COVID-19 came to us by way of a virus that jumped from animals to humans.  Many believe this happened like SARS before it in one of China’s wet markets. Unsurprisingly, many people are furious that the markets, which were closed in the immediate wake of the outbreak in China, are already reopening.

It’s easy to point the finger at these foreign places and blame them for generating pandemics. But doing that ignores a crucial fact: The way people eat all around the world – including in the US continues to be a major risk factor for future pandemics.  In essence, if you want to create global pandemics, then build factory farms. For more of the story, read, “The meat we eat is a pandemic risk.

What’s Your Lentil IQ

If there’s one dried legume you should always have on hand, it’s no-soak, quick-cooking lentils. From a practical standpoint, the big difference between lentils and dried beans is that lentils don’t need to be soaked in water before they’re cooked. They also cook in a fraction of the time it takes to prepare a pot of beans.  For a quick overview of which type to use  read “ What Are Lentils – How Are They Different from Beans?

Visiting Parks and Recreational Facilities
Know Before You Go

Staying physically active is one of the best ways to keep your mind and body healthy. In many areas, people can visit parks, trails, and open spaces as a way to relieve stress, get some fresh air and vitamin Although the rules have changed there are still many wonderful opportunities when visiting parks and recreational facilities.  For tips on how to protect yourself and others from COVID-19 read “Visiting Parks and Recreational Facilities.”

A Reality Check

COVID-19 is not the only danger waiting out there, and for most of us, it is far from the gravest. Here, for instance, are the most recent annual mortality statistics for the United States from the National Center for Health Statistics at the CDC.

  • Heart disease: 647,457
  • Cancer: 599,108
  • Accidents: 169,936
  • Chronic lower respiratory diseases: 160,201
  • Stroke:146,383
  • Alzheimer’s: 121,404
  • Diabetes: 83,564
  • Influenza and pneumonia: 55,672
  • Nephritis: 50,633
  • Intentional self-harm: 47,173

            Every death counts. But as the diverse causes above imply, rapt fixation on any one cause compounds the actual peril with the danger of massive distortion. Read more in the article “Coronavirus Mortality Reality Check” by David L. Katz, MD.  If you prefer to watch a video rather than read the article, fellow ACLM member, Dr. Katz, joins Bill Maher to discuss whether the fight against COVID-19 is worse than the disease.  The video is “Dr. David Katz in Real Time with Bill Maher” (15 min).  Unfortunately, the perspective Dr. Katz shares is one the public failed to appreciate in the midst of a politically charged election year.

Trusted COVID-19 Resources

COVID-19 is impacting each of us differently. Fortunately, when we need answers, the library provides an easy way to get reliable and up-to-date information.  To read the Library’s initial post regarding information about COVID-19, please click here.

Often it’s difficult to find a well-rounded view of a subject. A good way to do this is to find your subject on websites like Allsides and TheThreadWeekly.

Potato-Onion Pizza

This Italian delight is surprisingly easy to assemble. The whole wheat dough takes only 20 minutes to make, and white beans mashed with subtly sweet roasted garlic hold the topping in place. Potato pizza is an authentic Italian delight. Click here for the recipe.

Recipes for Ripe and Overripe Bananas

Got a ripe banana or two sitting around? You’re in luck. Ripe and overripe bananas are a superhero of whole-food, plant-based baking, keeping things moist while adding flavor and natural sweetness. This collection of 22 vegan recipes include banana bread, muffins, pancakes, brownies, carrot cake, oatmeal, French toast, a smoothie bowl, and six banana ice cream recipes, (aptly named “nice cream”). Go bananas with ripe bananas! Click here for the recipes.

Roasted Sweet Potato Wedges

The trick to making great roasted sweet potatoes without oil is to steam them before you put them in the oven. This precooking step makes the wedges tender, not chewy. 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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