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Germs Public Health

COVID-19 Update #9

By one recent estimate, over three billion people are currently under some type of lockdown and yet in some countries like Sweden, elementary schools, businesses, and restaurants are open. In Belarus, it’s business as usual with the President showing up at hockey games.  You might wonder, why such a difference in strategies?

Indeed, there continue to be significant disagreements over which approach can save the most lives and do the least economic damage.  Unfortunately, we are unlikely to have that answer for several years. At a time in the future, epidemiologists, economists, and others will pour over the data with conclusions offered.  While science may seem to work at a snail’s pace, it does work when given time.

In countries that have chosen lockdowns, governments are now facing a ‘jobs vs. deaths’ dilemma that would have perplexed Solomon.  Aside from what is ideal, the public is growing restless with a situation that paralyzes the economy and limits social mobility.

In response, most countries allowed the virus to spread widely and too late lined up behind one of two unproven strategies based on contradictory hypotheses.  In each case, the hope is that the human toll can be kept at acceptable levels while vital economic activity can be maintained.  After having spread, should the virus run wild or should it be controlled?

A third strategy based on eliminating the virus is being tried in Singapore, Taiwan, South Korea, Iceland, and New Zealand.  In this strategy, the presumption is that the virus can be eliminated by stopping importation at the borders, contact tracing, and stringent containment procedures.

In the United States, and most other countries the virus long ago escaped containment and can only be managed by social distancing and strategic lockdowns when the rate of infections gets out of control.

The dilemma with lockdowns is that they only slow a highly contagious virus from spreading until the lockdown is released.  In countries that minimized deaths early on by containment, flare-ups still occur each time social distancing is relaxed. It’s as if nature abhors a life that hasn’t been infected by COVID-19.  As a few countries have shown, this struggle with nature appears winable but ultimately takes an army of contact tracers to make it work. By one estimate, the United States would need 300,000+ people trained as contact tracers to make it work.  Of course, the infrastructure to support contact tracing would need to be perpetually in place, like a standing army.

In a sense what we are watching play out is the World Cup of Virus Control.  Each country has a strategy and each country hopes to demonstrate that its strategy can win.  In the agonizingly long race to the finals, there is a bit of good news.  The virus appears to be far less lethal (on average) than originally presumed. And, the extent of asymptomatic and mild infections may be far greater than previously estimated. The bad news is that if the virus later returns in a more virulent form there may yet be a playoff to determine the winner.

While we look with amazement at the early success of countries that succeeded in a containment strategy, it’s far too early to call their approach the ultimate winner.  For now, their attempts to delay herd immunity will continue to result in successive small waves of infections until a vaccine is available.  What remains to be seen is whether their early lead ultimately beats the herd immunity approach.  For now, absent long term data, no country has a certain answer. Quite possibly, without a vaccine, all paths lead to the same result.

By way of analogy, there is something about fighting a fire that attracts attention.  In contrast, the root cause of fires seldom gets more than a footnote.  While this may be the norm, any fireman will tell you that addressing the root cause is what saves the most lives and the most economic loss. Hopefully, this lesson hasn’t been lost when it comes to contagious diseases that have jumped from animals to humans.  For now, what should be an obvious root cause with an obvious solution is probably still a mystery to most following the 24/7 news cycle.

What a review of case histories has made clear is that those most at risk of poor outcomes suffer from classic lifestyle issues like high blood pressure, heart disease, diabetes, and excess weight. Absent these, lifestyle diseases, COVID-19 appears to rarely be worse than the seasonal flu. In other words, if you don’t have these lifestyle issues, your chances of having a bad outcome are pretty small. Contrary to what is often reported, being over 65 isn’t the important factor.  Overwhelmingly among the young, the key risk factor for being hospitalized is the lifestyle diseases previously mentioned. In other words, at any age, the best way to avoid a bad outcome from COVID-19 is a lifestyle that balances nutrition, exercise, sleep, stress, and social connections.

There is a reasonable expectation that COVID-19 or some mutation of COVID-19 will return next year or the year after. There is also a reasonable expectation that the seasonal flu will return in the fall and depending upon the strain that dominates the season may bring a very bad flu year.  And, with an increasing population demanding more animal meat, there is an expectation that more viruses will get transmitted from animals to the human population.

From this perspective, it’s clear that our health, our national security, and our financial well-being depend on having a strategy to weather these storms. And yet, the national debate about the correct course of action is devoid of any meaningful discussions that follow the science.

Before COVID-19, the national healthcare cost was exceeding $3 trillion a year. The total cost of COVID-19 is unknown but may ultimately exceed 10 trillion when all direct government costs and indirect economic costs are factored in.  That alone adds up to a cost of over $25,000 for every person in the United States.  How can our current lifestyle be sustainable if we repeat the mistakes of the past?

Oddly, in the face of these unsustainable costs, the national debate is still about hoped for testing, miracle medications, and vaccines.  Then, routinely the debate shifts to why someone else must be the problem.  The next virus may very well come from a factory farm in the United States.  While blaming a wet market in China is fair enough this time, the virus could have easily been of our making.  As a country, we may have ourselves to blame for the next virus.

To minimize the effects of diseases like COVID-19, seasonal flu, and future viruses America needs to follow the science and through public policy make a healthy diet the preferred diet. Rather than subsidize crops that make fast food cheap, we need to use farm subsidies to make healthy human foods less expensive. This is especially important for foods made available to schools and dependent populations. We also need to begin making lifestyle training part of every doctor’s education. Just as a house on a poorly built foundation can result in high maintenance costs, a person with a poor foundation in lifestyle can also be expensive to maintain.  Without a change in public policy, we are facing future costs that will be impossible to manage.

Finding miracle cures for a people in intensive care is a noble calling, Far better though to keep a person from being in intensive care in the first place.

            Nancy Neighbors, MD

Delayed Hugs

Celebrations during quarantine time take some creativity.  Indeed, for a while, many traditional gatherings will be put on hold, but that doesn’t mean the celebrations have to end. Many are making the best of the circumstances and figuring out creative ways to celebrate holidays and birthdays while still practicing social distancing.  Video calls with friends and drive-by birthdays have become part of the new rituals.  Celebrations across time zones that once seemed difficult to arrange are now happening more routinely with the aid of video meeting apps like FaceTime, Skype, Teams, WhatsApp, and Google Meet.

 Summer vacations present a new set of dilemmas.  Traveling abroad looks chancy given the possibility of quarantine at a foreign destination.  That makes domestic vacations that afford social distancing more attractive.  For this year at least, the United States economy could certainly use any travel dollars you are intent upon spending.  Our last summer family vacation provided the ideal social distancing at a time when social distancing wasn’t a concern.  If planning a family vacation this summer I would likely rent the same beach house again.  Alabama has an abundance of open spaces where a mask isn’t needed.  For this summer, I expect to spend more time with my flower garden and walking the local greenways.

For those that missed a graduation event, lost a job, or perhaps lost a friend to COVID-19 this may seem like a lost year. Still, there is some good that may come.  The national consciousness has been raised to appreciate how contagious and deadly the seasonal flu can be. Now there is a possibility that in a bad flu season people will know what it means to treat others as you would want to be treated.  Little things like getting vaccinated, staying at home if contagious, and wearing a mask if you must go out could become more common.  When the shopping list includes facemask alongside toothpaste, Band-Aids, and aspirin, we will have a safer world.

A Few Thoughts About Masks

A dangerous aspect of masks is the feeling they give that we are safe when in fact we have at best only reduced the possibility of infection.  Even with the best of intentions, few know how to properly don and doff a mask or perform safe hand hygiene. While masks may help reduce transmission, the important message must be that masks only lower the risk. Should you get out more just because you wear a mask then you have likely lost the protection you hoped to gain.

So when you go to the grocery store and the bagger keeps tugging on his mask and rubbing his nose with his purple gloves, and then proceeds to touch every item you are taking home, maybe the best you can do is laugh.  We can all do better and in time we will.  It’s a learning process for the country.

A few points about facemasks are worth keeping in mind.

  • Countries that mandated face masks seem to be benefiting.
  • Facemasks help prevent asymptomatic carriers and symptomatic patients from spreading droplets.
  • When two people both wear a mask and talk, contagion can be significantly reduced.
  • Facemasks can help people keep from touching their face – especially the nose and mouth.  They can also increase face touching if not comfortable.

What a Difference a Week Makes

As the virus that causes COVID-19 moves through the population, each new day the number that can be infected is reduced by the number that has recovered.  In New York, the virus went through much of the population like wildfire.  Now, the virus seeks new host, just more slowly since there are fewer people left to infect. As shown in the table below, Alabama had a 25 times lower death rate than New Your on 4/25/2020 but only a 21 times lower death rate a week later.  This is an expected trend since a higher percentage of people in Alabama have yet to be infected.

StateDeaths/Million 4/25/2020Deaths/Million 5/3/2020
Alaska1212
Arkansas1627
Texas2333
Tennessee2733
Alabama4461
Florida5168
Georgia88121
Michigan329415
Connecticut520714
New Jersey660895
New York1,1171271
From Worldometer

While Alabama looks pretty good compared with the Northeastern states, we are on a path where we may eventually catch up with them when the virus has had its full run.

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.

CountryDeaths/Million 4/25/2020Deaths/Million 5/3/2020
Taiwan0.30.3
China33
S. Korea55
Germany7083
USA166211
Sweden217274
UK305423
France350386
Italy441481
Spain496544
Belgium612684
From Worldometer

                               

While services like Worldometer probably report data accurately, the reliability of the data sources remains questionable.  For example, data from China may change significantly when verifiable data is available.

Brain Food

If downloadable audio programs haven’t been part of your life, you may be missing out on some of the best brain food available.  In a recent development that recognized how far podcasting has come, a first-ever Pulitzer was awarded for a podcast.

            While the following three podcasts missed getting a Pulitzer, they do provide quite a few helpful ideas about how to have a healthy brain and get the most from it.

The first talk is, “The End of Mental Illness” (42.40 min) by Daniel Amen, MD. In this talk Dr. Amen presents ideas for improving your mood, sharpening your mind, and preventing dementia.  Dr. Amen is a psychiatrist and twelve-time New York Times best-selling author.

            The second talk is “The Alzheimer’s Solution” (53.33 min) by Dean and Ayesha Sherzai, MD.  From their talk, you will learn about simple food and lifestyle choices that can reduce your risk of Alzheimer’s by 90% or more. As neurologists and brain science researchers, Drs. Dean and Ayesha Sherzai believe that brain health starts at home. As directors of the Alzheimer’s Prevention Program and the Healthy Minds Initiative, the largest community-based Brain Vitality research programs in the country, the Sherzais help their patients and many communities adopt brain-protective programs.

The third talk is “The Best Foods to Boost Your Brain” (48.31 min) by David Perlmutter, MD. In this talk, you will learn how your everyday choices can help you cultivate a clear mind and lasting happiness.  Dr. David Perlmutter is a board-certified neurologist and five-time New York Times best-selling author.

            To hear these talks as YouTube audio click here.  If new to the world of downloadable audio programs, be aware that streaming audio can use hundreds of megabytes from your cell phone data plan.  To avoid this issue, download the file to your personal computer and then transfer the file to your cell phone.  Here is one way to do it.

  • First, copy the embedded hyperlink in the above link (it would be https://youtu.be/SiUrbV_13jc). 
  • Next, use a file downloader program like ‘WinX YouTubeDownloader’ to download the full audio program to your personal computer.
  • Then transfer the downloaded file to your cell phone.

A Personal Story

On the morning of August 12, 2012, Aaron Calder woke up feeling physically sick. He had been feeling ill every day for over a year. But that morning when he threw up, there was blood.  In time he discovered that transitioning to a plant-based diet was the most important part of his recovery.  Within months he was getting comments about his weight loss and how much better he looked.  For more about Aaron’s story click here.

Has America’s Junk Food Diet
Made Us More Vulnerable

The typical American eats too much, drinks too much, snacks too much, sits too much –  then tries to make amends by relying on the marvels of modern medicine to repair their battered bodies.  Unfortunately, these behaviors have made many Americans prey for the latest coronavirus.  The unfortunate truth is that we don’t really have a serious COVID-19 problem so much as we have a problem with preventable chronic illnesses.  For the full story, click here.

Bean Stew / Frijolada

The Frijolada is a stew of beans usually served with beef or pork. It is commonly prepared in many Latin American and Caribbean countries and the recipe differs slightly from one country to another. The naked version of this dish is absolutely scrumptious and includes plantain for a touch of both tradition and flavor in one delicious tropical meal. Click here for the recipe.

Gourmet Eggplant Rollatini

Traditional eggplant rollatini is stuffed with two or more cheeses and topped with even more cheese—a fat- and cholesterol-laden nightmare. This Naked version uses a mashed potato mixture instead, with nutritional yeast imparting the desired “cheesy” flavor. 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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