AS CORONAVIRUS cases continued to spike in some 20 states, infectious disease specialist Dr. Anthony Fauci said last week, “We’re still in a first wave.” For people continuing to search for the ways to protect themselves, the answers remain the same: Wear a mask, wash hands and nearby surfaces and keep a physical distance—preferably outdoors.
For specific advice, a survey asking epidemiologists about personal safety choices was one of four most-read New York Times stories in the week that ended June 14 —despite many flaws, such as the participation of just over 500 among the more than 6,000 epidemiologists invited, leaving room for self-selection bias in the conclusions.
Among those epidemiologists who declined to participate, some criticized the survey design use of multiple-choice questions to select the amount of wait time before beginning each activity: “this summer,” “3 to 12 months,” “one year-plus” or “never again.” Others faulted the presentation of results, which lumped responses together without accounting for different experiences, notably those dependent on geographic location.
While some survey questions received fewer than 300 responses, the one addressing travel by airplane received 512, with the largest group, 44%, opting to wait 3 to 12 months, and the next largest, 37%, longer than a year.
Many physicians contend that HEPA (high-efficiency particulate) air filters on airplanes offer more than adequate protection. On the other hand, “passengers can still breathe in tiny floating droplets from a coughing passenger seated nearby—before the air carrying those droplets can be vented out of the cabin and filtered,” according to the Washington Post.
In 2003, during the outbreak of Severe Acute Respiratory Syndrome (SARS) caused by another coronavirus, 22 of the passengers who traveled with a feverish man —who later died of atypical pneumonia—subsequently received a diagnosis of SARS, including two who sat seven rows in front of him.
Other survey questions that both received more than 500 responses, with the majority of responses falling into the category of waiting 3 to 12 months, included eating at a dine-in restaurant, 56%; attending a small dinner party, 46%; and hiking or picnicking outdoors with friends, 41%.
Finally, responses with majority percentages falling into the category of more than one year included “attending a sporting event, concert or play,” 64% (489 responses); “stop routinely wearing a face covering,” 52% (513); and “attending a wedding or funeral, 42% (501).”
Public restrooms are one issue that didn’t show up in the NYT survey. According to the Boston Globe, however, “nearly every person the Globe spoke to thought he or she was alone in their ‘bathroom obsession, but in fact nearly half of people informally surveyed by the American Restroom Association, at the Globe’s request, said they are limiting trips” due to coronavirus concerns.
In response to these concerns, restaurants like McDonalds require sanitizing restrooms at least every 30 minutes; and restrooms at highway rest stops are reportedly extremely clean. But while the general advice about toilets includes putting the top down while flushing to keep aerosolized particles inside, public toilets rarely have tops, making the mask-on strategy especially important for using these.
UV-C ultraviolet light may offer additional cleaning possibilities for public places, and newer devices on the market tout protection for personal devices like phones and more. But UV-C has not yet proved to kill this coronavirus. Other drawbacks include the failure of UV-C light to work on rough surfaces or get into nooks and crannies—for example, on buttons or cell phone cases, explains New York University pathology professor Philip Tierno.
In addition, for UV-C to kill microorganisms, surfaces must be free of dust, skin cells and skin oils. Finally, because UV-C rays do not produce heat or bright light, people might fail to take the precautions needed to protect eyes from damage and skin from burns.
Another counter measure in use without sufficient caution: cleansers and disinfectants. Calls to poison centers concerning exposure to cleaning products and disinfectants increased more than 20% from January, just before Covid-19 began to spread, through March—compared with the same period last year.
People reported washing vegetables and fruit with bleach, misting their bodies with disinfectant spray and gargling with cleaning products. Used correctly, however, these products help prevent the spread of aerosolized particles, which may remain on surfaces for days—although respiratory droplets are the much more common mode of virus transmission, for which the best protection is wearing masks.
A new reason to worry about aerosol particles while they remain airborne is the possibility that these “could enable the virus to penetrate deeper into the lungs and trigger a more severe infection,” according to microbiologist Raymond Tellier at McGill University.
Despite intense focus on the virus itself—modes of transmission, mutations and dosages—the most critical factor is the person getting infected, the “host,” according to the Post. National Institutes of Health Director Francis Collins suggested that some people’s immune systems might be better able to protect against this new invader because of previous exposure to genetically related coronaviruses.
Investigations into whether increasing vitamin D—via supplements or sunshine exposure—might help protect against the coronavirus led to the conclusion that “people with lower vitamin D have a higher risk of Covid infection, but it looks like this is explained by other risk factors and not by the vitamin itself,” according to Claire Hastie, public health researcher at the University of Glasgow.
That said, daily vitamin D intake via food or supplements should be around 800 I.U. for those 71 and older, and 600 for those younger—and adding 1,000 to 2,000 I.U each day via supplements could help avoid a deficiency, says Harvard Medical School professor and preventive medicine specialist JoAnn Manson. Manson cautioned against taking higher doses.
Another suggestion is that an individual’s genetic susceptibility could create greater risk for inflammation or the other problems associated with severe Covid-19. In one study, patients with Type A blood had a 50% higher risk of needing a ventilator—possibly because Type A blood is associated with small blood clots, found in many of the most serious cases. Type O blood seemed to have a partial protective effect. When genetic links are clearer, a blood test early in the course of the disease could help determine which patients are most vulnerable.
What is better known is the higher risk of severity among those over 60 due to immunosenescence, the diminishing of immune response with age; those with preexisting conditions of diabetes and hypertension; and those considered obese. In the NYU Langone hospital system, obesity was the number one risk factor in those under 60, according to hospital epidemiologist Jennifer Lighter.
Based on age, gender and pre-existing conditions, the United Kingdom has created two categories of risk for reopening, with those at low risk advised to social distance and those at higher risk, to “shield:” stay inside as much as possible and avoid contact with others.
Among those looking at risk groups in the U.S., Lighter points to the clear advantages of being young and healthy: among 238 sailors aboard the aircraft carrier USS Theodore Roosevelt who tested positive for the virus after an outbreak on the ship, only two required hospitalization, according to the CDC. And one out of 5 reported no symptoms at all.
For everyone else, the advice is to stay healthy and fit, says Carl Heneghan, director of the Center for Evidence-Based Medicine at Oxford University. “If you’ve got diabetes, you’ve got to lose weight and moderate that. If you do all those things, your risk of dying is small, or very small.”
—Mary Carpenter
Well-Being Editor Mary Carpenter continues to update us on Covid-19. To read more of her posts, click here.
DO YOU have immediate family members who have lived unusually long lives? The current consensus traces about 25% of the variation in human longevity to genetic factors. And genetics appears to play a progressively important role in maintaining the “healthspan,” or ongoing good health, of individuals as they age into their 80s and beyond, according to researchers at the University of Calabria in Italy.
Studies of supercentenarians (ages 110+) and semi-supercentenarians (ages 105-109), however, also found that many don’t smoke, don’t drink much alcohol, are not obese and cope well with stress, according to Genetics Home Reference. And most are women — notably in locations with famously long-lived populations, including Okinawa (Japan) and Ikaria (Greece) — as well as Sardinia, though, exceptionally, centenarians there include a significant proportion of men.
Age-related diseases—high blood pressure, heart disease, cancer, type 2 diabetes— are less likely in people with centenarian parents, and if the diseases do appear, they occur later than in the general population. So-called longevity genes include variants associated with these age-related diseases, for example the APOE gene variants linked to greater risk of Alzheimer’s disease.
Among genetic variants, or alleles, associated with a “very long life,” for example, is the variant of the ABO gene that determines an individual’s blood will be type O —which is linked to lower risk of coronary heart disease and cancer as well as lower cholesterol levels. A variant in another gene, CDKN2B, plays a role in the cessation of cell division, called senescence, which is thought to contribute to aging.
In a study of more than 75,000 United Kingdom Biobank participants, the offspring of longer-lived parents had more of the protective alleles known to have prominent roles in cardiovascular-related pathways—specifically affecting coronary artery disease, systolic blood pressure, body mass index, cholesterol and triglyceride levels, type-1 diabetes, inflammatory bowel disease and Alzheimer’s disease.
But the single gene, most often called the longevity gene, is sirtuin 6 or SIRT6, which is responsible for repairing DNA. DNA is increasingly prone to breaks with age, which leads to gene rearrangements and mutations that are hallmarks of cancer and aging.
Among 18 rodent species, the SIRT6 gene was more prominent— and DNA repair more efficient—in beavers, which have a lifespan of about 32 years, than in mice, with a lifespan of about three years. Other cellular functions affected by genes include maintenance of regions at the ends of chromosomes, called telomeres, and protection of cells from damage caused by unstable oxygen-containing molecules, known as free radicals.
People with centenarian parents are less likely at age 70 to have age-related diseases common among older adults, according to Genetics Home Reference. On the other hand, during the first seven or eight decades, lifestyle—eating well, not drinking much, avoiding tobacco, staying physically active—is a stronger determinant of health and life span than genetics.
In locations with long-lived populations, one variable that stands out is the “ipoproteic” or low-protein diet, such as the Mediterranean diet: lots of vegetables and beans. Diet may interact with genes, creating more efficient metabolism of nutrients that not only modulates lifespan but also produces epigenetic modifications, according to the Calabrian researchers.
Dietary-restricted mice, which live longer and show a very delayed aging phenotype compared to mice fed ad libitum —eating what they want —have different expression patterns for genes related to DNA repair that is correlated with life extension.
In Sardinia, where the proportion of male centenarians is about equal to that of women, some research has linked the shorter height of men with greater longevity —although only an average of two years longer. Sardinians in general are shorter than Europeans elsewhere; and, in a study comparing local municipalities, as the average height of men declined, their longevity increased.
On the other hand, for everyone in Sardinia— one of five “blue zones,” with the world’s highest proportions of centenarians—the likelihood of living to be 100 years old is about 10-fold higher than for Americans, according to cardiologist James O’Keefe. Attributing their longevity, not to genes, but to lifestyle, O’Keefe gives credit to more exercise on the hilly terrain, but mostly to lower stress; more time spent with friends, for both men and women; and the willingness of both sexes to talk about stress when it occurs.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
MONTHS OF the coronavirus pandemic have produced valuable information on its modes of transmission and the range of effects on its victims. As localities begin to open up, knowing how to protect yourself and others becomes ever more crucial.
The SARS-CoV-2 virus has three modes of transmission. One is the familiar respiratory droplets, which can carry virus particles or virions about six feet from an infected person but fall quickly to the ground.
Also familiar is transmission via fomites, contaminated surfaces that act as vehicles for the virus. On one cruise ship, forks and knives may have played a major role—with viability lasting up to three days on stainless steel and plastic and about 24 hours on cardboard.
The third mode is aerosols, tiny virion-containing drops that can travel for miles and remain airborne for hours. “Even the smallest breeze will do something,” University of Amsterdam physicist Daniel Bonn told the New York Times.
Aerosols float on air currents—at least as far as barbecue or cigarette smoke, according to Kimberly Prather, aerosol researcher at UC San Diego. Aerosols “can remain infectious in indoor air for hours and be easily inhaled deeply into the lungs.”
Washing hands with soap is the best defense against virus particles picked up from fomites. In all soap—bar or gel—the combination of a fat or oil and an alkali, such as lye, destroys the coronavirus’s lipid membrane, containing the proteins it needs to infect the body. Twenty seconds is the critical amount of time it takes for lathered-up soap to inactivate the virus. (Avoid products that say “soap-free.”)
Masks are the best protection against both droplets and aerosols, Prather contends, noting the success of Asian countries in halting spread of the coronavirus. Taiwan, for example, has had only a few hundred cases and only seven deaths despite never implementing a national lockdown. On average, Asian countries—where people, and especially those who are sick, more commonly wear masks—have counted fewer than 10 deaths per million inhabitants compared with 300 in the US and more than 500 in Britain, Italy and Spain.
Although “silent spreaders,” or asymptomatic carriers, have infected up to 50% of cases, the highest risk occurs when a gathering includes one “superspreader.” Researchers are still investigating what makes some people so infectious.
Dose is the key and depends on three variables: proximity to the infected person, air flow and timing. And the higher the dose for any one person, the more severe the symptoms and the more likely they are to spread infection.
Enclosed spaces with lots of people are the riskiest. Many believe the reason European countries have not seen a spike in cases with their gradual relaxation of restrictions is that, with warmer weather, most large gatherings take place in open outdoor spaces—and most people wear masks.
Besides its transmission modes, SARS-CoV-2 requires many fewer virions than most viruses to establish infection in humans—hundreds of particles compared with thousands for the virulent MERS. And, according to one theory, SARS-CoV-2, unlike most flu viruses, penetrates deep into the lungs, which are designed to move gases in and out of the bloodstream, enabling the virus to make a similar journey.
The complicating factor of the ACE2 (angiotensin-converting enzyme 2) receptor: It not only provides a route for the virus into cells, but it can also modulate some of the damage that takes place, according to the New York Times.
For each of the body’s organs, the number of cells with the potential for “ACE-2 expression” affects the likelihood of that organ becoming a reservoir for infection: from 83% of cells in the lungs to 7.5% in the heart and 4% in the kidneys.
“Master of disguise,” one of this virus’s nicknames, refers to the wide variety of symptoms that can appear at different times with different severity—with the added uncertainty of which symptoms are caused by the virus and which by the inflammation created when the body’s immune system overreacts.
For severity of infection, with hydroxychloroquine showing no improved protection to date, researchers are looking elsewhere, for example, to vitamin D, which plays a role in the body’s immune response. Higher levels of vitamin D—which can both bolster the immune system and restrain it from dangerous overreactions—have in some studies led both to better, but also worse, outcomes for Covid-19.
Of every 10 people infected by the virus, about 35% will have no symptoms, and among the rest, symptoms will be mild for about 80%. Although people over 80 are at greatest risk of death from the virus, the presence of other health conditions, or co-morbidities, increases this risk but may vary among different populations.
For heart disease, the risk may be around 9% higher, with diabetes at 7.3% and hypertension at 6.0%. With high blood pressure, which affects almost half of older Americans, abnormalities in blood vessels can impair the ability of oxygen to reach the organs.
In more than 80% of infected individuals, Covid-19 begins with a temperature and a cough; most have a low white blood cell count and nearly all have pneumonia. But infection can also begin with a skin rash that looks like hives or bumps around the toes and heels. And loss of smell and taste occurs in about one-fourth of sufferers.
Infection can also appear first with intestinal problems, possibly a result of the virus traveling directly to the stomach in swallowed saliva. And although stomach acids would normally kill microbes entering the gut, heartburn medications that neutralize the acidic environment might make it more vulnerable to the virus.
For the kidney, degree of injury correlates with worsening respiratory symptoms—either due directly to viral infection or to the inflammatory cytokine storm that causes blood vessels to leak, reducing blood flow and thus oxygen transport to the organs. Blood clots are another serious risk, notably those that lead to stroke, with autopsies of Covid-19 patients showing evidence of small clots in many organs.
Anyone beginning to feel cavalier about SARS-CoV-2 should remember, not just the suffering of older victims, but also the thousands of young sufferers with no co-morbidities but debilitating symptoms that can last months, so called “long-haulers.” DC elementary school teacher Chloe Kaplan, for example, who is in her 30s, with a young child, recently marked Day 78.
—Mary Carpenter
Well-Being Editor Mary Carpenter continues to provide coronavirus updates. To read more of her posts, click here.
THE CORONA VIRUS pandemic has been devastating for so many people, because of the virus itself, job loss, hunger and fears about future survival. For anyone able to carry on a semblance of normal work and life from home, the difficulties can be less serious but still challenging.
Zoom— and other face-to-face online meeting options—create problems worth paying attention to as more activities connected with work but also with doctors’ visits, pain management and real estate are expected to go online in the future.
Group zooms create an experience that London-based designer P.L. compares to an AA meeting: everyone else has to maintain a carefully nonjudgmental expression as each person takes their turn.
Even for a party zoom, the full attention of all participants—with each face filling its gallery-view box—makes each person feel as if their turn to weigh in demands more thought, planning and even formal delivery than an in-person group. The result can be Zoom fatigue.
Being on a video call makes our brains work harder to process nonverbal cues like facial expressions and the tone and pitch of the voice, Gianpiero Petriglieri, associate professor at the international business school INSEAD, told the BBC. “Our minds are together when our bodies feel we’re not”— causing dissonance, which is exhausting.
Knowing that you are on camera makes you feel social pressure to perform, and “being performative is nerve-wracking,” says Petriglieri. Also, silences on video calls make people uncomfortable: studies have found that video silences negatively affect others’ view of the speaker.
When prolonged eye contact is the strongest facial cue readily available, “it can feel threatening or overly intimate if held too long.” writes Julia Sklar on National Geographic.
Sklar compares the continuous partial attention on lots of faces required with Zoom to trying to cook and read at the same time. By challenging “the brain’s central vision, forcing it to decode so many people at once…no one comes through meaningfully, not even the speaker.”
In contrast to phone conversations that deliver on a small promise of conveying only a voice, Zoom can overwhelm the brain with “unfamiliar excess stimuli while searching for non-verbal cues it can’t find” — which can be frustrating and lead to Zoom gloom.
New York analyst Cynthia Chalker told The New Yorker she compares doing Zoom therapy to “interviewing kidnap victims or hostages…there’s something about seeing anxiety not in person that’s very strong and moving.”
When connectivity issues cause the video to move jerkily or the audio to break apart into incomprehensible noise, people must make additional efforts to piece together what they are hearing and seeing. Weak internet signals can produce cybersickness, most commonly among virtual reality users.
“With motion sickness you feel ill because you feel movement in your muscles and your inner ear but don’t see it,” according to Lumes, makers of blue-light blocking lenses for computer users. “With digital sickness it’s the opposite. You see movement on the screen but you don’t feel it.”
Once motion sickness sets in, it can last hours, can be both distracting and unpleasant, and can make doing anything else online more difficult. “Videos, animated graphics or even just scrolling through your Instagram feed can all contribute to the effect…can be especially disorientating for people who are already prone to motion sickness,” writes Lumes. Some 50 to 80% of people are affected by nausea from computer screens.
“It’s a natural response to an unnatural environment,” Cyriel Diels, cognitive psychologist at England’s Coventry University, told Lumes. Diels’s advice, which applies to an array of Zoom-related difficulties but especially to those prone to nausea, is to stare at a fixed point when possible to help remind the brain that you are stationary.
Follow the 20-20-20 rule: look at something 20 feet away for 20 seconds, every 20 minutes. Alternatively, take yourself much farther away than 20 feet, not just to rest your eyes but because walking and taking deeper breaths can be a relief from “screen apnea” — the tendency to take shallow breaths when using a screen.
Or simply decide to show up “in voice only,” on the phone. “When we’re not chained into posing as a ‘living headshot,’ we can move around…sit outside in the sunshine,” writes Suzanne Degges-White. Also, rather than doing “double-screen duty” when taking notes on a split screen, write them on paper by hand — which has been shown to increase retention in the classroom.
Try to make the space where you work feel different— either by doing it in a different room or by changing the lighting, adding music, using a different coffee cup, or anything to create a boundary between work and the rest of your life.
According to Petriglieri, “the self-complexity theory posits that individuals have multiple aspects —context-dependent social roles, relationships, activities [and] when these are reduced, we become more vulnerable to negative feelings.”
When Zooming becomes too exhausting, a different suggestion is to “go old-school,” says Petriglieri: “Write a letter to someone…tell them you really care about them.”
On the upside, human connections have flourished in new ways with video chatting, according to Quebec researcher Claude Normand. We can “maintain long-distance relationships…and foster some sense of togetherness during a pandemic.” His suggestion, besides turning off the camera: if the meeting can be done by phone, try walking at the same time. “Walking meetings…improve creativity and probably reduce stress as well.”
IT’S BEEN 16 years since the FDA last approved a new drug to treat the cognitive deficits of Alzheimer’s disease (AD). More than 400 clinical trials in the interim have failed to produce any new medications, notes Ohio State neurologist Rawan Tarawneh.
Most AD research has focused on the buildup of amyloid plaque in the brain, a primary marker of AD, because it interferes with transmission of messages between brain cells. And drugs now on the market treat AD symptoms but not the underlying causes, nor do they slow progress of the disease. Also the drugs work only for about half the people who take them and, in that group, for only six to 12 months.
In an alternative approach to both treatment and disease, some researchers have turned their attention to infection—to the “amyloid protection hypothesis,” which links beta-amyloid buildup to the brain’s immune response to chronic infections, such as Lyme disease and herpes simplex. For the latter, a recent study from Taiwan reported that long-term antibiotic treatment lowered AD risk, although only to the level of people with no history of herpes infection.
In 2017, a “first-of-its-kind symposium opened the way for a paradigm shift in studying the pathogenesis of AD… to a new ‘innate immune system dysregulation hypothesis,’ which may well permit and lead to the discovery of new treatments for for AD patients,” according to the symposium report.
People looking for ways to forestall or combat Alzheimer’s disease—along with the statistic that up to 80% of older Americans have dormant, if not active, herpes infection—ask why not take a daily “maintenance” dose of the antibiotic valacyclovir, prescribed for active herpes infections.
One concern is that valacyclovir works only when herpes infection is active, a rare occurrence for most who have the virus. A trial now underway at Columbia University is investigating the effects of valacyclovir versus placebo on 130 herpes-positive people with AD.
“The possibility that amyloid beta is part of the brain’s way of fighting infection “revolutionizes our way of thinking about amyloid,” notes Tarawneh. And while “there has been no single study with strong enough evidence to show cause and effect…new approaches to Alzheimer’s disease are vital.”
The Harvard laboratories of Robert Moir and Rudolph Tanzi observed the protective action of plaque formation in response to two common forms of the herpes virus. “Amyloid beta is not junk or functionless,” said Moir. “Instead it appears to be a key player in the brain’s own immune system, created to trap any kind of infection that enters the brain.”
“The overproduction of plaque that occurs in Alzheimer’s may be caused by a chronic infection, such as gum disease,” said Moir, or “a sign that the brain’s immune system has gone off the rails. Plaque buildup…if it continues to increase…will eventually lead to inflammation in the brain.”
Said Tanzi: “amyloid is the match… neuroinflammation is a forest fire…microbes are what’s lighting the match.” And according to a Dana Foundation report, “since innate immunity is a general reaction to foreign material, the theory suggests a mechanism by which other factors might raise AD risk, such as fine particulate air pollution.”
“It’s not known whether microbes are causative or a passenger of the AD process,” emphasizes National Institute on Aging neuroscientist Mack Mackiewicz. “Long-dormant viruses may be activated by a disease process already underway…rather than a factor initiating it.”
And while “data tying antiviral treatment to lower risk of dementia is compelling,” says recent Alzheimer forum leader Philip Pellett from Wayne State University, the herpes-AD connection “meets some but not all of the criteria for causation.”
But because herpes infection in the brain appears more common in those with AD who have the ApoE4 variant, one theory is that ApoE4 increases the likelihood of the herpes virus entering the brain—which could be part of the reason people with ApoE4 are at increased risk for AD. Alternatively, herpes virus in the brain may influence the behavior of genes like ApoE4 linked to amyloid buildup.
The forum’s conclusion: “Herpesviruses do not cause AD. And yet, because they seed, and speed, amyloid plaque deposition and inflame the immune system, they likely press on the gas pedal to accelerate the disease process.”
On the other hand, amyloid plaque is very common in older people’s brains, but not everyone with amyloid will develop dementia. Likewise, herpes is very common, but AD is much less so.
Thus, “even if these viruses accelerate the amyloid pathology in the brain, the role of amyloid plaques in mediating AD itself is controversial,” notes NIH Alzheimer’s expert Avindra Nath.
Commenting on the Taiwan paper, Nath pointed out that “a wide variety of substances accelerate amyloid formation.” And in an email to mylittlebird, Nath wrote, “My guess is that any infection of any sort would cause inflammation and thus would bring out an underlying neurodegenerative disease in a vulnerable population. The idea of viruses and Alzheimer’s has been bouncing around long before I was born. But the data is very weak.”
As for the possibility of a Lyme-Alzheimer’s connection, some people who take a “maintenance” dose of doxycycline have noticed a diminution of symptoms. But a population study found, instead, that the 13 states with the highest incidence of Lyme disease reported the lowest number of deaths due to Alzheimer’s.
Until the roles of these variables are clearer, another hope for combating AD comes from flavenols, a large class of compounds found in most fruits and vegetables. Of 921 men and women with no dementia, average age 81 and average follow-up six years, 220 developed AD: those in the highest one-fifth on flavanol consumption had a 48% lower risk of AD than those in the lowest fifth.
While people consuming more flavonols tend to have higher levels of education and to participate in more cognitive and physical activities, the study, published in early 2020 controlled for these factors as well as for age, sex and the ApoE4 gene. While earlier research assessing five flanonols —tea, apples, broccoli, onions and tofu—found no association, it may be that a broader high-flavonol diet, for example, including leafy vegetables and berries, may offer better protection. Food is a better source than supplements, the researchers note.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
PARTS OF the U.S. are beginning to move from “strict social distancing” to a more relaxed “distancing in daily life”—vocabulary from South Korea’s experience; in other words, from the “hammer” of strict measures to the “dance” of testing, contact tracing and ongoing degrees of quarantine.
Loosening relies on increased responsibility of individuals: to keep a good distance from others; to wear a mask; to avoid large groups of people, especially indoors; and, when at risk—because of recent personal experience or if pinged from an “exposure notification” app—to return to stricter measures that include isolation.
In the absence of better disease surveillance tools— widespread testing and contact tracing—authorities rely increasingly on smart phone location data, although these are “remarkably blunt tools against a lethal, contagious disease,” writes Craig Timberg in the Washington Post. While decreasing mobility over time slows new infections, apps cannot tell how well people maintain social distancing once they reach their destination—did they sneeze, were there physical barriers?
According to companies that aggregate cellphone location data, many Americans appear reluctant to reopen. From Safegraph: after spending 93% of the time at home during the peak of the collective lockdown— compared with 70% in early March —by the end of April, U.S. residents were still at home 89% of the time; from Cuebiq, by state, with a peak of up to 54% of people staying home (New York), percentages from most states went down less than 10%.
For apps that track contacts and alert those at risk, privacy issues have driven Apple and Google to relabel their tracking apps “exposure notification.” As a Washington Post editorial points out, however, “any digital solution to our problem that’s sufficiently privacy-protective also won’t be sufficiently useful without a lot of humans in the loop.” The best option would be for anyone pinged to call a manual contact tracer to register status and get advice.
Among the most useful apps, the Covid Symptom Study app can predict with nearly 80% accuracy whether a person is likely to have Covid-19, based on age, sex, and a combination of four symptoms – which are the latest to rise to the top of most likely indicators of infection with the virus: loss of taste or smell, persistent cough, fatigue and loss of appetite. (Both the exposure notification apps and the Covid Symptom Study app are still under development; both will require opt-ins and express consent before they are used.)
Because the key to transmission is viral exposure over time, large groups of people congregating in enclosed indoor spaces create the highest risk. An infectious dose needs about 1,000 SARS-CoV2 viral particles—with droplets from a single cough or sneeze containing “as many as 200,000,000 (two hundred million) virus particles,” explains U. Mass Dartmouth biology professor Erin Bromage.
Staying outdoors should be the safest. In a Chinese study of 318 outbreaks involving 1,245 cases in 120 cities, fewer than .3% of infections occurred in an outdoor environment, Bromage writes. While wind can help disperse viral particles, it can also carry them from an infected individual, especially to those in the direct draft or slipstream. But, Bromage notes, because the formula is dose plus time, “you would have to be in their airstream for five-plus minutes for a chance of infection.”
Indoors, every individual presents a potential risk: at least 44% of all infections occur from people who are asymptomatic —during or for days before and after active infection. Viral particles from speaking and breathing can remain in the air for 5-10 minutes—thousands of particles per second from loud speech and more particles on an out-breath through the mouth than through the nose.
Sneezing can release 30,000 droplets, and coughing, 3,000—that can travel across a room as well as linger in the air. Specific warnings concern public toilets, which can release 8,000 droplets that can carry infection—so best to wait a few minutes after the last user flushes for droplets to fall to the floor.
With the eyes a vulnerable access point for transmission of the virus, the main advice is never to touch them. Some also recommend wearing eyeglasses (not contact lenses); and for occupational exposure protection, safety goggles on top of prescription lenses or indirectly vented goggles that fit snugly and require prescription lenses.
Abstinence-only doesn’t work for sex—and is unlikely to work when imposed on all human contact, caution public health experts experienced with the HIV epidemic. Noting the economic and psychological hardships of extreme distancing, they urge understanding that quarantine fatigue is real and warn against pandemic shaming —of anyone perceived as violating mask and distancing rules.
For contact tracing, currently the best strategy for controlling new outbreaks, the U.S. is way behind on hiring and training the hundreds of thousands of people needed for this labor-intensive work. In South Korea, for example, for one man who visited several nightclubs and four days later tested positive, contact tracers turned up 7,200 possible victims, of whom more than 100 have to date reported positive test results.
On “herd immunity,” experts are saying anywhere from 50% to 80% of the population must have been infected to slow progression of the virus. But in France and Spain, with just under 30,000 deaths each, antibody tests have been positive for 5% or less of the population—similar to results throughout the U.S.—putting all these countries at risk for second outbreaks. More worrisome, antibodies to this coronavirus might not be protective against future infection.
A better supported goal is the R0 (r-aught), or reproductive number of 1.0, meaning each infected person passes the virus to only one more person—indicating “stagnation” rather than increasing spread. Caveats include delayed accounting of a week to 10 days for the R0 and the need to combine it with total numbers of new cases. (Lower numbers of new cases give individual outbreaks a stronger influence on the R0 number.)
Among rare silver linings of this pandemic, breathing through the nose—the advice for an exhale less likely to spread the virus—can be calming. Because nose breathing encounters more resistance, the breath becomes slower and deeper, which stimulates the vagus nerve —which in turn slows and relaxes the heart and muscles, and spreads calm throughout the body.
And even with increased opening, there may be no return to the “old dispensation,” as Roger Cohen writes in a NYT Op-Ed. Cohen quotes from T.S. Eliot’s “Journey of the Magi,” from the story of the kings returning home after their visit to the newborn Christ to find themselves “no longer at ease here, in the old dispensation.”
If the “virus is a searchlight that lays everything bare,” Cohen writes, notably the “fragile environmental health of the planet,” the aftermath may include “rebalancing…from consumption to contemplation, from global to local…from frenzy to stillness, from carbon to green.”
For now, though, a kiss is no longer a kiss—not for filmmakers, not for saying hello or goodbye. And for people who can do it: stay home.
—Mary Carpenter
Well-Being Editor Mary Carpenter continues to provide corona virus updates. To read more of her posts, click here.
WHEN FEELING fearful, try blueberry crisp, suggests Washington Post food videos editor Mary Beth Albright, who gives comfort diet advice for four “fundamental human emotions”: afraid, sad, glad and mad.
But former FDA chairman David Kessler, who warns above all against eating starch, notes: “When I get stressed, I fall off the wagon.” While previously sugar, fat and salt have been the villains, Kessler says, “the delivery device of harm” is starch.
“I primarily see the world through a food lens,” writes Albright; while David Kessler considers starch his “different lens.”
From the Harvard Health letter advice on comfort eating, the main suggestion is to figure out why you need it —does it calm you down, cheer you up, compensate for a tough day—and what are your triggers. In these days of the pandemic, though, the why and the triggers are both less of a mystery but also harder to counter.
Kindness can override diet, according to the “rabbit effect”—the name given research on rabbits fed very high-fat diets that found only those cuddled and read to while eating escaped the host of heart problems suffered by the rest, according to Judith Newman.
Finally, comfort in times of sickness may come from foods like garlic and turmeric—in the belief that they boost immunity. The link between these foods and immunity could help explain why some countries, including India, Japan, Lebanon and Thailand, have much lower rates of coronavirus infection than would be expected based on variables like overcrowding, an aging population or more travelers to and from China.
Albright chose comfort foods based on the microbiome-body connection, which affects both immunity and mental health. Probiotics (food containing bacteria such as yogurt and kimchi) help to maintain healthy levels of good bacteria to support immune defenses, according to University of Newcastle molecular nutritionist Emma Beckett.
And “prebiotic” food (including legumes, oats and beans), which remain largely unaltered during digestion, feed the healthy bacteria. The gut and the brain communicate about mood, state of mind and stress level, according to NYU clinical medicine professor Lisa Ganjhu, who refers to the brain as part of the gastrointestinal system.
In people suffering from depression, several species of gut bacteria are missing, according to a European study. But whether the absence is a cause or effect of the illness is unclear. Because gut microbes have an average lifespan of about 20 minutes, one meal can quickly alter the entire population of an individual’s microbiome.
About blueberry crisp, writes Albright: “it’s weirdly satisfying to put your fingers right in the topping,” and makes your home “a place that smells like good things are happening.” After choosing the four human emotions, though acknowledging there is some disagreement about these, she usually starts with her “dominant one.”
For sad, she recommends “pureed (insert any vegetable) soup”; for glad, hummus is “eminently shareable” and chickpeas are rich in choline “that supports your brain and moods.” For mad, she chooses smashed cucumber salad—whole cucumbers in a Ziploc bag smashed with rolling pin until flat – or “almost any activity that safely engages angry energy.”
Four emotions also form the core of emotional eating—fear, anger, tension and shame (FATS), with fear being the root emotion, according to psychotherapist Doreen Virtue, author of Constant Craving: A-Z (Hay House, 1999). Cravings for food stem intuitively from emotional or physical imbalance, writes Virtue; and are a sign that the body and the emotions are in need of peace or homeostasis.
Rolled oats, one of the blueberry crisp ingredients, is on David Kessler’s list of good foods – along with legumes like chickpeas, quinoa and brown rice—to choose instead of starch (which includes ground and instant oats). Starch, as described by the Washington Post, is the “white, powdery tasteless substance found in processed foods that results when food manufacturers mill, puff, pop and otherwise refine wheat and corn, stripping out its natural structure, which makes it rapidly absorbable by the body.”
“Fast carbs,” as Kessler calls them in his book, Fast Carbs, Slow Carbs, are both irresistible and absorbed so quickly that we don’t feel full—and thus remain hungry for more. Eating fast carbs can cause insulin resistance, which allows sugar to build up in the blood and can lead to metabolic syndrome and in turn to stroke and heart disease.
Medical schools now include courses on culinary medicine, “unconcerned with the hypothetical case, and instead concerned with the patient in immediate need, who asks, ‘What do I eat for my condition?’” writes Santa Barbara physician and nutrition expert John LaPuma, “As food is condition-specific, the same diet does not work for everyone.”
What can also be both comforting and immune-boosting is tea made with fresh turmeric and ginger—and anything containing the anti-oxidant resveratrol: red and white wine, grapes and berries, peanuts and pistachios, and dark chocolate, especially comforting in a warm cup of cocoa.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
IN THE CORONAVIRUS pandemic, rescue from medical advances may not come any time soon—from testing either for infection or for antibodies, or from a vaccine. Alternatively, the human factor creates ongoing uncertainties but also the best hope, which involves concentrating strict social distance regulations in virus hot spots while relaxing them elsewhere for slow, gradual reopening.
For the four Asian countries—Singapore, Hong Kong, South Korea and Taiwan—that brought Covid-19 numbers down early on and then again following a second wave, two strategies worked: contact tracing and social distancing. Because up to 50% of Covid-19 cases are asymptomatic, nationals returning from abroad managed to pass through various virus checkpoints and to initiate another wave of community infection, which involves unlinked local cases.
In response, the countries imposed 14-day quarantines on every returning national in the “containment” phase, which included “following every infection back through its chain of contacts and isolating all those people from the general population,” according to Wired. Contact tracing can also help pinpoint local “hot spots” of the virus—from cities and towns to medical institutions.
Hong Kong and South Korea “didn’t do so much of physical distancing by shutting down whole cities and regions,” noted David Holtgrave, dean of Albany University’s School of Public Health. Instead, they used testing data and contact tracing to determine where to impose the strictest measures. Likewise, New Zealand has gotten the number of newly diagnosed infections into the single digits and has eased restrictions.
Because containment—testing, identifying and isolating—always misses a few cases, the next phase, “mitigation,” involves social distancing. The goal: to reduce the “reproductive number” (called R0, or r-aught) to below one, meaning that each contagious individual infects only one person or less.
Widespread testing for infection can assess ongoing spread of the virus through a community, as well as determine for individuals when to isolate and begin treating. While infection testing is important for individuals who are regularly exposed to the virus through their work and for those with symptoms, others who are healthy and well protected could get a negative result one day and then have another reason to get tested again the next day.
Testing to detect antibodies—serology tests performed on blood samples—can also give some idea of how much the virus has spread through a community, with the hope that herd immunity will eventually protect individuals. (For individuals, uncertainties of antibody testing, however, remain about what levels constitute protection and how long that protection might last.)
Unfortunately, recent research in New York and California found that for many antibody tests, false positive results—incorrectly indicating the presence of antibodies when in fact the person had no immunity—ranged around 5%.
“Those numbers are just unacceptable,” University of Pennsylvania microbiologist Scott Hensley told the New York Times. False positive results are dangerous both for the individual who incorrectly believes they are safe from infection but also for communities seeking information about how to safely regulate distancing and when to begin reopening.
For antibody testing, another stumbling block is the amount of time following infection before the body produces measurable antibodies as well as for the tests to accurately detect them. Test accuracy, which improves over time, does not approach 80% until at least three weeks following the original infection.
In the New York and California communities, positive results from antibody testing occurred in 2.5 to 15% of the population—with the highest at 24.7% in the epicenter of New York City—far from the 70% minimum needed for sufficient herd immunity to stop, or at least slow, disease transmission.
Another confounding human factor is the variability of the virus, why people get sick from Covid-19 in a wide range of ways: from asymptomatic to severe; from a steady decline to a second wave of illness; from infection remaining in the body for up to six weeks; and from the most severe symptoms occurring in the respiratory system to those in the heart, liver, kidneys, intestines, eyes, nose, brain and toes.
Meanwhile, the currently most-promising drug in development, the anti-viral remdesivir, failed in a Chinese study reported in the Lancet; and even in a recent U.S. study, it shortened hospital stays from 15 to 11 days, but did not reduce the number of deaths at a statistically significant level. Many older drugs now under consideration for repurposing to treat Covid-19 include Thorazine as well as those used to treat osteoporosis and Parkinson’s Disease.
While research is ongoing for about 90 vaccine candidates, different vaccines may work better for certain groups, like children or older people, or at different dosages, according to Emilio Emini, a director of the vaccine program at the Bill and Melinda Gates Foundation.
Hope soared with the recent announcement that a vaccine candidate at Oxford University could be ready for limited production by the end of the summer. The Oxford researchers had an advantage over other teams, who need to conduct small safety trials before proceeding to the next step, because it had already tried a similar inoculation against an earlier coronavirus.
National Institute of Allergy and Infectious Disease Director Anthony Fauci, however, continues to warn that a widely available vaccine will take at least until Christmas if not longer.
Meanwhile, evaluation of both antibody tests and vaccine candidates could meet a potentially insurmountable obstacle as containment and mitigation become more successful. As the number of infected people decreases to the point that very little virus remains circulating in a community, it becomes more unlikely that either vaccinated individuals or those with positive antibody results will come into contact with the virus at all —thus making it impossible to collect statistics on efficacy.
In the absence of good treatments or vaccines, contact tracing becomes more valuable. But its reliance on large numbers of people creates another human-factor obstacle, especially in the U.S., where agencies have seen a drop in the numbers of trained staff (those who previously worked on STDs over the past 20 years) from more than 5,000 to around 1,600 today. “The reality is that we at least need a work force of 30,000 people,” according to David Harvey, executive director of the National Coalition of STD Directors; while others place the number at ten times higher.
As of May 1 in the DMV, the numbers of infections and deaths were still increasing, especially in more disadvantaged areas—numbers that must go down before containment and mitigation can lead to relaxing restrictions and reopening society.
Mary Carpenter
Well-Being Editor Mary Carpenter continues to provide corona virus updates. To read more of her posts, click here.
CONQUERING CONSTANT nonallergic sniffles may require as little as eating a very spicy meal every few months—or, for anyone with a sensitive stomach, capsaicin nasal sprays can do the trick with effects lasting up to six months.
(In the face of the corona virus pandemic, sniffles are not a common symptom of Covid-19 but can appear worrisome to others; also, a runny nose is difficult to manage beneath a mask.)
Sniffles that occur in the absence of infection or allergies—also called chronic idiopathic (no known cause) rhinitis —affect some 7% of the population but may be responsible for between 17 and 52% of seasonal allergy-like symptoms,” according to Consumer Reports. These symptoms are more likely to include a stuffy or runny nose and postnasal drip—but usually not the itchy nose or eyes, or scratchy throat of allergy sufferers—and, for many sufferers, have no seasonal pattern.
Problems of the aging nose are the focus of most news features on nonallergic sniffles (including a recent Washington Post Health section summary of the Consumer Reports article)—despite a comprehensive paper highlighting two alternative causes but appearing ten years ago in the Proceedings of the American Thoracic Society.
While aging nose issues respond well to moisturizing with saline or steam, the other two conditions—localized allergic disease and nasal hyperreactivity—do better with nasal sprays containing capsaicin, anti-inflammatory steroids or antihistamines.
“There has not been enough effort in the medical and scientific communities to address nonallergic rhinitis which, indeed, affects many people,” wrote allergist Alkis Togias, branch chief at the National Institute of Asthma and Infectious Diseases and co-author of the Proceedings article, in an email to mylittlebird. “Very few people are working in this field.”
The historic classification of chronic rhinitis into allergic rhinitis and non-allergic, non-infectious rhinitis “does not reflect the complexity of the rhinitis syndrome,” according to Spanish researchers who investigated the local allergic condition.
Local allergic rhinitis (LAR) involves a low-level sensitivity to allergens that affects only the nasal mucosa—in contrast to the body-wide response of allergy sufferers. Also, while histamine plays a role in allergy sufferers’ symptoms, local inflammation in those with LAR involves different cells, eosinophils, produced by the immune system.
For the other alternative, nasal hyperreactivity, there is no inflammation but sufferers appear hyperresponsive to cold air and spicy food. Also called vasomotor rhinitis (VMR), “motor” refers to nerves that in this case are “unusually sensitive to irritation.”
Capsaicin falls into the category of nasal irritants but produces mild irritation that can lead to a long-lasting improvement of symptoms. Used twice daily for two weeks, capsaicin nasal spray produced “dramatic improvement in most cases of nonallergic rhinitis symptoms” compared to a placebo in research at the University of Cincinnati.
Treatment with capsaicin— extracted from hot chili peppers and also used for its ability to interrupt pain signals —calms sensory fibers in the nose, which leads to prolonged improvement in reactivity and in turn reduces nasal responsiveness to cold air.
For everyone, cold air in the nose can induce significant water loss, causing the body to constantly replenish moisture, which in turn produces a runny nose—in wintertime called “skier’s nose.” Providing added moisture from steamy baths or humidifiers can reduce or stop the sniffles for many people.
Dryness is also the main cause of sniffling that worsens with age, due to a decrease in body water; degeneration of mucus-secreting glands and reduced effectiveness of the mucus in clearing out nasal passages; and decrease in nasal blood flow that leads to drying of the membranes.
Saline nasal irritation is the most common recommendation to replace moisture—using a neti pot or bulb syringe —although hot steam inhalation and hot baths can be more appealing.
Among over-the-counter nasal sprays, capsaicin sprays such as Sinus Plumber ($25.95 for 2-pack) can help with nasal hyperreactivity; while Flonase ($38.90 for 2-pack) can help with localized allergic reaction.
Evaluation by a medical professional can rule out systemic allergies; also, the antihistamine azelastine, which works well for some nonallergic cases, is available only by prescription. Alternatively, to investigate potential causes for sniffles unrelated to infection, allergies or aging, experimenting with different OTC treatments might be the easiest route.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
Author’s note: As an introvert, I appreciate having time alone to recharge as well as days without plans—which puts me on the side of those experts who find positive aspects of solitude, in contrast to others who contend that isolation, even in the absence of loneliness, is detrimental to health.
“NO MATTER how hygge [Danish, loosely translated as cozy] you’re feeling at this moment… the negative feelings and experiences associated with prolonged isolation will come for us all,” according to Wired: “Isolation can “numb your brain with boredom.”
Loneliness acts as a “biological alarm bell”—like hunger and thirst—that drives us to seek social connection, according to just-published research from MIT on 40 participants who underwent fMRI (functional MRI) scans after each experienced two 10-hour sessions, one of hunger and one of social isolation.
Long-term negative effects on health due to the ongoing “social recession” will parallel those on the economy, according to those experts who blame isolation, even in the absence of loneliness. They point to physical effects, such as inflammation throughout the body, that lead to higher rates of heart disease, stroke and early death.
(For clarity here, “isolation” refers to the objective, physical state of being alone; “loneliness,” to subjective, unpleasant feelings; while both “solitude” and “aloneness” connote positive experiences of being alone.)
Most research on isolation fails to include people who prefer solitude and who see unstructured time as providing opportunities for creativity and personal growth. Experiencing such possibilities may help others adjust to the quarantine.
“Solitude is “more devalued now than it has been in a long time,” says Matthew Bowker, a psychoanalytic political theorist at Medaille College in Buffalo. Bowker argues that “mistrust of solitude” makes it harder for us to define ourselves separately from a group. As a result, fear of missing out (FOMO) causes widespread anxiety in younger generations and for many older adults as well.
Alone, people suffer from lack of “positive inputs into their small worlds,” contends University of Houston clinical psychologist John Vincent. With some 43% of people over 60 reporting loneliness—and that was before the quarantine—former U.S. Surgeon General Vivek Murthy diagnosed today’s society with “an epidemic of loneliness.”
Social isolation, with or without loneliness, can have as large effect on mortality risk as smoking, obesity, sedentary lifestyle and high blood pressure, according to the late University of Chicago neuroscientist John Cacioppo, nicknamed “Dr. Loneliness” for his extensive research and writing on the subject.
According to the “evolutionary theory of loneliness” that emerged from Cacioppo’s studies, separation from the group causes hyper-vigilance, triggering a fight-or-flight response that becomes embedded in our nervous systems and that in turn produces anxiety and a state of “profound distress.”
In a study of 32,624 healthy men, living alone had worse health consequences than “perceived isolation”—though the researchers’ definition, lack of companionship and support, sounds more like the subjective experience of loneliness. All participants living alone had a 90% increased risk of cardiovascular death and double the risk of non-fatal stroke—amounting to a 32% increased risk of mortality.
For the MIT study, to create social isolation, each participant spent one session from 9am to 7pm in a room without phones or devices or fiction —“ in case fictional characters provided some social sustenance”—although they could have puzzles as well as “pre-approved nonfiction reading or writing.”
For their 10-hour hunger session, subjects could not eat or drink anything but water. Following both periods of deprivation, fMRI scans showed the same midbrain regions, which play a role in motivation and craving, responding to images of what subjects had been deprived of; and the magnitude of responses matched the subjects’ reports of how hungry or lonely they’d been.
Noting the “shared neural signature” of the two states—deprivation of food and social connections —MIT neuroscientist Livia Tomova concluded that “social contact is a very basic need.”
In studies on mice, however, the search for food activated different brain regions depending on whether the mice were starving or simply seeking tasty rewards, which the researchers dubbed “hungry” vs. “yummy.” For the mice, seeking social contact after extreme deprivation affected the same neural pathways as “hungry”—in contrast to the search for the pleasurable rewards of social interaction, which involved the “yummy”-responding regions of the brain.
Positive experiences of solitude, however, depend on certain conditions —the “ifs,” according to University of Maryland developmental psychologist Kenneth Rubin: if it is voluntary; if one can join a social group when desired and maintain positive relationships outside of the group; and if one can regulate one’s emotions effectively—the final “if” being the cause of extreme disagreement.
Understanding an individual’s motivation for seeking solitude may help predict the varying effects of isolation. The Motivation for Solitude Scale (MSS) begins with “when I spend time alone, I do so because…” and responders answer on a continuum that ranges from not important or relevant, to extremely important and relevant.
About half the questions focus on negative motivations, reasons for avoiding people, that include feeling anxious, unliked, uncomfortable, or “as if I don’t belong;” and “regretting things I say or do.” The remaining questions illuminate positive possibilities of solitude: sparking creativity, staying in touch with feelings and engaging in activities of personal interest—as well as the introvert motivator, “I feel energized when I spend time by myself.”
Exploring solitude can be unpleasant, even for those who choose it, explains sociologist Jack Fong at California State Polytechnic University, because it can force people to confront who they are. But even isolation that is enforced or sought for negative reasons can create “what Fong calls ‘existentializing moments,’ mental flickers of clarity.”
“Productive solitude,” according to Medaille College’s Bowker, can lead to “the most important relationship anybody ever has, the relationship you have with yourself”—and can occur wherever “the individual can find an interior solitude.” Notes Bowker, “Some people can go for a walk or listen to music and feel that they are deeply in touch with themselves. Others cannot.”
For anyone new to isolation—under quarantine, in retirement—adjustment can be a process and can benefit from the creation of new routines, for example, around exercise and meals. Regularly planned social encounters can help, even those online, with new “videoconferencing” options, such as Zoom and BlueJeans.
For anyone who longs to travel, Italian author Tiziano Terzani—after spending a month alone in a Japanese cabin to experience seclusion— found that “the only real teacher is not in a forest, or a hut or an ice cave in the Himalayas. It is within us.”
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
“THE VIRUS is basically in charge right now,” New York University infectious disease epidemiologist Danielle Ompad told the Washington Post, “because we don’t have a vaccine, and because there aren’t proven effective treatments.”
As of mid-April the currently raging coronavirus, officially SARS-CoV-2, continues to pose conundrums that range from mechanisms of contagion, such as the quickly retracted alarm about ocean waves, to crucial questions about severity and testing, and about how and when the crisis will end.
Hospitalization rates help explain why Covid-19 is more severe and demands more extreme precautions than seasonal flu: 19% for Covid-19 versus 2% for the flu, according to a Vox chart.
And of about 20,000 patients hospitalized in New York City, some 4,000 or 20% have died. Case reporting, however, is unreliable: Numbers from the Texas county that includes Houston, for example, at one point showed 966 hospitalized but fewer than 950 confirmed cases.
Meanwhile, fatality rates remain unknown as long as inadequate testing makes the total number of cases impossible to compute—and as long as around 50% of cases are asymptomatic, and most common SARS-CoV-2 tests currently have a 30% risk of false-negative results (negative in the presence of active infection).
Testing is the key, according to Governor Andrew Cuomo, although New York alone needs tens of millions. Until SARS- CoV-2 tests become much more available (the best might be do-it-yourself and inexpensive like pregnancy tests), questions will arise about how often and at what point to test each individual, for example, after any possible exposure.
But a different kind of test that detects antibodies to SARS-CoV-2 could indicate immunity and provide a sort of return-to-work passport. However, because people with detectable antibodies can still be infectious, they would also need testing for the virus itself before being cleared.
Herd immunity is the most likely candidate for ending the crisis. For many viruses, 80 to 95% of the population must be immune to stop a disease’s spread; in the case of measles, 19 out of every 20 people must receive the vaccine to block person-to-person transmission. Unlike measles immunity that endures for decades, however, immunity to this coronavirus could last as little as a few months or up to a few years.
Vaccination is the safest route to herd immunity because, if herd immunity depends on infection spreading throughout the population, the severity of Covid-19 could kill high numbers of people. Also, social distancing, currently the best weapon against the spread of SARS-CoV-2, creates an obstacle to achieving herd immunity by causing the virus to spread more slowly.
Many vaccines are in the pipeline, but clinical testing requires at least a year, and any vaccine could need rejiggering as the virus mutates. Similarly, drugs currently in the pipeline, such as hydroxychloroquine, need months or longer to show sufficient effectiveness to justify the risk of side effects.
Among other tricky coronavirus issues, length of contagion varies greatly among individuals. A New Rochelle, N.Y., teacher remained infected and contagious for at least 11 days after her last symptoms. About half of Covid-19 patients in Chinese research continued shedding the virus for up to eight days after symptoms disappeared. (While some patients report getting Covid-19 a second time, the new symptoms are likely a continuation of the original infection.)
Both the differing symptoms and the severity of individual cases depend on the quantity of virus in the initial exposure and on personal genetics. “It’s a dosage thing,” Manhattanville College virologist Anna Ueung-Cheung told Slate. The likelihood of health care workers becoming infected is high because of intense exposure.
Although only a fraction of those infected get sick, those who do have a wide range of symptoms, from fever and cough to stomach cramps and diarrhea to debilitating fatigue. “Very rare mutations… are likely driving cases of extreme susceptibility,” according to University of Oxford researcher Stephen Chapman—especially in young, apparently fit adults.
Other factors affecting severity include race and pollution. In Michigan, with the state population 14% black, African Americans made up 35% of cases and 40% of deaths.
“Large overlap” occurred between higher levels of dangerous particles known as PM 2.5 and higher death rates from Covid-19 in a nationwide study by Harvard public health researchers. According to the study across 3,080 U.S. counties, DC “is likely to have a higher death rate than the adjacent Montgomery County, Md.”
As for ocean waves spreading the virus, the rumor arose after the LA Times reported that “every time the ocean sneezes with a big wave or two, it sprays these particles into the air.” The expert at the heart of the story, however, told CBS later the same day: “SARS-CoV-2 has not been detected in the ocean or atmosphere by anyone.”
Talking to the LA Times, Scripps atmospheric chemist Kim Prather had intended to make the point that six feet may not be a sufficient distance between people on a windy beach, where even those who are symptom-free may be exhaling aerosol particles that extend farther and can remain in the air for hours.
Social distancing on the beach and everywhere else is still the key to “squashing the curve”—meaning that even when case counts begin to decrease, restrictions must continue for as long as most of the population remains vulnerable.
—Mary Carpenter
Well-Being Editor Mary Carpenter is keeping her eye on the corona virus for us. For more of her posts, click here.
ANOSMIA OR “smell blindness” has recently emerged as a possible early indication of coronavirus infection – and it also may be for neurodegenerative diseases, including Alzheimer’s and Parkinson’s.
But until something goes wrong, smell is an underappreciated sense—not tested regularly like vision or hearing. Most “olfies,” people with a typical sense of smell, don’t realize that “anosmics” miss out not only dangerous gas leaks and bad body odor but also on emotions and memories associated with smell.
Of those testing positive for COVID-19, more than 60% of German patients and about 30% in China described losing their sense of smell for several days, according to STAT. While widespread testing has not yet confirmed the association, anyone noticing a diminished sense of smell should self-isolate, wear a mask in public and try to contact a medical professional and to get tested.
Nasal/sinus infections and respiratory disease are the most common causes of olfactory dysfunction along with head trauma. Smell also declines with aging, called presbyosmia. On the University of Pennsylvania Smell Identification Test (UPSIT), a typical average score of 37 declines to around 34 in one’s 70s and 26 in the 80s—with lower values classified as dysfunction.
In addition to anosmia, hyposmia is a diminished sense of smell; in parosmia or distorted perception, odors like rotten eggs can replace those of flowers; and phantosmia involves smelling something that’s not there, most commonly something unpleasant like dead animals.
Infection in the nasal cells can produce a dead-animal odor. And a simple head cold can completely destroy the sense of smell. Respiratory viruses inflame or damage cells in the nose, and that blocks the passage of odor molecules to neural receptors located in the mucosa.
Qualitative odor sensations—of flowers or spoiled food—arrive in the brain via the first cranial nerve (CN1). A second facial nerve (CN5) relays somatosensory information from the eyes and skin as well as the nose —stimulated for example by irritation from a cut onion, also by foods like ginger and mint.
In addition to its smell sensors, blood vessels in the nose provide a route into the bloodstream and in some cases across the blood/brain barrier: for vaccines, such as FluMist; and for drugs—both legal, including those for psychiatric disorders, and illegal like cocaine.
In olfaction, detection is the first step—and the first tested when a problem arises. Discrimination, the second step, involves comparing scents against each other. The final step, identification, involves memory and diminishes with age and with age-related diseases. For Alzheimer’s patients, olfactory identification deficit is most often related to delayed memory processing.
In clinical research, patients receive odor stimuli via scratch ‘n sniff strips, perfumed paper strips, glass vials and felt-tip pens. But sensitivity to “monomolecular odorants,” such as the rose-like odor of phenylethyl alcohol, varies greatly even among those with a normal sense of smell.
A bigger challenge for assessing olfactory function can be a patient’s familiarity, based on personal or cultural experience, with test odorants. Adapting the UPSIT for Taiwanese subjects, for example, involved replacing scents like clover, cinnamon and gingerbread with others like sandalwood, jasmine and grapefruit.
In the case of head injury, even minor impact-collisions that cause the brain to lurch back and forth in the skull can block or sheer the CN1. Following a bicycle accident and subsequent surgery to relieve bleeding in his brain, Philadelphia artist JC had about 50% permanent loss of smell. He can detect a person smoking but not whether the smoke is marijuana—and he relies on a carbon monoxide monitor to detect smoke at home.
Smell contributes about 30% to taste, according to JC’s surgeon. While other variables like texture help him distinguish strawberries from bananas and good wine from bad, JC cannot discriminate among fine wines.
“Many people with anosmia believe they have also lost their sense of taste,” according to Philadelphia’s Monell Chemical Senses Center. But what they have usually lost is the ability to sense flavor: while sugar has a sweet taste, strawberry and banana flavors “are actually smells.”
Combining aroma with the five basic tastes—via the airway connecting the mouth and nose—creates thousands of flavors. To experience taste in the absence of smell, place salt, sugar, vinegar and/or black coffee on the tongue; alternatively, to assess flavor alone, eat two flavors of the same brand of ice cream, such as vanilla and chocolate.
The inability to distinguish such odors as the smell of lilacs or a baby’s head can diminish emotions and memory associated with these experiences—and can lead to “symptoms of depression, anxiety and isolation. [Those with anosmia] describe the condition as like experiencing the world through a frosted window,” according to the Monell Center.
The connection of olfactory function to neurodegenerative diseases remains unclear. The Center states: “There is no evidence” that unexplained smell loss—not caused by head trauma or rhinosinusitis—will increase risk or is a sign of these diseases in the absence of other symptoms.
On the other hand, among patients with Parkinson’s disease, olfactory dysfunction occurs in 80 to 90% and can precede motor symptoms by several years. And, of 3,000 participants in one study, those unable to name at least four of five common smells (peppermint, fish, rose, orange and leather) were more than twice as likely to develop dementia in the next five years.
Among the rest, 78% were able to name at least four scents; 14% just 3; and 5% only 2. Those able to name just one had an 80% risk of a dementia diagnosis; and, of those unable to name any, almost all received this diagnosis.
Also, Swedish research looking at adults aged 40 to 90 over a 10-year period found that those who had lost their sense of smell had a 19% higher risk of early death.
As Philadelphia artist JC explained, a cause of olfactory dysfunction among painters is the fumes from paint thinner in closed studios with bad ventilation, especially for those starting out, with little money to afford something better. But for JC, the effects of his head injury have an upside: in the belching smoke of a city bus, instead of exhaust fumes, he sometimes smells night-blooming jasmine, which he remembers from evenings in his grandmother’s Florida garden.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
RESPIRATORY VIRUSES, like seasonal flu and coronaviruses, cause symptoms that begin “mild” and can progress to “moderate” or “severe”—most commonly in those over 60 and those with underlying health issues.
Even people with “mild to moderate” respiratory symptoms can develop pneumonia, infections traced to viruses or bacteria that cause air sacs in the lungs to fill with fluid or pus. Infants younger than two and people over 65 are at higher risk because their immune systems aren’t as strong.
An overly active immune response, on the other hand, can lead to severe inflammation that destroys lung tissue and limits oxygen—and can lead to a dangerous cycle of more inflammation, less oxygen reaching the organs, organ failure and death.
For Covid-19–the d refers to disease—“moderate” symptoms can include a dry cough, fever above 100.4, chills and fatigue. These symptoms can be reason for hospitalization when accompanied by dehydration or difficulty drawing a breath.
Shortness of breath that can develop with Covid-19 also occurs in a “wide spectrum” of severity depending on the related activity, explains Montefiore Health System epidemiologist Theresa Madaline: from climbing stairs to no activity at all, like sitting in a chair.
With confirmed or suspected Covid-19, shortness of breath is a “symptom to always check with a health care provider. Period,” according to pulmonologist Kenneth Lyn-Kew at Denver’s National Jewish Health. “Because shortness of breath can mean low oxygen levels in the blood.”
When insufficient oxygen is getting to the body’s organs, a breathing machine—respirator or ventilator—may be necessary to prevent multi-system failure leading to organ shutdown and death.
To test for pneumonia, a “pulse-ox” (pulse oximeter) finger clip can measure the percent of oxygen in red blood cells, which should be at or greater than 95%. Also, blood testing can reveal the presence of bacteria. But the chest x-ray is the definitive test for pneumonia.
When a respiratory virus enters the body through the nose or throat, symptoms often include a sore throat or cough. The viral particles can keep moving down the bronchial tubes and into the lungs, particularly when the immune system is weak due to underlying conditions, such as diabetes, heart disease and obesity.
Weakened immunity can also be traced to other illnesses, including severe seasonal flu or the common cold, which leave the airways raw and inflamed and more vulnerable to viruses as well as to bacteria—which can cause sinus infections and bronchitis.
When viral particles reach the lungs, inflamed mucous membranes make it more difficult for the alveoli, or lung sacs, to supply oxygen and remove carbon dioxide from the blood. Infection can continue spreading downward through the gastrointestinal tract to the rectum; can enter the bloodstream and move throughout the body; and can directly attack organs including the heart, kidney and liver.
High fever in someone who has been sick can signal an overactive immune response, also called a cytokine storm—referring to immune cells called cytokines that normally protect the lungs—that can be deadly if untreated. Specific tests and treatment of out-of-control immune reactions may have helped cure some Covid-19 pneumonia sufferers in China.
While researchers elsewhere are waiting for the Chinese to publish specific data on the patients and drugs involved, the World Health Organization has initiated a global trial called SOLIDARITY with plans to include thousands of sufferers. Among medications that showed good results in the very small numbers of Chinese patients, the antimalarial drugs hydroxychloroquine and chloroquine—which combat autoimmune reactions in people with lupus and rheumatoid arthritis—may control cytokine release syndrome in critically ill patients.
Excessive inflammation from an overactive immune system can travel throughout the body, in the worst cases leading to septic shock, with organ shutdown that can cause death. Even when patients seem to be stable or recovering, bacteria can attack already-damaged, vulnerable lung tissues, causing relapse and death.
While about 80% of people infected with the currently circulating novel coronavirus have mild symptoms, about 20% become more seriously ill and 3 to 5% will die. Besides strength of the person’s immune system, outcomes depend on underlying conditions and probably genetic makeup.
In Italy, among more than 2,000 deceased, women were less likely to die (601 cases) than men (1,402) and were older (average age 83.7) compared to men (79.5) (personal communication based on translation from the Italian newspaper La Repubblica).
Besides precautions like hand washing and social distancing to avoid getting sick, keep your immune system strong with diet and exercise— and don’t hesitate to call the doctor if you have symptoms, especially unusual shortness of breath.
—Mary Carpenter
Well-Being Editor Mary Carpenter is keeping her eye on the corona virus for us. For more of her posts, click here.
SALT MAY no longer be a villain. Arguments for the dangers of too-low salt intake are “gaining ground,” according to the BBC, “casting doubt on decades of research and shedding light on the questions that still remain unanswered about our favorite seasoning.”
High salt consumption will remain a problem for people with hypertension or high sensitivity to salt, which can depend on age as well as ethnicity, body mass index and family history—although some now argue that a “low-salt diet is just as much of a risk factor for developing high blood pressure as high salt consumption.”
But in studies on healthy individuals, low-salt diets have been linked to insulin resistance—which causes high blood sugar levels and can lead to Type 2 diabetes, heart disease and other metabolic complications—as well as increased risk of death from heart disease and stroke.
The American Heart Association recommends an upper limit of 2,300 mg of sodium/day, equal to about 1 teaspoon of salt, but some researchers now suggest a daily intake between 3,000 and 5,000 mg of sodium—closer to what Americans consume each day. (Sodium makes up 40% of salt, and the remaining 60% is chloride.)
The body relies on sodium to help transport oxygen and nutrients, to provide the electricity to conduct nerve impulses, to contract and relax muscles, and to maintain the right balance of water and minerals. Healthy kidneys maintain a stable amount of stored sodium, retaining sodium when levels are low and excreting more when they are high. Decreasing effectiveness of kidneys, which can happen with age, allows sodium to accumulate in the blood, causing excess water retention that in turn increases pressure on the arterial walls.
“Randomised trials showing salt’s effect on the body are almost impossible to carry out,” according to cardiologist and epidemiologist Francesco Cappucio at the University of Warwick, whose eight-year literature review found positive effects of lowering salt intake by 1,400 mg/day: a 42% decline in fatal strokes and 40% drop in heart disease-related deaths.
Most agree that it’s difficult to separate the effects of lowering salt from other diet and lifestyle behaviors, because people more conscious of salt intake are more likely to have healthier diets overall—if only by reducing processed foods, including canned and frozen food, packaged food, meat, bread, breakfast cereals and some dairy products like cheese.
For most people, about one-quarter of their daily sodium intake comes from the salt shaker. The rest is mostly from processed foods, such as 1,000 mg in a cup of spaghetti sauce and more in some canned soups; and condiments, such as soy sauce, with 1,000 mg/tablespoon.
Many less-processed products also contain sodium: milk—about 100 mg. in one cup of lowfat; and the saltier cheeses—about 1,000 mg in 30 grams of Roquefort, compared to 500 mg for cheddar and 300 for mozzarella. And one survey found great differences among products within each variety: for gorgonzola, one option was six times saltier than the least salty.
Questions about limiting dietary salt began with the ongoing National Health and Nutrition Examination Survey studies involving thousands of people and producing intermittent sets of results: in one set, those eating the least salt died at a rate 18% higher than those eating the most salt; and in another, the low-salt group had a 15.4% higher risk of death.
Additional observational studies have found daily sodium intake below 3,000 mg increased the risk of dying from heart disease and stroke. For people with heart failure (when the heart is unable to pump sufficient blood for the body’s oxygen needs), those who restricted sodium intake had a 160% higher risk of death—although results from other studies disagree.
In an early-2000s review by the Institute of Medicine, the committee found that for heart failure, there was “sufficient evidence to suggest a negative effect of low sodium intakes.”
What may be more important than the quantity of sodium consumed is its ratio to that of potassium, which relaxes blood vessels—decreasing blood pressure—and helps the body excrete sodium. In the ratio of the two, potassium should be higher, but most Americans eat about 3,300 mg of sodium/day compared with about 2,900 mg of potassium.
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
OVER A few weeks, 60s-something DC lawyer D.M. fainted three times from a standing position, causing bruises as well as raising anxiety about what could be wrong and what the next fall might bring. On one ER visit, doctors said she’d had a stroke. Then a neurologist said no stroke, but maybe a meningioma, a generally benign tumor occurring on the brain’s membranes.
Months later, the fainting has stopped but D.M. still seeks an explanation for ongoing symptoms that include extreme fatigue, inexplicable bouts of feeling hot and sweaty—she had no hot flashes during menopause 10 years ago —and pulse rates above 100.
(She also takes medicine to control blood pressure, after her systolic reading occasionally spiked as high as 180. Pulse rates refer to the number of heartbeats/minute; the normal range is between 60 and 100, while blood pressure indicates the force of blood moving through the vessels.)
Although high blood pressure and occasional bouts of fainting can point to myriad diagnoses, one that may be “significantly more common than we realize,” as Mayo Clinic neurologist Jeremy Cutsforth-Gregory puts it, is dysautonomia: disruption in the autonomic nervous system, which is responsible for bodily functions like blood pressure and digestion.
The “simple faint,” also called neurocardiogenic syncope (NCS), is one of the most common signs of dysautonomia, occurring either occasionally or often. NCS patients experience a recurrent, transient loss of consciousness accompanied by sudden decreased heart rate and lower blood pressure, and then spontaneous recovery.
(The simple faint can also refer more specifically to “vasovagal” syncope, fainting triggered by an emotional event.”)
The other common sign is postural orthostatic tachycardia syndrome (POTS), lightheadedness on standing up. Without an immediate reaction from the autonomic nervous system to get blood moving back up towards the head, it remains in the lower part of the body, making the heart beat faster and the blood pressure drop suddenly. Most POTS patients have other symptoms like fatigue and headache.
What sends the nervous system out of whack is often a previous health trauma, such cancer treatment, infections or food poisoning; a mental health trauma; or something simpler like dehydration or stress. For about half of those with POTS, the condition follows an immune reaction to an infection—and auto-immune markers remain in sufferers.
Auto-immune diseases, such as multiple sclerosis and diabetes, are often the primary diagnosis in dysautonomia sufferers. Many others have at least one additional diagnosis, such as anemia, chronic fatigue or Guillaume-Barre syndrome, for which treatment can diminish dysautonomia symptoms.
Although sufferers like D.M. can keep working, others like Tori Foles have been “bedridden, hospitals..battles every day…last couple of years,” according to her husband, Jaguars quarterback Nick Foles.
“There is a huge knowledge gap” concerning the nervous system, how it works and why it breaks down, according to Ryan Cooley, co-director of the Dysautonomia Center in Grafton, Wisconsin. Because detecting dysautonomia is challenging and can take years, patients often tell doctors who finally make the diagnosis: “No one believed me.”
Treatment depends on individual symptoms, which vary widely among 15 different kinds of dysautonomia. For some, advice includes drinking fluids, wearing compression clothes to help prevent blood from pooling in the legs, and boosting salt levels.
For D.M., the number of medications prescribed so far, including those to treat low potassium, low thyroid and high blood pressure, seems overwhelming. Doctors have confirmed her meningioma but say it’s not worrisome. Her next steps involve more specialist visits, including to the cardiologist who originally cleared her but now, at D.M.’s suggestion, has scheduled a carotid artery test; and a neurologist to figure out the fainting, though she’s still searching for someone local who specializes in NCS.
Meanwhile, debilitating fatigue makes it difficult for her to progress on any of these fronts, though she still makes it through a full day of work and loves her job.
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
“SOCIAL DISTANCING”— keeping at least six feet away from other people—is the advice for those over 60 and those with severe, chronic medical conditions, to minimize risk from the current coronavirus.
On March 6 the CDC advised that these two groups “stay home as much as possible”—based on data indicating that older people are twice as likely to become seriously ill from the virus.
“I think clearly the time has come to take these steps,” said University of Minnesota infectious disease specialist Michael Osterholm, a frequent advisor to the federal government on public health issues.
Avoid travel by airplane, going to movie theaters, attending family events, shopping at crowded malls and going to religious services, suggests Vanderbilt University Preventive Medicine Director William Schaffner, longtime advisor to the CDC. For religious services, Schaffner says, “Don’t go. Be reverent at home.”
As of March 8, recent cases included an Uber driver in Queens, New York, and an attendee at CPAC (Conservative Political Action Conference), which President Trump and Vice President Pence attended but were never in the same room as that individual. Locally, Montgomery County, Maryland, has reported five confirmed cases of coronavirus, with two in D.C. and three in Virginia—based on limited testing.
Insufficient paid sick leave may be among the most intractable obstacles to preventing contagion, according to past CDC head Richard Besser, among other “failures of public policy and imagination” responsible for the millions of Americans living with inadequate or no health insurance or who otherwise have no easy access to healthcare.
For many travelers, the greatest worries about the virus concern the inconveniences of getting stuck for two to three weeks in quarantine and the heightened risk of infection among passengers in confined spaces, particularly on airplanes. Anyone purchasing tickets now should look for “cancel-for-any-reason” trip insurance.
Some airlines have canceled flights to and from China, Hong Kong, South Korea and Milan until late April or early May. Many offer relaxed cancellation policies, and some sent out notices about additional hygiene precautions on aircraft using HEPA filters and additional disinfectants and cleaners.
“When we are advised by the CDC of a person who has traveled on board and is potentially exhibiting corona virus symptoms, that aircraft is taken out of service,” according to United’s email to passengers. United is offering free exchange over the next 12 months for any ticket purchased between now and March 31.
The most important, persistent questions concern the total number of people infected with the virus—because if, as suspected, that number ends up at two to ten times the current published total, just above 100,000, rates of serious illness and death will plummet. On the other hand, the number of deaths now attributed to the virus might be low as well.
Don’t shake hands. Say “Namaste” instead. / Photo/ iStock
In addition, the current death rate of about 1% of symptomatic cases is unevenly distributed—maybe as low as .1% in younger groups, with rates for those over 60 climbing to 5 or 10%. Regardless of the numbers, the virus has already killed thousands of people.
In the U.S., lack of test kits along with overly strict limits on who gets tested have been obstacles to accurate accounting. When the CDC was unwilling to reveal total numbers of people already tested, The Atlantic conducted interviews with public health officials and surveys of local data across the country that as of March 6 led to a paltry total of 1,895 tests —of which about 10% tested positive.
Even with ramped-up production, only about several thousand test kits will be available each day—in contrast to the million-plus kits promised by the FDA and the Vice President, according to The Atlantic: “The figures we gathered suggest that the American response to the coronavirus…has been shockingly sluggish, especially compared with that of other developed countries.”
The CDC has encouraged “jazz hands” greetings (pictured above) in the age of corona virus. / Photo/ iStock
In the U.S, inadequate testing for the coronavirus also stands in sharp contrast to past responses to new viruses, such as the 2009-10 H1N1 pandemic virus—also called “swine flu,” similar to the virus responsible for the 1918-1920 Spanish flu—when the CDC organized production of huge quantities of test kits around the country. Beginning in April 2009, the H1N1 virus affected an estimated 60.8 million people and caused 12,469 deaths in the U.S.
While warm weather may lead to the waning of this coronavirus—typical behavior for seasonal flu—the H1N1 arose in springtime and continued through the summer. Also because the current coronavirus is new, with no existing immunity in the populations, experts say its behavior is impossible to predict.
Healthy greetings—rather than handshakes—include fist bumps and the customary Indian greeting, “Namaste.” The CDC has encouraged jazz hands: either with extended arms or hands along the sides of the face, palms facing the greetee, fingers splayed, and hands waving sideways and/or fingers wiggling.
—Mary Carpenter
Well-Being Editor Mary Carpenter is keeping her eye on the corona virus for us. For more of her posts, click here.
FLU SYMPTOMS—fatigue, cough, aches and fever—these days create fears of the circulating coronavirus, particularly among travelers to China and northern Italy. But for travelers and those living in the West—or Mexico or South America—an increasingly likely diagnosis is Valley Fever, caused by a fungus carried by desert dust.
In fact, climate change may wreak its worst havoc on human health by way of airborne organisms, which are increasing with hotter, drier lands and warmer waters.
In drier regions of the country, Valley Fever has been on “a steady climb” over the past two decades—mostly in western states, including New Mexico, Texas and Nevada, with the highest numbers in Arizona and California, according to pulmonologist Michael Peterson at UCSF Fresno.
“It’s hard to be a doctor in Fresno and not have to deal with Valley Fever,” Peterson said. According to some predictions, “a warming climate will allow Valley Fever to expand throughout much of the western United States” by 2100. Even now, many people diagnosed with pneumonia in those regions may have Valley Fever, meaning many thousands more cases than official totals—15,611 in 2018, with more than half in California.
Besides flu-like symptoms, Valley Fever can cause a rash of painful red bumps on the lower legs, chest and back. The disease can resolve without treatment or can progress to a chronic form of pneumonia, most often in people with weakened immune systems.
The most serious outcome, disseminated coccidioidomycosis, causes nodules, ulcers and skin lesions throughout the body that are sometimes mistaken for cancer; painful joints; and meningitis, infecting membranes of the nervous system, including the brain.
Those most prone to develop serious infection are people of African-American and Filipino heritage, with African-Americans 10 times more likely and Filipinos 175 times compared to Caucasians—making susceptibility most likely genetic for these groups. Other populations at risk include those over 60 or with weakened immune systems, for example, living with HIV-AIDS.
“We actually know much less about fungal pathogens than we do about other types of microbial pathogens,” explains UCSF microbiologist Anita Sil. Coccidioides immitis is a class of soil fungi that can shape-shift inside the host, in one phase growing larger than the immune cells that would normally destroy harmful microbes. “These fungi…become attuned to manipulating the human immune response and are really very good at surviving long-term in the human body,” according to Sil.
Another airborne threat, smoke from worsening wildfires contains gases as well as particles from burning trees that can impair lung function and worsen chronic lung and heart disease. Despite advice to residents to stay indoors and use indoor air filters and, when outdoors, to wear medical-grade masks, health risks from smoke are difficult to avoid—even for those living many miles from the fires.
The EPA’s “good air quality” upper limit for microscopic particulate pollution, called PM 2.5, is 12 micrograms per cubic meter. Particulate pollution after the Camp Fire in California last year rose to the “very unhealthy” level of 200—and levels in Bethesda, Maryland, on its worst day of 2019, rose to 38.
For those living or vacationing near oceans and lakes, red tides and blue-green algae blooms linked to global warming send toxins into the air that risk damaging the lungs, liver and nervous system. While Florida has had the worst outbreaks in recent years, blue-green algae has appeared in the Chesapeake Bay, New England and elsewhere.
Following last year’s several months-long spike in blue-green algae levels in Florida, scientists detected cyanobacteria toxins (associated with liver cancer and neurogenerative diseases like Parkinson’s) more than a mile inland, according to marine biologist Mike Parsons at Florida Gulf Coast University, interviewed for the video series “Protect Your Water.”
“Makes you wonder if other waterborne pathogens can aerosolize, like PFAS, glyphosate, atrazine,” says one of the video producers. “We know enteric bacteria does—you can smell it.”
PFAS, fluorinated chemicals used in consumer products including fire-retardants and nonstick pans, may cause prenatal health issues, high cholesterol and immune system dysfunction. These chemicals have shown up in the drinking water of dozens of U.S. cities and are widespread in rainwater.
Glyphosate, the primary ingredient in the weed killer Roundup and linked to hormone disruption, has made its way into the majority of U.S. rivers and streams and appears in about 70% of rainfall samples. Atrazine is the more toxic herbicide ingredient that glyphosate was designed to replace.
Another airborne threat, microplastics—from tires, textiles and personal care products—have dispersed in oceans and snow from the Arctic to the Alps and can cause lesions in the respiratory system especially harmful to those with existing lung problems.
Efforts to reverse global warming with the hope of reducing air- and water-borne health risks often looks like one step forward followed by a giant step back. But spreading awareness about risky microorganisms, chemicals and microplastics can help with diagnosing specific health issues—and may boost motivation among individuals to play their part in combating climate change.
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use
Note: This post addresses readers’ questions regarding my February 2 post on collagen—most related to choosing among different formulations: powdered collagen, gelatin and bone broth.
COLLAGEN IS suddenly everywhere: huge displays of giant powdered collagen containers at Whole Foods; and dozens of choices of brands, and more choices within brands, on Amazon. In my first consultation about joint pain with a new doctor, he gave me one prescription: bone broth!
Because there is no FDA regulation of supplements, including any ingestible collagen—either of actual content or of purported health benefits—most information about health claims and criticisms, positive and negative, come from manufacturers and fans. What made an impression on me was three acquaintances, all with advanced degrees in science, who told me about daily doses of collagen causing their hair and nails to thicken—probably not a placebo effect in their cases because none desired this result.
Research mentioned in my previous post—although involving only about 800 subjects in 11 studies —found that some collagen formulations worked well for aging skin, healing wounds and other problems, while others showed good results for increasing skin elasticity and hydration.
Studies on joint mobility and pain have been less conclusive. A recent study by British and Italian investigators of 120 patients found improved mobility and reduced pain —but they took a “nutraceutical” that included, along with hydrolyzed fish collagen, “vitamins, antioxidants and other active ingredients” — making it unclear what caused what.
In the absence of FDA oversight or adequate research, online review sites that compare and rate collagen powders —which can be made using ground-up animal, fowl, or fish parts (those marketed as “plant-based” do not contain collagen) —can provide helpful information.
The Smarter Reviews comparison concluded that bovine collagen is the most “potent and effective”— and recommended “hydrolyzed” collagen, with broken-down amino acids that are more easily absorbed by the body.
Those touting collagen from beef contend that cows and pigs have an amino acid profile closer to humans. For people who don’t want to eat meat products, fish collagen preparations score high on most reviews.
For bovine collagen, the question arises: why not the old, familiar, and by far cheaper Knox gelatin? The most common reason is the inability to obtain information from Knox about their source animals — in particular about whether the animals’ diets are organic and/or non-GMO —as well as which parts of the animals are used. Also, compared to Knox, newer formulations have little or no taste.
A related question concerns the difference between gelatin and powdered collagen. According to manufacturers, formulations of both offer the same health benefits, but most gelatin dissolves only in hot liquids and has a thickening effect, while most collagen powders do not thicken, and they dissolve in liquid at any temperature.
While people generally add gelatin to hot cereal or other hot foods, most add collagen powder to coffee—and most agree about the advantages: easy to mix, tasteless and no thickening. But a few fans say they can taste the added product or that in cold liquids some formulations fail to dissolve completely, leaving gooey clumps that float and stick to the sides of containers.
The greatest number of questions arise about the choice of powder—not just which brands, but which products made by those companies. Great Lakes, for example, voted best overall in the “Best of 2020” by verywellhealth, offers several different products.
Great Lakes “bone hydrolysate” (red-printed label) comes from bones and hooves, preferred by some for the minerals; while for hydrolysate alone (green-printed label), collagen is extracted from the animals’ hides, explained in a call to Great Lakes customer service.
Another brand, Vital Proteins, won top awards at three sites, including “best powder” at number two on verywellhealth; and number three on Smarter Reviews.
Bone broth offers a completely different collagen option, seeming the most natural because it’s food not powder— although some worry that the amino acids in broth, not hydrolyzed or broken down, may be less well absorbed by the body.
Confusingly, bone broth is unlike traditional “broth,” which involves cooking bones with meat —or almost anything including vegetables—for an hour or so. “Bone broth” is closer to the thicker “stock,” made by boiling cleaned bones for 18 to 48 hours to allow collagen to be released.
Investigating my new doctor’s bone broth prescription, I found hypotheses and research on the connection between my issues—joint hypermobility, inflammation and chronic pain, sometimes called “joint hypermobility syndrome”—and inherited disorders of collagen synthesis, like Ehlers-Danlos syndrome.
To combat the ravages of aging skin, ingesting collagen seems to offer the best evidence for improving hydration and elasticity, although friends’ accounts of thickening hair and nails are better motivators for me. For joint pain, I try to go with recommendations from a new doctor when possible —I bought a balance board despite doubting I will ever master it sufficiently to benefit. But I have already tried and failed with so many other hopeful potions (glycosamine, hyaluronic acid, cortisone) that I might not add bone broth if I hadn’t already been hearing and reading about collagen. And because I resist adding bone broth to my diet every day—certainly not for breakfast as suggested—adding collagen supplements seems worth a try.
Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter delivers health news you can use.
