Another Covid Surge!

Hello everyone.

Dr. Chuma here.

Sadly, rather than discussing more interesting lifestyle issues, with rising numbers, I felt that a Covid update was in order.

After many months of continuously declining numbers of hospitalizations and deaths from Covid, there has been a significant recent surge. The hospitalizations from Covid have risen nationally by 25% in the last 2 weeks. Fortunately, the number of serious cases needing ICU admission or leading to death have not risen to the same degree, but these numbers always lag behind by a few weeks so we will see how things go in the near future. 

This rise in hospitalizations certainly indicates an increase in Covid cases in the community but it is very hard to get a good handle on these numbers since no one is testing anymore and all the systems which were used to track Covid have been dismantled.

There are a few reasons for the present spike. Many social gatherings such as graduation parties and proms bring many people together, but more importantly less vigilance when it comes to preventing spread of diseases in general is primarily to blame.  

Despite being in a very high risk specialty, I managed to avoid catching Covid, until 2 weeks ago. I developed some fatigue, achiness and nasal stuffiness. I was concerned that I had caught some bug from the office or hospital. With the upcoming Fathers day weekend and a few gatherings I was going to attend where there were older or at risk people, I tested myself and there it was. The positive red line. I tested myself twice just to be sure. I was devastated, not because my Covid-free “streak” was broken, but because I had put myself and others at risk. I let my guard down somewhere and got infected. Fortunately, none of my patients, coworkers or other close contacts developed Covid. 

I was surprised to hear from some medical colleagues that they wouldn’t have bothered testing. After all, “you don’t know you have Covid if you don’t test”. I was disappointed by this attitude since this disease is still very much present in our society and it has serious implications for many people. There is still a significant mortality rate and there is also an 8% long-haul symptom rate. 

It was a reminder that Covid is still very much around, no one is immune, and we have conveniently forgotten about it and how it spreads. 

So here are a few refresher facts.

It is spread by simply breathing, not just by mucus and saliva when we sneeze or cough. It is unique in that regard. That is why Covid is not seasonal. 

There is a prevailing idea that masks do not work. This is patently untrue. Although the majority of masks people are wearing don’t work, clearly N95 or KN95 masks work very well. Cloth and even surgical masks are minimally effective, but they at least alert everyone that something is up.

The notion that vaccines do not help is also ridiculous. There is no question that vaccines have saved millions of lives worldwide and have significantly reduced the severity of symptoms if you still get infected. Vaccines are no guarantee against infection, and I am proof of that, but they can significantly reduce the severity of the disease, which I am also proof of since I only had mild symptoms for a few days.

The isolation protocol if infected has not changed. The recommendations are still to isolate for 5 days from symptom onset, and then to wear an N95 mask for an additional 5 days if around people, but only if free of fever or other major symptoms such as coughing or sneezing for at least 24 hours. 

Follow up testing is also not recommended. First of all, there is a significant false negative rate so assuming you are no longer infectious after one negative test should not shorten your isolation or masking responsibilities. Secondly, both lab and home tests can continue to be positive weeks to months after someone is no longer contagious.

Remember that 75% of people remain infectious at day 7 and 10% can still spread it at 10 days. 

As we head towards another holiday weekend, there will undoubtedly be get-togethers. Given the sharp rise in Covid cases, please be careful and if you have any symptoms, stay home regardless of Covid status. Sick is sick. But please do test, protect those around you and take care of yourself.

If you do get sick, rest, drink plenty of fluids and push the fruits and vegetables which are full of fiber, antioxidants, vitamins and minerals. If you are over 65 or have any chronic diseases which put you at increased risk, consider taking the antiviral Paxlovid. Be sure to check with your doctor about possible drug interactions. Common ones are cholesterol meds or blood thinners. 

And don’t look for any other magic bullets. There aren’t any.

Despite some of the crazy political rhetoric out there, we enjoy some amazing freedoms and advantages not experienced by most of the rest of the world. It’s important to appreciate what we have in this great country, and not complain and whine about what we want!

Enjoy your family and friends. Thank you to all those who serve, protecting all of our freedoms.

Have a great and safe Independence Day, and for my Canadian brethren, have a great Canada Day.

Stay Safe and be well

AC

“Human beings are the only species that deliberately deprive themselves of sleep for no apparent gain. Many people walk through their lives in an underslept state, not realizing it.”

Sleep is CRUCIAL. Animals, including humans, die of sleep deprivation sooner than they will of starvation. 

Without proper sleep, many chronic diseases worsen significantly, including dementia which is on a dramatic rise in all developed countries.

Just like any other part of the body, the brain builds up debris. It is washed away by the lymphatics of the brain but this cleansing system is only active when we sleep. With a proper night of sleep, the brain actually shrinks by as much as 65% to allow this process to function more efficiently. 

Amyloid is the most concerning type of debris which builds up in the brain and excessive amounts impair nerve function leading to dementia. Even 1 night of poor sleep not only causes the cells responsible for this cleaning process to stop clearing the amyloid away, but it switches their function into a destructive one, breaking down healthy tissues.

In addition to cognitive changes and dementia, many other health issues are affected by poor sleep. The day after Winter Daylight Savings Time, when you lose only 1 hour of sleep, there is a 24% rise in heart attacks. The reverse happens when we gain an hour. Similar increases and decreases are also seen in the number of road accidents and even in the suicide rate. 

Only 4 hours of sleep deprivation results in a 70% decrease in production of natural killer cells, immune cells responsible for looking for and destroying cancer and other unhealthy cells which are generated in the body on a daily basis. 

One study showed that sleeping 6 hours or less negatively affected over 700 genes. Those associated with chronic inflammation, stress, cardiovascular disease and cancer were activated while genes associated with immune system protection and metabolic stability were turned off.

Various compounds such as hormones are secreted mostly at night when we sleep. When sleep is disrupted, they can’t function normally. For example, at least 3 hormones responsible for apatite management malfunction with poor sleep, contributing significantly to weight gain. We also produce 95% of our growth hormone during sleep, mostly between 10pm and midnight.

There are 4 equally important stages of sleep and we move from one stage to another with each cycle lasting about 90 minutes. As the night progresses, the amount of time spent in different stages changes. Many different restorative functions occur during specific stages of sleep. For example, it’s during REM, or rapid eye movement sleep that we transfer short term memories and knowledge accumulated during the day into more permanent memories. That stage increases during the night so if you don’t sleep long enough, your short term memory quickly becomes impaired.

Almost 20% of Americans take something to help with sleep but drugs are not the answer. They almost all put you to sleep, but the quality of your sleep is just as bad, if not worse. Almost all of them disrupt the normal progressive patterns of sleep. One of the few exceptions to this is the mineral Magnesium, which is important for good sleep but is deficient in almost half of Americans because of the lack of enough fruits and vegetables in their diet.

So what are the top behaviors which impact on sleep quality?:

REGULARITY AND CONSISTENCY. Waking up at the same time every day is the most important habit to develop to improve sleep quality. It’s more important than going to sleep at the same time.

DIM THE LIGHTS. We evolved going to bed when the sun went down and getting up when the sun rose. The concept of “night owls” is a myth and is a byproduct of artificial light exposure. As the light diminishes, the levels of the sleepiness hormone melatonin increases. Light exposure, whether natural or artificial, slows that rise and impairs how quickly you are able to get to sleep and worsens sleep quality. Dim the lights and stop looking at ANY screen at least an hour before bed. Staring at a TV, iPad or iPhone for an hour before bed decreases production of melatonin by 50% and delays its peak production by 3 hours.

More importantly, devices overstimulate the brain which is the opposite of what our brains should be doing in preparation for sleep.

GET AMPLE MORNING LIGHT. As important as it is to turn down the lights at night, it is equally important to reset our internal clocks by getting some sunshine as soon as possible after we get up.

STRESS REDUCTION TECHNIQUES like prayer and meditation slow down the brain and help induce sleep.

LIMIT CAFFEINE. Caffeine is a stimulant and is eliminated very slowly from the body. Although it may not prevent some of you from falling asleep, it definitely fragments and causes poor sleep quality. Try not to consume any after lunchtime. Even decaffeinated beverages can still have a significant amount of caffeine depending on how they are decaffeinated.

LIMIT ALCOHOL. Even one drink will impact sleep quality. Although initially alcohol is a sedative, its breakdown products are stimulants. It also causes sleep fragmentation and suppresses REM dream stages of sleep. Alcohol also makes you pee more, which disrupts sleep and it leads to brain dehydration, contributing to headaches and fatigue.

EXERCISE. It’s great for you and does help you sleep, just don’t do it within a few hours of sleep. The adrenaline which is produced during heavy exercise is a stimulant.

Keep the bedroom as DARK as possible. Using an eye mask can be helpful if your blinds are not light blocking.

KEEP THE TEMPERATURE COOL. Although some people love the feeling of warm blankets, they work better if the room itself is cool, ideally around 68 degrees. Elevated body core temperature impairs sleep. One way to cool your core is by taking a bath or warm shower before bed.

SLEEP ON AN EMPTY STOMACH. Melatonin actually slows digestion and digestion reduces melatonin production. It’s a loop. Eating late also causes reflux which affects sleep quality. Don’t consume anything at least 2 hours before bed.

If despite all your efforts, you can’t sleep for more than 20′, it’s better to get up and do some reading or something light. The brain is an incredibly associative organ and you don’t want the brain to think that the bed is a place to lay awake ruminating about things and not sleeping. The same goes for having a TV in the bedroom.

The bottom line is that sleep is very important for your overall health and getting into patterns which produce natural sleep of appropriate duration should be the goal.

There is a lot more information about sleep and ways to improve it on my website doctorchuma.com

Have a great weekend and happy Father’s Day.