Covid Updates and fears over a NEW Chinese Outbreak

Ok, I have to admit that the title was click bait!

There is an outbreak of respiratory issues, including significant pneumonia in China, especially in kids. MAny of these cases are from COvid, but there is no NEW variant of concern nor is there a NEW virus or outbreak to worry about. 

What China is experiencing is a significant rise in respiratory infections, but it is from a combination of Covid, RSV, the Flu as well as a bacterial infection we do see here as well, Mycoplasma. Now, unlike here in the US where we really did not have any significant lockdown relatively speaking (more on that below), China’s “0” Covid policy led to draconian lockdowns, unfortunate avoidable deaths from such things like appendicitis because of those policies. They truly have what is now called “immune debt”. With all of these bugs not circulating the way they normally do during non-pandemic lockdowns, providing some degree of local immunity, their population is now overwhelmed with little to no protection. Add to that that their Covid vaccination policy was and remains surprisingly very loose and a significant proportion of their population remains unvaccinated. During the lockdowns, kids also failed to receive their routine vaccinations, making them more vulnerable.

Did that happen here? We yes we did have a reduction in the cases of Flu, RSV and other infections, but it was not because of any lockdown. What the US experienced as a lockdown was comparatively speaking pretty minimal. At the start of the pandemic, 40 states did impose some kind of restrictions, but they were mostly lifted within 2 months. In addition, “essential workers”, who were exempt from any restrictions in some states, accounted for as much as 82% of the entire workforce. The rampant spread of Covid and the number of deaths in the US, a rate higher than any other country in the world, is proof of that.

So what accounted for the drop in infections? It is not clear. But it is strongly felt to be actually related to all the Covid we saw. We do know that the chances of getting Covid is low within a few months of having the flu and vice versa. This probably has to do with a boosted immune system, while the body was trying to combat the first infection. The same phenomenon is thought to account for the reduced rates of dementia, particularly Alzheimer’s Dementia, in those who regularly got the flu vaccines. Increased immune activity clears more amyloid plaque from the brain. Increased immune activity protects us from other pathogens.

OVER RUN HOSPITALS? Or understaffed with fewer open beds? Our healthcare system is the most expensive in the world, easily doubling the nearest developed country. Reimbursement drives services and the fact remains that even the best run hospitals all lose money. The result is fewer beds, increased stress and a shrinking workforce from all the stress. Take nursing numbers for example. Before the pandemic, there was about a 10% early retirement rate amongst nurses, a result of an already taxed and over demanding system. The number doubled to 20% during the pandemic and remains at that rate. Physician provider attrition rate is also very high. The chances of you seeing a non MD/DO provider in any emergency room is very high. Now many of these providers may be great, there are some clinical situations that require a level of decision making that should be reserved for doctors. I experienced this exact situation over Thanksgiving. I was on call and got called to see a patient with a potentially lethal throat infection more than 18 hours after they were admitted. I should have been called immediately. Fortunately the patient did fine, but things could easily have gone the other way.

COVID. As far as this is concerned, numbers are once again on the rise in the US and CANADA, 2 countries who can provide at least accurate and reliable hospital numbers. In the US, Covid related hospital admissions went up from 15,000 a few weeks ago to 18,000 cases per week but ICU admissions remain stable. The Covid death rate is still about 1200/week. ER visits for respiratory issues represent ~ 2% of cases, but Covid accounts for 1.8%. Wastewater testing is elevated in every single area in the US except for the south, where it remains high, but stable. In Canada, hospitalizations are high and in fact are higher than where they were during the Delta wave in 2021. As is the case here, ICU admissions remain low however.

In Europe, Italy and the northern European countries are experiencing significant uptics in cases, hospitalization but deaths remain stable and low.

Worldwide, reporting is a shitshow. The WHO reports that only 44 of countries who are even bothering to report identified only 1 case of Covid between October and November. And only 18% reported a single death. Only 13% are providing any hospitalization data. So who knows what the heck is going on worldwide.

As much as people want to deny it, Covid is here and it’s not going anywhere. 

We can make a dent in this disease and protect the most vulnerable, but it takes vaccination, testing and isolation if positive.

As far as vaccination is concerned, the numbers are pathetic.

• Only 15% of adults have received the most recent booster
• More significantly, only 17% of nursing home residents, the most vulnerable, are up to date with their vaccines.
• Even more pathetic is that only 2% of nursing home employees, those charged with caring for the most vulnerable, are up to date.
• 40% of surveyed adults report that they will never get another Covid vaccination.

We CAN control this disease, but it takes being responsible and doing what we know works.

1. Get updated with all your vaccinations. Flu, RSV, Shingles, Pneumococcal and of course Covid.
2. If you are sick, Covid or not, stay away.
3. Test, Test, Test. You can get free tests from Covid.com/tests. As far as timing is concerned, if you are fully waxed or have had Covid in the last 6 months, you may have some protection and positive tests may not develop for up to 5 days after developing symptoms. So re-test if you are concerned.

Protecting our loved ones in the upcoming holiday season is crucial so please look out for yourselves and all those around you.

Have a great weekend.

Stay safe and Be Well.

AC

Although there have been a number of smaller studies linking various vaccinations with lower risks for developing Alzheimer’s Disease (AD), a recent study showed a striking link between the flu vaccine and lowering the risks of developing this devastating condition.

Dementia in general is the 7th leading cause of death in the US (3rd in Britain) with Alzheimer’s accounting for as many as 70% of the cases. There are other forms such as vascular dementia (associated with heart and vascular disease), Lewy body dementia, frontotemporal dementia (seen in people who played contact sports when they were younger, including even soccer!) and alcohol-related dementia. It is the most expensive disease to treat and manage, primarily because of the skyrocketing costs of supporting people who may be of relatively sound body, but can no longer care for themselves. Dementia is on a rapid rise and costs continue to increase, bankrupting many families as a lot of the supportive care these patients need are not covered by insurance.

Drug studies have cost billions over the years and with the exception of a relatively new drug Leqembi® (lecanemab) which only slows progression and does not reverse AD, no drug has ever been shown to be of any benefit. Even Leqembi has a significant brain-bleed risk and is very expensive. In addition to the $26,500 annual price tag for the drug, treatment could cost $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, such as dealing with complications and hospitalization. Lecanemab is a monoclonal antibody developed against amyloid. It binds to the amyloid and helps to clear it, however it does not clear the amyloid already bound to tissues. It does significantly slow the rate of progression of AD, but only in very early stages of the disease. It is NOT a cure.

Today, 10% of Americans over 65 have some form of dementia. Over 80, the numbers rise dramatically to almost 33%. 

Although there are some genetic mutations which can increase the risks of dementia, as much as 75-80% of cases are related to our lifestyle (poor diet, little exercise, too much stress, terrible sleep…) and can be prevented, delayed or slowed down dramatically.

I’ll elaborate a little below on lifestyle changes proven to prevent, delay and slow cognitive decline and dementia below, but let’s talk about vaccination for now.

This most recent study followed close to 1 million people, mostly over 65 years of age, for more than 8 years and looked specifically at the flu vaccine. If patients got the vaccine for 3 years in a row, their AD risk was reduced by 20%. If they received yearly vaccines (4-8), their risks were reduced by 40! 

Although one could argue that people who get vaccinated every year probably do other things to stay healthy, this study did account for such things like sleep, exercise, diet, education and financial stability, at least to the best of their ability to eliminate these confounding factors.

Other vaccines such as the pneumococcal vaccine, shingles and DPT (diphtheria, pertussis tetanus booster) also showed lowered dementia risk in other studies, however they were much smaller studies.

Why would vaccines provide any benefit against dementia? The answer is not clear but it is hypothesized that it has to do with, in addition to not getting those infections, they lead to boosting the immune system in general, which allows inflammatory processes in the brain causing dementia to be reduced. There may be improved clearance of inflammatory amyloid plaques which build up, impairing nerve conduction in the brain. Even Dr. Alois Alzheimer, who first described this disease ~ 1900, thought that there may be an infectious/inflammatory process contributing to the disease named after him.

What about the Covid vaccine? We just don’t know yet but it will likely prove to also lower dementia risk. We already know that the SARS-Cov-2 virus does attack the brain causing neuro inflammation so preventing infection would obviously reduce that contributor to cognitive decline.

As far as other strategies to reduce the risks of dementia, or at least delay it or slow its progression, there is a lot we can do. Even if you have any of the predisposing genetic mutations. There is a saying that “genetics loads the gun but lifestyle pulls the trigger”.

EXERCISE. One study showed that even walking briskly for 40 minutes 3x a week reduced the risks and even reversed some early cognitive changes. The hippocampus, the area of the brain responsible for memory, actually grows in those who maintain a regular exercise regimen. There are various benefits of exercise, but one significant one is that it leads to the production of BDNF (brain derived neurotrophic factor), a molecule which improves synaptic connections in the brain and even grows brain tissue. The more you exercise, the better. All forms are good. Some resistance training adds the benefit of strengthening muscles and bones, which is also very important as we age.

SLEEP. Chronically poor sleep has a significant impact on the development of cognitive decline and dementia. Shoot for 7-8 good quality hours a night. There are lots of strategies to improve your sleep. I have a lot about this on my website linked here https://doctorchuma.com/other-wellness-issues/#SLEEP_BETTER.

NUTRITION. Diet has a huge impact on not just reducing dementia risks but mental health in general. The Chicago Health and Ageing Project, which followed tens of thousands of people for decades identified saturated fat from animal sources as the most significant contributor to dementia. Plenty of fruits and vegetables were the most protective. And yes, a whole foods, plant based diet was the healthiest.

STRESS. Chronic cortisol production (the stress hormone) leads to various changes in the body including the brain. It impacts on how the brain uses nutrients and how insulin functions in the brain. Some forms of dementia are nicknamed “Type 3 diabetes” because of how important insulin is to brain health. Obviously other things like diet impact on insulin function but stress is a biggie. Stress also impacts sleep as well. 

HEARING LOSS. The MOST significant modifiable risk factor when it comes to brain health however is hearing loss! The problem with hearing loss is that the damage resulting in loss later in life starts very early and progresses very slowly so most people aren’t even aware of what they are missing. Just a couple of shows as a teenager where you left the arena with ringing in your ears is enough to cause loss later in life. Blow dryers, food processors, vacuum cleaners are examples of unexpected common everyday sources of noise. Obviously lawn mowers and leaf blowers as well as some recreational activities like hunting and loud cars can also contribute. If you are 40 or over, you should get tested. At least to know what your baseline is. Even a mild loss in your 40’s, if left unaddressed, doubles your dementia risk.

The bottom line is that there are many things you can do to reduce your risks of getting dementia or at least delay its onset or slow its progression. And vaccination is one of them.

As the number of flu and covid cases rise, it is imperative that you get vaccinated ASAP. It takes 10-14 days to reach maximal protection. 

As of last week, Covid still kills about 1200 people per week. That’s 62,000 people per year, close to the worst flu season we had in decades. Remember that in the 3 years of the pandemic, Covid killed over 1 million people in the US alone.  

The present Covid booster does cover the most prominent variants circulating today.

Also, doing all those other things which are protective is important (masking, distance, hygiene…).

A great reference about dementia and lifestyle measures to prevent it is “The Alzheimer’s Solution” by Dr. ‘s Dean and Ayesha Sherzai, neurologists who run the dementia clinic at Loma Linda University in California. I’ve linked the Amazon site if you want to get it.

Have a great weekend and a great Thanksgiving. Enjoy your families and friends.

Stay safe and Be well.

AC