The value of FEVERS and KEEPING YOUR NOSE WARM!

Although we hate to admit that our mothers were right, they may have had the “don’t go out without a jacket or you’ll catch a cold” issue right. The cold air and temperatures can raise the risk of an infection taking hold in many ways, from drying the lining of the nose and mouth to suppressing inflammatory cells circulating in our bodies. Now there appears to be another way that the cold air can lead to infection.

My good friend Ollie sent me a news item where they referenced a Journal of Allergy and Clinical Immunology article describing how just reducing the temperature inside the nose by as little as 9 degrees Fahrenheit (5 degrees Celsius) can dramatically increase the risks of actually getting sick after exposure to a bug.

Colder temperatures in the nose result in fewer immune, bug fighting cells, by as much as 50%. One of the side effects of that is that small structures called extracellular vesicles (EV’s) produced by those cells also become significantly reduced.

Compared with the cells which make and release them, EVs contain as much as 20x more viral receptors on their surface and 13x more microRNA (mRNA) which attacks and kills viruses specifically. They attract more viruses and have a greater capacity to kill them. The number of EVs in the nose typically go up by 160x during an active infection, unless the nose is cold! These vesicles also act as “decoys” preventing the virus from invading actual cells they can replicate in. EVs lack the machinery for viruses to hijack and reproduce (they technically don’t reproduce, just make copies of themselves).

A simple fix is to wear a mask. Everyone has certainly noticed that the nose is warmer and produces a little more mucus when wearing a mask. I found no actual data on how much masks increase nasal temperatures but it makes sense that it would. There are studies showing increases in oral temperature but only by a degree or so. Although tight fitting N95 masks provide the best antivirus protection, a surgical mask and even a cloth mask would increase the temperature of inhaled air. So, there we have it. Another reason to mask up.

FEVERS. Although we think of a fever as a side effect of infection, and it is, it’s value is more as a means to combat the infection. When the body is attacked by an invader, body temperature increases. This happens for a variety of reasons including things like improved blood flow to tissues so that oxygen and nutrients can be delivered for recovery. But from a microbial attack standpoint, fevers actually are a very important defense mechanism. Here are a few points:

• First of all, they are a sign that something is wrong! Infection, dehydration, injury… PAY ATTENTION!
• Fever activates immune cells and promotes the production of cytokines, the inflammatory molecules which combat infection. When overactivated, cytokines produce the dreaded “cytokine storm” we heard about at the start of the pandemic. This is an over reaction of an overwhelmed immune system.
• Viruses replicate more at cooler temperatures. As an example, the Polio virus replicates 250x faster at normal body temperatures than at febrile temperatures.

• Fevers help maintain the integrity of tight junctions in the gut, preventing microbes from penetrating in.
• Fevers also trigger production of viral-combating compounds by the intestinal lining.
• As we age, the ability to mount a febrile response diminishes which is partly why older people are more prone to complications from infections. It is also a less reliable sign of infection in the elderly.

A fever is a fever. The standard cutoff is 100.4. However, there are some differences based on age, and even time of day. An adult probably has a fever when the temperature is above 99°F to 99.5°F (37.2°C to 37.5°C) as measured orally. A child has a fever when the temperature is at or above one of these levels:

• 100.4°F (38°C) measured in the bottom (rectally)
• 99.5°F (37.5°C) measured in the mouth (orally)
• 99°F (37.2°C) measured under the arm (axillary)

If you can handle the discomfort a bit, suck it up and deal with the fever. You’ll recover faster. Make sure to stay well hydrated since dehydration alone will cause a fever and when you’re sick, your metabolism is ramped up and you lose more water. If you’re above 102 degrees, or there are any issues with seizures in the past, treat it.

Remember to keep doing all the important things to keep yourself, and all those around you protected and healthy.

MASK

DISTANCE

HYGIENE

VENTILATE

VACCINATE

GET HEALTHY!!

Have a great weekend.

Stay safe and Be well.

AC

This term has been used in the public recently, describing not just the pandemic caused by the SARS-Cov-2 virus which causes the  Covid-19 infection, but also the significant presence of 2 other viruses, the influenza virus as well as RSV which has particularly affected kids.

Although both of these additional infections are certainly making their presence known, we can’t lose sight of the fact that Covid should still be our primary concern. And the good news is that strategies to prevent getting Covid and minimizing the severity of infections which work against Covid also work against the Flu and RSV.

Both the Flu and RSV have been around for many decades but this year has seen the earliest start to their infectious seasons in over 10 years. The numbers of hospitalizations have also significantly gone up however, some of the numbers are skewed.

For example, there are reports of pediatric hospitals being full of RSV patients. While it is true that there are many kids affected by this virus and the numbers are worse than in previous years, the overall numbers are not that dramatically different. And the shortages of beds are partly due to the trend over the last few years of hospitals closing wings and having fewer beds available as well as having less staff being able to take care of all the patients.

The flu numbers are also elevated and much earlier but keep in mind that Covid-related hospitalizations are still 3x higher than Flu-related hospitalizations. The worst flu season in recent decades was in 2018 when about 70,000 people died in the US but this pa;es in comparison to how many have died from Covid. Covid deaths today are at its lowest point since the start of the pandemic but 400 a day are still dying, which is over 140,000 a year, double our worst flu season.

The statistics about the benefits of vaccination, especially getting the bivalent booster, remain positive and strong. Without the booster, you are at least twice as likely to have a more serious infection and need to be hospitalized and/or die from Covid. Sadly, the booster rate remains very low and the Covid death rate remains stable, still #4 on the list of causes of death in the US behind cardiovascular disease (#1 since we’ve kept such records in the late 1800’s), cancer and accidents.

All the other strategies protecting people from Covid also work very well against Flu and RSV. Masking, keeping your distance, staying away if you are sick, proper hygiene, and don’t forget improving your general health status. This last piece is so important but sadly, the general population’s health has continued to decline and weight continues to rise.

CHINA CRISIS is a 1980’s New Wave band responsible for such hits as “Dance Hall Days” and “To Live and Die in LA”. I’m an 80’s guy, but that is not what I am talking about. China’s “zero Covid” strategy is failing miserably. Although their reported cases and deaths are low, their strategy to achieve this is backfiring. The people are rebelling against the Chinese government’s draconian lockdown policies and there are signs that, rather than risk a complete rebellion by the people, they will start to ease restrictions. This will most likely lead to massive spread of Covid for a few reasons. 

First of all, despite their control of the masses, their vaccination/protection rate is very poor. The official statistics from China look great claiming that 90% received the full vaccination, however, some claim that their rate is closer to 65%, particularly in the elderly, most vulnerable population. But their booster follow up has been dismal, even by their reports. With their low infection rates, this also means that few people have gotten ill and have some degree of natural protection.

Secondly, their Sinovac vaccine, the only one available to the masses, stinks. It provides poor protection against the original strain and virtually no protection against the variants.

Thirdly, their medical infrastructure is challenged. Their ICU bed numbers are 1/10th of what we have here in the US and they have a significant rural population, unable to get adequate medical care. So if there is a significant Covid outbreak, and all signs are already pointing to this, it will lead to collapse of their medical system, with many people not being able to get treatment and many unnecessary deaths. Scenes like what we saw in Italy and NYC in the early stages of the pandemic may be common.

For the rest of the world, more Covid outbreaks in China will lead to many mutations and viral variants surfacing, so the cycle of worldwide spread and repeated spikes will continue.

We can say what we want about what we think China should do, but their government will do whatever it wants. One could argue that all we can do is just sit back, watch what happens and hope for the best, but there is lots we can do like working on our health, building up a foundation of resilience to deal with the likely future waves of Covid-19.

Please get your Covid vaccine and/or bivalent booster if it’s been 6 months. I’ve been really saddened by recent discussions with patients and even some close relatives who are getting influenced by online theories about how the vaccine may be causing harm and even causing deaths. I am no fan of the pharmaceutical industries, and they do lie and intentionally confuse the public, but these vaccine rumors are simply not true and the studies clearly show that the benefits considerably outweigh any minimal risk. Please get both the Covid and flu vaccines. You can get them simultaneously.

If you do get sick with Covid and have risk factors, please get the antiviral Paxlovid. It DOES reduce symptoms and risks of serious disease quite significantly. And again, the rebound issue is a non-issue. The rates are identical to the rebound rates in people who did not get the medicine.

If you get the flu, talk to your doctor about taking Tamiflu, the antiviral drug against influenza. It’s been around for many years and has proven beneficial. 

No vaccine or antiviral treatment are available for RSV or other common viruses out there like adenovirus, as well other types of coronaviruses.

Which brings me to my last point. This 5 day rule about isolation and return to work has been abused and should be really reconsidered. Studies show that 60% of people remain contagious 9-10 days out! Some remain contagious for up to 20 days, especially if one had a rebound flare up. If you do go out after 5 days, please wear an N95 mask for an additional 5 days to protect everyone else. It also protects you since your immune system is impacted by the infection, increasing the risks of getting another infection and I have seen many patients who got the double whammy of flu followed by Covid within a week or two, and vice versa and these people are miserable for many weeks afterwards. As far as using a “test-based” strategy, keep in mind that the tests are much less accurate when it comes to the most recent variants both from a positive and negative perspective. DO NOT assume you are no longer infectious if you test negative if it has only been a few days after a positive test. Test and retest.

Have a great weekend.

Stay Safe and Be Well.

AC