General Wellness

ASYMPTOMATIC vs PRE-SYMPTOMATIC SPREAD

 

Just to show how information and misinformation is changing regarding Covid-19, the WHO (World Health Organization) announced and then retracted 2 statements last week. One had to do with how much disease is being spread by people who have no symptoms. Initially, they felt it was a lot, then maybe, not so much, and then now…we just don’t know. 

 

There is no question that people without symptoms can transmit the virus but we don’t know how many cases that accounts for. We do know that there are many patients who develop Covid with no known contact. This could be asymptomatic spread or simply touching a contaminated surface and then subsequent infection after touching your face or mucus membranes.

 

To add a little to the confusion are some other terms bantering about out there.

 

Asymptomatic spread means spread by people who have no symptoms. Many people who get the infection simply never get symptoms. This could be as a result of a healthy immune system, low degree of viral load which does not overwhelm the body or some other combination of factors we are still learning about like Vitamin D levels, blood type (O- are the most protected and A+ the least) or something else.

 

Pre-symptomatic spread is spread by people who are just about to develop symptoms. This is an important point since people are most infectious in the day or two before they develop symptoms. This is when the viral load is the highest in most people. This is why it’s important to do contact tracing and self-monitoring if you find out you were with someone in the day or two before they developed symptoms.

 

Remember that although most people develop symptoms with 3-7 days of exposure, the incubation period has been seen as long as 14 days.

 

Pauci-symptomatic spread. “Pauci” loosely means little or few. Some people may not have the classic symptoms of fever, cough and breathing difficulties. We now are adding loss of smell or taste, headache and GI symptoms to the list of common symptoms. But some people may have very mild symptoms like a simple runny nose, common during allergy season. Or they may just feel a little achy for a few days.

 

What all this means is that you need to be vigilant. This infection will be with us for a LONG time. Here are some hard facts:

1. The virus is mutating and becoming more infectious. This may not be bad since the significant disease or death rates do not seem to be changing but you never know. It is estimated to be 10x more infectious than before. If mutations continue, however, the virus becomes a bit of a moving target, like the yearly Influenza (regular old flu which killed 70,000 Americans in 2017). It could als become more deadly.
2. To reach herd immunity, if that’s even possible, we need 70% of the population to have antibodies either through exposure or immunization. The present exposure rate is barely 5-6% in both the US and worldwide. Furthermore, the company getting the most press about their vaccination development and trials says that if all goes well, a viable vaccine is still a number of months away, maybe 6, and when they are ready, they are hoping to be able scale up production to immunize only 6% of the population in the first year. Even if you assume that other companies are able to develop a viable vaccine, we can’t possibly hit that 70% number in less than a year. How long will it take? Anyone’s guess, but not soon. We may be dealing with this for a few years.
3. What about a second wave in the fall? We are still in the midst of the first wave. Despite never even showing a slight decline in infection rate, some states are opening up and numbers continue to climb. Lets not get ahead of ourselves.

 

I was recently asked my opinion about a few things, some involving how long this infection will be around along with some other questions about the environment and I was labeled as a “doomsdayer”. I think that we are capable of getting through this, or at least getting to a point where we can manage it, but ignoring facts and resuming regular behaviors and old habits is not going to get us there. We must learn from all of this and change. If nothing changes, nothing changes.

It’s important to socialize and get out there. It’s important to support our economy. But we must do so in a measured, smart manner.

Practice personal distancing (not “social distancing”).

Wear a mask. It just makes sense.

Don’t touch your face, nose or mouth.

Wash your hands and use sanitizer sensibly.

If you’re concerned about your exposure or someone else’s, just stay away. We must protect the most vulnerable.

Most importantly, GET HEALTHY! 

As Dr. Dean Ornish says:

Eat better.

Move more

Love more and 

Stress less.

 

Stay safe and be well. 

 

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷

 

WEEK’S WRAP UP

Happy 55th anniversary to my amazing parents in Toronto.

I love you.

It’s been a busy week with lots of things going on, on various fronts. A few coronavirus things I wanted to mention which are floating around out there:

1) Kids CAN get and CAN transmit the virus. They are much less likely to actually develop the disease for a variety of reasons like a more robust innate immune system, fewer ACE-2 receptors, the ones which the virus binds to, as well as spillover protection from other immunizations. They are however, just as likely to be exposed to and harbor, and thus transmit the virus. I would argue that because of poorer hygiene and physical distancing (I’m now using this term rather than “social distancing”), they may even transmit more virus, but we just don’t know for sure what percentage of infections come from kids.

2) Protection after infection and potential for a vaccine. Although we simply have not dealt with this virus for long enough and really do not know for sure, it appears that there MAY be some, at least short-term protection once you have been infected since there have not been many cases of re-infection documented. We do know, however, how much protection other infections have provided. Previous infections like SARS-1, now apparently eradicated, and MERS, another lethal coronavirus infection still floating around mostly in the Middle East, have been well studied and the issue of long-term protection is not all that encouraging.

Examination of survivors of these infections does show early protection with elevation of antibody levels as well as immune cells such as specific programmed NK (natural killer) cells, however after a few years (~2-3), levels seem to drop off, along with that immune protection. The programmed cells never go away, but the levels of antibodies which react to an invader slowly wane. (The same happens for example with chicken pox and that is why adults should get the vaccine to minimize the risk of getting shingles). The programmed immune cells do become reactivated with a new exposure and antibodies are once again produced but it takes time. This means that you may still get the infection, but it may not be as severe. This is also the principle of vaccination by the way.

Furthermore, we have never been able to develop a vaccine for either of those coronavirus infections, nor for the two coronaviruses which cause the common cold. That doesn’t mean we won’t develop one for this one, but we should not count on it.

3) Long term complications. Just to be clear, the vast majority of people are getting through this infection relatively unscathed. For the most part, those who are getting very sick or are dying are older and/or have at least one chronic condition, the main 3 being oveerweight/obese, hypertention and diabetes. We are seeing some cases of long term complications in survivors with some extreme cases of kidney damage and scarring of the lungs. These are by far the minority. Some people who get Strep Throat develop heart, kidney or joint problems by these are by far the minority.

4) Quarantine Fatigue. People are restless and want to get out. I have definitely noticed it with my patients. We see it on the streets. Although the recent protests have been absolutely necessary and justified, the violence and looting have certainly not been and this behavior is undoubtedly flamed by the frustration and restlessness caused by the preceding few months of social isolation, uncertainty and financial strain caused by unemployment. We are social creatures and need each other. We need to venture out and interact but also need to do so wisely. No one wants another overwhelming situation which occurred in such places as NYC when all this started.

5) Prevention. No new update. Physical distance. PPE. Stay healthy. The same supplements seem to be holding fast: Vitamin D, Zinc, Vitamin C and my usual recommendations of as many fresh, whole fruits and vegetables as possible with no dairy and as little meat as possible. Avoid processed foods and added sugars, both of which increase inflammation, as do animal products.

6)Treatment. This is also constantly evolving and, quite honestly, I can’t keep up. There is a new cocktail of 4 drugs for severe infections but the previous hopefuls like hydroxychloroquine and even remdesivir fizzled out. In fact, hydroxychloroquin, which our fearless leader promoted and, against sound medical advice decided to take, has been shown not to help and even to even make things worse. Don’t obsess on treatment. Focus on controlled prevention but mostly on getting healthier to deal with all of this better.

Again, we are learning about this disease as we are experiencing it.
We know it will be around for a while, probably 2 years, before we can develop herd immunity, if that even happens. Estimates are that we will need at least 70% of the population which have been exposed to the virus or were immunized to achieve herd immunity. In the US, as well as Worldwide, we are only at a little over 5% overall. We have a long way to go.

We also know that the healthier you are, the better off you are, not just in dealing with this disease, but all diseases to come, not to mention all the chronic diseases like diabetes, vascular disease causing heart attacks and strokes, autoimmune diseases and obesity, which continuously unnecessarily kill many more people than Covid ever will.

• Stay hydrated.
• Eat your fruits and vegetables.
• Minimize animal products.
• Sleep well.
• Manage stress.
• Exercise.
• Socialize, just do so at a reasonable distance and outdoors if possible. Remember, we need to “Physically distance”, NOT “Socially distance”
• Wash your hands.
• Don’t touch your face.

Have a great weekend.

Stay safe and be well.
AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷