General Wellness

Let’s start with some positive news. 

Despite a very early and robust start to the flu, RSV and general cold season, things have tapered off and at this stage, hospitalizations and deaths are no worse than where we were in previous years. They are no better, but really no worse. This same pattern happened in the southern hemisphere and it is not clear why, despite an aggressive start, things have tapered.

That having been said, hospitalizations from these conditions remain significant enough that they are putting a huge strain on an already very taxed healthcare system because of Covid and shortages, not only from a manpower standpoint including people at all levels of healthcare, but also with respect to availability of drugs, equipment, beds…

The bad news is that Covid is still here and it will only get worse.

First, domestically, Covid-19 remains the 3rd leading cause of death in the US, just behind cancer and cardiovascular disease and above accidents and strokes. The average this week is 420 deaths a day (over 150,000 a year). That’s 100 more daily deaths than the leading cause of cancer deaths, lung cancer. Hospitalizations are on a slow rise and last week’s daily average hospitalization rate was 40,000 a day!

Despite that, looking around at our society, it looks like nothing is going on. People are back to “normal”. Then again, people continue to smoke, despite those 320 lung cancer deaths a day and continue to eat like crap and not exercise, leading to 2380 cardiovascular deaths a day! People don’t care, until you need to make an appointment with a doctor and can’t get in for months (6 months to see a cardiologist or neurologist in my area) or go to the hospital where wait times remain upwards of 12 hours. Patients routinely stay in the ER for many days before a hospital bed becomes available.

And it will only get worse given what is going on in China.

Since relaxing their draconian “zero-covid” policies after major protests all over the country, China has now landed itself in the midst of a horrific Covid disaster, rivaling what was going on in New York and Italy at the start of the pandemic. 

Hospitals are overrun. Mostly with elderly patients who are the most vulnerable. Despite their official reports of good vaccination rates, their numbers are actually quite poor. Booster status is even poorer. And their available vaccines are much less effective. They still do help reduce severity of disease however.

To make matters worse, their equivalent of our CDC is no longer giving daily updates on cases. They announced that they will only provide a once-a-month report. Adding to their unreliable statistics is their very strict definition of what constitutes a “covid-related death”. Only deaths related to respiratory failure are linked to Covid. Any other condition, even if is Covid is the main driver of their illness, is not reported as related to Covid. 

The reality from independent reports is that hospitals are overrun. Healthcare workers are dropping like flies. Morgues have a backlog. People are dying at home, much like how it was in other places at the start of all this. One report stated that deceased citizens remain at home for over up to 5 days before bodies are picked up because of the backlog.

Complicating things is that their per capita ICU bed number is 10x less than what we have here in the US. In addition, because of the low numbers of Covid cases they have had, because of their severe lockdowns, doctors are simply not experienced at treating Covid.

The predominant variant worldwide, including China, is BF.7, which is significantly more infectious than the original Wuhan wildtype. The R0 (R-Naught) represents how many people a single infected person is expected to infect. The wildtype R0 was 2-3. But BF.7s R0 is 16! The number of cases doubles every 1-2 days! Thankfully, it does seem to cause a much more mild form of the disease. The problem however is once again the numbers. A small percentage of a large number, and in this case it’s a HUGE number, is still a huge number. Many millions. There are over 250 million people estimated to be infected with over 5000 deaths a day.

And finally, drugs like Paxlovid are simply not available the way it is here. As was the case in Italy and even here in some places, oxygen is in great demand as well.

BF.7 is present in the US, but again, disease severity is mild and it seems to already be on the downswing as the predominant variant. Covid cases overall are on a slow rise in the US. The newest variant of concern is called XBB.

What does the situation in China mean for us? Simply put, more spread leads to more mutations which leads to more variants. And the doomsday scenario is a more lethal form of this virus in combination with increased infectiousness. And we can limit travel as much as we want but there is no way to limit spread of such variants indefinitely.

And keep in mind that almost everything we buy and use in our daily lives comes from China! Phones, drugs, toys, appliances, cars… If everyone over there is sick, who is going to make our stuff! I want my Oompa Loompa daddy and I want it NOW!!! (Willie Wonka reference). Joking aside, at the start of the pandemic, we were all panicking because even surgical masks were all made in China. We used to make them in the US but because they can make them for a few pennies cheaper over there, it was outsourced. We are likely headed into a major shortage of many things we rely on and use every day.

China is not the only place where there are Covid spikes. Japan and S. Korea are hitting record numbers of cases and deaths. Both Britain and France report more than 30% increased hospitalizations in the last week.

Covid-19 is still very much a PANdemic.

This post is getting long and I have written and rewritten the ending, trying to sound intellectual and philosophical about our life, society… I’m not an intellectual or philosopher. I just do my best taking care of people. I try to teach people what I can about how to take care of themselves, since ultimately, healthcare is really selfcare. Although there is a lot of resistance to change, there are enough people who listen and improve, and that makes it worthwhile. I feel guilty for feeling burned out since there are many more physicians and nurses who are getting their butts kicked in the ERs and ICUs in this country, not to mention family doctors and pediatricians offices. Everyone is burning out.

All we all can do is the best that we can but self improvement and care for our family and neighbors is our mandate. We are social creatures who cannot survive on our own.

Have a great and prosperous New Year. Remember those less fortunate than you, including the brave soldiers and people of Ukraine, who really are not only fighting for their freedom, but are fighting for all of us against oppression in general.

One last time in 2022:

MASK UP when appropriate and wear a good one.

DISTANCE and STAY AWAY if you’re sick. The 5 day rule is not reliable. You really need to be careful for the full 10 days.

HYGIENE. Wash, but don’t over wash or sanitize.

TEST before getting together with people, especially if they have some health issues and are at risk.

VACCINATE. It remains the single most important medical measure you can take to prevent, but more importantly minimize disease.

GET HEALTHY. Above and beyond medicine, your general health is the most important asset you have to keep you out of the hospital, and to live a great life in general. Only you can get healthy. Move more. Stress less. Sleep well and Eat more plants!

Stay Safe and Be Well

AC

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