Can Wearable Health Monitors Predict COVID-19?

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As of this writing, there are a minimum of five studies in the U.S. to determine whether wearable health-and-fitness monitors can predict the COVID-19 infection before noticeable symptoms actually occur. They’re looking at masses of data, rather than individual data points. Some are trying to predict how severe the infection will become using the data, which would allow a city, county, region, or even a state to move the necessary resources to the locations where outbreaks will occur. It would be a real step forward in the use of digital monitoring for tracking the potential outbreaks of disease.

While I hope they’re successful, there are two problems. The devices are expensive and only about 20% of the U.S. population actually owns them; how many use them is another whole question. Fitbits and Apple Watches are purchased by the type of people who are already interested in their health. This would limit the applicability to the general population.

The second problem is that it doesn’t do an individual any good at this point. Because the data are collected anonymously, no one could be informed if they’re at risk. As more treatments are discovered, early treatment may limit the severity of any long-term effects, but that doesn’t really help if you don’t know your data.

The issue is the right to privacy and especially health information privacy. I understand that and agree with it, but there should be some way an individual could be notified. Maybe this is the point where artificial intelligence could be used to keep human eyes out of it. And when we get to that point, odds are good that insurance will cover such devices because it always cost less to treat disease in its initial stages.

If you own such a device, such as a Fitbit, Apple Watch, Oura, Garmin, or other device, there’s a list of research studies at the end of this Memo along with the contact information I could find. Check them out. The more we know, the better prepared we can be for this or any other potential epidemic in the future.

What are you prepared to do today?

        Dr. Chet

Wearable Device Study Information:
Duke Covidentify: https://bit.ly/2XXTAp6
Scripps Detect Study: https://bit.ly/3gWkMNy
Stanford Covid-19 Detection Study: https://stanford.io/2XuTGWa
RNI Wearable Devices for Covid Monitoring: https://bit.ly/37022IB

Heart Rate and Viral Infections

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What might we gain by collecting and analyzing data from fitness and health devices? In a recently published study, researchers collected data from over 200,000 different Fitbit users. They selected users from the top five states of Fitbit users and collected data on height, weight, and age as well as heart rate and sleep data. It’s important to note that the data were collected anonymously so there was no invasion of privacy.

They ended up with data sets on over 47,000 people. That’s where this study became mathematical in nature. They correlated heart rate and sleep data with the rate of flu-like cases reported in each state by the Centers for Disease Control. They found changes in heart rate and sleep time correlated with the increase in reported cases of the flu. It helped improve the prediction model between 6.3% and 32.9%.

This is important for a couple of reasons. First, they were able to handle billions of data points; that seems so easy to say, but think about what that involves in terms of data storage. Second, they were able to show some predictive use for the data.

Although they were improving the ability of the CDC to predict the number of cases in general, it requires a lot more to actually predict who has a viral infection. More about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:https://doi.org/10.1016/S2589-7500(19)30222-5.

Health Monitors and COVID-19

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Do you have a Fitbit that you use regularly? Does it track your heart rate? How about an Apple Watch? Can it track your temperature? Blood pressure? Millions of people use those types of devices. Think of the potential for collecting data. It could be millions of data points per second.

I recently wrote about a study that integrated data collected from smartphones with health reminders and recommendations to see whether texts and emails could impact behavior. I didn’t believe they could, based on the limited data used by the computer to send recommendations. That was really an issue of total numbers of subjects; they had 300 and they needed 300,000 or better yet, 3,000,000.

These new studies overcome the problem of limited subjects. Several research groups are collecting data anonymously from fitness devices to find out if they can predict when someone has the COVID-19 virus. What could those devices track that might predict a viral infection? Heart rate, for one. I’ll talk about that study on Thursday.

What are you prepared to do today?

        Dr. Chet

Researching GOLO’s Claims

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Before I get into the rest of the research on the claims made by GOLO, I want to be clear that I have nothing against any products or programs in the market. I’m not assessing the entire program for any company. But having worked for a couple of decades with companies that follow the FDA and FTC Guidelines for dietary supplements very closely, it’s more than frustrating when companies play loose with the research. If they make a structure-function claim, they should be able to substantiate those claims according to the guidelines.

Published Studies

The GOLO website refers to two studies that were published in journals. In the first study, a researcher assessed the effectiveness of the GOLO program on measures of weight and glycemic control. The study lasted 13 weeks; 16 out of 26 subjects completed the trial. There were significant reductions in body weight and insulin levels.

In a second study, the same researcher compared the subjects who used the GOLO weight loss program. The control group was given a placebo and the experimental group was given the program’s dietary supplement. The treatment group lost more body weight than the controls; there were also positive changes in serum insulin and a score of insulin resistance.

The implication is that in all studies, published or not, the dietary supplement made the difference in the results. There’s no way to tell. While every study talked about caloric intake, they did not report comparative data, either within subjects when there was no control group, or between groups when there was. This is simply poor research methodology and statistical analysis.

Does the Research Prove the Claim?

As I said on Thursday, while the company makes many claims on the website, I stuck to the one that said the product was “clinically proven to reduce insulin resistance.” They did not prove that the dietary supplement helped reduce insulin levels, blood glucose levels, or HOMA-IR, a measure of insulin resistance. There were just too many confounding variables they did not examine. I already made mention of the caloric intake. The program evolved over time from one where they planned a 500-calorie deficient diet for the subjects to one where they were advised on how to construct a diet from certain food selections. That’s why caloric intake is so important; we need to know that to find out how well the subjects met the dietary guidelines. The best they could claim is that the supplement may have assisted some subjects to lose weight.

In each study, the changes in HbA1c were relatively meaningless in the real world; reducing HbA1c by 0.18% and 0.61% is within the error of the method. As for the use of HOMA-IR, the researcher who developed the algorithm has said that it was not suitable for these types of clinical trials, just for large epidemiologic studies. Finally, the reduction in blood sugar in every trial where it was measured could be explained by exercise, which they also did not account for in the analysis; many people don’t realize exercise can modify insulin resistance by the third workout.

The Bottom Line

There were many more issues with the selection of data used in the multiple analyses and in the choice of statistics themselves. Most importantly, the significant loss of subjects—all four lost up to 40% of all subjects—was acknowledged by the authors, but they didn’t explain its impact. I could go on with errors, but it’s unnecessary. For the claims made, the level of substantiation is simply not sufficient to exhibit the dietary supplement’s benefit for insulin resistance. The weight loss program may be beneficial, but it can’t be verified by any of the studies they completed or by the materials provided on their website.

Eat less. Eat better. Move more. Do those long enough and you will be able to lose weight, get fit, and improve your metabolism as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Diabetes Updates, 2019 doi: 10.15761/DU.1000125.
2. Trends Diabetes Metab, 2019 doi: 10.15761/TDM.1000109.

Dental Cavities Are an Engineering Wonder

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Continuing our look at the process of dental decay, the methodology for this study was complex to say the least: preserving the plaque, analyzing the structure, obtaining samples of the bacteria, attempting and succeeding to grow the structures on enamel surfaces that mimic teeth, getting photographs of the electronic polymeric structure, and more.

This study demonstrated that the Streptococcus mutans bacterium doesn’t merely attach to the biofilm and multiply; it organizes itself and other bacteria into dome-like structures in order to protect the most inner part of the dome. They tested this by exposing the teeth to a commonly used anti-bacterial rinse and found only the most exterior part of the dome was destroyed. The bacteria then reorganized themselves and the other bacteria so they could continue the attack that causes tooth decay. As long as the medium is present, in spite of treatment, the bacteria will continue to organize its structure to promote decay. Amazing.

What was the conclusion? There was none at this point because this is new research. I have one for you that isn’t controversial nor does it require anything that you probably already don’t do intermittently: cut out a sugary diet for your children and yourself to stop the constant feeding of the bacteria. Then brush regularly after every meal; teach your kids to swish with water after every popsicle or gummy bear. And to break up the plaque, floss every day. That seems to be the only way to address this oral bacterium that’s an engineering marvel.

What are you prepared to do today?

        Dr. Chet

Reference: doi.org/10.1073/pnas.1919099117

Investigating the Architecture of Cavities

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Have you ever wondered how your kids get cavities or why you got them as a kid? As I was researching studies on the microbiome, I found a fascinating article on cavities.

Cavities, also called dental caries, are a disease caused by bacteria that attack the biofilm known as plaque and damage the enamel of the teeth by creating an acidic atmosphere. In addition to the bacteria, cavities are also dependent on diet. All that stuff about sugar causing tooth decay? Yes, it’s actually true—just maybe not in the way we thought. The primary bacterium associated with tooth decay is Streptococcus mutans, an aggressive plaque builder and acid-producer. But how?

Researchers from two universities wanted to examine any types of structures that might be built on teeth by S. mutans and other bacteria that might contribute to cavities. What kind of structures are we talking about? No one really knew for sure. But to find out, they needed to study the structures as close to the mouth as possible but not actually in the mouths of children; they used the extracted teeth of children who had so much decay the teeth couldn’t be saved and preserved them for analysis. As unbelievable as it may sound, up to 2.5 billion people, mostly children, are impacted by this type of decay.

We’ll continue this look at the topic on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: doi.org/10.1073/pnas.1919099117

Vitamin D and COVID-19: What Would a Reasonable Person Do?

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The Medscape article did not call for any conclusions or recommendations nor should it have. That’s not the purpose of that type of article. However, that didn’t stop healthcare professionals from voicing their opinions in the comments section of that article. We’ll take a look at what they said, discuss the potential benefit of vitamin D testing and supplementation for COVID-19, and determine what a reasonable person should do.

Comments Abound

I rarely read the Comments section on any posting. There’s no point, because people will disagree about almost everything, especially when interpreting scientific information. If you think people attack people only on social media, not true; academic arguments can get really vicious.

There were not just comments about the Medscape article, but about what people posted in response to the article: accusations of “junk science,” “pseudoscience,” or “snake oil salesman.” These are healthcare professionals at all levels going after one another. They may not use the same language, but the insults and accusations about being shills for pharmaceutical companies are still there. You see the condescending attitude of some physicians about research and the opinions of people who treat patients with supplements. The end result is the same as a Twitter fight; it accomplishes nothing beneficial.

Potential Benefit of Vitamin D

Within the Medscape article was a reference to an article that hasn’t been peer-reviewed yet. That paper attempts to quantify the relationship between vitamin D deficiency and extreme responses to COVID-19 infections. They looked at vitamin D and C-reactive protein (CRP), a marker that indicates inflammation. CRP is depressed in severe cases of COVID-19 infection but not as depressed in milder cases of infection.

They found that “the risk of severe COVID-19 cases among patients with severe vitamin D deficiency is 17.3% while the equivalent figure for patients with normal vitamin D levels is 14.6%; that’s a reduction of 15.6%.” Understand that this paper makes many assumptions about the relationship between vitamin D status and CRP that may or may not be correct. However, if the number of severe COVID-19 cases resulting in deaths in the U.S. were reduced by half that amount, that would mean thousands fewer deaths.

The Bottom Line

I began this by asking the question “What would a reasonable person do?” That’s a term often used in legal matters, but I think it applies here as well. Based on the Irish study, optimal vitamin D levels should be maintained between 50 to 60 nmol/L. You would need a blood test to find out if you’re there. If your physician is not amenable right now, use the last vitamin D test you had as the base level. I just had my blood work done in the past couple of months, and it was 30 nmol/L. If you’re in the optimal range, keep doing what you’re doing.

If you’re low, as I was, it’s time to increase your vitamin D intake. This is especially true if you have a comorbidity such as being obese, having type 2 diabetes, an autoimmune disease, asthma or another lung disease, or are over 60. Talk with your physician about increasing your vitamin D intake. By how much? You could safely increase your intake by 1,000 to 2,000 IU or 25 to 50 mcg, but get your doctor’s input on whether you should take a higher amount for a while to increase your vitamin D levels faster.

As I said a week ago, respect this virus. One of the ways you can do that is by treating your body as any reasonable person would, including getting your vitamin D to optimal levels.

What are you prepared to do today?

        Dr. Chet

References:
1. Irish Med J. 2020; 113 (5):81-88.
2. Vitamin D: A Low-Hanging Fruit in COVID-19? – Medscape – May 17, 2020.
3. doi: https://doi.org/10.1101/2020.04.08.20058578

Vitamin D and COVID-19: Debating the Research

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The paper published in the Irish Medical Journal inspired a lot of commentary by healthcare professionals in all forums. I selected one report from Medscape, an online journal I subscribe to, that summarized all sides of the issue. The writer interviewed a variety of vitamin D experts including the authors of the study in the Irish journal.

The predicted response came from a researcher in Maine: there are no randomized controlled trials, scientific research’s gold standard, that prove that raising vitamin D levels will protect against serious COVID-19 infections. That’s not quite as harsh as it sounds. He recognizes the importance of vitamin D—he’s studied it for 25 years. He’s just stating the facts as he sees them.

The author of the original paper acknowledges that but suggests that because a deficiency in vitamin D can be remedied quickly with vitamin D supplementation, let’s grab the low-hanging fruit and act now with minimal potential for side-effects or negative outcomes. A leading epidemiologist suggests that for some people, vitamin D may reduce the risk of the “cytokine storm” that happens to some people that leads to death from the virus.

What are we supposed to do with such disparity between experts? You haven’t seen anything yet, but we’ll come up with some recommendations on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Irish Med J. 2020; 113 (5):81-88.
2. Vitamin D: A Low-Hanging Fruit in COVID-19? – Medscape – May 17, 2020.

Vitamin D and COVID-19: Upside-Down World

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Vitamin D has been in the health news as it relates to the COVID-19 virus. Are vitamin D levels related to the severity of symptoms if you’re exposed to the virus? We’ll take a look at a recent observational study and the medical responses to it this week.

There have been reports that people with higher vitamin D levels in their blood were doing better in response to the COVID-19 infection than those with lower levels. Researchers in Ireland decided to check that out in a unique way. Using epidemiological data from European countries that were hit with the COVID-19 virus, they found something interesting. Countries such as Spain and Italy that had more sunshine had lower vitamin D levels and did poorly in response to the virus. Countries in northern Europe such as Norway and Finland with their short winter days had higher levels of vitamin D and did better in response to the virus.

This is counter to what we would expect. The higher the sun, the higher the vitamin D, right? Evidently not. What was the difference? Due to the lack of sunshine in the north, supplementation with vitamin D was recommended by government health agencies, but there were no vitamin D recommendations in the southern countries. Is vitamin D the solution to this COVID-19 virus? Nothing is ever quite that simple, as we’ll find out on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Irish Med J. 2020; 113 (5):81-88.

Not Fear, Respect!

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I’ve read many comments on social media platforms about COVID-19, and the tone remains the same. An ever-growing group of people are talking about theories and conspiracies of all type. “The numbers are rigged to show more deaths from COVID-19 than there really are,” or “Doctors have discovered treatments that work and are being suppressed.” Lately we have this “Plandemic” movie making the rounds. Then there are the people who claim that our liberties are being taken away by being forced to stay home, wear masks, and not work or go to restaurants; they claim we are being forced to be afraid to go into public.

Our perspective on life is governed by the prism we look through. People who fear vaccinations are already saying they will never get a COVID-19 vaccination if there ever is one. People who fear the government are alarmed by the slightest perception of the infringement of their constitutional rights. Almost everyone who understands the disease is afraid of the COVID-19 virus. I want to change your perspective. In doing so, I’ll explain why staying home is a good idea.

In case you’re wondering why my opinion carries any weight, there’s this: in my heart of hearts, I’m a scientist and a teacher. You can check my website bio to learn more, but the important point is that I probably understand science and scientific research better than you do (you undoubtedly know more about your area of expertise than I do). I don’t look at the science news with a political bias, just with a solid education and years of experience that helps me understand what the science really means and what the studies really prove. My mission in life is to share that information with you to help you be healthier, and I can’t think of a time that offer to share has been more important than now.

The Virus: We Just Don’t Know Enough

The virus is the enemy. In order to defeat it, we need to know enough about it to beat it, but we just don’t know enough yet. Here are the most significant questions.

Why do some people catch the virus and don’t have symptoms, yet they can spread it to others very easily? This is the primary question we need answered. Is it that the virus mutates more easily in some people than in others? Is it the total amount of exposure? Is it a genetic factor? The easy ones such as ethnicity, hair color, and eye color haven’t been explored as deeply as they should. Is the microbiome a factor? I could go on and on, but until we know why some people have no symptoms while the virus kills others, we should be prudent in exposing ourselves to it.

Why do some treatments work well in some people and not in others? Case in point is intravenous vitamin C; it helped some people live longer when treated with hydroxychloroquine and the Z-pack while it had no impact on others. We have a partial answer: it worked only in those who were deficient in vitamin C. That also tells us that even people who had enough vitamin C were still susceptible to the virus and died. Not everyone can take the malaria drug hydroxychloroquine because it causes fatal arrhythmias in some people. Until we get a treatment in place that can work for just about everyone if they get the severe form of COVID-19, we should be prudent in being exposed to the virus.

Do we have to wait for a vaccine? No, because there may never be one. While it’s a completely different virus, there’s still no vaccine for HIV some 40 years after its discovery, and it’s possible there may never be a vaccine for this one either. However, scientists seem to be making progress so it looks hopeful, but probably not for 18–36 months.

Testing

Testing is going to have to be part of the solution. Who wants to go to a place of business for an extended visit such as a gym or a haircut or a meal if you don’t know if the people working there have the infection or not? The number of tests required to open the economy and keep it open should create an economy of scale that lowers the cost, and in time the testing should be dependable, precise, and cost effective. The industrial health-manufacturing complex should take on the task of providing these products at the lowest price possible to make it worthwhile for businesses to provide it for employees and customers.

Antibody testing to see if a person had the virus should also be a priority. Antibodies may not create immunity, but they may have some benefit against the virus should a person be exposed again. That’s important to know.

If I had a business where people must show up in person, I’d begin to create the signage “All employees tested daily!” and “We test our customers for free!” That will happen at some point and the sooner the better.

The Bottom Line: Respect

The word “respect” should replace “fear” when talking about COVID-19. People can rant and rave in social media if they want; that’s their right. But if they’re exposed to enough of the virus, they will get it. What happens to them? We can’t predict. We also can’t predict what will happen to their family, their friends, and every person they come in contact with. I can’t imagine anyone who would be willing to put people they care about at risk.

One of the saddest aspects of our time is the stark partisanship and the way it colors everything we see—red versus blue, urban versus rural, white collar versus blue collar. When it shapes the way we see science, it frankly scares me. It’s not a situation where, oops, you might gain a few pounds or vomit for a couple days. This virus could take your life or your parent’s life or your friend’s life; even if you or they survive, you or they may face a lifetime of health challenges such as severely diminished lung function; as an example, a runner may never have the lungpower to run again. And at this point, we know the virus can produce devastating symptoms in a small percentage of children who get it, but we don’t know why and we have no idea what the life-long aftereffects may be; most parents (and grandparents) won’t want to take that gamble.

I don’t want you to be afraid, I just want you to respect the power of the virus and the scientific knowledge we’re slowly gaining.

I’m staying home with the exception of grocery shopping and doctor’s appointments that can’t be done by phone, and I wear a mask when I go out—not to protect myself, but as a courtesy to others. Same for Paula.

We’re not prisoners. The warm weather is finally here, and there’s work to do in the yard. We’re blessed because Paula and I have been working at home for years. We don’t fear catching the virus. We just respect it and understand where we stand at this moment in time.

If you change the prism you look through, respect makes a lot more sense than fear or disbelief. Act accordingly.

What are you prepared to do today?

        Dr. Chet