Tag Archive for: coronavirus

ACE2 Receptors: Gateway for COVID-19

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The number of cases of COVID-19 continues to rise and rise and rise. As restrictions on shopping, dining, and entertainment have been reduced, and then sometimes reinstated, the debate over which businesses should be open, social distancing, and even whether to wear a mask continues. Let me make it simple for you: wear your mask to protect others from you and you from them. Period.

There has also been a tremendous rise in the research on COVID-19, specifically, the short-term and long-term effects of the virus on the body. This virus is different from others; it isn’t as simple is getting the flu or a severe cough, and then life returns to normal after a week or so. Research is finding some significant long-lasting effects on the body. The locations impacted seem to contain high numbers of the ACE2 receptor, the receptor used by the virus to enter our cells. We already knew the sinuses, lungs, and adjoining blood vessels contain significant numbers of ACE2 receptors as well as the kidneys.

Researchers for a data analytics company examined every published paper, over 100 million of them, to find out where ACE2 receptors have been found and then performed an analysis examining every potential interaction, over 45 quadrillion of them. They found that there are significant numbers of receptors on the tongue, the nasal passages, and the ciliated passages to the lungs. The most significant find was the enterocytes that line the small intestine. That means that should the virus get to those locations, it can potentially wreak havoc there. We’ll talk about some of the organs and systems that have been impacted by COVID-19 the next two days.

What are you prepared to do today?

        Dr. Chet

Reference: eLife 2020;9:e58040 DOI: 10.7554/eLife.58040

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

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

Get This Free COVID-19 Audio

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The COVID-19 virus is impacting our lives, yet there seems to be a lot of confusion about what is and is not real. That’s why I’ve put together this free download on the COVID-19 virus. I’ve included the answers to questions I’ve gotten and divided them into a logical order. What is the history of the virus? Where did it come from? When will this be over? What do we do to protect ourselves? And finally, what are the myths surrounding the COVID-19?

This is the reference audio to use as baseline information. The numbers will certainly change; there will be new potential treatments; and there are certainly more myths being promoted every day. This audio is where to begin.

There are so many experts in all kinds of media right now, and you may wonder why you should listen to me. Here’s a link to my bio so you can see what my background is and decide for yourself.

What are you prepared to do today?

        Dr. Chet

What Is ACE?

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Angiotensin-converting enzyme—ACE—is the enzyme that converts angiotensin I into angiotensin II (ANG2). You’re probably thinking, “Well, that clears it up!” Here’s the problem: under the right conditions, ANG2 causes vasoconstriction and sodium and water retention, and the result can be hypertension because the overwhelmed kidneys can’t get rid of sodium or fluids.

However, it gets more complicated. There are two ANG2 receptors, A1 and A2, but A1 creates the problems related to blood pressure. It also contributes to pulmonary hypertension and pulmonary fibrosis under the right conditions. The problem is that we don’t know exactly what those conditions are.

What we are finding out is this: the lung contains A1 and A2 receptors, and it just so happens that the COVID-19 virus can use those receptors to allow the virus entry into cells. Once there, the viruses can multiply and may contribute to the extreme immune response of the lower lungs.

For people who are being treated for hypertension and are taking an ACE inhibitor, it would seem prudent to take your medication on schedule. If you take a medication whose name ends in “pril”—that’s your ACE inhibitor. We don’t know for sure that it will help and there’s a lot of research to go, but we will find out. Until then take your BP medications and do all those other things you’re supposed to do to lower BP.

What about the rest of us? Is there something we can do? Maybe and I’ll cover that on Saturday.

Reminder: my audio High Blood Pressure: Getting It Down is half price this week, CD or MP3. Learn more about what you can do to control your blood pressure.

What are you prepared to do today?

        Dr. Chet

References:
1. DOI: 10.1101/2020.02.24.20027268.
2. doi: https://doi.org/10.1101/2020.01.26.919985.