Tag Archive for: virus

How Vaccines Can Affect COVID-19

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In vitro studies, more commonly called test-tube studies, are used when you want to see if there’s a relationship between cells and microorganisms. In the case of the researchers in the Netherlands, blood cells, vaccines, and the COVID-19 virus were used. While the laboratory techniques were complex, here’s what they found.

The researchers isolated peripheral blood mononuclear cells from the Buffy coat layer of cells. The Buffy contains primarily white blood cells after centrifugation. The researchers then exposed the white blood cells to the flu vaccine commonly used in the Netherlands for 24-hours. Half the samples were also exposed to the bacille Calmette-Guérin vaccine, typically used for tuberculosis. After a week, the samples were exposed to the COVID-19 virus. The objective was to see if immune system markers were increased after exposure to the virus.

The flu vaccine increased the immune capability of the white blood cells. The addition of the BCG vaccine increased the capability of the immune response. The cells were better able to make cytokines faster. If it happened in humans, the cytokines would be able to respond faster thus reducing the ability of the COVID-19 virus to replicate.

What does this all mean? I’ll finish this on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: medRxiv preprint doi: https://doi.org/10.1101/2020.10.14.20212498

The Flu Shot and COVID-19

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This week, I’m going to review a series of studies that outline a strategy that includes getting the current flu vaccination. The first study is an observational study. In my opinion, it’s the way research should begin: look for relationships between factors first, and then conduct experimental trials.

Researchers in the Netherlands used the medical records database of a large hospital to find out the answers to a couple of questions. First, of over 10,000 healthcare workers who worked there, they wanted to find out how many got the flu vaccination during the 2019–2020 flu season last fall. Then they examined how many employees got the COVID-19 infection since the pandemic began. They learned that of those who were not vaccinated, 2.23% got the COVID-19 virus; of those who got the flu vaccination, 1.33% got COVID-19. That works out to a 39% reduction in the risk of catching COVID-19 for people working in a healthcare setting if they get vaccinated for the flu.

As we know, there’s not a cause-and-effect relationship in these types of studies. But it does indicate that it’s a place to look—which is exactly what they did in the next phase of the research paper. More on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: medRxiv preprint doi: https://doi.org/10.1101/2020.10.14.20212498

Swiss Cheese COVID Protection

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You’re probably thinking “First, zeptoseconds, then speeches and dancing, and now Swiss cheese? How are they related?” I’ve used the concept of discrete time intervals to make a point. Each discrete time interval of seemingly separate tasks can be put together to make up something that can be greater than each individual part—in this case, a way to control the spread of the COVID-19 virus.

The Swiss cheese concept is credited to Dr. James Reason who applied it to safety in many industries, but it fits here very well. For example, wearing a seat belt every time you drive reduces the risk of serious injury. But a specific type of collision, say hitting another vehicle from behind that doesn’t have operational brake lights, could still cause serious whiplash. In a time interval too fast for human response, a sensor sends a signal to deploy an airbag to limit injury, and there are now sensors that will automatically brake to stop the car. Different actions performed in discrete time intervals put together can make driving safer.

The Swiss cheese idea is that while there are holes in any single slice, the holes don’t extend the entire brick of cheese; any single hole will eventually get blocked. If you have enough safeguards, the combination of imperfect strategies will work together to lower your risk. I’m adding time to it to illustrate how little time it can take.

Four Steps to Keep Yourself Healthy

1. Wear a mask all the time when in public. Using my five-year-old grandson Riley as an example, it takes no more than 10 seconds to put on a mask. (He and his classmates wear masks all day in kindergarten, so don’t tell me it’s too hard to do; here’s more on masks.)

2. Social distance and spend no more than 15 minutes in any single encounter (four hours in a poorly ventilated space with strangers is just asking for trouble). A shorter time is better.

3. Clean and sanitize surfaces regularly. This may take up to 10 seconds for the surfaces we encounter frequently.

4. Wash your hands often with soap and water; sing the ABC song to make sure you scrub long enough. Or use a hand sanitizer with 70%+ alcohol, and the virus is destroyed within 30 seconds.

Any single strategy has holes, but used together, we can keep the risk for ourselves and others very low.

The Bottom Line

My point this week is to demonstrate that you have enough time to reduce the COVID risk for yourself and others. Small discrete acts can add up to a powerful strategy; doing enough of them helps put the odds in your favor. As I said before, there’s nothing to fear. Just respect the virus and act accordingly.

If you’re a U.S. citizen, make sure you vote next week. With everyone glued to the election results, including many readers in other countries, I’m sure your attention will be elsewhere so Paula and I are taking next week off. The leaves and the mulch await, and I’ll work on getting prepared for some great new ideas for the New Year.

What are you prepared to do today?

        Dr. Chet

Reference: doi: 10.1097/QMH.0b013e3182418294.

Mental Health Update: Fall 2020

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As I write this, I just got back from working out. I went to my gym for the first time since it opened last Wednesday after closing in March. Everyone wore masks. Everyone cleaned up their equipment, but that’s the standard anyway so that wasn’t surprising. Nobody fainted from lack of oxygen. Everybody just worked out, cleaned up after themselves, and went on their way. No big deal.

But it’s a big deal to many people who have been anxious over the closures in their states, including their gym. That can lead to depressive symptoms. If you follow social media, that can hurt considerably: comments suggesting the virus is one big scam or people are too concerned. In fact neither is true; spending less time on social media might be the single best thing you could do for your mental health. I go back to what I wrote several months ago: don’t let yourself be immobilized by fear of this virus, but show it the proper respect.

On top of that, the political climate is a mess. There are no longer any discussions, just arguments that can be vicious. The anger is palpable. When you lose contact with family and friends you care about because of political differences, that also leads to anxiety and depression. Throw in unemployment, concern about finances, keeping a roof over your head, and more, and it seems our mental health is taking a beating.

But is it? I’ll take a look at the research this week.

Reminder for all Insiders: our monthly Conference Call is tomorrow night at 9 p.m. ET. One topic I’ll be discussing is a remarkable study done on COVID-19 and genetics by a supercomputer. You don’t want to miss it. If you’re not yet an Insider, you have until 8 p.m. to join and still participate live.

What are you prepared to do today?

        Dr. Chet

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.