About stoneagedoc

Pediatric infectious diseases specialist, author and public speaker. After 35 years in clinical practice including 40 years in academic pediatrics I now share that experience in helping others to enjoy a long, healthy life without the burden of chronic disease.

Stone Age Doc’s Pandemic Perspective #5

The perfect (cytokine) storm

Why is there such extreme variability in the outcomes of persons who have been infected with the COVID-19 virus? Some persons have an unbalanced immune system that overreacts when challenged by something like the new coronavirus.  These individuals overproduce particular kinds of immune cells that release cytokines, chemicals that fight the virus but that when present in excessive amounts can also damage the host’s tissues. When this cytokine-driven inflammatory response is at low levels lasting for years it results in coronary artery disease, stroke, cancer, type 2 diabetes, autoimmune diseases such as lupus and rheumatoid arthritis and even osteoporosis. When massive amounts of cytokines are suddenly released during an influenza or coronavirus infection the result is cytokine storm, which results in multiple organ failure.

“Fat doesn’t just sit there!” has been my mantra for years. Fat stores contain several types of immune cells, the ones that produce cytokines. The more fat, the more cytokines. Obese persons who become infected with a virus are thus at risk of an overproduction of cytokines, which largely explains why older persons, MOST of whom are overweight or obese and who have heart or kidney disease, have the highest mortality rate.

Fatal outcomes are not limited to the elderly; a significant number of younger persons do not survive. I surmise that when we have detailed statistics we’ll find that most (in my opinion) will be found to be overweight or obese.

All this should be a wake-up call. It’s time for all overweight Americans to get moving and to eat less. It’s not easy but consider this: if we eliminated overweight and obesity we would eliminate almost all coronary artery disease, type 2 diabetes, stroke and kidney failure.

 

 

In the news

Apples, oranges and viruses

The old cliché, you can’t compare apples and oranges, certainly applies to many aspects of the COVID-19 epidemic. Why are attack rates and mortality rates so variable between countries, cities and even racial groups? When will business get back to normal? It will be months, perhaps years before we have complete answers but here are some thoughts that might help you to make sense of the news stories that are circulating among the media.

If we look at the tragic numbers in New York City we can get an idea of why it has been hit so hard. First, the population there is incredibly dense, as you undoubtedly know if you have ever walked through Manhattan or traveled on crammed subways or commuter trains. Social distancing is difficult in clusters of apartment buildings and offices, and warnings were not disseminated early in the outbreak.

It didn’t take long to recognize that the elderly were at serious risk of dying from this disease but there are several factors that pertain to that age group. Many of them have underlying heart disease, which by itself accounts for nearly a million deaths per year. They are more likely to be overweight and diabetic; both conditions impair immune systems that are already in decline simply because of age.

Is race a factor? Yes and no. Pacific islanders are particularly susceptible to leprosy, for instance and Native Americans to certain fungal diseases. But viruses don’t appear to discriminate by skin color. On the other hand, CDC statistics reveal that blacks are almost three times as likely as Asians to be obese (49.5% vs. 17.4%) and that carries a much greater risk of type 2 diabetes. The COVID-19 mortality rate among blacks is roughly twice as high as their representation in the population. It is well known that black communities have less access to health care but that is only a part of the reason why they are suffering in greater numbers from COVID-19. Of 19 people who died of this virus in Milwaukee, all but four were black and all of them had diabetes or disease of the heart or lungs.

Unlike entertainment and sports venues, business that cater to small numbers of persons at a time will probably open up first. After all, if supermarkets can continue to do business, why not hardware stores, libraries and hotels? Tests for viruses and blood tests for antibodies are on the way but probably won’t be widely available at least until mid-summer. I’m hopeful that a vaccine will arrive by late September; never has the vaccine industry moved at such speed.

The face mask issue gets more complicated by the week and I’ll address it in another blog. Yes – do wear one when you leave the house. It’s better than nothing and is a reminder of the three Ds: don’t touch your face, distance yourself from others and do wash your hands after touching anything that might have been touched by someone else.

 

Lifestyle

Another annoyance of aging: How dry eye am.

About 70 percent of persons over the age of 70 have dry eye syndrome, a condition that results from insufficient tear formation or rapid evaporation of tears. It truly is an annoyance but seldom results in eye damage.

Causes include wearing contact lenses, exposure to tobacco smoke and prolonged computer use. Some medications, especially those prescribed for allergy, high blood pressure or depression may lead to dry eye syndrome. A rare cause in this country is vitamin A deficiency.

Sometimes it only takes a change in the environment to relieve the condition: avoid tobacco smoke, wear wraparound glasses if you can’t avoid a draft or change your computer habits. Your doctor might adjust your prescription medication or prescribe artificial tears or even recommend Restasis, a medication that is effective but has some side effects.

Dry eye syndrome always calls for an evaluation if simple steps don’t work because it could be due to an autoimmune disease such as lupus or rheumatoid arthritis, or type 2 diabetes.

The message is clear: don’t hesitate to get an evaluation by an ophthalmologist. It could spare you years of discomfort and possibly save your life.

Stone Age Doc’s Pandemic Perspective #4

Humor isn’t just for laughs

For the past couple of weeks I have been sending humorous cartoons, videos and jokes to several dozen people on my contact list almost every day. In a way I feel like I am imposing but I have a particular strategy in mind: I want to help you strengthen your immune system. If that sounds like a stretch, I assure you that it is not.

The medical community has known for decades that laughter is linked to better health and we’re beginning to get some specifics. Academic studies from institutions like the Mayo Clinic, Indiana State University and Rush University show that several minutes of day of laughter results in lowered stress hormones, raised endorphin levels, decreased blood pressure, reduced perception of pain and enhanced immunity. This last factor has been narrowed further – increasing specific cells of the immune system that target, for example, influenza viruses.

I’m blessed with family and friends that shower me with funny stuff every day and I try to send the best ones and to avoid duplication. Keep them coming – I can always use more material.

Are we overlooking something that can help in the COVID-19 fight? (Thanks to fellow pediatrician Dr. John Garretson who brought this to my attention.)

Nearly 100 years ago two French microbiologists developed a vaccine that helped to prevent tuberculosis (TB). Called Bacille Calmette-Guerin (BCG) after its discoverers, it has been protecting children from tuberculosis ever since. Moreover, it protects them from other infections as well although that aspect has not been extensively studied.

Vaccination against tuberculosis with BCG has been dropped by many developed countries and it was never used here in the U.S. because the likelihood of getting tuberculosis in these countries is very low. In 2020 the majority of persons with tuberculosis are either immigrants or are infected with the HIV virus. Although the BCG vaccine has an excellent safety record, it makes the TB skin test less reliable as a diagnostic tool because it causes that skin test to be positive in varying degrees for some time.

Two observations should make it mandatory to investigate this vaccine as a means to prevent coronavirus infections. First, two countries with the longest history of BCG use, India and Japan, not only have fewer cases of COVID-19 than “advanced” countries that do not use the vaccine, but the mortality rates are also lower. For instance, as of April 10 (from the Johns Hopkins Coronavirus Resource Center) Japan has had only 5,530 cases of the disease and 99 deaths – fewer than the city of Philadelphia! Japan’s mortality rate from this infection is 1.8 percent.  In contrast Netherlands, which does not use the BCG vaccine, has had 23,249 cases and 2,511 deaths, a mortality rate of 10.8 percent.

Another observation is that studies during the SARS outbreak in 2002 – another coronavirus – showed that persons who had received the BCG vaccine had a milder form of the disease. Even earlier studies showed that children who had received BCG vaccine had fewer respiratory infections.

There are still a couple of issues that have to be resolved. The first is that there are various forms of BCG currently in use and not all of them have the same effect on the immune system. Another potential problem is that BCG is standard therapy for certain forms of bladder cancer and there are already some supply problems.

A COVID-19 vaccine is months away. The BCG vaccine is available right now. Studies of this vaccine against the new virus are already under way in Australia and the U.S.. Let’s hope that it works and gives us one more tool against the virus that has crippled the world’s economies.

 

Correction to OASIS address.

The links that I have posted to direct you to the OASIS learning center only take you to the national website, from which it is difficult to locate a class in San Diego. My error.

The proper link is http://www.oasisnet.org/sandiego. In the upper left corner of the home page, “Click here for a current listing of Online Classes”. You can select my classes by entering my name in the Instructor box – Goscienski.

 

Stone Age Doc’s Pandemic Perspective #3

Exercise strengthens your immune system.

Persons who engage in regular, moderately intense physical activity have better immune function than couch potatoes do. Generally, as we get older we exercise less and accumulate more fat. Both of those conditions depress our immune function.

Those of us who are gym rats are frustrated by the closure of fitness centers where we could engage in a variety of exercises, socialize a little and return home with energy to spare. How can we fill the void – or begin an exercise routine if we haven’t had one previously? In a nutshell there are two elements: First, make it a priority. Decide that it is such an important element in your life that nothing should stand in your way, especially if you no longer have job at the moment. Second, schedule your home workout for a specific time of day. I used to go to the fitness center at about 10 a.m. and that is the FIRM starting time for my new routine.

Perhaps the single best exercise is the ordinary push-up. It involves the arms, shoulders, chest, back, abdomen and legs, which is why I referred to it as the perfect exercise in a column a few years ago. Vary the width of your hands in order to bring different muscle groups into play. Eventually you should be able to do at least 25 push-ups at a time no matter how old you are.

Another simple exercise is the crunch, a kind of partial sit-up, best done with the feet flat on the floor. Do NOT anchor your feet under a piece of furniture.

For more variety use elastic bands or hand weights. You’ll find countless tips on getting the most from them on the Internet.

Key point: If you’re new at this, start slowly in order to avoid DOMS (Delayed Onset Muscle Soreness). If you’re not a regular exerciser, consider starting with three sets of 5 push-ups and add one more push-up each time you exercise. You’ll be amazed at how quickly your body will respond.

What about walking?

Walking is not only an excellent exercise, it’s a chance to get out of the house. You might even want to go for a brisk walk a couple of times a day. Start slowly if you have not been doing it already, no more than 10 minutes the first day. Add 5 minutes per session until you are walking for at least 60 minutes.

How fast? You should be able to engage in conversation; if you are able to sing while walking you’re going too slowly!

My personal guarantee: you are going to feel noticeably better by the end of your second week of exercising.

 

What is a fomite?

A fomite is an inanimate object that can be contaminated with an infectious agent and transmit that germ to another person. The term comes from the Latin word for “tinder” – a quite appropriate image when you consider that a single doorknob can be the source of infection for dozens, perhaps hundreds, of people.

Healthcare workers can transmit infection via fomites such as stethoscopes, even lab coats and neckties!

Anything that you touch with contaminated fingers can spread the infection to others. Obvious fomites include doorknobs and handles, railings, gym equipment, grocery cart handles, etc. But have you thought about light switches, elevator buttons, computer keyboards (especially in libraries), gas pump handles, the ATM machine and money?

Carrying alcohol wipes and using them on everything that you touch outside the home is not a bad idea, but they are a little messy and inconvenient. I’d like to share the Cocktail Napkin Defense. You probably have a stack of cocktail napkins around from your last party or holiday season. They might still be available in local stores, especially the Dollar stores, since most people don’t think of them as tissues or paper towels. I carry a few in my jacket pocket at all times. I use one to open the door at the store, on the lever of a water fountain, when I hold onto a handrail, or even press an elevator button at the doctor’s office – a pretty likely place for viruses to lurk!

Fomites are the best reason for washing your hands several times a day, even if you have used that cocktail napkin!

 

Upcoming presentations

            Until the COVID-19 crisis is over and we can again meet in groups, my presentations at OASIS will be given online using ZOOM, an extremely user-friendly application that can be set up in just a few minutes. The system being used by OASIS has been working very well.

            If your computer does not have a microphone/speaker you can follow the presentation by phone while the video portion is displayed on your computer monitor. You will receive detailed, easy-to-follow instructions when you register for the online class.

            Each of these classes has relevance to the current pandemic.

Friday, April 3, 11:00 a.m. OASIS Online. Immunizations: the good, the bad, the future. Vaccines have been around for centuries and they are responsible for the eradication of several deadly diseases. They are not entirely benign, however. Immunization is no longer only for children. There are at least two adult vaccines that can save your life. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Thursday, April 9, 1:00 p.m. OASIS Online. The antibiotic crisis: how we got here. Only three generations of humans have lived during the antibiotic era. This presentation describes how antibiotics were discovered, how they work, why they are becoming less effective and how we can protect ourselves from antibiotic-resistant microorganisms. Sponsored by OASIS. To register see their web site at www.oasisnet.org.

Thursday, April 16, 1:00 p.m. OASIS Online. Probiotics and Prebiotics: The care and feeding of germs that keep us healthy. Beneficial bacteria populate the outside and inside of our bodies, improve our immunity, lower cholesterol and provide energy. Learn how to safeguard this critical resource. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

 

In the news

Be careful of phony cures or preventive supplements for this pandemic virus.

Among all the uncertainty regarding COVID-19 there is one element that holds true: there are as yet no documented, proven treatments for this new viral illness. I hope that this will change in the next couple of months. Those who promote things like vitamin C are not necessarily malevolent. Rather, they are desperately hopeful and jump on unsubstantiated claims.

Our example of vitamin C is a case in point. It’s an important nutrient but its effect on cold viruses and coronaviruses is minimal at best. Intravenous, high-dose vitamin C has been tried on coronaviruses in the past with marginal benefit but such dosing is not possible except in a hospital setting. High oral doses may cause stomach upset and in some persons can cause kidney stones. Two or three servings of fresh fruit every day are sufficient for most people. For the 80 percent of Americans who never or rarely eat fruit, a vitamin C-containing multivitamin makes sense.

Coconut oil, curcumin and elderberry extracts have no proven value.

You’ll find objective, reliable information on this topic at one of my favorite websites, http://www.consumerlab.com.

Lifestyle

Another in our series on annoyances of aging: cracked fingertips.

       During cold weather some seniors develop painful cracks on the tips of their fingers, most commonly the thumbs.

Moisturizing creams, hydrocortisone and herbal preparations are often recommended but nothing beats Super Glue! Just place a single drop on the crack and by the time you get the cap back on the tube the pain will be gone. Super glue is safe and is commonly used in emergency rooms to close minor lacerations.

A single application is all that’s necessary if you put it on as soon as you notice the crack and feel the pain. If you wash your hands multiple times a day, as most of us are doing these days, you might need to apply it again but the crack usually heals itself under the glue in two or three days.

 

 

 

 

 

 

 

 

 

 

 

Stone Age Doc Pandemic Perspective #2

Rady Children’s Hospital hosted a webinar on COVID-19 on March 27th by Dr. David Kimberlin of the University of Alabama. Additional comments were presented by Dr. Mark Sawyer of UCSD.

By now we accept that at this stage of rapid developments, facts are fluid, scientific opinions are often contradictory and no one knows when life can return to normal – “normal” being perhaps quite different from what it was when the new year began. Here are some of the highlights of Dr. Kimberlin’s presentation.

No one can be sure when the peak of the epidemic will occur in the United States although sometime in mid- or late April is likely.

Social distancing has clearly been shown to limit transmission of the virus within the community. This coronavirus will probably be a seasonal, i.e., recurring problem, in much the same way that influenza is. By April 2021 it’s likely that about two-thirds of the global population will have become infected.

Significant mutations (which could change the pattern of a future epidemic) such as those that occur with the influenza virus, do not appear to be a problem. Coronaviruses tend to show strain differences but the impact of those changes is not clear.

The immune response to COVID-19 is not durable, so that later reinfection with the same strain is possible. It will be at least a year before we can have some idea of the duration of immunity developed by a future vaccine.

The occurrence of asymptomatic infection is higher than initially suspected; it ranges from 20-40% depending on the population and the methods used to identify infection. The average is about 30 percent.

Chloroquine and hydroxychloroquine are being studied at many sites but no definitive data have yet been published.

The virus appears to have little effect on children below the age of 10 years. This is the age group in which the coronaviruses long known to cause ordinary colds are common, so that these children have cross-protection and do not become seriously ill.

I’ll be publishing these perspectives every Saturday for the foreseeable future. You can receive them automatically by clicking on the link on the home page of this web site on the lower right.