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.

In the news                  September 1, 2020

The flu vaccine – but wait! There’s more!

The flu season doesn’t officially begin until October 1st but the vaccine is already available. Becoming infected with the influenza virus is always risky, especially for older persons but children are also at risk. More than 150 youngsters died in the season that ended earlier this year.

The influenza vaccine is not all that great compared to the highly protective childhood vaccines like measles or the ones that are strongly recommended for adults, such as the pneumonia or shingles vaccines. You can still get the flu if you are vaccinated but that’s not the primary consideration. We’re facing a new complication this year, COVID-19.

Some viruses weaken the immune system. That effect lasts for two years or more in the case of measles. Some of the worst secondary infections due to bacteria in my experience as a pediatrician occurred in kids with chickenpox. Influenza fits this pattern. Pneumonia caused by bacteria commonly occurs in patients hit by influenza, especially seniors. During the 1918-1919 influenza pandemic many, possibly the majority of fatalities, were due to secondary bacterial pneumonia, leading physicians to attribute the disease to a bacterium called Hemophilus influenzae, even erroneously naming the germ as the causative agent.

The influenza vaccine lowers the risk of pneumonia by about 20 percent and decreases the likelihood that a flu victim will require hospitalization. The studies are impressive: the influenza vaccine reduces the risk of dying by 36 percent, decreases ICU admission by 19 percent and reduces the need for mechanical ventilation by a whopping 34 percent. Several studies show that there is a significant reduction in heart attacks and strokes in vaccinees compared with those who are unvaccinated. In contrast, there is an increased risk of heart attack and stroke in the 6 months following a bout of influenza.

Kidney failure is becoming increasingly common, largely due to the epidemic of type 2 diabetes and most patients are unaware of it until severe symptoms appear, including heart failure. Recent studies show that patients with chronic kidney failure are less likely to develop heart failure if they have received the influenza vaccine.

We don’t yet know how the coronavirus pandemic will interact with the inevitable influenza infections. However since influenza, as noted, weakens the immune system, it’s likely to make the coronavirus infection worse. As you are aware by now, 90 percent of deaths due to COVID-19 have occurred in persons with one or more underlying disease, including obesity and diabetes.

Consider this: 42 percent of Americans are obese and 12 percent have type 2 diabetes. Only about half of seniors have received the vaccine against one of the leading causes of pneumonia in persons with influenza.

In light of all the above, failure to get the influenza vaccine is sheer folly. The current vaccine is already available. Some people defer the vaccine until January or February because protection seems to wane after several months. In this year of the coronavirus that is not a sensible strategy.

 

Lifestyle

California’s fitness centers are open! Great news but when you return to your pre-pandemic workout, take it slow. For the first week or two it makes sense to use only light weights. Hard workouts lead to DOMS – Delayed Onset Muscle Soreness – which can be very painful.

Make sure that you’re getting enough protein to rebuild muscle, especially since exercise breaks down muscle cells – which is why they get bigger and stronger when the body repairs them – and protein is the building block of muscle. The average daily requirement for dietary protein is about one-half gram per pound of body weight; heavy exercisers need twice as much.

Don’t let yourself get dehydrated, even a little. Dehydration will make you more fatigued during your workout and it is the single most important factor in the development of kidney stones. Gyms now limit access to water fountains. You’ll have to bring your own bottle but they’ll let you refill it.

What? You don’t exercise? Did you know that regular, moderately intense exercise strengthens the immune system? That’s something you need now more than ever.

Stay safe!

 

 

 

 

 Pandemic Perspective #23                         The coronavirus crystal ball

Making predictions can be dangerous, especially when they are in writing. That’s even more precarious when the virus and the pandemic that it has spawned have revealed so many surprises, overturned long-accepted medical principles, embarrassed politicians and their healthcare advisors, thrown political campaigns into knots, threatened the viability of whole industries, transformed the workplace, encouraged migration away from cities and forced the nation’s education facilities, especially colleges and universities to adjust to the still-uncertain online methods of delivering their content. Whew!

What will the world look like at the end of 2021? It’s certain that the SARS-CoV-2 virus, by then having spun off several mutated strains of unpredictable invasiveness, destructiveness and the response to a vaccine, will still be around. It’s unlikely that we will have arrived at herd immunity considering that as of late summer 2020 only about three-tenths of one percent of the global population has been infected.  Even in the United States the number is below two percent (assuming that the numbers are even close to being accurate). Herd immunity may require that at least thirty times as many of us need to experience the virus, even more if we rely on the measles model that requires nearly ninety percent to reach an effective level.

As noted in last week’s blog a vaccine is only part of the solution; vaccine effectiveness and distribution are significant challenges and cost is a major factor in developing countries. The pharmaceutical industry has not yet brought forth a single drug or combination that can stop COVID-19 in its tracks, at least to the satisfaction of medical professionals, pundits and politicians. Convalescent plasma is promising but such a complex biological material is likely to reveal allergic reactions and other problems when it enters wide use.

Are you working from home? Will you ever go back to an irritating daily commute, spend five days a week in a (currently empty) office building and have to wear something besides PJs or sweats? Public transportation and commercial office space have taken a hard hit and they have taken municipal tax revenue with them.

Colleges and universities are in turmoil. They still have to maintain classrooms, administrative spaces and dormitories but students and their families are already balking at having to pay full tuition for online courses and the revenue from athletic events has vanished. To some parents of younger school-age children, home schooling has revealed clear benefits and there are now several permutations of this approach to education. Pooling of parental talent, choice of curriculum, fewer worries about safety from predators or bullies, lower transportation costs and a sense of control add to the appeal. Proponents of school choice have been energized by new opportunities and bolstered by the reluctance of teachers’ unions to reopen schools.

Then there’s the face mask issue. No civilian version is 100% effective. Simple cloth masks are minimally effective; those with valves actually increase the risk of spreading disease. Yet Dr. Fauci has told us that we’ll be wearing masks throughout 2021. Good luck with that! (On the other hand, maybe he will have changed his mind again.) More and more people refuse to wear them and many others wear them below the nose. Unless there is a sharp downturn in the rate of infection you can expect more states and cities to mandate their use for the remainder of this year, as several have already done.

Dr. Fauci has also told us that we must stop shaking hands – forever! Even fist bumps are suspect.

“Fine dining” has become an oxymoron. There is nothing charming about eating at a table in what was a parking space a few months ago. When indoor dining does return there will be at least one benefit: the restaurant will be quieter with only a quarter to half as many patrons. The wait staff will also be more eager to please, with only a fraction of the tips that they had become used to. I doubt that the restaurants that will still be open at the end of 2021 will be allowed to return to their prior capacity.

Flying had become an unpleasant experience even before TSA security lines. The airlines predict that it will take years for them to recover. Permanently furloughed crews and ground personnel never will. Perhaps TSA will implement a new express lane for passengers who can show a certificate of immunity or proof of vaccination. Like the pink dot on your driver’s license that identifies you as an organ donor we can apply for a “COVID-19 Free” sticker to help us zip through the line.

COVID-19 testing is evolving as technological advances make it more accurate, faster, easier, more comfortable and less expensive. Test kits will be as ubiquitous as pregnancy tests on the shelves of Wal-Mart sometime in 2021. It’s not much of a stretch to imagine a COVID-19 test combined with a DNA test (to prevent fraud) in a national database. That will  give privacy advocates nightmares but there isn’t much about each of us that isn’t already in a database somewhere to which we have contributed willingly.

The national lockdown will have ended by December 2021 but the effects on our psyche will be as lasting as those that followed the stock market crash of 1929 or World War Two. Hugs and handshakes will be less common but wearing a face mask will become a habit for many persons. We’ll unconsciously keep social distancing when we’re among strangers. Zooming won’t just be for business; together with Instagram and other apps it will replace ordinary phone conversations. The benefits of working from home will have been solidified and welcomed both by employers and employees.

But then, these are only predictions. I can’t wait to see the reality!

And feel free to share any ideas that you might have regarding post-pandemic America. How do you think your life will change?

 

 

 

 

 

 

 

Pandemic Perspective #22   August 22, 2020

What do you think of a COVID-19 vaccine?

Vaccines have been one of the major reasons for the dramatic change in life expectancy among children. Barely two centuries ago one child in four didn’t make it past the first birthday. That number is now about one in 1000. Better nutrition and improved sanitation had much to do with that progress but vaccines deserve most of the credit.

There is a wariness about the COVID-19 vaccine. Like prescription drugs, vaccines sometimes have severe, occasionally fatal, side effects. That will undoubtedly be true for the COVID-19 vaccine by the time the first million or so doses have been administered.

At no time in history has there been such an enormous, frantic effort to produce a vaccine. Among more than 200 candidate vaccines a handful are already in the human testing phase. Even if at least one is approved for use by the end of this year it will likely take most of 2021 to administer it to the globe’s seven billion inhabitants, and that may be an optimistic estimate.

There are several barriers to completion of a successful vaccine program. It may turn out to be like the influenza vaccine, only partially effective and requiring annual administration. Like the influenza virus, coronaviruses undergo frequent mutations, some of which may dictate periodic retooling of the vaccine. A worse scenario is that vaccine recipients, instead of being protected from a subsequent natural infection, may have a paradoxical, worse illness upon such exposure.

Perhaps the most serious challenge to universal coverage is vaccine refusal. Polls indicate that at least a third and perhaps half of adults will refuse to get immunized. Their reasons cover a wide spectrum that includes fear of injury, concern about effectiveness, the cost of the vaccine or even conspiracy theories that range from the plausible to the idiotic.

In all this there is a lesson to be learned from the influenza vaccine. Its ability to prevent illness is nothing to celebrate, ranging from about twenty to fifty percent. That is not the issue. What matters is that even when the vaccine is only partially protective it almost always does modify the disease and – and this is extremely important – it keeps victims from requiring hospitalization. Hospitals breed antibiotic-resistant bacteria that kill tens of thousands of Americans every year. A growing number of bacteria are resistant to all currently available antibiotics.

The next wave of influenza will be in full swing early in 2021 and there is already a consideration that we will see a combination influenza-coronavirus vaccine. I seriously doubt that such a dual vaccine will be available for at least a year. It will require even more testing, although combination vaccines for children have been in use for decades. Contrary to earlier fears, such mixtures are no less potent than individual vaccines and reducing the number of shots is something every parent and child can appreciate.

An intriguing question: how will social distancing, obligatory wearing of masks, closure of usually crowded entities such as schools, theaters, restaurants and other venues influence the spread of influenza? Unless the coming season’s version of the flu virus is unusually contagious there is a strong likelihood that we will see fewer cases of influenza and thus fewer deaths than in most years. That should not deter anyone from getting a flu shot, especially since there is a real risk of acquiring both viruses at the same time – a really scary scenario.

To my knowledge, none of the candidate vaccines consists of live coronavirus particles although a few utilize benign live viruses to transport the coronavirus material into cells for processing and ultimate protection.

The SARS-CoV-2 virus has turned out to be full of surprises from which medical scientists have learned a great deal. I’m certain that the COVID-19 vaccines will provide even more.

 

 

 

 

Pandemic Perspective #21 Covidiocy August 15, 2020

More than six months into the coronavirus pandemic there are contradictory opinions about whether it is rising, leveling off or declining. That’s nothing compared to the idiocy – already named Covidiocy – that permeates society like an epidemic. (Sorry – couldn’t resist.) Scientists, journalists and politicians (especially politicians) are all part of the clown force.

Covidiocy is defined as the loss of the ability to think logically during a pandemic. It’s nothing new; bizarre ideas and practices have been rife during everything from the Black Death to the Spanish flu. The modern media, of course have put it in our faces like never before.

Speaking of faces, the covidiots that wear face masks are the most obvious.  It’s bipartisan; Anthony Fauci, Jerry Nadler and Gavin Newsom have been photographed with their masks under their noses or hanging on their chins. Democrats point to the times when Donald Trump went barefaced completely. Before our fitness center closed I actually counted 16 fellow exercisers right around me who thought that they were wearing mouth masks, not face masks.

It’s hard to open a web page these days that doesn’t include an ad for masks – including the ones with valves, which make breathing easier but also allow any germs in your exhalation to waft unimpeded through the air around you. Plain cloth masks such as bandanas are comfortable but just as worthless.

Perhaps the most idiotic are the politicians who have decreed that we should wear a mask even when home alone, alone in our cars, during a Zoom session, when walking in the park with a family member or even when having sex! How scientific!

Then there is statistical covidiocy – such as the numerous instances in which persons, listed as fatal cases and who died with the coronavirus were included among those who died of coronavirus – including one report of a person who died of a gunshot wound. (I’ll concede that some of those reports are made up but many, not just a handful, are valid.)

The just-announced democrat vice presidential candidate is recorded on video as saying that young people are stupid. Having at some point in the past being young and stupid myself, I totally agree. Seeing the many videos and photos of young people at parties, bars and other venues, crowded together, vocalizing, maskless and clearly not “distancing” reinforces that opinion.

By the way, how is your supply of toilet paper?

 

Pandemic Perspective #20 – August 8, 2020

Thinking zinc? Think again.

Zinc has come out of the shadows, thanks to SARS-CoV-19. It is an essential nutrient, participating in several hundred chemical reactions throughout the body. Zinc deficiency can have severe consequences that range from hair loss to severe mental retardation and dwarfism but it is uncommon in places like the United States. It’s also vital for a healthy immune system; elderly persons may have inadequate levels of zinc, making them more susceptible to infections, especially pneumonia.

Red meat, shellfish, whole grains, beans and nuts are good sources of zinc. Supplements are rarely necessary and most multivitamin/multimineral preparations provide the recommended intake of roughly ten milligrams daily.

Because zinc is important for optimal immune function it is being studied, especially in conjunction with hydroxychloroquine, for the treatment of COVID-19. As of this date (August 8, 2020) there is no conclusive evidence that taking a zinc supplement will influence the outcome of coronavirus infection although some studies do show some benefit.

Zinc supplements have been around for years for the prevention and treatment of simple colds. There again, studies are mixed, although there is evidence that such supplements shorten the duration of a cold by a couple of days. In developing countries, where zinc deficiency is common, the benefit of zinc in preventing respiratory infections is clearer.

High doses of zinc, especially when taken for more than a few weeks, can cause gastrointestinal irritation and in persons who use an intranasal preparation, loss of the sense of smell can be permanent.

Should you take a zinc supplement to prevent COVID-19? The answer is no. If you take it when you are starting to develop a cough, sore throat or runny nose, don’t take it for more than a few days and never more than 40 milligrams per day.

If you are in a group that might be at risk of zinc deficiency (older, diabetic, vegan) a multivitamin/multimineral that provides a full complement of nutrients is a better choice. Even better is a healthy diet: fruits, vegetables, nuts, beans, whole grains, fish, occasional red meat – and no junk food!

 

 

 

In the news                  August 1, 2020

The other diabetes – a new scenario

You may have read that the lethality of the current coronavirus increases dramatically in persons with diabetes. Several countries have reported that more than half of those who died had diabetes, overwhelmingly type 2, which had previously been known as adult onset diabetes.

As I have noted in past blogs, pediatricians have recognized for decades that when a disease such as mumps occurs in genetically susceptible persons they sometimes develop type 1 diabetes (juvenile onset). It appears that the virus not only destroys insulin-producing cells within the pancreas, it releases fragments of those cells that trigger an immune response that finishes off the cells that are left. When the production of insulin ceases, daily injections are necessary to sustain life.

The mumps virus is just one example but other viruses can also be the villains. In 2002 the SARS virus and in 2012 the MERS virus, both coronaviruses, were found to be capable of destroying insulin-producing cells. Italian physicians were among the first to report that some SARS-CoV-2 patients had type 1 diabetes (T1DM) and that in many cases the condition had not previously been diagnosed. This raises the disturbing possibility that SARS-CoV-2 actually causes T1DM and that because of the sheer numbers of infected persons throughout the globe we are going to see an epidemic of the disease.

The picture is far from clear and it is much more complicated than the simple explanation that I offer here. Besides genetics other factors come into play including the mechanism by which viruses attack those insulin-producing cells, the details of the patient’s immune response, the effect of antiviral drugs or other medications that might halt or slow down the process and how physicians can manage the complex biochemical abnormalities that result from the combination of a life-threatening viral infection and an equally lethal metabolic disorder.

The big question for those who have type 1 diabetes or have a family member who does: will COVID-19 increase the risk of dying? It appears not. In fact, physicians in Italy suggest that the risk of acquiring the infection and of having severe complications appears to be lower in persons with type 1 disease. However, the numbers observed so far are very small, the explanation may have nothing to do with the virus itself and systematic analyses are only now getting started.

Stay tuned as we experience one more surprising element of this unusual pandemic.

Lifestyle

Annoyances of aging: that pesky intestinal tract.

This week we’ll start from the top with GERD (GastroEsophageal Reflux Disease) that can be as mild as heartburn or as severe as bringing up stomach acid that you can taste. This happens when the valve-like apparatus between the esophagus and the stomach becomes relaxed and incompetent as we get older. Sometimes the cause is a hiatal hernia, a defect in the diaphragm, the sheet of muscle that separates the chest from the abdomen.

In most persons the symptoms of GERD are mild and can be relieved by taking a Tums or two. When the acid-induced irritation of the lower esophagus becomes frequent and severe it’s time to see your local gastroenterologist. He or she may determine that the cause is related to a prescription medication, to a hiatal hernia or simply obesity. It may be necessary to take a look or to do other tests in order to rule out specific conditions such as Barrett’s esophagus, which carries a low but real risk of cancer.

Medications that lower the production of stomach acid include PPIs (Proton Pump Inhibitors) and H2 blockers but both of these prescription drugs are associated with side effects that include a greater risk of cancer, dementia and fractures. One of these, ranitidine (Zantac), has been removed from the market by the FDA. Stomach acid is necessary for the proper processing of vitamin B12 and medications that reduce it can induce anemia as well as damage to the nervous system.

You can take some consolation from the fact that you have lots of company: about 20 percent of Americans have GERD and even more have simple heartburn. Most of us can handle it well with antacids but when the symptoms are severe it’s another one of those annoyances of aging that in reality are indicators of a more serious problem.

 

 

 

 

 

Pandemic Perspective #19    July 25, 2020

COVID-19, obesity and Type 2 diabetes. Is this the wake-up call?

For more than a half century the First World has been experiencing epidemics of obesity and type 2 diabetes. They are so closely related that some use the term diabesity to emphasize their twinship. Together they are responsible for or contribute to the chronic non-infectious diseases that comprise nearly all of the leading causes of death. From the earliest weeks of the COVID-19 pandemic it was clear that obesity and diabetes, along with their complications of heart disease, hypertension, kidney disease and immune system dysfunction were serious comorbidities, especially among the elderly.

At the beginning of the 20th century only about five percent of Americans were obese and type 2 diabetes, which occurred mostly in persons of late middle age, was so uncommon that it wasn’t clearly differentiated from type 1 diabetes until the 1950s. Today’s numbers are appalling: more than forty percent of us are obese and nearly as many more are overweight. More than ten percent have type 2 diabetes, and 34.5 percent of Americans have prediabetes according to the CDC (Centers for Disease Control and Prevention in their 2020 report). These trends are getting worse, killing increasing numbers of Americans and threatening the economic stability of the healthcare system.

The SARS-CoV-2 virus is a particular threat to older persons not only because they have diabesity but because these conditions weaken an immune system that is already faltering because of the aging process. Diabetes causes damage in another way: the long-term elevation of blood sugar causes blood vessels to become distorted, leaky and unable to properly deliver oxygen and nutrients and to dispose of waste products. The final blow is coronavirus infection, which attacks already-damaged blood vessels. This seems to explain the high incidence of heart attacks, strokes, blood clots and peculiar changes in the fingers and toes of many victims.

The new coronavirus, already the source of surprises, has come up with another: it causes abnormally high levels of blood sugar in persons with no prior history of diabetes or prediabetes, a phenomenon called stress hyperglycemia. Patients with this complication as well as diabetics whose blood sugar has not been well controlled are two to three times as likely to die as those whose blood sugar stays in the normal range.

It’s a sad fact that obesity and type 2 diabetes are the results of lifestyle, not aging. Perhaps humanity can salvage something from the tragedy of this pandemic. Our children should learn the basic principles of good health in the classroom: a mostly plant-based diet that is free of refined grains and sugar, and regular physical activity. When the next pandemic arrives – and there certainly will be others – a population that is free of diabesity will handle it as well as the COVID-19-infected youngsters of 2020, virtually all of whom have come through it with ease.

Pandemic Perspective #18      July 18

School opening  part 2

The calls to re-open schools are increasing, led not only by exhausted, frustrated parents but by national child advocate organizations urging that wherever possible, students should begin the new school year in the presence of teachers and other children. The American Academy of Pediatrics, the National Education Association and the American Federation of Teachers are among those who recognize that SARS-CoV-2 poses little risk to persons of school age but that more than education is involved.

In my last post I referenced coronavirus parties at school analogous to chickenpox parties of the pre-varicella vaccine era. That was a misguided comment, as brought to my attention by someone whose opinion I respect. There is a vast difference between deliberately exposing children to infection as compared with allowing them to be present in schools, where there may be infected persons. Still, the comment was misleading and not appropriate.

A major factor in this decision process is the recognition that as of July 17, 2020 there have been no deaths from coronavirus in children under the age of 18 in California. In other states and countries, including Spain and Italy where the disease has ravaged the populace, deaths among this age group have almost always occurred in children with underlying heart or lung disease. Until a vaccine is available for susceptible adults and children, including teachers and administrators, they should not return to school.

As noted by the AAP and other groups, schools help children to learn important social and emotional skills. Meals for disadvantaged children are important and so is the opportunity to identify situations in which a child is threatened by abuse or other safety issues. Special needs children are especially at risk but I cannot imagine any city that is unable to provide a separate, protected location for their special education teachers to educate and care for them. Both the students and their teachers can be screened in order to prevent transmission of the virus.

A national tragedy is emerging in that online learning is simply failing.  In measured studies, minority children are most at risk of falling behind, compounding the problems that already plague that group. It gives new meaning to the phrase “A mind is a terrible thing to waste.”

 

 

 

In the news             July 15, 2020

A few days ago I wrote about herd immunity, pointing out that if it comes about naturally it requires a very long time and it is temporary, whereas if it can be accomplished by a continual immunization program it is likely to occur relatively quickly and become permanent. For example, when immunization against the pneumococcus bacterium, a cause of minor infections such as ear infections and major ones such as meningitis and bacteremia (invasion of the bloodstream) became routine in children the incidence of pneumococcal pneumonia caused by vaccine strains among adults diminished significantly.

In the case of COVID-19 we need to think about children for another reason: they seldom become seriously ill from this new coronavirus unless they too have an underlying condition such as heart or lung disease. If we compare COVID-19 with chickenpox it reveals why opening the schools now will have significant value long-term.

Until the chickenpox (varicella) vaccine was developed in 1995 it was rare for anyone to reach adulthood without having experienced the disease. The illness is generally so mild in children that parents often staged “chickenpox parties” in the neighborhood to “get it over with.” Unfortunately about 150 children in the United States succumbed to the disease or to secondary infection every year. The story was quite different in adult victims, about twenty percent of whom developed chickenpox pneumonia and whose risk of dying was far greater. In some years prior to release of the vaccine an adult was 25 times more likely to die from chickenpox than a preschool child. Now that the virus has almost disappeared there have been almost no deaths due to chickenpox in this country in recent years.

How does this relate to COVID-19? Fatality rates begin to increase after the age of twenty; there is a dramatic rise beyond age sixty. Those beyond the age of eighty have the highest risk. In each of these age groups there is a progressively increasing incidence of type 2 diabetes. In the past few days there has been a cluster of medical journal articles (that I will discuss in next Saturday’s Pandemic Perspective blog) indicating that elevations of blood sugar even in persons who have not been diagnosed with diabetes increase the risk of severe disease and death. Obesity rates increase with age and it is a high-risk factor that often leads to the dreaded cytokine storm.

We should not fear the exposure of children to SARS-CoV-2. They have an innate resistance to severe disease, just as they do against chickenpox and they do not have the risk factors that are present in the vast majority of older adults. Further, as we have seen in other viral infections, the natural disease is likely to result in longer and stronger immunity than the vaccine-induced stimulus. A clear example is mumps, whose vaccine-induced immunity wanes dramatically during adolescence but in which natural infection produces lifelong immunity. By protecting children from COVID-19 infection we may be setting them up for a greater risk of disease when they become adults, whether or not they receive the COVID-19 vaccine.

 

Lifestyle

            Memory loss. Is this the worst annoyance of aging?

We dread it more than death, fearful that having difficulty in remembering names is a prelude to dementia. The prospect of becoming unable to recognize loved ones and to be incapable of managing the day-to-day routines of living is terrible to imagine. The good news is that we can do something to ward off memory loss and postpone the onset of Alzheimer’s disease and vascular dementia. Although Alzheimer’s disease has a strong genetic component, vascular dementia has little to do with aging; it is the product of the modern lifestyle and comprises about one-half of dementia cases.

Contrary to what I was taught in medical school, we can form new brain cells throughout life by engaging in physical exercise and we can increase connections between brain cells many-fold by engaging in taxing mental activity.

Exercise is important in maintaining normal body weight. Overweight and obesity lead to a loss of brain volume; excess body fat increases the risk of type 2 diabetes by a factor of eighteen (!) which leads to blood vessel damage within the brain. That in turn leads to starvation of brain cells and increased brain cell death.

In other words, regular, moderate physical activity – 4 or 5 times a week for at least one hour at an intensity that works up a sweat – not only reduces obesity but grows new brain cells and supports the health of old ones.

Good nutrition is also critical, especially omega-3 fats, abundant in fish (or a supplement if you just don’t like fish!)

Stimulate brain health by learning a new language, how to play a new musical instrument, reading, puzzles and games.

Okinawa has the highest percentage of centenarians on the planet, people who live beyond 100 years. They can take care of themselves and they can remember the names of their great-great-grandchildren. What do they have in common? Few labor-saving devices; they carry out most chores by hand or with simple tools. They eat almost no red meat and no refined grains or sugar; most of their calories come from plant foods.

A pretty simple lifestyle, and it works.

Pandemic Perspective #17   July 11, 2020

Is herd immunity a false hope?

Almost since COVID-19 became the leading story of 2020 there has been the hope that herd immunity would bring the pandemic to an end. Not likely. Authorities have flip-flopped on issues such as transmissibility, susceptibility, mask effectiveness, the efficacy of old and new drugs and ventilator therapy. We shouldn’t be surprised if the concept of herd immunity will be tested.

When a new microbe invades a population it sickens some, kills some and infects some who show no apparent symptoms. At a given point there are too few potential victims remaining or they are too widely dispersed so that the infectious agent seems to vanish. It might circulate quietly without causing much notice but can resurface when a new population of susceptible persons arises. The surviving herd is now relatively immune but danger always lurks.

That is not the ideal type of herd immunity because it is only temporary. A more desirable form of herd immunity is based on vaccines. When most of a population has been vaccinated – measles is a good example – a virus that arrives from the outside has no place to go. As long as immunization rates remain high, ideally above ninety percent, herd immunity is permanent and can remain so for generations, unlike that which occurs in natural infections.

Because measles vaccination was so effective by the end of the 20th century the United Sates was declared to be measles-free, a state that quickly changed when increasing numbers of parents refused to allow their children to receive routine childhood vaccinations, including MMR (Measles-Mumps-Rubella). In the past two decades there have been several outbreaks of measles when persons from outside the United States introduced the virus to a population not all of whom had vaccine-induced immunity.

How will the herd react to the coronavirus? The honest answer is that no one knows. In a world without a vaccine it will take years, perhaps decades, before most of the population has been infected, leaving behind so few susceptibles that the virus becomes an annoyance and not a threat, at least temporarily as noted above. As of mid-July there have been fewer than 15 million cases worldwide. Some epidemiologists believe that there are at least ten times that many persons who have encountered the virus but who have been misdiagnosed or missed entirely because they have had few or no symptoms, a total of perhaps 150 million. Among a global population of 7.5 billion that represents only 2 percent who have experienced the virus thus far. The likelihood of a naturally-occurring herd immunity is vanishingly small, especially when government officials are madly scrambling to prevent the development of herd immunity by limiting exposure.

Enter an effective, i.e., fully protective and long-lasting vaccine. Even if some of the more than 150 companies now racing toward this goal are successful, what will it take to provide herd immunity? Again, no one knows. Some vaccine candidates require two doses; some, like the influenza vaccine, may require annual doses. Protecting most of the world’s population with even a single lifetime dose will require a logistical effort unlike any that the world has ever accomplished.

Unless there is an immediate breakthrough with a highly effective drug against the SARS-CoV-2 virus it’s likely that a quarter-million Americans will have died of this disease by the end of 2021. Roughly half will have had conditions such as diseases of the heart, lungs or kidneys; most of those will be the elderly; being overweight and having type 2 diabetes are major risk factors. Perhaps a COVID-19 vaccine will protect individuals in these groups. I certainly hope so.

Unfortunately, herd immunity will not be a factor.