In the news                  October 15, 2020

            Two coronavirus vaccine programs have been paused because recipients have developed serious medical conditions that might have been caused by the vaccine. What does that mean? How concerned should we be?

            The development of a vaccine is not as simple or straightforward as producing a new version of an iPhone or Samsung Galaxy. Though complex, a smartphone always conforms to physics; biological systems do too but the variations they share are complex beyond imagination.

            There is no one on the planet who is exactly the same as you, not even if you are an identical twin. We carry about 25,000 genes, each of which not only has several versions but whose functions may be turned on or off by environmental factors. You might think that fingerprints or retinal scans are unique but that is nothing compared to the enormous complexity of our immune system. No two people on the planet have had the identical exposure to viruses, bacteria, fungi and parasites so each of us has a unique immune system. When confronted by a new agent in the form of a vaccine, no two people will react in the exact same way. Therein lies the challenge for vaccine developers.

            One coronavirus vaccine recipient has developed a condition called transverse myelitis, a condition in which inflammation damages an area of the spinal cord. This can have multiple causes, usually a virus but sometimes a vaccine. The current case is being investigated but it’s not yet been determined if it was caused by the vaccine. If another case pops up among the next few thousand vaccine recipients the game will change dramatically.

            There have been more than a dozen cases of transverse myelitis due to naturally acquired SARS-CoV-2. If the vaccine mimics the natural infection, it’s possible that it will cause similar complications, although hopefully at a much lower frequency.

            The pause in the trial of this vaccine should be encouraging, not the opposite. It is the way that vaccine trials are designed and such interruptions are the norm in vaccine development. That’s why they usually take so long, sometimes years.

            Among the more than 150 vaccines now in development there are some whose design is unique, innovative and therefore unpredictable. Somewhere among them we might discover a silver lining.

Lifestyle

            See what happens when you change a dietary habit.

            Americans eat about six times as much sodium as hunter-gatherers and we pay a high price for that. Among African hunter-gatherers who take in about 600 milligrams of sodium daily the incidence of high blood pressure (hypertension) is zero. Their genetically identical cousins in the U.S. average about 3500 milligrams a day and hypertension is a leading cause of death in that group.

            Our taste for salt is acquired but if you go on a very low sodium diet for about six weeks by avoiding most fast and processed food and putting away the salt shaker you’ll find that when you eat a pretzel or a potato chip at the end of that time you won’t enjoy it! You might also discover that your blood pressure has come down a few points.

            The average sugar intake in the U.S. is more than 150 pounds per year; in colonial America it was about six! Try the same test with sugar. Stop eating candy, dessert and soft drinks for a month; don’t add sugar to your coffee. I’ll bet that you won’t be able to finish a Krispy Kreme donut by then.

            Heart disease is the number one cause of death and type 2 diabetes has moved up to number three! Two thirds of Americans over the age of sixty have at least one marker of coronary artery disease and a similar number at that age have either type 2 diabetes or prediabetes.

            You can’t change the world by cutting way back on salt and sugar but maybe you can change your world! Is it worth a try?

Pandemic Perspective #29     October 10, 2020

Hydroxychloroquine: on again, off again, on again???

            Well, it’s another head-spinner! Hydroxychloroquine (allow me to abbreviate it to HC), a medication that has been used by physicians to prevent and to treat malaria and in the treatment of several other diseases since 1955, fell victim to politics and the media with the arrival of SARS-CoV-2.  

            In 2003 an article in Lancet, a respected (until recently) British medical journal, described the drug’s antiviral and immune-boosting properties and suggested that it should be considered in the treatment of AIDS and SARS. A section of the paper entitled Safety considerations noted its “low incidence of adverse events during chronic administration” and “the safety of a high dosage of the drug even during pregnancy.” It can cause damage to the retina of the eye in persons who have been taking the drug over five years. The WHO placed it on its List of Essential Medicines, the safest and most effective medicines needed in the health system.

            Early in the pandemic several groups published their experience with HC in coronavirus patients, especially when given with Azithromycin and reported a significant decrease in viral load and earlier discharge of ill patients from the intensive care unit.

            But then the HC hit the fan when Donald Trump sang its praises and reports emerged of its cardiac toxicity and ineffectiveness in the treatment of COVID-19. Rheumatologists, who have had decades of experience in treating patients with lupus, rheumatoid arthritis and other autoimmune diseases, were aware of its potential to cause abnormal heart rhythms and noted the importance of monitoring patients with known heart disease. Like every other prescription drug, by the time millions of doses had been given for malaria and the diseases mentioned, other side effects emerged but when given for a short time these were usually limited to abdominal cramps, nausea, vomiting, diarrhea and headache.

            Goodbye HC. But wait! In a report from the David Geffen School of Medicine at UCLA, although individual trials of HC did not show a “statistically significant impact on prevention or treatment,” when these trials were pooled into a meta-analysis, early use of the drug yielded a “significant 24% reduction in risk of infection, hospitalization or death.”

            One of the authors of the study noted that when the results of this meta-analysis are combined with the results of seven nonrandomized controlled trials “This is extremely strong evidence of benefit.”

            Stay tuned. Who knows what next week will bring?

Pandemic Perspective #28         October 3, 2020

            The latest on coronavirus vaccines.

                A former colleague, Dr. Stephen Spector, a pediatric infectious diseases specialist at UCSD gave an excellent overview of the status of coronavirus vaccines in an online presentation on October 2nd.

            Of more than 150 vaccines under development only a handful are in the final phases prior to release. As noted in earlier blogs, some are using unique and innovative methods and the range of techniques is remarkable.

            Dr. Spector could not predict when the first ones will be released but he did offer some encouraging news that all of us should be aware of. The best news, in my opinion, is that the vaccines provide antibody responses similar to those of natural infection. That could mean long-lasting immunity. Protective levels are reached in about 14 days.

            To date there have been no reports of serious side effects. The most common one is pain at the injection site in about 50 percent of recipients and many persons have some muscle aches for a few days. Some vaccines require two doses but the good news is that side effects do not increase with the second dose.

            The target effectiveness – the level of protection that the developers expect in a best case scenario — is only 60 percent, a little better than most influenza vaccines. We’d like for it to be much higher (the current measles, shingles and hepatitis vaccines are protective in more than 90 percent of recipients) but it’s likely that even at that level it will modify the disease enough to prevent hospitalization and severe complications.

            One downside to most of these vaccines is the need to maintain storage at very low temperatures, making it a challenge for developing countries that don’t have the freezer technology required.

            Another challenge is matter of acceptance by the public. Only 40 to 60 percent of persons report that they will get the vaccine. Acceptance differs considerably between members of the major political parties. And no, I won’t go there!

In the news          October 1, 2020

Vaccines: the good, the bad, the ugly – what will the SARS-CoV-2 vaccine be like?

            The remarkable decline in child mortality that began more than a century ago was due to three major advances: sanitation, antibiotics and vaccines.

            Vaccines have been around for thousands of years. The ancient Chinese and Persians inoculated their children with the dried crusts of smallpox lesions, a practice that was used until the late 18th century when the more benign cowpox vaccine came into wide use. A concerted effort led by the World Health Organization eradicated smallpox in the 1970s, a dreadful disease that killed several hundred thousand persons every year.

            A unique feature of vaccines is the variability in their effectiveness, duration of protection and side effects. Persons who received the ancient smallpox vaccine sometimes died; even the modern smallpox vaccine often caused severe disease in children with eczema and it killed those who had an unrecognized defect in their immune system.

            The truly ugly feature of immunization is human error caused by contamination or by mistakenly administering the wild virus instead of the benign vaccine version. Such catastrophes occurred with a diphtheria vaccine and a polio vaccine, respectively.

            There is no prescription medication that does not have side effects, sometimes fatal ones. We shouldn’t expect that vaccines will be entirely benign either although except for the immunocompromised person, as mentioned, a fatal outcome is rare.  

            There is no way to know how effective or how risky coronavirus vaccines will be, especially since there are more than 150 companies in the race and some developers are using new and innovative formulations. Even if we assume an extremely optimistic rollout of a billion or two doses in 2021 it will take at least a few months and possibly more than a year before physicians can be assured of its effectiveness.

            The media regularly warn that political pressure will lead to hasty, premature release of an inadequately tested vaccine. I doubt that for one simple reason: the lawyers, not the politicians or the scientists will decide when a vaccine is ready to be released. A company that has everything to lose if their vaccine fails will not be let out of the gate until the corporate attorneys say so.

Lifestyle

            Here’s another Annoyance of Aging: discrimination. Although there are laws against age discrimination in the workplace there are some logical and acceptable reasons for leaving seniors out of some occupations that require strength and stamina. On the other hand there is no reason why a car rental company won’t give a 71-year-old access to a vehicle as in some countries, or even 61 in the case of Morocco. Kudos to Finland, where you can rent a car until your 97th birthday!

            There is a bright side, of course. Movies cost less, national parks are free, people hold the door open for you and you can’t get pregnant.

 Pandemic Perspective #27    September 26, 2020

            COVID-19, the worst pandemic since the Great Influenza of 1918-1919, should in this age of scientific enlightenment, be the most measurable and manageable disease in the last century. Instead it has been on a tortuous path marked by confusion, uncertainty, political pressure and wild conjecture.

            A statement that has been (wrongly) attributed to Mark Twain – “There are lies, damned lies and statistics” – seems appropriate.

            According to the Johns Hopkins Resource Center there have been 7,015,242 cases of SARS-CoV-2 infection in the United States as of September 25, 2020. Such a precise number implies accuracy but it is neither precise nor accurate. The exact number will never be known. Even St. Anthony (Fauci) acknowledges that “It is now clear that about 40% -45% of infections are asymptomatic.” The estimate from UCLA is that the number of actual cases may be 35 times as many as have been reported.

            Flip-flop recommendations regarding masks, distancing, therapy, school openings, etc., have left all Americans confused. How should we manage this abundance of confusion and misinformation?

            First, be assured that the risk of dying, while of concern, is less than 2 percent overall if we rely on the Johns Hopkins figures and less than one-half of one percent if Dr. Fauci is correct. Nearly all the deaths have occurred in the elderly, and among the obese, diabetic and immunocompromised in those who are middle-aged or younger.

            The CDC provided a “best estimate” (glad they’re being honest about that being just an estimate!) yesterday, September 25, that the risk of death for persons 19 and younger is only 0.003 percent; for those 20-49 years old it is 0.02 percent and for those below the age of 70 it is one-half of one percent.

            Among all the hand-wringing regarding school opening we can be reassured that youngsters are often asymptomatic, have mild symptoms when they do become ill, have a very low mortality from the disease and are poor spreaders of the virus. To keep this in perspective, 26 children under the age of 10 years have died from the coronavirus so far; about 100 children die in bicycle accidents per year and about 700 die from drowning. Among the 121 persons under the age of 21 years who have died, approximately one-fourth have had a comorbid condition such as lung disease, heart disease or obesity.

            It still makes sense to maintain personal protection: wear a proper mask, stay away from crowded places if you don’t have to be there, stay well nourished (e.g., maintain healthy levels of vitamins C and D) and don’t go near sick people unless you need to care for them. Wash your hands – a lot.

            Finally, pray that our leaders will develop some common sense and let us return to a normal life.  

Pandemic Perspective #26   September 19, 2020

                This week’s perspective veers a little off the COVID issue but not by much. There is increasing concern regarding the rapid emergence of the so-called superbugs, bacteria that are resistant to all currently available antibiotics. Infectious disease specialists, of which I am one, worry that unless there are several – not just one – breakthroughs in the development of antibiotics, we are facing an antibiotic winter, meaning that humanity will be as susceptible to common but deadly infections as we were prior to the 1930s, when something as minor as a splinter could lead to death.

            This is already a common problem, especially for hospitalized persons. On the other hand, there are now strains of the agent of gonorrhea, the second leading cause of sexually transmitted diseases that have developed extreme resistance.

            What does this have to do with the current pandemic? Persons who are seriously ill from COVID-19 have several characteristics that make them extremely vulnerable to hospital-acquired infections. They are often obese and diabetic; both conditions lower immunity. They are burdened with multiple pathways to infection – intravenous lines, urinary catheters, breathing tubes, drains to remove accumulations of fluid and pus within the chest cavity, etc. They are hospitalized for weeks, sometimes months, allowing plenty of time to be exposed to infectious agents.

            A new form of treatment is emerging: bacteriophage. The term comes the Greek – bacteria eater. These are viruses that are present throughout the environment but especially in the foulest places such as sewage. They attack and destroy bacteria, a battle that has raged for millions of years. This form of treatment for bacterial infection originated several decades ago but research declined dramatically when penicillin arrived on the scene.

            Tens of thousands of persons succumb to these antibiotic-resistant bacteria every year. The best way to avoid them is to stay out of the hospital by following public health precautions and by maintaining a strong immune system, as described in multiple postings on this site.

            For an extremely informative narrative of this challenge I highly recommend The Perfect Predator by Steffanie Strathdee and Thomas Patterson. When Steffanie’s husband Tom developed a serious abdominal infection with a highly virulent bacterium, she initiated a hunt for a bacteriophage that would cure him when all known antibiotics failed. The book is extremely well written, the audio version * is superbly narrated and it takes place in San Diego, where the couple are on the faculty at UCSD. The medicalese is handled very well; non-physicians will not feel left behind. You can also find their story on YouTube and a Ted Talk.

* – You can download it free from the Libby app at http://www.overdrive.com via your local library membership.

In the news                  September 15, 2020

Vitamin D and friends – their role in COVID-19

            Early in the course of the pandemic several supplements, including vitamins, minerals and herbal products were touted to be preventative or even curative for the SARS-CoV-2 disease that is now labeled COVID-19. How well have they performed? Unfortunately there are very few valid studies, i.e., randomized, placebo-controlled, double-blind with enough “power” or numbers of participants to raise hopes of a cure. However there is an emerging sense among the scientific community that some supplements, especially vitamin D, do make a difference in terms of susceptibility to severe disease.

            A low level of vitamin D may eventually be considered as a comorbidity along with obesity, diabetes, high blood pressure, kidney disease, heart disease and immune suppression. An article in the journal Nutrients by reputable researchers from several countries makes the point with the intriguing title Evidence that vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.

            Since vitamin D is produced in the body by the action of a specific wavelength of sunlight, we form less of it in the winter. This correlates with the peaks of influenza activity that are the opposite in the northern and southern hemispheres, occurring in their winter seasons.

            There are several ways in which vitamin D is protective against severe influenza and coronavirus disease, but especially that it lowers pro-inflammatory cytokines and raises anti-inflammatory cytokines, the agents of the often-fatal cytokine storm.

            By now everyone is aware that older persons have a high fatality rate from COVID-19 and the reasons become clearer when we realize why they have low levels of vitamin D: blood levels of this vitamin decrease naturally with age; older persons tend to have limited exposure to sunlight; they are more likely to take several prescription medications, especially those such as antihypertensives, antibiotics and anti-inflammatory drugs that lower vitamin D levels; they are more likely to have generous fat deposits in which vitamin D becomes sequestered and unavailable to bolster the immune system.

            The authors of the above article make a bold statement: “To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5.000 IU/d.” Even those of us who recommend at least 1,000 IU (International Units) per day are surprised by this but it could well be preventive for persons at risk and even that level of intake carries absolutely no risk of side effects.  

            They also suggest that magnesium, because it helps to activate vitamin D, should be taken with the supplement. Vitamin C and zinc participate in the immune process. Most of us get enough zinc. Immunologists find that the recommended dietary allowance for vitamin C is too low. It’s enough to prevent scurvy but not enough for optimal immune function. The latter may require 200-500 milligrams per day of vitamin C.

            You can expect more studies on nutritional approaches to boosting immunity as humanity faces the increasing frequency of pandemics and the disturbing rise in antibiotic resistant bacteria.      

Lifestyle

            Another annoyance of aging — it’s the C-word: constipation.

            One of the world’s most famous poopologists, Dr. Denis Burkitt, practiced for many years among the natives of Central Africa. I won’t go into detail about his findings but he noted that because of their diet that was high in plant foods, he never saw among them three conditions: constipation, appendicitis and diverticulitis. Of course, all of us have experienced the first, many the second and a few the third.

            As you can guess from the above paragraph, all three problems are obviously diet-related, since the American descendants of Africans are familiar with all of them. Hunter-gatherers take in approximately ten times as much plant fiber as we do, so no wonder. Most of our calories come in the form of refined grains and sugars, which makes the problem worse.

            The sedentary lifestyle contributes to constipation – ask any long-haul truck driver – so you should add regular exercise to your high-fiber diet. 

            There are two reasons why constipation should not be ignored or tolerated. When it becomes chronic it leads to diverticulosis, the formation of pockets that bulge out from the wall of the large intestine and when these become infected the result is diverticulitis, a condition that is always painful, sometimes requires hospitalization and occasionally causes death from peritonitis. Another reason is the increased risk of colon cancer, a risk that is small but real.

            As in so many of these “annoyances of aging” the presence of constipation may indicate disease, one of the most common of which is hypothyroidism, low thyroid activity. Some prescription drugs, especially opiates, are notorious for the bowel sluggishness that they cause.

            Laxatives are not the answer but if you can’t relieve constipation with diet, consider stool softeners like Miralax and Metamucil.

Pandemic Perspective #25     September 12, 2020

Upcoming presentations

Wednesday, September 16th, 1:00 p.m. Medical miracles since you were a kid. In the year 1940 the world stood on the threshold of many if not most of the astounding advances in the field of medicine. Since then three generations of physicians and scientists have performed surgery on infants still in the womb, restored vision and hearing to the blind and deaf, eliminated through drugs and vaccines diseases that killed tens of millions of children every year and made organ transplants routine. Join us as we describe these and many other medical marvels that were once in the realm of science fiction. Sponsored by OASIS. To register see their web site at http://www.SanDiegoOasis.org. (Don’t follow this link, but go via Google.)

Monday, September 21, 9:30 a.m. Medical miracles since you were a kid. In the year 1940 the world stood on the threshold of many if not most of the astounding advances in the field of medicine. Since then three generations of physicians and scientists have performed surgery on infants still in the womb, restored vision and hearing to the blind and deaf, eliminated through drugs and vaccines diseases that killed tens of millions of children every year and made organ transplants routine. Join us as we describe these and many other medical marvels that were once in the realm of science fiction. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Wednesday, September 30th, 1:00 p.m. Being a kid in the Stone Age. A pregnant woman in the Stone Age was healthier than a modern woman and her child benefited as a result. In spite of the hazards of infections that have been under control in the Western world for many decades, children who were born tens of thousands of years ago would become strong, healthy adults. None would suffer from the chronic diseases of modern life. Learn about how they were born, raised and nurtured in a primitive world. Sponsored by OASIS. To register see their web site at http://www.SanDiegoOasis.org. (Don’t follow this link, but go via Google.)

A four-pronged vaccine strategy

            With more than 150 companies scrambling to market the first and the best COVID-19 vaccine, not enough attention is being paid to three other vaccines that are going to play a major role in the nation’s health in the next few months.

            In contrast with those who endured the influenza pandemic of 1918-1919, we have less to fear from bacterial infections that were the actual causes of death a century ago. It wasn’t the virus that killed most of those who died during what has erroneously been called The Spanish Influenza. Although many did suffer from a rapid and devastating viral disease, there were four common bacteria that caused most deaths. One of these, Hemophilus influenzae, was recovered from about a third of autopsied victims and it was incorrectly thought to be the actual cause of the pandemic. Many were infected with the pneumococcus, one of the most common agents of simple pneumonia (as well as serious diseases such as meningitis and bloodstream infections in children).

            Hemophilus influenzae seldom causes disease in adults and the vaccine that children receive has virtually eliminated serious infections such as meningitis and throat infections that formerly were common causes of death and disability.

            An effective vaccine has been available for the pneumococcus for decades and it is recommended for anyone over the age of 65. The recommendations change from time to time so you need to check with your physician. It is also routinely given to children.

            If you were born prior to 1995 you probably had chickenpox – and maybe you thought that you had lifelong immunity. That’s only half right. You won’t get chickenpox again but that sneaky virus never left! It has taken up residence in your spinal cord and when conditions are right it will creep out, usually through nerves that emerge in the side of your chest or abdomen, sometimes in the face, to cause an intensely painful, blistering rash called shingles.

            One of those “conditions” is anything that temporarily lowers your resistance, and a viral infection is a good example. Influenza is one of those viruses, like measles and chickenpox itself that dampens the immune response. That’s why influenza victims so commonly are carried off by secondary bacterial invaders. And when you have the flu, which impairs the immune response, the chickenpox virus takes the opportunity to emerge and produce shingles. The good news is that the new shingles vaccine, called Shingrix, is much better than the older version and the protection lasts longer. The bad news is that it requires two injections, two to six months apart, and the side effects are a little worse: pain at the injection site and just feeling lousy for a couple of days. However, considering that common side effects of shingles include post herpetic neuralgia, pain that can last forever, and blindness if the shingles rash emerges on the face, the side effects of the vaccine are a small price to pay.

            Then there’s the influenza vaccine. As noted in prior blogs, it doesn’t always prevent the flu but it nearly always works well enough to keep you out of the hospital where dangerous bacteria, some of which are resistant to all available antibiotics, always lurk. Let that one settle in!!

            The fourth vaccine and the most problematic is the SARS-CoV-2 vaccine. No one can predict how well it will work, what kind of side effects to expect and how long it will maintain its protective effect. Although the first release may happen before the end of the year it will take many months before we know the answers to those questions.

In the meantime:

            Get the flu, pneumonia and shingles vaccines.

            Stay well-nourished, especially to make sure to have an adequate intake of vitamins C and D, protein and omega-3 fats

Pandemic Perspective #24   September 5, 2020

            Wearing a plastic face shield instead of a cloth mask has its advantages. Others can see your smile, you won’t smudge your make-up, your glasses won’t fog up and breathing is sure a lot more comfortable. That’s the upside.

            The downside is that it won’t protect the folks you encounter from the virus that you might be carrying before symptoms show up, or if you are truly asymptomatic but still showering your environment with live virus. And they only do a fair job of protecting you. That was demonstrated in a Swiss study in which shield-wearers were not protected as well as persons who wore a properly fitted cloth mask.

            If you’re unknowingly carrying SARS-CoV-2 most, but not all, the droplets that you sneeze, cough or simply exhale while you’re talking, singing or shouting will be directed downward or sideways from the shield and sink to the floor harmlessly. Aerosols are another matter. Those tiny particles – really tiny — that escape from below or to the side can float around for hours.

            If you do use a shield be sure to wash it thoroughly every day. And just like a mask, if you touch the outside of the shield you’ll transfer any virus particles onto your fingers and then to your eyes.

            The CDC recommends that persons who wear a shield because it looks cool or to protect their eyes should also wear a mask! Now that’s a bummer!

            The bottom line: no face covering is perfect. Maintaining distance from others and frequent handwashing still matter.

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!