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.

 

 

Stone Age Doc’s Pandemic Perspective #1

This is the first weekly blog post that will address issues regarding COVID-19 that are not obvious from the usual news sources. This week’s post will discuss face masks; next week I’ll cover fomites (doorknobs, etc.) and fitness.

Face masks

Sometimes referred to as respirators, they are of two main types, surgical and N95. Surgical masks, the flat cloth or paper types, are worn to keep the surgeon from depositing secretions from the mouth and nose into the operative site. They do offer some protection from incoming germs such as the current coronavirus but not as well as N95 masks. These are stiff, rounded, paper-like devices with a metal clip that can be molded to fit more tightly over the nose. Some designs, referred to as surgical N95s, are more protective than simpler types. Although they are not usually reusable some persons cover them with a cloth mask that can be disposed of so that the the N95 can be worn for a longer period.

The designation N95 indicates that they will filter 95 percent of particulate material in the environment. That still leaves five percent of particles – or germs – that will get through. The longer the mask is worn the less protective it is. Some medical experts claim that the main advantage of the N95 mask is to prevent the wearer from touching his or her face, which most of us do unconsciously scores of times a day.

How many will each person in your family need until the COVID-19 crisis has passed, considering that you are not likely to get more than one day’s use from them, especially the cheaper ones? And the cost? It ranges from about $2.00 to $24.99 on Amazon. What does that tell you about the quality of the cheapest ones? And by the way, if you order them today, delivery time ranges from April 10th to June 19th – and I only checked out a handful of offerings. “Available now” only means that they are in stock, usually from China.

Don’t expect to find them locally. They are even more scarce than toilet paper!

N95 masks are uncomfortable. I wear one when I use bug spray around the house. That takes only about an hour but it’s pretty wet on the inside by the time I finish. And that metal piece that squeezed down over your nose begins to hurt in just a few minutes.

One other thing: you also need to wear surgical gloves when you wear a face mask. You’ll be touching and adjusting it a lot and those viruses on the outside will get on your fingers, and then transferred to anything else you touch.

And unless you’re also wearing goggles you might still become infected. Many infectious agents enter the body via the eyes.

Bottom line: wear a mask if you are in the presence of an infected person but don’t expect to be fully protected.

 In the news

COVID-19 update: The situation is changing at incredible speed and the enormous disruptions in our lives are hard to fully comprehend. Many businesses will never recover. In a few days I’ll provide some more information that will  help you avoid becoming infected, what NOT to believe and what to expect in the next couple of months.

The new buzzword: Fasting.

Fasting does work to help you to lose weight but what does “fasting” really mean?  A “fast day” in the Christian tradition means having only one regular meal per day and two smaller meals that together would not amount to a full meal – and no snacking! I’m willing to bet that no one loses weight during Lent.

A medical fast prior to next morning’s blood tests means nothing to eat after dinner the prior evening until completion of the blood test or other procedure. Some people fast by eating nothing one day per week, maybe two. A three-day or longer fast leaves you grumpy and constipated. Anything longer than that might cause hallucinations.

Here’s my version of the Goldilock’s Fast: don’t eat anything between dinner and breakfast – that’s about 12-13 hours. A small study (19 overweight or obese women) from the Salk Institute of La Jolla bears this out. The women were instructed to limit their food consumption to 10 hours per day, so that they fasted for 14 hours for 12 weeks. They were not instructed to limit their food intake during those 10 pleasurable hours.

Their weight loss was consistent but not very much – about 3 percent reduction in BMI (Body Mass Index), body fat, visceral fat – the most dangerous kind – and a 4 percent reduction in waist size. The weight loss was not dramatic, only about one-half pound per week over the twelve weeks. But think about this: that would amount to about 25 pounds in a year, which in most persons would bring down blood pressure and blood sugar, which is exactly what happened in the study group in only three months.

There were other important changes. Total and LDL cholesterol came down by an average of 11 percent; HbA1c, a measure of blood sugar levels, was lower by about 4 percent. Over a year or two those changes could mean better health and a lower risk of heart disease.

And nobody became grumpy or constipated! Priceless!

This is a “fasting” routine that is easy for the whole family to do, has no side effects, and can be maintained for a lifetime.

 

Lifestyle

Another in the series of annoyances of aging: cracked fingernails

          Cracked fingernails are common among older persons but before you accept this as one of those changes that are inevitable as we get older, you should know that it might indicate a medical problem. Three conditions in particular are dangerous because they can proceed for a long time with few other symptoms except for fatigue, which most people feel is just part of aging.

Iron deficiency can have several causes, from poor diet to intestinal bleeding. A good friend was once hospitalized when his blood count dropped to 25 percent (!) of normal. The only other symptom was a feeling of being tired all the time.

Thyroid disease is another problem that may occur over a period of many weeks or months. There may be other symptoms but these too might be written off as due to aging – weight gain, constipation and intolerance to cold.

Kidney disease has many causes but one of the most common these days is type 2 diabetes, which now affects 13.3 percent of persons over the age of 18. By the time a person is diagnosed with type 2 diabetes, more than half are likely to have at least one complication of diabetes, one of which is deteriorating kidney function.

Keep in mind that your doctor isn’t likely to check your fingernails as part of the physical exam. Your cracked fingernails may be normal, but maybe not.

 

 

 

 

 

 

 

 

 

Renaissance Magazine has published my article, Child health during the Renaissance in the Spring 2020 issue. You can Google it: Renaissance magazine Goscienski or go directly to this link: http://www.omagdigital.com/publication/?i=648518&p=30 )

The article, especially the illustrations, shows how far we have come in a few hundred years.

Upcoming presentations

Tuesday, March 10th, 2:30 Mission San Luis Rey, Oceanside. A day in the life of a physician in ancient Egypt. 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, March 25th, 1:00, OASIS Center, Grossmont Center. Plagues and pandemics. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org. This will include an update on the current Coronavirus outbreak.

In the news

Panic or preparation – a perspective on COVID-19

What is your risk of encountering the Coronavirus?          The COVID-19 virus that emerged from China in September, 2019, has now appeared in at least 60 other countries, making it a true pandemic. The low mortality rate of about 2 percent – mostly in older persons with heart or lung disease – makes it much less dangerous than the other two anxiety-producing coronaviruses that arose in this new century.

SARS (Severe Acute Respiratory Syndrome) affected fewer than 10,000 persons and had a mortality rate of about 9 percent; MERS (Middle East Respiratory Syndrome) infected fewer than 2,000 persons but had a fatality rate of about 38 percent. Influenza viruses kill between 40,000 and 100,000 Americans each year but that terrible number doesn’t seem to bother Wall Street very much.

The difference, of course, is that China has shut down factories and has restricted commerce. That means that you might have to wait some time for your next iPhone, TV or computer, or even your resupply of Ibuprofen or an antibiotic. Almost all of these products are made in China.

More Americans are going to become ill from the new coronavirus between now and next fall and it’s going to throw many into a panic, in which they’ll empty store shelves of water, bread, milk – and face masks. The value of the last item is that it keeps you from touching your mouth, nose and eyes, all of which are portals of entry for viruses. It is almost worthless in protecting you from infection. BTW – surgeons wear masks to keep from contaminating the surgical field with germs from their body; they are not worn to protect the surgeon.

There are plenty of reasons to keep a two-week supply of water, food and other necessities in your home but an epidemic isn’t one of them. Fire, flood, earthquake and a massive power outage are much more likely.

Prepare but don’t panic.

Lifestyle

Another one of those annoyances of aging: liver spots.

       Blotches that usually appear on the back of the hand, some of which have the brownish coloration of calves’ liver, have nothing to do with your own liver. They were so named by one of our imaginative ancestors many years ago and the name stuck.

Like other signs of aging — wrinkles, skin cancer – liver spots are the late effects of sun exposure. You can hide them with any one of the myriad of products at the cosmetic counter. For more lasting effects, a dermatologist can make them less noticeable with laser therapy or dermabrasion. Don’t try this at home!

 

 

 

 

 

 

 

 

In the news

Low-carb vegetables and fruits

          One of the drawbacks of the ketogenic diet is that most versions allow almost no fruits or vegetables, especially during the induction phase that usually takes about two weeks. That eliminates the kinds of nutrients that our bodies are designed for – phenols and flavonoids and similar nutrients that protect us against inflammation and cell damage, as well as fiber that we need for a healthy gut.

A strict ketogenic diet allows for 50 grams or less of carbohydrate, less than you would get in a BLT sandwich. And that means that for the rest of the day you could only have protein and fat in your diet. There is a happy solution however.

Some vegetables have little carbohydrate because much of their bulk consists of water and fiber. They include things like bell peppers, asparagus, avocado, tomatoes, spinach, broccoli, cucumber, kale, cabbage and mushrooms. (You can find how much carbohydrate there is in a serving of your favorite food at Google – or just ask Siri). In other words, you can still get the plant nutrients in vegetables if you pick the right ones. Root vegetables like potatoes, beets and carrots have more carbohydrate – a medium baked potato has 50 grams of starch that rapidly breaks down into sugar — but an occasional small serving won’t destroy your diet.

Fruits are another matter. They are bred to be sweet, which means sugary and even a medium-sized banana has about 30 grams of carbohydrate, a medium orange has about 25 grams and an apple about 20.

But here’s the good news: you don’t need to go full keto in order to get its benefits. In addition to those I listed above, things like kale, Brussels sprouts, eggplant, zucchini, cauliflower and green beans are low enough in carbohydrate that you can have one or two servings every day with lunch or dinner and not feel like a martyr – or annoying your family with bad breath!

 

Lifestyle

Here’s another annoyance of aging. Unfortunately it’s one of those that has no remedy: thin, fragile skin           

As we age we inevitably begin to lose some of the fatty tissue and connective tissue beneath the skin, especially on the back of the hand and on the forearm. Skin becomes paper-thin and a light brush against a doorway peels away some skin. Oral or topical steroids, drugs like prednisone, bring it on faster.

Retinol, a prescription drug, or fish oil supplements might help but the best solution is simply to protect susceptible areas. When you work outdoors wear light gloves and a long-sleeved shirt, even in warm weather. They can be a protective barrier.

This kind of injury is so common after the age of about 65 that you might want to have a couple of band-aids in your wallet or purse. It’s cheap, unobtrusive insurance.

 

 

I recently did a TV interview that covered a variety of health-related topics, especially the concept that most of the so-called age-related diseases are actually lifestyle-related. Click on the following link, https://www.facebook.com/SeniorStayOrGo/videos/2576759122420057/

Upcoming presentations

Wednesday, February 5th at 1:00 p.m., the Serra Mesa Library, 9005 Aero Drive, San Diego, Health benefits of wine and chocolate, just in time for Valentine’s Day. Wine and chocolate are derived from plants and thus contain nutrients that have specific health benefits. Not all forms of these pleasurable foods are healthy, however. Learn which claims are legitimate and how to select the healthiest kinds of wine and chocolate. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Friday, February 7th at 1:00 p.m. at the Temecula Higher Education Center, Osteoporosis: calcium is not the answer. Osteoporosis is not an inevitable consequence of aging and taking calcium will not delay its onset. Learn the single most important thing that you can do to maintain a healthy skeleton. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 13th at 1:00 p.m. Coronado Library, Health benefits of wine and chocolate, Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 19th at 1:00 p.m., Stagecoach Community Center, Carlsbad, Serendipities that affect your life and your health, Accidents happen but the outcome is not always bad. Scientific breakthroughs from the Big Bang theory to cataract surgery, from penicillin to post-it notes, from vaccines to Viagra, have come from efforts directed to a different objective. Simple mistakes have led to miraculous discoveries, several of which affect each of us every day of our lives. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 20th, 1:00 at the Oasis Grossmont Center, Keeping your wits: ten ways to prevent dementia and Alzheimer’s disease. Most forms of age-related dementia, including Alzheimer’s disease, can be avoided or delayed by following a prudent lifestyle. Ten simple measures will preserve brain function and even improve it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Tuesday, February 25th, 12:30 at the University Community Library, 4155 Governor Drive, San diego.  Shingles, a better vaccine is here. Shingles, whose medical name is herpes zoster, is occurring more often as our population ages. For most victims it’s uncomfortable but for many it results in pain that can last for years, sometimes results in blindness and is associated with stroke and heart attack. A much more effective vaccine that was released in December, 2017 is nearly twice as effective as the previous one. Learn how it begins, who is at risk and how we can avoid it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 26th at 1:00 p.m. at the Point Loma Library, A day in the life of a Gold Rush physician, Sponsored by OASIS.  It began with a nugget no larger than a thumbnail but it transformed the United States. Physician-adventurers followed the gold, bringing old ideas as well as newly-emerging medical discoveries. It was a unique period in history that tested a physician’s skills and stamina. To register see their web site at http://www.oasisnet.org.

In the news

The Wuhan Coronavirus: a perspective.

            The world is on edge because of a new virus that has emerged from China where it has sickened nearly 12,000 victims and claimed the lives of 259, according to official Chinese figures. As of this writing on January 31st there have been no reported deaths outside of China and only 7 nonfatal cases in the United States.

Financial markets have reacted as if this is a Black Swan event –an unexpected event of large magnitude, a random, catastrophic and massive disaster that can affect perhaps millions of lives. This does not, in my view, qualify as a Black Swan event.

The very cautious approach of health officials is justified in spite of the low – so far – mortality rate of only about 2 percent. Two other coronaviruses had much higher fatality rates: 9.6 percent for SARS (Severe Acute Respiratory Syndrome, 2002-2003) and 38 percent for MERS (Middle East Respiratory Syndrome, 2012-present). The Wuhan virus may yet turn ugly but the latest statistics are encouraging.

 

There have been more than 6,000 cases of Coronavirus infection worldwide since about September 2019; there have been more than 8,000 deaths due to influenza just in the United States in that time. There will be no vaccine to prevent Coronavirus in the near future but there is one to prevent the flu. The latter vaccine is far from perfect but it dramatically reduces the likelihood that persons who become ill will need to be hospitalized or will die from the secondary bacterial infection that is so often the actual cause of death.

A little more than a century ago an influenza pandemic (i.e. worldwide) killed at least 50 million persons at a time when the global population was about one-fourth what it is today. It’s extremely unlikely that such a catastrophe – a true Black Swan – will occur again. In 1918-1919 many people were overcome because of malnutrition. Remember that these were the years when The Great War came to an end. There were no antibiotics back then and most fatalities were due to infection by bacteria of the types that are almost always susceptible to today’s antibiotics.

A hundred years ago doctors didn’t even know what viruses were. In contrast, the Wuhan Coronavirus has already been identified, a diagnostic test is available and work has begun on a vaccine. Is this a Black Swan? Not at the moment but it should be a reminder that we should take advantage of all the vaccines that are available to us and wash our hands frequently, especially after having been out in public.

Lifestyle

Avoiding another annoyance of aging: muscle cramps.

These painful spasms can occur at any age but they seem to be more frequent as we get older. To make things worse they often occur at night, spoiling a restful sleep. There are several causes but most of the time they can’t be explained.

Dehydration – the lack of adequate fluid intake – is one of the causes that we can do something about. Because thirst is not a sufficient sign of the need for fluids in older persons we need to have a more reliable indicator, and we do. Your urine should always be light yellow with only a mild odor; dark, smelly urine means that you are getting behind in fluids. Of course, taking more fluid late in the day means that you’ll probably have to make an extra trip to the bathroom during the night but it’s worth it not only to prevent cramps but also to avoid developing kidney stones.

Maintaining moderate physical activity throughout life has many benefits, one of which is healthy blood flow to your muscles. That supplies your muscles with nutrients and oxygen and removes accumulated waste products that can increase the likelihood of developing cramps. After you exercise (and not before!) you should do some stretching movements.

Some persons have low levels of calcium or magnesium. Muscle cramps can also be a sign of diabetes, liver disease or thyroid problems. If you have frequent muscle cramps it’s worth a trip to the doctor to rule them out.

Sometimes chewing on a Tums tablet will relieve the pain.