Older Bolder Life

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COVID-19

Inquiring Minds Want to Know: Older Bolder Links, Reads, Recipes, and More 24 March 2020

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I don’t know if you’re one of the many who are suffering from a bit of SARS-CoV-2 and COVID-19 fatigue these days, we certainly are around our camp, but it remains a critical imperative that we all stay in the loop to pick the gems of reporting and updates out of the flood of misinformation out there every day.

From where I sit today as a retired physician it is reassuring to see more acknowledgement of the simple and critical fact that we have no idea how big the actual denominator is – how many are actually infected and experiencing the mild or asymptomatic forms of the COVID-19 clinical syndrome (most suggest 80% or more of the actual total). Knowing the actual denominator is of course the only way the true CFR (case fatality rate), actual risks of serious infection and clinical outcomes, and overall R0 values can be accurately determined.

And finally, a quick reminder on nomenclature. The virus itself is the SARS-CoV-2 you see in the literature and news, and COVID-19 is the clinical syndrome / disease the virus causes in humans.

An updated example above of a critical care one-pager on COVID-19 management as of 22 March. Updates posted every several days at the link, and you can view other systems’ “cheat sheets” there as well.

Anosmia (loss of smell) as a prodromal symptom.

Two recent looks at hydroxychloroquine for COVID-19: from a US rheumatologist and a French intensivist.

Flattening the curve in S. Korea.

Some thoughts on how a ketogenic diet might impact immune modulation.

A nursing home team working the isolation game. Well done.

How much toilet paper do you really need? Of course there’s an online tool to calculate that.

How About a Little Fasting and Fitness News?…

A TRE/TRF review from an unlikely source. (Free Medscape account required)

A 10-hour TRF window yielded impressive results in a metabolic syndrome cohort.

Jeff Cavaliere’s bodyweight workout for those of us homebound.

How about Arnold Schwarzenegger’s no-gym home workout?

Food, Glorious Food

What do vegetable oils do to your body? A solid video from Dr. Benjamin Bikman.

OB NOLA BBQ Shrimp.

Inquiring Minds Want to Know: Older Bolder Links, Reads, Podcasts, Recipes, and More 18 March 2020

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After leading off with links covering SARS-CoV-2 and COVID-19 for the past several links posts, let’s lead off with a few other interesting reads and topics today – the pursuit of wellness and good health goes on despite the 24/7 news cycle of doom and gloom.

Low and very low calorie ketogenic diet safe -and effective- in mild renal failure patient group.

Stubbornness lessens ultimate AD risk?

Germans spending less time on Facebook are happier.

Another shot across the Sucralose bow.

Don’t let perfectionism get in the way of achievement.

Squat for health?

COVID-19 Links and Reads That Caught My Eye This Week

Please note, this is in no way meant to serve as a comprehensive posting of the very latest news and data on the story – you’re inundated by that around the clock, and we’re (as greater humanity) still hampered by lack of hard data regarding how this virus behaves and how to best combat its impacts.

A Seattle Intensivist’s One-pager on COVID-19. (Note – updating continually, full size image at the link)

Medscape’s COVID-19 resource page.

Youth sports in the COVID-19 era.

One view of social distancing.

30 home workouts when you’re bugging in.

Speaking of workouts, I’m a longtime fan of BeachBody’s home program (P90X still rocks.)

Podcasts of the Week

Brad Kearns with the PHC team talking keto and longevity.

One of the clearest thinking minds I’ve found on the COVID-19 story is that of Karl Denninger, a Florida-based economist breaking the story down daily from a math perspective. He’s candid, unabashedly not politically correct, and one of the brightest minds I’ve read in a long time. Try this podcast, or look for the latest posted on his landing page (click the logo at the top of the page).

Food, Glorious Food

Southern chefs talk hot sauce.

Add this one to your organ meat list – the lost art of Southern Hash.

Our favorite Mu Shu Pork cheat for home.

Two Quick Things to Remember Today…

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As many in the world stand agog at the disruption and chaos invoked worldwide by the SARS-CoV-2 virus and the COVID-19 infection it causes, please take time today to remember a couple of simple yet critical things.

Remember, and Reach Out to, the Elderly and Infirm in Your Neighborhood

While it’s clear that there is far, far more we don’t understand about the behavior of the SARS-CoV-2 virus and the intermediate and longer term responses of the human body to the COVID-19 process, it’s brutally obvious that the virus has thus far has been devastating to those in their 8th and 9th decades of life in particular.

Take a bit of time today and reach out to your more mature family, friends, and neighbors – make sure they’ve got the immediate essentials needed to manage these first of what indeed may be a number of days at home, and offer words (and deeds if needed) of encouragement and support.

The more mature among us, hopefully wiser as well, have seen various life challenges come and go, and most understand that ‘this too shall pass’ is much more often true than not.

And Remember Those Who “Keep Us Alive”

Reader JK in Houston sent in a link to an article recently posted in National Review – Remembering Who is Keeping Us Alive – a worthy, quick read today.

From the article –

…The point is that in our age of necessary shutdowns and staying home, one thing we must do is eat — and eat well to stay healthy. And that means lots of people have to go to work and produce food and transport it to the major cities, and not always in isolation on the south 40.

Farmers do a lot more than just drop a seed in the ground and then by rote watch it sprout into a corn stalk, as one of our nation’s richest and most influential figures lectured us not all that long ago. For millions to subsist at home, to force the virus to sputter out, they must eat, as well as have power, running water, law enforcement, and sanitation. And that means millions of Americans must go to work as usual and sustain the elementals and existential forces of American life for 330 million, usually out of sight and out of mind, as we concentrate on the required quarantining of universities, offices, bureaus, sporting events, etc…

Hang in there, be smart, turn off the news, and do some remembering today.

Inquiring Minds Want to Know: Older Bolder Links, Reads, Podcasts, Recipes, and More 11 March 2020

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The news cycle is still dominated by the COVID-19 process induced by the SARS-CoV-2 virus; here are a few additional viewpoints that you might have missed this week. Note that in last week’s links post I listed a handful of CDC and tracker site links that you might find useful as well.

The power of hand washing to prevent COVID-19. (Free Medscape account required)

Over 60: Stock up and avoid crowds? Might be painting with a pretty broad brush here…

Higher humidity and viral transmissibility.

COVID-19 mortality may be under 1%.

EPA list of approved products to use against COVID-19.

Why we’re still traveling. (Though you have to wonder if their opinion is changing this week…)

Fats and Fat Consumption in the News

Another plug for olive oil.

The dietary guidelines fat dilemma.

Odds and Ends Roundup: Fitness, Dementia, Longevity, and More

Leisure time physical activity lessons AD risk.

Senior fitness yields multiple dividends.

Live longer if you spring clean?

The science of slime (mucous).

Rectal insertion of potatoes won’t cure hemorrhoids. How impressive is it that this even need be discussed…

Need to work on your biceps?

Podcast of the Week

Gundry interviews Sisson; two of the big boys chat it up.

Food, Glorious Food

Everybody should have a tiny potted kitchen garden.

45 fat bomb recipes.

Hot damn tri-tip chili.

Older Bolder Question of the Week: Is It Time to Panic Yet?

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From reader AB in Alabama yesterday –

…we’re both in our 50s, pretty healthy though my husband is a former smoker who suffers from a bit of COPD that’s always set off by seasonal allergies in the spring. We’re dedicated LCMPHF eaters, and are both avid walkers. Reading media reports, and talking to several friends who are full blown panic over the virus situation this weekend, my husband at one point turned to me and asked if it was time to panic yet? Is it? Should our daughter with two young children panic now?…

In a nutshell, no, it’s not time to panic.

Here’s several data points that you’ll find of interest and hopefully comforting, gleaned from CDC, WHO, and other medical reporting this weekend.

Young children (particularly those under 4) appears to have been thus far minimally impacted by the SARS-CoV-2 virus; I can find no record of deaths related to the virus in this age group as of yesterday morning.

Ordinary, otherwise healthy adults under 65 (give or take a few years pending metabolic fitness) appear to be at very low risk of having a serious (hospitalization required), critical (intensive or extraordinary support), or fatal outcome if infected by the SARS-CoV-2.

Of note, those older than 65, and particularly those older than 75, have been much more impacted by the SARS-CoV-2 virus (causing what is being termed the COVID-19 disease process), and the risk of a bad outcome rises almost exponentially with advancing (>65) age.

Also of critical note, those with significant medical conditions (co-morbidities in medical lingo) – particularly those co-morbidities which impact cardiopulmonary function, for example COPD, chronic asthmatics, concurrent pneumonia or other pulmonary dysfunction from yet another viral process have been impacted at higher rates, though people who are markedly above ideal body weight and those with T1DM or poorly controlled T2Dm appear to be at notably higher risk as well.

Again, given the information you’ve provided in your question – it’s not time to panic, but….

It is time to use common sense with regard to exposure risks? Hell yes, and count me – at least given the information available today – among those who agree that exposure to large groups, closely associated as in a church, concert, or movie venue for example, very likely offers an unacceptably high risk for those with elevated risk factors (age, the co-morbidities listed above). Any relative, friend, acquaintance, or co-worker who exhibits symptoms or is known to be infected MUST be avoided.

The vital importance of hand-washing simply cannot be overemphasized; make sure those grandkids understand that too.

Is it prudent to lay in a couple of weeks of any medications you take, food stocks, and household goods to tide you over through an (as of yet in North America) unlikely imposed home-based quarantine? Of course it is.

Stay with your healthy eating plan, and as the season turns to spring, keep walking, and make sure you’re pursuing a well-rounded (don’t forget to lift heavy things and sprint occasionally) fitness program. Your overall fitness, and metabolic/functional capacity, is one of the critical keys to battling off insults like this.

And finally, exercise caution in terms of what sources you consistently read and trust regarding news on the virus. By all indications, this will not lead to the collapse of civilization as we know it, despite the insistence by some in the media that’s the case. Those preaching that SARS-CoV-2 is the advent of the apocalypse should probably be avoided. My most trusted mentors continue to insist the biggest impacts will be financial over the long haul, and I’m inclined to agree at this point, despite the terrible medical burden some will bear.

No doubt, the virus is a damned serious one, and will be devastatingly impactful for those with cardiopulmonary compromise and the very old. Be vigilant, stay informed, and recognize that there’s still a truckload that we still DON’T know about this virus.

Inquiring Minds Want to Know: Older Bolder Links, Reads, Recipes, Podcasts, and More 4 March 2020

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As the world remains riveted to the updating news on the COVID-19 outbreak, I’ve gathered a few resources that you should peruse if you’ve not already. Granted, the story is evolving quickly, and the the links following are CDC biased – count me among the many who would argue the CDC has made a boatload of errors and missteps regarding the outbreak thus far, but they are the organization tasked with aggregating and disseminating information regarding the outbreak in America. More to come…

CDC COVID-19 situation summary page.

CDC COVID-19 main landing page with links out.

COVID-19 mapping tool from Johns Hopkins CSSE.

CDC COVID-19 guidelines for health care professionals.

CDC COVID-19 travel restrictions and advisories.

Hand washing at airports – an Occam’s razor approach to pandemics?

Nutrition and Fat in the News This Week

On the lighter side, a cartoonist takes on the food pyramid.

Eat less, live longer.

2020 American Diabetes Association standards of care. (I’ve not had time to read in detail, but potentially another swing and a miss on the optimal dietary approach.)

So perivascular fat might be a good player?

Fitness and a Few Other Odds and Ends

Crossfit wants grandpa to work out in the box.

Sleep for athletes (part 4 in a series).

A quick riff on the imposter syndrome.

Heads up runners and walkers: pedestrian deaths are up.

Podcast I Enjoyed This Week

Paul Saladino MD dishes on the carnivore diet.

Food, Glorious Food

Harrison Ford’s boring diet. Healthy? Yes. Interesting and sustainable over the long haul? Probably not…

History of Sichuan peppercorns.

Spicy Salt Roasted Shrimp

Question of the Week: A Few Quick Thoughts on the Coronavirus Story

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Over the past few weeks I’ve had a number of friends, family, and clients asking what I’m seeing and thinking about the coronavirus story that’s (at least now and again) dominating the news cycle of late. The question I’m hearing most often is some version of “should I be worried about the coronavirus outbreak?”

The honest answer, from the perspective of a medical scientist/ physician at least, is at this point in time, it’s damned hard to really tell, though there are some caveats to consider.

From a medical science standpoint there’s much about the coronavirus story that’s absolutely fascinating, yet objectively, there’s very little known about the virus itself and the syndrome it inflicts, particularly considering the news flowing (leaking) out of China.

The data out of China is highly suspect; everything from numbers of cases, rate of growth, the frequently discussed “R naught” values, death rates, quarantines of huge blocks of the billion plus citizens of China is clouded in secrecy, and some of it (the perfect quadratic growth of death rates for instance) is all but impossible to achieve in nature and strongly suggest data smoothing/modeling/manipulation.

The fact that China has refused to allow virology teams from the CDC to investigate is damning; apparently other offers from nations around the world have also been refused.

You’ve most likely read the virus appears to access the human system via the ACE2 (angiotensin-converting enzyme 2) receptors in the lung (not their only occurrence in the body, but theorized to be the viral portal of entry). There’s anecdotal discussion out and about that there are significant ethnic and sex influences on ACE2 receptor density (Asian males with the highest levels), though there’s much more conclusive evidence that smoking drives ACE2 receptor generation in lung tissue, with another pertinent hypothesis suggesting that exposure to particulate air pollution (rampant in China) might induce similar impacts.

Though several medical channels I’m also hearing discussion of concerns there’s a virulent fecal load of the virus, contaminating water supplies, exposing caretakers to aerosolized viral particles, etc.

The key point is that without corroborating, detailed, sophisticated analysis of the coronavirus, clearly requiring assistance from and expertise held by teams outside of China, theories and conjecture will continue to run wild.

News media and some governments around the world are also clearly providing misleading information, some even along the tune of “nothing to see here, more along”…

So finally, back to the question of the week, should I be worried about the coronavirus?

Part of the answer to that question depends on where you happen to live. For example, most of our readers here live in North American, Europe, and Australia where the viral incursion has been limited thus far. Readers in those regions aren’t going to see a viral disaster unfold in the immediate near term.

I’d suggest that one invest a bit of time every few days reading updates from reliable, scientifically sound sources, like the CDC resource page here, the Johns Hopkins COVID-19 heat map (that’s their latest update from this morning above, and perhaps even NextStrain’s mapping project.

Mind your travel to higher risk areas (if there’s any question, see the Johns Hopkins heat map above), and recent experience would suggest cruises in the Far East to be a lousy idea.

IF the virus is as virulent (or even more so) than some hypothesize, under-developed/third-world regions (India and Africa being the ones most often referenced in discussions I’ve read) may be devastated, further generating travel risk and exposure.

For those still smoking, if you ever needed a kick in the pants to push your cessation program into motion, here it is.

Standard and time-tested protocols for managing flu risk certainly aren’t harmful to consider these days, and while many scoff at the idea of having a few weeks worth of food and water stored in case you needed to hunker for a time, count my family among those who have prepped for such a need (it’s far, far more simple than you might think).

One of the most interesting aspects of this story, at least from where I sit, is the fact that this all could change quickly if and when we learn more about the true nature of the coronavirus; it will eventually be studied by cooperative scientists and we’ll understand more about the natural history of the infection. Stayed tuned.

Post script – given the role that China plays for much of the world as a manufacturing hub, the economic impacts from COVID-19 may be more substantial for many around the world than the infection itself. This part of the story is just beginning to unfold as well.