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Older Bolder Coronavirus Update 2 March

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There’s been a fair amount of water under the bridge since I first posted a few thoughts about the COVID-19 story unfolding with ever increasing speed and vigor around the world two weeks ago.

While not intended in any way to be a comprehensive primer on the COVID-19 outbreak, here’s a quick rundown of key points I’ve been sharing with friends, family, and clients this past week in response to questions that keep rolling in.

There’s Still a Lot We Don’t Know (and for a Variety of Reasons)

One of the hallmark features of this COVID-19 story has been the lack of hard data available for public perusal, beginning from the earliest days in January when eyes and ears around the world began to pay attention to what was happening in Wuhan Province.

The authorities in China have a long and checkered history of not disclosing information which shines a revealing light on life there, and there of course has been and continues to be extensive criticism of early management of the COVID-19 outbreak and the lack of critical and accurate information provided the rest of the world as the virus has advanced beyond China’s borders.

To be sure, there’s much, much more information available today than two weeks ago, for example, the genome has been well mapped and tracked as the virus mutates (typical viral behavior) as it migrates through new hosts.

Vital information detailing the actual disease process induced by the viral infestation, how truly infectious the particle is, the impact of various co-morbidities on the natural history of the resultant illness, and even testing protocols have yet to be fully developed and dispersed.

Digging into the clinical details takes time; hard data is coming, but it’s simply not available at the granular level we’ve all come to expect in North America.

Hello, I’m Here from the Government, and I’m Here to Confuse You About COVID-19

Sadly, and impressively, the Chinese authorities haven’t been the only agency withholding information. The debacle unfolding in Washington State is a stunning example of such – it’s becoming clear that at least one of the early infections among the nursing home patients and staff was identified as early as six weeks ago, and not explored and addressed with purposeful intent and care in its earliest stages. (References: 1 2 3 4 )

Impressively, the mis-handling of the nursing home nexus in Washington has exposed thousands in the community unnecessarily; heads should roll once the relative crisis there has been averted.

Several states are withholding numbers and locations of patients under monitored or isolation protocols, and the frank – and let’s be damned honest about it – overt politicization of the issue by many at the national level is absurd, inflammatory, distracting, and harmful. RUN from anyone attempting to make this a political game – it is most certainly not – and you can be damned sure that any politician, regardless of stripes or tenure, doesn’t have your or the nation’s best interests in mind if they’re playing the COVID-19 politics card. RUN, and don’t look back.

Who Should Genuinely Be Concerned About COVID-19 Today?

As to who should be genuinely concerned about the COVID-19 outbreak today, those with preexistent lung and / or cardiopulmonary disease, especially if symptomatic, remain at the very top of the “should I really worry list”. By the relatively limited available data, most fatalities related to COVID-19 have occurred in this group, and those older than 80.

I’m hearing some chatter among physician friends that those with T1DM appear to be at higher risk, and of course anyone with impaired immune function for what ever reason needs to exercise due caution.

Another issue you won’t hear discussed in main stream media venues is a probable fecal-oral vector; this is very likely part of the nursing home catastrophe in WA, and would raise the potential for critical issues in locales such as San Francisco, where you need an app to navigate city streets to avoid current defecation sites. Cities with large homeless populations – LA, SF, Portland, Seattle, Austin, etc. – will need be watched carefully, and if they’ve not yet disclosed outbreaks by now, count me among those betting it won’t be long.

So What’s a Prudent Family to Do This Week to Deal with COVID-19?

So what’s a prudent family to do this week?

You’ve no doubt heard much of this same stack of advice from many other sources, and you’ll hear it / read it again and again this week as well. There are of course easy points to add to a list like this – don’t travel to high risk countries, cruise ships aren’t a great choice right now (at least in the Orient), and it’s worth keeping an eye on outbreaks as they develop around the country – at least as they’re reported – using your local health department or the John Hopkins mapping tool here.

Standard, time-tested and proven protocols for managing flu season risk are good to brush up on. Even better – simple hand washing and avoiding touching your face (especially around the eyes) – lower flu season risk dramatically and are available to everyone.

Might you have to sequester yourself in your home for a short time? Perhaps, if you live in the epicenter of a community eruption such as the one very likely coming in Kirkland, WA (the nursing home story we’ve been talking about) or have someone in the family with very high risk factors.

In many locales it’s probably too late for a full-on “prepper” stock-up, though putting together two weeks of food, water, personal hygiene items, medications, and home care products isn’t a complex game. As I write this late yesterday afternoon, there are reports across media outlets of runs on grocery stores (Costco in particular for some reason) all day yesterday.

I agree with those who suggest the supply chain disruptions caused by this event may be more seriously impactful on daily life than the risk of the actual infection, which for most will most likely be a flu-like event. Supply chain problems are just beginning to develop now, and will worsen down the line; having a store of food and supplies offers a buffer for these issues as well.

Still smoking? The data suggests that smokers are at particular risk for COVID-19 infection and more serious clinical syndromes – it’s past time to stop. Get it done, and now.

Have a potential option to work from home? It might be a good idea to chat about options and work through a few details with your employer before the (potential) sh*t hits the fan at some point down the road.

And finally, if you’re overweight, have the metabolic syndrome, are carb-dependent, and out of shape, any effort you expend starting NOW to overhaul your nutrition plan and begin to rebuild your fitness will pay off in the months to come, regardless of what issues this viral syndrome brings to your own neighborhood.

Pay attention, plan well, get moving.

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.

Help!!! I’ve Been Exposed to Someone with the Flu (Or a Bad Cold)

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Over the past couple of days I’ve been flooded with requests from friends, family, and clients to offer up tips, suggestions, tricks, and perhaps even the latest form of voodoo to help stave off the flu (or colds and URIs) for folks that have been exposed at home, at work, or in the community.

There are a host of good practices to follow, most of which should be considered to be common sense yet now and again we could all use a reminder about; you’ll find a reasonable list below that just about anyone could implement today without much effort or expense.

For the record, I’m a firm believer that the Standard American Diet wreaks havoc on the immune system function of most who follow it, and that following the best nutritional plan you can over the long haul is very likely the most useful tool in your toolbox when it comes to fighting off the seasonal cold and flu onslaught. It’s never too late to get started making the changes you need to.

And of note, I’m deferring coverage of flu vaccines and antiviral agents to a later post; now, let’s talk about things we all can and should do during the flu season…

Sleep, Sleep, Sleep. A common sense point that doesn’t need a lot of explaining; the key point being that sleep deprivation critically impacts the immune response. One of your best preventative tools too.

Mind Your Hands – Wash, Wash, Wash. This one is perhaps the most basic of all common sense approaches to protect yourself, yet is potentially the most overlooked and inconsistently performed. Note you don’t need anything but warm water and standard soap here, and remember to scrub thoroughly for 20 seconds (say the ABCs twice to get a feel for the time). Wash after every encounter where you’re exposed.

Mind Your Hands – Don’t Touch Your Face. There’s no question what while the most common vector pathway for most flu and cold exposures is via aerosol (the guy on the bus or plane beside you sneezing for the last hour), viral transmission via our hands to the membranes of our eyes, nose, and mouth is also a critical pathway. Be intentional about this one…

Clean Surfaces You Touch Routinely. You don’t need to go OCD overboard here, but it’s time to use the handy cleaners for grocery carts for example, and be mindful of cleaning needs when you have a sick loved one at home – think counters, door knobs, etc. And DON’T share towels.

Blow Your Nose. Another common sense, ‘mind what your mother used to tell you’ point. Remember not to overdo it; you don’t have to sound like a trumpeting elephant to get the job done. Be gentle, do it frequently, aiming for one nostril at a time.

Gargle up to four times a day. Lightly salted water, or with a splash of vinegar or lemon juice all at least moisten a sore throat and/or ease a tickle. A client recently insisted that steeped raspberry leaves in 2 cups of hot water (or raspberry tea) have been a useful family recipe for decades.

Hot, Steamy Shower and Sauna. One of my personal favorites, maybe with a drop or two of eucalyptus oil in the shower floor.

Drink Plenty of Hot Liquids. Another classic from the your-mother-told-you-so file; think tea, broth, thin (non-dairy) soups, even warm/hot water. You don’t have to consume just hot/warm liquids; adequate hydration is critical when you’re staving off or battling an infection.

Stay the Course with Your Healthy Eating Plan. There’s a plethora of evidence supporting the fact that a disordered diet can critically impact immune system function (for example, see this paper). Sugars in particular can play an impressive role in stunting your immune response; watch for overly sweetened lozenges and OTC cough/cold medications.

Become a Stress Management Ninja, and That Includes Workouts Too. One of the principle stress hormones, cortisol, when chronically elevated suppresses immune function. Those of us prone to fall back into chronic cardio patterns or crush that weekend-warrior, pack it all into one day workout beware.

There’s no question life is damned stressful these days, I get it. Almost all of us can improve (significantly) our stress management routines – whether that’s committing to some relaxation and chill out time every day, or using prayer, meditation, yoga, self-directed biofeedback, or other approaches. Just do it.

Be Vigilant About Exposure Risks. Granted, some people you encounter every day during flu and cold season are shedding virus and not necessarily clinically ill enough to alert you to change your behavior (avoid them!). I’m talking about interacting closely with people you know to be infected, or getting slimed by a sneezer while commuting, at work, or via your lovely spouse or kids at home. Some go as far as to suggest you don’t fly, bus, or ferry during flu season, but that might be a tough call for daily commuters. Stuck sitting by a cougher/sneezer in tight quarters? Some would even argue a mask might help…

Supplements: Friend or Foe for the Flu? Conventional medical wisdom, for the most part, still appears to frown on the genuine efficacy of many “natural supplements and remedies” for cold and flu syndromes.

That said, there’s been research done covering the flu and cold (viral syndrome) impacts of vitamin C, vitamin D, vitamin E, echinacea, zinc, elderberry extracts, garlic, ginseng, andrographis (Indian echinacea in some circles), and several more commonly recommended supplements and natural aids. This is a big and fascinating topic, deserving of it’s own post(s), and one I’ll address at some point down the road.

That said, my personal approach to supplements, when exposed to a cold or flu, is to up my vitamins C, D, and E, omega-3s (via fish/krill oil), add a standalone zinc supplement, and perhaps some echinacea if that tickle develops in my nasopharynx…

More on this topic to come.

Flu Vaccines. I’m very intentionally going to dodge the somewhat controversial (at least in some circles) topic today, as the focus of this post is what to do at the point you’re exposed to the flu. Running for the vaccine the day (or week) of a significant exposure won’t help you win that impending battle. As with the point above, this one is deserving of a post or two of it’s own.

Finally, I’ll join the chorus of those who argue that when it comes to seasonal colds and flu events, your best defense is very likely a strong offense in this game – that being optimizing your health and wellness approach year round, every single day. And some years, no matter how good your game, and likely due to exposures beyond reasonable control, you’ll get doused in viral particles and contract the flu or the seasonal cold running around your neighborhood. It happens, and the better your overall health status, the less impacted you’ll be, and the more quickly you’ll get back on your functional feet.

Stay healthy out there my friends.