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SARS-CoV-2

Inquiring Minds Want to Know: Older Bolder Links, Reads, Recipes and More 1 April 2020

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As we continue to grapple with the real and imagined impacts of the SARS-CoV-2 virus and the resultant COVID-19 infection process it causes, it’s impossible to escape the onslaught of daily news (medical/investigational and in the lay press) that we all see every day. Here’s a few topics that have caught my eye this past week you might find interesting…

Fauci on COVID-19 from the 26th – a bit more optimistic perhaps.

Antivirals and COVID-19 – A British trial.

More detail on the loss of taste and smell as prodromal symptoms.

Most critical comorbidities seen in North America’s severest cases.

Vitamin C being used aggressively in NYC treatment after Asian success.

More on the COVID-19 and ACE2 connection.

Another interesting clinical marker of more severe disease?

A fascinating reminder of the history of hand washing in medicine.

Sometimes the most useful innovations arise from times of distress.

Should you exercise during these trying times? Hell yes.

Keeping your car clean.

A Slightly Lighter Look at These Trying Days

How a Texas Grocer Got Ready – a model for logistic planners.

Modeling COVID-19 fashion Texas style.

Jocko’s heart hammer.

I’d love to see gardening make a huge comeback in society; reminds you of Victory Gardens and gardening is great therapy.

COVID-19 Video of the Week

A Reminder of the Several Key Imperatives from NYC Doc

Food, Glorious Food

Grant Achatz omelette tips.

Even the pros fail an omelette flip now and again.

Thyme Butter Basted Red Snapper

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.

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.

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.