Unifying theory as of September 2020

 

September 21st, 2020

Warning - very technical piece. I am attempting to put together a coherent hypothesis as to the pathophysiology of this fascinating disease. However, it explains a lot about risk and lifestyle choices mechanistically. We are learning a lot rapidly. There is no time to waste to reduce your risk and be a part of the 99%.

What do we know or better yet, what do we THINK that we know. This reminds me of the Donald Rumsfeld comment on the known knowns and the known unknowns and so on.

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Allergies

September 28th, 2020

Seasonal allergies and pollution irritants are reduced by the wearing of masks for COVID prevention. Dr. Dror and colleagues looked at the effects of the pandemic mask wearing intervention and allergic rhinitis suffering. They found that individuals wearing masks had significant reductions in allergic rhinitis symptoms presumably due to reduced allergen exposure. There was little benefit from adding the tightly woven N95 type mask over the standard good quality surgical mask. The masks also cause increased humidity to breathed air which has differential effects on allergen responses.

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Covid Isolation and Weight

 

 Septemeber 28th, 2020

Covid Isolation has had a nasty side effect of weight gain and excessive screen time. Over the past 6 months, we have been asking parents and children how much screen time they were and are allowing and or getting. The answer was a disturbing 6-8 hours a day, before remote schooling began and more since. This is a mix of on demand streaming movies/videos and video gaming as well as instagram/tiktok/ snapchat and more. My own experience with the schooling situation is sad. My children are being asked to watch videos all day with minimal to no interaction with the teachers.

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Mental health and Microbiology

September 28th, 2020

It has been emerging in the literature for years now that your intestinal microbiome has direct bidirectional crosstalk with your brain. Dr. Valles-Colomer and colleagues published a lovely article in Nature Microbiology looking at the microbes and the patient's mental phenotype. They found that butyrate-producing Faecalibacterium and Coprococcus bacteria were consistently associated with higher quality of life indicators. Together with Dialister, Coprococcus spp. were also depleted in depression, even after correcting for the confounding effects of antidepressants. (Valles-Colomer et. al. 2019)

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Volume 10, Letter 42 Coronavirus Update 20

 

October 5, 2020

Crowds, indoor environments, poor ventilation and time are a recipe for a negative COVID19 outcome. In section II, I am going to look into an excellent and plausible article in The Atlantic magazine this week.

Latest numbers show that we are in a mixed bag situation. Cases are moving to the suburban and more rural areas that have seen little to no exposure. North Carolina peaked on July 23rd and has remained low in case volume prompting further lifting of state imposed restrictions. Enter phase 3.

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Coronavirus Update 20

October 5th, 2020

1) A new study out of Boston University has shed light on another aspect of SARS2 and the ability to hijack the immune system's capability to wage war against the virus. SARS2 can reduce the lung tissue's ability to release interferon chemicals to recruit immune fighting cells. This is a major problem for us as the interferon chemicals are the critical early warning signals. The release of the interferon class of chemicals is a necessary part of immune surveillance and rapid viral killing. This disruption can allow the virus to replicate unchecked for a period of time that increases the systemic viral load overwhelming the remaining functioning immune system.

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SECTION II - The Atlantic Magazine article

October 5th, 2020

When we look at the totality of the transmission/spreading data for the past 6 plus months, we have seen many inconsistencies, for example, Sweden. Why have they done so well? Why are certain parts of a country affected while others are not. We have discussed these realities in theory for months now as we narrowed down the likely reasons as to why we are seeing what we are seeing. Now, we have a very well written and thought through article on spread. They do a great job of breaking down the science of spread.

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Section III - What am I doing?

Oct 5th, 2020

Many people have asked me, "what are you doing?" " are you going to take the vaccine?" Etc....

I am 100% trying to avoid anything that over stresses my body.

COVID has allowed me to focus even more acutely on what matters most right now. LIFE!

I am/have/will:

1) sleeping 7 to 9 hours nightly. This is on average a 60 minute increase over my historical norm.

2) exercising with a core group of friends 6 days a week in a micro bubble in an outdoor environment.

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Cognitive Dissonance

October 12th, 2020

I have long thought about the world of manipulating one's thoughts to maintain a wrong belief because it aligns with what the thinker wants or needs. In the field of medicine, I am constantly amazed at the entrenched beliefs of my colleagues when they are faced with solid evidence that the belief that is held tight is likely untrue. This brings me to the theory of Cognitive Dissonance as written by Leon Festinger in 1957:

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Covid Infection Fatality Rate

 

 October 13th, 2020

A question has arisen. Where do you get the 99% COVID19 survival number from?

This is the infection fatality rate percentage that is based on multiple sources including the CDC and the WHO. This is the number of people infected not just tested versus the number of deaths reported. This number sits between 0.25% and 0.7% at present. This number is actually likely to go down further as the current trend is more positive test results and less deaths overall comparatively.

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If you missed it

October 12th 2020

If you missed it last week, a new Covid-19 Pedcast is available with DOCSMO at this link. Dr. Paul Smolen has been podcasting for 10 years and is widely listened to by pediatricians and parents. I had the privilege of joining him to discuss Covid-19. He asks, can a child look healthy, but be metabolically ill? Can Covid-19 be prevented? What can parents do to prevent Covid-19 in their children? What is integrative pediatrics, What is metabolic health, Why do some children get very sick with SARS-CoV-2 and others not?

I hope that you enjoy it.

Dr. M

Volume 10, Letter 44

 

October 19th, 2020 

Crowds, indoor environments, poor ventilation and TIME are the recipe for a negative COVID19 outcome based on your personal risk.

Latest numbers show that we are moving in the wrong direction with case numbers nationally. Cases continue to move to the suburban and more rural areas. North Carolina peaked on July 23rd and has now had a second spike in case volume almost reaching the July peak.

There is still no change in the knowledge that more than 80% of deaths

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Coronavirus Update 21

October 19th, 2020

1) Micronutrient deficiency is not helpful when fighting a virus. Dr. Guerri-Fernandez looked at low zinc serum levels and COVID19 death risk. "Mean baseline zinc levels among the 249 patients were 61 mcg/dl. Among those who died, the zinc levels at baseline were significantly lower at 43mcg/dl vs 63.1mcg/dl in survivors. Higher zinc levels were associated with lower maximum levels of interleukin-6 (proteins that indicate systemic inflammation) during the period of active infection." (Guerri-Fernandez et. al. 2020)

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SECTION II

October 19th, 2020

The more people that gather together in a closed indoor environment coupled with the amount of time spent together coupled with a lack of protective mask use is the current worst case scenario for COVID exposure and illness development. Your inherent genetic risk coupled with your lifestyle induced disease risk puts you in a specific category of the 94% or not.

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Section III

October 19th, 2020

Zinc and Vitamin D containing foods that I would encourage you to feed your children

Zinc -
1) Shellfish - especially oysters - can be pureed into spaghetti sauces. Kids generally like shrimp and scallops pan sautéed with olive oil, basil and fresh garlic
2) Chick Peas as hummus or roasted like popcorn
3) Nuts and seeds - cashews and pumpkin - pureed in anything from smoothies to sauces

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Volume 10, Letter 45

 

October 26th, 2020

What does it mean to lose?
Vision, health, vitality
What does it mean to lose?
Your joy, desire, plans
What does it mean to lose?
Something or nothing

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Halloween

October 26th, 2020

Whether you choose to participate in Halloween this year all depends on your fear of Covid19 transmission while trick or treating and obtaining food stuffs from others in large volume as tends to occur. The risk is likely to be quite low as the event occurs outdoor and your exposure to any one person will be limited reducing risk tremendously. Couple this with the fact that children that tend to trick or treat are between the ages of 4 and 12 years old which is a very low risk group for developing and or transmitting the virus. Each family should choose to participate based on their personal risk tolerance.

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Injuries

October 26th, 2020

All terrain vehicles, motorcycles, bicycles, skateboards, rip sticks and so on carry significant risks for head and neck injury.

I tell patients all of the time that injuring your arm is a low risk endeavor when riding a wheeled machine, but breaking your neck or hitting your head on a tree is a major problem for concussion or a significantly worse outcome.

Now, as Americans, we never shy away from a challenge when it comes to sports and activity. This is our collective ethos. Knowing that, how do we keep our kids safe when engaging in sports where head and neck injuries can occur?

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Appendicitis in Children

 

 October 26th, 2020

67% of 1078 children treated for appendicitis with antibiotics did not go on to need surgery according to a new study by Minneci and colleagues in JAMA.

Appendicitis patients choosing the non operative route received 24 hours of IV antibiotics in hospital followed by 6 days of oral antibiotics at home.

Why does this study matter?

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Chemicals are back in the news! Reboot

 

July 28th, 2020

Are Your Sperm in Trouble? The 2017 NYTimes article reports on human sperm damage from chemical exposure in our environment. What is the story and what chemicals are the trouble makers?

Endocrine disruptors are chemicals that may interfere with the body's endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans and wildlife. EDC's are unfortunately heavily involved in hormonal regulation and metabolism throughout the body.

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