July 14, 2020

Following up on last week's article on schools and COVID, I thought that it would be useful to discuss risk moving forward. Dr. Koontz and I had a lengthy discussion about the large number of older and elderly who may be placed into harms way as schools return to in class activities. There are many individuals over the age of 65 years who have comorbid conditions and are the primary caregivers for children that will return to school this fall.

While the need to go back to school is clearly of paramount importance for many reasons, there is a potential recipe for trouble for those with risk as COVID19

is still present and increasing in case volume in parts of North Carolina. A recent article in the Washington Post added a layer of fear mitigation as many countries went back to school with little to no transmission from children to the population at large during the period in the spring where children returned to school.

In another recent study in the Journal Pediatrics, Dr. Psfay-Barbee and colleagues noted that children are not spreading to adults so much as the reverse is true. From the article: "In 79% of households, ≥1 adult family member was suspected or confirmed for COVID-19 before symptom onset in the study child, confirming that children are infected mainly inside familial clusters. Surprisingly, in 33% of households, symptomatic HHCs tested negative despite belonging to a familial cluster with confirmed SARS-CoV-2 cases, suggesting an underreporting of cases. In only 8% of households did a child develop symptoms before any other HHC, which is in line with previous data in which it is shown that children are index cases in <10% of SARS-CoV-2 familial clusters; however, with our study design, we cannot confirm that child-to-adult transmission occurred." (HHC is house hold contact) (Posfay-Barbee et. al. 2020)

Having some data to hang out collective hats on is always better than blind assumptions. As with last weeks data set, I repeat that children are not the problem in the majority of cases.

Therefore, I believe that the discussion must switch to prevention for those at risk as school avoidance for another 6 to 12 months or longer is not a good idea, online education is inferior and the combination could cripple a child's mental and social growth especially in the underprivileged among us. If we know that there are people that are at risk of death, we must identify them and educate them on risk reduction.

Who is at significant risk:
1) Individuals over the age of 65
2) Individuals with cardiovascular disease, type 2 diabetes, hypertension, cancer, lung disease, sickle cell disease, kidney disease and to a lesser extent autoimmune disease

What can you do if you are at risk and will be caring for a school child this fall? Here is a link to the Institute for Functional Medicine's prevention Strategy which is detailed.

1) Continue to take all of your medicines as directed. Early data shows that statins, antihypertensive drugs, anti coagulants and immune modulators are important for mortality prevention.

2) Change the antecedent triggers of metabolic syndrome: I see that a strong tilt toward an anti inflammatory diet is critical. See the link under Quicklinks three for details. If you decrease inflammatory and immune suppressing foods like refined carbohydrates and poor quality fats, you stand a strong chance of reducing your risk. Eat a whole foods diet that is mediterranean or anti inflammatory in nature. Strictly avoid all refined carbohydrates including sugared beverages and flour based products. Adding in large volumes of colorful vegetables and fruits provides a bounty of polyphenolic compounds that are very beneficial.

3) Look to add supplements like zinc and zinc ionophores like quercetin while increasing mineral vitamin containing foods. This is critical for immune function but also has the added benefit of reducing viral replication and inflammation globally. Talk to your provider about appropriate dosing.

4) Increase your consumption of omega three fatty acids as small oily fish, or fish oil to add precursors for resolvins, protectins and defensin chemicals for the resolution phase post infection. These are anti-inflammatory prostaglandins that are very powerful.

5) Before you get ill, maintain adequate levels of vitamin D and A for T regulator cell activity. Eat lots of bright red/orange/yellow vegetables and fruits. Get 30 minutes of direct sun a day or consider getting your levels checked and supplement accordingly per your providers recommended doses. Vitamin D is known to help reduce NLRP3 inflammasome activity which helps reduce an overactive immune response. Increasing your intake of vitamin C as citrus fruit and/or a supplement can also be beneficial for immune viral attack.

6) Get 8-9 hours of sleep nightly. Melatonin which rises at night as we get ready for sleep is critical for innate immune based inflammasome repression and control. Avoid blue light screens at night after the sun goes down. Dim lights in general an hour before bedtime.

7) Practice daily meditation and prayer for stress reduction. Stress is a nightmare for immune function. Choose happiness
as often as possible despite a negative situation. Positive mental states enhance immune activity.

8) Consider wearing a mask at home, avoid all bodily fluid exposure and transfers especially via beverages and food, socially distance wear possible. The volume of viral exposure has a lot to do with that initial viral load and the subsequent infectious morbidity as health care workers have shown worldwide.

 

9) Wash your hands with soap and water for 20 seconds frequently and avoid touching your face completely unless your hands are thoroughly washed.

 

10) Love your children no matter what as they are the next and best generation for our beautiful country.

Links to more detailed newsletters discussing prevention: (1), (2)

As the school year approaches, prepare to compromise in your mind for the betterment of children.

 

Dr. M

Birnbaum Washington Post
Posfay-Barbee Pediatrics
Arizona Center for IM PDF
Munro Archives of Disease in Childhood
AAP School Re-entry Document
Peter Attia Discussion
CDC Document
Viner Lancet
Yung Clinical Infectious Diseases
Lee Pediatrics