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.

This virus continues to amaze in ways that make you wonder about its evolution.

2) Where did we get the 3 foot or 6 foot distance designation from to avoid Covid. Joanne Silberner has a nice historical piece in The Smithsonian that is worth your time to read. Link.

3) It appears that less than 10% of the United States population has antibodies to SARS2 spike protein according to Dr. Anand and published data in The Lancet. (Anand et. al. 2020) This tells us very little, unfortunately, despite the widespread media coverage as the SARS2 antibody response wanes rapidly with this illness by 8 weeks in many individuals and says nothing about T cell immunity which appears to be protective. The likelihood that we are truly at less than 10% exposed is very low. How far along we are remains a mystery.

4) Early data on school COVID spread is looking good and mirroring early data from Europe. There is a new dashboard by Brown University tracking school COVID related numbers. Link. The summary of the early data set is that primary school spread is minimal and much less than the surrounding spread outside of school environments. This is very reassuring for those of us that are screaming to get our children back in school. My personal experience and that of the polled patients and their parents is that virtual learning has been a complete disaster for learning while being a massive boon for all types of screen time and social deprivation. Kids are NOT the main source of the viral spread of this pandemic and are suffering tremendously now on many fronts. The longer this plays out as a virtual experience the more behind and mentally malnourished they will become.

5) Red blood cell distribution width, RDW, when elevated is associated with morbidity and mortality with COVID. Patients whose RDW increased during hospitalization had higher mortality compared with those whose RDW did not change. If the RDW was normal at admission but increased, mortality increased from 6% to 24%. If the patient had an elevated RDW at admission, mortality increased from 22% to 40%. (Foy et. al. 2020) Elevated RDW is a marker of poor red blood cell production, inflammation and nutrient deficiencies. "the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D3 and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization." (Bujak et. al. 2015) RDW is an independent predictor of all-cause death, cardiovascular death, and cardiovascular events in patients with history of MI. (Tonelli et. al. 2008) The reduced RBC production and clearance causes a reduced oxygen carrying capacity leading to hypoxia chronically in the blood stream. This has a side effect of TH2 polarization on the immune system which is a net negative against pathogen surveillance and killing. In essence what the authors are saying is that humans that have excessive inflammation, hypoxia, reactive oxygen species damage and nutrient deficiencies are at higher risk for disease of vascular circulation and subsequently Covid. This is inline with the disease risk comorbidities. RDW appears to be an independent marker of risk only in that it shows that a patient is metabolically dysfunctional already and/or from the viral illness's pathological attacks. This is similar to the biomarkers of diabetes and other inflammatory metabolic diseases, cancer and risk overall.

Interestingly, Vitamin D is involved in RBC formation and when deficient is associated with an elevated RDW. Vitamin D deficiency is also associated with COVID death. Coincidence? I think not.

This is yet more evidence that baseline health is so important to COVID survival. If your RDW is high, you must take a hard look at yourself and your lifestyle choices. Do not practice cognitive dissonance and think that your improvements will be enough if you are still consuming large volumes of Standard American Food and/or being exposed to lots of toxins through your actions. SARS2 doesn't care. It loves a metabolically unhealthy person.

6) More on Vitamin D: From Dr. Maghbooli in Journal PLOSOne we find: "Based on CDC criteria, among our study patients, 74% had severe COVID-19 infection and 32.8% were vitamin D sufficient. After adjusting for confounding factors, there was a significant association between vitamin D sufficiency and reduction in clinical severity, inpatient mortality, serum levels of C-reactive protein (CRP) and an increase in lymphocyte percentage. Only 9.7% of patients older than 40 years who were vitamin D sufficient succumbed to the infection compared to 20% who had a circulating level of 25(OH)D< 30 ng/ml. The significant reduction in serum CRP, an inflammatory marker, along with increased lymphocytes percentage suggest that vitamin D sufficiency also may help modulate the immune response possibly by reducing risk for cytokine storm in response to this viral infection." (Maghbooli et. al. 2020) This adds to the previous data looking at the benefits of vitamin D for COVID prevention and morbidity reduction. This is a vitamin that is absolutely worth taking based on your blood levels and need.

7) Is COVID19 a pandemic or a syndemic? Such is the question asked and discussed in The Lancet this week. An interesting read - Link. Follow up Link. The simple reality is that this problem has always existed and we need to look at how to change it if we are ever to stem the tide of chronic unremitting diseases of lifestyle choice and poverty. A great place to start would be for the State and Federal Government of these United States to stop bankrolling processed food commodities and instead subsidize vegetables, fruits and high quality proteins. Providing the poorest among us with good whole high quality food should be ground zero for a healthy lifestyle for all.

8) Article on Sweden and the decisions that made such good sense in hindsight. Link.

Dr. M

Boston University Article
Silberner Smithsonian
Anand Lancet
Smith BMJ Opinion
Meckler WAPO
Foy JAMANetwork
Bujak Disease Markers
Tonelli Circulation
Maghbooli PLOSOne