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)

All of the minerals and vitamins involved in immune surveillance and pathogen killing are essential to outcome risk mitigation. Zinc is just one of many. Vitamins D, A, C are also big players in the game. More evidence to support a high quality whole foods diet supplemented with targeted minerals and vitamins.

2) T cell immunity is becoming more apparent in antibody negative post infected and unexposed SARS2 individuals. In an excellent article by Nelde in Nature Immunology, we see further evidence that the antibody testing is not sufficient nor necessary to prove that someone had an infection to SARS2 or has cross immunity from other coronaviruses. We know that antibody responses wane rapidly in post infected individuals. Now, hopefully, we can have a test that checks for T cell specificity to SARS2 and learn risk moving forward,. (Nelde et. al. 2020)

3) Does the PCR test have a way to give us a heads up on who is more infectious? Maybe? In an article in the Journal Science, we see an analysis of a way of detecting potentially very infectious individuals. The author looked at what is called the cycle threshold or how many cycles it takes for the polymerase chain reaction, PCR, test to find the SARS2. The smaller the number, in theory, the more infectious virus volume a given person has in their nasopharynx as it takes very few cycles to find the virus. Having an early and thus lower cycle threshold PCR result could be used to educate physicians about potential higher morbidity risk based on a perceived higher viral load. This could be very useful for prioritizing the most likely to super spread or be high on the list to contact trace first. ( Service, R. 2020)

4) Monoclonal antibodies against the SARS2 virus may be the major shift in care that allows us to return to some sense of normalcy. Multiple companies including Cytodyn and Regeneron are in the midst of reviewing and asking for emergency use authorization for use based on phase 3 trials. This would be a welcome change to reduce the fear of activity, contracting the virus and death risk while we practice reasonable prevention based lifestyle choices.

5) Early data on school COVID spread continue to look good. Keep an eye on the new dashboard by Brown University that tracks 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. Read the article by Emily Oster in The Atlantic.

She states, "Democratic governors who love to flaunt their pro-science bona fides in comparison with the anti-science Trump administration don’t seem to be aware of this growing body of evidence. On Monday, for instance, New York Governor Andrew Cuomo claimed that businesses were not “mass spreaders,” as opposed to schools, and subsequently announced that he would close schools in hot-spot areas."

I personally believe that this data set combined with the European data has given us enough key information to move forward with getting kids back in school. The current virtual experiment has been an abject failure in my eyes.

6) Diabetes control by medication tied to lower mortality again. First noted with metformin, now noted with sitagliptin. The bottom line here is that any medicine that reduces hyperglycemia reduces inflammation and immune dysregulation which in turn reduces viral induced mortality. Or, better yet, stop consuming the foods that notoriously spike blood sugar.

7) Are fomites a risk for transmission? When evaluated in the hospital setting, it appears that viral fomites on inanimate surfaces are not a major source of infectious transmission. (Mondelli et. al. 2020)

8) Increasing evidence is mounting that a subset of people develop persistent symptoms after recovering from COVID-19. Symptoms that persist are all neurological and include headache, vision/hearing changes, loss of taste/smell, memory and cognitive impairment. Why do some people get more central nervous system involvement? This is as yet unanswered. I have my hypothesis. I think that certain individuals have more viral transmission across the blood brain barrier based on barrier dynamics putting them at increased risk. The more the virus enters the brain the more inflammation that will follow leading to symptoms. If the inflammation doesn't resolve well then we are left chronically ill. The antecedent lifestyle choices driving COVID risk in general are also known to increase barrier permeability of the gut lining as well as the blood brain barrier. Diabetes, coronary artery disease, obesity and hypertension are all independent risk factors for barrier integrity issues which are all caused by systemic inflammation.

If 99+% of us are to survive this, then the next worry is lasting side effects. Mitigating this next risk is accomplished through the same methods as all cause risk reduction. It appears that simple.


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

Dr. M

Guerri-Fernandez Medical Xpress
Nelde Nature Immunology
Service Science
Nauck Diabetes Care
Oster Atlantic
Mondelli Lancet Infectious Diseases
Starr British Medical Journal