Volume 10, Letter 50 Coronavirus Update 24
November 30th, 2020
Every two week cycle of writing about COVID is humbling to say the least. Every time it seems like we have a pattern understood, that reality changes.
The combination of colder weather, more indoor activity and pandemic fatigue has spawned a new and continuing mess. 2 weeks of data is showing significant negative change.
Crowds, indoor environments, poor ventilation and TIME remain the recipe for a negative COVID19 outcome based on your personal risk.
Latest numbers show that we are going up with peak daily case numbers nationally. Cases seem to be everywhere in the country now. We may even be starting to see cases in previously hit areas. That overall data is pending. NYC data is starting to climb again for the first time since the spring. North Carolina has had a new peak in cases this week, again. The case increases began in early September and still show no signs of turning the corner. Multiple tracking sites are showing a slight correlation between case number and the 2 week tracking death risk. Current death rates per infection are still significantly less than earlier in the pandemic which is a continued blessing. The big risk here is that a regional hospital system gets overwhelmed. To my knowledge this is not occurring yet, but some areas are close.
There is still no change in the knowledge that more than 80% of deaths are skewed toward the over 55 age group and 94% of all deaths occurred in a person with a co-morbid chronic health disease. More biological antibody medicines are on the horizon that may along with a mixture of vitamin A , D, zinc and melatonin be employed for a safe resolution to COVID19. If you did not read the newsletter about an Integrative approach to health in the COVID era, read this link and this link.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us.
Coronavirus Update 24
1) A breakthrough in death risk was just published in the journal Science this month. Drs. Bastard, Zhang and colleagues looked at the genetics and autoantibody profiles of COVID patients from two groups, very sick and asymptomatic/mild. They found that the group of proteins called interferons which are involved in viral killing are dysfunctional for two reasons in the sick groups. One group has a problem where the interferons are targeted by autoantibodies reducing their ability to function. These autoimmune antibodies were found in 10% of the severely ill patients but not at all in the mild/asymptomatic group. The other risk group had defects in the interferon genes function reducing SARS2 killing and leading to viral volume explosion, morbidity and death.
The study also noted that the autoantibodies against the interferons were found in 2.6% and 12.5% respectively for women and men. This is yet another reason why men are significantly more likely to die from COVID19. These antibodies are 5 times more prevalent in men as the mutation is on the X chromosome. (Bastard et. al. 2020)
This study adds to a pile of other genetic and epigenetic risk studies that are teaching us that we may be able to identify at risk populations in the future based on their genetic makeup and get a head start on management and/or target them for the first round of vaccination for this pandemic and others in the future.
It is becoming crystal clear that while 94% of the cases associated with COVID and a death outcome are based on lifestyle induced diseases, a smaller subset of otherwise healthy people can still die from this virus despite making the right decisions. This leaves me with this simple truism. Control what is in your control. Mitigate the lifestyle factors that are associated with disease and death while practicing safe activity. This is no way changes the reality that 99.7 percent of us will survive.
2) What kind of immunity do we have post COVID infection? We know from multiple studies over the past 8 months that many people have T cells that are antigen SARS2 specific post infection offering an unknown but likely reasonable immunity. In a study by Dr. Dan and colleagues, we find quality memory B cells as well as the CD4 and CD8+ T cells specific to SARS2 in the serum many months post infection. They looked at 185 COVID positive subjects that had all degrees of illness. 90% had immune cells recovered at 6 months. I highly encourage you to read the whole study as it is far too much digest here. (Dan et. al. 2020)
Suffice it to say that we are likely developing quality immune responses to SARS2 after infection. How long the immunity lasts is still in debate, but is likely much longer than is being touted. This understanding as well as the length of immunity conferred by a vaccine will take quite a while to elucidate, however, these are hopeful scientific papers.
3) Psychiatric diagnosis post COVID infection is significantly elevated as noted in a study by Dr. Taquet and colleagues. After diagnosis, the incidence of a psychiatric diagnosis (anxiety, dementia, insomnia) was 18.1% for all study patients between 14 and 90 days post illness. 5.8% were first time psychiatric diagnosis. (Taquet et. al. 2020) The data nightmare continues to pile up for mental health crisis. Not only are psychiatric disorders up overall from COVID stress in general, but now we have to contend with COVID infection induced brain changes altering our psyches. This is a major mess coming our way as we already have a poorly functioning and overwhelmed mental health system.
4) School closures in the spring amounted for on average 10.8 weeks of lost school education. (Christakis et. al. 2020) These days are unlikely to ever be replaced or made up. Thus, children will enter college behind or worse not interested in further education after getting a large taste of prolonged non school based freedom. As I have stated in the past, COVID19 is a lose lose and this is a snapshot of loss educationally.
5) More on the lack of lockdown effectiveness. The Lancet published a study this month noting that, "Increasing COVID-19 caseloads were associated with countries with higher obesity, median population age and longer time to border closures from the first reported case. Increased mortality per million was significantly associated with higher obesity prevalence and per capita gross domestic product (GDP). Reduced income dispersion reduced mortality and the number of critical cases. Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns and reduced country vulnerability to biological threats (i.e. high scores on the global health security scale for risk environment) were significantly associated with increased patient recovery rates." (Chaudhry et. al. 2020)
Study after study shows us that the big problem with pandemic preparedness is the time to control of the index cases before the reproductive spread rate of 1.3 becomes exponential. In other words, if one person is ill and identified quickly only 1.3 people will be infected and likely caught. If that person is missed, then he or she will infect 1.3 more people until identified. Then all of the infected then become 1.3 infectors. The math gets very ugly very quickly. As happened in the United States, early cases were not identified and then the virus became endemic in American society. To get it to go away at this point is next to impossible. A lockdown, as we saw in the spring, only delays the spread unless a lockdown is kept in place for the time it takes to get adequate vaccination in place. Thus, as a meaningful tool, lockdowns are ONLY useful to slow the spread or flatten the curve. Eradication is impossible at this point. The economic, mental and societal traumas of a lockdown are obvious and truly damaging. What we have seen since the summer is that society cannot handle a prolonged restriction of movement and activity. Coronavirus fatigue is real and ushered in wave 3 as we are seeing right now.
This experience is a truly extraordinary event that we must learn from for the next time we undergo this form of trauma. Our national leaders have to focus the future on developing strategies to rapidly identify index cases and isolate them quickly. This means that we need an Operation Warp Speed for viral testing, PPE distribution, and quarantining of people at risk. This means that we MUST have an in country pipeline for all raw materials as well as stockpiles of PPE. If we quarantine hot spots of index cases, the government should cover all lost wages while those quarantined to reduce the incentive for people to go to work for fear of lost wages. This is especially important for the low wage hourly worker.
As noted above, obesity is the recurring problem in this whole pandemic. We must as a society place a heavy focus here.
6) Antibodies to SARS2 are definitely associated with reduced reinfection and disease for 6 months and likely longer. At study onset, 12,219 Healthcare workers had anti-spike IgG antibodies measured. 11,052 were negative and 1,246 were positive. 89 Polymerase chain reaction confirmed symptomatic infections occurred in the negative people. No symptomatic infections occurred in IgG antibody group. (Lumley et.m al. 2020) This is yet another very important data set looking at the risk of reinfection and the severity.
7) Who is really spreading the infection? The preponderance of the data says that it is ill persons. However, asymptomatic individuals may and are likely also spreaders but to a lesser extent. 20% of SARS2 positive individuals have absolutely no symptoms. It appears from the data that in a household, an asymptomatic person will spread the virus at 1/4 the rate as a sick person. From B. Nogrady in Nature, "To understand what is happening in people with no symptoms, Cevik and colleagues conducted a systematic review... on the viral dynamics and transmissibility of SARS-CoV-2... Some studies showed that those without symptoms had similar initial viral loads — the number of viral particles present in a throat swab — when compared with people with symptoms. But asymptomatic people seem to clear the virus faster and are infectious for a shorter period. The immune systems of asymptomatic individuals might be able to neutralize the virus more rapidly, says Cevik." (Nogrady B. 2020)
8) Melatonin is associated with decreased SARS2 positivity. 28% decreased risk of developing SARS2 positive diagnosis for all tested individuals and a 52% decrease for African Americans specifically as a subgroup. (Zhou et. al. 2020) Melatonin is a T helper cell type 1, TH1, inducer which over time increases viral surveillance and killing. Melatonin also improves sleep onset and thus may increase sleep time for users. This increases total body rest which decreases body stress. This is also TH1 promoting. Melatonin appears to be an adjunctive medicine for SARS2 risk reduction.
9) Drier and colder air is associated with a higher SARS2 reproductive rate indicating increased spread in the dry winter weather. (Ma et. al. 2020) Raising your homes humidity above 50% with a humidifier can counter this effect. This study sheds further light on the known reality that winter is respiratory virus season. Dry and cold air is better for viral replication and secondarily causes increased crowding indoors which together are ingredients to increased pandemic spread.
10) Masks in the news again. In an excellent editorial in the Annals of Internal Medicine, Dr. Laine and colleagues reviewed the recent study DANMASK19 (Bundgaard et. al. 2020). They accurately state that the study does not in any way put a negative mark on mask wearing, but instead gives a more nuanced reality to the benefits of mask wearing. Read the editorial as it is worth your full digestion. (Laine et. al. 2020) Many people have looked to this study as a mark in the column of masks are stupid to wear. It is not so. Masks are a part of total package of risk reduction. Social distancing is the most useful intervention for preventing exposure and contraction. Hand washing and not touching one's face is next and then mask wearing brings up the rear of effectiveness.
Taquet Lancet Psychiatry
Christakis JAMA Network Open
Chaudhry Lancet E Clinical Medicine
Zhou PLOS Biology
Laine Annals of Internal Medicine
Bundgaard Annals of Internal Medicine