We are one and a half months into our social isolation and distancing. We hope you are all remaining healthy and keeping your spirits high finding the blessings we all share. It is what we all need to do until we are encouraged to begin liberalizing our activities.
Video of the week – Masks are very in! 😷
Why we might bring back the question – Who was that Masked Man? (What TV show was this from and Bonus question: Name the main actor who starred in this show. see below for the answers at the end of this newsletter)
Masks are making a fashion statement these COVID days and we all should be wearing them if we go out in public to protect not ourselves but others should we be infected and spread the CoVID virus through respiratory droplets.
But masks are hard to come by. So here is a simple video for you to watch so you can make your own CDC certified mask.Watch Video
Obesity as a risk factor for severe COVID-19 manifestations
In the same vein as Dr. Howard’s share of brilliant content on exercise and the video 23.5 hours, I would like to make a few comments on weight gain as it relates to CoVID-19. If you missed it, you can watch the video here.
A recent publication in Lancet Infectious Disease, April 1 highlights a possible link between body weight and more severe COVID-19 outcomes. Investigators defined overweight and obese as BMI of 24 to 27.9 and over 28, respectively.
Folks defined as overweight had a 75-86% greater risk of more severe pneumonia. Those defined as obese had a greater than 3-fold risk of severe pneumonia.
Though not statistically significant, when adjusting for sex the risk appears to be lower in women. Sorry gentleman!
Why does carrying a few extra pounds increase your risk?
The investigators in the study highlight previous work suggesting that individuals with higher levels of body fat disproportionately allocate a higher fraction of total body oxygen consumption to their respiration. Absence of oxygen is incompatible with life, but it is also an oxidative stressor causing damage to our tissues through consumption. The theory is that this oxidative stress renders the lungs more susceptible to other stressors, including that of infection.
Another theory has to do with signalling molecules called cytokines. We know that a adipocytes (fat cells), particularly those around the abdomen, are more than an inert storage container. Adipocytes secrete inflammatory cytokines including tumor necrosis factor (TNF).
Some of you may be familiar with biologic agents, Enbrel, Humira, Cimzia, Simponi and Infliximab (Remicade and Inflectra) that block TNF for rheumatoid arthritis, psoriasis or other autoimmune disease. These cytokines are part and parcel of the disease process.
The idea is more body fat = more inflammatory cytokines. More inflammatory cytokines translate to a background inflammatory state in the body, which may render CoVID-19 infected individuals more susceptible to bad outcomes.
Another layer of defense – resilience
Viruses, bacteria and widespread illness come and go. Certainly, pathogens vary in the harm they can cause. But in most cases, not everyone is impacted in the same way. If we take a homogenous set of individuals and expose them to a pathogen or stressor, some will have a minimal reaction. Others will have severe reactions, long term complications or even death. This variance in response is called resilience. How resilient are you?
Genetics and less controllable factors set a baseline, but there is much we have control over.
Avoiding exposure and good hygiene have helped us flatten the curve and are an incredibly important layer of defense. But do also consider the attribute of resilience or rather the health of the person the virus infects. Ask yourself the questions about your own resilience below:
- Are you at a healthy body weight?
- Are you exercising 30 minutes per day?
- Are you eating your vegetables?
- Are you staying hydrated?
- Are you going to bed on time?
- Are you smoking?
- Are you listening to dreadful narratives and bad news all the time?
- Is your blood sugar and blood pressure controlled?
- Do you have a chronic illness that is controlled?
- Are you taking your cod liver oil (yum)?
There are a few boxes I cannot check here, even for myself as a physician. Naughty doc! But hey, the silver lining here is that you and I can feel empowered in knowing that we have some level of control in our outcomes. Wishing you and your family great health and resilience.
Answers to video quiz above.
- Mask question: The Lone Ranger
- Bonus question: Clayton Moore