Monday May 4 News & Updates

Arthritis Health - Friday 20 Mar 2020 News & Updates

We have a weekly video by popular demand and two articles.

The Video – How to make your own hand sanitizer – especially if you are having trouble finding it in stores or on line or if you want to make your own and possibly save on the cost.

The two article are longer than usual but both important. I have written a summary of our current lockdown, why we have done what we have done and were we go from here. Hopefully some reason and science will guide us. The second article is by Dr. Mitchell on Vitamin A and its key role in immunity.

How to make your own Aloe hand sanitizer!

Purchase materials to make the sanitizer from the links below:

Buy Alcohol Buy Aloe Vera Gel

When Do We Start Opening Up Our World?

We are shuttered in place – in shutdown. When do we start to open up?

Our governments ordered us to stay locked down. The reason we did this for the past 6 weeks was to spare the health care system of being overloaded. We all listened and we all did as we were advised.

We did a great job! 

Everywhere, from NYC to Los Angeles, we have reduced the influx of CoVid 19 patients into the medical system. This has allowed us to practice medicine at the highest ethical levels. Had our medical systems been overwhelmed beyond their capacities, we would have had to practice battlefield medicine, triaging who would live and who would die. Who would get respirators and who would not. Even as it were, we were stretched. We pushed the limited supplies of protective equipment, life supporting machines, medicines and personnel.

There have been many heroes throughout this spring, pulling together to care for the sick, maintain our essential businesses, working together to help aid and protect our fellow citizens. But the job is not done. We are only in Act 1 of this play.  We now have to decide how and when we begin to resume more normal lives. So where do we go from here.

The first thing to realize is what social distancing accomplishes. It does not eradicate Covid-19. It does not necessarily reduce the number of deaths from the disease.  It delays infection and death. Practice more social distancing, there is less disease transmission. Practice less social distancing, there is more disease transmission. Unless there is some miraculous cure for this disease which does not appear imminent, the infection will continue. We have accomplished a slowdown.

I believe we need to open up gradually. We can not remain shuttered, closed up and waiting for a cure. Too many people have lost their jobs. Too many people have had their economic lives threatened. We need to start opening up our economy.  For those who have the security and financial wherewithal to survive the lockdown, there is no rush, but for most of us, we need return to a more normal situation. But how safe is it.

Are we making decisions based on fear or facts?

These are my personal opinions based on my understanding our knowledge of CoVid -19 virus.  It is hard for me to step out and share these opinions – far easier to hide behind “we do not know”. We need to make decision and I will outline key issues which then help make decisions how we proceed to live our lives.

How lethal is this COVID-19?

In the new analysis, published in the Lancet, the death rate in confirmed COVID-19 cases is estimated to be 1.38%, while the overall rate, which includes estimated unconfirmed cases, is calculated at 0.66%.

Age matters: Recent studies confirms earlier studies showing that both rates of death and hospitalization vary by age and increase with age. Children are least likely to die, with death rates in confirmed cases of less than 1% in newborns to 9-year-olds. That rose to 4.28% in people 70 and older, and to 7.8% in people 80 years and above.

This infection is much more lethal than the standard influenza.

Can you have COVID-19 without knowing it?

The short answer is no.  It is very rare. Truly asymptomatic cases are uncommon according to Maria Van Kerkhove, an American epidemiologic specialist in emerging infectious diseases with the World Health Organization.  Studies in China estimate that about 1.2% of confirmed cases are asymptomatic. But Van Kerkhove said even this number is falsely high.   When the scientists on the WHO mission to China pressed for more detail, it became clear that most of the people who were first described as asymptomatic actually were pre-symptomatic — they’d been detected through contact tracing before their symptoms manifested. They were not truly asymptomatic.

How long is the incubation period – 5 day is the average, in a study in Nature this month, people were infectious however 3 days prior to having symptoms – so there is real concerns that someone with CoVid-19 may be “pre-symptomatic”  and infectious for 3 days prior to developing symptom – so the bottom line is that social distancing and use of masks is still important.

Can you get re-infected with the COVID-19?

Again, the short answer is no. There has been concern on social media about reports of people getting infected, recovering, and then later developing symptoms again. Some scientists from China have suggested the virus is able to re-infect people after a very short time. Van Kerkhove said this probably is not what is happening. Knowing how the immune system operates in fact, it would be unusual if an immune system that had just successfully conquered a viral invader would forget how to recognize it and fend it off within a period of days or a few weeks.

How is the disease spread?

Short answer, via respiratory contact – droplets. And where does that happen? Breathing or coughing in close proximity causes infections. And where does this occur? In close family contact and institutional settings. It is much less likely in casual social interactions.

How dangerous are casual social interactions?

Short answer, not very dangerous. Maria Van Kerkhove who studies the Wuhan outbreak directly found the disease was not spread in casual interaction but in close family contacts and institutional settings.

Hendrik Streeck, the virologist leading an investigation of a severe outbreak in Germany’s Heinsberg district, found similar results. He found little evidence that shopping or even touching contaminated surfaces posed a significant risk to a well-advised public. What is a “well-advised public? I believe is means those who do not feel well or are sick adhere to strict self quarantine and for those of us who are healthy continue to use social distancing including use of masks to protect others.

Who is truly at higher risk for serious or lethal complications from the Coronavirus?

Here we go. I will list these from high to low risk

  • Age – older than 65
  • Living in nursing homes or long term care facilities
  • Coexisting illnesses
  • Highest Risk
    • Lung and heart, disease, particularly poorly controlled
    • Active cancer and cancer treatment
    • Blood disorders resulting in abnormal white blood counts
    • Poorly controlled AIDS or HIV
  • Moderate Risk
    • Kidney and liver disease, particularly poorly controlled
    • Obesity ( > BMI  40)
    • Diabetes, particularly poorly controlled
    • Autoimmune diseases – particularly uncontrolled or poorly controlled
    • Prolonged use of moderate to high dose steroids
    • Use of non steroidal anti-inflammatories such as Ibuprofen and Naproxen
  • Lower Risk
    • Low dose steroids, Rheumatologic immunosuppressive medications
  • Your Immune system –  this is hard to determine but clearly some people have immune systems that are predisposed to the “cytokine storm”, a lethal immune reaction caused by the Coronavirus.

So what should we do?

Continue social distancing. Wear a mask or face guard.  And everyone should be wearing a mask around you in casual social settings – such as in stores, work and play area.

I vote for letting people make their own decision concerning their level of social interaction which will be based on individual risk and benefit assessment.  If someone decides to completely reduce the risk of Covid-19 exposure, they will remain in a “bubble” interacting only with as few and known people as possible,   Others may wish to increase their social interaction and still continue to practice careful hygiene, social distancing and appropriate use of masks.

I vote for people to be able to choose their level of social exposure with the caveat to remain careful, hygienic, and vigilant.

Building your resilience – Vitamin A and Immunity

Picking up on last week’s discussion of building your resilience, let us talk food. Eating your fruits and vegetables is not only good for you, but helps fortify you against pathogens, including the Covid-19 virus. We are going to zoom in on one specific nutrient today, Vitamin A.

What is Vitamin A

Vitamin A, a fat-soluble vitamin also known as retinol, is a critically important factor for your immune system.

In the old days, it was referred to as the “anti-infective vitamin” because of our realization of how important this nutrient is to normal immune functioning. In fact, one of the reasons infectious disease is so rampant in third world countries is due to poor access to Vitamin A dense foods.

Vitamin A and your immune system

The functions of vitamin A are threefold:

  • Prevention of entry of pathogens into the body
  • Regulation of antigen presenting cell function
  • Regulation of inflammation

Keeping the bad guys out

Think about the way TSA works at an airport. We have security checkpoints that intercept trouble makers, preventing them from getting into the airport.

Vitamin A is necessary for the production of checkpoint-like proteins called secretory IgAs that line our mucosal surfaces (nasal passages, throat, lungs and digestive tract). These proteins will catch viruses, bacteria and other pathogens preventing them from getting into the body.

No Vitamin A, no TS”A”!

Regulation of antigen presenting cell function

Antigen presenting cells are white blood cells that are your first responders. Should a bad guy get through TSA, your first responders will essentially eat the pathogen, destroy it and show it to members of your homeland security in command. The commanders will then orchestrate an inflammatory cascade and prepare the body for a potential emergency. You can think of this as just good communication. Bad communication and lack of intel means bad outcomes!

How this occurs is through toll-like receptors on the surface of these antigen presenting cells. Vitamin A ensures these receptors work properly and that you can have a healthy supply of first responders.

No Vitamin A, no communic”A”tion!

Regulation of inflammation

We think of inflammation as a bad thing, but that is far from the case. Without inflammation our species would not endure the legion of different environmental insults we encounter daily, including that of viruses and other pathogens. Inflammation is part and parcel of the process of eliminating bad guys.

Where inflammation becomes a problem is when it is poorly controlled. We want very specific coordinates for our immune system’s weaponry and communication mechanisms in place to call off the assault. Our bodies produce white blood cells called T-cells that orchestrate the inflammatory cascades in our bodies. Vitamin A is a factor needed for the differentiation of these T-cells into what are called T-regulatory cells. These T-regulatory cells put the brakes on the assault, keeping inflammation from running uncontrolled.

You have probably read about the cytokine storm that is spoken of in CoVID-19. T regulatory cells are a key component of minimizing the probability of cytokine storm and severe respiratory outcomes.

Eat your Vitamin A and increase the probability you will be okAy! Regulate your Inflamm”A”tion!

How to get enough Vitamin A

A large fraction of Americans DO NOT eat enough Vitamin A dense foods!

Below is data from a study published by the American College of Nutrition in 2015. You can see that many Americans may not be meeting their need of nutrients crucial for immune function!

It is always best to get our nutrients from food. Supplements are a great way too, but you want to make sure you have a discussion with your rheumatologist or naturopath before starting any new supplements. Taking large amounts of vitamins or minerals can cause imbalances in other nutrients.

Adults require around 5000 to 6300 micrograms per week.

Want a pro tip? A single 68-gram slice of liver once per week will give you all the Vitamin A you need. That is slightly less than the size of a deck of cards! Let’s be real here, though. Liver is not very patable. Or is it? See a neat recipe here

Other great sources of Vitamin A in amounts that will help you hit the aforementioned weekly target.

To simplify, you could easily meet your need adding a 1-2 servings of the foods above on a daily basis. Bonus points if you want to eat a little liver.

If you would like assistance constructing a dietary program to meet all of your needs you can schedule an appointment with our Naturopath!

Agarwal, Sanjiv, et al. “Comparison of prevalence of inadequate nutrient intake based on body weight status of adults in the United States: an analysis of NHANES 2001–2008.” Journal of the American College of Nutrition 34.2 (2015): 126-134