Pat Hartman | Childhood Obesity News

Coronavirus Chronicles — The Research Realms

Pat Hartman June 8, 2020 2 Comments

The whole peer review process is in disarray because of the need for additional experts to look at which scholarly articles will achieve publication. A process that customarily has taken months has been accelerated as much as possible, congruent with preserving accuracy and the highest professional standards. Meanwhile, we face the sad truth: Relative to how much there is to know about COVID-19, very little is known.

Experts are needed, who are qualified to vet all the new research. Where can they be found? In their labs and offices, doing their own work, which qualifies them as competent authorities. Possibly their schedules are already filled by promises to study and comment on some of the thousands of other research papers currently being generated.

But first, why is Childhood Obesity News even concerned with this topic? What discoveries have already made an impact?

1. The earlier in a human life obesity begins, and the longer obesity holds sway over that life, the more difficult it will eventually be to dislodge. Obese kids grow up to be obese adults, more and more of them every year.

2. Obese children are more likely than others to catch COVID-19. When they do, treating them is more difficult for logistical reasons, and their hospital experiences are more miserable.

3. Apparently, once the disease gets into the body, it aims straight for the fat cells as if they were five-star hotels. The virus loves fat cells, and fat cells seem to love the virus.

Writer Nicholas Feenie says,

[…] obesity compromises the immune system and its ability to fight viral respiratory infections.

4. And now, medical institutions are treating Pediatric Multi-system Inflammatory Syndrome, or PMIS, a horrible thing children get, that seems to be related to the coronavirus.

For Contemporary Health, Feenie refreshed readers’ memories with the information that the COVID-19 risk factors are advanced age, maleness, obesity, hypertension, heart disease, Type 2 diabetes, and respiratory diseases. There is mechanical obstruction. Feenie writes,

Individuals with obesity often have respiratory dysfunction due to the presence of large fat deposits around the chest and upper abdomen. This is characterised by altered respiratory mechanisms, increased airway resistance, impaired gas exchange and low lung volume and muscle strength. As a result, obesity increases the risk of contracting respiratory tract infections including influenza and pneumonia.

Also, the immune system, to put it non-technically, goes haywire, and the Natural Killer cells lose their mojo. Next thing you know, there is a cytokine storm.

In other words,

The low-grade, chronic inflammation caused by excess visceral adipose tissue surrounding vital organs in the abdominal cavity, which is implicated in cardiometabolic complications of obesity, has also been highlighted as a possible cause of the over-exaggerated immune response seen in many Covid-19 fatalities.

Not only do fat cells lay down the virtual “Welcome” mat at the door, they apparently offer the invaders free storage space:

It has also been suggested that visceral adipose tissue may act as a ‘reservoir’ for Covid-19. [I]t is feasible the virus could infect visceral adipose tissue which then becomes a reservoir for more extensive viral spread, increased viral shedding, immune activation, cytokine amplification and systemic tissue damage…

Your responses and feedback are welcome!

Source: “Covid-19: One of the many Obesity related co-morbidities?,” ContemporaryHealth.co.uk, 05/15/20
Image by Randy Cline via Flickr

Coronavirus Chronicles — Cross-Addiction Creep

Pat Hartman June 5, 2020 No Comments

Impacted by food shortages and isolation, some people who suffer from eating disorders have been pushed out of their comfort zones and forced to adopt new displacement behaviors as vessels for their anxiety. This begins to encroach on territory we have examined before, namely, cross-addiction.

Some addictions pertain to substances, like nicotine and cocaine and (in the patients’ own estimation, anyway) certain types of food. Sugar is a notorious one, with thousands of people who are certain that its grip on them is the same disease that enslaves any heroin-hooked junkie.

Some eating disorders, like binge eating and purging, are more on the behavioral addiction side than the substance addiction side. Many eating disorders come into being because something else has been expunged: namely, an addiction to nicotine, alcohol, or some other drug.

Six of one, half a dozen of the other

Cross-addiction is also called addiction transfer, and could logically be called omni-addiction or any-addiction, because the person’s life circumstances play a larger role than the particular substance or behavior. As some experienced problem users have expressed, addiction is determined by personality and opportunity, and by the escape hatch they happened to be exposed to at the vulnerable time, a.k.a. “whatever got there first.”

Addiction is tolerant and adaptable. It is willing to cooperate and welcome in something else to fill the hole left by shedding a different addiction. This is why isolation can be so dangerous. After healing from an eating disorder, it is very easy for a person to pick up a new problem. Conversely, in straitened circumstances where another dependency is thwarted, an eating disorder can step in.

At any give time, it is estimated that substance use disorder affects around 20 million Americans while, astonishingly, almost half that many have a serious gambling problem. Journalist Adrian Bonenberger notes, “there is almost certainly some overlap.” In the days of coronavirus, that modest assessment has assumed ominous overtones. In discussing the possible consequences of the pandemic, Bonenberger points out that the closure of physical casinos, racetracks, and other gambling venues have led to “problematic video gaming” and Internet-enabled gambling addiction.

Dr. Brian Fuehrlein, a psychiatrist who works for the Veterans Administration, sees a worrying trend. Either spooked by the very real possibility of catching COVID-19, or relieved to discover a convenient excuse, many people who had been on track, heading for inpatient substance abuse treatment, have decided to stay home instead. Dr. Fuehrlein says,

A quarantine, particularly at home, may lead to bingeing on video games, alcohol, or drugs… It could also lead to a relapse for those who had been doing well previously. Second, those who may have been considering coming to treatment now may suddenly be hesitant given possible exposure to the virus in a hospital or treatment setting and have decided to delay getting help.

Of course, the same can be said for people who had been on the verge of committing to residential programs to treat eating disorders, or who had planned bariatric surgery, or who had almost decided to seek help from recovery networks. A hooked person needs treatment specifically designed for hooked people. This is why the alcohol 12-step program has been so widely adapted to other disorders.

Meanwhile, to take advantage of virtual resources, any person who is struggling with this issue is urged to call the National Eating Disorders Association Helpline at (800) 931-2237.

Your responses and feedback are welcome!

Source: “Falling Through the Cracks in Quarantine,” Yale.edu, 03/21/20
Image by pixishared/CC BY-SA 2.0

Coronavirus Chronicles — It’s Hard to Maintain

Pat Hartman June 4, 2020 No Comments

Nobody knows yet how this crisis is going to play out. But we do know a few things about human nature. One of them is that in a fraught situation, a person will grab for a solution that “worked” in the past — even if that “working” represented the epitome of dysfunction. As Dr. Lauren Muhlheim more elegantly phrases the concept,

During times of stress, people automatically tend to revert to their past coping strategies. For those with eating disorders, these often include eating disorder behaviors.

For instance, people will stock up on food, which in these times is not a totally irrational response. But confronted with skimpily-stocked grocery shelves, they might easily cross the line into extreme acquisition mode and become capital-H Hoarders. And then, with the home cupboards bursting and the coronavirus headlines ratcheting up the tension, it might make a lot of sense to go ahead and eat the food. Because what if you die next week? It would be really irresponsible to let all those good provisions to go to waste.

A certain number of problem eaters have found a way to prevent themselves from going off the deep end. That methodology involved making peace with an adequate but narrow range of foods. But nowadays, people cannot always get the specific food items they want and/or need, or believe they need. The unavailability of those acceptable items could be a dangerous trigger. It might sound farfetched, but as professionals know, no two patients have the exact same eating disorder, down to the last detail.

Snares are everywhere

In the course of struggling with food issues, someone who never before experienced an alcohol or drug problem could develop one. Conversely, someone who spends every ounce of mental and emotional energy to deal with a longstanding alcohol or drug problem could now face a blossoming eating disorder.

A lot of people’s exercise opportunities have been curtailed, and for many of them, that translates to an acute sense of deprivation. Even if weight control is not the primary objective of regular exercise, an awful lot of folks depend on it for mood adjustment and a general sense of accomplishment and well-being. Journalist Gabby Landsverk spoke with Melainie Rogers, executive director of Balance Eating Disorder Treatment Center:

Rogers said potential warnings signs of excessive anxiety include irritability, feelings of being overwhelmed, or constant feelings of being on the verge of tears.

“Try to objectively gauge what’s going on in your thoughts, if you’re having obsessive thoughts about weight, food, exercise,” she said. “If you’re weighing yourself more frequently, for example, that can be a barometer of your internal state.”

Your responses and feedback are welcome!

Source: “Eating Disorders During the Coronavirus (COVID-19) Pandemic,” VeryWellMind.com, 03/30/20
Image by Isaac Mao/CC BY 2.0

Coronavirus Chronicles — Displacement Is Substitution

Pat Hartman June 3, 2020 2 Comments

In the literature associated with the W8Loss2Go smartphone app, Dr. Pretlow says:

The brain tends to glom onto any behavior that relieves stress, in this case eating, and this becomes a behavioral addiction. Nervous eating involves the mechanical actions of eating — biting, chewing, crunching, hand-to-mouth motion, and especially swallowing.

Displacement activity occurs in many forms, of which eating is one. But what happens when there just isn’t any food? What happens when the substance that fuels the obsession, i.e. food, is simply not available?

When the pantry shelves are empty, we can fill them, symbolically, with displacement activity and/or and cross-addiction (to be discussed.) When we can’t fight or flee, or muster up any number of decreasingly likely courses of action, we go for a substitute. As Dr. Pretlow wrote in “Displacement Activity” (April 2019),

Displacement activity is an innate, hard-wired, instinctual, automatic biobehavioral mechanism… Displacement activity is rechanneling of overflow energy from conflicted or thwarted drives into another drive.

Some examples enumerated by Dr. Pretlow include fingernail biting, skin picking, hair pulling, and even sleep, which is the least harmful possibility. In movies and TV shows, a familiar Old West trope is the fellow chewing on a twig, toothpick, matchstick, pipestem, or stalk of grass. Who knows? Twig chewing might become popular again.

Exercise is a favorite displacement activity, especially among people who frankly admit that without strenuous physical workouts to take the edge off they might physically assault their fellow citizens.

Precarious mental states

Doctors from the Henry Ford Health System have warned that if a patient shows up with the coronavirus and an altered mental status, it could be Covid-19-associated acute necrotizing hemorrhagic encephalopathy. In other words, the virus can attack the brain and nervous system. Speaking from another institution, the Baylor College of Medicine, Dr. Chethan Rao explained that while the lungs harbor the most cells likely to be affected,

The cells with the right receptors for SARS-CoV-2 […] are also found in blood vessels in the blood-brain barrier and in nerve endings.

In other bad news, related by D. A. Kirk,

In Walnut Creek, California, one doctor at John Muir Medical Center recently told local news station ABC7 Eyewitness News that his facility had “seen a year’s worth of suicide attempts in the last four weeks,” and mental health experts have expressed concerns that the situation could become much worse.

Your responses and feedback are welcome!

Source: “Coronavirus Might Attack the Brain, Too,” Medium.com, 04/08/20
Source: “An Open Letter to Every American Who Doesn’t Want to Wear a Mask,” Medium.com, 05/25/20
Image by Sustainable Economies/CC BY-SA 2.0

Coronavirus Chronicles — People Still Confined and Troubled

Pat Hartman June 2, 2020 No Comments

Wouldn’t it be great to stop dwelling on COVID-19? But with the caseload in the United States growing by more than 20,000 per day, maybe it is not yet time to drop the subject. Recent events have brought people outside and into extensive contact, and there is a very real fear that the coronavirus numbers, in the next couple of weeks, might rise astronomically. Americans might start voluntarily staying at home again. Governmental edicts might make that a non-voluntary option.

Meanwhile, people are trapped in their individual hells, ranging from exhausting boredom to a constant dread of domestic violence. Maybe a person just has one semester of college in their history, and now must live back in the place that no longer feels like home and perhaps never did. Maybe they struggled for months or years to finally be able to move out, and then lost a job or a game of birth-control roulette. Or maybe a pandemic came along.

At any rate, plans had to change, and now they are in the proverbial “Mom’s basement.” Whatever stresses a person hoped to escape by leaving the ancestral home are now facts of life.

The Emily Program is a University of Minnesota Medical School Affiliate program that offers recovery support in the form of residential and outpatient treatment modalities. Their page describes the dilemma of moving back home:

Perhaps it’s the environment where you first engaged in disordered behaviors, a place that stirs up tangled memories or old family dynamics. And for those who typically protect their recovery by leaving the house, finding space from the fridge and pantry and private bathrooms, it may be unbelievably triggering.

Missing graduation, whether from 6th grade or college, is very disturbing. Older kids had exciting vacation plans, or their first summer job lined up. A very large number of kids have had the rug pulled out from under them in a major way. Almost overnight, we arrived in a radically disordered reality — literally a whole different world, because there is not a country on earth unaffected by this insatiable virus. Even animals in zoos have caught it.

The pitiless math

Of the problems engendered by the pandemic, some affect only a small number of people. The children who, at any given time, would have comprised the clients of residential treatment centers, are relatively few. But they are missing out on the opportunity of a lifetime. Likewise, not that many children and teens suffer from severe obsessive-compulsive disorder.

“Contamination OCD” is a particular brand of malaise that can only be worsened by an epidemic where everyone is encouraged to practice a lifestyle that is usually considered aberrant. Described by D. A. Kirk, it is…

[…] a type of OCD that compels you to do everything you can to avoid exposing not just yourself, but also the people you love, to germs, viruses, and bacteria.

I wore gloves as often as possible, refused to shake hands with coworkers and strangers alike, and carried a bottle of hand sanitizer everywhere I went. I did everything humanly possible to eliminate physical contact not just with other people, but with any object that someone else had already touched or would need to touch in the near future…

The point is, all the relatively rare cases, the singular cases, add up. And as the Emily Program, states, no two people have quite the same eating disorder. There are a thousand ways to suffer, and a thousand ways to cope — most of them detrimental. Displacement behaviors are available in quite a few forms, that subject will be discussed next.

Your responses and feedback are welcome!

Source: “Advice for those struggling with an eating disorder during COVID-19,” EmilyProgram.com, 03/26/20
Source: “An Open Letter to Every American Who Doesn’t Want to Wear a Mask,” Medium.com, 05/25/20
Image by George Ian Bowles

Coronavirus Chronicles — Stuck at Home Inside Your Head

Pat Hartman June 1, 2020 No Comments

We saw how a person’s eating disorder will take advantage of the current unrest, and seize every opportunity to barge back into their life and create havoc. For many people, their eating disorder functions just like an addiction to alcohol, hard drugs, or gambling. No matter how threatening it might be to their ability to maintain income, relationships, or even life, the addictor comes out on top.

In any week of the year, a certain number of people are released from inpatient rehabilitation facilities. Those who have been released in the past couple of months are turned loose in a world that is even less ready than usual to support them. Marion Renault, writing on “The Heartbreaking Struggle to Stay Sober Under Lockdown,” quotes a man who says, “I’m more afraid of a relapse right now than I am of coronavirus.”

Although an addictive relationship to food might not cause bad consequences as immediate and dramatic as alcoholism, it is a killer nonetheless, and deserves to be taken seriously. A contemporary comedian (apologies for not making a note of this entertainer’s name) has a joke that goes approximately this: “I just don’t get the concept of an intervention. Why would I want to sit down and listen to the same people who caused me to start drinking in the first place?”

Why indeed? But with a deadly disease raging outside, vulnerable people are trapped inside with company that is very harmful to their mental health and sobriety.

Not recommended

For someone struggling against substance abuse isolation and boredom are very hazardous conditions. By picking up their old, destructive habits, addicts are apt to feel a totally illusory and deceptive sense of control, which is an irrational paradox and an example of stinkin’ thinkin’.

In the recovery world, face-to-face support is the gold standard. Belief in the efficacy of 12-step meetings is so strong, judges order people to attend X number of meetings within Y amount of time or else go to jail. And now, we are forbidden to gather in person. A sponsor who would normally be willing to answer a 2 AM call and get together for coffee and discussion is not supposed to do that any more. In the hard-drug realm, where people are required to show up in person to submit urine samples and collect their daily meds, extraordinary measures have needed to be instituted.

For many people, the potential for relapse is dangerously present, and all they have to hold onto is the tenuous connection of telemental health. As Renault writes,

Still, many of the new or modified options are unavailable to the most vulnerable populations with substance use disorder — those not in treatment, people experiencing homelessness, anyone in the estimated 18 million American households lacking high-speed internet at home or through a mobile phone.

When both patient and therapist are forced to be in close quarters with their own families, even if both parties have the correct equipment, neither has the complete expectation of privacy. After the disclosures from Edward Snowden and other whistleblowers, no one is able to rest easy in the belief that their phone calls or video conferences are confidential.

Avoiding the contagion is a matter of life or death — but so is recovery. And again, that is equally true for the people whose problem substance is food, and whose intractable habit is eating. A person whose problem is eating might not fall off a balcony or collapse with a needle protruding from the crook of their elbow, or wind up in the drunk tank at the local jail. The consequences may not be as obviously dramatic or cinematic, but they are just as seriously real.

Your responses and feedback are welcome!

Source: “The Heartbreaking Struggle to Stay Sober Under Lockdown,” Medium.com, 04/19/20
Image by Penn Libraries/CC BY 2.0

Coronavirus Chronicles — The Curse of Uncertainty

Pat Hartman May 29, 2020 3 Comments

Rightly or wrongly, like it or not, Americans feel free to choose the degree of isolation they are willing to endure — ranging from totally staying at home, to flouting every suggestion about how to stop the virus from spreading, and even deliberately coughing on the food in stores, and on other people. On May 26, the U.S. reported almost 2,000 more cases of COVID-19 than the previous day’s total.

Some adults can afford to opt for the maximum degree of self-quarantine, and it suits them perfectly. It might be their long-awaited opportunity to read a stack of books, or to write one. But when children are involved, staying home can be a nightmare. One aspect of that dystopia is the extra burden imposed in adults who must not only manage their own neuroses and disorders, but strive to avoid handing down the weirdness to any children under their care.

It is a truism that a person can tolerate just about anything, if they know how long it will last. But we just don’t know the end point. It’s time to co-opt an expression that meant something different to mystics in the Middle Ages, because the phrase is perfect to describe the situation that responsible adults find themselves in today. We have entered the cloud of unknowing.

The cloud of unknowing

For how long do we need to stretch these paltry dollars in the savings account? Will there ever be another job? Aunt Phoebe arrived for an unannounced visit, and while we may be able, just barely, to put up with her for a week, what if strict new public-safety rules are passed, and she can’t rent a car or get on a plane, and we’re stuck with her indefinitely? Teaching the kids at home was doable for a couple of months, but what if schools can’t reopen in the fall? Will it be possible to address the math requirements while avoiding an actual murder? How long can the stash of canned goods in the pantry be made to last?

The rationalization of rationing

In one respect, it is more stressful to have a small stockpile that must suffice for an unknown period than to literally be out of food. If you’re down to a bowl of rice per day, and beans every other day, and the kids know there are still several cans of beans left, how do you stick to rationing? There is a temptation to throw caution to the winds and just eat everything. Bring on the worst-case scenario. Because then, at least, you know the score.

An uncredited writer for The Emily Program, whose mission is recovery support, points out that while no two people have quite the same eating disorder (ED), they all have certain things in common.

The master manipulator it is, your eating disorder can mold any situation into a reason to use ED behaviors. Your disorder may be using this opportunity to elbow its way back into your life. Capitalizing on uncertainty and fear is its signature trick, one it does insidiously and incessantly.

These are some of the things that a person’s eating disorder is apt to whisper into a vulnerable ear:

“No school, no work? Well, this quarantine is your chance to lose weight!”
“Soon there will be no food left. You better eat all of this now. . .”
“You know, no one will blame you for relapsing during this.”
“Look around — I’m the only one here when things get rough.”
“This is a hard time. No big deal if you restrict, binge, or purge. Why don’t you ‘relax’ for a bit? You can get back to recovery once this thing passes over.”

Journalist Gabby Landsverk obtained this quotation from licensed clinical social worker and body image therapist Sarah Herstich:

This is uncharted territory for all of us. If people find themselves restricting, hoarding, or bingeing, my hope is that they don’t judge themselves, but they ask themselves what they might need to care for themselves.

Landsverk emphasizes the importance of staying in touch with friends, family, and if necessary, medical professionals:

The National Eating Disorder Association (NEDA) offers many resources for people to connect with virtual support, as well as a map of treatment centers across the US. Many dietitians are now offering meal support, chats, and support groups online via live streaming or other virtual platforms. National Eating Disorders Association Helpline is (800) 931-2237.

Your responses and feedback are welcome!

Source: “Advice for those struggling with an eating disorder during COVID-19,” EmilyProgram.com, 03/26/20
Source: “Coronavirus anxiety and quarantining could increase eating disorder risk. Here’s what to look out for,” Insider.com, 03/23/20
Image by Alan Levine

Coronavirus Chronicles — ICU, Where No One Wants to Be Seen

Pat Hartman May 28, 2020 No Comments

Where COVID-19 is concerned, obesity, as we have been discussing, is a huge risk factor for both adults and children. And staying home to avoid the illness is a huge risk factor for obesity. They feed off each other in a devastating partnership.

There are other interesting factoids (trivia would certainly be an inappropriate word) about the sickness to know. For example, no matter how much a patient suffers, if the blood levels can be maintained without supplemental oxygen, the case is officially categorized as “mild.”

Onward, now, to the science-fictional environment where a person least wants to be. It looks like an alien abduction scenario. A 2012 study concentrated on the Intensive Care Units of 106 American hospitals, some with multiple ICUs, bringing the total to 156 units in all. But wait until you hear the number of patient records that were studied — almost 200,000.

The specific object of the quest was ICU recidivism. In other words, how many of those patients were not ready to be released, and had to return to the ICU? The number at that time was about 4% returnees, within an arbitrarily designated five days after discharge. In other words, after five days, a necessary readmission would be considered a separate incident, not a continuation of the first incident. We will see why such a detail matters.

A very significant digression

Just imagine a world where all middle-school students took a class in how to read a scientific study. Those reports are all organized the same way, and there is a method to extracting the pertinent information. Sadly, journalists often don’t. They skip over the parts they don’t care for, or put too much stress on the part they do like, and have a tendency to ignore the caveats that the researchers prudently included. Consequently, segments of the news-consuming public get strange ideas.

Also, journalists, and people with particular agendas, might do the equivalent of comparing apples to oranges. Looking at any pair or group of studies, the meta-analyst has to be really scrupulous about making sure the details match up. Say there’s another study, from Britain perhaps, of neonatal ICU facilities and how many babies are released when they are not quite ready. And those researchers define a medically dangerous release as seven days. So, already, two factors are different.

When researchers set out to do a meta-study employing data from many different studies, as a preliminary step they have to comb through the available material carefully, and probably reject a good many papers, unable to line up enough methodological similarities to validate the drawing of any conclusions.

So what?

Opinions about COVID-19 are very contentious, partly for this same reason. People compare studies that really should not be linked for informational purposes; or latch onto the title and disregard the fine print. The reluctance or inability to understand a research paper can lead to a perception that scientists are a bunch of bumbling idiots, or worse yet, that ordinary people are being lied to.

Sometimes, to learn what is really going on takes a lot of drilling down. Research typically finds not a slam-bang answer, but an incremental one, revealed over time in a frustrating dance of seven veils. In Coronavirus Land, patients who make it to the ICU typically stay hospitalized for a few weeks. This is not optimal, because practitioners need answers now. Here is a sad detail of that 2012 study:

Readmitted patients had a much higher mortality (20.7%) than first-time ICU admissions (3.7%).

The massive outbreak in the Lombardy region of Italy led to tracking of patients admitted between late February and late March. Out of 1,300 people, 1,287 (or almost all of them) needed respiratory support (intubation: 88%; non-invasive ventilation: 11%). The ICU mortality rate was 26%, or just over one-fourth.

This paragraph of a multi-author study give a sense of the limitations faced by researchers:

First, this was a retrospective study, and data were acquired via telephone. Second, the critical nature of the Lombardy situation did not allow the coordinator to obtain more detailed information, such as baseline medication use. Third, the follow-up time is still relatively short compared with the course of the disease, and the reported mortality data and length of stay data reported in this study could change. Fourth, there were relatively large amounts of missing data for some outcomes.

Because the problem is new and ongoing, most coronavirus studies are very small and necessarily inconclusive. The question of a one-year survival rate, for example, is not even broached because a year ago, nobody had the disease. In one small Seattle study, half the patients died without ever leaving the ICU. Journalist Aylin Woodward mentions another Washington State study of 21 coronavirus patients in ICU (17 of them on mechanical ventilation) where 67% died, and when the study ended 24% were still critically ill, and only two individuals had been discharged.

Your responses and feedback are welcome!

Source: “‘She’s Out of the ICU Now.’ ‘That’s a Relief, Isn’t It?”: The Growing Problem of ICU Recidivism,” ATSJournals.org, 05/01/12
Source: “Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy,” JAMANetwork.com, 04/06/20
Source: “Boris Johnson is in intensive care with COVID-19,” BusinessInsider.com, 04/07/20
Image: Public Domain

Coronavirus Chronicles — Whatever It Is, It’s Not Over

Pat Hartman May 27, 2020 No Comments

COVID-19 is many things, but finished is not one of them. May 20 — only a few short days ago — was notable for chalking up the highest 1-day increase of cases, worldwide, since the pandemic started. The United States has a total of 1,141,371 currently active cases — or maybe 1,237,162, depending on which statistically-oriented website you visit. The experts at this particular site explain why:

States are currently reporting two fundamentally unlike statistics: current hospital/ICU admissions and cumulative hospitalizations/ICU admissions. Across the country, this reporting is also sparse. In short: it is impossible to assemble anything resembling the real statistics for hospitalizations, ICU admissions, or ventilator usage across the United States.

Even to keep tabs on the deaths is an incredibly time-consuming and convoluted process, as explained in excruciating detail by this Centers for Disease Control page. And testing? As it turns out, when testing is discussed, most people don’t have the faintest idea what they are talking about. They don’t know the difference between viral tests and antibody tests, or what each one means, or why it is crucial that the two be tallied separately.

They don’t understand why testing is not universally available, or how the accuracy of testing is assured (or not.). Any reader who wishes to become thoroughly depressed is invited to soak up the information about testing on this page.

Fumbling around in the dark

In other words, nobody seems to really have a handle on keeping the numbers current and complete, so they differ. Apparently, the U.S. has around 4,770 more cases today than yesterday, and they seem to increase by about 22,000 per week. Shamefully, our country has almost one-third of the worldwide total.

And yet, inexplicably, people are out there celebrating as if it’s all over — or, as some epidemiologists would have it, doing a bang-up job of setting up for the second wave. Experts have pointed out how ridiculous it is to even use that terminology, when we are still in the throes of the first wave.

Thanks to the hard science of analyzing virus mutations and the soft science of contact tracing, we learn more every day about how COVID-19 spreads among populations. Most people are incapable of understanding how quickly the numbers can multiply.

As Childhood Obesity News has mentioned, the terrible Navajo Nation outbreak occurred as the result of a local Patient Zero, who unknowingly brought the contagion from the nearest city to a rural church service. Many similar examples are available, of which journalist Ed Yong offers two:

[M]ost of New York’s cases likely stemmed from one introduction from Europe in mid-February. Most of Louisiana’s cases arose from just a couple of introductions from within the U.S.

This theme is expounded on by Derek Thompson, staff writer for The Atlantic, who points out quite vehemently that in enclosed spaces, even staying six feet away from each other doesn’t mean diddly-squat. A Japanese study shows that the indoor infection risk “is almost 19 times higher than in open-air environments.” He also names horrific examples:

Many of the largest super-spreader events took place inside — at a church in South Korea, an auditorium in France, a conference in Massachusetts… A Hong Kong paper awaiting peer review found that of 7,324 documented cases in China, only one outbreak occurred outside — during a conversation among several men in a small village.

Yong points out painful truths:

— Social distancing works only if people agree to sacrifice some personal freedom for the good of others.
— Even in the biggest hot spots, most people were not infected and remain susceptible.
— New infections can take weeks to manifest in regional statistics.
— Cities that thought the worst had passed may be hit anew.

Meanwhile, because of the enforced circumstances, children who were always normal weight are becoming overweight. Kids who were overweight are becoming obese. All else being equal, obese kids are more prone to get the coronavirus and more likely to have a very rough time of it.

Your responses and feedback are welcome!

Source: “The COVID Tracking Project,” CovidTracking.com, 05/25/20
Source: “America’s Patchwork Pandemic Is Fraying Even Further,” TheAtlantic.com, 05/20/20
Source: “Social Distancing Is Not Enough,” TheAtlantic.com, 05/22/20
Image by Bingxiong Chen/(CC BY 2.0)

Coronavirus Chronicles — Between a Rock and a Hard Place

Pat Hartman May 26, 2020 1 Comment

Associate Professor of Biology Erin S. Bromage reminds us that a single cough or sneeze from a COVID-19-infected person can contain 200 million virus particles, and explains the “virus x time formula” which is integral to contact tracing:

Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected. Anyone who shares a space with you (say an office) for an extended period is potentially infected.

Social distancing guidelines don’t hold in indoor spaces where you spend a lot of time, as people on the opposite side of the room were infected.

To call these times uncertain is to put it very, very mildly. Two days ago, ABC News published a photo from South Africa, in which hundreds of people are lined up to receive donated masks, sanitizer, and food. Although plenty of space is available in a large field, they are not socially distanced, and so will likely need all the personal protective equipment they can get. Also, in the Netherlands, cats are suspected of spreading the disease among the farmed mink.

Worldwide, May 20 marked the “highest 1-day increase since coronavirus outbreak began,” with 106,000 more cases than on the previous day. In some American states, the numbers of people who test positive, or are actually sick from COVID-19, are growing. Texas, Alabama and Florida are expected to become worse.

And yet, many states and cities are plunging boldly into what they hope will resemble normalization. The Washington Post says,

The CDC this week issued a detailed road map for reopening schools, child-care facilities, restaurants and mass transit. On Tuesday night, the agency issued additional guidance in the form of “health considerations” for summer camps, including overnight camps, and youth sports organizations and colleges.

It is reported that during the previous weekend, over 800,000 tourists socialized in Maryland and Virginia, having left closed areas like the suburbs of Washington, D.C. For these and other reasons, many people are expecting a “second wave.” Dr. Bromage says,

Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained. So throughout most of the country we are going to add fuel to the viral fire by reopening.

As if all this were not sufficiently distressing, a new horror has been unleashed, a condition similar in ways to both toxic shock syndrome and Kawasaki Disease, and it affects children. Pediatric multi-system inflammatory syndrome, or PMIS, seems to be related to COVID-19, although confirmation is elusive. The theory is, the child’s body does its best to make protective antibodies against the coronavirus, but goes too far, producing a potentially fatal inflammatory response.

Danger signs include…

[…] a high fever for no other apparent reason, and other symptoms such as red eyes, belly pain, a prickly heat rash all over the body, muscle aches, vomiting, or diarrhea…

Recommended: “Help Stop the Spread of COVID-19 in Children” guidelines by the CDC.

Your responses and feedback are welcome!

Source: “The Risks — Know Them — Avoid Them,” ErinBromage.com, 05/20/20
Source: “World sees highest 1-day increase since coronavirus outbreak began,” Go.com, 05/20/20
Source: “Experts warn of second coronavirus wave in Dallas, Houston, Alabama and parts of Florida,” WashingtonPost.com, 05/20/20
Source: “PMIS: Rare Inflammatory Syndrome Affecting Kids May Be Related to COVID-19,” YaleMedicine.org, 05/15/20
Image by Osseous/(CC BY 2.0)

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