Coronavirus Chronicles — COVID-19 and Kids, More to the Story

We were discussing how medical professionals turn to social media to report their own observations and consult their colleagues about current developments.

Emily Porter, M.D. (@dremilyportermd) tweeted that her five-year-old caught the virus at school in December and transmitted it to the entire family of six. Gastroenterologist Tom Wallach (@md_wallach) noted via Twitter that “90% of my consults this last week on service were for complications of pediatric COVID. ” Conversations with pediatricians all over the country convinced him that his experience was widely shared, and “there’s some interesting and complicated pathology going on here.” He also mentions, not surprisingly, that most of the children he has seen, in or out of a hospital, had not been vaccinated.

In the same thread, a grandmother/retired doctor wrote, “Omicron doesn’t seem at all “mild” for the pediatric crowd.” A civilian wrote that every baby she knows right now has COVID, and she knows “a ton of babies.” Even if not literally true, this speaks for the weight of sorrow and frustration that has come with the realization that yes, children can catch the virus — even infants.

Last week, Tom Perumean wrote for MSN.com that the “insidious” virus is causing serious damage, especially among children who are obese. He quotes Dr. Kyle Happel:

We do have pretty good evidence that COVID-19 virus itself can indeed infect fat cells. So individuals that have more adipose, or more fat tissue, are more likely to have a higher load of the virus in their body… And so, to sum it up, people who are obese are much more likely to experience severe inflammation, organ failure or blood clots.

He went on to speak about the extensive inflammatory response that COVID-19 usually elicits, which looks to be more harmful than the virus itself. The writer also quoted pediatrician Dr. Anthony Hudson:

There is a phenomenon associated with childhood obesity and the rates at which the lungs in the larger airways grow that essentially leads to air trapping in the lungs and again worsening prognosis of COVID-19 infection.

When authorities are deciding which children need to be hospitalized, obesity is a determinant, according to the Centers for Disease Control and Prevention.

An obese child is starting out with a disadvantage, because chances are they already have poor cardiovascular health and/or pre-existing lung dysfunction. Pamela Comme wrote about a report that covered children and teens with COVID-19 in six different hospitals, during July and August of 2021:

Of those who were admitted, 77.9% were hospitalized for acute COVID-19. Approximately two-thirds of those aged 12-17 years had obesity.

If a child has already shown diabetes symptoms, those will probably get worse too. Kids under 18 with COVID have a higher likelihood of receiving a new diabetes diagnosis than those who have not caught the virus.

Your responses and feedback are welcome!

Source: Tom Wallach, M.D., Twitter, 01/22/22
Source: “Obesity and COVID, a bad mix,” MSN.com, 01/17/22
Source: “Obesity increases the risk of COVID-19 complications in children, report shows,” KVUE.com, 01/15/22
Source: “Risk for Newly Diagnosed Diabetes…,” CDC.gov, 01/14 /22
Image by Véronique Debord-Lazaro/CC BY-SA 2.0

Coronavirus Chronicles — Body Weight and Body Fat

Obesity and the coronavirus make things easier for each other, and harder for the rest of us. The two harmful conditions could not keep their relationship discreet forever. More and more experts are noticing how relentlessly they work together. It is very clear, they are friends with benefits only for each other, and pain for everybody else.

Forty percent of Americans are said to be obese. Obese people are more apt to catch COVID-19, more likely to get very sick, and more likely to die from it. In countries where most of the adults are overweight, the death rate is 10 times higher than in slimmer countries. The adults who face these odds are yesterday’s obese children. Today’s obese children are tomorrow’s obese adults.

Speaking of which, we are told by the American Medical Association that “Overweight or obesity increased among 5- through 11-year-olds from 36.2% to 45.7% during the pandemic.” One school of thought holds that the government has been wrong to close parks, gyms, schools, and other locations where people should be able to exercise and burn calories to avoid obesity. There seems to be some room for nuance. Why not keep a park open, if people stay far away from each other? On the other hand, a gym could so easily be the perfect environment for spreading COVID.

Reprieve?

Still, there is hope. According to Steven Nissen, M.D., senior author of a paper explaining recent Cleveland Clinic research,

Striking findings from the current study support the reversibility of the health consequences of obesity in the patients with COVID-19. This study suggests that an emphasis on weight loss as a public health strategy can improve outcomes during the COVID-19 pandemic and future outbreaks or related infectious diseases.

Specifically, a group of obese patients who had already lost weight through bariatric surgery had a 60% lower risk of developing severe COVID-19 complications. So yes, excessive body weight is a modifiable risk factor. But surgery is expensive, with a long and arduous qualifying process. Most people with the ability to lose weight through bariatric surgery have probably already tried it, or at least looked into it. When it comes to 40% of the population, surgical intervention is not a likely solution.

What else is there? One Boston obesity clinic’s waiting list has more than 1,000 names on it, most of them added since the pandemic began. A lot of people have, in the words of Dr. Fatima Cody Stanford, “really made that connection between obesity and COVID and the need for them to get appropriate care.” Where and how do they procure such care? Those are difficult questions.

News about news

Recently a news network tweeted something about the proven link between obesity and COVID-19, and fellow media experts took the opportunity to get all snarky, pointing out that the “new” studies they cited had actually been around for a while. (August 2020, February 2021, and April 2021). This is the kind of nonsense that adult professionals engage in while millions suffer and die.

Your responses and feedback are welcome!

Source: “Substantial weight loss can reduce risk of severe COVID-19 complications,” MedicalXpress.com, 12/29/21
Source: “Can losing weight help protect you against COVID-19?,” WTAE.com, 01/03/22
Source: “Critics rip CNN over late tweet linking obesity to serious COVID cases, death: ‘Where have you been?’ ‘Thanks for catching up’,” FoxNews.com. 01/03/22
Image by Nik Anderson/CC BY 2.0

Coronavirus Chronicles — The Clues Add Up

Thanks to the news and especially to social media, plenty of people are now aware of the connection between COVID-19 and obesity. Sadly, for most obese people, it is far too late to take effective action. They either already caught the virus, or carry too many pounds to do anything useful about prevention at this point.

Sure, we can use an official-sounding phrase and call fat a “modifiable risk factor,” but fancy language is of no practical value. It’s not as if a person can just make an executive decision, “Hey, I’m gonna drop 50 pounds,” and magically make it happen. If weight loss were that easy, wouldn’t people — because of the other health hazards associated with overweight, or because of basic human vanity — have slimmed down already?

Where this information really comes in handy is in the realm of childhood obesity. The time to prevent obesity is now, because it looks like the virus is likely to be around for a while. Now is the time to prevent children from becoming the plump, tasty morsels of victimhood that the SARS-CoV-2 organism enjoys so much.

Vitro and vivo

Inevitably, an enormous amount of medical knowledge is couched in Latin which, although people do not actually speak it anymore, is a quite valuable language for the accuracy it makes possible. “In vitro” is an inclusive phrase for reactions that take place within a glass test tube or petri dish or, by extension, at other sites outside the body. “In vivo” refers to a scientific test, experiment, or procedure that takes place within the actual living body of a lab animal or a human.

Inflammation of adipose tissue

The website known as bioRxiv is a “preprint server,” meaning it publishes reports that have not yet been formally peer-reviewed, or printed by one of the venerable journals of record. Nevertheless, scientists and scholars are intensely interested in information that emerges via this route.

Less than three months ago, such a report was introduced by this one-sentence summary:

Our work provides the first in vivo evidence of SARS-CoV-2 infection in human adipose tissue and describes the associated inflammation.

Even though not yet peer-reviewed or officially, capital-P published, this is big news. It is not just a coincidence, or the product of some over-active imaginations, that obese people catch the coronavirus more easily and suffer more acutely from its depredations. Something is definitely going on. One sign, as the authors state, is that…

[O]besity is a risk factor even in young adults and children who do not have other comorbid conditions.

Other studies had already abundantly demonstrated that coronavirus RNA could be found in victims’ lung, brain, intestine, pancreas, and other types of tissue. But what about body fat? The exciting discovery was:

We harvested adipose tissue from multiple depots in uninfected obese humans for in vitro infection and obtained autopsy specimens of various adipose depots in individuals who died from COVID-19. Our results clearly show SARS-CoV-2 infection in macrophages and adipocytes from multiple adipose depots, with an attendant increase in inflammatory profile.

As the writer of a subsequent commentary phrased it, “These cells act like velcro for COVID-19.” Anti-government theorizers and anti-traditional medicine enthusiasts greeted this news with joy, taking the occasion to print such scolding words as:

Of course, you already know that the authorities have said virtually nothing about dietary and lifestyle interventions, like weight loss, metabolic health and vitamin D status.

This snarky claim is difficult to reconcile with the fact that the eight-year Obama presidency was famous for the First Lady’s efforts to prevent kids from getting fat. At any rate, the new research suggests that within fat tissue, the virus can hide and multiply undetected and unchallenged. To bring the point home, that author quoted Johns Hopkins professor Dr. David Kass:

If you really are very obese, fat is the biggest single organ in your body.

Your responses and feedback are welcome!

Source: “SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19,” bioRxiv.org,10/25/21
Source: “These cells act like velcro for COVID-19,” GrasslandBeef.com, 12/22/21
Image by Jernej Furman/CC BY 2.0

Coronavirus Chronicles — COVID-19 and Careers

Not long ago, in India, screen star Rubina Dilaik began to receive hate mail for gaining around seven kilos, which amounts to, for heaven’s sake, only about 15 pounds. Plus, she had a good reason — she had recovered from COVID-19 and decided to treat her body gently for a while. But rather than express gratitude that the actress’s life had been spared, some of her alleged fans got all blamey and judgy. Via social media, she replied, in part…

You are relentlessly sending hate mails and messages , you don’t see my worth… you are threatening to leave fandoms coz I am fat now… Well , I am indeed disappointed that, FOR YOU, my physical appearance is far more important than my talent and my commitment to my work…

“Long covid is destroying careers…,” read a Washington Post headline last month, as journalist Christopher Rowland published a detailed profile of long-haul COVID patient Tiffany Patino, who had been ill for a year. She, her boyfriend, and their 14-month-old child had been living rent-free in a relative’s basement, saving up for their own place, and maybe even for a better car. But now, at age 28, she finds a walk to the playground unbelievably taxing, and going back to work is a distant dream. The reporter describes her as “exhausted, racked with pain, short of breath, forgetful, bloated, swollen, depressed.”

Rowland’s research showed that many Americans have what can fairly be called long-haul COVID, with a percentage of the victims “experiencing such unbearable fatigue and other maladies that they can’t work, forcing them to drop out of the workforce, abandon careers and rack up huge debts.” As Patino said, “My world shattered, and everything just came crumbling down.”

Help is not easily available to these victims of a “newly emerging chronic disease that has no established diagnostic or treatment plan.” If they were not already suffering from the general pandemic conditions, coming down with the disease, and being unable to shake off its effects, has definitely brought depression and anxiety into their lives. Rowland writes,

Insurers are denying coverage for some tests, the public disability system is hesitant to approve many claims, and even people with long-term disability insurance say they are struggling to get benefits. Often referred to as “long haulers,” they experience mild symptoms to begin with, then get stuck with months of chronic fatigue, shortness of breath, confusion and memory loss, erratic and racing heartbeats, radical spikes in blood pressure, painful rashes, shooting pains, and gastrointestinal problems.

The symptoms sometimes subside, lulling long haulers into a false sense of relief, only to come roaring back after performing simple chores like vacuuming a living room or raking leaves.

The victims are not just people with low-income service jobs. Rowland interviewed 64-year-old emergency medicine physician John Buccellato, who rapidly went from treating patients in Manhattan to experiencing profound disability and helplessness. He told the reporter that not only had the virus had taken his career, but he could no longer pay to park his car in a garage, or even keep up his medical insurance. This is what happened to the doctor:

A lawyer helped him file a disability claim with the Social Security Administration, which a member of his support team said was recently successful. Because he left work for medical reasons, he was not eligible for unemployment insurance.

Rowland interviewed a Baltimore teacher who “has blown through $12,000 in savings and is on food stamps.” She too was planning to apply for disability. But both the government and private insurers have been slow on the uptake, says the reporter:

[M]any patients applying for disability insurance benefits are initially denied and require lengthy appeals, according to patients, doctors and lawyers, in part because the medical community is still grappling with how to diagnose their symptoms.

Your responses and feedback are welcome!

Source: “Rubina Dilaik trolled for gaining weight,” IndiaTimes.com, 11/24/21
Source: “Long covid is destroying careers, leaving economic distress in its wake,” WashingtonPost.com, 12/09/21
Image by Michael 1952/CC BY 2.0