PICTURE PERFECT
Joe Glenn was lucky enough to spot this beautiful deer while visiting Avalon Park & Preserve in his hometown of Stony Brook. While the park remains open to visitors, the entrance at the Stony Brook Grist Mill is now temporarily closed for renovations.
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By Daniel Dunaief
Halfway between where they grew up and their home in Stony Brook, Malcolm and Waveney Bowman had a choice to make: venture back northeast to New York, which was in the midst of a growing coronavirus crisis or return southwest to New Zealand, where the borders were quickly closing.
The couple chose New Zealand, where their extended family told them not to dare visit. The Do Not Enter sign wasn’t as inhospitable as it sounded.
Malcolm Bowman, a Distinguished Service Professor at Stony Brook University’s School of Marine and Atmospheric Sciences, recognized that he could continue to teach three courses from a great distance, even a camper on a small stretch of land in the northwest part of the Coromandel Peninsula in New Zealand.
“We could be anywhere on the planet,” Malcolm suggested to his wife. “Why don’t we see if we can set up camp?”
Climbing aboard the last plane out of Honolulu before New Zealand closed its borders, the Bowmans didn’t have much of a welcoming party when they arrived at the airport. Their family told them, “We love you, but you can’t come anywhere near us,” Malcolm recalled. “Coming from the states, you could be infected.”
If his family took the American couple in, they would have had to report the contact, which would have forced Waveney’s brother and his wife, Derek and Judy Olsson, into personal isolation for two weeks.
Derek filled the trunk of an old car with food and left the key under the front tire. The Stony Brook couple set up a temporary living space in two campers on a small piece of land in the middle of the night, where they have been living for over a month. All told, their 235 square feet of living space is about 12% of the size of their Long Island home.
The country has been in lockdown, where people are practicing social distancing and are limiting their non-essential outings.
Malcolm realized he had to “rise to the challenge” which, in his case, literally meant climbing out of his bed at all hours of the morning. New Zealand is 16 hours ahead of New York, which means that he had to be awake and coherent at 2 a.m. on Tuesday morning in New Zealand to teach a course that meets at 10 a.m. on Monday morning on Long Island.
With a cell tower up the hill behind their camper, the Bowmans could access the internet. While they had shelter, they still needed electricity. Fortunately, Malcolm’s brother Chris, who is an engineer, provided solar panels to generate electricity.
Living south of the equator means the Bowmans are heading into winter in New Zealand, where the days are shorter and the sun is lower in the sky, which makes the solar panels that provide electricity less effective. Malcolm describes the biggest challenges as the “time difference and mosquitoes.”
In a typical day, the professor rises at 4 a.m. or earlier local time to teach his classes, participate in online seminars, attend University Senate and other committee meetings, continue his research and take care of his students, all through Google Meet and Zoom. He co-teaches Physics for Environmental Studies, Contemporary Environmental Issues and Polices and Advanced Coastal Physical Oceanography.
Malcolm’s favorite part of the day occurs at sunrise, when the cloud formations over Mercury Bay serve as a canvas for the colorful red and orange rays of the sun that herald the start of another day down under.
He recognizes that he and his wife’s current indefinite time in New Zealand provides them with a comfortable connection to the land of his youth, where he can enjoy some of the beaches that have made the country famous and hear the sounds of flightless birds near his camper home.
Given the focus on work early in the day, Malcolm can choose his activities in the afternoon, which include catching up on emails, reading the New York Times, cleaning up the campsite and fishing for the evening’s meal.
Even from a distance of almost 9,000 miles from New York, the Bowmans agonize with their neighbors and community members in the Empire State.
“It’s very difficult watching all the suffering, sickness, death, inadequate availability of life-saving equipment, the enormous stress health care workers are under and the loss of income for many families,” Bowman explained in an email. “Our eldest daughter Gail is a medical worker at the Peconic Bay Medical Center in Riverhead so she is fighting at the front line. Very exhausting work.”
The Bowmans, who are naturalized American citizens, have no idea when international flights will resume from New Zealand.
A retired elementary school teacher who taught at the Laurel Hill School in Setauket for 34 years, Waveney wears a mask when she visits a large supermarket that is 12 miles away once a week. Malcolm, who also goes to the supermarket, said the store only allows one family member per visit.
As New Zealand natives, the Bowmans can live in the country indefinitely, but their intention is to return to Stony Brook as soon as possible.
Even though the shorter daylight hours and rainy days lower the amount of power the Bowmans can collect from their solar panels, the couple loves the outdoors. They have camped with their four children during summers in the hills of New Hampshire and Vermont and have both been involved with scouting activities, which emphasizes self sufficiency and living close to nature.
As a former amateur radio enthusiast, Malcolm is also adept at setting up communication systems in remote settings. He offers a message of hope to Long Islanders, “You can weather this storm. If possible, work and stay home and stay isolated.”
The Bowmans have followed the advice of the 37-year old Prime Minister of New Zealand, Jacinda Ardern, who urges people to “be especially kind to each other.”
All photos courtesy of Malcolm Bowman
By Daniel Dunaief
I am a journalist, which means I know a tiny bit about numerous subjects, but I am out of my depth once the questions dive below the surface. Oh, sure, I can play the journalistic game, where I throw around some terms, but I’m certainly not qualified to answer the best questions I could ask. Nonetheless, given the quarantine and the difficulty of getting people who are informed, funny, or funny and informed on the phone these days, I’m going to interview myself about the state of the world.
Question: How do you think we’re doing?
Answer: Well, that kind of depends. If we’re talking about humans in general, I would say we’re struggling. We were struggling before, but this virus has pushed us deeper into our struggles.
Question: Are we any better off today than we were yesterday or maybe last week or the week before?
Answer: Yes, yes we are.
Question: Do you care to elaborate?
Answer: No, no I don’t.
Question: Come on! You can’t just ignore me. I need to know.
Answer: No, you don’t. You’ll read what I write and then you’ll move on to the comment section of other articles, where clever people share their witticisms.
Question: Wait, how do know about the satisfaction I get out of some of the better comments?
Answer: Are you really asking that question?
Question: No, let’s get back on topic. If we’re better off today than we were yesterday or last week, will that trajectory continue? If it does, are we going to be able to live our lives with a new normal that’s more like the older normal, or will we have to wear masks and practice the kind of safe distancing that makes people long for the days when Jerry Seinfeld was annoyed on his show by a “close talker,” who, in the modern era in New York, would probably get a ticket for his close talking habit?
Answer: You had to pander with a TV reference, didn’t you? Don’t answer that! Anyway, yes, the trajectory looks better than it did, but there’s no guarantee it won’t change. You see, it’s a little like the stock market. Just because a company’s past performance is solid or impressive doesn’t guarantee anything about its future.
Question: Right, right. So, do you think my kids will ever get out of the house again?
Answer: You buried that question down low, didn’t you? Well, yes, I think they will return to a version of school that may also be different, but that also has some similarities to what they knew.
Question: Oh, good. Wait, so, you don’t really know, do you?
Answer: I do know that schools are pushing hard to solve the riddle, the conundrum, the enigma, the total ##$@!$ fest that has become the modern world. I know that parents the world over would like to go to the bathroom without someone following them into the room. I know that people would like to talk on the phone without worrying that their kids are listening, that people need adult alone time, and that the Pythagorean theorem isn’t going to teach itself.
Question: What does the Pythagorean theorem have to do with anything?
Answer: It’s out there and it’s on the approved list of things to learn. Are we almost done?
Question: Yes, so what do you think about the election?
Answer: I think it’ll happen in November and it’ll be an interesting opportunity to exercise our democratic rights.
Question: Who do you think will win?
Answer: An old man.
Question: Which one?
Answer: The one who yells at us through
the TV.
Question: They both do.
Answer: Then I’m going to be right.
By Leah S. Dunaief
“It’s May, it’s May, the merry month of May!” according to the Elizabethan poem by Thomas Dekker and then twisted a bit to “lusty month of May” by “Camelot’s” Lerner and Loewe. I’m willing to believe them, if you are, and there are a couple of items of good news that we can celebrate in our war against the novel coronavirus as the
month begins.
First is the unexpected progress coming from the University of Oxford toward a vaccine. Despite the earliest hopes for such an effective halt to the COVID-19 pandemic involving a 12 to 18- month timetable, which would suggest toward the end of 2021, it turns out that scientists at Oxford’s Jenner Institute are way ahead.
They have been holding previous clinical trials against an earlier coronavirus that are proving harmless to humans. Having cleared that major hurdle, now they can go to the head of the international race. They will be holding trials involving over 6,000 people with their new vaccine toward the end of the month. Not only do they want to show that the vaccine is safe but also that it works.
Then, “with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective,” according to an article by David D. Kirkpatrick that appeared on the front page of this past Tuesday’s The New York Times.
There is evidence from the National Institutes of Health’s Rocky Mountain Laboratories in Montana that this new Oxford vaccine may indeed work. It has been in a limited animal trial there and found to protect against COVID-19.
Other scientists at Oxford “are working with a half dozen drug manufacturing companies across Europe and Asia to prepare to churn out billions of doses as quickly as possible if the vaccine is approved. None have been granted exclusive marketing rights, and one is the giant Serum Institute of India, the world’s largest supplier of vaccines,” according to the Times. The idea of having several is to obtain billions of doses quickly and to avoid anyone making a lot of money from the pandemic.
There are a couple of American companies that are also doing research, along the same lines as Oxford, of altering the virus’s genetic material and conducting small clinical trials. They too must demonstrate both safety and effectiveness. The same goes for a Chinese company.
Another avenue of defense against COVID-19 is the use of blood plasma from the disease’s survivors on other desperately ill patients. Again, according to another article in Wednesday’s The New York Times by Audra D.S. Burch and Amy Harmon, the treatment may work. This involves finding survivors, with the same blood type as the ill patient, who will then volunteer to donate blood. The plasma in that blood, now termed convalescent plasma, is then injected into the gravely ill patient in order to bolster the patient’s immune system with new antibodies, “giving him more soldiers in his body to fight this war,” said Dr. Leslie Diaz, an infectious disease specialist at the Palm Beach Gardens Medical Center in South Florida where there was such treatment administered.
Initially to find such a donor, a frantic search was launched on social media that discovered an appropriate donor some 80 miles away. There is now a national program overseen by the Mayo Clinic, with the approval of the Food and Drug Administration, to use this experimental treatment on 2500 patients in U.S. hospitals. It should be said, however, that it is not clear whether having antibodies that are not their own would ultimately help or harm patients. This is only an experimental treatment under study.
So as we leave April behind, we should salute the American writer, T. S. Eliot, who began his 1922 landmark poem, “The Waste Land” with the words, “April is the cruelest month.” A hundred years earlier, he knew.
As the number of COVID-19 cases rise in minority communities at a higher rate than primarily white areas, North Shore residents may think those numbers don’t affect them, but they do.
The members of these communities are our co-workers, our restaurant workers, our laborers, our neighbors — whether they live next door or in the next town. The pandemic has made it glaringly obvious many of our society’s problems, among them the disparities minorities face on Long Island.
A good deal of information coming out about coronavirus cases shows that black and Hispanic Americans are dying of the disease at rates higher than Caucasians. In Suffolk black residents make up 13 percent of those who have died from the virus and Latinos 14 percent. These numbers are high considering black Americans make up just 8 percent of Suffolk County residents. Latinos are approximately 19 percent of the population, but the number of cases among the immigrant community is likely very undercounted, as crucial information about the virus has had a harder time reaching non-English speakers.
Many from these communities work “essential” jobs in service and blue-collar industries, many of which pay a lower income overall. This can lead to poor or no health care, which would hinder someone from visiting a doctor when they become sick. It also means many who would rather stay home lack a choice but to go out and work, potentially bringing the virus home to their families.
While Suffolk has identified areas where higher populations are testing positive for COVID-19, and in turn are extending testing in those areas, more can be done for these populations. This virus has reminded us that our health care system needs an overhaul — and that these populations are at greater risk due to higher cases of heart disease and diabetes. While it may be too late to make major changes during this pandemic, there are small things we can do right now.
For one, this is no time for one to worry about a person’s immigration status. During a pandemic, as health care professionals and elected officials try to manage the storm, everyone who is currently in the U.S. needs to know they can go to a hospital with no questions asked to receive the care they need. There also needs to be a way to provide alternating housing for those who come down with the virus, whether that means opening up hotel rooms or college dorms. There are many, right here on Long Island, who live in crowded apartments and houses. Situations like those make it difficult for someone to isolate themselves from others to prevent more infections. For those living in houses with multiple generations, this also presents a huge danger to vulnerable populations like the elderly.
Personal protective equipment has been in short supply throughout the country, and it’s up to elected officials as well as business owners to ensure that their employees have the proper amount of gloves, masks and other gear to do their jobs. It shouldn’t matter whether they’re on the front lines at hospitals or cleaning bathrooms in a medical facility, serving as home health aides, delivering groceries or working the fields.
There is always more we can do for our friends and neighbors. One day this pandemic will pass but let’s hope the lessons we’ve learned, especially about those who have suffered because of inequities, will stick with us and inspire us to do better.
By Sapphire Perera
The COVID-19 pandemic has been a temporary solution for the climate crisis. For many years, people have sought out various approaches to bring down greenhouse gas emissions and improve the environment through renewable energy sources. However, the coronavirus pandemic has proved to be the most effective solution yet. The earth is finally being allowed to breathe. Many scientists are calling this pandemic a temporary solution to the climate crisis but I believe that we can continue to have air with lower carbon dioxide levels, water that is clear and clean and a healthy environment if we all worked hard to change our daily routine.
The COVID-19 started healing the environment in China: the most polluted country on earth. Due to the forced closings of factories, shut-downs of manufacturing plants and mandatory quarantines for its citizens, there were reductions in coal and crude oil usage. It resulted in a reduction in CO2 emissions of 25 percent or more, which is approximately six percent of total global emissions. Italy was the country next in line to feel the devastating effects of the coronavirus pandemic. However, with everyone in quarantine, Italy followed China in terms of environmental revival. In only a few months, the people of Venice were able to see the fish and the bottom of the canals that were once murky and polluted. In India, similar improvements were being seen. The beautiful snow-covered Himalayas were once hidden by smog but after months of quarantine and a strict curfew, they could be seen by the Jalandhar citizens from more than one hundred miles away; they claim that it’s the first time in 30 years that they’ve clearly seen the Himalayas.
These changes to the environment are being seen all across the world. However, once quarantine ends, the earth will be suffocated by humans once again. To prevent this, I believe that more time and resources should be invested in the search for permanent solutions that would ameliorate the climate crisis. In terms of individual change, I know that there are hundreds of ways for us to stop partaking in the activities that promote the oil industry and fossil fuel industry. For instance, we can stop using cruise ships and motorboats for personal entertainment. According to the 2016 Pacific Standard report, “each passenger’s carbon footprint while cruising is roughly three-times it would be on land”.
In addition to regulating our carbon footprint through marine activities, we can also start placing more emphasis on alternative sports that don’t require corporate culture producers who promote environmentally unfriendly functions and corporations. Also, while this last one might be a small change, it can have a great impact. This change requires us to use less of our private vehicles to get places, and more of the public transport system. Transport makes up about 72 percent of the transport sector’s greenhouse gas emissions. If public transportation is increased to the point that families are taking buses and trains more than their own cars, we might be able to significantly reduce the percentage of gas emissions that come from driving.
U.S. Rep. Alexandria Ocasio-Cortez’s (D-NY-14 Bronx) Green New Deal reinforces some of these ideas and has already shown results through the pandemic. Some proposals in the Green New Deal include high-speed rail, removing combustible engines from the road, upgrading all existing buildings, and retraining coal workers.
One very important aspect of this Green New Deal is to reduce air travel. Many people find that to be too drastic a step towards fixing climate change, but is it really? According to a Center for Biological Diversity report, airplanes will generate about forty-three gigatonnes of planet-warming pollution through 2050. But with the current travel restrictions and just a few months of limited air travel, we are seeing clouds of nitrogen dioxide begin to evaporate from places above Italy and China. In addition to being less dependent on air travel, we are now less dependent on the coal mining industries. This has resulted in a dramatic decrease in the employment of coal workers; over 34,000 coal mining jobs have disappeared in the U.S. in the past decade. Fortunately, the Green New Deal focuses on training the coal workers in occupations pertaining to renewable and clean energy, and infrastructure. By eliminating the coal mining industry we would be making great leaps in the fight against the climate crisis.
Ever since the green revolution, humanity has been taking more than they need from the environment. We have abused Earth’s natural resources and expanded into territories that were inhabited by other species. I hope that this coronavirus pandemic has shown us that humanity doesn’t have to behave like a virus. We don’t have to continue worsening the climate crisis but instead, we could learn from this pandemic and start implementing regulations such as limited air travel and increased public transportations. We can turn consumerism to conservation, capitalism to socialism, and industrialism to environmentalism.
Sapphire Perera is a junior at Port Jefferson high school. The “Turtle Island,” as the name for this ongoing column refers to the Native American mythology about North America existing on the back of a great turtle that bears every living being on its spine.
By Barbara Beltrami
I feel like Old Mother Hubbard going to the cupboard and finding it bare or nearly so these days. As I sit and try to order groceries online and find “no delivery slot” or miraculously manage to order online but have to wait a week or so for delivery, I go to the fridge and find an expired container of yogurt, a bottle of ketchup and half a can of cat food. In the vegetable drawer I find a few slimy unrecognizable leaves, a lone scallion and a totally collapsed cucumber and the stark reminder that the fridge could use a long overdue cleaning. I go to the freezer to find nothing but an ancient package of phyllo dough and half a cake from my birthday a year ago. I turn in desperation to my pantry.
I inherited from my mother the practice of stockpiling multiple cans and jars and packages of staple items so what I do have is lots of cans of beans, tomatoes and tuna, a couple of boxes of pasta, a box of rice and a whole shelf of pickles I put up last year.
Now the challenge is: What can I concoct out of these few things? I could do a Pasta Puttanesca with the tomatoes and tuna. I could do a Tuna and Bean Salad or I could make a Vegetarian Chili. Here are the recipes I came up with. Things being what they are, all measurements are approximate, main ingredients are generic, and if you don’t have some of the secondary ingredients, no big deal. You’ve got more important things to worry about these days. Be safe, be well, be grateful.
Vegetarian Chili
YIELD: Makes 8 servings
INGREDIENTS:
1/4 cup olive oil
1 onion, chopped
1 green pepper, chopped
2 garlic cloves, chopped
3 tablespoons chili powder
1 teaspoon cumin
1 teaspoon coriander
Two 14-ounce cans beans, rinsed and drained
One 14-ounce can tomatoes with juice
Salt and crushed hot red pepper flakes to taste
DIRECTIONS:
In large heavy saucepan or skillet, heat oil over medium heat, add onion, pepper and chopped garlic and cook over medium heat until slightly softened, about 8 to 10 minutes. Add garlic chili powder, cumin and coriander and cook, stirring once or twice about one minute. Stir in beans, tomatoes, salt and pepper flakes. Serve hot with rice, tortilla chips and a salad or green vegetable.
Pasta Puttanesca
YIELD: Makes 4 servings
INGREDIENTS:
1 pound pasta
1/4 cup olive oil
One 28-ounce can tomatoes with juice
1 garlic clove, minced
1 teaspoon each dried parsley, basil, oregano
1 tablespoon capers, rinsed and drained
1/3 cup black olives, pitted and chopped]
One 7-ounce can oil-packed tuna, drained
Salt and freshly ground pepper to taste
DIRECTIONS:
Put pasta water on to boil. Cook pasta according to package directions. Meanwhile in a large skillet heat oil over medium heat; add tomatoes, garlic and herbs. Cook over medium heat, stirring occasionally, until sauce is thickened, about 10 to 15 minutes; add capers, olives, tuna, salt and pepper and cook another 5 minutes. Serve immediately with a dry white wine.
Tuna and Bean Salad
YIELD: Makes 3 to 4 servings
INGREDIENTS:
One 7-ounce can tuna, drained
One14-ounce can beans, rinsed and drained
2 tablespoons minced pickles
2 tablespoons minced onion or scallion
2 tablespoons chopped fresh parsley
1/4 cup olive oil
2 tablespoons vinegar
Salt and freshly ground pepper to taste
DIRECTIONS:
In a medium bowl mix all ingredients together. Let sit at room temperature 30 minutes. Serve with lettuce or arugula and rustic bread.
EVENING MIST
Theodore Kleppe of Mount Sinai snapped this eerily beautiful photo of the east side of Port Jefferson Harbor on the early evening of March 29.
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By Daniel Dunaief
Mikala Egeblad couldn’t shake the feeling that the work she was doing with cancer might somehow have a link to coronavirus.
Egeblad, who is an Associate Professor and cancer biologist at Cold Spring Harbor Laboratory, recently saw ways to apply her expertise to the fight against the global pandemic.
She studies something called neutrophil extracellular traps, which are spider webs that develop when a part of the immune system triggered by neutrophil is trying to fight off a bacteria. When these NETs, as they are known, are abundant enough in the blood stream, they may contribute to the spread of cancers to other organs and may also cause blood clots, which are also a symptom of more severe versions of COVID-19, the disease caused by the coronavirus, which has now infected over two million people worldwide.
“I always felt an urgency about cancer, but this has an urgency on steroids,” Egeblad said.
Cold Spring Harbor Laboratory reached out to numerous other scientists who specialize in the study of NETs, sometimes picking up on the tweets of colleagues who wondered in the social networking world whether NETs could contribute or exacerbate the progression of Covid19.
Egeblad started by reaching out to two scientists who tweeted, “Nothing about NETs and Covid-19?” She then started reaching out to other researchers.
“A lot of us had come to this conclusion independently,” she said. “Being able to talk together validated that this was something worth studying as a group.”
Indeed, the group, which Egeblad is leading and includes scientists at the Feinstein Institutes for Medical Research and the Research Institute of the McGill University Health Centre, published a paper last week in the Journal of Experimental Medicine, in which they proposed a potential role for NETs.
“We are putting this out so the field doesn’t overlook NETs,” said Egeblad, who appreciated the support from Andrew Whiteley, who is the Vice President of Business Development and Technology Transfer at CSHL.
With a range of responses to the coronavirus infection, from people who have it but are asymptomatic all the way to those who are battling for their survival in the intensive care units of hospitals around the world, the biologist said the disease may involve vastly different levels of NETs. “The hypothesis is that in mild or asymptomatic cases, the NETs probably play little if any role,” she said.
In more severe cases, Egeblad and her colleagues would like to determine if NETs contribute or exacerbate the condition. If they do, the NETs could become a diagnostic tool or a target for therapies.
At this point, the researchers in this field have ways of measuring the NETs, but haven’t been able to do so through clinical grade assays. “That has to be developed,” Egeblad explained. “As a group, we are looking into whether the NETs could come up before or after symptoms and whether the symptoms would track” with their presence, she added.
To conduct the lab work at Cold Spring Harbor, Egeblad said her team is preparing to develop special procedures to handle blood samples that contain the virus.
As the lead investigator on this project, Egeblad said she is organizing weekly conference calls and writing up the summaries of those discussions. She and the first author on the paper Betsy J. Barnes, who is a Professor at the Feinstein Institute, wrote much of the text for the paper. Some specific paragraphs were written by experts in those areas.
At this point, doctors are conducting clinical trials with drugs that would also likely limit NET formation. In the specific sub field of working with this immune-system related challenge, researchers haven’t found a drug that specifically targets these NETs.
If the study of patient samples indicates that NETs play an important role in the progression of the disease, particularly among the most severe cases, the scientists will look for drugs that have been tried in humans and are already approved for other diseases. This would create the shortest path for clinical use.
Suppressing NETs might require careful management of potential bacterial infections. Egeblad suggested any bacterial invaders might be manageable with other antibiotics.
NETs forming in airways may make it easier to get bacterial infections because the bacteria likes to grow on the DNA.
Thus far, laboratory research studies on NETs in COVID-19 patients have involved taking samples from routine care that have been discarded from their daily routine analysis. While those are not as reliable as samples taken specifically for an analysis of the presence of these specific markers, researchers don’t want to burden a hospital system already stretched thin with a deluge of sick patients to provide samples for a hypothetical pathway.
Egeblad and her colleagues anticipate the NETs will likely be more prevalent among the sicker patients. As more information comes in, the researchers also hope to link comorbidities, or other medical conditions, to the severity of COVID-19, which may implicate specific mechanisms in the progression of the disease.
“There are so many different efforts” to understand what might cause the progression of the disease, Egeblad said. “Everybody’s attention is laser focused.” A measure that is easy to study, such as this hypothesis, could have an impact and “it wouldn’t take long to find out,” she added. Indeed, she expects the results of this analysis should be available within a matter of weeks.
Egeblad believes the NETs may drive mucus production in the lungs, which could make it harder to ventilate in severe cases. They also may activate platelets, which are part of the clotting process. If they did play such a role, they could contribute to the blood clotting some patients with coronavirus experience.
Egeblad recognizes that NETs, which she has been studying in the context of cancer, may not be involved in COVID-19, which researchers should know soon. “We need to know whether this is important.”
By David Dunaief, M.D.
Autoimmune diseases affect more than seven percent of the U.S. population, most of them women. More than 80 conditions have autoimmunity implications (1). Among the most common are rheumatoid arthritis (RA), lupus, thyroid (hypo and hyper), psoriasis, multiple sclerosis and inflammatory bowel disease.
In all autoimmune diseases, the immune system inappropriately attacks organs, cells and tissues of the body, causing chronic inflammation. Chronic inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). Once you have one, you are at high risk for acquiring others.
Drug treatments
The mainstay of treatment is immunosuppressives. In RA, where there is swelling of joints bilaterally, a typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies seem to reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. Disease-modifying anti-rheumatic drugs (DMARDs), a class that also includes Plaquenil (hydroxychloroquine), may slow or stop the progression of joint destruction and increase physical functioning.
However, there are several concerning factors with these drugs. First, the side effect profile is substantial. It includes the risk of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections.
It is no surprise that suppressing the immune system would result in increased infection rates. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).
Tangentially, there is also concern that these drugs might make those who contract COVID-19 more susceptible to severe symptoms and consequences. On the flip side, some are being studied to determine whether they can improve outcomes for others by suppressing immune system overreactions.
Second, these drugs were tested and approved using short-term randomized clinical trials, but many patients are prescribed these therapies for 20 or more years.
So, what other methods are available to treat autoimmune diseases? These include medical nutrition therapy using bioactive compounds, which have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression and supplementation.
Nutrition and inflammation
Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. While I have not found studies that specifically tested diet in RA treatment, there is a study that looked at the Mediterranean-type diet in 112 older patients where there was a significant decrease in inflammatory markers, including CRP (5).
In another study, participants showed a substantial reduction in CRP with increased flavonoid levels, an antioxidant, from vegetables and apples. Astaxanthin, a carotenoid found in fish, was shown to significantly reduce a host of inflammatory factors in mice, including TNF-alpha (6).
Fish oil
Fish oil helps your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (7). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory, such as NFkB.
In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (8). When treating patients with autoimmune disease, I typically suggest about 2 grams of EPA plus DHA to help regulate their immune systems. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood thinning effects.
Probiotic supplements
The gut contains approximately 70 percent of your immune system. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (9, 10).
In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor, TNF-alpha (11). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.
Fiber
Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (12).
In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (13).
Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation and potentially autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects and thus treat and prevent autoimmune diseases.
*Especially in this time of COVID-19, do not alter your medications, in other words, stop or start medications, without discussing it with your physician first. It is much more important to control the autoimmune disease than tot worry about drug effects on the immune system.
References:
(1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Am J Clin Nutr. 2009 Jan;89(1):248-256. (6) Chem Biol Interact. 2011 May 20. (7) Am J Clin Nutr. 2009 Aug;90(2):415-424. (8) Drugs. 2003;63(9):845-853. (9) Gut. 2003 Jul;52(7):975-980. (10) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (11) Gut. 2002;51(5):659. (12) Arch Intern Med. 2007;167(5):502-506. (13) Nutr Metab (Lond). 2010 May 13;7:42.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
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