Health

METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

There are some compelling studies that show exercise’s powerful effects in altering our genes. Recent studies show its impact on specific diseases. Exercise has effects on diabetes and a host of other chronic diseases, including kidney stones, osteoarthritis, cardiovascular disease and breast, colorectal and endometrial cancers (1).

There are also studies on simple ways to motivate yourself during exercise. One showed that those who repeat positive mantras like “feels good” while exercising were able to persist in their exercise routines for longer periods (2).

Why is this so important and why am I harping on exercise during the holidays? Because we are too sedentary, and this is the time of the year when we are inclined to overeat. According to data from the 2015-2016 National Health & Nutrition Examination Survey, we spend 6.4 hours a day sedentary (3). And this percentage is trending up.

Exercise and your genes

While you may be waiting for gene therapy to cure our chronic illnesses, it turns out that exercise may have a significant impact on our genes.

No waiting required; this is here and now.

Photo from Pixabay

In a study, results showed that thousands upon thousands of genes in fat cells were affected when participants exercised (4). The study involved sedentary men and asked them to exercise twice a week at a one-hour spin class. According to the researchers, the genes impacted were those involved most likely in storing fat and in risk for subsequent diabetes and obesity development. Participants’ gene expression was altered by DNA methylation, the addition of a methyl group made up of a carbon and hydrogens. These participants also improved their biometrics, reducing fat and subsequently shrinking their waist circumferences, and improved their cholesterol and blood-pressure indices.

The effect is referred to as epigenetics, where lifestyle modifications can ultimately lead to changes in gene expression, turning them on and off. This has been shown with dietary changes, but this is one of the first studies to show that exercise also has significant impacts on our genes. It took only six months to see these numerous gene changes with modest amounts of cardiovascular exercise.

If this was not enough, another study showed substantial gene changes in muscle cells after one workout on a stationary bike (5).

Exercise versus drug therapy

We don’t think of exercise as being a drug, but what if it had similar benefits to certain drugs in cardiovascular diseases and mortality risk? A meta-analysis — a group of 57 studies that involved drugs and exercise — showed that exercise potentially has equivalent effects to statins in terms of mortality with secondary prevention of coronary heart disease (6).

This means that, in patients who already have heart disease, both statins and exercise reduce the risk of mortality by similar amounts. The same was true with prediabetes and the use of metformin vs. exercise. It didn’t matter which one was used, the drug or the lifestyle change.

Don’t change your medication without consulting your physician.

Kidney stones and exercise

Anyone who has tried to pass a kidney stone knows it can be an excruciating experience. Most of the treatment revolves around pain medication, fluids and waiting for the stone to pass. However, the best way to treat kidney stones is to prevent them. In the Women’s Health Initiative Observational Study, exercise reduced the risk of kidney stones by as much as 31 percent (7).

Even better, the intensity of the exercise was irrelevant to its beneficial effect. What mattered more was exercise quantity. One hour of jogging or three hours of walking got the top results. But lesser amounts of exercise also saw substantial reductions. This study involved 84,000 postmenopausal women, the population most likely to suffer from kidney stones.

Sex as exercise

We have heard that sex may be thought of as exercise, but is this myth or is there actual evidence? Try to keep a straight face. Well, it turns out this may be true. In a study published in the PLoS One journal, researchers found that young healthy couples exert 6 METs — metabolic energy, or the amount of oxygen consumed per kilogram per minute — during sexual activity (8).

How does this compare to other activities? Well, we exert about 1 MET while sitting and 8.5 METs while jogging. Sexual activity falls between walking and jogging, in terms of the energy utilized, and thus may be qualified as moderate activity. Men and women burned slightly less than half as many calories with sex as with jogging, burning a mean of 85 calories over about 25 minutes. Who says exercise can’t be fun?

I can’t stress the importance of exercise enough. It not only influences the way you feel, but also may influence gene expression and, ultimately, affects the development and prevention of disease. In certain circumstances, it may be as powerful as drugs and, in combination, may pack a powerful punch. Therefore, make exercise a priority — part of the fabric of your life. It may already be impacting the fabric of your body: your genes.

References:

(1) JAMA. 2009;301(19):2024. (2) Med Sci Sports Exerc. 2013 Oct 10. (3) JAMA Netw Open. 2019;2(7):e197597. (4) PLoS Genet. 2013 Jun;9(6):e1003572. (5) Cell Metab. 2012 Mar 7;15(3):405-11. (6) BMJ 2013; 347. (7) JASN online 2013, Dec. 12. (8) PLoS One 8(10): e79342.

Dr. David 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.

A sign of the times outside Smithtown Town Hall. Photo courtesy of Smithtown Library

Even before some family gatherings provide a potential breeding ground for the coronavirus, Suffolk County residents have tested positive for COVID-19 at rates not seen since the worst of the first wave, in April.

In the last day, 501 people have tested positive for the coronavirus which is the highest number since April. That represents a 4 percent positive test rate, which is also the highest figure since May 18.

“It is unclear if we are plateauing or whether [these numbers] will continue to go up,” County Executive Steve Bellone (D) said on a conference call with reporters. He is concerned about “where we may go after the Thanksgiving holidays.”

Indeed, Dr. Shahida Iftikhar, Deputy Commissioner for the Department of Health, said the numbers were likely climbing as a result of smaller gatherings, which is what triggered an increase after the Halloween weekend.

Long Island surpassed 1,000 cases on Tuesday, according to officials. More communities on Long Island are close to being named so-called yellow zones by the state, which might mean more restrictions and the potential rolling back of the phased reopening seen earlier this year.

Gov. Andrew Cuomo (D) said during his Wednesday livestream the virus is being spread mainly by bars and restaurants that sell alcohol, gyms and small gatherings. New restrictions have been placed on all three earlier this month. Cuomo also said places like Monroe County, whose officials said cases were mainly due to small gatherings and not places like gyms, were outliers, and stressed people limit gatherings on Thanksgiving.

I give thanks for the intelligence of New Yorkers, but we have to stay safe, we have to keep the infection rate down through the thanksgiving holiday,” he said. ““Don’t be a turkey, wear a mask this Thanksgiving.”

Despite the move away from contact tracing in other regions with widespread community spread, Suffolk County continues to use contact tracers to call people who have received positive tests and to warn anyone they might have infected.

For those residents who have received a negative COVID test and plan to gather with family and friends, Dr. Gregson Pigott, Commissioner in the County Department of Health, cautioned that people can have a negative test and still transmit the virus after they are exposed.

There is a lot of “asymptomatic spread,” Pigott warned.

To limit the spread of the virus, Bellone urged people to follow state guidelines, limiting gatherings to 10 people, washing their hands, wearing face coverings where possible and keeping a distance of at least six feet, particularly from vulnerable members of the population.

In anticipation of gatherings, the Suffolk County Police Department has added patrols and will perform compliance checks with bars and restaurants to ensure that these businesses are adhering to the state requirements that they shut down indoor food and beverage service after 10 p.m.

The SCPD will not go from house to house counting cars, but they will respond to any reports of private residences that exceed the 10-person limit.

New York State has designated Riverhead and Hampton Bays as yellow zones. Bellone encouraged residents living within these zones to get tested. Residents can find testing sites at the web site suffolkcountyny.gov.

Cuomo said New York, among other states, has started adding field hospitals again, much like what was seen during the first wave of the pandemic. The first field hospital has been set up in Staten Island, though more be on the way.

Free testing sites, supported by New York State, are opening Monday at the Northwell Health Dolan Family Healthy Center in Huntington and on Tuesday at Sun River Health in Patchogue.

As the Board of Elections continues to count votes, Bellone said one of the people who worked for the elections tested positive. The county has tested 111 people who worked in the building, with eight people testing positive and 37 quarantined because of close contact.

On the positive side, Suffolk County’s testing in schools in Riverhead and Hampton Bays has demonstrated a low rate of infection. In Riverhead, 12 out of 524 people tested positive, while Hampton Bays had four positive tests out of 417 people tested.

“While we continue to monitor the rise in cases, we are not currently seeing community spread happening in our schools,” Bellone said. “As long as students and faculty are kept safe, schools should remain open.”

Additional reporting by Kyle Barr

Mather Hospital changed its visitation policies Nov. 23. File photo by Alex Petroski

This story was updated Wednesday to include Stony Brook University Hospital.

Amid increases in the percentage of positive tests for coronavirus, Northwell hospitals including Huntington Hospital and Mather Hospital have changed their visitor policies.

Effective on Tuesday, Nov. 24, Mather Hospital has suspended patient visitation, including the Emergency Department and Transition Care Unit.

The exceptions for visitors include patients for whom a support person is considered medically necessary, including people who have intellectual or developmental disabilities and patients with cognitive impairments, including dementia.

Additionally, patients in imminent end-of-life situations may be allowed a family member or legal representative as a support at the bedside. The Department of Health defines imminent end-of-life as a patient who may die within 24 hours.

Pediatric visits in Emergency Departments are limited to one parent or guardian. Adolescent psychiatry, meanwhile, is limited to one parent or guardian between 3:30 and 4:30 p.m. and 6:30 and 7:30 p.m.

Visitors must meet several criteria at Mather. They have to be 18 years old or older, have not been exposed to COVID-19 and be screened for symptoms. Visitors also have to wear appropriate personal protective equipment. Those who don’t wear such PPE won’t be permitted in the hospital.

Visitors will have to stay in the patient room during the visit. When they leave the room, visitors will remove their PPE, wash their hands and leave the hospital. Visitors should not be in the room during aerosol-generating procedures.

Patients can choose who can and can’t visit and may select priority support people.

A view of the front entrance to Huntington Hospital on Park Avenue in Huntington. File photo

Huntington Hospital

Meanwhile, at Huntington Hospital, all visitation, except for extraordinary circumstances, is suspended, effective Nov. 30.

The hospital has experience an increase in cases, although the total numbers remain low, with fewer than 20 people hospitalized with COVID-19 as of Tuesday.

“Social Distance and mask wearing by the community is critical,” Nick Fitterman, Executive Director at Huntington Hospital, said through an email.

One support person for patients in the Center for Mothers and Babies may remain throughout the hospital stay.

Outpatient Radiology services are canceled, effective Nov. 30.

Huntington Hospital’s surgical services are fully operation. The staff will take COVID-negative surgical patients through the hospital’s safe pathways.

The hospital strictly enforces universal masking, protective eyewear, hand hygiene and social distancing.

“We remain confident in these practices, and that they will protect our patients from COVID-19 while in the hospital,” Fitterman said.

File photo

Stony Brook Hospital

Starting on Friday, Nov. 27, all visitation is suspended except for patient support persons or family members and/or legal representatives of patients in imminent end-of-life situations.

Hospitals will permit a patient support person at the bedside for patients in labor and delivery, pediatric patients patients with intellectual and/or developmental disabilities or patients with cognitive impairments including dementia.

Older folks are going to be struggling mentally this holiday season, as with current travel and gathering restrictions it will be harder to connect over long distances. Stock photo

Before, during and after major storms, state and local officials typically urge residents to check on elderly friends and neighbors to make sure they have what they need.

While the pandemic hasn’t torn up trees or left a physical mess strewn across impassable roadways, it has triggered the kind of problems residents might have during an ongoing storm.

Indeed, after a brutal spring that included school and business lockdowns followed by a summer respite when the number of infected people declined, the fall has proceeded the way many infectious disease experts had anticipated, with a resurgence in positive tests, steadily rising hospital bed occupancy and the possibility of renewed lockdowns.

Dr. Youssef Hassoun, the medical director at South Oaks Hospital, offers advice with connecting to the elderly over the holidays. Photo from Northwell Health

All of this is happening against the backdrop of a time when elderly residents typically welcome friends and extended family during Thanksgiving and through the December holidays. Many people have canceled or postponed seasonal rituals indefinitely, things that normally offer an opportunity to reconnect.

Holidays are a “needed process that are embedded in our culture and society and, for most, bring significant joy and purpose,” said Dr. Youssef Hassoun, Medical Director of South Oaks Hospital. “For the elderly, that is exaggerated, simply because that is their time to connect back with their loved ones.”

Elderly residents are managing, though they are feeling numerous stressors.

The mental health toll on elderly residents has increased since the pandemic began. In the first few months after the virus upended life on Long Island, the number of elderly residents seeking mental health support declined at Stony Brook, according to Nikhil Palekar, Associate Professor of Psychiatry and Director of Geriatric Psychiatry at Stony Brook University’s Renaissance School of Medicine.

In the last few months, “we have seen a significant increase in referrals our center has received for mental health services,” Palekar explained in an email.

Stony Brook has not had to increase their staffing yet, but if the demand for mental health services continues to be as high as it has been for the past couple of months, the university “will be hiring more clinical staff to provide care,” Palekar explained.

Elderly residents are trapped in a battle between the fear of contracting the virus and the impact of loneliness, which can increase the rate of depression, anxiety and cognitive impairment, Palekar added.

Indeed, the number of nursing home residents contracting the virus has increased in the country and in Suffolk County, according County Executive Steve Bellone (D) during a Tuesday call with reporters.

For people who are battling against the loneliness triggered by isolation, “our recommendation to our elderly patients is to use televideo conferencing to connect with their loved ones, peers and support groups,” Palekar wrote.

Ongoing Stress

For Baby Boomers, concerns about loneliness predated the pandemic, said Adam Gonzalez, Founding Director of the Mind-Body Clinical Research Center and Assistant Professor of Psychiatry at the Renaissance School of Medicine at Stony Brook University.

“COVID adds a whole ‘nother layer of barriers that might get in the way of people connecting,” Gonzalez said. “It’s definitely a high-stress and overwhelming time for many.”

Indeed, ongoing stress, including from concerns about COVID, can trigger cognitive stress.

“Stress can make it harder for people to think,” said Chris Christodoulou, Research Assistant Professor of Psychiatry & Behavioral Health and Neurology at Stony Brook University’s Renaissance School of Medicine. When people are thrown out of their habits, that can be “disorienting and stressful.”

‘For the elderly, [that need for holiday joy] is exaggerated, simply because that is their time to connect back with their loved ones.’

—Dr. Youssef Hassoun

A stressful situation can also reveal cognitive vulnerability for people who are suddenly unsure of themselves and their environment.

“Chronic stress changes our brains in ways that are not healthy and may contribute to lots of diseases, including those affecting the brain,” Christodoulou said.

As for what to pay close attention to when checking in on elderly residents, Palekar suggested that people listen for key words or phrases, such as “feel lonely,” “don’t like myself,” “poor sleep and appetite,” or “can’t stop worrying.” Additionally, members of a support network should pay close attention if others feel helpless, can’t concentrate, have lost interest in doing things or are tired all day.

Solutions

Christodoulou said activities like yoga and aerobic exercise can prevent and slow the decline in cognition.

Hassoun also urged residents to have an open conversation with elderly family members.

“We are very good at assuming that someone appreciates” the risks of larger or even medium-sized family gatherings, Hassoun said. People may understand those risks differently.

The South Oaks Hospital medical director suggested conversations begin not with the unknowns related to potential sicknesses or even new tests, treatments and vaccines, but rather with the knowns of what’s working. While residents may be tired of hearing it, the reality is that masks, social distancing and hand hygiene have reduced the spread of COVID-19, along with other pathogens and microbes that might spread through family contact during the holidays.

Doctors and mental health professionals urged people to be creative in their efforts to connect with others this year.

“How can we get dad, who has never enjoyed looking at an iPad, let alone using it, to find it more fun to have a zoom Thanksgiving together?” Hassoun asked.

He added that these unconventional Thanksgiving interactions could be a way to connect relatives and even children who may not participate as actively in group discussions during these holiday meals.

Residents can improve the holiday during this challenging year by making the most of each interaction, even if it’s not in the familiar personal setting.

Chris Pendergast at an ALS Ride for Life event

When Christopher K. Pendergast was diagnosed with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s Disease, he was told he had three years to live. He lived 28 years instead. And what a 28 years they were.

Chris Pendergast

Chris, who died on Oct. 14 at age 71, went on to found the ALS Ride for Life in 1997, raising over $10 million for ALS research. The Center for ALS at Stony Brook Medicine now bears his name. And along the way, he met with everyone from U.S. Presidents to legislators to the manager of the New York Yankees. It was all part of his unending quest to help others.

“I want to make a difference,” said the elementary schoolteacher from Miller Place. “I want the extra few years I have to count for something.”

Did he ever.

Chris knew what he was up against. He disdained the term “survivor,” because he knew he would not survive. Instead, he preferred saying that he had lived with ALS for “X” number of years.

On the day he died, his family issued a media statement, saying, “Our dad, despite all odds, lived life just how he wanted until his last morning. He fought ALS bravely for 28 years and dedicated 23 of those years raising awareness and funds for ALS. He touched so many lives but at the end of the day, he was just ‘our dad’ who happened to do remarkable things.”

It wasn’t just by happenstance.

Over the course of 28 years, Chris advocated for patients with ALS, driven to raise funds for ALS research, awareness and patient care through the Ride for Life. He met with other patients with ALS privately and offered them his insights and his friendship for the difficult journey that he knew lay ahead.

Although a quadriplegic, on a ventilator, and using an eye-gaze computer to communicate, Chris remained active with the Ride in his final days.

“Chris taught us much about the range of possibilities of individuals with ALS, about humanity, and the art of what is possible,” said Kenneth Kaushansky, MD, Senior Vice President, Health Sciences, and Dean, Renaissance School of Medicine at Stony Brook University. “His legacy as a trailblazing ALS advocate through the Ride for Life organization and his work at Stony Brook will last for generations to come.”

Based on his work, Chris received the Lifetime Achievement Award from the ALS Association. The ALS Center at Stony Brook Medicine was renamed the Stony Brook Neuromuscular Disease and Christopher Pendergast ALS Center of Excellence in his honor.

“We are proud to have known Chris as a friend, colleague and warrior against ALS,” Dr. Kaushansky said. “We will continue to work to find a cure for ALS, in honor of his life and vision.”

— STONY BROOK MEDICINE

Stock photo

As the percentage of positive tests throughout the county continues its rapid climb to about 3.5% from around 1% in the last 10 days, Suffolk County has started its first school-based testing in Hampton Bays and Riverhead.

Those two school districts, where county and school officials are testing students who have received permission from their parents, recently started testing students for COVID-19 in an effort to monitor and reduce the spread of the virus.

Hampton Bays has a 6.5% positive testing rate over the last five days, while Riverhead has a 5.6% positive rate for that same period, according to County Executive Steve Bellone (D).

About 400 tests for students, teachers and faculty in Hampton Bays, which started on Thursday, Nov. 19, will be administered before the Thanksgiving holiday.

Four employees from Suffolk County are on site to administer the rapid tests, which provide results within 15 minutes.

“The goal in launching this free school-based testing program is to be proactive in an effort to get control of these numbers in the county,” Bellone said on a conference call with reporters. More testing will help the county locate the potential source of community spread, helping to enable schools and businesses to remain open.

The school testing is part of a “comprehensive effort to get our arms around these nubmers and stop the surge in the county,” Bellone said.

The Riverhead tests will start on Friday, Nov. 20. The county hasn’t determined how many tests it will administer at that location. The Riverhead and Hampton Bays testing kits came from New York State.

Additional pop up testing will occur in the Hamptons Bays that Stony Brook South Shore Hospital will administer over the next two weeks, which will continue on an as-needed basis.

Bellone said the spread of positive tests is occurring throughout the county and isn’t localized in any one region.

“What we’re seeing is the spread is happening everywhere across the county,” Bellone said. “The announcement today is part of a larger, comprehensive effort to get community spread under control.”

While schools in Manhattan have closed in response to a rise in positive tests, Bellone said concerted efforts in the county may prevent the eastern part of Long Island from the same fate.

These efforts include increasing the number of contact tracers to 150 today from just 30 before this surge began. The Suffolk County Police Department is also increasing enforcement around the holiday about social host laws and gathering limits below 10 people. The Suffolk County Department of Health is also working through social media to remind residents about their public health responsibilities.

Bellone reiterated that some of the increase in cases in the county came from gatherings around Halloween. With Thanksgiving next week, which typically brings multiple generations of families together, the result from these gatherings could continue to increase the number of positive tests.

Bellone said the county would continue to follow local data. If other communities also have positive test rates above the average in the county over a long enough period of time, the county will “engage with those school districts” as it has with Hampton Bays and Riverhead, Bellone said.

At this point, the county has no plans to conduct additional testing after Thanksgiving.

“We’re not seeing the spread happening inside the school,” Bellone said. “The effort we are engaged in today is part of a larger, comprehensive effort trying to get a handle on this in the county. It’s not, per se, an issue about the schools. We are looking at certain communities” where the positive rate is above the average for the community.

The county executive said he would provide data about the school-based testing once it was collected.

METRO photo
Diet choices trump exercise for weight loss

By David Dunaief, M.D.

Dr. David Dunaief

To quash guilt about Thanksgiving meal indiscretions, many of us will resolve to exercise to burn off the calories from this seismic meal and the smaller, calorically dense aftershock meals, whether with a vigorous family football game or with a more modest walk.

Unfortunately, exercise without dietary changes may not actually help many people lose weight, no matter what the intensity or the duration (1). If it does help, it may only modestly reduce fat mass and weight for the majority of people. However, it may be helpful with weight maintenance. Ultimately, it may be more important to reconsider what you are eating than to succumb to the rationalization that you can eat with abandon during the holidays and work it off later.

Don’t give up on exercise just yet, though. There is very good news: Exercise does have beneficial effects on a wide range of conditions, including chronic kidney disease, cognitive decline, diabetes, cardiovascular disease, osteoporosis, fatigue, insomnia and depression.

Let’s look at the evidence.

Exercise for weight loss

The well-known weight-loss paradigm is that when more calories are burned than consumed, we will tip the scale in favor of weight loss. The greater the negative balance with exercise, the greater the loss. However, study results say otherwise. They show that in premenopausal women there was neither weight nor fat loss from exercise (2). This involved 81 women over a short duration, 12 weeks. All of the women were overweight to obese, although there was great variability in weight.

However, more than two-thirds of the women (55) gained a mean of 1 kilogram, or 2.2 pounds, of fat mass by the end of the study. There were a few who gained 10 pounds of predominantly fat. A fair amount of variability was seen among the participants, ranging from significant weight loss to substantial weight gain. These women were told to exercise at the American College of Sports Medicine’s optimal level of intensity (3). This is to walk 30 minutes on a treadmill three times a week at 70 percent VO2max — maximum oxygen consumption during exercise — or, in other words, a moderately intense pace.

The good news is that the women were in better aerobic shape by the end of the study. Also, women who had lost weight at the four-week mark were more likely to continue to do so by the end of the study. This was a preliminary study, so no definitive conclusions can be made.

Other studies have shown modest weight loss. For instance, in a meta-analysis involving 14 randomized controlled trials, results showed that there was a disappointing amount of weight loss with exercise alone (4). In six months, patients lost a mean of 1.6 kilograms, or 3.5 pounds, and at 12 months, participants lost 1.7 kilograms, or about 3.75 pounds.

Exercise and weight maintenance

However, exercise may be valuable in weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (5). When exercise was added to diet, women were able to maintain 30 percent more weight loss than with diet alone after a year in a prospective study (6).

Exercise and disease

As just one example of exercise’s impact on disease, let’s look at chronic kidney disease (CKD), which affects 15 percent, or one in seven, adults in the United States, according to the Centers for Disease Control and Prevention (7).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD, stages 3-5 (8). Yes, this includes stage 3, which most likely is asymptomatic. There was a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death when walkers were compared to non-walkers.

Walking had an impressive impact; results were based on a dose-response curve. In other words, the more frequently patients walked during the week, the better the probability of preventing complications. Those who walked between one and two times per week had 17 and 19 percent reductions in death and kidney replacement therapy, respectively, while those who walked at least seven times per week saw 44 and 59 percent reductions in death and kidney replacement. These are substantial results. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

Therefore, while it is important to enjoy the holidays, remember that food choices will have the greatest impact on our weight and body composition. However, exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

So, by all means, exercise during the holidays, but also focus on more nutrient-dense foods. At a minimum, strike a balance rather than eating purely calorically dense foods. You won’t be able to exercise them away.

References:

(1) uptodate.com. (2) J Strength Cond Res. Online Oct. 28, 2014. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) Obesity (Silver Spring). 2010;18(1):167. (6) Int J Obes Relat Metab Disord. 1997;21(10):941. (7) cdc.gov. (8) Clin J Am Soc Nephrol. 2014 Jul;9(7):1183-1189.

Dr. David 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.

Suffolk County Executive Steve Bellone. File photo by Alex Petroski

On the night before Thanksgiving, high school and college students typically come together to reconnect, share stories and share a drink.

This year, as COVID-19 cases climb throughout the U.S., including in Suffolk County, County Executive Steve Bellone (D), along with the Suffolk County Police Department and local enforcement offices, are discouraging gatherings that might cause further spread of the virus.

Enforcement efforts will using social host laws, which fine residents for allowing underage drinking, and state-mandated gathering restrictions, which combined, could lead to “serious consequences,” Bellone said on a conference call with reporters Nov. 17.

“No matter where you are or what you are doing, social distancing and mask guidelines must be followed,” Bellone said. “We’ve come too far to go back now.”

With new state restrictions that limit the sale of alcohol after 10 p.m. through bars and restaurants, Bellone said enforcement efforts would be on the look out for gatherings at private residences. Some of these viral spreading events have occurred during smaller gatherings.

“The spread of COVID-19 at these types of parties is very, very real,” Bellone said. “We’ve seen it countless times. We all need to take personal responsibility,” which includes parents who need to comply with social host laws and the state’s gathering limits in homes.

Bellone announced a partnership between the Suffolk County Department of Health and the nonprofit Partners in Prevention, which is starting a social media campaign to inform the community about social host laws. Bellone called this information “critical” leading up to Thanksgiving celebrations.

While Suffolk County enforcement efforts will respond to calls about larger group gatherings, Bellone said police would use “common sense” and would not be “going door to door to check on the number of individuals in a house.”

As for the infection rates, the numbers continue to rise, returning to levels not seen in months.

“We expect our numbers [of positive tests] to be around 400 today,” Bellone said. The positivity rate is about 3.4 percent, while the number of people hospitalized with symptoms related to the virus approaching 100.

“We have not been above 100 since June 18,” Bellone said. In the last 24 hours, the number of people who have required hospitalization from the virus increased by 16.

While the virus has exhausted people physically and mentally, the county cannot “jeopardize our continued economic recovery” and the health of the population by stepping back from measures such as social distancing, mask wearing and hand washing that proved so effective in reducing the spread earlier this year, Bellone said.

“Now is the time to double down on common sense measures that work,” he added.

Some of the positive tests are coming from people in nursing homes, who are among the most vulnerable population.

“With the nursing homes, that is obviously a big concern,” Bellone said. The county is “making sure they have the PPE [personal protective equipment] they need.”

The Department of Health is staying in close contact with these facilities as cases continue to climb.

Bellone urged residents who dined at a Friendly’s restaurant in Riverhead on Nov. 5 or 6 to monitor their symptoms for the next two weeks. Six adults who worked at the restaurant have tested positive for the virus.

Anyone who is exhibiting symptoms of the virus, which include fever, a runny nose, lost of taste or smell, fatigue, shortness of breath, can find a testing site at suffolkcountyny.gov/covid19.

Separately, when asked about the possibility of schools closing in response to the increasing incidence of positive tests, Bellone urged schools to remain open at this testing level.

“We are not seeing the spread happening in the schools,” Bellone said. “The protocols being put in place and the execution in the schools has really worked.”

Stony Brook students performed self mouth swab COVID-19 tests before leaving for home. Photo by Julianne Mosher

Stony Brook students and faculty have been utilizing the campus’ quick, free saliva swab testing to stay clear of the Coronavirus before holiday break.

Stony Brook University student volunteers, from left, Elah Ginsburg, Patricia Indelicato and Emily Lam help test students before they leave for Thanksgiving. Photo by Julianne Mosher

Although students will not be returning to campus after the Thanksgiving holiday, the university began implementing swab testing sites on three parts of campus for commuter students, residents and faculty.

Earlier this month, Marisa Bisiani, assistant vice president for student health, wellness, and prevention services issued a message to students concerning COVID testing and the Thanksgiving holiday.

“We are committed to maintaining the health and safety of our campus community,” she said. “This includes requiring COVID testing for students who, like you, live off-campus, but may come to campus for an in-person class, work on campus or visit campus facilities.”

In accordance with SUNY policy, all commuter students must complete a COVID test within the 10-day period prior to the start of the break.

“As many COVID cases are asymptomatic, meaning you can be infected, and unknowingly and unintentionally spread the disease to others, we want you to know your health status before Thanksgiving to help keep you and your family safe,” she added.

Faculty and students who are on campus from Nov. 9 through Nov. 20 must get tested. If a student will not be on campus at that time, they must fill out an exemption form online.

After scheduling an appointment online, students are able to visit the Student Activity Center, the Health Sciences Center Galleria and for East End students, at the Stony Brook Southampton campus’ student center. There they receive a mouth swab and safely hand it over to the workers for testing. Results come back two to five days after the swab.

“We get over 150 tests done a day,” said Elah Ginsberg, a sophomore on campus who works at the testing site. “Yesterday we have 300 come by.”

The need for quick testing on campus began early last month, with new requirements that faculty, staff and commuter students to get checked for the virus.

“All commuters have to get their cheeks swabbed,” Emily Lam, a senior volunteer at the site, said. “I think it’s way safer and ensures that they’re healthy when they come to campus.”

Patricia Indelicato, health administration coordinator on campus, said she loves that this opportunity is so easily available. “It’s great and it’s helping to keep the community safe.”

Lauren Crennan, who works at the university’s undergraduate college, said that although it’s required for her to get tested, she doesn’t mind doing it one bit.

“I’m happy that they’re doing it,” she said. “It gives me a peace of mind and it’s an easy two-minute walk from my office.”

The head of pediatrics at Stony Brook Children's Hospital said current restrictions on daily life has not meant young people have not been exposed to normal childhood diseases. Stock photo

The school and day care mixing bowl of bacterial and viral illnesses has changed. As schools, day-care centers, clubs, sports teams and other organizations change the way they manage group gatherings amid the pandemic, the game of illness tag children seem to play has slowed.

“We are seeing potentially less viral illnesses thus far in the sense that we have not seen an increase yet in respiratory syncytial virus, or RSV,” said Christy Beneri, Associate Professor of Pediatrics and Program Director of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “We are still waiting to see what happens with the flu.”

The chance of children contracting some of those illnesses would likely be less this year amid the infection control measures to reduce the spread of COVID-19, the disease responsible for the pandemic.

Beneri said children are getting somewhat fewer infections, although doctors are still seeing strep throat, ear infections and pneumonia.

Viral-induced asthma visits have declined at Stony Brook. Children who have asthma are still seeking medical attention, particularly if their condition doesn’t have a viral trigger.

At the same time, the effects of social isolation, uncertainty about the future, and household anxiety has triggered an additional mental health burden, particularly for adolescents.

Pediatricians are “asking patients more about those issues,” she said. “We maybe didn’t ask as much as we should have in the past.”

Even though children generally have less contact with their contemporaries this year, they are still developing illnesses, as their immune system receives challenges from microbes through dirt, pet saliva and other sources.

The dynamic is “slightly different in terms of getting some of these viruses from other people, [but] there are still pathogens in their environment,” she said.

In the current environment, with positive tests for COVID-19 setting new national daily records, Beneri said it is important to practice infection control measures in certain settings, which will impact what children are exposed to over time.

The cultural shift from sending children who might have mild symptoms to school to keeping children home for the good of their fellow students and staff has helped reduce the spread of COVID and other potential infections.

“We’ve taken a step back from what makes sense not just for my child, but for others my child might be exposing,” Beneri said. The decision about whether to send a child who might be battling an illness, cold or minor discomfort to school “is not just about us. It’s about those in our communities and, hopefully, there’s a better recognition” about the impact an infected child can have.

Some of the infection control measures, such as hand hygiene and staying home when children are sick should continue even after companies start providing a COVID-19 vaccine.

At this point, with the virus still prevalent in the community and country, she said acute care visits are declining, as parents are managing at home and are watching and waiting to see how their children recover from any infection.

As a parent, Beneri is dealing with the disappointment and disruption of life in the pandemic for her seven-year-old daughter. Twice, the family has had to cancel a trip to Disney World and has scheduled it for a third time.

Once the worst of the pandemic passes and children get back together again, the pediatric program director said there might be an increase in certain infections, but that doesn’t necessarily mean the county will see horrific outbreaks.

With the approach of Thanksgiving and the December holidays, Beneri urges families to be creative about gatherings. She suggested that smaller groups might want to get together over two weekends, rather than all gathering at the same time.

As for advice to schools, Beneri urges people to remain mindful of their activities outside of school.

“It’d be a shame to have to close schools,” Beneri said.

Beneri added people can celebrate milestones like turning 16, but they should not have a 40-person event in the current environment.