Health

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Focus on reducing pain and improving mobility

By David Dunaief, M.D.

Dr. David Dunaief

Osteoarthritis has been diagnosed in over 54 million Americans, with 43.5 percent of them reporting symptoms that limit their activities and significantly impact their quality of life (1). Historically, the disorder was thought to be solely a wear-and-tear degeneration of the joint(s). However, Osteoarthritis (OA) also involves inflammation with the release of cytokines and prostaglandins — inflammatory factors — which cause joint destruction and pain (2).

The joints most commonly affected include the ankle, knee, hip, spine and hand. OA may affect joints asymmetrically, meaning that it affects a joint on only one side of the body.

Mainstays of treatment include analgesics and COX-2 inhibitors (Celebrex). Common analgesics used are acetaminophen and NSAIDs, such as ibuprofen (Advil), naproxen sodium (Aleve). A benefit of NSAIDs is that they have anti-inflammatory effects. Meanwhile, COX-2 inhibitors may also improve joint mobility.

There are adverse effects with NSAIDs, including increased gastrointestinal (or GI) bleed and, with long-term use, an increase in cardiovascular events, such as heart attacks, with the elderly being most susceptible.

Neither medication type, however, structurally modifies the joints. In other words, they may not slow OA’s progression nor rebuild cartilage or the joint space as a whole. Are there therapies that can accomplish these feats and, if so, what are they? We will look at hyaluronic acid, glucosamine and chondroitin, and lifestyle modifications such as exercise and weight loss.

Chondroitin sulfate beneficial for hand OA

The results with the use of glucosamine and chondroitin have been mixed, depending on the joints affected. In the FACTS trial, a randomized controlled trial, chondroitin sulfate by itself showed significant improvement in pain and function with OA of the hand (3). The dose of chondroitin used in the study was 800 mg once a day. The patients, all of whom were symptomatic at the trial’s start, also saw the duration of their morning stiffness shorten.

There was also a modest reduction in structural damage of hand joints after three months, compared to placebo. The benefit was seen with prescription chondroitin sulfate, so over-the-counter supplements may not work the same way. Patients were allowed to use acetaminophen, and there was no change in dose or frequency throughout the trial.

Crystalline glucosamine sulfate

In knee OA, crystalline glucosamine sulfate showed reduction in pain and improvement in functioning in a randomized controlled trial (4). When assessed by radiologic findings, it also slowed the progression of structural damage to the knee joint. In other words, the therapy may have disease-modifying effects over the long term. The glucosamine formulation may work by inhibiting inflammatory factors such as NF-kB. The trial used 1500 mg of prescription crystalline glucosamine sulfate over a three-year period. Again, it’s not clear whether an over-the-counter supplement works the same way.

Glucosamine and/or chondroitin for knee OA

In a meta-analysis (group of 10 studies), glucosamine, chondroitin or the combination did not show beneficial effects — reduced pain or mobility changes — in patients when compared to placebo (5). It was not clear whether supplemental or prescription-level therapies were used in each trial — or whether that makes a difference. This study was published prior to the crystalline glucosamine sulfate trial of the knee, discussed above, which did show statistical significance.

There is not much downside to using glucosamine and/or chondroitin for OA patients. However, use caution if taking an anticoagulant (blood thinner) like Coumadin, since glucosamine has anticoagulant effects. Also, those with shellfish allergies should not use glucosamine. If there is no effect within three months, it is unlikely that glucosamine and/or chondroitin are beneficial.

Hyaluronic acid

In a meta-analysis (a group of 89 trials), the risks outweighed the benefit of hyaluronic acid, a drug injected into the joint for the treatment of OA (6). Viscosupplementation involves a combination of hyaluronic acid types that act as a shock absorber and lubricant for the joints. Some of the studies did show a clinical benefit. However, the authors believe that adverse local events, which occurred in 30 to 50 percent of patients, and serious adverse events, with 14 trials showing a 41 percent increased risk, outweigh the benefits. Since there are mixed results with the trials, it is best to discuss this option with your physician.

Impact of weight loss and exercise

Obesity treatment with a weight-loss program actually has potential disease-modifying affects with OA (7). It may prevent cartilage loss in the medial aspect of the knee. The good news is that, even with as little as a seven percent weight loss in the obese patient, these results were still observed. The study’s average weight loss was nine to 10 pounds, and results were seen on a dose-response curve — the greater the weight loss, the thicker the knee cartilage.

Writing in The New England Journal of Medicine, Dr. David Felson observed there is an inverse relationship between the amount of muscle-strengthening exercise, especially of the quadriceps, and the amount of pain experienced in the knee joint. It is very important to do nonimpact exercises such as leg raises, squats, swimming, bicycling and on elliptical machines.

Fortunately, there are a number of options to prevent, treat and potentially modify the effects of OA. With weight loss in the obese patient, quality of life can dramatically increased. Glucosamine and/or chondroitin may be of benefit, depending on the joints affected. The benefits are potential improvements in pain, mobility and structural-modifying effects, which are worth the risk for many patients. When taking glucosamine and/or chondroitin in supplement form, ConsumerLab.com may be a good source for finding a supplement where you get the dose claimed on the box. I would also use formulations in the trials that showed results, even in supplement form.

References:

(1) MMWR Morb Mortal Wkly Rep. 2017 Mar 10;66(9):246-253. (2) Rheumatology. 2011;50(12):2157-2165. (3) Arthritis Rheum. 2011 Nov;63(11):3383-91. (4) Ther Adv Musculoskel Dis. 2012;4(3):167-180. (5) BMJ. 2010;341:c4675. (6) Ann Intern Med. 2012;157(3):180-191. (7) Ann Rheum Dis. 2012;71(1):26-32.

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.

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Get a flu shot now. 

While timing a flu shot can seem like timing the stock market — buying or selling a stock now might mean missing out on gains later — it’s not. A flu shot generally provides immunological coverage against the flu from about four weeks after the shot until six months later.

With a flu season that doesn’t follow a yearly calendar, residents sometimes try to balance between minimizing the possible effect of exposure to the flu in the next few weeks with exposure to the flu in the middle of the spring.

“It makes most health professionals very uncomfortable when people [suggest holding off on protection through the spring] as a reason to delay immunization, as it takes four weeks for protective antibodies to mature,” said Michael Grosso, Chief Medical Officer at Huntington Hospital. Influenza season can begin as early as November and sometimes earlier, so “any time now would be the right time.”

Medical professionals urged people to be even more proactive about getting a flu shot this year, as the pandemic continues to lurk in the shadows, on door knobs, and within six feet of an infected individual.

When people contract the flu along with other respiratory illnesses, the combination, as people might expect, can cause significant sickness.

“The novel coronavirus is just that, it’s novel,” Grosso said. “We don’t know exactly how it will interact with influenza. We do have significant prior experience with concurrent infections with other respiratory viruses. Individuals coinfected with one or more serious respiratory viruses frequently get sicker.”

That’s the case for both children and adults, Grosso added.

Getting an influenza vaccine could also reduce the confusion that will occur if people experience flu-like symptoms, which are also a hallmark of COVID-19 cases.

“Getting as much of the population immunized as possible is even more important than at other times,” Grosso said.

Each year, somewhere between 150,000 to 180,000 people are hospitalized from the flu and the death toll can range between 12,000 to 61,000 people per year in the U.S.

Doctors recommended that people who are 65 and older get a quadrivalent flu shot, which includes an additional influenza B strain.

In a trial of 30,000 people over 65, people who received the quadrivalent shot had 24% fewer illnesses compared to those who got the standard shot, according to the Centers for Disease Control and Prevention.

Susan Donelan, Medical Director of Healthcare Epidemiology at Stony Brook Medicine, said the side effects of the flu shot include an uncomfortable arm for a few days, a low grade fever and fatigue.

“The vast majority of people can easily manage the minor side effects for a day or two with Tylenol or Ibuprofen or a cold pack on their arm,” Dr. Donelan said.

Doctors said practices such as wearing a mask, social distancing and frequent hand washing, which are designed to reduce the spread of COVID-19, are also helpful in cutting down on the transmission of the flu.

Those measures will only help if residents exercise them correctly. Masks that fall below the nose of the wearer, which may make it easier to breathe, are not as effective at reducing the spread of these viruses, Dr. Donelan said.

 

While there have been no reported cases on Long Island, five people in Connecticut recently were infected with flesh-eating bacteria. File photo

With reports of five people who have been infected with flesh-eating bacteria across the Long Island Sound in Connecticut, area doctors answered questions about the dangerous pathogen.

For starters, the bacteria in Connecticut is called Vibrio vulnificus, and even though it’s extremely rare, it is especially problematic for people who have open wounds and have gone swimming in warm, salty or brackish — a combination of fresh and salty — waters.

Smaller cuts aren’t as much of a likely entry point for these bacteria, but open wounds such as skinned knees or elbows are, said Dr. Sharon Nachman, chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.

Those residents with open wounds who have swum in salty or brackish water can lower the risk of infection by washing their wounds with soap and freshwater soon after coming out of the water.

“Soap and water work,” Nachman said. “If you have no access to soap, regular water would be great.”

Vibrio is a rapidly spreading bacteria and is often visible soon after swimming.

“If you swim and you have an open wound and it looks different an hour or two after you get home than it did that morning, seek medical attention quickly,” Nachman advised.

The wound tends to get hot, is tender and red, and makes people who contract the bacteria feel sick. Getting ahead of the spread is particularly important.

Residents who are concerned that their wound might be changing can take a picture of the area and then, an hour later, compare that picture to how the injury looked.

While everyone doesn’t need to race to an emergency room for a possible wound that may look different after a swim, Nachman suggested people approach possible exposure with “thoughtful concern.”

An untreated infection can become much more serious, sometimes leading to amputations and even death. The five Connecticut cases haven’t involved any such dire developments.

Residents whose wounds appear to have a Vibrio infection typically receive at least two antibiotics either orally or intravenously. Some other pathogens in the water also can look as bad as Vibrio, but they need different antibiotics, which include Aeromonas. These other bacteria also find their way into bodies through open wounds and can cause rapidly progressing infections.

“When you go to the hospital, [medical personnel] may say that it looks like one of these [bacteria], and we are going to give you two to three antibiotics and see what happens,” Nachman said.

Once the medical staff determines the cause of the infection, they will likely cut the antibiotics back to the one that’s more effective for that specific bacteria.

With fewer people on the beach as school has restarted and people are engaged in more fall activities, potential infections from Vibrio have decreased.

While antibiotics are effective, they take time to beat back the bacteria.

With over 25 years in practice, Nachman has seen several cases of children who have contracted Vibrio. The children have been very sick, but have recovered.

People who have certain conditions can be more vulnerable to Vibrio, including people who have diabetes, are obese, or have heart or kidney problems.

Vibrio typically appears through wastewater. Shellfish, which are filter feeders, effectively clean the water. Warmer temperatures, however, or a big storm can cause shellfish beds to get upended, where pathogens might be dumped back into the water.

For more information, visit www.cdc.gov/vibrio/wounds.

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The statue of St. Charles outside the hospital. Photo by Marilyn Fabbricante

So much attention has been paid to the people who come down with COVID-19, the inability to breath, being put on a ventilator and the struggle to deal with the massive influx of patients seen just a few short months ago. 

Laura Beck, the VP of rehab at St. Charles, says they have taken what they learned from other rehab programs and used them for COVID patients. Photo from St. Charles

However, not nearly as much focus has been paid to those who struggled and survived the ordeal, particularly those with lasting health impacts.

That’s something St. Charles Hospital is trying to rectify with a new Post COVID Rehabilitation Program, which offers physical therapy for those who are still feeling the health impacts of living with the virus.

The rehab program officially started Sept. 7, and currently has two people starting their recovery. Hospital rehab officials said they are hosting evaluations with more people to initiate them into the group setting.

Laura Beck, St. Charles’ vice president of rehabilitation, said there is very little available data that discusses exactly what are the health impacts of people after they’ve already suffered through the virus, but anecdotally, people have described profound muscle weakness, joint pain and many issues with patients’ ability to breath, even long after they have come off a ventilator. One study, published in the Journal of the American Medical Association back in July, showed that close to 87% of hospitalized COVID patients reported lingering symptoms for two months or more after the fact.

Building off the rehabilitation program the hospital has for pulmonary patients, St. Charles has designed the new COVID rehab with the same mindset.

“The most frequently reported symptom that does exist is shortness of breath and fatigue, followed by joint pain,” she said. “All three of those things are frequently addressed by physical therapy, and were commonly addressed in our pulmonary rehab program. We had the staff and experience to address these things.”

Post-COVID patients are given an initial evaluation and then are put into a group setting to be treated by a physical therapist, similar to what St. Charles does in other rehab settings. Toward the end of each patients’ time they are given another quality of life assessment as well as an endurance test to see how much they improve physically. 

A few outpatient care facilities have launched post-COVID rehabilitation, but St. Charles is one of the first major hospitals on Long Island to offer an in-house clinic in a traditional group setting. 

How many physical therapists eventually get involved depends on how large the program becomes. Currently the class size is kept small to try and space people out and adhere to social distancing. For patients that cannot tolerate a group program, Beck said they do plan to offer a more one-on-one situation until they can be put into the full exercise class.

Director of St. Charles’s Rehabilitation Services Pattianne Ruppel said most likely people who are feeling lasting effects of COVID are older, though that’s not always the case. Those who were young and/or asymptomatic likely wouldn’t feel any lasting symptoms. 

Because so little is known about what are the true lasting health effects from being crippled by the coronavirus, the St. Charles officials in charge of rehabilitation said this is also a chance to start gathering data on what is common amongst post-COVID patients. If they get enough people in the program, the St. Charles officials said they could even look to put out their own information.

“We would all love to say that some time in the future we won’t need this program,” Ruppel said. “We still see people with these lasting respiratory symptoms, so I definitely see a need for sure.”

Watching four or more hours of television has shown to cause an increased risk of cardiovascular disease mortality of 80 percent. METRO photo
Expanded viewing habits have effects on your physical and mental health

By David Dunaief, M.D.

Dr. David Dunaief

Comcast, one of America’s largest cable and internet providers, reported in May that Americans were watching an additional 8-plus hours of programming a week, whether on a television, computer or a portable device since the pandemic’s beginning (1). For our purposes, we’ll call this TV, because most is consumed while sitting, although the average watching modality has shifted considerably.

What impact does all this watching have on our lives? It may be hazardous to your health. I know this seems obvious, but bear with me. The extent of the effect is surprising. According to 2013 Netflix research, binge-watching, or watching more two or more episodes of a single program in a row, is perceived as providing a refuge from our busy lives.

This also has an addictive effect, prompting dopamine surges as we watch. Interestingly, it also can lead to post-binge depression when a show ends and to isolation and lower social interaction while viewing (2). Of course, while socially isolating, binge watching can help kill hours, but the negative effects are still relevant.

TV’s detrimental effect extends beyond the psychological, potentially increasing the risk of heart attacks, diabetes, depression, obesity and even decreasing or stunting longevity. My mother was right when she discouraged us from watching television, but I don’t think even she knew the extent of its impact.

Cardiovascular events including heart attacks

There was a very interesting observational study published in the New England Journal of Medicine that showed watching sporting events increases the risk of heart attacks and other cardiovascular events, such as arrhythmia (irregular heartbeat) and unstable angina (severe chest pain ultimately due to lack of oxygen). The researchers followed Germans who watched the FIFA (soccer) World Cup playoffs in 1996.

How much did watching increase the risk of cardiovascular events? This depended on what round of the playoffs and how close a game it was. The later the round and the closer the game, the greater the risk of cardiovascular events. Knockout games, which were single elimination, seemed to have the greatest impact on cardiovascular risk.

When Germany was knocked out in the semi-finals, the finals between France and Italy did not have any cardiovascular effect.

Overall, men experienced a greater than three-fold increase in risk, while women experienced an increased risk that was slightly below two-fold. According to the authors, it was not the outcome of the game that mattered most, but the intensity. The study population involved 4,279 German residents in and around the Munich area (3).

Another study found that, compared to fewer than two hours a day, those who watched four or more hours experienced an increased risk of cardiovascular disease mortality of 80 percent. I know this sounds like a lot of TV, but the average daily American viewing time is significantly over this. This study, called the Australian Diabetes, Obesity, and Lifestyle study (AusDiab) was observational looking at 8800 adults over a six-year period (4).

Impact on Life Expectancy

The adage that life tends to pass you by when you watch TV has a literal component. An observational study found that TV may reduce the life expectancy of viewers. In the study, those who watched at least six hours per day during their lifetime had a decrease in longevity of 4.8 years. However, this is not the whole story. What is even more telling is that after the age of 25, for every hour of TV, one might expect to potentially lose 21.8 minutes of life expectancy (5). According to the authors, these results rival those for obesity and sedentary lifestyles.

Diabetes and Obesity Risk

In the Nurses’ Health Study, for every two hours of television viewing on a daily basis there were increased risks of type 2 diabetes and obesity of 23 percent and 14 percent, respectively (6). The results show that sitting at work for two hours at time increased the risk of diabetes and obesity by only five percent and seven percent respectively, much less of an effect than TV-watching. The authors surmise that we can reduce the incidence of diabetes and obesity by 43 percent and 30 percent by cutting our TV time by 10 hours a week.

Modestly reducing the amount of television is a simple lifestyle modification that can have a tremendous impact on longevity, quality of life and prevention of the top chronic disease. So, step away from your television, tablet or computer and take a walk outside, do some calisthenics, or even take up a new hobby that doesn’t involve sitting on the couch. Your body and your psyche will thank you.

References:

(1) corporate.comcast.com (2) nbcnews.com/better/health/what-happens-your-brain-when-you-binge-watch-tv-series-ncna816991. (3) N Engl J Med 2008; 358:475-483. (4) Circulation. 2010 Jan 26;121(3):384-91. (5) Br J Sports Med doi:10.1136/bjsm.2011.085662. (6) JAMA. 2003 Apr 9;289(14):1785-91.

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.

Photo from SBU

The coronavirus pandemic is a time like no other in U.S. history. The virus, which hit the New York area particularly hard, had Stony Brook University and Stony Brook University Hospital on high alert for months on end.

The hospital not only saw the heroic actions of doctors and nurses already on Stony Brook Medicine’s staff, but was also assisted by visiting nurses; medical students who graduated early to help fight on the frontlines; doctors and researchers jumping on ways to find a possible cure as quickly as possible; and essential workers who played an integral role in ensuring every process and procedure ran as smoothly as possible.

Students on the Stony Brook University campus during the Fall 2020 semester are wearing masks as a precaution against COVID-19 spread. Photo from SBU

On the University’s main campus, 3-D shields were printed as a PPE shortage was looming; hand sanitizer was created by several chemists in the Chemistry laboratory; and a prototype of a respirator was put together by a team from the College of Engineering and Applied Sciences which could be assembled quickly and used if necessary.

Now, Stony Brook University Libraries has announced the development of “Documenting COVID-19: Stony Brook University Experiences,” a new digital archive project established to collect, preserve, and publish the institutional history of Stony Brook University during this unprecedented moment in history.

“The archive will primarily be formed from submissions received directly from students, faculty, staff, and alumni that document life during the COVID-19 pandemic. Interviews, first-hand accounts, flyers, photographs, and more will be important sources to consult in the future to study, interpret, and derive meaning from this historic time period,” said Kristen Nyitray, University Archivist and Director of Special Collections and University Archives at Stony Brook University.

All from the Stony Brook University community are invited to contribute to the archive by submitting content or participating in an interview via a dedicated web page, “Documenting COVID-19: Stony Brook University Experiences” from which the library project team will collect information, photos, videos, personal stories and other COVID-19 related information.

For more information, visit www.library.stonybrook.edu/special-library-initiatives/documenting-covid-19/.

*Update* On Sunday, the Port Jefferson School District updated parents saying that after the middle school student was determined as positive for COVID, the Department of Health has quarantined a number of other students and staff who were determined to be in contact with the individual. All the individuals have been notified by the district.

The Department of health has determined students are cleared to return to the building on Monday. Staff not made to quarantine are supposed to report Monday as well as the students scheduled to be in school for learning that day. 

“The situation today is a reminder about the importance of social distancing,” said Superintendent Jessica Schmettan in a letter to parents. “The community needs to remain vigilant to avoid closures in the future.”

Original Story

The evening of Friday, Sept. 18, both the Rocky Point and Port Jefferson school districts reported positive COVID cases among a single student each.

Rocky Point Superintendent Scott O’Brien wrote in a letter to parents Sept. 18 that a student at the high school had tested positive for COVID-19. The district said they were in contact with the Suffolk County Department of Health, and “all appropriate areas are being cleaned and disinfected over the weekend.” The school is planned to reopen Monday to follow the school’s hybrid schedule.

“As per the Suffolk County Department of Health, the individual who has tested positive for COVID-19 was last in the building Thursday, Sept. 17 and will not be allowed to return to school for at least 10 days after a negative test result has been provided to the district,” the school’s statement read.

The district is assisting the county DOH in contact tracing. Those contacted by the DOH will need to remain quarantined for 14 days from last exposure to the individual.

PJSD

Following another case Monday where Port Jefferson School District officials said an elementary student had tested positive, the district again sent a message to parents Friday saying that, after dismissal, the district was notified a middle school student had tested positive.

“We have been in contact with the Department of Health and have begun contact tracing procedures,” the district said in its notice to parents. “Students or staff members that were in contact with this student will receive a separate correspondence and a possible quarantine from the Department of Health.”

The district asked that people be mindful of their interactions with people as the investigation by the DOH is ongoing. The district said it will update parents of any further details once they recieve more guidance from the department of health.

Doctor Says People Can Be Impacted by Califorinia Fires as Far as Long Island

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Scenes of the ash and smog from wildfires in the West Coast not only trigger sympathy for those with friends and family living in a paradise under siege, but also are a cause for concern for doctors who specialize in the lungs.

Dr. Norman Edelman. Photo from SBU

While doctors don’t know how far and wide the effects of these fires might be for those who are already struggling with their breathing, such as people with asthma, chronic obstructive pulmonary disease or chronic bronchitis, physicians said the effect could spread well beyond the areas battling these blazes.

The danger is “not just at the site of the fire,” said Dr. Norman Edelman, a professor of medicine at Stony Brook University and a core member of the program in public health at Stony Brook. “I’m sure [the effect of the fire] is pretty wide.”

Indeed, at some point down the road, the small and large particles that are aerosolized during the fire could reach as far away as Long Island.

“We know quite firmly that air pollution from coal burning generator plants [in the Midwest] emits pollution that makes its way all the way to the East Coast,” Edelman said.

The current use of masks may offer some protection for residents on the West Coast.

Particulates, which are aerosolized particles that can get in people’s lungs and affect their breathing, come in various sizes. The larger ones tend to get lodged in people’s noses, throat and eyes and can cause coughing, hacking, and watery eyes. An ordinary mask can filter some of those out, although masks are not completely effective for these bigger particles.

The smaller ones are more dangerous, Edelman said. They can get further into the lungs and can exacerbate asthma, chronic bronchitis and emphysema. They can even contribute to increased incidence of heart attacks.

“Nobody really knows” why these smaller particles contribute to heart attacks, Edelman said. Anecdotal evidence suggests that a reduction in pollution improves the health of a population.

When New York banned smoking in all public places, the level of heart attacks dropped by 15 to 20 percent.

“This level of pollution is nothing like what we’re seeing in the area of the wildfires,” Edelman said.

Additionally, lower pollution can improve the health of people with lung problems.

At the Summer Olympics in Atlanta in 1996, officials put in alternate day driving restrictions, which allowed people to drive every other day. By cutting down the pollution from traffic, doctors noticed a 25% reduction in admission to the emergency room for asthma.

If he were a doctor on the West Coast, Edelman said he would make sure his patients had all their medications renewed and available. He would also check in with his patients to make sure they had emergency instructions in case they need to boost the amount of any pharmacological agents.

The effect of the pollutants on people with asthma or other lung issues can be more severe if they are already dealing with an inflamed airway.

“The effects of various irritants are probably synergistic,” Edelman said. “If this is your allergy season, you become much more susceptible to the inflammatory effects of air pollution.”

COVID and the Lungs

As for the pandemic, Edelman said he didn’t come to the emergency room to work at the Intensive Care Unit during the pandemic.

His colleagues did, however, ask him to take care of patients who didn’t have to come in by telehealth. He’s continued to see many patients over the last three or four months.

One surprise from the data he’s seen related to the pandemic is that asthma does not seem to exacerbate the effects of COVID-19.

People with asthma “are not dying with COVID at any greater rate than the general population,” Edelman said.

He hasn’t yet seen the data for people with chronic bronchitis or COPD.

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State Dashboard Shows Comsewogue HS With Two Positive Tests, But District Says Not to Worry

PJSD said the Edna Louise Spear Elementary School has been temporarily closed and all students moved online after on student was tested positive. Photo from Google maps

*Update* The night of Sept. 16, Port Jeff Superintendent Jessica Schmettan released a follow up letter about the student who was confirmed positive. She said the elementary school was “thoroughly” cleaned after the district received the news. The New York State Department of Health interviewed the family and district, and has since advised the district that classrooms are cleared to reopen, saying the student was not infectious while on school grounds.

Students who had close contact with the student have been contacted, and contact tracing is underway. 

“The situation today is a reminder about the importance of social distancing, the use of masks, and proper hygiene,” Schmettan said in the letter. “The community needs to remain vigilant in order to avoid closures in the future.”

Original story:

Parents in the Port Jefferson School District received a message Wednesday morning saying a student was tested positive for COVID-19 and that the Edna Louise Spear Elementary School would be closed for the meantime.

“This morning the Port Jefferson School District was notified that a student at the elementary school tested positive for COVID-19,” Superintendent Jessica Schmettan wrote in a message to district parents shared with TBR News Media. “Following our procedures and protocols and guidance from the [New York State] Department of Health, the elementary school is closed today for distance learning.”

The district added they will be conducting contact tracing and disinfecting the elementary school. Parents will be updated as the situation develops.

As of Sept. 15, Comsewogue High School has been listed by the New York State dashboard as having two positive cases in the Comsewogue High School. 

Comsewogue Superintendent Jennifer Quinn described the situation as two siblings who had tested positive for COVID in another country, though she said the name of the country was not released for fear of the students being outed to their peers. They were cleared by the New York State Department of Health to come back to school, though while in school another test taken in the states came back positive.

Quinn said the Department of Health was aware of the situation, and health officials told the district the two students were likely positive because of the viral load still in the body, though they were not infectious. Both students have volunteered to stay home in the mean time.

 

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Dr. Nick Fitterman said they wouldn't necessarily endorse a COVID-19 vaccine immediately without first getting all the information. Photo from Huntington Hospital

Huntington Hospital won’t automatically endorse a COVID-19 vaccine, even if it receives approval from the federal government.

The hospital plans to evaluate the data from the vaccine’s phase 3 trials to ensure that the vaccine is safe and effective.

“We’ll see if things are starting to uptick long before it’s more obvious to the public.”

— Nick Fitterman

“It’s part of our oath, ‘Do no harm,’” said Dr. Nick Fitterman, executive director at Huntington Hospital. “If we don’t think the safety is there, I will scream it from the rooftops. It has to be a combination of safety and efficacy.”

Fitterman said at least seven vaccines are in phase 3 trials, with over 250 experimental vaccines in the works in total.

Fitterman was pleased to see that nine vaccine makers signed a pledge to uphold medical standards and not succumb to governmental pressure for rapid approval.

At this point, Fitterman would only take a vaccine after publication of the evidence from the clinical trials.

Once he is convinced that a vaccine is safe and effective, he said he would feel an urgency to take it as a health care worker.

“If you take care of people who are high risk, you’re going to need to take it,” Fitterman said.

The hospital would likely have the same policy for a COVID vaccine that it does for a flu vaccination: if workers choose not to get a vaccine, they will be required to wear a mask.

For the flu, hospital workers with purple badges on their name tags have had a flu shot.

At this point, it is unclear how long a COVID-19 vaccination might provide potential protection. Like tetanus or mumps, no vaccine wards off infection indefinitely, which means people will likely require boosters.

“I’m more worried about people getting complacent because they have been vaccinated,” Fitterman said.

Years down the road, the virus could return.

Asked whether those people who have antibodies for the virus would need a vaccine, Fitterman highlighted a recent case in Hong Kong. Published in the journal Lancet, doctors shared the story of one patient who contracted COVID-19 and then tested positive again.

The virus currently has several strains, so a vaccine might provide greater protection than natural antibodies against a single type of COVID-19.

The man who contracted the virus twice had antibodies that “didn’t protect him from another infection,” but he did not have any symptoms during the second positive test.

An infection in which a person develops antibodies could “protect you from the disease, but it doesn’t [necessarily] protect you from getting infected again,” Fitterman said.

A health care worker in particular would benefit from a vaccine that prevented infection from numerous strains to prevent that worker from spreading a disease to which he or she would likely be exposed during the course of any increase in cases.

With the possibility of a second wave of COVID-19 overlapping with the flu, Fittterman strongly urged residents to get a flu shot, which would help prevent the virus from overwhelming a health care system that might again face an influx of hospitalizations from the coronavirus.

“It’s part of our oath, ‘Do no harm.'”

— Nick Fitterman

Huntington Hospital recently started making the flu vaccine available to frontline workers and urged people to get flu shots this month. He reminded people that the vaccine only works two weeks after an injection after the immune system has had a chance to recognize the virus.

Fitterman is encouraged by the range of current vaccines in trials for COVID-19, including those that use messenger RNA.

Fitterman said Huntington Hospital is prepared for a potential second wave of COVID-19. He monitors the data every day.

“We’ll see if things are starting to uptick long before it’s more obvious to the public,” Fitterman said.

As a part of Northwell Health, Huntington Hospital has stockpiled personal protective equipment. Northwell also gave Huntington $4 million to be prepared, which includes having more ventilators, dialysis machines, and negative pressure rooms ready. Huntington can handle 10% more than the number of patients who needed medical help in the spring.

“We are beyond ready [but we] hope we don’t have to exercise any of that,” Fitterman said.

Fitterman urged those people who need other hospital services, such as cancer screenings, to come to the hospital.

When the spring surge for COVID-19 occurred, the hospital told people who were dealing with nonemergency situations not to come to the hospital because they needed the beds, and not because they felt patients would be exposed to the virus.

Indeed, after the viral numbers declined, the hospital tested its staff for the presence of the antibodies. They found that 9% of the staff had antibodies to the virus, which is below the 14% for the surrounding community.

“What we did works,” Fitterman said, which included PPE and procedures to protect the staff. The hospital is a “safe place to be,” he said.

In monitoring the daily changes in infection in Suffolk County, Fitterman said positive tests have been rising and falling during the last few weeks. So far, he has not seen an increase in hospitalizations.

“Our numbers continue to go down,” Fitterman said, as the hospital had three people with COVID-19 as of Sept. 8.