For the first time since June 12, Suffolk County reported no deaths from COVID-19.
“I do hope and pray that it will not be another 17 days for me to be reporting zero deaths again,” County Executive Steve Bellone (D) said on his daily call with reporters. “Hopefully, this is the start of something we will continue to see.”
The total number of deaths from the virus in the county remained at 1,979.
The number of positive tests, meanwhile, was 33, bringing the total to 41,339. With 4,481 people receiving tests in the past day, the positive tests were among the lowest the county has had in weeks, at 0.7 percent.
The number of people who tested positive for the antibody who didn’t have a positive COVID-19 test was 19,074.
Hospitalizations continued to trend slightly lower. The number of people in the hospital overall fell by three to 72. The number of people in Intensive Care Units with COVID-19 also declined by three to 23.
Hospital bed occupancy was at 68 percent, down from 70 percent the day before. ICU bed occupancy was at 62 percent.
An additional 20 people were discharged from the hospital in the last day.
Separately, the county announced a plan, starting today, to walk back some protective measures put in place for Suffolk County Transit. In March, the county asked residents to use fast fare. Busses did not take cash, riders had to board from the back of the bus, and residents needed to leave the first few rows of the bus vacant to protect drivers.
Now that the county is in Phase 3, Suffolk County Transit has re-instituted front door boarding and will accept cash, even as it is encouraging riders to use the mobile app.
The county has provided protective barriers on all busses to keep the drivers safe from infection. Riders are still required to wear face coverings until further notice.
Finally, officers in the Third Precinct arrested Pablo Figuero, a convicted sex offender, last night at 10:20 pm. He was found in a parked car on Suffolk Avenue in Central Islip and was charged with Criminal Possession of a Controlled Substance in the 7th Degree. He was taken for arraignment today and will be held in jail. Bellone said he is wanted out of New Mexico.
Suffolk County continued to keep viral numbers low. The number of new cases in the last day was 53, bringing the total since the beginning of the COViD-19 epidemic to 41,306.
The number of people who have tested positive for the antibody was 18,970.
The hospitalization figures remained relatively flat. In hospitalizations as a whole, two people left the hospital. The total stands at 75.
The number of people in the Intensive Care Unit with the virus was 26, which is an increase of 1.
An additional 10 people were discharged from the hospital.
Capacity remained at safe levels, with hospital occupancy at 70 percent and ICU bed capacity at 63 percent.
One person died in the last day, bringing that total to 1,979.
GERD is a common condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. Stock photo
You may avoid medications by making simple changes
By David Dunaief, M.D.
Dr. David Dunaief
Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.
Reflux typically results in symptoms of heartburn and regurgitation, with stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (1). As such, it typically doesn’t require medical treatment.
Gastroesophageal reflux disease (GERD), on the other hand, differs in that it’s long-lasting and more serious, affecting as much as 28 percent of the U.S. population (2). Can you understand why pharmaceutical firms give it so much attention?
GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.
Smoking and Salt
One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.
Medications
The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on PPIs, for which more than 100 million prescriptions are written every year in the U.S. (6).
The most frequently prescribed PPIs include Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Prevacid (lansoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.
However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. However, maintenance therapy usually continues over many years.
Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (7).
Bacterial infection risks
The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (8).
B12 deficiencies
Suppressing hydrochloric acid produced in the stomach may result in malabsorption issues if turned off for long periods of time. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (9). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing possible supplementation with your physician if you have a deficiency.
Lifestyle modifications
A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (10). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). This was a prospective (forward-looking) trial. The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (11).
Obesity
In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (12). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.
Eating close to bedtime
Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. A study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (13). Therefore, it is best to not eat right before bed and to avoid “midnight snacks.”
Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first — and most effective — approach in many instances. Consult your physician before stopping PPIs, since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.
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.
County Executive Steve Bellone (D) reminded Suffolk County residents as they grapple with the mental health toll from the public health and economic crisis of the services that can help.
Residents can reach out to the Family Services League at FSL-LI.com. They can also call a hotline that is available 24 hours a day and seven days a week at (631) 952-3333.
Residents who know people who are struggling with their mental health or substance abuse that are exacerbated by COVID-19 should reach out to these services, Bellone urged.
As for the viral data, the numbers continued to move in a favorable direction for a region that is still recovering from the virus.
Over the last 24 hours, an additional 45 people tested positive, bringing the total to 41,253. These positive tests represented less than a percent of the total tests.
An additional 18,816 people tested positive for antibodies.
Hospitalizations remained steady, with one person leaving the Intensive Care Unit, bringing that total to 25.
Hospital occupancy was at 70 percent, while ICU occupancy was at 60 percent.
An additional three people died in the last 24 hours, bringing the total for the region to 1,978.
The county distributed 20,000 pieces of personal protective equipment in the last day.
Pierce Gardner, MD, Professor Emeritus at the Renaissance School of Medicine at Stony Brook University, is the recipient of the 2020 Dr. Charles Mérieux Award for Achievement in Vaccinology and Immunology from the National Foundation for Infectious Diseases (NFID). The award honors individuals whose outstanding lifetime contributions and achievements in the fight against vaccine-preventable diseases have led to significant improvement in public health.
Dr. Gardner’s career has centered on global health policy and training the next generation of public health providers to tackle health issues in low-resource countries. The Setauket resident has done extensive international work and has been a consultant for the World Health Organization, the Centers for Disease Control, and the Armed Forces Epidemiological Board (now the Defense Health Board). He served in many educational roles while at the Renaissance School of Medicine and remains instrumental in fostering students’ global health interests related to their career paths.
Previous recipients of this national award include luminaries in infectious diseases such as D.A. Henderson (who wiped out smallpox), Arnold Monto (a pioneer in influenza vaccine), and Kristin Nichol (a pioneer in pneumococcal vaccination).
As the number of COVID-19 infections and hospitalizations in other parts of the country, such as Florida and Texas, surge to levels that put a strain on the health care system, County Executive Steve Bellone (D) appreciates the difficult and hard-fought effort that has put the county on the other side of the deadly viral curve.
“The numbers that we have right now relative to where we’ve been… are really outstanding,” Bellone said on his daily conference call with reporters.
Bellone empathized with the challenges other states and counties faced.
“To see it happening to other places around the country, it’s a terrible thing,” Bellone said.
Bellone urged residents to follow the same “common sense” things they have been doing, including wearing face coverings when they can’t socially distance, staying home when they’re not feeling well and washing their hands and using hand sanitizer.
Indeed, the numbers for the county continued to be well within the limits, even as the county entered the third day of the Phase 3 reopening.
An additional 57 people tested positive for the coronavirus, bringing the total to 41,208 since the pandemic started. The total number of tests administered in the county was 5,076, which means positive tests were around 1.1 percent.
The number of people who tested positive for the antibody, who didn’t have a previous COVID-19 test, was 18,669.
Hospitalizations declined by eight to 77. The number of people in the Intensive Care Unit increased by one to 26.
Hospital capacity was at 68 percent overall and 58 percent in the ICU.
An additional 10 people were discharged from the hospitals.
One person died in the last 24 hours, bringing the total killed from complications related to COVID-19 to 1,975.
The county distributed 12,000 pieces of personal protective equipment over the last day.
Bellone urged residents to participate in the Veteran Run Series, which has raised about $1 million this year. The third race, the Michael P. Murphy run around the lake, is this Saturday Residents interested in running can register at sufflkcountyveteransrunseries.com.
County Executive Steve Bellone (D) was pleased that the county legislature passed the Child Protective Transformation Act this week.
Created after the death of eight-year old Thomas Valva, who died in his father’s garage from hypothermia, the package of six bills creates new measures to strengthen the child protective system, the improve oversight and to institute safeguards to protect children.
“This will ensure that [Child Protective Services] never operates the same way again,” Bellone said on his daily conference call with reporters. “What happened to Thomas Valva can never happen again.”
The transformation act, which passed in the legislature June 23, puts in place measures to make sure the CPS is operating as efficiently and effectively as possible, Bellone suggested.
Bellone thanked Suffolk County Legislator Kara Hahn (D-Setauket), Deputy County Executive Jon Kaiman and Deborah Thivierge, the Founder of the Elija School and the Elija farm for their help in this effort.
As for the viral figures, the numbers continue to remain within a safe range for the county.
The number of people who tested positive for COVID-19 in the last 24 hours was 50, bringing the total to 41,151. The percentage of people who tested positive for the coronavirus was 0.9 percent.
The number of people with the antibody to the virus stands at 18,513.
Hospitalizations declined by three to 85, while the number of people in Intensive Care Unit beds declined by one to 25.
Hospital occupancy overall was at 69 percent, while the percent of occupied ICU beds was at 59 percent.
In the last day, 14 people have been discharged from hospitals in the county.
The number of deaths from complications related to COVID-19 increased by 2 to 1,974.
The county distributed 25,000 pieces of personal protective equipment in the last day.
Separately, the county is canceling the movies scheduled for the rest of this week because of a problem with the equipment that needs repair. The county hopes to have those movies back up and running by next week.
Suffolk County has moved to Phase 3 of its economic reopening following a prolonged lockdown from COVID-19, as restaurants can offer limited seating dining and nail salons and tattoo parlors can reopen.
Additionally, the number of people that can gather together increased to 25 from 10.
For personal care and indoor dining, the maximum capacity is half of the pre-viral levels. Employees must be tested every two weeks at these establishments.
“It’s another huge step for all of us,” County Executive Steve Bellone (D) said on his daily conference call with reporters.
The viral numbers in the county continued to remain well below guidelines and limits.
The number of people testing positive for the virus was 45, bringing the total to 41,101.
The number of people hospitalized with the coronavirus declined by one through the 24 hour period ending on June 22, bringing that total to 88.
The number of people in the Intensive Care Unit with complications related to the virus decreased by two to 26.
The percent of hospital beds occupied was 64, while the percent of ICU beds in use was 60 percent.
The number of people who died from complications related to COVID-19 increased by two to 1,972.
Suffolk County distributed an additional 15,000 personal protective equipment in the last day, with much of that going to the police department and nursing homes.
Separately, Suffolk County is continuing its movie series, which kicked off this past weekend with the showing of “Jaws” on the 45th anniversary of the shark film’s debut.
Reservations are open starting today for “ET The Extra-Terrestrial,” which will be shown next Wednesday, July 1. Upcoming movies include “Willy Wonka and the Chocolate Factory” and “The Addams Family.”
After Governor Andrew Cuomo (D) indicated recently that Phase 4 reopening would exclude malls, movie theaters and gyms, Bellone said he is continuing to communicate with the state about these limits.
Bellone said he believes malls “can reopen with a limited capacity and requiring face coverings.” After looking at the Phase 3 data, he expects the state may reevaluate those guidelines to see what else can be reopened.
Dairy may not be as beneficial as we have been led to believe. Stock Photo
Does calcium really reduce risk?
By David Dunaief, M.D.
Dr. David Dunaief
The prevalence of osteoporosis and low bone mass increase dramatically as we age. According to the Centers for Disease Control, over 48 percent of those ages 65 and older in the U.S. are affected by low bone mass, and 16.4 percent by osteoporosis (1).
Why do we care? Because they may lead to increased risk of fracture and, subsequently, lower mobility, which may have significant quality of life impacts (2). That is what we know. But what about what we think we know?
For decades we have been told that if we want strong bones, we need to consume dairy. This has been drilled into our brains since we were toddlers. Dairy has calcium and is fortified with vitamin D, so it could only be helpful, right? Not necessarily.
The data is mixed, but studies indicate that dairy may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again, the data are mixed, but supplements may not be the answer for those who are not deficient.
Holes in the dairy paradigm
The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (3). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.
For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, 3 percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no increased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.
This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.
Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume up to three servings of dairy per day (4). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.
Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (5).
Calcium disappointments
Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (6).
The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not considered.
Vitamin D benefit
Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis involving 11 randomized controlled trials, vitamin D supplementation resulted in a reduction in fractures (7). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.
Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.
In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.
Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.
References:
(1) cdc.gov (2) JAMA. 2001;285:785-795. (3) BMJ 2014;349:g6015. (4) health.gov. (5) JAMA Pediatr. 2014;168(1):54-60. (6) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (7) N Engl J Med. 2012 Aug. 2;367(5):481.
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.
Officials celebrate the installation of a denitrifying septic system in Nesconset in 2015. Photo from Bellone’s office
County Executive Steve Bellone (D) has made two proposals to the legislators that he believes will protect taxpayers and environmental programs in the wake of the economic effects of COVID-19.
He would like to use two existing tax stabilization funds to mitigate the budgetary impact of the virus.
These proposals, which he would like to add as a referendum for voters in November, would “protect taxpayers and essential employees and 100 percent protect environmental programs,” Bellone said on his daily conference call with reporters. “Any legislator who votes no on this legislation is only making layoffs more likely to occur.”
He urged legislators to give taxpayers the option of voting for these proposals, which he suggests will protect taxpayers, employees and environmental programs.
In addition, Bellone said he appreciated the efforts of U.S. Reps Tom Suozzi (D-NY-3) and Lee Zeldin (R-NY-1) to reverse the effect of an Internal Revenue Service ruling that taxes homeowners who participate in a septic improvement program, which was designed to protect Suffolk County’s waterways.
Suffolk County residents “care about clean water,” Bellone said. “These individuals should not be liable to pay taxes on grant money that never even touches their hands.”
The county executive applauded people who move beyond earlier versions of wastewater treatment systems, which, he said, “degraded” water quality and represented a mounting threat.
Separately, the county has no plans to provide any fireworks for the 4th of July celebration. Belone said some local municipalities have considered such an option.
Amid concerns about the illegal use of fireworks, Suffolk County Police Commissioner Geraldine Hart said the police have made two arrests to date and will be providing a public service announcement regarding fireworks and the dangers involved.
Residents who see or hear illegal fireworks, which can lead to injuries, fires or cause other damage, can call crime stoppers at (800) 220-TIPS.
“We want people to enjoy themselves,” Bellone said. “These fireworks are dangerous. The best thing you can do is to leave fireworks to the experts.”
As the county prepares to move into Phase 3 of its reopening tomorrow, Bellone called the continued reopening, which is occurring two weeks after the start of Phase 2, a “big milestone for us.”
Bellone will continue to monitor the viral figures that come out of upstate New York, where several counties are entering phase 4, to get an indication of whether the next phase of reopening could begin two weeks from now.
Viral Numbers
Even as other states, such as Florida, Texas and Arizona are encountering a surge in cases and hospitalizations, Suffolk County continues to move down the infection curve.
In the last 24 hours, an additional 46 people have tested positive for the coronavirus. That is a positive rate of 1.3 percent among those tested, which is above recent trends but still well below rates during the worst of the pandemic on Long Island. The number of people who have tested positive for the virus is now 41,056.
The number of people who have tested positive for antibodies to the virus stands at 18,188. These are people who didn’t have a COVID-19 positive result, but whose bodies have produced antibodies.
Hospitalizations declined by one to 89. People with COVID-19 in the Intensive Care Unit increased by one to 28.
Hospital capacity remained well below guidelines, with hospital beds and ICU beds at 63 percent and 60 percent capacity, respectively.
An additional six people were discharged from the hospital over the previous day.
Meanwhile, the number of people who died from complications related to COVID-19 increased by five to 1,970. During each of the previous four days, one person died each day from the virus.
The county distributed 4,000 pieces of personal protective equipment over the previous day.
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