Even as public health information in other areas of the country are climbing at alarming rates, threatening to create a strain on health care on other health care systems that is all too familiar to Long Islanders, the COVID-19-related numbers have remained low enough to keep Suffolk County on track for a Phase Three reopening this Wednesday.
Phase Three will allow for indoor dining at restaurants, for groups of about 30 to convene and for more personal care businesses, like massage parlors and spas, to reopen with limitations on capacity, occupancy and services.
The number of people who have tested positive for the coronavirus was 44, which brings the total to 40,908. The percentage of people testing positive was at 1 percent.
The number of people who have tested positive for the antibody is 17,833.
The number of people afflicted with COVID-19 in the hospital fell by four to 106. The number of people in the Intensive Care Unit increased by two to 31.
For the second day in a row, one person died from complications related to COVID-19, bringing the total to 1,963.
Many Illnesses Carried by Ticks Share Symptoms with COVID-19
A deer tick is a common type of tick on Long Island. Stock photo
With summer close by and as New York State continues to relax shutdown restrictions, residents will naturally want to get some fresh air. But while open spaces like parks and nature preserves provide a temporary reprieve from the COVID-19 pandemic, they are also home to ticks. These arachnids can carry Lyme disease and other serious tick-borne illnesses. Experts say this is the time when ticks are most active and when their numbers increase.
“We have already passed a month of tick activity here on Long Island,” said Jorge Benach, distinguished Toll professor of Molecular Genetics & Microbiology and Pathology at the Renaissance School of Medicine, Stony Brook University. “With minimal contact because people were staying indoors due to the pandemic, we have seen less cases.”
Benach said that could change in the coming summer months, especially with an already large tick count this year. Currently, we are entering the second phase of tick season, which is when the arachnids are in the nymph stage and are harder to spot.
“For some reason Long Island has a heavy population of ticks,” Benach said. “It has the perfect environment for them and they really thrive.”
Three species of ticks call Long Island home. The deer tick can carry Lyme disease, anaplasmosis and other illnesses, while American dog tick can carry Rocky Mountain spotted fever. The lone star tick can transmit tularemia and ehrlichiosis.
“The lone star tick, we believe, is the most aggressive of the three species, and we didn’t know it existed until 1980,” the distinguished professor said. “And then it somehow found its way to Long Island.”
A 2019 study, headed by Benach and Rafal Tokarz, assistant professor of epidemiology at Columbia University, with co-authors from SBU and Columbia, found prevalence of multiple agents capable of causing human disease that are present in three species of ticks in Long Island.
Another concern this season is that tick-borne illnesses like Lyme disease and anaplasmosis have symptoms that overlap with those of COVID-19, including fever, muscle aches and respiratory failure, but without persistent coughing.
“It is true that they have overlap in the initial symptoms, but once you get past that first stage it should be easier to diagnose if that person has a tick-borne illness,” Benach said.
Tick-borne diseases are usually treated with antibiotics. The effects range from mild symptoms that can be treated at home to severe infections that if left untreated can lead to death in rare cases.
The distinguished professor stressed the need for people to be aware of ticks when they are in certain areas outdoors.
Repellents and wearing long-sleeve pants and shirts can be good deterrents for ticks. Other tips include walking along the center of trails, washing and drying clothing when you come home and keeping pets from areas that could be tick infested.
Benach said there is a misconception that humans get ticks from dogs. Instead, it is more likely one gets a tick from being in the same space as your dog.
“You should be checking yourself, and if you spot a tick get it off as soon as possible,” he said. “If you develop any symptoms or illness contact your doctor.”
Suffolk County has created a new website to connect jobless residents with shops that need workers.
And so it begins.
The Suffolk County economy, stalled for over two months as Long Island tried to contain the spread of a deadly virus, has restarted, entering Phase One of a gradual reopening process today.
Calling the reopening a “new beginning,” County Executive Steve Bellone (D) said on his daily conference call with reporters that the county was “up to the test in every way imaginable.”
To bring employers and employees together, Bellone announced the start of a virtual career and talent portal that is part of the Department of Labor. The portal will link job seekers with Suffolk County businesses that need workers.
Bellone called the site a “one stop shop” that will do everything virtually, enabling employees to see job postings in real time. Veterans will get first priority for these jobs, as the county wants to honor those who have served the nation with a 24-hour hold on these postings. Residents can access the site through SCNYForward.info.
Amid the opening, the viral numbers continued to move in a positive direction for the county.
Hospitalizations declined by 30 to 305 as of May 25. The number of people in the Intensive Care Unit also declined by 12 to 94, which is the first time since March that the number of people in the ICU with COVID-19 was below 100.
Hospital capacity remained well below 70 percent, with 65 percent of beds available in hospitals and 60 percent available in the ICU.
In the last day, nine people have left the hospital to continue their rehabilitation and recovery at home.
The virus continues to claim the lives of residents. In the last day, 10 people died from complications related to the coronavirus as the number of people who died from COVID-19 in Suffolk has reached 1,861.
On the first day of reopening, the county executive said he hadn’t had any negative reports about people violating any ongoing restrictions on businesses or social distancing rules.
With contact tracers in place and the county monitoring public health, Bellone didn’t anticipate the county backsliding into another version of New York Pause.
The contact tracers should “give us the ability to target our response,” the county executive said, “rather than what we had to do at the beginning of the outbreak.”
Bellone said the county had learned important lessons on the other side of the viral peak, which should put it in a solid position to monitor any pockets of positive tests.
“I’m certain we are going to do this safely as we open up,” Bellone said.
Separately, Bellone urged the federal government to invest in infrastructure projects on Long Island, including a sewer project.
The county has one of the largest infrastructure projects for sewers in the region in decades, Bellone said.
“With federal investment in infrastructure, we would create jobs, boost our economy, improve water quality, a win-win for everybody,” Bellone said in a statement.
Protesters hung signs on their cars at a May 1 rally. Photo by Lorraine Yovino
Protesters in Commack May 1 made it clear that they wanted New York to get back to business.
A protester in Commack joins others in asking for all nonessential businesses in New York to be reopened. Photo by Lorraine Yovino
Dozens lined up in front of the Macy’s parking lot at the intersection of Veterans Memorial Highway and Jericho Turnpike rallying for New York to open up its economy. For weeks, after an executive order from Gov. Andrew Cuomo (D), businesses deemed nonessential such as clothing stores, hair salons, barbershops, casinos and more were mandated to shut their doors to customers to slow down the spread of the coronavirus.
The rally was organized through the Reopen NY Facebook page, and similar events have been held across the country in the last few weeks.
These protests have taken a politically partisan edge, with many wearing “Make America Great Again” hats and waving “Trump 2020” signs in support of President Donald Trump (R).
Protesters held signs while others hung them on their cars. One read, “If it’s forced, are we free. Reopen NY Now.” Another sign said, “Small business is essential.” One car had an “Impeach dictator Cuomo” sign on its window, while a protester held a sign that read, “Stop the spread of tyranny.” One woman held two signs where one read, “All jobs are essential” and the other, “Hey Cuomo, domestic violence and poverty does equal death.”
Among those lining the street, some wore masks while others had no face covering. Children were among the protesters with their parents, many holding signs as well.
Setauket resident George Altemose attended the event with friends from the North Country Patriots, a conservative group that rallies on the northeast corner of Bennetts and North Country roads in Setauket every Saturday morning.
“I was there because of the ongoing COVID-19 problem, to show my support for President Trump and to express my disapproval of the misguided policies of Governor Cuomo, Mayor De Blasio and other politicians that are counterproductive in our battle to restore our normal lives,” Altemose said in an email after the rally.
He said he was pleased that he attended the May 1 rally.
“It was a most refreshing and uplifting experience to gather with hundreds of like-minded friends and neighbors in Commack, and to enjoy the enthusiastic responses from the passing motorists, the majority of whom took the time to wave, blow their horns and give us the “thumbs up” sign,” he said. “It looks like Nov. 3 will be a day to remember.”
For Altemose, the protests were about more than the closings. He said he has taken issue with a few of Cuomo’s mandates, including that nursing homes must admit those afflicted with the virus, “even though they are not hospitals and are not even close to being equipped to deal with a problem of this nature and magnitude.”
Altemose applauded the president’s performance during the COVID-19 pandemic.
“President Trump has provided outstanding leadership from the earliest possible day of this crisis, including the placement of responsibility where it belongs,” he said.
Lorraine Yovino, from Hauppauge, said in a phone interview after the protest she was delighted to see so many people show up for the rally.
“The whole atmosphere was so positive and so hopeful,” she said. “It was just a very happy, hopeful group. I was so pleased to see so many young people too.”
Yovino said she has attended rallies in the past including the March for Life protests in Washington, D.C. and others in Albany. She heard about the May 1 rally through friends.
She said the Macy’s parking lot turned out to be an ideal place for everyone to park and protest as the lot was empty, unlike the Target parking lot in the next shopping center which was full.
“It’s unfair that the Target salespeople are considered essential, while the Macy’s people are nonessential,” she said. “One group gets a salary to support their families, and the other group is impoverished.”
While Yovino said she understands that there was not much information known about the virus at first, she said she feels experimental treatments, such as the anti-malaria drug hydroxychloroquine may be helpful to many. Though it has shown in cases to help treat the virus, it is still largely untested and has shown to cause heart issues in some who use it.
“It’s no longer justified to put American citizens into poverty and not let them go to work, not let them open their businesses, not let them support their families,” she said.
Yovino said she believes Trump has been doing a good job when it comes to dealing with COVID-19, and people need to ask more questions regarding the local elected officials’response to the pandemic.
“My heart is going out to so many people who are unnecessarily having their freedom taken away,”
she said. “Their constitutional rights are being trampled on.”
Earlier this week, Cuomo said that businesses in the state will begin opening after the May 15 pause deadline. However, the first nonessential businesses to open will be in areas with lower density in upstate New York, with those in the city and Long Island to follow at a later date. Currently, Suffolk and Nassau counties have not met much of the criteria set by the U.S. Centers for Disease Control for any kind of reopening.
Despite the worrisome sign that net hospitalizations rose for a second straight day in Suffolk County, the area has still met one of the qualifications for a phased reopening.
The U.S. Centers for Disease Control and Prevention has recommended that hospitals in an area have a three-day moving average where the number of hospitalizations from COVID-19 declines.
Over the last day, the number of hospitalizations from the coronavirus rose by 18, after inching up by four on Monday, bringing the total to 835 people. The number of people hospitalized with COVID-19 on Sunday had declined by 38, which means the three day moving average was a decline of over five people.
“The fact that we’ve had two days in a row of increasing hospitalizations is definitely something I’m concerned about,” County Executive Steve Bellone (D) said on his daily conference call with reporters. He doesn’t “want to see that trend continuing.”
For the second consecutive day as well, the number of people who were discharged from the hospital increased at a slower pace than it had in the last few weeks, with 37 people heading home to continue their recovery.
“Is this an indication that the people that are in the hospitals, which would be common sense, are people who are more sick?” Bellone said. He suggested that would be “logical,” although he doesn’t have any specific indication behind the numbers about why the net hospitalizations have climbed amid conspicuously lower discharges.
While Gov. Andrew Cuomo (D) has discussed a phased reopening of the state on May 15, when New York Pause ends, the decision of when to open different regions will depend on the data from those area. Upstate, for example, hasn’t been hit as hard as downstate areas like Nassau and Suffolk County.
“We are doing the work to prepare for that reopening downstate,” Bellone said. While the county executive is hopeful Suffolk County could open as soon as possible, he said the county would have to hit a range of metrics to make that possible.
These measures include a 70 percent or lower use of hospital beds, which is about where the county stands now. That, however, does not include elective surgeries, which, once they start picking up again, will require some hospital bed usage.
Additionally, the number of new hospitalizations in Suffolk County will need to be 30 or lower based on a three-day rolling average. Over the last 24 hours, the number of new hospitalizations from COVID-19 was 50.
“We’re not there yet,” Bellone said.
Amid ongoing testing throughout the county, including in seven hotspot testing sites, the number of new positive tests climbed to 715 to 38,252. The percentage of positive tests is 34.6 percent.
On the positive side, the number of people in the Intensive Care Unit declined by seven, as the number of intubations also fell.
“That’s a very good sign,” Bellone said.
The number of people who have died from complications related to coronavirus climbed by 23, bringing the total to 1,296.
“We know the terrible grief and tragedies that this virus has wrought upon our community,” Bellone said, as residents “haven’t been able to grieve in the way we are accustomed to as a community.”
The American Red Cross is providing crisis counselors who can work with families, supplying emotional and spiritual support.
Residents who would like to receive confidential help can log in to www.redcross.org/nyscovidfamilysupport where they will fill out a nine-question form. Alternatively, residents can call 585-957-8187.
Bellone said New York State and Northwell Health tested 700 police officers yesterday at the Suffolk County Police Academy for the presence of antibodies to the virus.
Suffolk County Police Commissioner Geraldine Hart said the police would use the information to track the location of positive cases to see if there are hotspots within the department.
Finally, Bellone is launching a new space on the county site where residents can share positive stories, at www.suffolkcountyny.gov/dashboardofhope. He is encouraging people to share positive stories about teachers this week, during National Teacher’s Week. Residents can share good news or can link to facebook, twitter, or videos.
Two weeks have made a huge difference for the health care community in the fight against COVID-19.
On April 10, hospitals throughout Suffolk County were struggling as 1,658 residents needed medical help to cope with the symptoms related to COVID-19. At the time, the Army Corps. of Engineers was racing to construct a hospital extension at Stony Brook that might handle more cases if the county continued on its trajectory.
Fortunately, the number of hospitalizations turned around, falling for the first time two days later, beginning a trend, with a few rises here and there, of fewer hospitalizations.
Indeed, over the last day, the number of people in Suffolk County hospitals declined by 143 people to 1,175, which means that, from the peak, the number of people separated from their homes and families has declined by over 29 percent.
This is “ great news,” County Executive Steve Bellone (D) said on his daily conference call with reporters. Bellone has been in the unenviable position of sharing details about the numbers of people who have been sick or who have died each day. The reduction in hospitalizations is a “huge jump, which is much higher than we’ve seen over the past few weeks,” he said.
Indeed, looking back to the dark days when the county became an epicenter for the virus, Bellone said his team had to discuss where to create a makeshift morgue, in the event that those who died exceeded the county’s capacity.
The county had considered using an ice rink as a temporary facility. Bellone nixed that, recognizing that children would eventually skate on that rink again. Instead, the county found an old processing facility, which they hoped they wouldn’t have to use but “unfortunately we have.”
As the Army Corps. of Engineers completed the construction of the Stony Brook Hospital Extension, Bellone again hoped the county wouldn’t need the additional hospital beds. So far, that has been the case, which, the county executive said, is a tribute to the residents who have respected social distancing rules and who have endured economic hardship as they have shuttered their businesses and remained at home.
The hospital extension is “empty today because of what everyone has been doing, because of the sacrifices that are being made right now,” Bellone said. “We have seen the incredible courage and bravery that has been displayed by health care workers and first responder agencies who have put themselves at risk. That is the reason why that hospital stands empty today.”
Gov. Andrew Cuomo announced new testing initiatives for those “essential” employees, including restaurant workers, grocery store workers, banks, laundromats and gas stations, just to name a few examples. The governor added it could be used for health care workers.
Testing of this kind is largely going to be handled by pharmacies. Cuomo said he will be signing an executive order allowing 5,000 independent pharmacies access to the testing.
In the last 24 hours, the number of people who have been discharged from the hospital has increased to 147, which is “another great number and a positive sign,” Bellone said.
The Intensive Care Unit has also experienced a drop in the number of patients, with a decline of 25 to 453.
The number of ICU beds currently available is 179, which is more than four times the number of beds available on April 10th, when the ICU had a low of 43 remaining beds in that unit.
Over the last 24 hours, the number of residents testing positive for Covid-19 has increased by 891 to 32,185, Bellone said. In total, the six hotspot sites have now conducted tests on 1,916 residents.
While the public health trends have been improving, the number of families who have suffered irretrievable losses through the pandemic have also passed a horrific milestone. Over the last 24 hours, the number of people who have died was 49, which means that one Suffolk County resident passed away each half hour. The total number of dead in Suffolk County from complications related to coroanvirus has climbed over 1,000, reaching 1,042.
The number of people who have died “continues to be staggering,” Bellone said, as he offered his thoughts and prayers to those who mourn the loss of family, friends, and neighbors.
Bellone’s office continues to look for personal protective equipment to help first responders and health care workers who are looking to heal and provide comfort to those afflicted with the disease. Bellone’s office has received another 100,000 ear loop masks and 3,000 face shields as a part of the county’s procurement order.
Continuing a process that began yesterday at a Stop & Shop in West Babylon, Bellone distributed cloth face coverings that he received from the federal and state governments to seniors at Leisure Village, Leisure Knolls and Leisure Glen. He was joined by Sarah Anker (D-Mt. Sinai).
“People were very happy to receive those face coverings,” Bellone said. “It’s important to distribute those out to the most vulnerable in our community.”
Bellone said the distribution plan for those face coverings would also include people who live in hotspot communities.
“We will be working with community-based organizations to identify need,” Bellone said.
For those looking to get back on the links, Bellone said golf courses will reopen starting on Monday, in line with the state policy. Golfers will be expected to follow social distancing guidelines and will need to spread out tee times by 15 minutes. Golfers can not use carts.
“If you want to come out, you have to walk the course, follow the additional guidance that is in place to reduce contact and help prevent transmission of the virus,” Bellone said.
Immune system regulation is complex and involves over 1,000 genes
By David Dunaief, M.D.
Dr. David Dunaief
Autoimmune diseases affect more than seven percent of the U.S. population, most of them women. More than 80 conditions have autoimmunity implications (1). Among the most common are rheumatoid arthritis (RA), lupus, thyroid (hypo and hyper), psoriasis, multiple sclerosis and inflammatory bowel disease.
In all autoimmune diseases, the immune system inappropriately attacks organs, cells and tissues of the body, causing chronic inflammation. Chronic inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). Once you have one, you are at high risk for acquiring others.
Drug treatments
The mainstay of treatment is immunosuppressives. In RA, where there is swelling of joints bilaterally, a typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies seem to reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. Disease-modifying anti-rheumatic drugs (DMARDs), a class that also includes Plaquenil (hydroxychloroquine), may slow or stop the progression of joint destruction and increase physical functioning.
However, there are several concerning factors with these drugs. First, the side effect profile is substantial. It includes the risk of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections.
It is no surprise that suppressing the immune system would result in increased infection rates. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).
Tangentially, there is also concern that these drugs might make those who contract COVID-19 more susceptible to severe symptoms and consequences. On the flip side, some are being studied to determine whether they can improve outcomes for others by suppressing immune system overreactions.
Second, these drugs were tested and approved using short-term randomized clinical trials, but many patients are prescribed these therapies for 20 or more years.
So, what other methods are available to treat autoimmune diseases? These include medical nutrition therapy using bioactive compounds, which have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression and supplementation.
Nutrition and inflammation
Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. While I have not found studies that specifically tested diet in RA treatment, there is a study that looked at the Mediterranean-type diet in 112 older patients where there was a significant decrease in inflammatory markers, including CRP (5).
In another study, participants showed a substantial reduction in CRP with increased flavonoid levels, an antioxidant, from vegetables and apples. Astaxanthin, a carotenoid found in fish, was shown to significantly reduce a host of inflammatory factors in mice, including TNF-alpha (6).
Fish oil
Fish oil helps your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (7). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory, such as NFkB.
In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (8). When treating patients with autoimmune disease, I typically suggest about 2 grams of EPA plus DHA to help regulate their immune systems. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood thinning effects.
Probiotic supplements
The gut contains approximately 70 percent of your immune system. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (9, 10).
In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor, TNF-alpha (11). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.
Fiber
Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (12).
In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (13).
Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation and potentially autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects and thus treat and prevent autoimmune diseases.
*Especially in this time of COVID-19, do not alter your medications, in other words, stop or start medications, without discussing it with your physician first. It is much more important to control the autoimmune disease than tot worry about drug effects on the immune system.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Until recently, many people thought COVID-19 was like the common cold or maybe like the flu. Now, most of us know somebody directly or indirectly who has been hospitalized with COVID-19.
While social distancing and handwashing are critical to prevent its spread, strengthening lung function is crucial to preventing its progression to severe disease.
Among those with highest risk for severe COVID-19 are those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape.
What can we do to strengthen our lungs? We can improve lung function with simple lifestyle modifications including exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Not only people with compromised lungs will benefit; studies suggest “healthy” people will also benefit.
Why is this important?
This virus starts in the throat but may progress to the lungs attacking the alveoli, small air sacs that allow gas exchange to take place. When this occurs, patients get short of breath and may have to be hospitalized and placed on a ventilator. Two factors influence this: inflammation and fluid in the lungs.
Both asthma and COPD increase inflammation of the airways and the lung’s functional tissue (parenchyma) thus, potentially making these patients more susceptible to severe COVID-19.
Let’s look at the research, taking a three-pronged, or “forked,” approach: diet, incentive spirometry and exercise.
Diet Studies in Asthma
In a randomized controlled trial (gold standard of studies) of asthma patients, results show that after 14 days those who ate a low-antioxidant diet had less lung function compared to those who ate a high-antioxidant diet (2). Researchers measured lung function with one-second forced expiratory volume (FEV1) and predicted forced vital capacity (FVC). Additionally, those who were in the low-antioxidant diet group also had higher inflammation at 14 weeks, as measured using a c-reactive protein (CRP) biomarker. Those who were in the low-antioxidant group also were over two-times more likely to have an asthma exacerbation.
The good news is that the difference in behavior between the high- and low-antioxidant groups was small. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Carotenoid supplementation, instead of antioxidant foods, made no difference in inflammation. The authors concluded that an increase in carotenoids from diet have a clinically significant impact on asthma and can be seen in a very short period.
Diet Studies in COPD
Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers. Bear with me, because the studies were done with men or women, not both at the same time. In one study of men, for example, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The high-fiber group was still below the American Dietetic Association-recommended 38 grams per day. This is within our grasp.
In another study, women had a highly significant 37 percent decreased risk of COPD among those who consumed at least 2.5 serving of fruit per day compared to those who consumed less than 0.8 servings per day (4).
The highlighted fruits shown to reduce COPD in both men and women included apples, bananas, and pears.
Incentive Spirometry
What is an incentive spirometer? It’s a device that helps expand the lungs by inhaling through a tube and causing a ball or multiple balls to rise. This opens the alveoli and may help you breathe better.
Incentive spirometry has been used for patients with pneumonia, those who have chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5).
A small study showed that those who trained with an incentive spirometer for two weeks increased their vital capacity, right and left chest wall motion, and right diaphragm motion. This means it improved lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. The brands used in the study are easily accessible, such as Teleflex’s Triflo II.
In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gasses, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.
Exercise Studies
Photo from METRO
Exercise can have a direct impact on lung function. In a study involving healthy women ages 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in as little as 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.
What is impressive is that it was done in older adults, not those in their twenties and not in elite athletes. Since most of us don’t have access to a treadmill right now, note that any physical exercise will be beneficial.
We should be working to strengthen our lungs, regardless of COVID-19. However, to potentially reduce our risk of severe COVID-19, this three-pronged approach of lifestyle modifications – diet, exercise and incentive spirometer – may help without expending significant time or expense. As Yogi Berra would say, “When you come to a fork in the road, take it!” There is no time to waste.
References:
(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Paul Bolliger, a 911 operator, talked a pregnant mom in Bellport through the process of delivery, as an infant girl couldn’t wait for paramedics for her birth.
Yesterday morning at 7:20 am, Bolliger received a call from a woman in labor.
“He quickly realized this delivery was going to happen very quickly,” County Executive Steve Bellone (D), said on his daily conference call with reporters. “He immediately went into action,” providing step by step instructions through the process.
Bellone offered words of thanks to Bolliger and to “all the dispatchers throughout our county who do an incredible ob each and every day, not just during this crisis.”
In a continuing signs of light amid the darkness of the pandemic, Suffolk County reported a gradual continuation of positive trends.
The number of hospitalizations declined for the third day in a row and the fifth day in the last week, falling by 24 to 1,538. The number of residents in the Intensive Care Unit also fell by three, to 518, while ventilator use also declined.
“This is three days in a row where we’ve seen those numbers all going down,” Bellone said. “We’ll see if that trend continues.”
The number of patients discharged from the hospital who can recover at home climbed by 123, also continuing a trend over several days in which over a hundred people can leave hospitals and return to their homes.
Meanwhile, Bellone expressed dismay about a report in Newsday that indicated that some financial institutions are allowing homeowners to miss mortgage payments, but that they are then requiring those payments in a lump sum.
“The notion that there are institutions that would be [requiring a lump sum payment] is deeply disturbing,” Bellone said. “We will be looking at financial institutions and the programs that they are putting in place.”
Bellone said the County Executive’s office would highlight the programs where the banks are “doing the right thing,” while also sharing the names of the those who are putting undue financial pressure on their customers.
The county executive also urged residents who aren’t receiving help during the crisis to reach out to his office by calling 311 and reporting the financial institutions.
“We are going to put together those stories,” Bellone said. He will share information about financial institutions with the public at some point.
Bellone also thanked U.S. Sen. Chuck Schumer (D) for his support for local and state governments. Bellone added that the federal government is the only level of government that has the ability to prop up the economy in a time of crisis. When the federal government leaves that responsibility to cash-strapped states and local governments, the local taxpayers bear the burden which is “unacceptable,” Bellone said.
We need help, and we need it fast. Not just for COVID-19, but also for diabetes, for the combination of the two is much worse than either disease alone. Type 2 diabetes can have devastating effects that can potentially result in patients dying prematurely from cardiovascular complications (1). COVID-19 symptoms can range from asymptomatic to severe or result in death.
Now combine diabetes with COVID-19 and you are at much higher risk of severe viral symptoms that require hospitalization and ICU admission. According to the CDC, about one-third ICU patients infected with COVID-19 have diabetes (2).
Keeping patients out of the hospital
We know containment is critical to control COVID-19, but it’s equally important to get ahead of the mitigation of symptoms curve; we need to control the chronic diseases that exacerbate the virus’s severity. And Type 2 diabetes is one of the largest contributors.
We can treat and reverse diabetes by empowering patients with lifestyle changes, especially diet. This is such an issue that the Mexican Deputy Minister of Health recently alluded to the fact that poor diet over at least the last 4 decades has resulted in more diabetes and obesity making people much more susceptible to COVID-19 and progressing to severe COVID-19 (3).
It is tempting while staying at home for most of the day to want reach for comfort foods. Don’t do it. In fact, take the opposite approach and improve your diet. A whole food plant-based (WFPB) diet has been shown time and time again to prevent, treat and reverse diabetes potentially resulting in patients getting off their drugs and achieving levels that are considered normoglycemic, or non-diabetic.
Let’s look at the evidence.
Treating and reversing diabetes
Drugs help treat glucose, or sugar levels, and help reduce the risk of microvascular diseases such as diabetic retinopathy (eye disease causing blindness); nephropathy (kidney disease); and peripheral neuropathy, which can result in amputation. A few medications can even reduce macrovascular risk, or cardiovascular disease. Still, diet is still the best tool we have for reversing diabetes overall, with only beneficial side effects.
With COVID-19, those whose glucose is not under control are at highest risk of severe disease that results in a progression from hospitalization to ICU and the need for a ventilator to increased mortality risk. High sugars may have negative impacts on the white blood cells, which makes patients more susceptible to infection from viruses (4).
Medications’ impact
Diabetes medication alone can help control sugars, but it can’t reverse diabetes. In fact, studies with medication alone may actually increase the risk of death from polypharmacy, or too many medications. In the ACCORD trial, patients were put on an average of four diabetes medications. Researchers stopped the trial early after 3.5 years, because of a 22 percent increased rate of mortality (5). Patients did not reach their HbA1C (a three-month sugar reading) target of under 6.0 percent, because the increased death rate occurred at around 6.5. This was a large randomized controlled clinical trial with 10,251 patients, a mean age of 62.2 years, and mean HbA1C of 8.1 at baseline.
Reversing Type 2 diabetes:plant-based dietary approach
On the other hand, studies with a WFPB diet, have shown significant reduction in sugars and potential reversal of diabetes. These include a small retrospective study and small randomized clinical trial comparing a WFPB diet to the American Diabetes’ (ADA) recommended diet.
In a small retrospective study, the results showed a reduction of HbA1C from 8.2, which was a similar baseline as with the ACCORD trial, to 5.8 (6). Remember, the goal of the ACCORD trial was to get patients below a HbA1C of 6.0. These results occurred over a mean of seven months. In addition, patients were able to stop all of their diabetes medications and reduce their total number of medications from four to one.The side effect was better health with a significant reduction in high blood pressure to normal levels, as well.
The weakness of this study was that it was retrospective (looking backward in time), only had 13 patients, and there was no control arm. However, it suggests that this type of diet is powerful to reduce and reverse type 2 diabetes. The foods used in the nutrient-dense WFPB diet included a non-starchy vegetable-rich approach, with an emphasis on dark green leafy vegetables, whole fruits, beans, and limiting grains, especially refined grains, and limiting starchy vegetables such as sweet potatoes, winter squashes, corn and pumpkin.
In a larger study, results showed that a high fiber diet in patients with type 2 diabetes and hypertension significantly reduced HbA1C, fasting glucose, systolic (top number) blood pressure, branchial-ankle pulse wave velocity, serum cholesterol and waist-to-hip ratio, ultimately reducing the risk of cardiovascular disease (7). The participants were considered to be having high fiber if they increased their consumption 20-25 percent above recommended daily allowances. The fiber came from foods, not supplements, including vegetables, fruits, beans and whole grains. There were 200 participants over a six-month duration.
A third study, which was a randomized controlled trial comparing the 2003 American Diabetes Association (ADA) diet to a low-fat vegan diet showed that a low-fat vegan diet significantly reduced the HbA1C compared to the 2003 ADA diet in a 74-week study (8). There were 99 type 2 diabetes patients in the study. A “side effect” of the low-fat vegan diet was that it also significantly reduced cholesterol.
Preventing diabetes
There have been numerous studies demonstrating that a WFPB diet reduces the risk of diabetes. One of the best was the Adventist Health Study 2 (9). The results showed that a vegan diet reduced the risk of type 2 diabetes by 49 percent. This study is interesting because the different groups were very similar and it showed that small changes could have a big impact. Semi-vegetarians, pesco-vegetarians, and lacto-ovo vegetarians all had a reduced risk of diabetes compared to plant-focused non-vegetarians, but not as much as vegans.
In a more recent study, results showed a 30 percent reduction in the risk of type 2 diabetes for those who ate a predominantly whole food plant-based diet including fruits, vegetables and whole grains (10). Participants were still eating some animal protein daily. This was over a 2-to-28 year period in a metanalysis involving nine observational trials.
In conclusion, the best way to reduce your risk of severe COVID-19 is to control and reverse chronic disease. Type 2 diabetes is one of the most common chronic diseases that may contribute to getting COVID-19 and progressing to a severe form. A nutrient-dense WFPB diet has been shown to potentially reverse type 2 diabetes. While you are mostly housebound, empower yourself by taking action to reduce your risk of getting COVID-19 and especially the severe disease. We have the tools: it starts with what you put on your plate.
References:
(1) Lancet 389(10085):2239–2251. (2) CDC.gov. (3) Reuters.com April 4, 2020. (4) Medscape.com March 18, 2020. (5) NEJM 2008;358:2545-2559. (6) OJPM 2012;2(3):364-371. (7) ACC Middle East Conference 2019 Presentation. (8) Am J Clin Nutr.2009 May; 89(5): 1588S–1596S. (9) Diabetes Care. 2009;32:791–796. (10) JAMA Int. Med. Online July 22, 2019.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
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