covid variants

Understanding COVID-19 Variants

Our concierge doctors are receiving many questions from our patients about the numerous COVID-19 variants. They want to know what they mean for the vaccine and how worried we should be about them. The U.K. variant, known as B.1.1.7, is spreading more rapidly in Florida at the moment than in any other state. We felt this would be a good time to summarize what we know about all of these questions.

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best face mask

Which Type of Face Mask Is Best?

We’ve been living with the coronavirus pandemic for a year now. Our concierge doctors are seeing more and more claims regarding special types of face masks that will supposedly offer more protection from the virus.

We’re also getting more questions from our patients on this subject. Especially now that at least three variants (mutations) of the coronavirus have been identified as circulating in this country.

So we thought we’d tell you what we know to date on how to find the best face mask.

Anti-microbial masks

Manufacturers have been producing so-called “anti-microbial” facemasks for months now. They claim to offer greater protection against the coronavirus. In Europe, brands such as Under Armour, Burberry, and Diesel have been marketing masks said to reduce viral activity that comes in contact with their masks.

Experts are dubious about these assertions. In the U.S., firms are prohibited from making claims like this without providing evidence. Neither the Centers for Disease Control and Prevention (CDC) nor the U.S. Food and Drug Administration (FDA) has so-far approved anti-microbial masks to prevent the spread of the SARS-CoV-2 virus.

Amy Price, a senior research scientists at Stanford Anesthesia Infomatics and Media (AIM) lab, advised the World Health Organization (WHO) on its face mask guidelines.

“The challenge is that sometimes claims are made, but they aren’t tested on the actual masks with the actual virus,” she told CNN on a video conference call. “So they’re like gimmicks.”

Dr. Charlaynn Harris, Ph.D., MPH, senior epidemiologist at Unity Band, makers of a wearable COVID-19 tracker, told POPSUGAR she wouldn’t recommend any mask not fully vetted by the FDA.

“I do feel as though these products could lead to false security for the wearer,” she added. “Claims of being antimicrobial lead the wearer to believe they have an added barrier against this highly infectious pathogen.”

Copper-infused masks

What about copper-infused masks, which are also selling briskly?

It turns out that it is true that copper kills viruses and other pathogens. When both bacteria and viruses come into contact with copper, they are killed “very quickly and without mercy,” Dr. Michael Schmidt told The Washington Post recently. Schmidt, professor of microbiology and immunology at the Medical University of South Carolina, studies the use of copper in health-care settings.

Comparing the reaction to “an exploding grenade,” he said viruses are no match for copper.

“The oxygen shrapnel first destroys the envelope,” of the viruses, he told The Post. “Then, additional oxygen radicals come in to destroy the viral RNA, and if the instruction set is not intact, you have no virus.”

There is a catch with copper-infused masks, however. The particles of the virus must actually come in contact with the copper strands within the mask. If it doesn’t touch the copper, it remains intact, and active. So copper-infused masks are still no guarantee of safety.

One side note on copper supplements, which are also being touted to protect from the coronavirus: Don’t take them. According to the Office of Dietary Supplements at the National Institutes of Health (NIH), ingesting high amounts of copper can lead to liver damage. And such unfortunate gastrointestinal side effects as abdominal pain, cramps, nausea, diarrhea, and vomiting.

Double-masking?

Remember that the coronavirus is transmitted primarily through the air, by both infected droplets and aerosols. This is why it so easily and stealthily passes from person to person.

And we now have three confirmed variant strains of SARS-CoV-2 in the U.S. All of which are far more transmissible than the strain we’ve been fighting for the last year.

Therefore, some experts have begun recommending that everyone wear not just one but two masks.

“The reason for that is you do wind up getting more filtration of viral particles,” Dr. Dave Hnida told CBS Denver. “It becomes more of an obstacle course for the viral particle to make its way from the air into your nose and throat and then into your lungs.”

We still have a shortage of medical-grade N95 masks, which filter out 95 percent of pathogens. So wearing two masks at the same time can offer better protection. In fact, wearing two can offer nearly the same protection as the vaccines, according to Joseph Allen, an associate professor at the Harvard T.H. Chan School of public Heath.

“A surgical mask with a cloth mask on top of it can get you over 91 percent removal efficiency for particles,” he told CNN.

Fit is key

Whichever type of mask you choose, if it doesn’t fit properly, it won’t work to protect you or others.

The CDC offers the following guidelines to find the best face mask for you:

  • Choose masks that have two or more layers of washable, breathable fabric.
  • Make sure the mask fits snugly against the sides of your face and doesn’t have gaps.
  • Do not choose masks that have exhalation valves or vents. These allow virus particles to escape.
  • Completely cover your nose and mouth. Note: If you have a beard, the mask cannot completely cover your nose and mouth. You might want to consider shaving it off until masks are no longer necessary.
  • If you wear a gaiter, use one with two layers, or fold it to make two layers.
  • If you wear glasses, find a mask that fits closely over your nose. Or find one with a nose wire to limit fogging.
  • Face shields are not recommended.
  • Scarves, ski masks, and balaclavas are not substitutes for masks. Wear a mask under each of these items.

Remember, the only mask that works—not only to protect yourself but also to help stop the spread of the virus—is the one that is worn consistently.

vaccine effects

What to Expect from the Coronavirus Vaccine

Our concierge doctors are receiving questions as the two approved coronavirus vaccines become more widely available. So we decided to answer many of those questions on the effects of the vaccine here.

The latest

The vaccine rollout has gone more slowly than anticipated. First, there aren’t as many doses available of either vaccine as had been promised originally. There are approximately 200 million Americans in need of the vaccine, which means 400 million total doses for two shots. But there are currently only about 100 million doses available, and approximately three percent of the population has been vaccinated.

Second, there has been confusion and controversy regarding who should be first in line to receive a shot, who should be next, and so on.

Finally, until the end of December, the federal government did not allocate enough money for states to pay for training additional vaccinators, adequately storing and distributing the vaccine, etc. The economic stimulus package passed in December allocated $8 billion for states. But health officials say it will take time to receive the money and implement necessary protocols.

In the coming weeks, however, these problems should begin to be resolved. Experts expect the vaccines to be more available to those who need it: front-line health care and essential workers, seniors in long-term care facilities, and those at high risk of contracting COVID-19. It will likely take longer than that for the general public to begin receiving vaccines.

Effectiveness

Both the Pfizer-BioNTech and Moderna vaccines require two doses for maximum effectiveness. Both vaccines show in early trials to deliver immunity rates around 95 percent. The flu shot generally has an effectiveness rate of between 30-50 percent.

While it is still too early to be certain, it appears the vaccines could take as long as 28 days to create the promised level of immunity. Although, one recent study found immunity can begin within 12 days. (The flu shot takes between 10-14 days for full effectiveness.)

There has also been controversy regarding whether to make sure everyone receives both doses. Some argue one will be enough for now, given the nationwide shortage. Experts still haven’t settled the question. But more are now leaning toward the concept of giving as many people as possible at least some protection– meaning, just a single dose initially until the supply shortage eases. Early research seems to show a single dose may confer between 80-90 percent protection, thereby strengthening that argument.

Health officials say at least 70 percent of the population must be inoculated in order to receive so-called “herd immunity.”

By the way, there is zero chance of contracting the virus from the shot. Unlike traditional vaccines that introduce a weakened or dead virus into the body, both COVID-19 vaccines use messengerRNA (mRNA) to trigger immunity.

And no, the mRNA won’t change your DNA. It never enters the nucleus of the cells where the DNA resides.

Side effects

When we talk about side effects, we mean both the allergic reactions noted in relatively few individuals and the expected aftereffects of a standard vaccination.

Allergic reactions

According to the CDC, nearly two million people received one of the coronavirus vaccines in the first week it was available. It said at least 29 of the had a severe allergic reaction called anaphylaxis. This condition can be life threatening, and must be treated immediately with an emergency injection of epinephrine.

“This is still a rare outcome,” said Dr. Nancy Messonnier, head of the CDC’s National Center for Immunization and Respiratory Diseases, during a media briefing. “Right now, the known and potential benefits of the current COVID-19 vaccines outweigh the known and potential risks of getting COVID-19.”

If you have a history of severe allergic reactions that require you to carry an Epi pen, check with us before being vaccinated.

Normal after-effects

Many of those who have already received the vaccine reported no side effects. Research from the vaccines trials reported most people can expect to experience at least one side effect from the shot. And that’s normal, as the body swings into action to mobilize its immune defenses against the coronavirus. It can also happen with the flu vaccine.

Reported side effects include

  • headache
  • fatigue
  • muscle soreness and aches
  • joint pain
  • pain, redness, or swelling at the injection site

These generally go away in a day or two. We believe such short-term discomfort is a small price to pay to keep from getting COVID-19. Just ask the “long haulers,” whose lives have been disrupted for months with lingering, debilitating effects from the virus.

If you have any questions about the effects of the vaccine, please let us know.

hospital delirium

Hospital-Acquired Delirium Catches Caregivers Off-Guard

The middle-of-the-night phone call from the man’s 91-year-old father was frightening.

“Call the police! They’re trying to kill me!”

“Who’s trying to kill you?”

“These people. They’re holding me captive, they’re starving me to death.”

Except “these people” were doctors and nurses, and the older man was in the hospital being tested for a possible stroke. He hadn’t had one, but during the brief two days he’d been in the hospital, he’d acquired a little-known condition called hospital-acquired delirium.

Our concierge doctors are aware of it, but few outside the medical community have heard of it unless it has happened to their loved one.

Wild delusions

The hallucinations may range from mild to outrageous. 

They can imagine they’re fighting a war they were never in; they’ve been captured by spies and spirited out of the state or even the country; that their nurses and doctors are trying to kill them. These delusions are absolutely real (and terrifying) to them, and no amount of reasoning can argue them out of it, and often result in attempts to escape their “captors.”

At the other extreme, patients may become withdrawn and unresponsive. Other symptoms may include confusion, disorientation, altered states of consciousness, or an inability to focus. Or the patient may change personalities, from a normally easy-going personality to angry or combative, for example.

The main difference between hospital-acquired delirium and dementia is the time period of onset. Dementia slowly progresses over the course of months or years. Although up to 40 percent of those with dementia can also suffer from delirium, the latter syndrome occurs suddenly in patients who were otherwise perfectly lucid prior to entering the hospital. It can develop in a matter of hours or days following admittance.

A common occurrence

According to a report Harvard Health Publishing, hospital-acquired delirium is the most common complication of hospitalization among older people, although it can occur in patients of any age. It is most prevalent in those who undergo such major surgeries as hip replacements or heart surgeries, or who were admitted to an intensive care unit. In fact, the syndrome was originally called ICU delirium.

The prognosis for recovery is mixed. Most people return to normal within a week or two after returning home. One study, however, found people over age 65 admitted to a hospital and diagnosed with delirium were more likely to die within a year than those who hadn’t. And the episodes of delirium may continue for months after discharge in up to a third of patients.

Possible causes

There are many reasons why a patient might slip into hospital-acquired delirium. These include:

  • Sleep deprivation—The constant noise, lights, interruptions, and general activity in a hospital setting can make a peaceful night’s sleep impossible. This naturally leads to a confused mental state.
  • Undiagnosed infections—Many untreated infections can cause delirium. Urinary tract infections are the most common culprit in a hospital setting. 
  • Dehydration—It may sound too simple, but dehydration can lead to delirium.
  • Drug reactions/interactions—Older adults often take multiple medications, and new ones may be introduced at the hospital, causing unforeseen reactions or interactions. This is especially true with certain categories of drugs (e.g., antihistamines, antidepressants) that can trigger side effects, including delirium. Conversely, the sudden withdrawal of medications can also cause such a reaction.

How to help

It’s important that hospital staff rule out physical causes for unusual behavior in a patient, such as treating infections or performing tests for a possible stroke, for example. Be sure they know that the use of physical restraints and sedatives are not recommended, because they can increase the patient’s agitation.

But there are ways you can help.

  1. Try to spend as much time as possible with your loved one. If pandemic restrictions prevent in-person visits, at least make sure they have such necessary items as glasses, hearing aids, and dentures. Bring family photos or other familiar items to help reorient them. Make sure they have their phone and charger available and call them as often as possible.
  2. Ask the staff to minimize sleep deprivation, waiting until morning to do blood pressure checks or give medication, for example. Also ask to lower and to keep noise to a minimum at night to allow for restful sleep.
  3. Encourage exercise. Even a brief walk down the hall two or three times a day will help.
  4. It’s important not to panic if your loved one becomes delirious following a stay in the hospital. If you tell them their hallucinations are not real, they likely won’t believe you. Remain calm, reassure them you are there to look out for them, and try to calmly redirect their thoughts into their surroundings.

Remember, once they are out of the hospital setting, they will most likely return to normal. 

children COVID

All Children in Study Show Blood Vessel Damage from COVID-19

From the onset of the coronavirus pandemic, it became clear the majority of those most affected by COVID-19 infections were adults over the age of 65. The severity of the illness and deaths decreases in younger people. Many began to believe we didn’t have to worry about children when it came to the virus.

Children may be carriers and able to infect others. But many thought if they should become ill, in most cases they’ll exhibit either mild symptoms or none at all.

Dangerous misconception

Our concierge doctors want to warn you that this is a misconception. At least 120 children in the U.S. have died from COVID-19. And a new study last month at the Children’s Hospital of Philadelphia (CHOP) found a disturbing result of coronavirus infection in children. They found elevated levels of a biomarker (C5b9) related to blood vessel damage, even in those with minimal or no symptoms.

They also found a high proportion of children with SARS-CoV-2, the coronavirus that causes COVID-19, were also diagnosed with a condition called thrombotic microangiopathy (TMA). TMA leads to clots in small blood vessel. It has been linked to severe COVID-19 symptoms in adults.

“We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms,” co-senior study author David T. Teachey, MD, said in a news release. Teachey is the Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.

“We should continue testing and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term,” he added.

The unknowns

There’s still a great deal we don’t yet know about this novel coronavirus, including why it affects both children and adults in varying degrees. At least 30-40 percent of adults, for example, show minimal or no symptoms at all. They still can transmit the infection to others, however.

Despite having a higher viral load, children are even less likely to exhibit symptoms. This means children tend to have a larger amount of the virus in their upper respiratory tracts than adults. Does that mean they can transmit the virus even more readily than adults? 

Again, we don’t know for sure. But a recent Harvard Health paper warns “the presence of high viral loads in infected children does increase the concern that children, even those without symptoms, could readily spread the infection to others.”

One thing we do know is a small number of children can have severe effects. One of these is a new condition. The Centers for Disease Control and Prevention (CDC) calls it “multisystem inflammatory syndrome in children,” or MIS-C. It now seems to have affected approximately 300 children in the U.S, at least five of whom have died.

Long-term implications

Originally, doctors thought there was an unusual outbreak of a rare form of Kawasaki’s disease. The symptoms reported were similar (persistent fever, rash, and inflammation of the blood vessels). It has now, though, been connected specifically with the SARS-CoV-2 virus.

“This [MIS-C] is a new childhood disease that is believed to be associated with [COVID-19], and it can be lethal because it affects multiple organ systems [including] the heart and the lungs, gastrointestinal system or neurologic system,” neonatologist Alvaro Moreira said in a statement. Moreira is an assistant professor of pediatrics at The University of Texas Health Science Center at San Antonio.

His team reviewed 662 cases of MIS-C worldwide between January and July of last year. They found more than half of the children studied suffered heart damage as a result of the condition. These children may require lifelong care and treatment, United Press International (UPI) reported in September.

“Evidence suggests that [these] children . . . have immense inflammation and potential tissue injury to the heart, and we will need to follow [them] closely to understand what implications they may have in the long term,” Moreira concluded.

Further study needed

Researchers in the CHOP study were surprised to find the biomarker C5b9 present. They found it not only in children with severe symptoms of COVID-19 and MIS-C, but also in those with minimal or no symptoms.

“Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-Cov-2 that are worthy of investigation,” Teachey said.

“The most important takeaway from this study is we have more to learn about SARS-Cov-2,” he concluded. “We should not make guesses about the short- and long-term impact of infection.”

Neither of the two vaccines approved for adults have been tested in children under age 12. It could be a long wait until kids get protection from the virus.

In the meantime, we urge parents to take the same precautions with their children that they do with themselves. Socially isolate as much as possible, frequently wash your hands, and wear masks when outside the family circle.

covid vaccine

MMR Vaccine May Protect Against COVID-19

With all the excitement and hope surrounding the rollout of the coronavirus vaccines, our concierge doctors want to highlight other vaccines that could also prove to be lifesavers. Particularly in the case of childhood vaccinations, we have seen a significant reduction in the numbers of children receiving routine immunizations.

And we are not alone. In one of the more troubling results of the pandemic, experts across the country saw a marked decline in children being vaccinated. According to a report released this month by the Wellmark Blue Cross Blue Shield Association, nearly nine million children have received fewer vaccinations than normal. There is a 26 percent decline from last year. This is partly due to the restrictions put in place to combat COVID-19. But, it’s also due to a growing resistance by some parents toward vaccines in general.

Kids need vaccines

Experts warn this drop could result in a renewed outbreak of childhood diseases. We could see resurgences of diphtheria, whooping cough, measles, and even polio.

“Although we don’t want to cause alarm, we do want to be mindful of what a drop in vaccination levels could mean,” Dr. Tim Gutshall, Wellmark’s chief medical officer, said in a statement to The Iowa Gazette. “If we dip below the [Centers for Disease Control and Prevention] benchmarks for immunity, we could wind up with an epidemic of vaccine-preventable diseases.

“The good news is the trend can be reversed if parents and guardians ensure these vital immunizations are up to date,” he added.

COVID-19 vaccine already here?

Now it appears there may be an even better reason for children to receive at least one type of vaccine: the MMR (for measles, mumps, and rubella). It’s been rumored since the start of the pandemic that the MMR vaccine might protect those who become infected with SARS-CoV-2, the virus that causes COVID-19. This is due to the similarity of both viruses.

Now a new study, published last month in the journal of the American Society for Microbiology, shows promise. It found patients vaccinated against mumps had less severe COVID-19 infections than those not vaccinated.

“We found a statistically significant inverse correlation between mumps titer levels and COVID-19 severity in people under age 42 who have had MMR II vaccinations,” lead study author Jeffrey E. Gold said in a media release. [Titer levels measure the amount of protective antibodies in the blood.]

“This adds to other associations demonstrating that the MMR vaccine may be protective against COVID-19. It also may explain why children have a much lower COVID-19 case rate than adults, as well as a much lower death rate. The majority of children get their first MMR vaccination around 12 to 15 months of age and a second one from four to six years of age.”

The study

Researchers split 80 participants into two groups. The first group included 50 Americans under age 42. This group received most of their MMR antibodies through the MMR II vaccine. The second group comprised those who had no record of ever having received vaccines and reported they had the measles, mumps, or rubella.

Those who actually contracted the mumps did not seem to show any protective effect against COVID-19. Those who showed high levels of mumps titers resulting from the MMR II vaccine were either asymptomatic (showed no symptoms at all) or were functionally immune from the virus, just as if they’d received one of the new coronavirus vaccines.

Researcher’s conclusions

This was a relatively small observational study. But study coauthor David J. Hurley, PhD, professor and microbiologist at the University of Georgia, appeared impressed by its findings.

“The MMR II vaccine is considered a safe vaccine with very few side effects,” he wrote in a statement. “If it has the ultimate benefit of preventing infection from COVID-19, preventing the spread of COVID-19, reducing the severity of it, or a combination of any or all of those, it is a very high reward-low risk ratio intervention.”

In fact, he suggested while the country is waiting for wider distribution of the newly approved coronavirus vaccines, the MMR II vaccine could stand in in the interim.

“Based upon our study, it would be prudent to vaccinate those over 40 regardless of whether or not they already have high serum MMR titers.”

Further studies coming

Our concierge doctors aren’t necessarily ready to start vaccinating all our older patients based on a single study. But we think it bears watching. That’s because—based on prior anecdotal evidence—other studies along these lines are already underway.

One of those is funded by a $9 million grant from the Bill and Melinda Gates Foundation, Wellcome Trust, MasterCard, and others. It plans to recruit as many as 30,000 healthcare workers worldwide in a clinical study. This would measure immunity to COVID-19 against those who receive the MMR II vaccine vs. those who receive a placebo injection.

It’s heartening to realize the best scientific brains around the world are working so diligently to conquer the scourge of COVID-19. There is hope on the horizon.

Meanwhile, please keep playing defense as much as possible:

  • wear a face mask around people outside your household
  • avoid indoor spaces as much as possible
  • wash your hands frequently

It won’t be much longer until this nightmare is a distant memory. And be sure your children are up to date on their vaccinations!

chocolate good for you

Check Out Chocolate for Your Health

Let’s face it—this has been a lousy year. We’ve either lost or postponed so many of our normal pleasures, it’s no wonder that we’re feeling deprived. But our concierge doctors have a prescription that can help cheer you up: chocolate.

And ‘tis the season for it, after all. Not to mention that, as we’ll explain below, it can be healthier than eggnog, frosted cookies and cakes, and all the other sugarplums we’re inclined to consume this time of year.

The good news

Many recent studies have found the right kind of chocolate consumed in moderation might benefit everything from the cardiovascular system to cognitive improvement. Some have even attributed consumption to a reduced risk of cancer and a lower risk of diabetes.

One study at Johns Hopkins University School of Medicine, for example, found that blood platelets clotted more slowly in subjects who had consumed chocolate. This can help prevent clots—and thus, heart attacks and strokes—from occurring.

Another study published in the journal BMJ suggested that consumption could lower the risk of developing heart disease by as much as a third.

“Based on observational evidence, levels of chocolate consumption seem to be associated with a substantial reduction in the risk of cardiometabolic disorders,” the authors wrote in a paper presented at the European Society of Cardiology Congress in Paris.

Several studies have looked at this claim

In a 2017 study, researchers found that consuming raw almonds, dark chocolate, and cocoa helped lower “bad” cholesterol in overweight or obese subjects.

A 2008 study found those who ate a small amount of dark chocolate each day had lower blood levels of a protein associated with inflammation.

A Canadian study of 44,489 subjects found those who regularly consumed chocolate were 22% less likely to suffer a stroke than those who abstained. That those who suffered a stroke saw a 46% decline in likelihood of death.

Other benefits attributed to this sweet include improved cognitive function, enhanced athletic performance, benefits to fetal growth and development, and lower cholesterol. (These tend to come from small studies that have not been confirmed.)

“(Chocolate) is a good antioxidant,” Dr. Owais Khawaja, a cardiology fellow at St. Vincent Mercy Medical Center in Toledo, Ohio, told CNN. “We think most of the beneficial effects are because of this.” Antioxidants are known to reduce the amount of free radicals in the body, those compounds known to cause cellular damage.

“More and more research is showing that [eating chocolate] is really more beneficial than we ever imagined,” said Katherine Tallmadge, a registered dietician and spokesperson for the American Dietetic Association told Live Science.

The bad news

But it’s not permission to gorge on the stuff. As with other indulgences, moderation is key, and the right kind of chocolate makes all the difference. Experts recommend limiting intake to no more than one ounce a day.

Compounds called flavonoids exist in chocolate as well as wine, beer, tea, berries, fruits, and vegetables. They may be responsible for chocolate’s healthful benefits. Flavonoids are antioxidants believed to reduce inflammation throughout the body.

One reason chocolate has received its bad reputation is because of all the sugar it typically contains. This leads to heart disease, obesity, tooth decay, and myriad health problems.

The more nonfat cocoa solids chocolate consists of, the more antioxidants it contains. Steer clear of chocolate products with added fats such as “milk fats,” or “partially hydrogenated vegetable oil.” These will tend to cancel out the beneficial effects of chocolate, in addition to causing weight gain.

The closer you can get to the original cocoa, the better. So natural cocoa powder is best (though it tends to be bitter); dark chocolate and semi-sweet chocolate chips are better. Milk chocolate is the least desirable. Milk proteins may bind to the flavonoids and make them unavailable to the body. White “chocolate” contains no cocoa solids at all.

The American Heart Association (AHA) says that chocolate can be part of an overall healthy diet, but the key phrase is “part of.”

Alice H. Lichtenstein, the Gershoff professor of nutrition science and policy at Tufts University in Boston, says, “If you enjoy chocolate, the important thing to do is choose the type you enjoy the most and eat it in moderation because you like it, not because you think it’s good for you.”

wearing a mask

CDC: Masks Protect Wearer, Too

As Florida closes in on the unenviable milestone of nearly a million confirmed cases of COVID-19, our concierge doctors wanted to share a bit of good news. We’ve mentioned before how critical it is to wear face masks in public to help keep others from becoming infected. People can be contagious for up to two weeks before they begin to show symptoms, which accounts for the rapid spread of the disease.

Now a new scientific briefing from the Centers for Disease Control and Prevention (CDC) confirms what researchers had long suspected: Masks protect the wearer as much as those around them. The revised guidance, released late last month, cites several studies. These show masks reduce the risk of contracting the virus by up to 79 percent.

In one case, for example, a study examined 124 households in Beijing with a single case each of COVID-19. It found mask wearing by the infected individual as well as others in the household reduced secondary transmission by 79 percent. Another case followed two hair stylists who were infected and showing symptoms. They wore masks while interacting with 139 clients over eight days. The clients also wore masks. Subsequent testing showed that not a single client contracted the disease as a result.

An added bonus

In addition to protecting both the wearer and the public, universal mask-wearing can also help the economy, the CDC notes.

“Adopting universal masking policies can help avert future lockdowns, especially if combined with other non-pharmaceutical interventions such as social distancing, hand hygiene, and adequate ventilation,” the CDC said.

Besides pandemic fatigue, another reason people have begun to rebel against stay-at-home guidance is because of the dire effect the early lockdowns had on the economy. Most people need to work, and economic stress is as unhealthy as any other kind of stress.

But the agency cites one recent economic analysis from Goldman Sachs. It found a 15 percent increase in universal masking could prevent losses of up to $1 trillion. This equals about five percent of gross domestic product (GDP).

So it turns out that wearing a mask is a win-win-win proposition.

But which mask is best?

The type of mask worn by health-care workers is the N95 respirator. This is the best at filtering out infected particles, which is precisely why you shouldn’t wear them.

“The CDC does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19),” according to the U.S. Food and Drug Administration (FDA). “Those are critical supplies that must continue to be reserved for health care workers and other medical first responders.”

There is a still a severe shortage of such masks, even after all this time. The CDC recommends the public wear others types of face coverings, many of which have been shown to be quite effective.

“Multiple layers of cloth with higher thread counts have demonstrated superior performance compared to single layers of cloth with lower thread counts, in some cases filtering [out] nearly 50 percent of fine particles,” the CDC said.

“Try to get at least a two-ply cloth mask and make sure it’s tightly woven,” Dr. John O’Horo, an infectious disease specialist at the Mayo Clinic in Rochester, Minnesota, told NBC News.

One test of effectiveness is to hold the mask up to the light. If you can see the outline of individual fibers in the cloth, it’s too thin to offer enough protection.

Dr. Scott Segal, chair of anesthesiology at Wake Forest Baptist Health in Winston-Salem, North Carolina, recently partnered with the Wake Forest Institute for Regenerative Medicine to test a variety of cloth materials. They looked not only for breathability and comfort, but also for the ability to filter small particles. They concluded the best masks were constructed of two layers of heavyweight “quilter’s cotton,” with a thread count of at least 180.

What doesn’t work

Now we consider what doesn’t work.

The most ineffective mask is one that doesn’t cover the nose. In fact, there’s little point in wearing one at all if the nose isn’t covered. The resulting nasal exhalations will spread the virus, and also allow the wearer to inhale infected particles. So will face masks with valves. They make for easier breathing, but they also allow the breath to leave the mask without any filtering.

Plastic face shields fall into this category as well. One recent study confirmed that plastic face visors allow nearly 100 percent of tiny airborne droplets such as those emitted by talking or breathing to escape into the surrounding air. Yes, doctors wear them . . . along with N95 masks.

Remember, it’s safest to always assume that everyone you meet outside your immediate household is infected. We now have the promise of two new effective vaccines on the horizon. But until they can be widely distributed, we’ll need to hang on just a little longer. And wearing a mask can help us control the spread of the virus sooner.

smoking and covid-19

Smoking and COVID-19: What You Need to Know

The annual Great American Smokeout is set for this week, November 19. So our concierge doctors thought this would be a good time to look into what we know about the combined effects of smoking and COVID-19.

This is especially important because there has been some confusing information on the effects of cigarette smoking on the disease, with some early reports even suggesting that cigarette smokers who contract COVID-19 actually fare better than non-smokers. Subsequent studies have found the opposite: that smoking increases the risk that the virus causes more damage in smokers.

Tobacco’s extensive effects

One study, reported in The Guardian, analyzed more than 11,000 COVID-19 patients. It found that about 30 percent of those with a history of smoking saw their conditions progress to a more severe or critical state, versus 17.6 percent of non-smokers. Researchers concluded that “smoking is a risk factor for progression of COVID-19,” with smokers nearly twice as likely to develop severe symptoms.

In addition to the well-known damage to the lungs and cardiovascular system—both of which are compromised by COVID-19—smoking has also been shown to suppress the immune system’s ability to fight infection in the body.

“Tobacco products cause inflammation in the airways and affect lung immunity, which makes people more susceptible to infection in general,” Dr. David Christiani, a professor at the Harvard TH Chan School of Public Health, told the paper.

In a scientific brief released this summer, the World Health Organization (W.H.O.) concluded that “the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients.”

The brief also reiterated that, in addition to the findings on the coronavirus, “Tobacco causes eight million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.”

We believe it’s safe to add COVID-19 complications to that list.

Benefits of quitting

If you smoke, you’re not alone. More than 32.4 million people in the U.S. still smoke cigarettes, according the American Cancer Society (ACS). Unfortunately, as a result more than 16 million Americans live with a smoking-related disease.

But it’s never to late to quit.

Here’s a timeline from the ACS showing what happens when you stop smoking:

  • Twenty minutes after quitting your heart rate and blood pressure drop.
  • Twelve hours after quitting the carbon monoxide level in your blood drops to normal.
  • Two weeks to three months after quitting your circulation improves and your lung function increases.
  • One to nine months after quitting, coughing and shortness of breath decrease. Tiny hair-like structures (called cilia) that move mucus out of the lungs start to regain normal function in your lungs. This increases their ability to handle mucus, clean the lungs, and reduce the risk of infection.
  • One year after quitting the excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically.
  • Five years after quitting your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker in two to five years.
  • Ten years after quitting your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx and pancreas decreases.
  • Fifteen years after quitting your risk of coronary heart disease becomes that of a non-smoker’s.

Ready to quit?

There are myriad ways to successfully stop smoking. What works for one person might not work for another. And studies show that the average smoker tries several times before giving up the addiction entirely.

“No matter your age or how long you’ve been smoking, quitting improves health, both immediately and over the long term,” the ACS says. “Giving up smoking is a journey, and it can be hard, but you can increase your chances of success with a good plan and support. Getting help through counseling and medications doubles or even triples your chances of quitting successfully.”

You can also download numerous quit-smoking apps to help, or find tools and tips at Smokefree.gov. The site also offers live chat help for those trying to quit. In addition, each state has a quit line, which you can access by dialing 1-800-QUIT-NOW (1-800-784-8669).

Of course there are various medications also available, so if you’re trying to stop smoking, please talk with us. We can help find the best path for you.

The coronavirus pandemic has had everyone on edge for months, and smoking may be one way you’ve used to cope. But, as with increasing alcohol or drug consumption, it’s unhealthy and ultimately unhelpful.

safely celebrate holidays

How to Celebrate the Holidays Safely

As we head into the holidays, our concierge doctors are concerned that pandemic fatigue might tempt people to throw caution to the winds and just celebrate, starting with Thanksgiving.

The fact is, we’re all fed up with the “new normal.” People want more than anything to return to the way our lives were before this scourge attacked the world early this year. Pandemic fatigue is not only real, it’s totally understandable.

“In the spring, it was fear and a sense of, ‘We’re all in it together,’” Vaile Wright, a psychologist at the American Psychological Association (APA) told The New York Times. “Things are different now,” she said. “Fear has really been replaced with fatigue.”

This led to a sense of complacency and carelessness. While understandable, this caused a wave of increased cases and deaths in the U.S. and around the world.

“Citizens have made huge sacrifices,” Dr. Hans Kluge, the World Health Organization’s (W.H.O.’s) regional director for Europe, told the Times. “It has come at an extraordinary cost, which has exhausted all of us, regardless of where we live, or what we do.”

The high cost of carelessness

A recent report in The Washington Post serves as a cautionary tale for our country. Canada celebrates their own Thanksgiving on the second Monday of October. Despite warnings from public health officials there to limit celebrations to members of the immediate household, apparently that advice went unheeded by many Canadians.

In the weeks after, Canada saw rising case numbers as a result. Ontario, for example, reported a record-high number of daily cases within two weeks of the holiday. A single gathering of 12 extended family members in Toronto resulted in a cluster of coronavirus cases.

“People did not mean to spread COVID-19,” Deena Hinshaw, Alberta’s chief medical officer of health, told The Post. “But it is a reminder that social gatherings where social distancing and masking are not used consistently are a significant risk for spread.”

We can understand the longing to get together for the traditional holidays, beginning with with Thanksgiving. But that is, unfortunately, a recipe for disaster.

“We are set up for just a perfect storm—a conflagration,” Megan Ranney, an emergency medicine professor at Brown University, told The Post recently. “Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country.”

This country’s leading infectious disease expert, Dr. Anthony Fauci, likewise warned that Thanksgiving celebrations could lead to even more cases.

“That is, unfortunately, a risk, when you have people coming from out of town, gathering together in an indoor setting,” he told CBS News recently. “It is unfortunate, because that’s such a sacred part of American tradition.”

Yes it is. But we’d like to suggest some ways to minimize that risk and safely celebrate the holidays.

A few COVID-19 reminders

First, let’s review a few facts.

The SARS-CoV-2 coronavirus is one of the most contagious viruses known to man. It spreads readily through the air and by surface contact, from those who have symptoms as well as those who don’t.

Because of this, areas with high air circulation, such as the outdoors on a windy day, tend to be safer than crowded indoor spaces with poor ventilation.

Far deadlier than the flu, the coronavirus travels through the bloodstream to every part of the body. This is why it’s so difficult to treat, and why many of its victims appear to suffer months-long aftereffects.

How to safely celebrate the holidays

With that in mind, if you’re preparing to celebrate the holidays, here are a few tips.

The Centers for Disease Control and Prevention (CDC) recommends limiting gatherings to those in your immediate household. If you’re going to host a Thanksgiving dinner, the CDC suggests holding it outdoors. It also says to only invite family and friends from your immediate neighborhood.

“Gatherings with more preventive measures, such as mask wearing, social distancing, and hand washing . . . pose less risk than gatherings where fewer or no preventive measures are being implemented,” the CDC says.

Other ways to judge risk, according to the CDC:

  • Indoors is riskier than outdoors.
  • Poor ventilation is riskier than good ventilation (e.g., places with open windows and doors).
  • Longer gatherings are riskier than shorter gatherings.
  • More attendees pose a greater risk than fewer attendees.
  • Local attendees pose less of a risk than those traveling from other areas who may have been exposed at home or during their travels but aren’t yet showing symptoms.

If you can’t control the environment, the attendees, or their behavior, you need to ask yourself whether one holiday is worth the risk.

“Staying home is the best way to protect yourself and others,” the CDC says.

As we noted above, we’re all tired of the precautions necessary to reduce the spread of the novel coronavirus. But parents, for instance, remain on high alert to ensure the safety of their children for eighteen-plus years. If you think of it in these terms, a year or two of vigilance might seem more acceptable.

Remember, the fastest way for this thing to be “over” is to deny it new hosts. This includes the bodies of you and your loved ones. Please follow these tips in order to safely celebrate the holidays.

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