One Way to Boost COVID-19 Vaccine Effectiveness: Exercise

If you need another excuse to slip on your running shoes and head outdoors, our concierge primary care doctors in Jupiter have a good one for you: Exercise can increase the effectiveness of coronavirus vaccines.

That’s according to a large study published last month in the British Journal of Sports Medicine. Researchers found that fully vaccinated study participants who logged high levels of physical activity were nearly three times less likely to be admitted to the hospital than those who were vaccinated but had lower levels of physical activity.

Even those with lower levels of physical activity saw a benefit.

This confirms an earlier study conducted last winter, showing that even a single 90-minute session of aerobic exercise could increase antibodies in those who had just been vaccinated.

The New Study

Researchers in Johannesburg, South Africa reviewed anonymous medical records, gym visits, and wearable activity-tracker data for nearly 200,000 fully vaccinated healthcare workers between February and October of 2021. (The Johnson & Johnson vaccine was the only one available to the population at the time.)

Participants were categorized according to their average recorded activity levels over the previous two years. Those with the highest weekly levels of physical activity (150 minutes or more per week) were 86 percent less likely to be admitted to the hospital after testing positive for COVID-19 than participants with a low level of physical activity (less than 60 minutes per week).

But even those in the medium and low categories of physical activity saw some benefit, compared to the sedentary group. The medium-level exercisers (60 to 149 minutes per week) were 72 percent less likely to be hospitalized, while with the low-level exercisers (less than 60 minutes per week) the risk of needing hospitalization fell by 60 percent as opposed to those who never exercised.

“The findings suggest a possible dose-response where high levels of physical activity were associated with higher vaccine effectiveness,” the researchers said in a press release.

“This substantiates the [World Health Organization] recommendations for regular physical activity—namely, that 150-300 minutes of moderate-intensity physical activity per week have meaningful health benefits in preventing severe disease, in this context against a communicable viral infection,” they wrote.

Prior Research

This large study confirms an earlier one published last February in the journal Brain, Behavior, and Immunity, which found that even a single 90-minute session of exercise could boost the immune response in those who had just received the flu or COVID-19 vaccine.

The study also found that 45 minutes of exercise did not increase antibodies, making 90 minutes the preferred target to see results.

“As far as we know, our findings are the first of their kind for evaluating exercise response on the COVID-19 vaccine,” Marian Kohut, Ph.D., a professor of kinesiology at Iowa lead researcher, told Medical News Today at the time.

“[They are] the first to show that light [to moderate] intensity, long-duration exercise enhances antibody response for the COVID-19 vaccine,” she said.

The Exercise Dividend

Even before vaccines became available, however, numerous studies showed that being physically active substantially lowered the risk of becoming seriously ill or needing hospitalization following infection with the coronavirus.

Robert Sallis, a family, and sports medicine doctor at the Kaiser Permanente Fontana Medical Center in California and former president of the American College of Sports Medicine, led a 2021 study of 48,440 adults before vaccines became available.

This research found that physical inactivity was associated with a higher risk for severe COVID-19 outcomes, including hospitalization rates, intensive care unit (ICU) admissions, and death. Those who were engaging in some activity, or regularly meeting physical activity guidelines, were about half as likely to need hospitalization as patients who were mainly inactive.

An earlier review of 16 prior studies involving nearly two million people likewise found that those who were physically active were far less likely to experience adverse outcomes from the virus.

Sallis told The Washington Post that these findings make sense because we know “that immune function improves with regular physical activity,” as do lung health and inflammation levels, which have been proven to protect against the worst effects of COVID-19.

Free Medicine

No one is sure of the reasons for these results. One theory suggests that exercise boosts blood and lymph flow, promoting the circulation of immune cells. The researchers involved in the South African study wrote that it “may be a combination of enhanced antibody levels, improved T-cell immunosurveillance, and psychosocial factors.” 

The Centers for Disease Control and Prevention (CDC) maintains that physical activity can improve overall mental and physical health, and reduce the risk of many chronic diseases such as heart disease, cancer, and type 2 diabetes. One 2008 study found that physical inactivity is responsible for more than five million premature deaths every year.

So it makes sense that regular physical activity would confer benefits to our immune system.

And it’s never too late to get moving, even with just a 10-minute walk, according to Jon Patricios, a professor of clinical medicine and health sciences at the University of Witwatersrand in Johannesburg-Braamfontein, who oversaw the new study.

“Doing something mattered, even if people weren’t meeting the full guidelines,” he told The Post.

“It’s an idea we call ‘small steps, strong shield,’ ” he said. “Plus, you don’t need a prescription, and it’s free.”

antibiotics

Why We’re Careful About Using Antibiotics

Among the many problems that resulted from the COVID-19 pandemic, one of the more serious was an increase in antibiotic resistance (AR), according to a new report from the Centers for Disease Control and Prevention (CDC). The agency estimates that in 2020, the first year of the pandemic, AR infections and deaths in hospitals increased at least 15 percent over 2019.

Our concierge primary care doctors in Jupiter were discouraged to hear this because concerted efforts by the medical community in the last ten years had succeeded in reducing these resistant infections by nearly 30 percent.

It’s worrisome news, because bacteria and other pathogens evolve, just as the coronavirus does to better ensure its survival. As bacteria mutate, they are able to resist the commonly used antibiotics used to treat them, meaning eventually our best weapons become useless and people die unnecessarily.

According to the CDC, at least two million people get an AR infection every year, and at least 23,000 die as a result.

What happened?

What was it about the pandemic that caused this jump in numbers?

For one thing, lack of knowledge; for another, sheer numbers. Medical staff facing patients with fevers and shortness of breath turned to antibiotics as one weapon in their frantic attempts to treat people with an illness they’d never encountered.

Second, whenever such invasive procedures as ventilators and catheters are used, they provide an opportunity for infections, which must then be treated by antibiotics, and the hundreds of thousands of hospitalized COVID-19 patients thus drove higher antibiotic use.

The CDC report says that from March 2020 to October 2020, nearly 80 percent of those hospitalized for COVID-19 received an antibiotic.

Finally, overwhelmed staff—desperately fighting to save lives—had less time to follow protocols normally used to prevent infections, the report says.

The problem with antibiotics

What’s wrong with using antibiotics if they might help?

According to the CDC, “If even one bacterium becomes resistant to antibiotics, it can then multiply and replace all the bacteria that were killed off. That means that exposure to antibiotics provides selective pressure, making the surviving bacteria more likely to be resistant.”

In addition, the CDC says, “When a patient (human or animal) receives an antibiotic they do not need, not only does the patient get no benefits, but they are also put at risk for side effects (e.g., allergic reactions, toxicity that affects organ function, C. diff). Evidence suggests that one in five hospitalized patients who receive an antibiotic has an adverse drug event.”

Antibiotics can cause such side effects as diarrhea when they destroy friendly bacteria, along with the invaders. Other possible side effects include stomach pain, rash, respiratory difficulties, nausea and vomiting, and joint swelling.

Other factors involved

But antibiotic overuse didn’t just happen during the pandemic and doesn’t just happen in hospitals.

One study by the CDC and the Pew Charitable Trust found that nearly a third of the antibiotics prescribed every year—whether in doctor’s offices, hospital-based clinics, or emergency rooms—are not needed and are ineffective for the illness they’re prescribed for.

This report found that at least a third of prescriptions were for conditions that didn’t warrant antibiotics. “An estimated half of antibiotic prescriptions given during pediatric ambulatory care visits are inappropriate,” the report found.

A large number of these prescriptions were provided at the request of patients, who demand their doctors “do something” for conditions that cannot be cured by antibiotics. These include the flu, colds, coughs, and sore throats not caused by strep. Other conditions for which antibiotics are not indicated include bronchitis, asthma, and allergies.

And not just doctors

Patients also play a role in the spread of AR by:

  • insisting on an antibiotic when the doctor has said it won’t help
  • sharing their leftover or unused antibiotics with friends or family members
  • not taking the full course of an antibiotic when one is prescribed

This last behavior, in fact, is a major contributor to the problem of antibiotic resistance. When a patient begins to feel better after a few days and stops taking the antibiotic, the bacteria may be weakened but not killed; their remaining numbers survive to mutate into a strain that can no longer be killed by the antibiotic.

Finally, animal agriculture also contributes to the problem. Antibiotics are used to feed livestock to accelerate growth and prevent disease in otherwise healthy animals that are kept in unnaturally confined conditions during their lifecycle.

A 2017 study by the Pew Charitable Trust confirmed that antibiotic use on farms and feedlots leads to the emergence of resistant bacteria and that these resistant bacteria are infecting humans, either through direct contact with the bacteria, with food produced from the animals, or through the environment.

How to help

These are the reasons why we’re very careful about when we prescribe antibiotics to our patients. You can do your part, as well, by:

  • not skipping doses of an antibiotic we have prescribed for you
  • not saving doses for the next time you get sick (different infections require different antibiotics)
  • never take an antibiotic prescribed for someone else
  • avoiding meat and animal products that have been treated with antibiotics during their lifecycle

Finally, it’s important to take steps in your daily life to prevent infections from taking hold in the first place. This includes frequent hand washing, getting all the vaccinations we recommend, and using safe sanitation practices when handling food.

monkeypox

Why Monkeypox Is Not Like COVID-19

Last month, the World Health Organization (WHO) declared the newly spreading monkeypox virus a global health emergency.

This has prompted many to fear we’re heading into another coronavirus situation, as our concierge primary care doctors in Jupiter have found from talking with our patients.

While this is a debilitating, painful, and—occasionally—deadly virus, there are many reasons why it’s very dissimilar to the SARS-CoV-2 virus, the virus that causes COVID-19.

The history is different

Although both originated as “zoonotic” diseases—that it, they began in animals and spread to humans—we have a far longer history with monkeypox, meaning we know more about it than we did when the coronavirus first appeared.

According to the Centers for Disease Control and Prevention (CDC), monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thereby giving the disease the name “monkeypox.” Its typical animal hosts, however, are rodents and other small mammals.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in humans in other central and western African countries.

Although relatively new to the U.S., a large monkeypox outbreak occurred here in 2003 as a result of imported rodents.

Transmission is different

Next, the ways the two viruses are transmitted are completely different.

Unlike the largely airborne transmission of SARS-CoV-2 through aerosols that linger in the air, the monkeypox virus can only be spread through close contact with an infected person or animal, or materials such as bedding or towels that are contaminated with the virus.

In addition, monkeypox appears to be far less transmissible than COVID-19. One study found that just three percent of those in close contact with an infected person would develop monkeypox.

It appears at this time to be spreading primarily among gay and bisexual men following sexual encounters, but anyone who comes into close and prolonged, direct contact with the pox sores can become infected.

Even women, and at least two children, have been reported to have contracted monkeypox, as a result of being in close proximity to men who have sex with other men.

The symptoms are different

Unlike the stealth infections of the coronavirus, it’s very apparent when a person is infected with monkeypox. As with COVID-19 and other viruses, they develop fever, headache or body aches, chills, muscle aches, and exhaustion.

These symptoms are also similar to those of smallpox, a cousin of monkeypox, with one difference:

“A feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes,” the CDC says.

Otherwise, however, both smallpox and monkeypox exhibit the same signature fluid-filled lesions (the so-called “pox”), which the coronavirus doesn’t produce. Some individuals have these sores all over the body, while others may have only a single lesion. This rash can be extremely painful.

The vaccines are different

When COVID-19 first appeared two-and-a-half years ago, it was a brand new virus (i.e., “novel” coronavirus).

We knew nothing about it, and at the time had no way to combat it in the form of either effective treatments or vaccines.

Because of our long history with monkeypox, however, we do have vaccines and antiviral treatments. Monkeypox and smallpox come from the same family of viruses (although monkeypox is not as severe as smallpox). That has allowed us to utilize the stockpile of smallpox vaccines and antivirals to fight monkeypox.

And, unlike the coronavirus vaccines, the vaccines for monkeypox are effective even after infection, if given within four days of exposure. Even if the vaccine is given as late as two weeks after exposure, it can still lessen the likelihood of severe illness.

Not to worry?

Does all this mean we don’t have to panic about monkeypox? Panic is never a good idea because it prevents thoughtful responses in a crisis. But at this time the monkeypox outbreak still appears to be confined largely to men who have sex with men and those who are closest to them and who may come in contact with the open sore or infected linens.

If you fall into one of those categories, it’s important to take precautions until the supply of vaccines and antivirals becomes sufficient to cover everyone at high risk of exposure, because cases are spreading rapidly in the U.S. At the end of July, the Centers for Disease Control and Prevention (CDC) reported more than 3,500 confirmed cases but noted that is probably a significant undercount.

Experts advise that, if you’re at risk, you temporarily reduce your number of sexual partners, reconsider sex with new partners, and exchange contact details with any new partners to enable follow-up, if necessary.

Infected people are encouraged to self-isolate from other humans as well as pets, and to wear a mask and long clothing over any sores.

Although there is currently a limited supply of vaccines in the U.S., the government has purchased 2.5 million doses, which should be available in the coming weeks. This means it isn’t yet enough available to offer shots to all high-risk individuals.

So until there is, take precautions, and let us know if you think your symptoms might be those of monkeypox. It’s a painful, debilitating, and sometimes deadly disease, but we can treat it if it’s caught in time.