Winter Preparation
November 23rd, 2020
Winter is beginning in many parts of the country. This is a uniquely different year as winter is associated with fear of COVID and indoor activities. Those realities exist, but we must maintain our eye on all preparation measures for a healthy winter.
What are the winter related concerns for kids?
1) Make sure that they are getting adequate vitamin D. Vitamin D is a fat soluble vitamin meaning that it stores for a period of time in fat cells.
Mental Health Concerns
November 23rd, 2020
According to the CDC, from April to October of this year, the proportion of children’s mental health–related emergency department visits as compared with 2019 rose significantly. Mental health–related visits for children aged 5–11 and 12–17 years increased approximately 24%. and 31%, respectively. (MMWR 10/27/2020) Couple this with the child abuse incidence increase this year and we are seeing the beginnings of an adverse childhood event or ACE wave that could and likely will have lasting ramifications for many decades to come. The rise is simple to see.
Volume 10, Letter 49
November 23rd, 2020
Answers to the questions from last week:
Have you changed your lifestyle behaviors in recent weeks to mitigate COVID risk?
75% said Yes
Based on everything that you have read and know, are you in favor of a lockdown?
69% said No
I appreciate all of the emails that are dissenting and affirming of the content as all discourse is worthy.
Dr. M
Opinion
Section III -
November 16th, 2020
The preponderance of the current data after 8 months of COVID research points squarely to the reality that mask wearing, social distancing, hand washing and self care are the routes to success with the SARS2 pandemic. I have found little to no evidence to support lockdowns or other draconian methods as currently being employed in certain cities. The other side of that coin is not welcomed again and stands to have much and long reaching ramifications if it is.
We all should individually push for a strong self care model coupled with mask wearing and social distancing as best as possible until this next and hopefully last wave passes.
Airline Safety
SECTION II -
It is becoming more and more clear that air passenger travel is a low risk endeavor. The evidence is showing us that airline carriers are doing a great job of disinfecting the planes in between flights. The planes have excellent air filtration and ventilations systems shown to reduce viral particles by 99+ percent. We are seeing no evidence that air travel is associated with super spreader events.
This is great news moving forward when people begin the process of rediscovering travel and vacations.
Dr. M
Volume 10, Letter 48 Coronavirus Update 23
November 16th, 2020
It is going to be very hard to find positives in the current COVID environment. It comes down to this. Can we all do our part now that things are not going as we had hoped? Each little step in the right direction can make a lasting impact.
This is another newsletter on the science behind the pandemic and strategies that seem to make the most sense for all of us.
Here we go. Unfortunately, the major wave that has happened in most previous historical pandemics is officially here nationwide. The combination of colder weather,
Screen Time and Sleep
November 9th, 2020
Continuing with the screen time theme, let's look at a study in the Journal of Adolescent Health. Dr. Charmaraman and colleagues looked into the effects of screen time use and sleep.
The results were expected and straightforward. They noted: "Quantity of social technology use (e.g., checking social media, problematic internet behaviors, mobile use), content viewed (e.g., emotional or violent videos, risky behaviors), and social context (e.g., bedtime behaviors, starting social media at an early age) were significantly related to later bedtimes and fewer hours of sleep on school nights.
Autoimmunity with SARS2
November 9th, 2020
"Severe SARS-CoV-2 infection is linked to the presence of autoantibodies against multiple targets, including phospholipids and type-I interferons. We recently identified activation of an autoimmune-prone B cell response pathway as correlate of severe COVID-19, raising the possibility of de novo autoreactive antibody production during the antiviral response. Here, we identify autoreactive antibodies as a common feature of severe COVID- 19, identifying biomarkers of tolerance breaks that may indicate aggressive immunomodulation." (Woodruff et. al. 2020)
Volume 10, Letter 47
November 16th, 2020
Life was much better when an apple and a blackberry were just fruits!
Unknown
Mobile phones and social media apps have brought us visually and virtually closer to far away people at a cost. We are far too often not present with the people in our midst.
The tradeoff initially seemed worth it, however, that reality is fading as the corporate intention of addicting us to the devices takes shape. We are losing ourselves and our social skills to an artificially intelligent driven world view.
Section III -
November 2nd, 2020
The preponderance of the current data after 8 months of COVID research points squarely to the reality that schools are not the source transmission problem, especially the less than 12 year old age range. There is now evidence that teachers may be at less risk because of potential prior cross reactive immunity. This can be gained from frequent exposure to young children who carry or are sick with other coronaviruses. They are also at less risk when wearing a mask and remaining 6 feet from children. There is good evidence for safely returning to full time school at this time after reviewing the Brown University school data.
SECTION II Mask
November 2nd, 2020
Wearing a mask? Should you? This has relatively been asked and answered in previous newsletters, however, a few recent experiences have pushed me to reiterate the why.
When a patient or parent comes in pleading personal freedom and the right to not wear a mask, we as a practice try to calmly inform the person that there are reasons behind our policy. We understand that our policy leaves some in a disagreeable state. While we applaud their first amendment rights and desires, we also reserve the right to have the policy complied with.
Volume 10, Letter 46 Coronavirus Update 22
Novemeber 2nd, 2020
Crowds, indoor environments, poor ventilation and TIME are the recipe for a negative COVID19 outcome based on your personal risk.
Latest numbers show that we are rapidly moving in the wrong direction with case numbers nationally. Cases continue to move to the suburban and more rural areas. North Carolina peaked on July 23rd and is now in the middle of a second spike in case volume that began in early September. Importantly, deaths are not following the increase in case volume as I will explain below. Multiple tracking sites are showing no current correlation between case number and the 2 week tracking death risk as was seen early in the pandemic. This is improved news for us moving forward. Hopefully, this is the new norm from now on as we work to get case numbers down. The other side of the coin, however, will be the recovered long haulers.
Appendicitis in Children
October 26th, 2020
67% of 1078 children treated for appendicitis with antibiotics did not go on to need surgery according to a new study by Minneci and colleagues in JAMA.
Appendicitis patients choosing the non operative route received 24 hours of IV antibiotics in hospital followed by 6 days of oral antibiotics at home.
Why does this study matter?
Injuries
October 26th, 2020
All terrain vehicles, motorcycles, bicycles, skateboards, rip sticks and so on carry significant risks for head and neck injury.
I tell patients all of the time that injuring your arm is a low risk endeavor when riding a wheeled machine, but breaking your neck or hitting your head on a tree is a major problem for concussion or a significantly worse outcome.
Now, as Americans, we never shy away from a challenge when it comes to sports and activity. This is our collective ethos. Knowing that, how do we keep our kids safe when engaging in sports where head and neck injuries can occur?
Halloween
October 26th, 2020
Whether you choose to participate in Halloween this year all depends on your fear of Covid19 transmission while trick or treating and obtaining food stuffs from others in large volume as tends to occur. The risk is likely to be quite low as the event occurs outdoor and your exposure to any one person will be limited reducing risk tremendously. Couple this with the fact that children that tend to trick or treat are between the ages of 4 and 12 years old which is a very low risk group for developing and or transmitting the virus. Each family should choose to participate based on their personal risk tolerance.
Volume 10, Letter 45
October 26th, 2020
What does it mean to lose?
Vision, health, vitality
What does it mean to lose?
Your joy, desire, plans
What does it mean to lose?
Something or nothing
Section III
October 19th, 2020
Zinc and Vitamin D containing foods that I would encourage you to feed your children
Zinc -
1) Shellfish - especially oysters - can be pureed into spaghetti sauces. Kids generally like shrimp and scallops pan sautéed with olive oil, basil and fresh garlic
2) Chick Peas as hummus or roasted like popcorn
3) Nuts and seeds - cashews and pumpkin - pureed in anything from smoothies to sauces
SECTION II
October 19th, 2020
The more people that gather together in a closed indoor environment coupled with the amount of time spent together coupled with a lack of protective mask use is the current worst case scenario for COVID exposure and illness development. Your inherent genetic risk coupled with your lifestyle induced disease risk puts you in a specific category of the 94% or not.
Coronavirus Update 21
October 19th, 2020
1) Micronutrient deficiency is not helpful when fighting a virus. Dr. Guerri-Fernandez looked at low zinc serum levels and COVID19 death risk. "Mean baseline zinc levels among the 249 patients were 61 mcg/dl. Among those who died, the zinc levels at baseline were significantly lower at 43mcg/dl vs 63.1mcg/dl in survivors. Higher zinc levels were associated with lower maximum levels of interleukin-6 (proteins that indicate systemic inflammation) during the period of active infection." (Guerri-Fernandez et. al. 2020)
Volume 10, Letter 44
October 19th, 2020
Crowds, indoor environments, poor ventilation and TIME are the recipe for a negative COVID19 outcome based on your personal risk.
Latest numbers show that we are moving in the wrong direction with case numbers nationally. Cases continue to move to the suburban and more rural areas. North Carolina peaked on July 23rd and has now had a second spike in case volume almost reaching the July peak.
There is still no change in the knowledge that more than 80% of deaths