What works when fighting a Pandemic?

Countries that successfully kept COVID-19 infections and deaths down not only acted early but in a more community-centred way, says a public-health physician who aims to improve preparedness for the next wave and beyond.

Dr. Saverio Stranges chairs the department of epidemiology and biostatistics at Western University's medical school in London, Ont. In a recent commentary in the International Journal of Health Policy and Management, he examined some of the reasons why places like South Korea, Vietnam, Hong Kong and Germany curbed community transmission of the novel coronavirus early on compared with Italy, France, Spain, the United Kingdom and the U.S. Stranges, colleague Mostafa Shokoohi and co-author Mehdi Osooli of Lund University in Sweden said that what counts is a strong community health response.

What works? A community-centred approach means testing people outside of hospitals quickly to find cases, tracing their contacts and containing infections in a timely and efficient fashion. Community-based approaches—implemented at the right time—are vital to reduce community transmissions and manage the response for pandemics until an effective vaccine becomes available.

Trained staff are an essential part of outbreak investigation and control programs. There is a need to boost training in infectious disease epidemiology, as well as in control and surveillance of communicable diseases and emerging infectious diseases. There is an existing body of evidence underscoring the need for promoting international partnership in mitigation and suppression strategies to fight epidemics, expanding national and international investments in prevention and control of emerging infectious diseases, allocating an adequate supply of scarce resources and facilities (e.g., personal protective equipment), increasing staffing capacities, enhancing collaborative research, and transparently sharing data during the pandemics. In addition, as supported by evidence from South Korea4 and Taiwan, utilizing the advanced information technology system for either tracing cases or aggregating critical data are essential in the containment process of the epidemics.

The paper's authors gave successful examples, such as:

·       South Korea's rapid expansion of diagnostic capacity and innovative drive-through and walk-in screening.

·       Quarantine of suspected cases and mass masking in Vietnam.

·       Taiwan's efforts to address stigma associated with people who test positive.

·       Germany's extensive testing policy to identify milder cases, including in younger people.

The talking frog

I love Serendipity as I was looking for an idea for this post, I was thinking about my friend who has talked about her anxiety and her attempts to deal with it and she talked about how she was now using, under guided practice a drug called psilocybin and how wonderful she thought the drug was. A few hours later was intrigued to read about a book written by a man who is called Ram Dass, but in an earlier life was called Richard Alpert who along with Timothy Leary, studied the therapeutic effects of psychedelic drugs psilocybin  and LSD at Harvard.

I decided to look up and find out some information about Ram Dass, as I weaved my way through the wilds of the Internet I stopped at a chapter about how our roles in life change as we grow older. One section caught my eye, it was on dwindling interest in sex with a funny frog story that is enough for today's blog post.

” An older man is walking down the street one afternoon when he hears a voice saying, 'Pssst – could ya help me out?' He looks around but there's nobody there.

“He starts to walk on, and again he hears, 'Pssst – could ya help me out?' Once again, he stops and looks around, and again, there's nobody to been seen. But this time he looks more carefully, and happens to glance down at the sidewalk, where he sees a huge frog.

“Though he's a little embarrassed to be talking to a frog, he asks: 'Did you speak to me?'

“Much to the man's surprise, the frog answers. 'Yes, indeed. Could ya help me out?'

“The man is intrigued and asks, 'Well, what do you want?'

“The frog replies, 'Well, I'm under a curse. If you would kiss me, I would be freed of the curse and I would turn into a beautiful woman who would love you and serve you. I would care for you, warm your bed, and make you so happy!'

“The man stands there for a moment, reflecting, and then picks up the frog, puts it into his pocket, and walks on. After a few minutes, the frog says, 'Hey! You forgot to kiss me.'

“And the man says, 'You know, at my age, I think it might be more interesting to have a talking frog.'”

I love the twist on the old kiss-a-frog story and the idea that he would rather have a talking frog than a “beautiful women is interesting?

Ram Dass takes off from there to discuss how we feel our diminishing sexual passions as a loss and wonder, perhaps, who or what we are without those feelings.

” Well into my 50s,” writes Ram Dass, “I spent a great deal of energy on my sexual appetites, and on appearing sexually attractive to those around me. The older I became, however, the less power that sexual currency seemed to wield.

“People seemed to treat me differently – they treated me with less desire but more respect, and at first this shift around ambivalent feelings...

“These regrets lasted for a number of years before I was able to settle down and relinquish the self-pity of the past.

“When this finally happened, I was amazed by how much more time and attention I had for other things in my life when the trumpets of sexual desire quieted down.”

So, is this story f the talking frog,  perhaps his attempt to understand his satisfaction with the way people treated him after a certain age?

Myths about COVID 2

This was published in Medical News Today. All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

Myth 3: Vitamin C can fight SARS-CoV-2

Vitamin C is another essential nutrient that has received a lot of attention. Many people believe that it can prevent or even cure the flu or common cold.

Although it is true that sufficient vitamin C can help support immune function, current evidence regarding its effectiveness in treating or preventing colds and influenza is limited and often contradictory.

Despite this, there have been claims that this Vitamin might help fight infections with the new coronavirus.

It is possible that people are basing these claims on an existing ongoing clinical trial in China, which is looking at the effects of high dose intravenous (IV) vitamin C on hospitalized patients receiving care for severe COVID-19.

The researchers expect to complete the trial by the end of September 2020. No results are available in the interim.

Commenting on the trial, experts from the Linus Pauling Institute — which focuses on health and nutrition — at Oregon State University in Corvallis explains that although high dose IV vitamin C might help alleviate COVID-19 symptoms in severely ill patients, regular vitamin C supplements are very unlikely to help people fight off infections with SARS-CoV-2.

The experts warn that “IV vitamin C is not the same as taking vitamin C supplements,” as they would never raise blood levels of this vitamin as highly as an IV infusion would.

They also warn people who may be tempted to up their dosage of vitamin C of the fact they could end up taking too much and experiencing adverse side effects.

Myth 4: The keto diet can cure COVID-19

Keto diets, which are high in fats and low in carbohydrates have also received some attention in the context of treating or preventing COVID-19.

This may be because there is some evidence to suggest that keto diets could help boost the immune system. However, much of that evidence is based on animal studies rather than human trials.

Also, an upcoming clinical trial from Johns Hopkins University in Baltimore, MD, proposes to look at whether a ketogenic intervention might help intubated COVID-19 patients by reducing inflammation.

The intervention would necessitate the administration of a specially devised ketogenic formula through enteral feeding. It would be a last-resort procedure for those in a critical condition.

There is currently no evidence to suggest that following a keto diet could help a healthy person prevent or treat an infection with SARS-CoV-2.

However, there is evidence to suggest that keto diets can expose people to certain health risks — such as by raising cholesterol levels. Keto diets may also have side effects, such as flu-like symptoms, headaches, nausea, and changes in blood pressure.

Myth 5: Herbal remedies can help

There are also claims suggesting that various herbal medicines might be able to fight off the new coronavirus.

This may partly be based on a statement issued by A Chinese official in April 2020, suggesting that certain herbal drugs could help treat COVID-19, as communication in The Lancet on May 15, 2020, reports.

Author Yichang Yang — from the Department of Traditional Chinese Medicine at the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China — warns that people should take encouragement to use herbal remedies in the treatment of COVID-19 with a pinch of salt.

Yang warns that herbal remedies — including the drugs that the Chinese official names — can have unexpected risks and may not be as effective as some people claim. Also, evidence from human trials is limited.

For similar reasons, he also notes that the mechanisms through which herbal drugs work on the body are often unclear, which may mean that they are not always safe.

A mystery “herbal cure” for COVID-19 on sale in Madagascar — a herbal tea made from artemisia plants — has also spurred worry among specialists, who say that the “remedy” may do more harm than good.

Although people may be tempted to try anything and everything in the face of such a threat to health as SARS-CoV-2, the most important preventive step is to follow official national and international guidelines for public health, as well as individual health advice from doctors and other healthcare professionals.

For more information on the new coronavirus and how to stay safe during the pandemic, look at the information from the Centers for Disease Control and Prevention (CDC) and the WHO.

Myths about COVID

This was published in Medical News Today June 20, 2020. All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. 

Even before the World Health Organization (WHO) declared the new coronavirus outbreak a “pandemic,” their director-general, Dr. Tedros Adhanom Ghebreyesus warned of the danger associated with spreading false information about the virus.

At a conference on February 15, 2020, he declared that “we’re not just fighting an epidemic; we’re fighting an infodemic.”

“Fake news spreads faster and more easily than this virus and is just as dangerous,” he emphasized.

However, it can be difficult to tell what is credible and what is not given the sheer quantity of information that people are sharing both on and offline.

In this Special Feature, we will take an in-depth look at five more persistent myths and explain why people should not take them at face value.

Myth 1: Vitamin D prevents infection

Some articles claim that if a person takes vitamin D supplements, they will be less likely to contract SARS-CoV-2.

In part, people have based these claims on a controversial paper that appears in the journal Aging Clinical and Experimental Research.

The paper’s authors claim to have found a correlation between low mean levels of vitamin D in the populations of certain countries and higher rates of COVID-19 cases and related deaths in those same countries.

Based on this correlation, the authors hypothesize that supplementing the diet with vitamin D may help protect against COVID-19. However, there is no evidence to suggest that this would be the case.

In a rapid review of the evidence published on May 1, 2020, researchers from the Centre for Evidence-Based Medicine at the University of Oxford in the United Kingdom unequivocally conclude: “We found no clinical evidence on vitamin D in [the prevention or treatment of] COVID-19.”

They also write that “[t]here was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19.”

Other researchers who have conducted reviews of the existing data surrounding a potential relationship between vitamin D and COVID-19 agree.

One report by specialists from various institutions in the U.K., Ireland, Belgium, and the United States — which appeared in BMJ Nutrition, Prevention & Health in May 2020 — also points to a lack of supporting evidence in favour of taking vitamin D supplements to prevent infection with SARS-CoV-2.

The report’s authors warn that:

“[C]alls [for high dose vitamin D supplementation as a preventive strategy against COVID-19] are without support from pertinent studies in humans at this time, but rather based on speculations about presumed mechanisms.”

They also note that although sufficient vitamin D can contribute to overall good health on a day-to-day basis, taking supplements without first seeking medical advice can be harmful.

For example, taking too much vitamin D in the form of a dietary supplement could jeopardize the health, especially among people with certain underlying chronic conditions.

Myth 2: Zinc stops the virus in its tracks

Another widespread rumour is that taking zinc supplements could help prevent infection with SARS-CoV-2 or treat COVID-19.

It is true that zinc is an essential mineral that helps support the functioning of the human immune system.

Starting from this notion, a team of researchers from Russia, Germany, and Greece hypothesized that zinc might be able to act as a preventive and adjuvant therapeutic for COVID-19. Their results appear in the International Journal of Molecular Medicine.

The researchers refer to in vitro experiments that apparently showed that zinc ions were able to inhibit the action of a certain enzyme that facilitates the viral activity of SARS-CoV-2.

However, they also point out the lack of actual clinical evidence that zinc might have an effect against SARS-CoV-2 in humans.

Other papers that cite the potential of zinc as an adjuvant in COVID-19 therapy — including one that appears in Medical Hypotheses — are more speculative and not based on any clinical data.

In a “Practice patterns and guidelines” paper from April 2020 — which appears in BMJ Nutrition, Prevention & Health — nutritionist Emma Derbyshire, Ph.D., and biochemist Joanne Delange, Ph.D., reviewed existing data about zinc (alongside other nutrients) in relation to viral respiratory infections.

They found that, according to available research in humans, zinc supplementation may help prevent pneumonia in young children, and that zinc insufficiency may impair immune responses in older adults.

However, they note that there is not enough evidence about the role of zinc supplementation in preventing viral infections in general.

“Rigorous trials […] are yet to determine the efficacy of zinc supplementation,” they write.