- Basic reproduction number – this is the number of cases, on average, that result from spread of a single infected person. The current best estimate is 2.5, meaning that for every one person infected, he/she will spread it to 2.5 others. The projected range is from as low as 2 to as high as 4. In more densely populated areas, this number would be expected to be higher than in areas with lower population density. If immunity develops following infection, this number would decrease over time to the effective reproduction number, which would be lower. At the present time, there is no data on how masks and social distancing play a role in affecting this number.
- Infection fatality ratio – the number of deaths from infection divided by the number of people with the infection, regardless of whether or not they have symptoms. For age 0-19: 0.003% (so survival rate is 99.997%); for age 20-49: 0.02% (survival rate is 99.98%); for age 50-69: 0.5% (survival rate is 99.5%); and for age >70: 5.4% (survival rate is 94.6%). There is a caveat for the last age range as the CDC states that the data is only likely accurate for those up to age 79, so there are not specific numbers for those 80 and older, and those less than 2 years old carry the highest risk in the pediatric age group, despite being grouped with those up to 19. Also, it is important to remember that certain medical conditions may also affect a person’s risk beyond simply the age-related risk so that he/she may be more vulnerable than statics suggest.
- Percentage of infections that are symptomatic – the current best estimate is 40%, although it may be as low as 10% or as high as 70%.
- Infectiousness of asympomatic individuals – again, this statistic has large variability with 75% being the current best estimate but a range as low as 25% or as high as 100%.
- Percentage of transmission occurring prior to onset of symptoms – it is currently projected that 50% of viral transmission happens before the infected person has symptoms. The range may be as low as 30% or as high as 70%.
The CDC recently provided some updates regarding COVID 19. These numbers address both how transmissible the virus is as well as the severity of infection. Keep in mind that these numbers are estimates, and there’s definitely been quite a discrepancy between computer modeling and actual outcomes in the past, although there is now 6 months of data to base these estimates on that wasn’t available before. That being said, here are the current numbers from the CDC website.
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With such dramatic changes on many people’s lifestyle this year from all the societal changes initiated by Covid, a good night’s sleep has become one of the first casualties. For some, newfound downtime during the day has led to increased napping and difficulty falling asleep at night. For others, stress plays a big role in keeping them up late or making getting up in the morning tough. The temptation is often to try taking a supplement rather than to change behavior (it’s easier to swallow a pill than ignore the siren call of the snooze button), and one of the most commonly used is melatonin. Here we’ll take a look at what exactly melatonin is and how it works.
What is melatonin? Melatonin is a hormone produced by the pineal gland (a tiny gland in the brain) that helps regulate the sleep-wake cycle. Production of melatonin generally increases as darkness increases, which in turn, helps make us sleepy as night approaches. Production is generally suppressed by light, so we tend to be more awake during the day. That cycle of sleepy and wakeful is referred to as our circadian rhythm. How does melatonin work? By signaling the body that it’s time to sleep, the thought is that it may help with insomnia or delayed sleep phase disorder (trouble falling asleep before 2 AM) as well as shift work disorder (those who work night shifts) and jet lag. That being said, studies have shown mixed results with regards to efficacy. Perhaps for those who are truly deficient, they may see more improvement of symptoms than those who are able to produce adequate amounts on their own, but for now, there doesn’t seem to be a way to determine which individuals would be most responsive to supplemental melatonin. Is melatonin safe? Generally, melatonin is considered relatively safe for short term use, i.e. 1-2 months, although long term safety information is limited. There are certainly those who should avoid melatonin use such as those on blood thinners, diabetes medications, immunosuppressants, dementia medications, and even birth control pills because melatonin can affect the efficacy of these medications. Also, use in children should be discussed with a pediatrician as there is a question of whether or not melatonin, as a hormone, can affect hormonal regulation of growth and even puberty or menstrual cycles in those with immature endocrine systems. As for those who are pregnant or breastfeeding, there is no quality data regarding safety for use of melatonin. Common side effects can include daytime sleepiness, anxiety, GI distress, dizziness and depression among others. Because it is considered a supplement in the U.S. (rather than a drug, which would be managed by the FDA), safety and efficacy data is limited. In fact, a study of melatonin supplements from a few years ago showed that the amount of melatonin listed on the bottle varied significantly from the amount actually in the product in most of those products evaluated, and around a quarter were contaminated by serotonin. In the end, reviews of safety and efficacy are mixed for supplemental melatonin. The American College of Physicians recommends cognitive behavioral therapy as a first-line treatment of insomnia. As for simple changes to make on your own, limiting daytime naps, having consistent bedtimes and wake times, exercising regularly and avoiding electronics (especially those emitting blue light) for several hours before trying to sleep can all be good places to start. Often, the hardest part of making these changes is avoiding the temptation to catch up on some missed sleep at night with naps during the day, but by being more tired when trying to fall asleep at night, resuming (or starting) a more regular sleep schedule can be within reach. Dr. Nick Since Marijuana has been legalized in many states, there is a general perception that it is a natural and safe drug unlike other drugs. This perception is reflected in the number of pregnant women who use marijuana while pregnant. In 2017, a study showed that 1 in 20 women used marijuana while pregnant. In 2002, the number of women who used marijuana was 1 in 10.
Now before we talk about marijuana use in pregnancy and autism, let’s review some stuff we already know about MJ use in pregnancy. First it does cross the placenta. THC crosses the placenta and can be found in fetal circulation at 10% of the maternal level. Second, we also know that marijuana can bind to fetal cannabinoid receptors as early as 14 weeks of pregnancy. Third, studies have shown that exposure to marijuana in pregnancy can disrupt normal brain development. Children born to women who used marijuana while pregnant are more likely to have low birth weight at birth, hyperactivity, and attention, cognitive and behavioral issues. So, a couple weeks ago a study out of Canada published in Nature showed that women who used marijuana while pregnant were 1.5 times more likely to have a child with autism. The researchers reviewed 500,000 births between 2007 and 2012 in Ontario, Canada. They found an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in these children. The incidence of autism spectrum disorder diagnosis was 4 per 1000 children who were exposed to marijuana and 2.4 among children who were not exposed to MJ in utero. So, while this study does not definitively prove that marijuana use during pregnancy causes autism, there does seem to be a strong association. Based on these findings, as well as ACOG (American College of Obstetricians and Gynecologists) recommendation, we encourage our patients to avoid using marijuana during pregnancy and breastfeeding. Dr. Pam Just like hormonal changes that can occur during pregnancy, there are also big changes that go on in a woman after delivery. These changes generally last at least a few months, and hormone levels can be affected in some women for as long as they choose to breastfeed. These fluctuations can influence everything from hair loss to libido to irregular bleeding, and for some women, the effects can be quite dramatic. Here’s a quick overview of what goes up and what comes down:
Dr. Nick The most common complaint I’ve been getting lately is this- “I’ve gained a ton of weight since this pandemic started.” Many of us went from working full time to working in our PJ’s at home. Everything has been closed including the gym. Fourth of July celebrations and the Rodeo were cancelled. Weddings, graduations, kids’ sports activities and summer vacations were are cancelled. After being told not to mingle with family or friends and just stay home to be safe, it’s easy to find yourself 19 pounds heavier. Here are some simple tips on what you can do to lose some of those pandemic pounds while regaining your mental and physical health.
Hopefully this helps! Don’t let the 'Rona get you down. Eat health and enjoy the outdoors! Dr. Pam If your family has been isolating together since the early days of the COVID-19 pandemic, tensions may be on the rise in your household. Let’s face it - as much as you love your family, it’s hard not to get on each other’s nerves when you’re cooped up indoors for an indefinite amount of time. As life gradually begins to feel normal again in many areas, you can find new ways to address and alleviate these tensions. If you’re struggling with any of these sources of tension in your household, here’s how to lighten the mood.
Avoid Chaos and Confusion Since the COVID-19 outbreak began, your family’s usual routines may have been thrown out of whack. Suddenly, your kids were home from school, you were working remotely, and you had to say goodbye to the old schedule that your family had followed for years. This may have caused confusion and chaos in your household, but establishing new routines can help you feel like you’re in control again. Create morning, afternoon, and evening schedules that everyone can follow so your family can regain a sense of stability throughout the next phase of this pandemic. Address Lack of Exercise Chances are, your family has been spending most of their time indoors for the past few months as a precaution. But according to MetalBladeCycles, a lack of physical exercise can contribute to stress and anxiety, and you’ll likely end up taking these negative emotions out on each other. If you’ve all been feeling a bit moody and sluggish lately, it’s time to exercise outdoors! Try engaging activities like running, hiking, biking, and even rock climbing - all of these sports will boost your family’s overall health. Gaining Quality Time Perhaps your family has been neglecting opportunities for memorable quality time, and because of this, you’re feeling distant from each other. In addition to outdoor sports, your family can also take advantage of time in nature to simply relax together. Try spending a sunny afternoon in your backyard, having a picnic at a nearby park, taking a road trip to a local beach for the day, or even going on a weekend camping trip. Afterward, your family will feel refreshed and rejuvenated! Make Space for “Me Time” Getting enough “me time” is especially important for people in your household who happen to be introverted, but that can be tough to achieve when everyone is in isolation. According to VeryWellFamily, kids need time alone to develop their imaginations and feel more independent. They might enjoy solo activities like drawing and painting, playing with blocks, or telling stories with their dolls and stuffed animals, which will give you a break! If you want to encourage your children to spend more time reading, consider purchasing a few entertaining graphic novels for them. Before buying a particular book, research the storyline, make sure it’s age-appropriate, and check out a few Amazon reviews to ensure your kids will enjoy it. Self-isolating is the simplest way to protect your family from contracting COVID-19. But there’s no denying that taking these precautions does present new challenges for your household. Many families in isolation feel exhausted and frustrated by the events of this year. However, if you come up with strategies to safely enjoy outdoor activities, find new sources of entertainment for your kids, and give everyone in your family some more time alone, your household will be able to ride out this pandemic with ease! Guest blog courtesy of Elena Stewart Photo via Pexels After the long Idaho winter (seriously, snow in June?!) and all of the Covid lockdown, those nice summer rays warming your skin are the last thing you want to block, right? Unfortunately, while a little Vitamin D from the sun is a good thing, a nice summer tan is a bit less healthy than you might think, and even worse for your skin is that first summer burn. Even for those diligently applying sunscreen, chances are good that you’re putting it on all wrong. Here’s what you should know about both the short and longterm effects of all that sunshine and how to enjoy the nice summer weather while protecting your skin.
What happens when you tan or sunburn? A tan is your first line of defense against the sun. Skin damage releases melanin, which in turn increases skin pigmentation, i.e. skin gets darker. While this does provide some protection, this level of protection is only about SPF 3. Once the level of skin damage begins to cause cell death, an inflammatory process increases bloodflow to the area, resulting in the warm, red appearance of a sunburn. Tanning is more of a chronic damage whereas sunburn is more of an acute damage. Even if you aren’t worried about the increased risk of skin cancer associated with this damage, do you really want to look like Magda from there’s something about Mary? Skin damage from the sun is a BIG contributor to aging. Don’t I have to get all of my Vitamin D from the sun? While Vitamin D is important for bone and immune health, not all of it has to come from the sun. Eggs, milk, and fish are important sources of dietary Vitamin D, and in fact, dietary intake can provide adequate levels of Vitamin D without the need for excessive sun exposure or additional supplements. How should I put on my sunscreen and what kind should I use? Sunscreen should generally be applied about an hour before sun exposure, and you should be using a lot more than you probably think. For the face alone, a nickel-size amount is appropriate, but for the entire body, a shot glass-sized amount (a full ounce) is necessary. Also, don’t forget to reapply frequently, every 1-2 hours, to prevent sunburn. As for the type of sunscreen, SPF 15 blocks about 93% of UVB rays, SPF 30 blocks about 97%, and SPF 50 blocks about 98%. Mineral sunscreen are typically more effective than chemical sunscreens. Another benefit of mineral sunscreens is that they don’t contain ingredients like oxybenzone or octinoxate that can be harmful to coral and ocean ecosystems. If you’re absolutely against sunscreen, there are certain clothing lines geared toward SPF protection. Some long-sleeved shirts, pants and hats can also be effective protection against the sun, but remember that any area of exposed skin will still be vulnerable to UV damage. So, should you hide in the shade all summer? Not necessarily. There’s evidence that some sun exposure may trigger release of nitric oxide and in turn lower blood pressure, but at the same time, there’s no sense in burning until you become a California raisin either. As with most things, moderation is probably key. Apply your sunscreen and don’t get sunburned, but go outside and have some fun, too. It’ll be snowing again before you know it. Dr. Nick How does osteoporosis happen? Our bones are constantly being broken down and replaced. Whenever the creation of new bone does not keep up with the loss of old bone, they become brittle and weak. When this happens even minor stresses can cause a fracture. These fractures most commonly happen in the hip, wrist, or spine. There are lots of things that contribute to the development of osteoporosis. Genetics, age, sex, race, nutrition, lifestyle choices and medical conditions can all contribute to osteoporosis. Unfortunately, White and Asian post-menopausal women are at the highest risk of developing osteoporosis. However, there are lots of different options to help prevent bone loss or strengthen weakening bones.
There are different medical treatment options available. The most common of these being bisphosphonates. Bisphosphonates prevent bone from being broken done. However, this may lead to less new bone formation as it prevents old bones from being broken down. In addition to this, this class of medications has lots of side effects- muscle aches, esophageal ulceration, osteonecrosis of the jaw, seizures and atypical fractures of the femoral shaft and even esophageal cancer. Other treatment options include estrogen and estrogen agonists like raloxifene. While it decreases the chance of osteoporosis, there are many individuals that are not good candidates for this type of treatment because of the increased risk of blood clots and even strokes. While we always recommend weight bearing exercises to prevent osteoporosis, recent studies have shown that exercise really bolsters bone mass in the hip and femoral neck decreasing the chance of developing hip fractures. Studies showed that increases in body mass density at the hip and femoral neck were particularly noticeable in women age 65 or older if exercise training lasted more than 200 days. Basically, exercise has a huge protective effect on bone mineral density and can prevent fractures without all the side effects that traditional medications like bisphosphonates and estrogen agonists can have. The thought is that as we age, our bodies produce cytokines that are inflammatory and destroy bones. Exercise prevents the production of these bone destroying inflammatory cytokines and increases growth factors that help produce new bone. In women particularly, exercise has also been shown to have a positive effect on estrogen concentrations which helps with bone remodeling. With all the innovations of modern society- dishwashers, washing machines, Alexa to turn on our lights and delivery of everything from groceries to dinner, we have become very sedentary. Unfortunately, our bodies were not built for this. Our bodies were meant to be active. Movement and exercise promote the resorption of old bone and the formation of new bone. This is vital to preventing fractures, back pain from fractured or collapsed vertebra, loss of height over time and stooped postures. While it’s important talk to your provider about your risk of bone loss and osteoporosis as you get older to see what options are best for you, don’t discount the importance of lifestyle choices like exercise to help prevent bone loss and fractures. Dr. Pam What happens to hormones during the menstrual cycle and why hormone testing can be misleading6/30/2020 A very common question at appointments lately is “I think my hormones are out of balance-can I get them tested?” While society may tell you that an imbalance is the cause for everything from weight gain to mood change to almost any other symptom, it’s not likely the culprit for women with normal cycles, and here’s why: the amount of sex hormones fluctuates markedly over the course of a menstrual cycle, and in fact, if they didn’t, there would be markedly dysfunctional cycles. Here I’ll review what happens during the menstrual cycle as well as each hormone involved, how it changes over the course of a menstrual cycle, and also what it does.
What is the menstrual cycle? The menstrual cycle starts on the first day of bleeding during the period and lasts until the first day of bleeding during the next cycle. The lining of the uterus is shed and then begins to thicken again in case pregnancy occurs. Ovulation generally occurs around the midpoint of the cycle (about 2 weeks before the start of the next cycle) in response to hormonal changes, and while the ovum (egg) is present, fertilization and pregnancy may occur. If there is no pregnancy, then the cycle starts over again. The length of the cycle can be calculated by using day 1 as the first day of bleeding and then counting days until bleeding starts again. Typical ranges can be from 24-38 days. Now that the cycle has been explained, we can move on to the important part – the hormones.
Dr. Nick There are lots of people out there that are worried about not taking enough Vitamin D supplements. Its more popular than most supplements out there including fish oil, probiotics, and antioxidants.
What is all the hype all about and is it real? Originally, we were told that Vitamin D helps prevent thinning of the bones. More recently is has been touted to be a panacea for just about everything. It helps boost the immune system and mood, helps with muscle weakness, fatigue, prevents cancer/heart disease/diabetes and even helps slow down the aging process. So whenever one supplement does all this, I think we should be a little skeptical. What does Vitamin D do? It helps your intestines absorb calcium. Without Vitamin d, your intestines can only absorb 10% of calcium from the diet; with it your body can absorb about 40%. Your body needs calcium to make your bones strong. Without enough calcium, your bones will start to thin, soften and can bow outward (known as Rickets in children) and can increase fractures in older adults. Many vitamins must be consumed from different types of foods because your body can’t make it. Not Vitamin D. Vitamin D is made in our skin when exposed to sunlight and then converted in the liver and kidneys to usable forms. Vitamin D is found in certain specific foods as well. Since certain states have long winters and less exposure to sunlight, the federal government has required that Vitamin D be fortified in certain foods like milk, yogurt and orange juice to prevent diseases like Rickets. This disease is pretty much nonexistent in modern times because of fortified foods. So why did experts think Vitamin D was so useful for so many things. Researchers did observational studies where they looked at people who took supplemental Vitamin D and found that they were less likely to have certain cancers, hypercholesterolemia, hypertension, heart disease, fractures and a myriad of other chronic illnesses that are common in our modern world. I thought Vitamin D was just supposed to help with bone health, so how did it help with everything else? In these observational studies, the individuals decided whether they took additional Vitamin D or not. The people that were more likely to take theses supplements were more likely to be healthy, i.e. exercise regularly, eat healthily, and thus less prone to chronic diseases like heart disease and diabetes. When randomized controlled trials with Vitamin D were done (the researchers picked who got Vitamin D and who got a sugar pill), the results were quite different. Most of those studies did not show any benefit in the group that received Vitamin D supplementation. Some even found that Vitamin D supplementation may cause more harm: high levels of Vitamin D could cause weakness (and increase falls causing fractures), vomiting, and kidney stones. So, what does all this mean? First, Vitamin D is not a cure all despite what celebrities may tell you. Second, the most important way to stay healthy is to get your vitamins and minerals from actual food and not from supplements. Third, get some sunshine (just not too much!*) and stay active outside. This will boost your levels of Vitamin D and provide way more benefit than you realize. Talk to your provider and decide whether you need Vitamin D blood level testing. Remember 97% of people in the US have adequate levels of Vitamin D (from the sun and fortified foods) when the Institute of Medicine and US Preventative Services Task Force determined that blood levels above 20 nanograms are adequate. However, more than 50% of individuals were noted to have inadequate levels when certain commercial labs changed the necessary level to >30 nanograms to have an adequate amount of Vitamin D. Hope this helps to clear up the craze surrounding Vitamin D. It would be awesome if a single supplement in pill form helped cure everything, but for better or worse, the old adage still holds-if you want to be healthy, balanced diet and regular exercise trump supplements**. Have a good summer and get your vitamin D the old-fashioned way, by enjoying that Idaho sunshine while it lasts! Dr. Pam *Too much sunshine, particularly without the use of sunscreen, could increase your risk of skin cancer. **Be sure to talk to your provider before discontinuing any recommended treatments. |
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