Wear a mask or go outside? A theory for a divided nation

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Why Numbers for a Nation Could be Wrong

TL;DR Version

Making sense of conflicting study recommendations: If you live in the northern 2/3 of the USA, are over 65, have high blood pressure, or are Vitamin D deficient because you work indoors or at night, it’s likely that you should listen to the shelter in home/wear a mask suggestions. If you live in the southern 1/3 rather than focusing on those recommendations, it may be more beneficial to spend more time outdoors.

The highlights version: If you live above this line, your recommendations for Covid-19 protection could be different than if you live in the sunbelt.

The Uncut Video

The full version discusses research and potential areas for improving our reactions to the pandemic. Check it out!

A part of me feels badly for those in charge of Public Health Policy for the United States.  Their job is to protect everyone, and yet we are facing a Covid-19 challenge that does not impact everyone equally.  The science is clear that those over 65 with blood pressure issues, those with low estrogen, and those who are Vitamin D deficient (which may come with the companions of sleep-poor but stress-rich) are likely the preferred targets of Covid-19. 

An ongoing study by the University of Florida has expanded on earlier findings and now reports among 1400 volunteers in an over-60 community,  zero tested positive for Covid-19.  Well, two did, but on follow-up both had either traveled and/or had symptoms when they registered for the test. The doctors tested nearly 900 symptomatic people (2280 total).  There were a total of 23 positives among 2280 tests, with 900 of those people having coughs, fevers, traveled, sneezes (I know, not a symptom, but it’s listed on the form), etc. That’s around 1% infection in the sample among high risk individuals, symptoms and not. Still zero asymptomatic carriers.

The question is Why.  Reports of 25% (CDC) to 50% (Iceland genomics company) of asymptomatic people could be carriers directly conflict with these findings.  My statements on this: First the Iceland story is bad reporting of the analysis.  In 9,000 DNA tests, 1% came back Covid-19 positive.  Half of those people didnt’ have symptoms.   That’s not the same as 50% of asymptomatic people carry Covid. The correct answer would be .5%. 

Second, the early reports on pre-symptomatic transimisson suggest a 3 day interval between contact with a case and the onset of symptoms.  This is why there are questions on screening forms about being in contact with travelers who have developed symptoms.  So now we have a new term: Pre-Symptomatic.  This is the bridge between those who have no symptoms and do, and only they know if they’ve been to an area with Covid-19 or in contact with people who are positive.  

The Grocery Store Boogeyman

This is where the fear kicks in. People are afraid that they’re going to get coughed on at Publix by an elderly Asian man and have to burn their clothes. I want to re-iterate something. In the UF The Villages sample, nearly 883 people looked like they were getting sick or had traveled. Only 23 had Covid-19. It’s up to you how you feel when someone in the grocery store coughs. But do understand that 97% of the time it is among a litany of other reasons- the dang pollen of spring, for instance, why it’s happening. Furthermore the data may not even be applicable locally. I’ll give you 3 guesses as to the main difference between Iceland and Florida, and the first 2 don’t count.

A nation divided on the 37th parallel

Which brings me to my hypothesis. I think Harvard figured out the answer in 2008. My hunch is that the UF findings will only be applicable to people who live in the South. I think we’re going to find Vitamin D levels have a lot to do with who is pre-symptomatic and who is flat out asymptomatic.

37th parallel
2008 Study on Vitamin D deficiency in United States

If you live above this line, wear masks. If you’re elderly, ask your kids about grocery delivery. Put the unending need to go to the hardware store on pause. However, if you’re below the line, go outside. Exercise in the sunshine. Practice activities that naturally encourage social distancing like golf with your partner, birdwatching, or taking the top off your Jeep and crawling through sand dunes. Author’s note: If any of your grandparents get stuck, I don’t want to hear about it. They should have a winch.

Covid-19: Uniting Medicine and Chiropractic for the first time since 1918

A rather interesting piece from the Association of American Physicians and Surgeons suggest we better understand who is at risk; we flatten the curve by targeting them for protection. Are you over 65 with high blood pressure? You wear a mask if you have to go out, but we will deliver you groceries. Are you a 3rd shift worker or Gig Economy worker? Let’s make sure your Vitamin D is up. The real problem, of course, is that if you’re a person of color you don’t produce Vitamin D at the same rate. If you’re over 65, you’re 4x less efficient at producing it. The same Harvard article does have some tips for you.

A warm, early spring may save the Midwest

Stress and obesity are the silent co- factors for low ACE-2 production, which leaves the cellular doorway open for Covid-19. This virus, as has been demonstrated worldwide, is less deadly to healthy people (including children and pregnant women) than most things we typically don’t worry about. The actual numbers are bearing this out. Yet instead of allowing people to go through it and thereby get stronger, Public Health authorities went the other way- everyone hide and maybe the virus will stop finding hosts.

While that IS a strategy, the AAPS article brings up a good point: Did anyone stop to think about what came along with that? The bias is noted- Physicians and Surgeons who do “elective” procedures like facelifts and knee replacements are businesses too. The question they’re asking is along with all other small businesses, did we have to go this way? What does our reaction, and their reaction, say about us as a country?

Color coded map of obesity in the USA 2018

Maybe the strategy was subtle acknowledgement that we have a population of stressed and overweight people who think that they’re healthy? In the map above, if your state is purple 35% of your neighbors have body mass indexes over 30. If your state is pink, it is 30-34.99%. If you have 4 weeks off your job to change some habits and you’re in a purple state north of the 37th parallel, your choice here could make a massive difference. Instead it’s presumed those people won’t (because we’re human and change is hard), so #saferathome it is. Which might cost us in oh so many ways.

” If you prepare an immune system well, when it meets a new virus or bacteria it will respond the way it’s been designed to since the dawn of humankind.”


The author of the AAPS piece also reiterates the principle I’ve driven home into my practice since I earned my degree: If you prepare an immune system well, when it meets a new virus or bacteria it will respond the way it’s been designed to since the dawn of humankind.

At the beginning of March I canceled a kickball tournament. It wasn’t for my practice demographic’s safety, but for the Grandmas receiving all those kids over spring break. At the time I also told my community that this pandemic was the dry run for parents who do not vaccinate. It is testing their systems, their health care strategy, and their educational strategy to see if they work in the case of that measles outbreak.

I would suggest that those parents who are ready (as ready as you can be) for the day their unvaccinated child gets measles are finding themselves far more mentally prepared. They have taken proactive steps in order to fight a virus they haven’t vaccinated against, and many are meeting the challenge of Covid-19 easier than they thought they would.

Who will we become?


Earlier I wrote that there is an opportunity for hope and change in this pandemic.
It presents valuable time for self-reflection and for bigger things to happen for us. I haven’t agreed with anyone that this virus is a conspiracy. But I have suggested that this moment reveals something about the United States. To this point people have been exceedingly compliant, upending their lifestyles over a scary-enough looking threat.

If as a culture we tend towards our echo chambers instead of trusting (but verifying) for ourselves, then we’ve become a nation that is exceedingly easy to scare. I’m going to risk sounding overly patriotic here, but that’s because I’m a patriot. Fear is the enemy of liberty, and it’s easier to control people if facts and objective truth cease to matter. The legacy of Covid-19 will be who we become, and what we were willing to give up in the process.

References

Harvard Health Publishing. “Time for more vitamin D.” Sept 2008, Harvard Medical School. Published online.

Tindale, L. et al “Transmission interval estimates suggest pre-symptomatic spread of COVID-19.” medRxiv 2020.03.03.20029983; doi: https://doi.org/10.1101/2020.03.03.20029983

State of Childhood Obestity. “Adult Obesity Rates.” 2019. State of Childhood Obesity