Thomas S. Bottiglieri, D.O.

Hey everybody, it’s been a little while since I recorded one of these and, there is lots of information to share. I’m going to start with herd immunity. Then we’re going to talk a little bit about some treatments, and then going into what you can do at home, what we can use, & how we can adapt. How much longer is this going to go on? And, in my circle as a sports medicine physician, the question we’re asking ourselves is, what’s next for sports? How are we going to get to the next place that we need to, to have people participating again? And when are we going to have organized sports starting with individual and maybe working up the team? It’s a difficult question to answer.

So, let’s talk a little bit about herd immunity. It turns out, in the news, that the first case was probably in California in early February in the United States and that’s interesting and sheds some light on how this disease may have spread across the country. Seattle & New York city being other hotbeds. Now we are starting to see some little epi centers springing up in other parts of the country, learning from Japan and seeing how their philosophy and their strategy is now starting to creep up again in terms of number of new cases.

In New York, we see a plateau and, probably the beginning of the decline, which is great news, but it doesn’t mean we’re out of the woods in terms of what to expect next. Understanding how this disease is spread. You may have heard of this concept of R0, which is how many people, if I was infected, could expose others to the disease while actively shedding of virus, would I infect? And with this disease, that number has changed.
You may have heard governor Cuomo talk about an R0 of, 1.1 versus 0.9. What that means is that a number greater than one = increasing cases, while if less than one, an infected person is infecting less than one other person. (In that case the numbers of new infections will continue to decline). And in a herd immunity concept, when 50% of the population is immune to this disease, there is a chance that every other person you meet is not going to be infected. And so the number of people you can directly spread that disease to starts to diminish. So in a herd immunity concept, depending on the infectivity, things like measles and very highly infective viruses that we, immunize against, the herd immunity percentage has to be much higher. 70 or 80% of the herd has to have been exposed in order for the vaccine or for the immunity to take effect for the population.
In our circumstance with covid right now, the number is probably closer to 50 or 60%. A lot of this is theoretical. We don’t have all the answers because we don’t have perfect antibody testing yet. But it’s great to see that we’re starting to get some antibody testing and people are starting to get a better idea of how many people may have been infected and, in New York, again, that number might be as high as one in five people, 20% of the population having been exposed already is actually a pretty promising and encouraging thing in terms of what to expect next. But we still don’t know. And so we have to play it a little closer to our chest in terms of opening up. (Massive testing, case tracing, and herd immunity as reviewed above are what is needed for sports to ramp up again.  Sports will follow schools at the high school and collegiate levels. Professional sports are beginning to implement plans for offsite training and competition.  We will likely see golf and other individual sports long before team sports.)

So what can you do? What should you do right now? Well, if you’re like me, you’re starting to feel pretty frustrated working from home.
Things aren’t the same. Your printer isn’t where you need it to be. Your keyboard is different. You don’t have the same terminal or computer setup that you would have at work. Two or three screens, a phone that’s accessible, friends and colleagues nearby that can help you with tasks as they come up. But we’re learning how to do this on the fly and it’s just a testament to human spirit. How quickly we’ve adapted to this. I hate the term “new normal.” I don’t know if you like it, but I don’t like it because nothing is permanent in life. Right? So new, normal, it sort of implies this is permanent. It’s not permanent. This is temporary. And I think that’s a really important thing for us to keep in mind. We’re all feeling a little squirrely.  The mental health is starting to suffer
People are feeling a little more depressed or anxious. And I think that comes from feeling a less lack of control of things. So what have people done?   In the beginning, everybody became an expert on critical care and vent settings and which medication should be next. But as people are seeing, as we’re all starting to see a lot of those things we get excited about, they start to show their faces either being really great or not so great examples such as hydroxychloroquine, which is proving to be not so great.  This idea that this is high altitude pulmonary edema. Yes, there are similarities. No, this is not high-altitude pulmonary edema. And there’s pretty good evidence, treating this as such would not be successful.

We’re also learning about how the virus infects different organs through the Angiotensin receptor.  The virus has the ability to attach to that receptor and that receptor is found in your lungs and your kidneys, your heart & blood vessels. And there’s regulation of blood pressure and lung function that normally occurs from that pathway. And so there’s some disruption of those, normal cycles. And no, taking an ACE inhibitor does not make you more likely to have terrible outcomes from this disease, which is another great thing that we’ve been able to show. If you take an ACE inhibitor, don’t stop it.

Keep your blood pressure controlled because cardiovascular disease, metabolic disease like diabetes, these are the things that are putting you at greatest risk. So as always, a plant based diet, let’s limit our process foods. Carbohydrates, low-glycemic index from good sources of nutrition to power your body. If you are obese or overweight, now’s the best time to start thinking about how we’re powering our bodies, and how we’re taking care of our bodies. So exercise is medicine is a big campaign, but more importantly, you are what you eat. The oldest cliché. Let’s start to think about those things.

The last thing I want to talk about is this, this idea of protesting. The people that are out there protesting the shutdown and we have to recognize the fact that there’s an information war in the world. The New York times put an article out showing how Chinese nationals/operatives are manipulating information from the start of this disease. They influence our social media. And if we think in our own individual mind that we’re immune to that kind of thing, you’re wrong. Our brains are highly impressionable. People will say things like, show me your 10 best friends, the 10 people in your inner circle, and I’ll tell you who you are. We are herd animals and we do take on the traits and identity of others. And when you open something, you open yourself up to ideas. You can often take on those characteristics. And unfortunately, we don’t always see this silent operation of information. Bending and twisting of information to try to create chaos. And if you don’t think that’s happening, read a little bit more about the information Wars that are being waged in this country right now. And it comes from within and without -meaning there are people within our country who seem to be hell bent on creating chaos for us. This isn’t a political thing on one side of the aisle or other. This is more along the lines of what can you control? What can you do right now to make your situation better? What can you do to make your friends and family situation better?

And that’s simple. Get on the phone and talk to the people you care about. Open yourself up, tell them what you’re feeling. Everybody gets anxious. Everybody feels depressed at times. There is a great project from Columbia called the lighthouse project. It’s about suicide risk. If you have a problem, speak up. If you think someone has a problem, ask them. That’s what you can do right now because everybody’s mental health is struggling right now. Everybody’s struggling with this anxiety. Everybody wants to feel like they’re doing something important or that they have a voice. But sometimes the best way to develop your voice is to listen. And the irony of that is not lost on me as I talk into this camera and try to spread the word to you – that I’m speaking in this moment and I am a voice in this moment.

But before I get behind this camera, I quiet my mind.  I take that deep breath, I remember to connect to what’s inside and I remember to connect to the people I care about. So please take the time to do that again today. Call somebody you care about. Reach out if you’re struggling, reach out and ask for help. If you think somebody needs help, offer a helping hand. And if you’re a small business or you’re a community operation or you work for a big business and you’re not sure what you can do, try to meet the road from where you are? People don’t have to make these heroic leaps. For example, you’re a videographer and now all of a sudden you’re trying to be an expert in infectious disease. I do community medicine and sports medicine. That’s my background. I try to think of things from that perspective and how can I help from that place?  (see above in terms of opening fields and sports starting back up following schools)

Let’s all try to do that. If you’re a bagel shop owner, how can you get the products that your patrons want to them? How can you change your menu or get people the things they’re looking for right now in a time where they’re trying to improve their health? Simple things. And the people that I know in my circle, they’re making these moves. They’re helping the people they care about. They’re helping people that patronize their shops. They’re helping the people that they serve, whether in a financial manner or a technology manner. And I have the benefit of their advice and their help in my own circle in my own life. So I hope I didn’t go on too long or bore you, but I really wanted to share a lot of what’s happening in the world and give you an opportunity to start to think about what it is that you, from where you are, can do to improve your health in addition to the daily routines, the exercise, the nutrition that we’ve talked about before. Let’s start to think about our mental health. Because without mental health, there is no health. You need to come from that place first. Restore balance yourself, rejuvenate, make sure you’re sleeping. And I look forward to seeing you all again soon.