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Laila Ali Gives Her Tips for Eating Clean and Being Thoughtful

It’s no secret that Americans struggle with diet and lifestyle. Almost 75 percent have too few vegetables and fruits in their diet, and most eat too much sugar, fat, and salt. Living through a global pandemic isn’t making things any easier.

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Laila Ali wants to inspire us all to be healthier. The daughter of legendary boxer Muhammad Ali, Laila carved out her own legend as the most successful female boxer of all time, and has since created her own lifestyle brand (lailaali.com) focused on building healthy relationships with food.

“I look at health and wellness holistically,” Ali said. “Physically, mentally, and spiritually. I can be in control of my own health by being intentional about my lifestyle choices. My routine is to eat well, exercise, pray, meditate, and practice gratitude.”

For Ali, the secret is knowing what you’re putting into your body.

“Eating clean, NON-GMO whole foods and purchasing the highest-quality ingredients that your budget allows are big factors for wellness,” she said. “Investing in high-quality supplements and vitamins is also key.”

As a mother of two, Ali has a lot of experience encouraging her family to make healthy choices.

“I have been focused on making sure my family was healthy way before the pandemic, but now more than ever, I remind them of why I always make it a point to make them drink smoothies, take vitamins, and eat organic NON-GMO foods,” she said. “We can feel confident in our immune systems and not be fearful because we are strong, and our bodies were created to fight sickness.

“Fear alone can weaken your immune system. So again, being in control of your health and mindset is powerful and healing in itself.”

Ali knows everyone moves at their own speed. “I encourage everyone to think about what they can add to their daily routine as opposed to what needs to be taken away,” she said. “The less overwhelming and forceful making good wellness choices can be, the more successful and long-lasting the changes will be.”

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Covid-19 and the heart: two new studies offer insights

Since the coronavirus pandemic first began, evidence has emerged showing that Covid-19 can damage more than the lungs.

The disease caused by the novel coronavirus can harm other organs in the body — including the heart — and now two separate studies, published in the journal JAMA Cardiology on Monday, provide more insight into how Covid-19 may have a prolonged impact on heart health in those who have recovered from illness and may have caused cardiac infection in those who died.

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“We’ve understood for a few months now that Covid-19 is not only a respiratory infection but a multi-system infection,” said cardiologist Dr. Nieca Goldberg, medical director of the NYU Women’s Heart Program and senior adviser for women’s health strategy at NYU Langone Health in New York, who was not involved in either study.

“There is an acute inflammatory response, increased blood clotting and cardiac involvement. And the cardiac involvement can either be due to direct involvement of the heart muscle by the infection and its inflammatory response. It could be due to blood clots that are formed, causing an obstruction of arteries,” Goldberg said.

“Sometimes people have very fast heart rates that can, over time, weaken the heart muscle, reduce the heart muscle function. So there are multiple ways during this infection that it can involve the heart.”

Inflammation of the heart

One of the JAMA Cardiology studies found that, among 100 adults who recently recovered from Covid, 78% showed some type of cardiac involvement in MRI scans and 60% had ongoing inflammation in the heart.

The study included patients ages 45 to 53 who were from the University Hospital Frankfurt Covid-19 Registry in Germany. They were recruited for the study between April and June. Most of the patients — 67– recovered at home, with the severity of their illness ranging from some being asymptomatic to having moderate symptoms.

The researchers used cardiac magnetic resonance imaging, blood tests and biopsy of heart tissue. Those data were compared with a group of 50 healthy volunteers and 57 volunteers with some underlying health conditions or risk factors.

© NIAID-RML his scanning electron microscope image shows SARS-CoV-2 (yellow)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (pink) cultured in the lab. Credit: NIAID-RML

The MRI data revealed that people infected with coronavirus had some sort of heart involvement regardless of any preexisting conditions, the severity or course of their infection, the time from their original diagnosis or the presence of any specific heart-related symptoms.

The most common heart-related abnormality in the Covid-19 patients was myocardial inflammation or abnormal inflammation of the heart muscle, which can weaken it.

This type of inflammation, also called myocarditis, is usually caused by a viral infection, Goldberg said, adding that she was not surprised by these study results.

“What they’re saying in this study is that you can identify myocardial involvement or heart involvement by magnetic resonance imaging,” Goldberg said.

The study has some limitations. More research is needed to determine whether similar findings would emerge among a larger group of patients, those younger than 18 and those currently battling coronavirus infection instead of just recovering from it.

“These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19,” the researchers wrote.

‘This infection does not follow one path’

In the other JAMA Cardiology study, an analysis of autopsies found that coronavirus could be identified in the heart tissue of Covid-19 patients who died.

The study included data from 39 autopsy cases from Germany between April 8 and April 18. The patients, ages 78 to 89, had tested positive for Covid-19 and the researchers analyzed heart tissue from their autopsies.

The researchers found that 16 of the patients had virus in their heart tissue, but did not show signs of unusual sudden inflammation in the heart or myocarditis. It’s not clear what this means, the researchers said.

The sample of autopsy cases was small and the “elderly age of the patients might have influenced the results,” the researchers wrote. More research is needed whether similar findings would emerge among a younger group of patients.

“I think both of these studies are important,” Goldberg said.

“One pretty much shows that the MRI scan can help diagnose the myocardial injury that occurs due to Covid and it was confirmed on biopsy,” she said. “The autopsy study showed us something else that’s interesting — that you can have viral presence but not the acute inflammatory process. So this infection does not follow one path.”

‘An increasingly complex puzzle’

Both studies “add to an increasingly complex puzzle” when it comes to the novel coronavirus named SARS-CoV-2, Dr. Dave Montgomery, founding cardiologist at the PREvent Clinic in Sandy Springs, Georgia, said in an email on Tuesday.

“Taken together the studies support that SARS-CoV-2 does not have to cause clinical myocarditis in order to find the virus in large numbers and the inflammatory response in myocardial tissue. In other words, one can have no or mild symptoms of heart involvement in order to actually cause damage,” said Montgomery, who was not involved in the studies.

“Viruses in general have a way of making their way to organs that are quite remote from the original site of infection. SARS-CoV-2 is no different in this regard,” he said. “What is different is that this virus seems to preferentially affect cardiac cells and the surrounding cells. These studies suggest that the heart can be infected with no clear signs. Personally, in my practice, we have seen similar signs of inflammation, including pericardial effusions,” or fluid around the sac of the heart.

Dr. Clyde Yancy of Northwestern University Feinberg School of Medicine and Dr. Gregg Fonarow of the University of California, Los Angeles, co-authored an editorial that accompanied the two new studies in the journal JAMA Cardiology on Monday.

“We see the plot thickening and we are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to COVID-19 may potentially evolve as the natural history of this infection becomes clearer,” Yancy and Fonarow wrote in the editorial.

“We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to con- firm or refute these findings,” they wrote.

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Local woman survived COVID-19, then hit with a nearly $50,000 medical bill

D’OXYVA can save a person from the worst effects of COVID-19 for less than 1/10th of the standard care, according to recent test results.

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“My doctor told me that he almost lost me several times. Having to be in the hospital alone without my children or family to hold my hand was terrible,” said COVID-19 survivor Joycelyn Raine.

57-year-old Joycelyn Raine survived a near-death fight with COVID-19.

“I’m just so thankful that I survived. My doctor said that I’m a miracle. He said that he thought he wouldn’t be having another conversation with you but you are a fighter. Thank God. Out of the thousands of people that had passed due to COVID. The Lord show to keep me here. I am grateful for that,” said Raine.

Raine was diagnosed with COVID-19 on April 5th. She then went to a hospital in Meridian where she spent 30 days getting treated for the virus.

“I was scared. I have faith in God but I was afraid I was dying,” said Raine.

After Raine was discharged on May 24th, she went to a rehab center where she spent an additional two months. A couple of weeks after she returned home, Raine received a $45,000 bill from the hospital

“COVID has been traumatic in my life because it put me in a terrible financial bind. Thank God for county assistance, my church family, and my family. I don’t know how I would have survived,” said Raine.

Raine said her team of supporters saved her life, and you can’t put a price on that.

Raine said her COVID-19 experience was scary and encourages everyone to wear their masks.

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D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a game changer.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.s

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Americans being blindsided by medical bills amid COVID-19 pandemic

Odds are you do, considering 61% of Americans say they have experienced these costs that could lead to financial hardship.

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PatientRightsAdvocate.org Founder Cynthia Fisher discusses why the need for price transparency in healthcare has never been more important amid the coronavirus crisis.

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Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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How Boris Kodjoe Is Supporting Black Americans and First Responders During the Pandemic

Boris Kodjoe, the star of ABC’s “Station 19,” is focused on self-care. He loves food but not diets, and says his schedule is too busy to spend hours working out.

“Moderation is key for me,” he said, noting his diet is mostly vegetarian, with no refined sugars. His fitness plan alternates between daily 25-minute interval/resistance training and stretching/mobility routines. He plays tennis some days.

 

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He and his family started KOFIT, a fitness app to help people introduce healthy habits into their lives.

“In these times of COVID-19, people need support in staying fit and healthy at home,” Kodjoe said. “KOFIT’s physical and mental health tips are simple and effective, and they help out the entire family.”

Nicole Ari Parker, an actress and Kodjoe’s wife, designed performance headbands with black women in mind. Called the GymWrap, the headbands wick away sweat, keeping women’s hair fresh, even during exercise.

“With the GymWrap, women can protect their hairstyles while exercising and staying healthy, yet still be ready to go to work after working out,” Kodjoe said. “We’re hoping men and women realize that adding some healthy habits to your everyday routine will increase your quality of life, even if you start out with five minutes a day.”

Supporting Black Americans

COVID-19 is affecting black Americans at a disproportionately high rate. Kodjoe says the crisis has revealed disadvantages in the community, including pre-existing health conditions and systemic discrepancies in healthcare, education, economic opportunity, social justice, access to healthy nutrition, and more.

Kodjoe and Parker are discussing social justice and equality issues with their two children.

“Nicole and I continue to guide our children through their fears and concerns, their hopes and dreams as we address these subjects, and teach them to speak up and be a part of the solution,” Kodjoe said.

The couple has actively advocated for wearing masks during the COVID-19 pandemic. Parker’s company has been selling masks and donating many to first responders through their #HelpOurHeroes initiative.

“We were inspired by the courage and commitment essential workers and first responders exhibited right from the start, and we wanted to help,” Kodjoe said, explaining they’ve given out more than 500,000 free masks so far and plan to donate more. “Hopefully more people will understand that wearing a mask is not about your personal right but rather your personal commitment to your neighbor’s health.”

Source

https://www.futureofpersonalhealth.com/infectious-diseases/how-boris-kodjoe-is-supporting-black-americans-and-first-responders-during-the-pandemic/

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D’OXYVA significantly helps people and their pets by gently and quickly spraying a patented and patent-pending ultra-purified, supersaturated solution on the skin surface to achieve major health benefits for well over 90% of users.

Experts call D’OXYVA a game-changer biotech. “Studies with D’OXYVA have shown unmatched results in noninvasive wound care,” Dr. Michael McGlamry. Anyone with an underlying condition should know this option is available.

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American Fitness Index Report: These are the fittest US cities in 2020

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The American Fitness Index found that Arlington, Virginia, is the fittest US city this year. For the third year in a row, Arlington, Virginia, is the fittest city in the U.S., according to a recent report.

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On Tuesday, the American College of Sports Medicine (ACSM) and the Anthem Foundation published the annual American Fitness Index, which put Arlington in the top spot on its list of the 100 largest U.S. cities.

To determine the ranking, the American Fitness Index analyzed those cities based on 33 measurements, including “health behaviors, chronic diseases and community infrastructure indicators,” according to a release about the report.

Arlington took the top spot because of its healthy behaviors and community infrastructure, the release said.

Aside from getting the overall top spot, Arlington was also found to be the city with the lowest rate of adults with obesity and the city with the highest rate of residents who meet aerobic and strength activity guidelines, according to the release.

The report also found that all 100 cities saw improvements in several areas including the rate of residents exercising, the number of residents who smoke, and the number of parks within a 10-minute walk.

However, in all 100 cities, only 22 percent of adults met guidelines for aerobic and strength activities.

“It should be of national concern that only one in four Americans meets national physical activity guidelines and more than 30 million have diagnosed heart disease,” American Fitness Index Advisory Board chair Barbara Ainsworth, a fellow of the American College of Sports Medicine, said in a statement.

“Sedentary lifestyles across the United States cost more than $117 billion annually in sick care services, adversely impacting both our nation’s health and economic well-being,” Ainsworth added. “This challenge has local solutions, and the Fitness Index is a prescription for communities to bring about positive change.”

According to the report, the coronavirus pandemic shows how important it is for cities to give residents the opportunities to have healthy lifestyles.

“We know from research that physical activity can build a healthier immune system and overall wellness, which help minimize harmful effects of illness and disease,” Ainsworth said. “This pandemic shows the need to have local parks, trails and connected sidewalks in all neighborhoods that allow people to exercise safely. City leaders and planners need to act boldly and decisively to enact policies and funding to promote physical activity, better health and stronger communities.”

To see what other cities made it to the top ranking, here are the top 10 fittest U.S. cities in 2020, according to the American Fitness Index.

10. Boston

9. Boise, Idaho

8. Denver, Colorado

7. Irvine, California

6. Washington, D.C.

5. San Francisco

4. Madison, Wisconsin

3. Minneapolis, Minnesota

2. Seattle, Washington

1. Arlington, Virginia

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D’OXYVA significantly helps people and their pets by gently and quickly spraying a patented and patent-pending ultra-purified, supersaturated solution on the skin surface to achieve major health benefits for well over 90% of users.

Experts call D’OXYVA a game-changer biotech. “Studies with D’OXYVA have shown unmatched results in noninvasive wound care,” Dr. Michael McGlamry. Anyone with an underlying condition should know this option is available.

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Actor Jonathan Adams Shares How COVID-19 Disproportionately Affects Black Americans

Actor Jonathan Adams is focused on staying healthy during the COVID-19 pandemic and he wants fellow Black Americans to stay safe, too.  The novel coronavirus has disproportionately affected Black Americans at a higher rate than other races. 

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New data shows Black and Latinx U.S. residents are three times as likely to get coronavirus, compared to their white neighbors. They’re also nearly twice as likely to die from the disease.

Adams, known for playing Chuck Larabee, Tim Allen’s neighbor on ABC’s “Last Man Standing,” has been talking with his family and friends about the pandemic, including with his sister, who is a nurse.

“All I can say is that it’s incredibly oppressive and very frightening,” said Adams, who wears masks and tries to stay healthy overall. He exercises every other day, including taking long walks with his dogs.

Socioeconomic issue

Adams says many essential workers like nurses, restaurant workers, bus drivers, and others, are people of color.

“It’s not necessarily a racial thing but I think it’s more a socioeconomic issue that we’re facing,” he said. “And we’re seeing a disparity in the fact that a lot of Black people, and a lot of Latinos as well, don’t have the white collar jobs that we can stay at home and do from home, do from a computer.”

In fact, 2018 Census data shows 43 percent of black and Latinx workers work in service and production jobs, which typically can’t be done remotely.

Black in America

It’s an emotionally challenging time in the United States

“There’s a lot of tension that comes along with just simply being black in America,” said Adams. “And I think that a lot of why we have hypertension is because of the tension of just trying to live in your own skin.”

The American Heart Association says Black Americans have one of the highest rates of hypertension in the world. While people with the condition are encouraged to relax, Adams says that’s hard to do.

“How can you relax when you’re under this constant pressure?” asked Adams, who calls the combined timing of COVID-19 and Black Lives Matter “a perfect storm.”

He’s ready for open conversations about these tough topics.

“Honestly, I think everything starts at home, and everything starts with your own family,” Adams said. “It all begins with someone you know, or even a small group of people having those arguments and discussions about this. We just need to hammer it out.”

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https://www.futureofpersonalhealth.com/infectious-diseases/actor-jonathan-adams-shares-how-covid-19-disproportionately-affects-black-americans/

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Experts say D’OXYVA® can help patients find relief. Overwhelming medical data shows people with preexisting conditions, including diabetes may experience serious complications with COVID-19.

D’OXYVA significantly helps people and their pets by gently and quickly spraying a patented and patent-pending ultra-purified, supersaturated solution on the skin surface to achieve major health benefits for well over 90% of users.

Experts call D’OXYVA a game-changer biotech. “Studies with D’OXYVA have shown unmatched results in noninvasive wound care,” Dr. Michael McGlamry. Anyone with an underlying condition should know this option is available.

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Comedian and Host Loni Love On Wearing Masks, Self-Care, and Supporting Communities of Color

Comedian and “The Real” co-host Loni Love is using her voice to help Americans, including those in communities of color, stay healthy during the pandemic.

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“You have platforms like ‘The Real’ that’s for a diverse audience that you should talk about things that are going to affect that community,” said the Emmy- and NACACP Image Award-winning talk show host.

She wants everyone to know that COVID-19 is disproportionately impacting the Black community. It’s one of the top topics she and her co-hosts talk about on the show, helping viewers realize how serious the situation is.

“We, as a community, we’re responsible for giving the right information, and if they can’t get it from us, where are they going to get it from?” she said. “I’m happy that we’re able to do that.”

Mask on

Love tries not to go out much these days but when she does, she’s very careful with her habits, including covering her hair, and keeping hand sanitizer and wipes in her car, and using them often. She washes her hands and her clothes frequently.

She’s a firm believer in wearing masks during the pandemic. She thinks many people aren’t wearing masks because they want to keep their regular lives.

“But life changes and when life changes, you have to make adjustments,” Love said. “But this is just an adjustment. We’ll get through it. We’ll get through it together when we all try to do the right thing and that is to wear masks.”

Self-care

Love has made exercise a priority, too. She joined online workout classes and enjoys the variety of options, such as the ability to do both 20-minute and hour-long workouts. She works out at least least three times a week.

She’s fueling her body in other ways too.

I try to put some things inside of my body to fuel my immune system up,” said Love, who drinks lots of water and takes vitamins, such as Vitamin C, as well as herbal supplements.

And even though it’s easy to stay up late during quarantine, she sets a bedtime and aims to get at least seven hours of sleep each night.

Mental health

Love checks in on her family and friends often, and has Zoom calls with her single friends who live alone.

Mental is just as important as physical health, and especially during a pandemic where you’re spending a lot of time alone,” she said. “I try to make sure that my friends are OK.”

She encourages others to reach out as well.

“Even if you just call one person, you’re still helping to spread the information, because that one person will tell another person, will tell another person, will tell another person,” Love said. “And that’s what we have to keep doing.”

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Experts say D’OXYVA® can help patients find relief. Overwhelming medical data shows people with preexisting conditions, including diabetes may experience serious complications with COVID-19.

D’OXYVA significantly helps people and their pets by gently and quickly spraying a patented and patent-pending ultra-purified, supersaturated solution on the skin surface to achieve major health benefits for well over 90% of users.

Experts call D’OXYVA a game-changer biotech. “Studies with D’OXYVA have shown unmatched results in noninvasive wound care,” Dr. Michael McGlamry. Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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The Coronavirus Pandemic Originated in Live-Animal Markets/Illegal Wildlife Trade and Leading Biotech Company, Circularity Healthcare, is Looking to Stop it for Good

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Circularity Healthcare is partnering with EndPandemics.earth to help prevent future pandemics by ending the commercial trade in wild animals, expanding wild habitats, and protecting livelihoods.

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Circularity announced a long-term collaboration with EndPandemics on June 16th, 2020 that, in line with Circularity Healthcare’s mission to provide real and affordable healthcare solutions, will create a global alliance to protect and regenerate nature and to help prevent future pandemics by ending the commercial trade in wild animals, expanding wild habitats, and protecting livelihoods. Contributions will not only protect global health and save wildlife, but also safeguard global biodiversity, enhance sustainable agriculture, and mitigate climate change.

Circularity Healthcare will also be donating its products to every member of this charity’s network to help them stay healthy and safe amid the current COVID-19 pandemic. This includes the D’OXYVA Start Health Set.

“Partnering with one of the world’s biotech leaders in proprietary circulatory health and noninvasive delivery technologies that actually helps to save the lives of those infected by pandemic diseases, was a no-brainer for EndPandemics. In our partnership with Circularity Healthcare, we are both looking forward to making a true impact across the globe to address disease surveillance gaps and prevent future outbreaks,” says Michael Mitchell, chairman at EndPandemics.

As the coronavirus pandemic continues to spread worldwide, companies must plan ahead and take necessary steps that will help them protect their employees, keep their business on track, and even prepare for the worst—business disruption. Most have revisited policies, considered new innovations and platforms, and canceled events that require mass gatherings – and yet many still require assistance.

As shops, restaurants, and bars across the nation and around the world continue to be shut down to help flatten the curve and slow the spread of coronavirus, many workers were sent home. For most, if not for all of these workers, that means uncertainty as to when they will see a paycheck again.

Given the current pandemic the world is facing, preventing future breakouts must be a global priority and for those who want to help it can be hard to know where and how to start.

“There are so many ways to help, and sometimes it gets very confusing, as there are so many charities to choose from, but during these hard times, all kinds of giving makes a difference,” says Jennifer Rose Boadilla-Pelaez, Circularity Healthcare’s Senior Sales and Marketing Manager, Creative Director. She continues by stating, “the direction that Circularity Healthcare decided to go in is with an extensive donation and outreach partnership with EndPandemics that will have a long-lasting, global impact on how we approach tackling and preventing current and future pandemics head-on, and for that we are grateful.”

If you are interested in learning more about Circularity Healthcare’s and EndPandemic’s partnership learn more here, or if you’d like to join the mission and donate, learn more here.

About EndPandemics
EndPandemics is a dynamic global alliance of organizations—representing conservation, climate, health, finance, security, agroforestry, business, technology, and communications—who have launched a global campaign to reduce the risks of pandemics by addressing the root cause of all zoonotic outbreaks: rampant wildlife trade and the destruction of wild habitats.

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physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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Months of Trial and Error in the ICU Offer Clues on How to Save Covid Patients

Faced with an unmanageable influx of coronavirus patients at Columbia University Irving Medical Center’s step-down unit, an intermediate care ward, Jelic made an unorthodox decision: she asked those struggling to breathe to roll onto their bellies while they waited for intubation to mechanically ventilate their inflamed lungs.

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It wasn’t a random guess. Laying patients in the stomach-down prone position is known to improve oxygenation in sedated, intubated patients with acute respiratory distress syndrome. But there was no guarantee the same would hold true for wakeful Covid patients who were gasping for air.

“We had to buy time,” Jelic, who is also an associate professor of medicine at Columbia University, recalled in an interview. “I remember, the first three patients really had a dramatic improvement in their oxygenation.”

In the absence of a cure, doctors like Jelic were left relying in part on trial and error, but months into the most destructive pandemic in a century, their collective experience is starting to build a framework of how best to cope with coronavirus patients.

As many as 1,000 Covid-related research papers are being released daily ahead of peer review and publication, according to Soumya Swaminathan, the World Health Organization’s chief scientist. “Our goal is to see that the learnings from science are as quickly as possible channeled into impacts for patients and communities,” she told reporters in Geneva on Thursday.

‘How You Do It’

The collective experience may be showing results. U.S. deaths, which often ranged between 2,000 and 3,000 a day in April and May, have mostly remained below 1,000 and in the low hundreds since the beginning of June.

The WHO is collating data from countries to identify crucial elements that reduce mortality. These include how health systems triage Covid-19 patients, how they protect those vulnerable to more serious complications, and the speed with which they provide intensive care.

The goal is to create a tool box that will enable doctors to provide better care for the full range of patients with Covid-19, which has turned out to be more than just a respiratory disease, said Sylvie Briand, the WHO’s director for global infectious hazard preparedness.

“It’s not only what you do — sometimes at this level there is no difference — but it’s how you do it,” Briand said in an interview.

Better Practiced

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, also credits better experience with medicines.

“Whenever you’re in an outbreak, there are two things about treatment that contribute to improvement,” he said. “Not only do you get better in practice, but you get better because of new treatments.”

In April, Gilead Sciences Inc.’s antiviral remdesivir, now approved with the brand name Veklury, was shown to speed recovery time. Last month, the inexpensive corticosteroid dexamethasone was found to reduce deaths by one-third among patients receiving mechanical ventilation. Doctors are also routinely administering heparin and other anticoagulants to prevent dangerous blood clots from forming in the veins of the critically ill.

Although the “awake proning” approach Jelic and colleagues tried hasn’t been properly studied yet in a large clinical trial, it points to a cheap and simple way overwhelmed health centers may be able to help severely ill patients. Their research, published in a June 17 letter to the Journal of the American Medical Association, indicated that it reduced the probability patients would need intubation. The journal also published an invited commentary subtitled “necessity is the mother of invention.”

“I couldn’t agree more with the title,” Jelic said. “I have never seen this much strain on our ICU resources.”

Laying on the stomach improves blood circulation in the upper portion of the lung, she said, increasing the volume of oxygen and carbon dioxide that can be exchanged. It also decreases pressure around the lung, and can help clear secretions from the airways, studies show.

While combination treatments — the HIV medications ritonavir and lopinavir, and the antimalarial drugs hydroxychloroquine and chloroquine with the antibiotic azithromycin — failed to reduce death in hospitalized Covid-19 patients, there’s optimism for others. These include antibody-based therapies and blood products from survivors.

‘Cytokine Storm’

The antiflammatory infusion infliximab, sold by Johnson & Johnson and Merck & Co. as Remicade, is being studied at Tufts Medical Center in Boston as a way of circumventing the major cause of lethal complications in a subset of Covid-19 patients: A damaging immune response, sometimes referred to as a cytokine storm, that usually occurs in the second week of illness.

Infliximab blocks tumor necrosis factor-alpha, a cell-signaling protein or “cytokine” that plays a key role in driving the immune system to exhaustion in response to infections, said Paul Mathew, a Tufts cancer specialist, who’s leading the study. The medicine may also help avert life-threatening blood-clotting problems that can occur in Covid patients.

“Little by little, we discovered new signs and symptoms of the disease,” said the WHO’s Briand. “Now we know that there is really a lot of possibilities for this virus to attack the human body.”

These range from a sudden lack of smell to a multi-system inflammatory syndrome in children — features that have become more apparent with more than 11 million Covid cases worldwide. Others include clotting-related disorders that can be benign skin lesions on the feet, sometimes called “Covid toe,” or potentially lethal strokes.

The more Covid patients Jarrod Mosier sees in his hospital’s intensive care unit in Tucson, Arizona, the more he says he’s convinced that saving lives comes down to protecting the lungs of those with acute respiratory distress syndrome, or ARDS, caused by pulmonary inflammation. Most patients need breathing support, but too little or too much air pressure and volume can damage the lungs further.

“I look at all of those things and tinker with the ventilator for a good while everyday to try to find that balance,” said Mosier, who is also an associate professor of emergency medicine and medicine at the University of Arizona. “To me, that is the thing that will save the most lives in this disease — just excellent critical care management of ARDS.”

Mosier said he’s hoping it results in better patient survival. “I think that’s the case, but it’s very hard to answer that question when you’re in the thick of it,” he said. “Some days I think we’re actually getting pretty good at this. And other days I think, ‘This is demoralizing.’”

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