Members get a daily Covid-19 topic focused on Covid in Tennessee.
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Tennessee Covid numbers since Friday:
New confirmed SARS-CoV2 infections: about 9,000
New Covid deaths: 109
Hospitalized: 3,274
Positivity: 11.88%
I expect Covid numbers in Tennessee to collapse in the next several weeks. Delta in India spiked hard then collapsed.
It's been a real test of immunity and health in our region, and we've done as poorly as predicted. Thankfully, we didn't have a contagion like delta until both monoclonal antibodies and vaccines were available for those who availed themselves.
Sadly, too many who did not in time were and are being killed by the virus or its complications.
Why is this virus so problematic?
Well, we've already talked about it being novel to our immune systems.
Then it's extraordinarily communicable and it infects and affects our airways.
That is because the spike protein of this virus is especially good at connecting with ACE2 receptors on human cells.
Once connected, the virus enters the cell and takes over its machinery to create copies of itself.
ACE2 receptors express in various types of cells in our bodies. Our airways have many, but so do the linings of our blood vessels.
Once the virus enters the bloodstream, it can enter and infect these lining cells, called endothelial cells.
Our immune system, once it figures out what is going on, starts looking for cells that are expressing indicators that they have been hijacked.
But immune cells aren't surgical. They don't fix the cells that are infected. They just eat them.
This exposes the basement membrane under the endothelial cell, which, in turn, stimulates clotting proteins and platelets to aggregate there, because the body assumes that this damage is a hole that needs to be fixed.
Lots of things happen then. These clots may use up clotting factors, or they may stimulate more clotting factors, making the blood more likely to clot.
One of the CRNAs I talked with recently described the blood of Covid patients as clotting immediately when he tried to get blood samples.
These clots may eventually break loose from where they formed and float downstream. We call them microemboli, and many collect in the capillaries of the lungs. This causes the blood oxygen levels to drop, which is part of why Covid patients have low oxygen levels.
If the patient is sedentary, laying in bed or on the couch, this thickened blood can cause large clots in the vessels of the legs or pelvis.
If those clots dislodge, they can cause a serious or fatal pulmonary embolism. This is the same process that kills some people on long airline flights, from sitting for prolonged periods of time.
So if you were wondering why part of my advice for Covid patients is activity, this is one of the reasons. The other reason is that you don't want to develop a pneumonia from not clearing your secretions, and activity and position change are helpful for that.
It appears that most people who have been vaccinated avoid these clotting issues, I assume because the virus isn't as free to replicate and spread in the bloodstream.
Separate topic: Always consider that you may be wrong. It keeps us humble and open to new evidence and new information.
We can all be wrong.
But we go with what we can figure out.
Do the best you can with the highest quality information you can find.
Stay healthy!
I'm on a weekend night call schedule this weekend, which always leaves me feeling under-rested and generally icky.
But I wanted to remind you that outdoor exercise without screens is really good for your mental health.
Go outdoors, preferably into the woods.
Get in tune with those surroundings, the sights, the sounds, the smells, even the movement of air and the varying temperatures as you walk.
We were made to be outdoors.
We were definitely not made to work in cubicles.
One Degree!
What you want from your body will dictate what you need to set as goals, and the goals will determine what you'll end up having to change to attain them.
I've spoken many times about systems being better than goals, and my position has not changed.
But goals are easier to discuss and to understand, so for this week, we'll be very specific about goals.
Do you want more muscle mass?
Do you want to be stronger?
Do you want to run faster?
Do you want to gain weight?
Do you want to lose weight?
Do you want to improve general fitness?
Do you want longevity?
Do you want strong bones?
Do you want to earn a Black Belt?
Understanding the benefits and costs of each particular goal may help you decide what you want.
For example, if you want to compete in body-building competitions, you'll not be doing the same thing as if you were focused on longevity. Same with strength competitions.
But general fitness and longevity go fairly well together.
Running is great but will increase the likelihood of needing knee or hip ...
I'll make this one short and to the point.
Spring time change is hard on all of us. Having to get up an hour early doesn't make going to bed an hour earlier much easier.
Yes, it's nice to have more productive time in the evening.
But it's at the cost of forcing us out of be an hour earlier, as we all know.
Our challenge is to adjust our circadian rhythm to match the world's expectations around us.
My main strategy is supplementing with a dose of melatonin about a half hour before I need to be asleep. It helps most people fall asleep more readily.
If you need a nap during your day, take it between mid-morning and early afternoon. Limit it to 20 minutes.
Taking a longer or later nap may make it even harder to get off to sleep in time.
All of the other normal advice applies even moreso:
- Take a 20-minute walk after supper.
- No screen time for the last hour before bed.
- Listen to calm music after supper.
- Don't eat for 2 hours before bed.
- Don't have conflict-laden conversations ...
