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“Metabolic optimization” probably won’t save you from COVID-19

A favorite claim by those favoring “holistic” therapies is that using diet to “optimize metabolism” can prevent or treat COVID-19. These claims are of a piece with similar claims for many other diseases and are just as exaggerated.

Since COVID-19 was officially declared a pandemic on March 11, unsurprisingly much of my concern has focused on the science and pseudoscience of COVID-19. In particular, I’ve concerned myself, both here and at my other blog, with medical misinformation, urban legends, astroturf disinformation campaigns, and conspiracy theories being spread in what is sometimes called a COVID-19 “infodemic”, as well as the regulatory and public health issues regarding proposed COVID-19 therapeutics and vaccines. However, there is one disturbing false (or at least highly distorted) narrative that we haven’t really addressed, at least not directly. I’m referring to a narrative that started very early on in the pandemic that “metabolic optimization” through nutrition and lifestyle can protect you against the coronavirus, or at least make it much less likely that you will develop life-threatening illness if you do “catch this cold“, as Del Bigtree so disturbingly and deceptively put it as he vastly understated the dangers posed by the virus and basically proposed leaving those at high risk for serious disease on their own during this pandemic. (I will be quoting him again later, near the end of this post.)

Of course, those inclined to distrust “Western medicine” and believe in so-called “alternative medicine”, or, as it’s increasingly called as it’s been infiltrating conventional medicine, “complementary and alternative medicine” (CAM) or “integrative medicine”, have long overemphasized the potential benefits of nutrition and lifestyle for “metabolic optimization” to prevent infectious diseases (or at least drastically ameliorate their symptoms to the point where they go from being potentially life-threatening to minor inconveniences that serve only to “strengthen the immune system”). Just as a reminder, I’ll cite an example over a decade ago during the H1N1 influenza pandemic. Then, HBO’s “politically incorrect” pundit Bill Maher, whom I had noticed spreading antivaccine talking points years before (and who’s still doing it), touted the benefits of nutrition and lifestyle and bragged that, because of it, he’d never catch the flu, even on an airplane. Indeed, Maher said, “I would never get the flu on an airplane”, presumably because his immune system is so healthy and, thanks to his lifestyle, there is no “swamp” there for the virus to breed in, leading his guest Bob Costas to retort in an exasperated voice, “Oh, come on, Superman!” (This was the best retort ever to Maher’s antivaccine nonsense, with the possible exception of Bill Frist basically calling him the “crazy person” when it comes to vaccine pseudoscience.)

Maher is just one of the more amusing examples of antivaxxers and quacks implying (or outright claiming) that nutrition can do a better job of preventing infectious disease than vaccines. I could quote many others, given that I’ve been following the antivaccine movement since the early 2000s. One particular favorite is a common antivaccine claim that, because children in Third World countries are much more likely to die when they contract measles than children in First World countries, nutrition and sanitation are far more important in preventing measles than vaccines, the idea being that better nutrition makes for a “stronger immune system”. Basically, it’s a good example of how antivaxxers take a pebble of truth (certainly poor nutrition does impact the immune system) and try to turn it into a boulder of an unsupported claim or outright lie (e.g., that nutrition can do as well or better, in “strengthening the immune system” to prevent infectious diseases, than vaccines).

It’s not just infectious diseases, either. This fetishization of nutrition and food above all permeates not just the antivaccine movement but all of alternative medicine. Indeed, when alternative practitioner Toni Bark developed a deadly cancer, the cognitive dissonance was such that her son had to admit that she developed her cancer even though she had lived what he considered to be an incredibly healthy lifestyle and consumed a vegan diet. (Yes, there is considerable victim blaming among the “nutrition cures everything” crowd.) A corollary of the “food as medicine” mindset is a persecution complex, in which advocates like to claim that any suggestion that food can cure or prevent disease is dismissed by nasty scientists and skeptics as “quackery”. (It’s not; only overblown claims for the medical benefits of foods, nutrients, diet, and lifestyle are so dismissed.)

So it should be no surprise that similar claims are being made regarding COVID-19 and have been since very early in the pandemic, including claims that vitamin C (of course!) or an “alkaline diet” (double of course!) can treat or cure COVID-19.

Which brings me to an article reviewing a book by Dr. Asseem Malhotra, The 21 Day Immunity Plan:

Winter is coming and the current spate of Coronavirus-related news is not encouraging: the pandemic is ravaging Europe, efficient cures are still just over the horizon, and many are prophesizing that the second wave will hit us even harder than the first one. But amidst this doom and gloom, Dr. Aseem Malhotra’s book, The 21 Day Immunity Plan (1), is a much needed breath of fresh air. Malhotra is a familiar name for European Scientist readers – in one of our most read articles of the year, Covid-19 and the elephant in the room, Dr. Malhotra excoriated the mainstream media for their failure to notice the role nutrition has in the outcome of Covid-19 cases. Obesity, diabetes, and other metabolic diseases led to increased hospitalization rates, overwhelming the NHS:
The government public health message enhanced by the media to stay at home, protect the NHS and save lives has been powerful and effective. Given the speed at which health markers for metabolic disease improve from dietary interventions, an equally strong if not more significant population health message should now be to “eat real food, protect the NHS and save lives.”
Driving that point home, Malhotra has now followed up on this story with a solid 21-day program on how to optimise the immune fonction [sic].

To see where this is going, let’s first look at what we know about the factors that predispose to death or serious illness from COVID-19.

COVID-19 risk factors

Since the earliest major outbreak of COVID-19 in Wuhan, China, doctors have recognized certain risk factors that portended a higher likelihood of life-threatening illness and death from SARS-CoV-2, the coronavirus that causes COVID-19. Many of these risk factors have been confirmed over and over again in multiple studies in multiple countries.

Unmodifiable risk factors for death from COVID-19

The first—and by far the strongest—risk factor for serious disease and death due to coronavirus is unchangeable. Specifically, it is age. It has been known since very early on in the pandemic that, the older you are, the more likely you are to die if you contract COVID-19—and not by a little. The CDC has published a handy-dandy guide that tells you how much higher or lower your risk of death due to the virus is compared to the reference group (18-29 year olds). There is a dramatic increase in the risk of hospitalization and death with rising age, going from a 2x higher risk of hospitalization and 4x higher risk of death for 30-39 year olds to a 13x higher risk of hospitalization and 630x higher risk of death in those 85 years of age or older:

Hospitalizations and deaths from COVID-19 by age

In terms of absolute numbers, the reported case fatality rates (CFRs, or the risk of dying if you develop symptomatic COVID-19) range from 13%-20% for those over 80.

Death by Age

A recent study from PNAS shows this age effect most starkly:

In terms of infection fatality rate (IFR), which includes all infections, including the asymptomatic, we know this

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19.


“COVID-19 is not just hazardous for elderly people, it is extremely dangerous for people in their mid-fifties, sixties and seventies,” says Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire, who has estimated that getting COVID-19 is more than 50 times more likely to be fatal for a 60-year-old than is driving a car.

This preprint quantifies the risk. (Note that preprints are not yet peer reviewed.)

Another major risk factor for death is also unchangeable in that sex also matters. Men have a significantly higher risk of dying from COVID-19 than do women, as also shown in the preprint:

COVID men vs women

A recent correspondence in The Lancet suggests, though, that the relationship is not straightforward:

The overall male to female mortality sex ratio per 100,000 population was 1·4 (crude ratio 1·3). This ratio was not equal at all ages. For example, for people aged 0–9 years the ratio was 0·81. The ratio was 1·9 in the 40–49 years age group, 2·3 in the 50–59 year age group, 2·6 in the 60–69 years age group, and 1·65 in people older than 80 years (appendix p 1).

There was some variation across countries, although broadly the pattern was similar, and the numbers became too small for clear-cut interpretation (appendix p 3).

These data alter our understanding of male–female differences; the relationship is not straightforward, and efforts should now be made to understand risk based on the interaction of sex and age, along with other factors.

Unsurprisingly, ethnicity also plays a role. Of course, it can be difficult to separate socioeconomic factors from ethnicity, but we do know that there is a considerable racial and ethnic gap in terms of COVID-19 mortality, with Black people suffering death rates twice as high as white people, and Hispanic/Latino people somewhere in between. There is also evidence that Native American and Alaska Native people are at higher risk of death and severe disease as well.

Of course, we’re still early in our experience with COVID-19, and it will take considerably more research to tease out the reasons for elevated risk of severe disease and death in various populations. My point here is that there are at least two major risk factors that are not modifiable (sex and age) and at least one that might not be modifiable (race, if the increased risk is truly due to race and not more due to comorbidities and social forces that disproportionately affect Black populations and other minorities). No matter whether risk of death from COVID-19 can be decreased by “metabolic optimization” or not, if you’re 80 years old you’ll still be many, many times more likely to die of COVID-19 than if you’re 20 years old.

Modifiable risk factors for COVID-19

Another observation that was made early in the pandemic is that a number of chronic comorbid conditions correlate strongly with the risk of severe disease and death from COVID-19. Currently, these conditions include:

  • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Obesity (body mass index [BMI] of 30 or higher)
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus

It’s also suspected that these conditions also predispose to severe disease from COVID-19:

  • Asthma (moderate-to-severe)
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Cystic fibrosis
  • Hypertension or high blood pressure
  • Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Liver disease
  • Pregnancy
  • Pulmonary fibrosis (having damaged or scarred lung tissues)
  • Smoking
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus

As you can see, these are a mixture of unmodifiable and potentially modifiable diseases and conditions. For instance, if you have cancer, chronic kidney disease, sickle cell disease, thalassemia, type 1 diabetes, or dementia, medical control can be optimized, but these can’t be reversed. The interesting question arises for conditions and diseases that can be impacted by lifestyle and nutrition, such as hypertension, obesity, and type 2 diabetes, the focus of the claims made by Dr. Malhotra.

Who is this Dr. Aseem Malhotra advocating “metabolic optimization”?

Upon looking into his claims, I realized that I didn’t recall having ever heard of Dr. Malhotra before. It turns out that he appears (to me, at least) to be the UK equivalent to Dr. Mehmet Oz, a celebrity doctor known for promoting all sorts of dubious medicine, particularly diet advice. In any event, Dr. Malhotra is a British consultant cardiologist best known for promoting a low-carb, high-fat fad diet known as the Pioppi diet, a diet that earned the “honor” of being named one of “Top 5 worst celeb diets to avoid in 2018” by the British Dietetic Association, along with the ketogenic diet, nutritional supplements, and a number of other fad diets, which characterized it as, in essence, a tarted up version of the Mediterranean diet that “recommends a higher fat diet than the traditional Mediterranean one” and notes that “adherents are encouraged to eat lots of vegetables, nuts, legumes, and fish and discouraged from eating red meat, starchy carbs, and sweetened treats.” It also encourages 24-hour fasting. Dr. Malhotra is also very much in the anti-processed sugar camp, having characterized sugar as “enemy number one in the Western diet.” To give you an idea of how anti-sugar he is, he recently made headlines by attacking Royal Free London NHS Foundation Trust for accepting a gift of 1,500 Krispy Kreme doughnuts sent to the staff as a gift for their work in dealing with the COVID-19 pandemic in the UK in March and April:

And I’m going to tell your mother! Amusingly, Dr. Malhotra was dragged hard for his remark (and deservedly so!), as you will see if you click on the Tweet above and look at the responses, although there were also people who bought into this demonization of doughnuts.

Dr. Malhotra also seems to argue that modern medicine does more harm than good treating chronic conditions with medications, channeling Peter Gøtzsche in claiming that “too much medicine can kill you.” Of course, it is not in itself unreasonable to criticize too much medical intervention, but to me a brief perusal of Dr. Malhotra’s oeuvre gave off a seriously disturbing vibe that medicine doesn’t do any good for chronic illness. Unsurprisingly, he is a statin denialist, even having gone so far as to suggest that stopping statins might save more lives and that statins might not benefit anyone.

You get the idea.

So what is Dr. Malhotra arguing? I haven’t read his book, although the review makes plain that it’s basically a repackaging of his promotion of the Pioppi diet. Of course, any book called The 21 Day Immunity Plan that implies that you can basically “fix” your immune system with diet in 21 days is going to draw a lot of skepticism, and rightly so. For instance, how does he justify 21 days? Why not 30 days? Why not 14 days? Why not 60 days? According to the credulous review:

Of course, one will question the arbitrary choice of 21 days. Why would three weeks be enough? Well, as it happens, the number 21 is explained at length by the author, who refers to numerous studies (4) as well as his first-hand experience with the program. In the context of the book, this is justified by good pragmatic reasons such as:
  • For most people it takes three weeks to break any habit, or for many what is a form of addiction to sugar and ultra-processed food. »
  • Most people with adverse metabolic health will start to see marked improvements to their health and/or shape albeit to different degrees within three weeks, without having to count calories. »
  • It is the need to change the narrative around the impact of lifestyle changes and show that their effect on health can be rapid and substantial. We should use this to motivate ourselves to continue to reap the benefits of improved health for life.

What’s Reference 4? Jean-Paul Oury, the reviewer, cites two studies without links or references to them:

A previous diet and exercise study carried out by researchers at the University of California involving 31 participants also revealed reversal of metabolic syndrome in 50 per cent of those that followed a low-fat, high-fibre diet combined with 45–60 mins of moderate intensity exercise per day. Markers of insulin resistance improved but again there was no correlation with weight loss suggesting an independent benefit on metabolic health. Similar rapid improvements in markers of metabolic health with reversal of metabolic syndrome in all participants were observed in a trial involving 7 obese children from a diet and exercise program within 21 days.

31 participants? Seven obese children? These are not particularly large studies. As for Dr. Malhotra’s “first hand experience with the program”, you know what they say about anecdotes…

Still, one has to consider the possibility that, history of overblown claims for the dangers of processed sugar and pharmaceutical medicine and the benefits of a specific fad diet aside, it’s possible Dr. Malhotra could have a point. In fact, he probably does have a germ of a good point. It’s clearly just massively exaggerated.

Can “metabolic optimization” prevent or treat coronavirus?

The first thing to realize here is that, if you’re obese (particularly if you’re morbidly obese), losing weight is a good thing for your health. Even if it doesn’t do a thing to decrease your risk of life-threatening COVID-19, reaching a healthier weight can decrease your risk of any of a number of complicating conditions, including hypertension, heart disease, type 2 diabetes, certain cancers, stroke, fatty liver disease, and more. There is no doubt that losing weight to come closer to a healthy weight range is associated with improvements in many of these conditions, especially type 2 diabetes and hypertension, which can sometimes be reversed by weight loss to the point where medication is no longer necessary.

At the risk of “going anecdotal”, I know that this can be true. Over about a two to three year period, I changed my diet and started exercising regularly, ultimately losing 50 lbs. As a result, the dose of blood pressure medicine that I need to keep my blood pressure under control has declined markedly, and I might even be able to get off of blood pressure medicines altogether. (We’ll see. Given that I’m now at my target weight, with a BMI in the “normal”—whatever that means—range, I might well have maximized my benefit on that score, and my family history doesn’t bode well for my ever getting completely off of blood pressure medication.) Similarly, I might well be able to get off of statins, as my total, LDL, and HDL cholesterol levels are quite acceptable now. (As an aside, I look at studies suggesting that ACE inhibitors might decrease the risk of life-threatening COVID-19, and I wonder if I want to be off my ACE inhibitor altogether or not while the pandemic is still raging.)

The bottom line is that we have no strong evidence yet that “metabolic optimization” will decrease the risk of severe COVID-19, although it is certainly scientifically plausible that weight loss to bring oneself out of the obese range could well help. It’s also undeniable that weight loss and exercise are good things for one’s general health if one is obese, and that a healthier diet can impact type 2 diabetes, hypertension, and other chronic “lifestyle diseases”. On the other hand, it is possible that it might be that treating the “root causes” of metabolic syndrome might not lead to a decreased risk of severe COVID-19, a scenario that could happen if the “root cause” of metabolic syndrome leads to metabolic syndrome through a different mechanism from the one by which it increases the risk of severe COVID-19. Basically, we just don’t know yet. Moreover, where Dr. Malhotra goes wrong is in touting a fad diet as The One True Diet to fix one’s immunity in three weeks, a claim for which there is no good evidence. For example, how do we know his diet is a more effective, healthier way to “metabolic optimization” compared to all the other “healthy diets” out there? We don’t.

It’s particularly irritating to see these sorts of statements:

In particular, there’s a distinct possibility of this:

More importantly, “optimizing metabolic health” takes time. It’s highly unlikely that 21 days would make a significant difference in decreasing your risk of severe COVID-19, and it’s unhealthy to lose weight too quickly. (We don’t know, but it’s not at all implausible that rapid weight loss could potentially actually be another factor for severe COVID-19.) It’s generally advised that you shouldn’t lose more than a pound or two per week. If you’re 25 lbs. overweight, that’s 12-25 weeks to get down to your target weight. Obviously, if you’re more overweight than that, it will be longer. Losing weight and changing your diet is also very, very hard. Many people can’t do it, or at least they have a lot of difficulty doing it. The reason I could do it is that I had several advantages, including:

  • I have money.
  • I don’t live in a food desert, where calorie-rich fast food is a main food source and it’s difficult to find vegetables, fruits, and other healthier choices for food.
  • I can arrange my schedule so that I have time for exercise.
  • I have a supportive wife.
  • And many others.

Not everyone has these advantages.

There’s another pernicious aspect to this narrative. Even if nutrition could prevent coronavirus, Dr. Malhotra’s is a very privileged position that basically excludes those unable to “optimize metabolic health”. These “nutrition cures and prevents #COVID19” people labor under a delusion of privilege in that they have the time, resources, and luxury to “optimize their metabolism”. There’s also a subtext of victim blaming where it’s your fault if you get sick because you didn’t “optimize your nutrition”. And, make no mistake, victim blaming is rampant among these “nutrition prevents/cures COVID-19” propagandists. Indeed, Del Bigtree did just that when he urged his presumably “healthy” listeners to “catch this cold“. That’s why I’m going to quote him again extensively:

What is the group that is really at risk? Let’s be honest about this and say something that might get me some trouble here, but let’s be honest. That group is very well known. It’s people over the age of 65—not just because you’re over the age of 65, but you’re sick with other diseases. You have heart disease. You have COPD. You have diabetes. You have issues, many of those issues coming from the fact that you didn’t treat your body very well while you were on this planet. And I want to talk about this for one minute as we close this down. That 0.26% are the most sick among us, and I have nothing against you. Go ahead and bubble wrap your house. Lock yourself in your basement. Go and do what’s necessary.

But here’s the problem. When you were my age, you were most likely eating food and fast food and Doritos and drinking Coca-Cola, which you’ll never find in my home. You were eating that all the time. You probably were drinking a lot of alcoholic beverages and really liked to party and enjoyed your cigarettes and said to yourself, “You know what? It’s more about the quality of my life right now. I don’t care if I live to be 100 years old. I want to enjoy my life right now. I like the finer things in life. I like good rich food. I like smoking a cigarette once in a while. I like to drink my drinks.” And you know what? Good on you! That’s the United States of America. No problem, that, some of my best friends think like that. It’s great, and they’re fun to hang out with. That’s perfectly OK. But here’s what’s not OK.

When you reach that point in your life where now your arteries are starting to clog up, your body is shutting down, and the alcohol is eating up your liver, and you have diabetes, or you have COPD, you have asthma, you can’t breathe, all the cigarette smoking has finally caught up with you, you have heart disease because of the way you decided to live your life in the moment, here’s what you are now. You are pharmaceutical-dependent. You did that to yourself, not me. You decided that the moment mattered, and now you find yourself pharmaceutical-dependent, which is really what that 0.26% is, and that’s OK too. Thank God there’s drugs out there! There’s drugs that allow you to eat the Philly cheesesteak even though your body knows it hates it, but, go ahead, take the Prilosec. What difference does it make? Drug yourself! Drug yourself! Get through the day! Don’t exercise! Maybe just attach an electrode and see if a little electricity to the stomach will give you the abs you want.

Come on! Grow up! You made choices! And now that you’re pharmaceutically dependent, here’s what you don’t get to do. You don’t get to say I have to take a drug to protect you. That’s what this is. You don’t get to say I have to wear a mask and suck in my own CO2 to protect you. You don’t get to say I have to lock myself in a basement and destroy my career and take away my own ability to feed children because you are pharmaceutical dependent. You lived your life. You made your choice. And thank God we live in the United States of America so you don’t have to worry about grocery police standing outside a grocery store saying, “Really? You really need four liters of Coca-Cola? You really need four bags of Doritos or Chitos or Fritos or whatever the heck it is, little cupcakes with synthetic icing on them? You really need all that?” Because we could go there. We could go there. If we’re really going to get into each other’s schiznit, that’s what we could do.

Or could we live and let live? Eat all the Twinkies you want! Drink all the bourbon you want, and smoke as many cigarettes as you want, and when you find yourself pharmaceutical-dependent I will go ahead and say thank God the drug companies are there for you, but you do not get to make me pharmaceutical-dependent. You do not get to put me in the way of Heidi Larson, who wants to eradicate natural health and natural immunity and make us all pharmaceutical dependent.

Again, make no mistake. Dr. Malhotra’s message is simply a more genteel, less obviously judgmental version of the message that Del Bigtree is promoting. As I mentioned when I first dealt with Bigtree’s message, I once coined a term, the central dogma of alternative medicine, to describe the belief that we have near-total control over our health through lifestyle, such as diet, activity, exercise, and a Secret-like belief that wishing makes it so. It never seems to occur to them that age is a major risk factor for death from COVID-19 and that people can’t do anything about how old they were when the pandemic hit, nor can older men like myself do anything about the fact that we were older men when the pandemic hit.

Certainly, a healthy weight, exercising, eating a healthy diet are all good things for your health. Who knows? They might even lower your risk of severe COVID-19. However, don’t be fooled by overblown claims for what they’ll do for your risk of COVID-19, and don’t forget the judgmental implications behind advice like that promoted by Dr. Malhotra. He’ll deny it to high heaven, of course, and maybe he personally doesn’t intend to be judgmental, but judgment is there nonetheless.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

100 replies on ““Metabolic optimization” probably won’t save you from COVID-19”

Victim-blaming seems to be the lingua franca of so many quackery claims–especially in cancer treatment quackery. It’s second only to treatment toxicity (the treatment killed you, not the disease); if you had a recurrence, it’s because you didn’t try hard enough; and the ever-present assumption that you can control the uncontrollable if you just follow our strategy. These ploys really are the ultimate arrogance spread by these people. And there’s also the darker motive of overt guilt inducement: you got sick because you didn’t follow our dogma/buy our miracle product, etc. The most offensive of these is when the patient becomes perversely responsible for his or her own condition. That’s just evil…….

There is an insufferable smugness about these type of people. ‘I am immune due to my greater than normal intelligence and complete understanding of the cause of covid ..which is unhealthy living.’ As a clinically vulnerable person (CF) I feel stressed enough without the Del Bigtrees of the world telling everyone to get infected. When I saw his video I felt like punching a wall. Well to be honest him.

It is not just that. I witnessed first hand the devastating effect of the “your kid is autistic because of what YOU did” trope on my auntie. The guilt made them spend tens of thousands euros in the various quacks’ ‘miracles’ before they finally came to term with the fact that it was not anyone’s fault. And it was’t even one of those super-serious situation, as my cousin is somewhere in the middle of the spectrum.

Doesn’t victim blaming always involve self-congratulation if not actual self-aggrandisement?

Amongst those I survey**, there is often outright contempt for those who eat an average diet ( for their culture) in contradistinction to the superior taste and “science” of the woo-meister:
people eat :” hotdogs, hamburgers, pizza, cakes, candy, ice cream” and other poisons- of course, they’ll eventually pay for their sins.
However, what they fail to understand is that not only one variable or factor ( diet) is responsible for outcomes.PLUS there is chance as well.

(I will risk purveying anecdotes :
I was very fortunate to have relatives who lived to quite advanced ages in both of my parents’ families. Not one of them followed a vegan, paleo, keto, Mediterranean plan or a diet that would be considered healthy today- except perhaps for my father in his last 10 years)

Alt med people focus on controllable factors to manage their own fears and to promote their belief system and product line: two of the major perpetrators of natural health report how family members died young because of medical intervention; similarly, vaccines cause autism , not genes, demographics or prenatal factors*** So again the issue of control enters the picture. Avoid doctors, meds and vaccines and you will thrive…

Extreme self-protective mechanisms insulate them from reality..

** there may be good news about a well-known scammer soon
*** Katie Wright dismisses research into genetics, prenatal and early indicators of ASDs because it’s all vaccine dependent.. . .

One thing I’ve noticed with COVID is that victim blaming not only allows for self-congratulation, but it also allows people to sidestep any responsibility to others. It means that they don’t have to consider the impact of their own actions, because if they get someone sick and that person is injured, well, it’s their fault for not doing “the right things.”

“The first—and by far the strongest—risk factor for serious disease and death due to coronavirus is unchangeable. Specifically, it is age.”

Wow. So age is the major risk factor regarding Covid and death…JUST LIKE THE FLU! Thanks for the big revelation! Now, can the rest of us get back to living our lives and stop the hysteria?

And, in the meantime, it IS good to shed extra lbs! Baseline health IS important! Extra weight contributes to health problems:

Good day and good health.

“Major risk factor”:
1) does not mean ONLY risk factor, and;
2) does not mean that younger people can’t or won’t die from COVID.

Even if the overwhelming majority of dead were elderly, that would still severely negatively impact the economy. Also, some of us have grandparents we care about and would be devastated to lose them. Finally, you’re forgetting that death isn’t the only possible negative outcome of suffering COVID-19. A huge number of people would survive, but with organ damage and a resultant loss of both productivity and quality of life.

Baseline health IS important! Extra weight contributes to health problems:

You have totally missed Orac’s point. He wasn’t saying healthy living wasn’t important, he was saying that it’s not a panacea, and that if you aren’t well off, it can be extremely difficult to live healthily.

You know, Natalie, usually I’d just say, “sure, go ahead, do a you please…”, but what gives you the right to “get back to living our lives and stop the hysteria?” and behave in a way that threatens vulnerable people?

It’s not “hysteria” to try to protect yourself if you are a healthy 70 year old who would like to see younger grandchildren grow up or to want to protect your immune-compromised adult son.

Your snappy comment is selfish and shortsighted–to be charitable.

@ Brainmatterz – Well, there are ALWAYS going to be vulnerable people. That is my point. It may sound callous but it is the truth. You all are okay with the “one in a million”(I still believe it is more) sacrifice that is keeping the rest of us supposedly healthy thru vaccination. If a person is vulnerable, THEY need to protect themselves as much as possible.

Good day.

@ Nathalie White

“If a person is vulnerable, THEY need to protect themselves as much as possible.”

That is pure wishful thinking and pure BS.

@ Everyone

Anyone seen Narad recently?

@Natalie White:

Well, there are ALWAYS going to be vulnerable people…If a person is vulnerable, THEY need to protect themselves as much as possible.

And we have no responsibility to take steps to protect the vulnerable? Is that what you are saying? Because we DO have such a responsibility.

You all are okay with the “one in a million”(I still believe it is more) sacrifice that is keeping the rest of us supposedly healthy thru vaccination.

We are talking a potential death toll of 1 in 100. Already, the U.S. has exceeded 200,000 deaths. This is at least partly due to people ignoring the rules because “muh rights”. With rights come responsibilities, and one of those responsibilities is to not endanger others through reckless behaviour.


I missed a call from him recently (got a voicemail), and I haven’t been able to get back ahold of him yet. His internet access probably isn’t super stellar. (Hopefully I’m not putting too much info out, just wanted to say he’s alright.)

@ JP

Thanks for the plug. Nice to hear back from you too. Whenever you have him on the phone (surprised you are in contact this way, BTW), please convey to him my best wishes, whatever is currently happening.

(BTW, for your antifa eyes — I’m not really fond of antifa, as you know, but never mind… — here‘s a splendid example of a french theocrat I’m busy bashing. Huge fun.)

I’ll definitely check it out just shortly here, F68.10. I’ve been just depressed and exhausted and sick from the smoke/air quality here; the air quality index, an American index, was over 600 for some time locally, and the scale is supposed to top out at 500. (We’re very close to Oregon which has been devastated with wildfires, and there was also an issue of smoke from the whole west coast being pushed back inland onto the whole PNW.) Things have been inching towards better and I’m feeling rather celebratory as the AQI here is officially in the “moderate” territory here now (80) and blue skies were actually visible after a storm and some west winds. Supposed to clear even more over the weekend, although of course there’s still plenty of smoke that can come back into the area…

@ JP

Do as you see fit. And take care of yourself.

If ever you go on this website, please take into account that there is a far amount of far right wingnuttery, so if you check my comments, please take them with more than a grain of salt as they are replete with irony that may not translate well into English. A commentator credits me with much more than off-beat humour. In other words: Operation Mindfuck with a rationalist twist.

BTW: Oregon seems to be a magnificent place.

Oh, Oregon is more than magnificent. Where I live might as well really be Oregon, sort of; we’re just north of the border. (In fact it’s definitely a border economy, due to th e goofy tax schemes.) Well, I suppose the National Forest we hang out in is a Washington one (the Gifford Pinchot) and our mountain is Washington (Mt. Adams) but we’re also a hop skip and a jump from Mt. Hood.

Lots of family in Oregon; some have been evacuated. Watching the news is sometimes just too much, and there are already fatalities and missing people being reported; who knows how many more once they can really start getting into places. It’s hard to bear. Worst devastation in the history of the state.

Yes, death is the only thing to worry about. You’re either dead or the infection is entirely consequence-free. Younger people who get infected and don’t die don’t have to worry about pain, distress, lost work, lost school, long-term consequences of coughs, headaches, or lethargy that persists, lung damage, the joy of being in a medically induced coma on a ventilator, or passing the virus on to a loved one it does kill. Such hysteria! (Oh, wait, as of July, I’m medically incapable of hysteria.)

I wish Natalie was the only person I had to hear that “well only 1% die” from, but sadly there are people I know from elementary school who are pushing the same nonsense. “I can’t stop living my life to survive.” (Direct quote, and when I stopped arguing.)

It would be less upsetting if they weren’t employers.

the joy of being in a medically induced coma on a ventilator,

And waking up amputated of a leg because some thrombosis led to necrosis. Happened to a Belgian lady in her late teen years, I must have talked about it in a previous thread, in July I think.
She was training to be a basketball player. Hardly the lifestyle of a potato couch.

passing the virus on to a loved one it does kill.

Happened with the flu virus between the sister and the mom of a friend of mine. I may have mentioned it already.
His mom’s story convinced me to do more effort to get the flu vaccine each year.

So, Natalie, you want to live in the world of Logan’s Run? (Look it up, it’s a classic.)

Yeah, no thanks.

Also, my grandparents were productive members of society right up until just a few years before they died, which is pretty dang good given my grandmother died at 98. How would my life be better if she had died when I was a small child?

Also, please note the age risk category starts at 55, not 85. Would you have much time left?

@ JustaTech – Logan’s Run? Really? Another fantastical leap made by you. Yes, I know the sci-fi classic and nowhere did I mention killing off anyone over 30. Now you’re just being silly. Thanks for the laugh.

Carry on.

You’re right Natalie, you didn’t say 30. You heavily implied whatever age at which people are more vulnerable to COVID-19. Which means that you don’t value anyone over a certain age, somewhere around 65.

Why do you think people over a certain age don’t deserve to be protected from this disease? Why do you think that it is OK for them to die?

And a nice side-step avoiding the rest of my comment.

Where do you live, Natalie? Here in the US, we’re over a million COVID cases and 200,000 dead. They predict ca. 410,000 dead by January. And thousands or tens of thousands “long-haulers”, with ongoing completely debilitating post-viral syndrome. When it’s such large numbers, that means that even groups with small chances of dying contain coonsiderable numbers of deaths.

To compare this to a higher fatality rate for older people with flu is callous and uninformed. And, “the rest of us stopping the hysteris” is outright denial. Like the people in Maine who recently held a small, indoor, maskless wedding, from which 247 new cases have resulted, as well as some deaths, mainly of people who didn’t even attend the wedding.

Please grow up and acquire some humanity. I’m not in the higher-risk age group, but I’m certainly not going to stop my hysteria of wearing a mask, social distancing, and avoiding large groups of people, at least for the next couple years.

“Please grow up and acquire some humanity.”

a href=””>???


This showed up in my RSS feed today.

Again with the victim blaming. And of course the obligatory, this isn’t meant to be used as medical advice. The Imperial College London website is down so I can’t read the whole press release.

And you can even get the cookbook free

I appreciate you noting that it’s much easier for higher SES folk to lose weight. That’s something I’ve been wondering about these analyses of ‘modifiable’ risk factors. Obesity and T2D, certainly, are associated with low SES, and low SES, especially in the US, is associated with having horrible ‘essential’ jobs that expose you to the public, and living situations that aren’t amenable to social distancing (in Marin and SF counties, the majority of infections are in PoC). I wonder just how independent these ‘modifiable’ risk factors are…

When I saw the higher rate for Marin I also learned that the figures reflected the presence of San Q- and of course POC are incarcerated more. Shocking figures if you look at rates of Covid in CA and NY area comparing Black, white and Hispanic people.

Congrats on being incapable of hysteria – in both senses of the term. .

Thank you! Surgical techniques are amazing these days. I had four little ‘portholes’ in my abdomen that healed rapidly, and was back to my usual activities within a week.

“Usual activities” being sheltering in place except for walking the dogs and running, and having conniptions about the lousy mask wearing (seriously, everything is on fire and based on smoke alone, you’d think a mask would be helpful?). I’ll be moving to Switzerland in November to finish my doctorate, and I’m under no illusions that everything will be great (they have vaccination issues over there for sure), but at least SARS-CoV2 is more under control there.

I keep reading distressing (and finally well-documented) data that PoC and those in poorer areas of the UK are disproportionately affected. Same is true in the US, especially in many areas of the South and in poor neighborhoods with majority populations of PoC.

This is a particularly odious form of victim-blaming because the root causes are demonstrably structural racism which underserves these communities to make it difficult to cope with food deserts, inadequate medical care, lack of assistance and resources to create lifestyle change, etc. This was made clear with one hospital in Queens that serves a preponderance of ethnic minorities and with the situation in many parts of Louisiana–greatly increased predominance of risk factors, hospitalizations, and deaths.

It galls me when some privileged person makes a blanket assumption, as this person did above, that lifestyle change involves personal behavior and choice. I’m starting to see more commentary that pandemics can be a deeply racist, poverty-driven problem. The Guardian has done a good job of discussing this.

To the person invoking what she coyly, superficially, and naively calls lifestyle change as a preventive, you try living in an area with underfunded hospitals, sparse medical resources, food deserts, and few educational resources–or MONEY–for luxuries such as good preventive care, nutrition counseling, and everything else that the affluent have access to.

Go live in one of those places (like many poor PoC) for a few months and see how easy it is. My guess is that people like this would eventually hear:”Lifestyle change? Are you kidding me? How? With what?”

One thing I think isn’t considered enough when we talk about changing (usually other people’s but also our own) diet is how very central food is to life as humans.

Think about it. Many other “primal” urges aren’t ‘polite’ conversation (reproduction, waste elimination). So when it comes to things that all people have in common, food is the most basic, most universal. It’s also one of the clearest markers of culture. (That and shelter – housing/clothing.) In any immigrant community you’ll find markets and restaurants selling the food of “home”. Famous chefs revere home cooking. You show hospitality through food, and as a guest you eat to show appreciation for that hospitality. For many food is a comfort when life is hard, when times are tough, when they’re in pain. Food sustains and soothes and invigorates and connects.

All of which makes radically changing what you eat, whether for aesthetic reasons or health reasons so very, very hard.
“Just don’t east pasta.” “But pasta is how Nonna shows me her love!”
“Just don’t eat cake.” “But my son baked me this cake for my birthday.”
“Just don’t eat meat.” “I don’t know how to cook without meat.”
“Just don’t drink coffee.” “Coffee is the only thing keeping me from putting you through that window.”

Which means that if someone is going to change their diet, first they have to want to, and second, they need support, not just from professionals (RDs, etc), but also from family and friends and coworkers. I think that’s why some fad diets succeed more than others: on Atkins you can still go out to a restaurant with friends. Raw vegan? Not so much. (Vegan is more possible these days, but not raw vegan.)

These people writing diet books provide precious little support, and a lot of blame. And then, when the people who buy their books try and fail, there is only more blame and no understanding.

Just what we need in a time of crisis: to take away and give nothing back, to shower with blame and provide no support.

I used to work for Manna, the nutrition education initiative, doing simple nutrition ed for what we now call disadvantaged elementary-age minority kids. Many were recent immigrants whose families clung hard to their traditional diets as an essential connection to their home countries and cultures. That has always been true. There are so many powerful cultural, historical, and family connections to cuisine that–as you say–that is a big reason why adopting another way of eating can be a very, very difficult and emotionally fraught experience. I’m in the Deep South, where it has been really difficult to get people to adopt healthier versions of traditional so-called soul food because it’s sometimes seen as a form of cultural sabotage and even erasure.

Many, many kids would tell us that our proposed tweaks of their grandma’s specialties just didn’t taste the same. Adults would tell us that they wanted their traditional comfort foods–often extremely unhealthy and nutritionally lacking–just as they tasted growing up because they were….comforting. Changing your diet can be a very complex challenge even when you have the tools to improve it. As I said above, “lifestyle” change especially for those of limited means in marginalized communities has many political elements and is not the simple enterprise the original poster imagines. You can give people the facts, but that never means they are willing to change their behavior or are able to because of limited aid and support.

I’ll starve and get ridged, up-curving fingernails before eating Pringles out of a bag.

Are mangroves edible? Wait; they don’t have that many anymore. They have golf.


I’ve seen ‘pyrocumulonimus’ once in my life. This is not that day, but I heard they had some. Insane:

pick ‘animate image’ pick 30 or 40 frames pick 100% pick medium zoom pick 1000×1000 or so pick your area of interest then when it loads, run the speed all the up to 11. Insanity. Swim out in the ocean and watch the world burn kinda stuff.

Because it is so difficult to change dietary patterns- given cultural backgrounds, personal preferences and ingrained habit- recommending a radically different regime with many prohibitions and little choice, gives diet gurus an out:
how can someone tell if it works or not, if hardly anyone can follow it for extended periods of time?
Raw vegan? Ultra low carb? Macrobiotic?
These are unlike diets any cultural group developed on their own naturally and may reflect alt med deliberate tampering: i.e. a business plan
To succeed, the mark either needs a lot of coaching/ goading and/ or a supplement or food plan to fill in the missing elements and stave off total misery
there might be a retreat or spa experience with intensive counselling and guidebooks or a powdered green vegetable/ red fruit powder so the client can attain the ideal of 12-15 fruits and vegetables a day. more easily.
Plus, it gives the provider ample opportunity for scolding clients.

This is being done, believe me.

Once I found a cookbook for the Canyon River Ranch Spa. Huge, heavy paper, beautiful photographs of dishes that were almost entirely plate and very little food. Just reading it I felt hungry and sad, and realized my mom’s joke about spas that serve one cabbage leaf for dinner was not as far off the mark as I’d assumed.

@ Tim – Looks like a nightmare movie I won’t be viewing in its entirety. However, this line from the scene does have a lot of truth to it, “You know the cure for the human condition? Disease. Because only then there is hope for a cure.”

“Modern” medicine, especially public healthscare, reminds me of the Hegelian Dialectic – Problem (real, imagined, manufactured), reaction (anger, division, victimization), solution ( “cures”, less freedom, more authoritarian control)

Soul food was originally food for slaves. They always got most undesirable parts of animals. Second thing is that slaves did work like a slave. They actually needed all that fat.
As for low carb diet, follow the money:
1) I want to push supplements
2) Someone claims people should eat fruits instead
3) Low carb diet exclude fruits
4) So people will buy my supplements instead-
5) So I promote low carb diet

Fat in moderation is good for you and is needed by the body. Overeating, empty calories from sugary/junk/fake food, artificial sweeteners, and a sedentary lifestyle is bad for you. Not rocket $cience.

Good day.

Low carb diet is bad for you. There is glucose homeostasis. When blood glucose goes down, correcting enzymes step in. One of them is cortisol, which indeed promote ketosis. It suppress immune system, its derivative hydrocortisone is used as a medication for this purpose. It does cause insulin resistance, by reducing glucose transporters on cell surface. It promotes gluconeogenesis, which turns amino acids and lipids to glucose
Supplement pushers of course sell supplements, and recommend them. Why do you not see problem here ? Fruits have sugar, would you avoid them, too ? Why promoting fruits would be shilling for Big Pharma, as you imply ?

My partner frequents a forum which seems to be full of people (various nationalities but a lot of Americans) who are, to put it bluntly, fat as fuck. Yet they are constantly complaining that their doctor wont give them whatever magic potion or procedure they’ve read about that will melt the fat away. Instead the doctor recommends that they eat healthily and exercise. Pfffft. What do the doctors know eh?

Natalie, your anti-science stance on protecting children is why no one should take health nor diet hints from you.

“Not rocket $cience.”

I used to one of those. Human biology is lots more complicated than aerospace engineering.

Computers are very good at solving ‘rocket science’ {at least the thrust, vectoring, and pointing within orbital dynamics} in microseconds. However, rocket plumbing is hard.

Yeah, the plumbing is part of the fluid dynamics, which was included in the propulsion class. And the reason for the old 1970s calculator game on tweaking the rockets to safely land a moon lander. And irrelevant for solid rockets. That is when the shape of the center hole is important. It is an elaborately shaped candle.

My structures professor had a roommate who dealt with the mechanics of solid propulsion, focused the solid fuel “slumping.” He used Jello as his proxy. My professor said that guy was the only one who he knew who could eat his experiments.

My tech aide job was next door in the fluid dynamics and high energy lab. The grad student I worked for was working on a laser created from the energy from mixing two gases together for a high exothermic reaction… my job was to make the aluminum diaphragms to separate the two gases until there was a certain pressure differential. Oh, and to create graphs from the computer printouts from the machines that required stacks of cards to fed into a card reader. I was the human graphics device.

Though in reality I was a mechanical engineer glorified with more applied math. It was not a coincidence the applied math department was in the same building.

Fluid dynamics specialists are a whole other level of expertise. Still, immunity in humans is much more complicated. Diet does nothing for autoimmune diseases nor for others who cannot create antibodies because of genetics. Humans are much more complicated than rocket engines.

@Deni¢e – Why encourage people to be healthier? There’s no money in that for healthscare and pHARMa. So, do your part, okay? Keep coddling and making excuses. Poor victims. They just can’t help themselves. In the addiction world, isn’t this called enabling.

Oh, btw, how’s your stock portfolio these days?

There is no cure or vaccine for COVID yet, so Denice Walter cannot promote either. She does not know which company will have a working vaccine, either. Actually investing on a basis of a non existing product is quite risky.

These are first world/affluent subgroups choices, and someone is always lurking and scheming to make a buck from the affluent and gullible. I wish the quackos would acknowledge that these options are not available/comprehensible to most of the world’s population. I had kids who had eaten nothing but fast food in their early years look at me as though I dropped in from Pluto when I said they, too, could learn to cook or grow their own food. One response: “I can’t do that. There’s a Popeye’s and a 7-11 around the corner. We don’t have grocery stores around here, and we live in a complex where we can’t grow anything.”

“and we live in a complex where we can’t grow anything.”

Well, there is always cannabis and that is a good thing.

New alarming study today showed that the hundreds of thousands who gathered unmasked with anti-mask obscenities on their t-shirts, various forms of contempt for protective behavior, anti-mask protests, etc. at the Sturgis motorcycle rally are projected to be responsible for 260,000 new cases. That’s about 20% of the US cases logged in the last few weeks. That’s 260,000 at a cost of well over $12 billion to the US. That’s billion with a ‘b.’ These people insist on their freedom to infect and then kill unknown numbers of people. The wedding party in Maine is now known to be responsible for hundreds of new cases, and three people have died.

I prefer to remain hysterical as well. It’s called “protecting public health,” Natalie-Whoever-You-Are. Perhaps you’ve heard of it. It has to do with not infecting and potentially KILLING other people.

The maskkless-acommadating beer store has been remarkably devoid of patrons (and the most loved, long time emplyees as well), of late.. I’ve caught them ‘staling’ their craft offerings on purpous. But, I think, the reduced traffic is because lots of old, fat people have just happened to have stop drinking after learning about the coorbidity risks.

Interesting development in the UK: After an initial meltdown among problem drinkers during the first few weeks of lockdown, many people with longstanding problems have been found to be moderating their drinking and using this as a time for reflection and action to make big changes.

Contrary to what was expected, people there are generally not using confinement at home to increase their drinking but are doing the opposite. Don’t know whether that’s true elsewhere. The sales numbers in many places there are now showing an overall decrease. Could be because the habit of drinking to decompress after a stressful work day was easier to break, and regular pub days were of course not an option.

Where I am there are fewer alcohol-related traffic accidents in the last few months. Of course, people don’t want to end up in the ER or jail, either. Fear factor at work…

@ Sara
I suppose drinking is very much a social thing for most people, so drinking will be done in the pub, where you are with your friends. At home it is probably different.

A friend of mine is an addiction counselor. She’ll point out that addiction is really three-fold. There’s physical dependancy, mental coping skills, and social patterns of behavior. It makes sense that a massive disruption of the last causes people to work on the first two.

A disturbing long-term trend is that successful middle-aged women are drinking more and more at home. Men tend to favor social drinking. A couple of studies have recently found that men are more bothered by pub shutdowns. More women were becoming solitary drinkers even prior to the pandemic. Some stressed young mothers who work and have also had to home-school seem to be persisting in a habit of wine o’clock. There have been some beneficial effects from the shutdown on problem drinkers, though. I’ve seen some encouraging data that the added free time has inspired some people to tackle existing or potential problems with their alcohol consumption.

I’m a former alcohol researcher who still tries to follow the literature somewhat.

I’ve had 2 friends who were addicted to alcohol and one who was addicted to gambling.
None of them thought of themselves as being addicted.
One stated, she wasn’t addicted, because she only drank sherry and never drank before 6 PM (this was often around the time she left her bed).
The other alcoholic finally seemed to accept she had a drinking problem, even if she only drank white wine and kicked the habit..

Yep. That’s a special hallmark of alcohol addiction. Because it’s legal and heavy drinking is normalized and socially acceptable in many cultures, it can be very, very hard to penetrate the denial. People who take street drugs or abuse Rx drugs often have to admit they have a problem much sooner because they have to go underground to get their drug of choice and learn how to avoid getting caught and earning themselves a trip to jail, criminal record, job/house/family loss, etc.

Until people suffer serious consequences from alcohol abuse or realize on their own that it’s ruining/running their lives, it’s very hard to penetrate that stone wall of denial. This is also why enforced rehab usually fails (and is meant to because the worst parts of that industry are purely profit-driven and their business model relies on relapse).

Sorry for threadjacking here. I find it really interesting how the pandemic has helped some people look at what is not working in their lives and commit to change.
Supposedly China saw a breakdown of more dysfunctional marriages and families when people were homebound with each other, and that seems to be happening elsewhere.

Just one clinician’s observation, but here’s what I’m seeing in my patients in clinic:

1) MOST who drink are doing so much more than they used to.
2) PHQ-9 scores WAY up.
3) Almost everyone is trending up in weight/BMI.
4) Patients who successfully quit smoking have restarted (Not just a couple, dozens.)
5) Massive loss of control of chronic conditions. Pts who managed their diabetes, HTN, etc, very well are no longer doing so.
6) Finally, and the hardest for me, is seeing kids who were always active and fit come in and they’re gained tremendous weight and sit around on devices and screens all day. Happy, robust little ones who are now dower and angry after being socialized bu the incels and other assorted trash that hang out on Rainbow Six or whatever. It is truly heartbreaking.

Is this every single patient through the door? No. Is it most? Yes. Maybe it’s the population I serve, not sure.

On our community health side:

1) Our food pantry is empty for the first time in 10 years.
2) We have to turn people away for couple’s counseling and other, similar, programs. Our two providers are completely swamped. What’s more – they look pretty demoralized, themselves.
3) Our MAT and other substance programs are completely swamped and are getting calls daily from folks desperate to get in.
4) The local health department basically stopped answering calls or emails.

I’m not saying every doctor is seeing this but it should concern us. There is no strategy. NO STRATEGY. Nothing about where we go from here.

Thank you for sharing. Proof we need to STOP THE LOCKDOWN immediately! It is destructive for humanity – cost to benefit ratio DOES NOT COMPUTE.

Natalie, why should we care about what you say/demand? You are just an anti-science sadistic child hater who likes to see people get sick. Are you hoping that your parents get Covid-19 and die?

The health crisis we are in are due to the present administration and folks like you. Were you part of the brigade of fools who drove to Salem, OR in big trucks with their license plates covered so they could beat up on other people?

I cannot make a comment about the cost:benefit ratio. I doubt anyone is qualified to. What I can say is that our leadership massively failed us. I guess this is what happens when you elect someone who hates government to govern.

That said, the lock down was meant to prevent a surge overwhelming medical resources. It most likely would have worked if it was implemented the way many other countries did. I don’t think anyone would argue that we want our hospitals swamped and shut down and all of our medical personnel out sick while the situation deteriorates around us.

Speaking of no strategy, anyone else get the feeling that Natalie would open the city gates to Vikings/Huns/Ottomans because she was tired of staying inside?

Yes, staying inside is bad. But just going out without a plan (extensive testing and tracing, and the money to let people quarantine without starving) is worse. This is when we all need some leadership!

@ MedicalYeti

“I cannot make a comment about the cost:benefit ratio. I doubt anyone is qualified to.”

Indeed. No one is qualified to. What happened is the first time in history we had lockdowns globally all over the world. No other data point. No way we can assess whether what was done was the right thing or not.

But even in France, without being a doctor, you could see such signs. People putting on weight was an obvious one.

Overall cost:benefit ratio is extremely hard to assess because even if you were pro-economy and anti-lockdown, there’s no way to know what level of inaction would have guaranteed a lack of disruption of the economy.

Seems like we only had bad choices available.

@ MedicalYeti “I cannot make a comment about the cost:benefit ratio. I doubt anyone is qualified to. ”

Well, there are health economists. They’re the folks who crunch the numbers on where you get the overall best bang for your buck in health care spending. It’s usually kids, based on things like DALYs and things like that. I don’t think that anyone’s ever tried to calculate something like this. They don’t call economics the dismal science for nothing, but even this might be a bit much for them.

But I bet the military has done it. Lots of militaries, probably. Going back to at least the Cold War.

So depressing…The positives may be somewhat region- and population-specific. It’s impossible to get through to the health dept. here, too, but the food banks seem to be in good shape. I’m starting to see many more homeless people, though.The economic chickens are coming home to roost.

Disneyland has been failing to report the numbers about infected employees, so they are resorting to word of mouth. A commercial testing lab here was just outed as as failing to report 75,000 test results.

I live in a state with a delusional Republican governor that fired the epidemiologist who ran the official COVID-19 dashboard for refusing to massage and hide some statistics. She responded by setting up her own dashboard, and the numbers there definitely tell a different story. There’s a lot of corruption and obfuscation going on here.

Now we have the CDC itself in real trouble. Science is flying out the window there in favor of brazen sycophancy. You-know-who crudely insulted and mocked his opponent yesterday for understanding the concept of that thing we call “public health” and of course refused to take protective action of any kind. So presidential.

“Natalie would open the city gates to Vikings/Huns/Ottomans because she was tired of staying inside?”

Well, I would. Just because muh wife would enjoy the novelty of it:

Psst. Sara apparently lives in FloriDuhh.Please be undeservably kind to her. She is surrounded by golf courses, alligators, rockets, and Florida Man. She is wading in bath salts her little nephues drop on the rug. She does not have a vintage 1964 Silver Stream travel trailer and that makes Sara sad.

Also, ask her about essential oils, if only to piss her off (totally worth it).

I saw two presentations related to the pandemic earlier today..
( London) Astra Zeneca paused the vaccine trial because of a possible ‘serious’ reaction in a participant
( Washington DC) the US Surgeon General discusses how flu vaccines and keeping up children’s vaccines are important as well as how medical inequality can be addressed with vaccines.

The anti-vaxxers** I survey are already going crazy about the first; the second will take a day or so. The SG, Dr Adams, is Black but I imagine anti-vaxxers will call him a racist because of his strong support for vaccination as being important for PH during the pandemic as well as helping disadvantaged people get better health care. He will be attacked, I’m certain.
Toby Rogers ( @ uTobia) compares vaccine trials in Newark to Tuskegee experiments. Mary Holland is predicting a million deaths due to a Covid vaccine (which doesn’t exist yet) via PRN..

** AoA, Kim Rossi, Katie Wright, Ginger Taylor, Del BIgtree, NN, PRN, Stop Mandatory Vaccination, etc..

The trial was paused when a subject suffered transverse myelitis was admitted to hospital: she will soon be released. I assume that anti-vaxxers will blame the vaccine.
I knew I had heard of something similar before and sure enough via Search , Orac wrote about a teenager who developed TM, became paralysed and later committed suicide ( see Colton Berrett; several posts). The condition could be caused by infection, cancer or many other conditions but anti-vaxxers have only one response: Orac explains why it is unlikely.

I imagine we’ll hear them soon.

Denice Walter,

This a rare thing that has now happened within a relatively small number group. It is auto-immune disfunction. Adenovirus vectors are dumb (as someone I trust here has noted) and this kinda thing has happened with them before. It (the adverse event) should not be so flippantly discounted.

I hold out hope for the pharma-shill Moderna one.. I might even take a shot in the mouth if it gets me a couple hundred hours outta quantine.

I no longer respond to trolls : I have bigger game in mind as you have probably already guessed

BUT for Orac’s minions who may wonder…
I have NO investments in pharmaceuticals– or in any individual stocks AT ALL – all mutual funds, bonds etc.
My major investments fund 1. governmental bonds ( mortgages, utilities etc) and corporate bonds and .2. growth industries such as high tech – you know their names.
very little of the aforementioned involves pharmaceuticals and/ or medical devices I DO NOT SELECT EITHER THE STOCKS OR THE SECTORS.,

HOWEVER because Orac’s minions support SBM, THEY may want to ilearn how to invest in pharmaceuticals in these turbulent times when people are seeking medical innovation
but I would be wary because there’s a lot to study and we’re already deep into that era
they can look at Investopedia articles such as “Best Pharmaceutical ETFs for Q2 2020” 11 August- although these underperformed the general market for the year and much of it is based on Chinese companies. It might be worth reading if this is your thing. .

@Deni¢e writes-

I have NO investments in pharmaceuticals– or in any individual stocks AT ALL – all mutual funds, bonds etc.
My major investments fund 1. governmental bonds ( mortgages, utilities etc) and corporate bonds and .2. growth industries such as high tech – you know their names.
very little of the aforementioned involves pharmaceuticals and/ or medical devices I DO NOT SELECT EITHER THE STOCKS OR THE SECTORS.,

RI from Denice Walter on July 30, 2020 at 10:58 am

@ Narad:

Some Load, some No Load.
My parents had loads ( heh) of life insurance and the company’s rep advised them to convert to mutual funds that had a fee; so every time it earns, it gets re-invested with that BUT it has really earned since 1984.
The other ones are standard no load, large cap, research funds, tech based etc. so it’s a roller coaster whenever there is a downturn, like this last spring but I ride it out. I expect that one of these owns stocks in companies developing Covid vaccines .I’ll have to find out.

Wait a sec….You expected “that one of these owns stocks in companies developing Covid vaccines”. So no go? Did you ever find out? You could be making serious $$$$$

Any other tips for the amateur investor?

Did you notice the point ? If you believe in COVID vaccine, invest in it. Trump may even issue EUA, and reduce liability. But if this happens, ethical thing would be not to invest.
Perhaps you want to invest ascorbic acid manufacturers instead ?

@ Aarno, \

You can’t argue with her.
She can’t read. I clearly state that I am highly invested in information technology NOT pharmaceutical companies, People can invest in anything they like: there are hundreds of choices just in mutual funds or ETFs alone.

So Natalie Whoever finally exposed herself as an anti-vaxxer some distance above. Thank you for that gift. Readers here now know your true agenda in hanging around and trolling. The Venn diagram of anti-vaxxers intersecting with anti-maskers and I’m-Free-to-Infect-Everyone-Else sociopaths is becoming ever more clear. Behold here a perfect specimen of that kind of self-righteous and arrogant ignoramus whose population is proliferating all over the underground web and thriving in the pandemic era.

A doctor over this side of the Pond ran 22 (if I recall correctly) miles whilst wearing a mask and using a pulse-ox. Just to disprove the bollocks being spread by the anti-mask wallys. Said it was pretty unpleasant but his SATS never dropped below 98.

“It goes through air, Bob,” Trump said. “That’s always tougher than the touch. You know, the touch, you don’t have to touch things. Right? But the air, you just breathe the air and that’s how it’s passed.”
It’s deadly stuff
“I wanted to always play it down,…”I still like playing it down, because I don’t want to create a panic.”

(feb 7) It goes through air, Bob. It’s a democrat hoax. Imma just going to have massive gatherings while badmouthing masks so as not to cause ‘panic’.

“Herman should have had better sense; He was old, a little fat, and black. And I haven’t spoken to him for weeks..he’s stopped responding to my tweets. He was a pizza magnate so we’ll be looking into that #WWG1WGA” — DJT probably

“BUT for Orac’s minions who may wonder…
I have NO investments in pharmaceuticals– or in any individual stocks AT ALL – all mutual funds, bonds etc.”

When you’re the CEO of AstraZeneca, you don’t need an investment portfolio. 😀

uh uh uhh.

After I left a scathing critique of Marissa Mayer on Yahoo! Answers { How is babby formed? }, she was outta there. After she ruined Yahoo email, I suggested that I hope she spit her newborn out upon the road and watch it flounder, flop around, and die from contact with the hot asphault (I would spell it ‘assfault’, but that just sounds like rectal prolapse (which does happen after a mental institution denies one a magnesium supplement taken 7 years prior so then the ‘patient’ craps out a bowling ball and destroys his shit forever) .

To be fair, the sexist in me augmented the statement with “I would still not kick her out of bed unless she wanted to fuck up a formerly funcional interface on the floor”.

I no longer use that address.

Ask her about essential oils.

Makes me think about a guy in The Hague, who is protesting everyday against the measures taken against the spread of the virus. He has had Covid-19, just like 6 of his friends who went on a winter sports vacation and 2 of them developped pneunomia. Still he thinks it’s not worse than the flu.

Luckily for him it may not have been. Of the sixty-or-so patients I’ve directly managed with COVID, almost all were nothing more than a televisit to say: “You tested positive, stay home, hydrate, etc, come to ER if you develop X, Y, or Z. STAY HOME. here’s a work note.”

I’ve also managed about a dozen on our COVID isolation ward who spent some time there, had varying degrees of sequelae, and went home.

Then there’s the hand full who went to the unit. It’s been a total 50-50 proposition; no one has been able to predict who will have what kind of course. Patients we expected to do poorly have done well, the opposite has also been true. About the only useful lab value so far has been their LDH going in, unsurprisingly.

Again – one clinician in one area of the country, not in a big city (Thankfully.) You figure of the 60-ish around six have died and many have had long-lasting effects (Harder to quantify since we have no guidelines.) Massive selection bias since these are people who have sought care.

@JustaTech writes, “Why do you think people over a certain age don’t deserve to be protected from this disease? Why do you think that it is OK for them to die?”

Good lord. Contrary to the persona of me on this blog, I do not enjoy the suffering or death of others. People need to do what they can to protect themselves. I’m not going around coughing and spraying spittle in peoples faces. I reluctantly wear my muzzle like a good ‘lil citizen when I have to go to a public, enclosed space. If I am outside, away from others, I do not wear my muzzle.

I’ll answer your question with a question: Why does the greater good apply when addressing vaccination for the masses when there are known adverse events? There doesn’t seem to be a whole lot of empathy or understanding for those victims. Instead, they are handled with suspicion, shame and ridicule. Your $cience has established that less than 1% of the population will be detrimentally affected by the Convid. Wouldn’t you say 99% is the greater good in this circumstance?

“Contrary to the persona of me on this blog, I do not enjoy the suffering or death of others.”

Then stop promoting the diseases so fervently.

“Why does the greater good apply when addressing vaccination for the masses when there are known adverse events? ”

Because you are totally ignoring the more dire adverse events from the actual diseases. You have failed show to any vaccine on the present American pediatric schedules cause more harm than the actual disease.

As I have said before: I have had a kid get seizures from an actual now preventable disease that required an ambulance to the hospital. Also I have had to take care of a six month old child with chicken pox.

Stop promoting actually getting the diseases! Your stance on vaccines is only logically explainable by you actually enjoying seeing kids suffer from seizures, fevers, covered in lots of itchy open wounds (pox) and all with an increased chance of permanent disability. Especially since you are just an obnoxious troll.

“Also I have had to take care of a six month old child with chicken pox.”

Forget that…. she thinks kids are invulnerable to vaccine-preventable diseases. Natalie thinks our immune system can handle it. I’m old enough to have experienced a fair number of those diseases because there no vaccines yet and witnessed a number of schoolmates who suffered complications….including an iron lung….. the immune system isn’t as strong as you claim it to be, Natalie.

Guess what? In a few years, if you had chicken pox, you WILL be at risk for SHINGLES….. and you will suffer if you develop shingles, sometimes for months or years even with treatment. The immune system doesn’t handle it at all well!

The only ways to prevent getting shingles are 1) Get vaccinated as a child or 2) get vaccinated as an adult.

Here is the most “fun” part: because the kid got chicken pox before their first birthday they are more likely to get shingles in their 20s. Our household went through a month of chicken pox hades a year before the varicella vaccine was available. It has been out for about 25 years. Yep, the kid is in their twenties.

First the kid had to get a titer test to show immunity to chicken pox before entering their masters program, and now after graduating last month they have to find a job during a pandemic. Shingles tends to occur in twenty-somethings during times of stress. AAARGH!

So far, 2% of the USA are confirmed cases, not your 1%……and that number is growing by 30+ thousand a day in spite of Trump trying to suppress the numbers….. with no end in sight. A very high percentage have shown very severe permanent damage, even if they were asymptomatic and in top physical condition (college /Olympic level athletes)……

How many already have asymptomatic cases that have not be confirmed? With the severe lack of disrespect shown by Americans for the damage this virus does by not social distancing/wearing masks/proper washing, how many more will get it? The damage to the American economy is going to be huge.

“Your $cience has established that less than 1% of the population will be detrimentally affected by the Convid.”

That’s an absolute lie. Detrimental effects are suffered by a large percentage of people who get Covid, but who don’t die, which you seem to think is the only “detriment”. The long-haulers, people who may never be able to work or live a normal life again, the people who have permanent heart or lung damage (the heart-damaged one I read about today is a 29-year-old former personal trainer), and all the people who will go bankrupt from medical bills although they didn’t die (because this is America, where losing everything you own to pay medical bills is a thing). All of those detrirmental effects were already mentioned, and you ignored them and lied.

And when you say “end the lockdown”, what are you talking about? “Lockdown”, as in only essential businesses being open, and only leaving one’s house for necessities, ended months ago. Now we’re all just wearing masks, social distancing, and keeping the number of people in gatherings low. Is that what you’re whining about as the so-heinous “lockdown”? What is so oppressively onerous about those hysterical actions that jusitifies millions more cases, with permanent detriment and death as the consequences for hundreds of thousands of people?

But, why expect sense or humanity from an anti-vaxxer…..

No, Natalie “Your $cience has established that less than 1% of the population will be detrimentally affected by the Convid.” That isn’t true.

What is known right now is that the death rate appears to be approximately 1%. That doesn’t include the known and unknown long-term consequences. The people who are still sick 6 months later. The people with heart damage. The people with lung damage. The people with brain damage.

What you can not seem to grasp is that the deaths of that 1% does not protect anyone. Every infection spreads the disease, increasing your risk of contracting it. And until the probabilities collapse, you don’t know if your case would be mild, or severe, or long-haul, or fatal.

I saw a patient in clinic today who took three weeks to get over COVID, that was a month ago, and she is still experiencing serious issues. She didn’t do a single day in the hospital because she had relatively mild respiratory symptoms. Today, she is still having some kind of “brain fog.” I’d read about it but this is the first patient I’ve ever seen with it. She was definitely confused but one could argue it’s an act or she’s being dramatic until you see that she had several cranial nerve deficits. Really odd. Looked sort of like a mild case of Bell’s Palsy mixed with a recent concussion. Symptoms have been there for almost a month and don’t seem to be going anywhere. Definitely not a bug you want to play roulette with.

A friend of mine was sick back in May/June for six weeks. And she still has post concussion type symptoms after all these months. They’ve gotten a little better, but very much still there.

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