April 24, 2020

Slow the Pandemic, Restart the Economy— Experts and History Demonstrate It Doesn’t Have to Be A Trade-Off

“Predictions are hard to make, especially about the future.” ~ Yogi Berra

How do we build our immunity—how can we protect our loved ones, support our communities and preserve our economy? When will the economy rebound—and what will it take for Americans to get back to work? Why are some people walking around with COVID-19, unaffected by its potentially fatal impact to the lungs, and others are on ventilators fighting for their lives?             

These are questions I’ve been seriously considering amid the novel coronavirus that almost immediately shut down our schools, businesses and way of life. The power of a disease to force an immediate pivot—to deflate a record bull market and strong economy, to shutter the places we gather, and to reverse the unemployment rate from very low to very high—is a reminder of how vulnerable and how fragile life is. Yet, during this time of lockdown, in spite of the fear and uncertainty we’re experiencing, we are also building relationships, using technology and preparing our country and healthcare systems for the future.

              Many of our elected officials, healthcare leaders and outstanding frontline responders have moved quickly and done everything possible. They’ve done everything they thought was right. But we were not prepared for a healthcare pandemic, and we are now recognizing the importance of preparation for major healthcare tragedies—because they will occur in the future.

              This pandemic is moving from a health problem to a major economic and now psychological problem. Feeling safe and staying healthy are necessary for a rebound. Raymond James & Associates presented these key points from Dr. Gelfand, a renowned cross-cultural psychologist with extensive experience in behavioral trends across societies. She discusses the implications that COVID-19 could have on long-term consumer behavior and how (and if) we will return to normal.

The take-aways:

  • Feeling safe is a prerequisite to normalcy.
  • If people feel safe, people rebound more quickly.
  • Those in lower socioeconomic positions are most likely to respond with caution and limit discretionary spending over the long-term.
  • People follow other people, so community reengagement will help people regain comfortability.
  • People feel safer when they have credible, consistent and authoritative data.
  • The media can help the rebound by promoting positivity.
  • People are quicker to adapt to things than you might think.
  • The pandemic is moving from a health problem to a psychological problem.
  • The rebound will likely take longer than the ‘tightening up’ period, but it will happen.

              This article will address the key issues as we live and learn in this time of COVID-19—and provide some answers from experts. We need to let go of the extreme views on both sides and take a balanced approach. My hope is to share knowledge that I gather from experts from different fields who are knowledgeable and experienced.               

The ABCs of Immunity and COVID-19

There are many ideas about why some people combat the disease better than others. And, what does it take to gain an edge? According to preventive medicine physician and wellness expert Sandra Darling, DO, Cleveland Clinic, boosting your immune system is about going back to the basics. Wash your hands for 20 seconds, don’t touch your face and take social distancing seriously.

              Dr. Darling also suggests choosing whole, unprocessed foods that are rich in immunity boosters, such as garlic, prebiotics (artichokes, asparagus), vitamin C and antioxidants like berries, spinach and carrots. Sleep seven to eight hours a night, meditate for even five minutes per day to see the calming health benefits, and exercise to increase your resilience, Dr. Darling advises.

              What supplements should we be taking? Cleveland Clinic is a world-class healthcare institution that has a 99% success rate with treating its COVID-19 patients. Cleveland Clinic is also ranked No. 1 for the most severe healthcare cases, overall—not just COVID-19. I’m proud to serve on its board of directors and I have incredible respect for its CEO, Dr. Tomislav Mihaljevic, and all of the caregivers. Cleveland Clinic advises daily Vitamin C, Vitamin B6 and Vitamin E, which helps the body fight off infection.

 Supplementing Your Health

There have been many studies evaluating intakes of nutrients and how they might combat infection. The Harvard School of Public Health reported the following:

  • Zinc: Inadequate zinc levels limit an individual’s ability to mount an adequate immune response to infection. Oral zinc supplementation reduces the incidence rate of acute respiratory infections by 35%, shortens the duration of flu-like symptoms by about 2 days and improves the rate of recovery. Studies used a dose of zinc ranging from 20/mg per week to 92 mg/day. Dose was not the main driver in effectiveness.
  • Vitamin C: This vitamin acts as an antioxidant, limiting inflammation and tissue damage associated with immune responses. Some critically ill patients with COVID-19 have been treated with high doses of IV vitamin C to hasten recovery. There is no clear scientific evidence.
  • Vitamin D: Clinical trials and pooled studies show that vitamin D supplementation lowers the odds of developing acute respiratory tract infections by 12% to 75%. Flu symptoms of infected individuals were fewer and recovery was earlier with doses of vitamin D greater than 1000 IU.

 Who Suffers the Most?

According to the CDC, almost 90% of COVID-19 hospitalized patients have some type of underlying condition/comorbidity: hypertension (high blood pressure), obesity, chronic lung disease or cardiovascular disease. NYU showed that obese patients under the age of 60 were twice as likely to be hospitalized for COVID-19 than those of a normal weight; and 40% of adult Americans are considered obese.

 Why So Fatal in Italy?

Dr. Ioannidis, a professor of medicine, epidemiology and population health at Stanford University is a co-director of the Meta-Research Innovation Center at Stanford. In an interview, he explained, “We have increasing evidence that there are major gaps in practically all of the key features that pertain to what this pandemic is about; how lethal it is; how many people it has infected or will infect; what is likely to be the eventual impact; and how effective the different measures that we are applying are.”

He is learning from Italian responders, trying to find out why their situation was so fatal. Here are some conclusions:

  • Demographics: Italy has the most elderly population in Europe. The average age of people who die in Italy is 81 and most have underlying diseases.
  • Smoking: Italy has a high rate of smokers and those with chronic pulmonary disease.
  • Heart disease: Italy has a high rate of individuals with heart disease.
  • ICU beds: Italy has about 1/3 of the ICU beds per capita for their population and their system runs at maximum capacity on a normal basis.
  • First in Europe: Italy was the first European country to experience the COVID-19 spread and the immediate reaction was to admit everyone to the hospital—including mild and moderate cases. Hospitals became saturated and overrun.
  • Nosocomial infection: Medical personnel got infected and spread the disease—called “nosocomial infection,” which is infection spreading within a hospital. The same issue is occurring in New York City due to the mass amounts of people within a confined space.

Saving Mental Health

What we aren’t counting is deaths related to COVID-19 but not caused by it—heart attacks from stress, higher suicide rates, drug and alcohol overdoses, anxiety and depression, along with a slew of other mental health conditions that are a result of social distancing, isolation, job loss, work pressure, and financial stress. Dr. Ioannidis told the Institute of American Stress in a March 30 article: “A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational…”

Every 1% increase in unemployment is 1% increase in suicide and other problems.

 A RealAge Health Approach

Dr. Oz showcased Cleveland Clinic Functional Medicine expert Michael Roizen, MD, author of YOU: The Owner’s Manual and a slew of other health and wellness titles, and founder of the RealAge concept. Dr. Oz also included insight from Mark Hyman, MD, founder and director of The UltraWellness Center and head of strategy and innovation and Cleveland Clinic Center for Functional Medicine.

Their advice for controlling lifestyle factors that can increase COVID-19 hospitalization include:

  • Maintain a healthy blood pressure. The goal is at least 120/80. Dr. Roizen points out that if you get infected with COVID-19, the inflammatory response can be up to 200 times what is normal. Short bursts of high-intensity exercise on a daily basis help relax the blood vessels, making them more elastic to improve blood pressure. Five-minute meditations also go a long way toward keeping blood pressure at healthy levels.
  • Measure your waist. Dr. Hyman notes that inflammation starts in the belly. Your waist circumference is an indication of belly fat and organ fat. 72% of people admitted to the ICU in a one-year case study were overweight or obese, and 88% of us are “pre-inflamed,” he says. Use a tape measure and measure your waist by your belly button. Women should be 35 inches or less and men should be 37 inches or less. Decrease belly and organ fat by choosing whole foods and avoiding starch, sugar and processed foods.

 COVID-19 Symptoms

Meanwhile, we are learning more about how to detect the symptoms. Of course, complicating this is the fact that many who get the disease will be asymptomatic. However, there is a range of symptoms as mild as nasal congestion, headache, chills and sore throat—and as serious as difficulty in breathing, persistent chest pain, and bluish lips and face. A Wall Street Journal article (4/20) shared that of nearly 56,000 patients in China, 87.9% had a fever, 67.7% had a dry cough, 38.1% experienced fatigue, and 18.6% had shortness of breath. The majority (81%) had mild symptoms and 4.7% were critically ill. 

 Testing—How Many, Which Ones?

Testing is a critical necessity before we can successfully return to work. The question is: How much testing do we need and who should get tested? Which tests are best and where do we get them?

              First, let’s take a look at data from the CDC as of April 22, 2020, related to recorded COVID-19 deaths. There is an obvious connection between age and mortality rate. So far, there have been 0 deaths among those under age 1, two deaths in the 2-4 age group, and 432 among those who are 35 to 44. The numbers more than double in the 45-54 age group with 1,129 deaths—and double again in those 55 to 64 with 2,712 deaths. Those most at risk from an age perspective are 85 and older, with 6,225 deaths.

              How do we test Americans so we can be sure those who are possibly carrying the disease do not infect those at risk?

              Unfortunately, not every American who wants a test can get one. And, not every healthcare worker can get a test. There is a shortage. According to an article in The Atlantic and its data initiative, COVID Tracking Project, the number of tests performed in the U.S. plateaued at about 130,000 to 160,000 per day. Of course, as I write this the numbers change. Testing is a constant evolution. The article states, “To safely reopen closed businesses and revive American social life, we need to perform many more tests—and focus them on the people most likely to spread COVID-19, not sick patients.”

              How much testing is enough?

              According to Morgan Stanley analyst Matthew Harrison and Harvard professor Ashish Jha, we could conduct a minimum of 500,000 tests per day. Others suggest we should be running 20 to 30 million tests per day.

              CDC guidelines give priority to hospitalized patients and symptomatic healthcare workers. Next comes high-risk patients, mostly those over 65 and suffering from other serious health conditions with COVID-19 symptoms. Some argue the downside of this is that asymptomatic people are not tested, even following contact with someone who tests positive.

              We need a plan for testing. And, testing is essential if we want to return to work and trigger an economic rebound. As states establish their own timelines for reopening their economies, testing is integral to building confidence since a possible rebound of the virus could occur if we return to work too soon.

              This leads to exactly what businesses must do to assure a safe environment so our economy can get back up and running again.

 Going the ‘Distance’ to Get Back to Work

There are some risks associated with going back to work, to the extent that some feel the longer we stay in lockdown the better—and others vehemently disagree. A shut-down economy is a damaging “side effect” of this pandemic, and it’s arguably going to force many workers to rethink their careers and retrain to obtain skills in demand from resilient industries that survive and thrive after the COVID-19 pandemic subsides.

              The key is to think in phases, based on what we are hearing from health experts. A Wall Street Journal article suggests that companies will continue to encourage telework and technology for collaboration, even on job sites. Reduced density in the office can include splitting workers into groups and alternating who comes into the office and who stays home. Cleaning precautions are also essential.

              We don’t know exactly when we’ll be back to “business as usual.” We’ve been forced to go digital faster than we expected. And, telework will continue. Software innovations will advance our remote-work capabilities.

Some industries and businesses that were already vulnerable are struggling even more. All turnarounds in life take longer, and there are more problems than we see. Just as COVID-19 attacks people who have autoimmune issues and health comorbidities, the same is true with life and business.

              Talent will prevail. The U.S. economy has long proven this. Consider our healthcare system and ability to manage COVID-19 compared to other countries with less developed healthcare systems. Again, Cleveland Clinic is experiencing a 99% success rate with COVID-19 treatment. Compare that to Italy where the mortality rate is anywhere from 1-in-8 to 1-in-10, depending on which report you read. That is 10% to 12%, and worldwide the mortality rate is about 4% to 5%.

              And, data always triggers debate.

              For example, a commentary titled An Advantaged Disease, Indeed by Bill Bennett (former secretary of education and director of the National Office of Drug Control Policy) and Seth Leibsohn (senior fellow at the Claremont Institute) notes that officials and media have warned us of 2 million deaths in the U.S., then they moved that number down to 200,000—then 100,000 and back up to 240,000. Worldwide, as of this week, there have been approximately 68,000 deaths. (Again, numbers changing daily.) The article points out that our country loses about 157,000 deaths monthly due to heart disease, cancer, asthma, bronchitis, emphysema, stroke, Alzheimer’s, diabetes, drug overdoses, flu and pneumonia.

 What’s Best for the Pandemic and Economy Is the Same

In the long run, there are no compromises between fighting the pandemic and preserving the health of the U.S. economy and financial markets, according to Barron’s. “The discussion is often presented as a trade-off: The faster the reopening, the less pressure on earnings, defaults, and asset prices,” said Andrew Sheets, chief cross-asset strategist at Morgan Stanley. “We disagree with this framing. What’s best for fighting the pandemic, the health of the economy, and the market may be the same thing—making sure the reopening of the economy is done right.”

In a paper published in Liberty Street Economics, “Fight the Pandemic, Save the Economy: Lessons from the 1918 Flu,” by Sergio Correia, Stephan Luck and Emil Verner, they acknowledged that areas more severely affected by the 1918 flu saw a sharp, persistent decline in real economic activity. Second, cities that implemented early and extensive NPIs suffered no adverse economic effects over the medium term. NPI stands for non-pharmaceutical measures—such as waring face masks and washing hands. However, cities that intervened earlier and more aggressively experienced a relative increase in real economic activity after the pandemic subsided. Pandemics can have substantial economic costs, and assertive action can lead to better economic outcomes and lower mortality rates.

The Hoover Institution at Stanford University is a public policy think tank. On April 22, it released an article, “The data is in—stop the panic and end the total isolation.” It suggests that leaders examine the data and focus on how to thoughtfully restore the country, and it identifies five key facts that are being ignored by those calling for near-total lockdown.

  • The overwhelming majority of people do not have any significant risk of dying from COVID-19.
  • Protecting older, at-risk people eliminates hospital overcrowding.
  • Vital population immunity is prevented by total isolation policies, prolonging the problem.
  • People are dying because other medical care is not getting done-procedures that can prevent life-threatening diseases, treatments, emergency care and even chemotherapy.
  • We have a clearly defined population at risk who can be protected with targeted measures.

 What About a Cure?

Abbott Laboratories recently announced a launch of a lab-based serology blood test to detect the president of the antibody IgG that tells if a person has had the coronavirus. Antibody tests are a way to determine if someone was already infected with the virus, unlike molecular testing that shows if a person currently has COVID-19. Abbott already received the FDA’s EUA for its molecular point-of-care test called ID NOW COVID-19.

              While there are currently no drugs or vaccines approved for the virus, more than three dozen are in development or being studied, according to a Wall Street Journal update. There are also clinical trials in China and one in the U.S. to evaluate remdesivir, an antiviral drug from Gilead Sciences that was also tested for Ebola. A malaria drug, hydroxychloroquine, has gained attention but there is no scientific evidence, according to experts. In fact, the AP reported on April 21 that there were more deaths among those given hydroxychloroquine vs. standard care.

              Meanwhile, Vladimir Zelenko, a board-certified family practitioner in New York, has successfully treated 350 coronavirus patients with 100% success using hydroxychloroquine + azithromycin (Z-Pak), and zinc sulfate. The shortness of breath resolved within 4 to 6 hours after treatment. The whole treatment costs only $20 over 5 days with 100% success. He defines success as “Not to die.”

              We know treatment will require significant trial and error. It’s a work in progress, but progress is being made. During this time, when we are bombarded with so much news, I hope this letter finds you holding on to what’s most important in life. We are resilient, and surprisingly adaptable. I want to close with this beautiful quote from Pope Francis.

              “Rivers do not drink their own water; trees do not eat their own fruit; the sun does not shine on itself and flowers do not spread their fragrance for themselves. Living for others is a rule of nature. We are all born to help each other. No matter how difficult it is… Life is good when you are happy; but much better when others are happy because of you.”

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