COVID Email: June 26

Here we go again…maybe?

As a country, our COVID-19 numbers have gone back to moving in the wrong direction. We enjoyed a slight plateau, even a bit of a drop in cases, for a short while. However, we have reversed that trend, which has the unfortunate consequence of generating another one of these emails from me :)

Previously, I’d written about the likelihood of a “second wave”. This is not a second wave though. What we are seeing now is the extension of the first wave, moving into regions beyond where the pandemic first struck the US. More than half of all states are seeing rising case numbers, some are setting records daily. It has been argued that this is due to increased testing, but the data clearly shows otherwise. Hospitalizations do not increase simply because more people get tested, yet that is what we are seeing. The percentage of all tests which return positive results has increased as well, so there is no validity to an argument that this increase is simply due to the US testing more people. Fortunately, we have not seen a rise in deaths. In fact, deaths continue to decline. Hopefully that signals a real change in the epidemiology, but I fear that deaths may simply be a lagging indicator, typically rising 2-3 weeks after case rates begin to rise. It could be the case that deaths are lower because many more of the infected individuals are younger. We are seeing more twenty- and thirty-year-olds getting infected, likely due to a widespread resumption of social activities. If those milder cases continue to comprise a greater percentage of all illness, perhaps that buffers the otherwise bad news of increased infection rates. Time will tell.

In my opinion, the current circumstances should serve as a reminder to all of us that normalcy has not returned. In fact, we are unlikely to see normalcy anytime soon. That doesn’t mean we need to castastrophize this increase in infections, but we should take it as a reminder that basic defenses still matter. Don’t let your guard down or be lulled into a false sense of security. COVID is here, and it’s not going anywhere in the near future.

There remain questions around immunity…probably more now than there were a month ago. It is still uncertain whether infection leads to immunity, and if it does, how long that lasts. It appears that some people may get infected, fight off the illness, yet not produce adequate antibodies to prevent a second infection. We just don’t know. Given that and the fact that infection presents a very real financial risk for many of my patients (athletes who can’t compete or earn a living when sick), I still think it makes sense to mitigate risk and avoid illness at this time.

Pro Advice

Last week, I attended the PGA’s RBC Heritage at Hilton Head Island. During the event, the PGA Tour had its first incidence of a player testing positive for COVID-19. This week, there have been a couple more positives at the event in Connecticut. Upon learning of the positive in Hilton Head, I sent an email to those of you who are PGA players. For the benefit of my patients who are not among this group, I’ve placed an excerpt of that advice below.

“I hope you all take this as a reminder that COVID is here and your actions matter when it comes to mitigating your own risk.  Hilton Head is crawling with people this week, and we’ve seen that very few of the vacationers are taking steps to socially distance.  You can make decisions to lower your risk of COVID…and avoid a forced withdrawal.

With this in mind, I want to address some things that may seem simple but will go a long way toward keeping you healthy this week and in weeks to come.

• This virus is primarily spread via close contacts with individuals in enclosed spaces.  This means any interaction closer than 6 feet from someone which lasts longer than 10 minutes while indoors.  Please limit these types of interactions, especially in public spaces.  In your daily routines while on the road, this typically occurs when in restaurants or gyms.  Of course, if someone seems ill, avoid interaction for any amount of time.

• In some of the emails I’ve sent during the pandemic, I discussed some strategies for supporting immune function and (hopefully) limiting your likelihood of infection.  Aside from basic hygiene, which is hugely important, there is scientific rationale for ensuring you are consistent with diet and supplement regimens.  Here is a link to one of the emails which included this information.

• As you get back to competing, things will seem more normal.  Don’t be lulled into a false sense of security.  Evaluate whether it makes sense to visit restaurants, bars, and coffee shops.  Consider options such as take-out or delivery.  Eat outside, away from others when you do visit restaurants, and limit trips into public spaces.

• When you go to the grocery or other locations away from the course, I would recommend that you wear a mask or cloth face covering.  Can’t hurt.  Might help.  Evidence for their utility is increasing.

• Consider ways that you can train without going to the gym.  If you can travel with equipment (dumbbells, kettlebells, TRX, bands), give it a try.  However, training in a gym may be necessary or simply preferred. If you do go to a gym, wipe down all equipment before you use it and again afterward, and avoid touching your face.  Take a container of Clorox wipes with you, and use them liberally.  Try to keep 12 feet or more between you and other exercisers.  As people exercise, their respiratory rate and force of breathing increases.  This would lead to an infected individual shedding greater amounts of virus while exercising.  Given that, I would suggest completing all aerobic or endurance training outdoors.

On the issue of masks, I find it strange and disheartening that it has become such a polarizing and politicized topic. Evidence for their utility continues to mount. The highly-respected journal, Annals of Internal Medicine, published a couple articles on this topic recently. For those inclined to read about it, HERE is one worth perusing. Masks aren’t perfect, but it’s not an issue of binary utility. In other words, it’s not that they either work or don’t work. Rather, it’s an issue of whether they help to limit spread, and the evidence suggests they do. Worst case, they don’t help much and you look silly in a mask. Seems a small price to pay for possibly helping to contain the outbreak. I honestly don’t see what all the fuss is about. When you go to the gym, the grocery, or take a flight, wear a mask!

The Podium (Our Podcast for You!)

The podcast is published! You can find it on our website, at Apple Podcasts, and most other places where you might get your podcasts. This project has been created as a resource for you, our patients at Podium! I hope you enjoy it.

We have started to record Season 2, but I want to highlight an episode from Season 1. Give this one a listen, as it has wide-ranging applicability!

Creatine

Episode 3 of Season 1 addresses the utility of Creatine as a supplement. Many think of it as something only for weight-lifters and power athletes, but there is good data to suggest its utility for endurance athletes and to aid in cognitive performance. I now take 2.5g of creatine every day, and I think there is likely reason for all of you to do the same. Take a listen, and let me know what questions you have!