A Message from the President of my Alma Mater that I thought I would share

This is becoming like a newsletter! Anyway, this blog is very different from my usual ones. For one thing it is not written by me, its written by the President of Harvard. I apologize in advance for any breech of privacy since it is written to the members of the Harvard community (newspapers release stuff like this all the time). The reason I am including it here is because 1) It is what I would also like to believe and 2) It is written so much more eloquently than I could say it. So here goes: (P.S I expect you all to bail me out :)! Dear Members of the Harvard Community, The last several months have been disorienting for all of us. COVID-19 has profoundly disrupted the lives of people worldwide. It has caused more than 365,000 deaths around the globe and more than 100,000 in the United States alone. Forty million Americans have lost their jobs, and countless others live in fear of both the virus and its economic consequences. In the midst of this incomprehensible loss, our nation has once again been shocked by the senseless killing of yet another black person—George Floyd—at the hands of those charged with protecting us. Cities are erupting. Our nation is deeply divided. Leaders who should be bringing us together seem incapable of doing so. I cannot help but think back to 1968, the spring of my junior year in high school. First, Dr. Martin Luther King Jr. was assassinated, then Bobby Kennedy. Riots broke out in nearby Detroit, as they did across the country. Then, like now, our nation was hugely polarized, and we desperately struggled to find common ground that might unite us. At the time, hope was in short supply. It seemed difficult to imagine how we would move forward, but we did. As I think about the challenges that we face today, I return again and again to what I believe: I believe in the goodness of the people of this country—and in their resilience. I believe that all of us, liberal and conservative, Democrat and Republican, whatever our race or ethnicity, want a better life for our children. I believe that America should be a beacon of light to the rest of the world. I believe that our strength as a nation is due in no small measure to our tradition of welcoming those who come to our shores in search of freedom and opportunity, individuals who repay us multiple times over through their hard work, creativity, and devotion to their new home. I believe in the American Dream. I believe in the Constitution, the separation of powers, the First Amendment—especially the right to a free and independent press that holds those in power accountable, and to a free and independent judiciary. I believe in the 14th Amendment’s guarantee of equal protection of the laws—for everyone, not just for those who look like me. I believe that no person is above the law regardless of the office they hold or the uniform they wear. Those who break the law must be held accountable. I believe that one measure of the justness of a society is how it treats its most vulnerable members. I believe we must provide opportunity to those who may not encounter it on their own so that they may achieve their full potential. I believe in the power of knowledge and ideas to change the world, of science and medicine to defeat disease, of the arts and humanities to illuminate the human condition. This is just some of what I believe. I hope you will pause during these troubled times to ask what you believe. Even more importantly, I hope you will find the strength and determination to act on your beliefs—to repair and perfect this imperfect world. Those of us privileged to work or study at a place like this bear special responsibilities. As Luke teaches us, from those to whom much is given, much is expected. Sincerely, Larry Lawrence S. Bacow President Harvard University © 2020 The President and Fellows of Harvard College | Harvard.edu Harvard University | Massachusetts Hall | Cambridge, MA 02138 Hospitalizations look like they are finally taking a downward turn. Now down under 1300, 600 people in ICU We are staying open so you can stay healthy! We have special protocols in place in the office to keep you safe and minimal waiting. No walk-ins. Anyone who doesn’t have a mask waits in their car until their appointment. Extra sanitation procedures daily and hand sanitizer for everyone! VIDEO LINK: https://youtu.be/kOzIp8kb1js Here is a video link to an International conference I presented at today. Unfortunately the Introduction was not recorded but hopefully you can still glean information! The topic was Coping with Covid: The Ultimate reset Corona Virus Testing: Breaking news! If you are interested in being tested for the corona virus in my office, either by the blood antibody test or the nasal swab please give us a call.

Coping with Covid: The Ultimate Reset

Here is a video that was taped today about 'Coping with Covid' and how to Reset your life after the pandemic.
Unfortunately the whole Intro was cut off but hopefully you can still learn from it.

https://youtu.be/kOzIp8kb1js

Stay safe!

Show seniors some love. Let's protect them from Covid-19

People in their 80's are 10 times more likely to die from Covid-19 than people in their 50's. Why? No its not just because 'they are old'. They do have a weakened immune system because of age but it can be strengthened by simple measures. Here is my "Senior Script". please follow it for any seniors that you care about. P.S Remember they need quality sleep.
This video discusses my recommendations. Please share with those who take care of and care for the elderly. Please do your part.

https://youtu.be/72YOFkzDeaM

The ‘new’ Covid disease in kids

 Understand that Covid-19 is no longer as sensational as it was and people have become numb to the numbers. How could it get any worse? By panicking parents of course!

It is true that the corona virus that causes covid-19 is a novel virus. It is brand spanking new and we don’t know much about it but one thing that we do know about is the Kawasaki syndrome. This is being touted as the ‘new’ Covid disease in kids and news reports designed to scare people are rampant.

As I have said many times before: public health communicators need to be credible, transparent and trustworthy. The sheer volume of Covid-19 misinformation and disinformation is ‘crowding out” accurate public health guidance. It is impossible to put out all the fires that sensational ‘news’ starts but I would like to give you the basic facts about the Kawasaki Syndrome also know as Kawasaki Disease.

Kawasaki syndrome usually occurs in children under 5. It is characterized by a fever lasting more then 5 days, rashes on the body especially in the armpits and groin area. Scaling of the skin of the limbs starting around the nails. A ‘strawberry’ red tongue or lining of the mouth and lips, red eyes (>90%), swollen glands on one side of the neck, arthritis (after the second week) of the large joints and organ dysfunction most notably of the heart. Kawasaki’s is not an ‘instant’ kind of syndrome and can go on for weeks. The highest risk of death is after the 10^th day of illness but the mortality rate is only <0.5% with treatment. The main cause of death is that it causes aneurysms (ballooning) and inflammation of the small arteries of the heart which can cause a child to have a heart attack.

The ‘Kawasaki-like’ syndrome of Covid has some symptoms similar to the original syndrome but it is generally more correctly called the multi-system inflammatory syndrome associated with Covid. Strangely there are usually no breathing issues with this and GI symptoms are commoner than cough. The biggest danger with this is heart damage. It is usually a latent condition that develops weeks after the initial coronavirus infection and then assaults a child’s circulatory system with inflammation rather than directly attacking the lungs.

Whatever the situation with Covid-19, in children and adults, the most lethal damage occurs when the immune system goes haywire. This causes release of cytokines resulting in a damaging condition called the cytokine storm which damages the tissues of several organs ranging from the lungs, heart, kidneys and liver. This is probably the underlying issue before the ‘Kawasaki-like’ syndrome starts.

The bottom line with kids and Covid is that so far, in the US, most of the kids that have died have had pre-existing conditions.  

Nearly half of those patients had complex developmental disorders like cerebral palsy or lifelong technology-dependent treatments like tracheostomies or feeding tubes. Other pre-existing health issues included cancer and suppressed immune systems from organ transplants or immunological conditions.

Anyway you cut it, the mortality rate for children in this country is still less than 2%  which is very low (much lower than influenza) and the basic tenets remain the same:

Hand-washing, sanitizing, social distancing, masks and gloves, modeling for kids. Vitamin C and vitamin D.

Please focus on the basics they will help you avoid any form of Covid illness, whatever you want to call it. Function on facts not fear.

Talking Numbers and Preventing Deaths

Let’s talk numbers

There is an infodemic going on and it is easy to get lost in the numbers. Let’s try and keep it basic. What two numbers do we really care about?

The number of cases in hospital and the number of deaths. If you follow these two numbers you will be able to appreciate trends which will give you a better sense of safety especially those numbers close to where you live.

Quite frankly the “number of cases” is a worthless number. Why? Because it depends on how many sick people got tested. If everyone doesn’t get tested that  number tells you nothing. When there is more testing there will be more ‘cases’ and when fewer people get tested there will be less.

On Saturday there were 1500 people in hospital, today 1460. A nice trend but not huge.

The number of deaths is a grim reminder of the seriousness of this condition. Isn’t it incredible that we now measure success by how many people died?

Sometimes you have to go back to basics to make sense of it all.

It sounds easy for people to say what should have been done and what should be done now. But believe me it’s the basic measures and simply following epidemiological guidelines that will get us through this.

Watch this clip from the BBC News.

Is it not amazing what people with little or no resources were able to achieve yet we, the ‘most powerful, richest’ country on earth have left 92,000  and counting dead bodies in our wake?

Now I want to talk about ventilators vs testing. 

Do you remember when there was all the brouhaha about who had enough ventilators and why New York didn’t need 30,000?

It costs $20,000 to $50,000 to make a ventilator and that doesn’t take into account the oxygen and all the pieces of equipment and highly trained personnel that go into making them actually work. Third world countries know they cannot afford ventilators. If you dropped off a 100 in the Navajo Nation health clinic they wouldn’t know how to use them. It would have to come with staff and PPE’s and so on.

It took a presidential decree to convert car manufacturer factories into ventilator producing plants so the country could get 'enough' ventilators.

It cost $1 to $5 (worst case scenario) to make a corona virus test kit. You do the math! The only life a ventilator saves is the one person on it at the time and then it needs to be disinfected and recalibrated, you get the idea.

The first day in an ICU bed in the United States costs $10,794 and tapers to $3968 per day by Day 3.

The average stay in the ICU with Covid-19 is between 8 and 14 days.

A regular bed hospital stay costs  $1488.

I know, its enough to make your head spin!

Do we get it yet?

Please follow the prevention measures I have been discussing in these emails. Believe me: Money and time spent on prevention is 100s of times more valuable than chasing cures.

Can you get Covid twice?

Why do seniors die from Covid? How do we change it?

Are we there yet? Is it time for you to go out?

Are we there yet? (AKA: Stop in the name of love!) Can you get Covid twice? Why do seniors die at higher rates with Covid?

Here are three VERY short videos about important topics.

The title may sound a little jovial but it is only an attempt to brighten the dark cloud we are under. Nothing can lift it as fast as taking this whole thing seriously and doing your part. Right now that includes staying home.

54 more Marylanders lost their lives yesterday (RIP). The worst hit counties are Montgomery, PG and Baltimore. Still it doesn't matter where, we are we are all connected, the sooner we realize that the better.

Please take a moment to watch the videos and let me know if you have any suggestions or questions. We can get through this but we are not quite there yet.

Here is the link to one. It is called "Are we there yet?"

. 

This video is about Covid-19 infection rates and whether we are ready to 'open up yet'. The real yardstick to determine that would be aggressive testing. Since we don't have that we have to go by the current numbers.

Are we there yet? Nope!

https://youtu.be/K4yFGMWZr5M

Here is a second link about the elderly and Covid

https://youtu.be/1GhHxMxO5eM

As people get older their immune systems weaken but there are lots of other factors that explain why a person in their 80's is 10 times more likely to die from Covid than someone in their 50's.

So why do the elderly die from Covid and how can we change that? Unfortunately, right now many are like sitting ducks.

Can you get infected twice?

Understand how immunity, whether to a vaccine or an infection works and why you can't be too complacent if you have already been diagnosed with Covid-19

Here's the third link
https://youtu.be/sHY6ZORabDs 

If you prefer to just click on the videos they are below.

Look forward to hearing from you

Love,

Dr. Tuakli

Does Vitamin D protect against Covid-19?

Does Vitamin D protect against Covid-19? The answer is yes! Several weeks ago I encouraged everyone to take Vitamin D daily to help protect against Covid. The benefits of vitamin D for the immune system, bones and cardiometabolic health has long been known and most of my patients know I have been a stickler for vitamin D supplementation. Well now it seems Harvard is on board, based on an article put out today by JoAnn E. Manson MD, DrPH, professor of medicine at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital in Boston. She noted that now it is more important than ever to take your vitamin D. There is a growing body of evidence that vitamin D status may be relevant to the risk of developing COVID-19 infection and to the severity of the disease, (as expected). Vitamin D is important to various parts of the immune system, most relevant right now is that it boosts immune function against viral diseases. Vitamin D has an immune-modulating effect and can lower inflammation, and this may be relevant to the respiratory response during COVID-19 and the cytokine storm. The cytokine storm (see previous blogs) is thought to be responsible for why a lot of the critically ill patients develop respiratory failure. The protective effect of vitamin D on respiratory cells has been demonstrated in the laboratory. But there is also evidence that patients with respiratory infections tend to have lower blood levels of 25-hydroxy-vitamin D. So now we have some evidence from COVID-19 patients as well. Studies from three south Asian hospitals showed that the prevalence of vitamin D deficiency was much higher among those with severe COVID illness compared with those with mild illness. In fact, there was about an eight fold higher risk of having severe illness among those who entered with vitamin D deficiency compared with those who had sufficient vitamin D levels. Did you get that? Eight fold! There was also an article in the prestigious BMJ (British Medical Journal) a couple of years ago which documented the protective effect of vitamin D in respiratory illnesses. So the evidence is becoming quite compelling. Getting outdoors is important and diet is also important. Everyone should be reading food labels which list the vitamin D content. Food sources that are higher in vitamin D include fortified dairy products, fortified cereals, fatty fish, and sun-dried mushrooms. Dr. Manson and her team are in the process of planning a randomized clinical trial of vitamin D supplementation in moderate to high doses to see whether it has a role in the risk of developing COVID-19 infections and also in reducing the severity of disease and improving clinical outcomes. In the meantime, taking vitamin D is something easy you can do for yourself and your loved ones. Clearly, while we wait for more results, it's important to encourage measures that will, on a population-wide basis, reduce the risk for vitamin D deficiency. Many of you have heard my lecture on vitamin D supplementation. But for those of you who haven’t, remember to take vitamin D with some food that contains some fat because it is a fat soluble vitamin. Otherwise you will not absorb it well. Better yet, take it as drops and then you don’t have to worry about not absorbing it. Check your levels when you can but in the meantime everyone needs at least 2000 i.u (maintenance) per day.

Dr. Tuakli Thanks in advance for your time. And as always, thanks for being a loyal patient. Your health is my success. My goal as always is to give you real information as a means to counteract so much misinformation. I want us all to still be here when this pandemic is over. Stay whole and be well. Sincerely, Dr. Nadu Tuakli

Opening up the schools safely after the Covid lockdown

IDEAS FOR COLLEGE STUDENTS TO RETURN TO CAMPUS BY SEPTEMBER

Buyer beware! Bad news for people taking vitamins!

Four things occurred in the last week which gave me cause to think about vitamins and supplements sold over the counter. First, my office manager told me that the vitamin shelves at Walmart were bare. My first response was “Great, At least people are finally taking their vitamins!” I didn’t think much more about it until one of my patients, called to let me know he is Covid positive. He said he had been following all my recommendations and didn’t feel too bad. “That sounds good” I told him “but now we need to increase your zinc, how much are you taking?” He thought was taking ‘zinc’ from Walmart. But despite his best efforts (bear in mind that he is a nurse) he said he could not see from the label how much zinc was in the product. “But it is citrus flavored” he said, which gave me even more cause for concern. He eventually sent someone to get zinc from my office. My comments regarding the research I did on zinc from Walmart are discussed below. It was also very distressing to hear from him that the geriatric nursing home that he works in Baltimore got its first case of Covid two weeks ago. But now 60 residents there have Covid-19 and 15 staff members are out sick with positive corona virus tests. As I was researching the zinc issue I came across a disturbing article about the findings of the New York Attorney General in 2015. In the New York State attorney general’s office report, they accused GNC, Walgreens, Target, and Walmart of selling “fraudulent and potentially dangerous” supplements. Here are a few more disturbing details from that same report: ·      GNC supplements contained ingredients that were not listed on their labels. Some of which are dangerous allergens for certain people, such as peanuts and soybean. ·      A ginseng supplement from Walgreens turned out to be only rice and garlic. ·      Six supplements from Target tested negative for the main ingredient they claimed, they actually contained beans, rice, peas, and carrots.  ·       At Walmart, the authorities found that it's ginkgo biloba, a Chinese plant         promoted as a memory enhancer, contained little more than powdered radish, houseplants and wheat — despite a claim on the label that the product was wheat- and gluten-free.” “The authorities… found that four out of five of the products did not contain any of the herbs on their labels. The tests showed that pills labeled medicinal herbs often contained little more than cheap fillers like powdered rice, asparagus and houseplants". (Reference: https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/) According to a Consumer Reports article - in two years alone – manufacturers selling into the US market “…voluntarily recalled more than 80 bodybuilding supplements that contained synthetic steroids or steroid-like substances, 50 sexual-enhancement products that contained erectile-dysfunction drugs, and 40 weight-loss supplements containing appetite suppressant which has been discontinued in many countries.” (Reference:https://www.consumerreports.org/cro/2012/05/dangerous-     supplements/index.htm) So it appears some of the supplements you are buying are anything but the real thing.  Meanwhile…. Back to zinc. Understand there are different kinds of zinc so they can not be directly compared. Be that as it may: More easily absorbed forms include zinc picolinate, zinc citrate, zinc acetate, and zinc glycinate. Zinc gluconate consistently contains the lowest amount of cadmium levels (many zinc products are contaminated with cadmium which can be harmful if you take high levels). Clearly investigative journalism is not my forte but my interest was piqued so I looked up some zinc products at Walmart, on line. The first thing that caught my eye was the Walmart ‘disclaimer’ “Legal Disclaimer Product packaging and material may contain more and/or different information from the website, including the product description, country of origin, nutrition, ingredient, allergen and other information. Always read labels, warnings, and directions and other information provided with the product before using or consuming a product. For additional information about a product, please contact the manufacturer. Then as far as ingredients are concerned. About This Item: We aim to show you accurate product information. Manufacturers, suppliers and others provide what you see here, and we have not verified it. See our disclaimer (The one I copied above). Interesting… So then I looked at a specific product: Wellness Zinc Lozenges and here is what the label says: Wellness Zinc Lozenges by Source Naturals Inc. 60 Lozenges Wellness Zinc Product .The Wellness Family of products are designed to support the body's defense system when under physical stress. Our zinc lozenges are specially formulated to contain the most active forms of zinc. Zinc is a trace element that plays a significant role in the human body. It is involved in normal cell growth and repair and helps support the body's natural defenses. Natural peach and raspberry flavors leave no zinc aftertaste. Source Naturals wellness Zinc lozenges 23 mg ·      Source Naturals wellness family of products are designed to support the body’s defense system when under physical stress. ·      Source Naturals peach raspberry wellness zinc lozenges are specially formulated to contain the most active forms of zinc. ·      Zinc is a trace element that plays a significant role in the human body. ·      Zinc is involved in normal cell growth and repair and helps support the body’s natural defenses. Sounds great! But then under ingredients it says (I kid you not!) Ingredients: Fructose, natural peach flavor, stearic acid, natural raspberry flavor, and magnesium stearate. I’m sorry, did we forget the zinc part that showed everywhere else on your label? The one that sounded really good for the body! Another product which claimed to have 50 mg of zinc said: “Zinc Lozenges are becoming a huge focus for its support of the immune system. Our Lozenges contain almost TWICE the amount of Zinc than the leading national brand”  bologna! Anyway I hope you get my point. It is often hard to find out where the original source material came from (often China) but do not assume because a supplement has a USA address on it that it was made in the USA. Hello Kirkland, anybody home? The FDA requires all products to have an USA address or phone number listed so people have a contact for questions or complaints. My advice: Choose supplements that are “Made in the USA” exclusively and are manufactured in GMP certified facilities. These have a set of regulations enforced by the US Food & Drug Administration that provide for systems that assure proper design, monitoring and control of manufacturing processes and facilities.”  Quality control is a huge part of those systems. To meet the regulations, every raw material is tested for quality and purity before it is ever used, and every finished product is randomly tested to be sure that each pill, capsule, or other form of the product contains exactly what the label says it contains.  If you decide to opt for a retail store, I recommend small, independent apothecaries that have an excellent reputation with knowledgeable staff. Once you find a good one, it can be a huge relief to be able to trust them. When it comes to what you’re putting in your body, we know now more than ever before that it is worth being vigilant. This is an important step in taking control of your health.