Month: March 2020

A recently released survey from Mattress Firm revealed some disturbing facts about sleep patterns in America, as shown in this short video. This is important since the effects of sleep deprivation can range from mild to devastating.

For instance, the Anchorage Daily News¹ recounts the story of third mate Gregory Cousins, who had slept a mere six hours between 8 p.m. on March 22, 1989, until just after midnight on March 24, when he ran the supertanker Exxon Valdez aground.

The accident devastated 23 species of wildlife and nearly 1,300 miles of coastline habitat. Many people may remember that the skipper of the ship was allegedly drunk (a jury later acquitted him of the charge), but what most don’t know is that the National Transportation Safety Board (NTSB) found that sleep deprivation was an important factor in this accident. In fact, it not only was a known issue on the Valdez, but across the board in the shipping industry.

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As it turned out, several of the Valdez’s crew members were sleep-deprived, and the oil spill was an accident waiting to happen. The problem was a direct result of Exxon trying to save money by not providing enough crew to provide breaks for sleep. In its report the NTSB said:²

The mates on the Exxon Valdez were usually fatigued after cargo operations in Valdez, and the vessel usually put to sea with a fatigued crew … The financial advantage from eliminating officers and crew from each vessel does not seem to justify incurring the foreseeable risks of serious accidents.

Unfortunately, sleep deprivation isn’t limited to sea vessel crews. According to the American Sleep Association,³ 37.9% of people report inadvertently dropping off to sleep during the day at least once a month, and 4.7% have nodded off while driving.

Most people cut their sleep hours short because they feel the need to “get things done” — not unlike the Valdez situation. However, like the Valdez, the evidence clearly shows that you are not productive when sleep-deprived.

Average Sleep Hours Fall as More Report Exhaustion

For several years Mattress Firm has commissioned a survey on sleep habits and the number of hours people are sleeping each night. This year, results show Americans are sleeping less and less. They asked 3,000 adults about their sleep habits, how satisfied they were with their sleep and about the frequency of sleeping and naps. They compared those results to those from 2018.⁴

What they found was a sad commentary on the speed at which modern society has chosen to live. It seems that getting at least six hours has become more challenging with each passing year. In 2018 results from the survey showed the average person asked was sleeping six hours and 17 minutes each night, but by 2019 that had dropped to 5.5 hours.⁵

Experts currently recommend adults from 18 to 65 years sleep consistently from 7 to 9 hours each night.⁶ In other words, most people are sleeping at least one- and one-half hours less each night than the minimum that experts think is important for optimal health.

While the number of hours you sleep is important, so is the quality. So, it’s even more disheartening to read that 25% of the respondents reported they also “consistently slept poorly in 2019.”⁷ Since the amount of quality sleep at night was on the decline, it makes sense the respondents reported they took more naps in 2019 than 2018. But, while more were taken, survey findings indicate there were many planned naps that didn’t get taken.

The survey defined a “great night’s sleep” as “quickly falling asleep and staying that way until morning.” There were about 120 nights fitting that criteria. Americans are so desperate for a good night of sleep they said they were willing to “pay $316.61 for just one night of perfect sleep.” This was $26.16 more than in 2018.⁸

Interestingly, the people who reported the best sleep were those who slept on their back or slept with a pet in their bed. While side sleeping was the more common position reported in the survey, these were the same respondents who had the most difficult time getting to sleep.

The survey also asked about bedtime rituals that respondents used to help them fall asleep. The top rituals included reading, taking a bath, drinking warm milk, meditating and having sex.⁹

Have You Been Too Tired to Cook or Go Out?

Sleep is an important foundation to your health and wellness and yet a significant number of people are having trouble accomplishing this seemingly simple task. A separate survey¹⁰ asked 2,000 British adults about their habits and found many reported being too tired to do everyday tasks.

The results showed the top two activities that respondents avoided when they were tired were house cleaning and working out. Half of those asked ordered their dinner out and 25% of women said they went to bed with their makeup on because washing their face before bed required more energy than they felt they had.

Of the 2,000 asked, 30% had canceled social plans and many reported avoiding grocery shopping, reading, driving and having sex because they were too tired. While Americans planned naps that weren’t taken,¹¹ Brits were taking three naps a week and still reported feeling “as though they have ‘no energy at all’ four times” every week.¹²

In Britain, energy levels were at their highest mid-morning and their lowest midafternoon. As the authors of other studies have found¹³ more were the most tired on Mondays. Researchers have theorized a lack of sleep is one of the reasons there are more heart attacks on Mondays than other days of the week.¹⁴

In addition to these details, 25% of survey respondents thought their lethargy was related to long working hours, stress or depressing weather.¹⁵ They also found 20% had visited their doctor with complaints of sleepiness and more than 50% felt their exhaustion affected their mood. These results are discouraging since the effects of sleep deprivation are significant.

Sleep Quality and Quantity Important to Health and Safety

Both the quantity and quality of your sleep are important to your health and safety — indeed, the safety of others as well. Not getting enough sleep slows your reaction time and leaves you cognitively impaired. In 2013, drowsy driving caused 72,000 car accidents, killing 800 people and injuring 44,000.¹⁶

In one study¹⁷ from 2018 a researcher found that sleeping less than four hours in the previous 24 hours increased the odds of having a car accident by 15.1 times, compared to those who slept seven to nine hours in the previous 24. Statistically:¹⁸

Drivers who slept for less than 4 hr were found to have crash risk comparable to that reported in previous studies for drivers with blood alcohol concentration roughly 1.5 times the legal limit effective in all US states.

The researcher explained:¹⁹

Being awake isn’t the same as being alert. Falling asleep isn’t the only risk. Even if they manage to stay awake, sleep-deprived drivers are still at increased risk of making mistakes — like failing to notice something important, or misjudging a gap in traffic — which can have tragic consequences.

Despite these statistics, many say they push through their sleepiness to complete what needs to be done. One significant problem is when construction workers, medical professionals and pilots decide to “push through” — like the Valdez, it can have lethal consequences.

Other research shows that sleeping less than six hours a night will also dramatically increase your risk of insulin resistance, which is at the core of many chronic diseases.²⁰ And, the list of health problems related to poor sleep continues to grow. The results of one study²¹ linked poor sleep with excessive aging of your heart; less than seven hours a night was enough to trigger that.

The lead researcher on the study from the Division for Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention said:²²

Prolonged periods of insufficient sleep have negative effects on multiple body systems including the cardiovascular system. Studies have shown significant relationships between sleep duration and heart disease risk factors such as high blood pressure, smoking, high blood cholesterol, diabetes, and obesity.

The difference between a person’s estimated heart age and his or her chronological age is ‘excess heart age.’ Higher excess heart age indicates a higher risk of developing heart disease.

However, sleeping a healthy number of hours may not protect you if the quality of your sleep is poor. Sleep quality has a significant impact on your risk of high blood pressure and inflammation of your blood vessels, also associated with heart disease.²³ The researchers found “Systolic blood pressure was associated directly with poor sleep quality … “

They believed the findings demonstrated direct evidence neglecting sleep problems could increase your blood pressure and blood vessel inflammation even if you get adequate amounts of sleep.

EMF Affects Heavy Metal Toxicity and Thus Sleep Quality

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One factor affecting sleep quality is your exposure to electromagnetic fields (EMF) and heavy metal toxicity associated with it. As Wendy Myers, functional diagnostic nutritionist, and I discuss in this short video, heavy metals are particularly detrimental to your mitochondrial function and when you have heavy metal toxicity you attract more EMF.

It’s a vicious cycle that ultimately damages your health. It also increases your levels of fatigue. In this short clip we talked about the interaction between fatigue, mitochondrial dysfunction and heavy metal toxicity.

In her research she discovered studies demonstrating how a variety of metals could affect the ability of the mitochondria to produce adenosine triphosphate (ATP), the energy currency of the body. There are several heavy metals Myers finds are of particular concern, including aluminum, arsenic, tin and thallium.

You can test for heavy metal toxicity using hair, urine or stool samples. Myers typically begins with a hair analysis as it’s easy, inexpensive and provides significant information. However, no one test is perfect, so I recommend doing all three. No one is exempt from heavy metal exposure as I found out when I tested positive for each of these metals in 2018.

Cycles of Light and Dark Affect Sleep Quality

Sleep has been a great mystery. It was once thought to be a waste of time, but as researchers discover more about how the brain functions, it’s become apparent sleep is a crucial component of a healthy lifestyle. Sleep deprivation can affect people of all ages, and unfortunately the effects are cumulative.²⁴

By maintaining a natural rhythm of exposure to daylight and darkness you affect the quality of your sleep. Light helps synchronize your biological master clock in your brain that helps wake you in the morning and improves your sleep at night.²⁵ Going outside in the morning hours and at lunch can help provide you with the light needed to anchor a healthy circadian rhythm.

However, just as important is the other end of the day. By using digital equipment after sunset, you stop the production of melatonin, important in getting quality sleep.²⁶ In one study²⁷ researchers found 99% of participants exposed to room light before bed produced melatonin later than expected.

In addition, light exposure during your usual hours of sleep can also suppress production by 50%. You’ll experience the greatest benefit by dimming your lights after sunset, using incandescent light bulbs and wearing blue blocker sunglasses indoors that help block blue light most responsible for blocking melatonin production.

While the list of health challenges associated with sleep loss is significant, you have options to help you improve the quantity and quality of your sleep. See “Top 33 Tips to Optimize Your Sleep Routine” for how to make a real difference in your overall health.

Sources and References

• ¹ Anchorage Daily News, July 1, 2016 Para 11-16
• ² National Transportation Safety Board September 18, 1990
• ³ Sleep Association Statistics
• ^{4, 8} Mattress Firm
• ^{5, 7, 9, 11} Study Finds, January 20, 2020
• ⁶ Sleep Health – Journal of the National Sleep Foundation, 2015;1(1):40
• ^{10, 12, 15} Study Finds, January 17, 2020
• ¹³ The Sleep Judge
• ¹⁴ Reuters, March 29, 2014
• ¹⁶ Centers for Disease Control and Prevention
• ^{17, 18} Sleep, 2018;41(10)
• ¹⁹ Science Daily, September 18, 2018
• ²⁰ Journal of Clinical Endocrinology and Metabolism, 2010;95(6):2963
• ²¹ Sleep Health, 2018;4(5)
• ²² Reuters, August 14, 2018
• ²³ Journal of the American Heart Association, 2018;7(12)
• ²⁴ Institute of Medicine Committee on Sleep Medicine and Research
• ²⁵ Frontiers in Neurology, 2015;6:128
• ²⁶ Harvard Health Publishing, August 13, 2018
• ²⁷ J Clin Endocrinol Metab. 2011 March; 96(3): E463

“My little angel” is how Christopher Jerry describes his daughter Emily.

At just a year and a half, Emily was diagnosed with a massive abdominal tumor and endured numerous surgeries and rigorous chemotherapy before finally being declared cancer-free. But just to be sure, doctors encouraged Chris and his wife to continue with Emily’s last scheduled chemotherapy session, a three-day treatment that would begin on her second birthday.

On the morning of her final day of treatment, a pharmacy technician prepared the intravenous bag, filling it with more than 20 times the recommended dose of sodium chloride. Within hours Emily was on life support and declared brain dead.

Three days later she was gone.

Sadly, Emily’s case is not unique. According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer.

Other studies report much higher figures, claiming the number of deaths from medical error to be as high as 440,000. The reason for the discrepancy is that physicians, funeral directors, coroners and medical examiners rarely note on death certificates the human errors and system failures involved. Yet death certificates are what the Centers for Disease Control and Prevention rely on to post statistics for deaths nationwide.

The authors of the Johns Hopkins study, led by Dr. Martin Makary of the Johns Hopkins University School of Medicine, have appealed to the CDC to change the way in which it collects data from death certificates. To date, no changes have been made, Makary said.

‘The system is to blame’

Makary defines a death due to medical error as one that is caused by inadequately skilled staff, error in judgment or care, a system defect or a preventable adverse effect. This includes computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed.

“Currently the CDC uses a deaths collection system that only tallies causes of death occurring from diseases, morbid conditions, and injuries,” Makary stated in a letter urging the CDC to change the way it collects the nation’s vital health statistics.

“It’s the system more than the individuals that is to blame,” Makary said. The U.S. patient-care study, which was released in 2016, explored death-rate data for eight consecutive years. The researchers discovered that based on a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year — or about 9.5 percent of all deaths — that stemmed from medical error.

Now, two years later, Makary said he hasn’t seen the needle move much.

“Medical-care workers are dedicated, caring people,” said Chris Jerry, “but they’re human. And human beings make mistakes.” According to him, the day Emily was given her fatal dose, the hospital pharmacy was short-staffed, the pharmacy computer was not properly working, and there was a backlog of physician orders.

Afterward Chris said he discovered that pharmacy technicians, rather than well-trained and educated pharmacists, are compounding nearly all of the IV medications for patients. And many states have no requirements, or proof of competency, for these pharmacy technicians.

To seek greater safeguards for patients, Chris founded the Emily Jerry Foundation in 2008. EJF focuses primarily on medication safety and better training for pharmacy technicians, as well as backup procedures that will improve the health-care system. Last year he unveiled the Emily Jerry Foundation’s National Pharmacy Technician Initiative, an interactive scorecard to make the public aware of unsafe pharmacy practices in the United States. He also travels throughout the country, speaking out about key patient safety-related issues and best practices proven to minimize the “human error” component of medicine.

Any new tools ‘will be a game changer’

Pascal Metrics, based in Washington, D.C., designs ways to increase patient safety and improve clinical reliability at health organizations.

Pascal’s chief medical information officer, Dr. David Classen, is also associate professor of medicine at the University of Utah and an active consultant in infectious diseases at the University of Utah School of Medicine in Salt Lake City. He admits there are problems: “The system of care is fragmented,” he said. “Any tools that enable patients to manage their health-care needs will be a game changer.”

To improve the safety of medication use, Classen developed and implemented a computerized physician order-entry program at LDS Hospital in Salt Lake City. “Harnessing health information technology through the use of electronic health records of hospitalized and ambulatory patients is essential,” he said.

Many hospitals, for their part, are seeking to keep pace with increasingly available technology to improve patient safety. Kim Lanyon, a senior ICU nurse at Danbury Hospital in Connecticut, said all electronic records there are double-checked, and fail-safe devices are in place.”

At Mount Sinai Hospital in New York City, Dr. Vicki LoPatchin oversees a Good Catch Award, given to medical personnel who identify potential or existing errors related to their patients’ care. Similarly, most physicians’ offices now keep records electronically, as well as recording conversations among doctors, nurses and their patients in order to make certain there is clarity and that no mistakes result.

Even so, Makary said ordinary complications can occur, especially from unneeded medical care. According to him, “Twenty percent of all medical procedures may be unnecessary.” He faults also the overprescription of medication following surgery, particularly opioids.

Doctors, he said, have been encouraged by drug companies, sometimes through cash payments, to “promote” their products, as revealed by the website Dollars for Docs.

What patients can do to protect themselves

According to Dr. John James, a patient-safety advocate and author of A Sea of Broken Hearts: Patient Rights in a Dangerous, Profit-Driven Health Care System, patients need to take charge. “There needs to be a balance between the provider community and the patients. It is not an even relationship at all.”

In 2002 James lost his 19-year-old son after he collapsed while running. He had been diagnosed with a heart arrhythmia by a cardiologist a few weeks prior and was released from the hospital with instructions not to drive for 24 hours.

“His death certificate said he died of a heart arrhythmia,” he said, but my son really died as a result of “uninformed, careless, and unethical care by cardiologists.” He explained: “If you have a patient with heart arrhythmias of a certain level and low potassium, you need to replace the potassium, and they did not. And they didn’t tell him he shouldn’t go back to running.” Communication errors, he said, are “unfortunately very common.”

In 2014 James retired early to devote his life to improving patient safety. His mission: to teach people how to be empowered patients. He has created a patient bill of rights, which he’s been pushing to become federal law. Yet so far he said his letters to the Centers for Medicare & Medicaid Services have gone unanswered.

“Makary has a lot of courage,” James said. “A lot of the retired doctors will tell you it’s a mess and it’s terrible. But for a young physician to come out and say what he did, that’s pretty bold. Makary is a brave guy.”

James’ site, Patient Safety America, lists the three levels in which patients can protect themselves. These include being a wise consumer of health care by demanding quality, cost-effective care for yourself and those you love; by participating in patient-safety leadership through boards, panels and commissions that implement policy and laws; and by pushing for laws that favor safer care, transparency and accountability.

Too often, the health-care system silences people around a problem.Dr. Martin Makarysurgical oncologist and chief of the Johns Hopkins Islet Transplant Center

Here are some other ways patients can be vigilant right now:

Ask questions. Gain as much insight as you can from your health-care provider. Ask about the benefits, side effects and disadvantages of a recommended medication or procedure. Use social media to learn more about the patient’s own condition, as well as those medications and procedures for which they were prescribed.

Seek a second opinion. If the situation warrants or if uncertainties exist, get a second opinion from another doctor: A good doctor will welcome confirmation of his diagnosis and resist any efforts to discourage the patient from learning more — or what Makary calls, “attempts to gag the patient.”

“Too often,” he said, “the health-care system silences people around a problem.” Why? Many doctors are reluctant to speculate, but some admit the answers range from simple ego to losing a patient to another doctor they trust more.

Bring along an advocate. Sometimes it’s hard to process all the information by yourself. Bring a family member or a friend to your appointment — someone who can understand the information and suggestions given and ask questions.

Ilene Corina, president and founder of the Pulse Center for Patient Safety Education & Advocacy, based in Wantagh, New York, urges both the patient and their advocate to be “respectful but assertive” in seeking answers to the questions they may have. In some cases, she recommends a “designated medication manager” to be a safety check on the advice the care provider gives.

Download an app. By having your medical information literally in the palm of your hand, you can work as a team with your doctor to cut your risk for medical errors. Health-care apps can be simple or complex, and depending on your age and condition, you can manage your well-being, medications and more.

I’m a doctor ‘on the front-line’ in the ‘war against COVID-19’. Yes, we have a huge problem, but it is not necessarily the virus itself. The real problem is hidden in plain sight. Let’s see if we can begin to discern it.

Lockdown Time

This is how doctors, nurses and other medical staff and administrators are handling this crisis.

They have set up “contaminated” respiratory circuits at clinics and hospitals, which are separated from the rest of the outpatients and health staff. Anybody coming in with a cough, or who is sneezing, or showing any sign of respiratory distress, is directed to this circuit and kept separated from those coming in with wounds or any other non-respiratory-related illness. That way, contagion is not propagated to the entire building, but is kept isolated within the respiratory circuit, which has its own doctors and staff handling cases there. Again, all incomers with respiratory symptoms – which in reality can be anything from the common cold to the typical seasonal flu, even a cough due to seasonal allergies – are sent to this respiratory circuit.

Every time a doctor has to record anything related to a patient’s consultation, he or she must type a note in a file (most of which are electronic) under a certain category. Because a pandemic has been declared, and in view of the global lockdown effort, that category is specified by international codes that have been designated for this particular coronavirus. After all, people require sick leave letters or isolation labels from doctors, who determine which to issue to whom depending on their likelihood of being infected or in close contact with infected people.

Here are the international codes that have been designated for this lockdown. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for COVID-19 are as follows:

• B34.2 for both COVID-19 confirmed cases and PROBABLE cases
• Z20.828 for possible cases and contacts of those who were confirmed and/or are probable cases.

Detailed instructions and updates as to how to use these codes in the clinical setting are arriving at medical facilities every day. In my country, a ‘definitive’ version was sent out in the last few days. At the beginning of this, many people were being labelled B34.2 [‘confirmed’/’probable’] when they should really have received the other code [Z20.828 – ‘possible’]. Additionally, those whose tests were inconclusive (probable cases), were nevertheless grouped together with ‘confirmed’ cases. While these codes of distinction make sense for managing a crisis situation, they unfortunately also leave much room for subjective interpretation.

Testing, Testing, 1-2-3?

Tests for the presence of this “novel” coronavirus are done through RT-PCR (real-time reverse transcription polymerase chain reaction) testing, which detects antigens of the virus or proteins or nucleic acids, which is the RNA genetic information of the virus. These genetic tests, even though there are limitations to what they can reveal, are the official and optimal way to test people.

Another way to test is by determining the presence of an immune response against the virus. These have been called “rapid tests” because they take much less time to do than the genetic tests. In this case, IgM antibodies are produced earlier and IgG antibodies later. Both can be detected in the rapid test. However, according to a published study on such tests for COVID-19:

“The seroconversion sequentially appeared for Ab [antibodies], IgM and then IgG, with a median time of 11, 12 and 14 days, respectively. The presence of antibodies was < 40% among patients in the first 7 days of illness.”

Therefore, rapid tests to measure the presence of IgM or IgG antibodies against COVID-19 are not useful for the detection of acute cases.

One problem brought to the fore by the lockdown is that they’re not testing the general population because the entire population is considered suspect anyway. It is, after all, an emergency. Those being tested are, for the most part, hospitalized patients. This creates numbers from samples that don’t reflect the overall picture of COVID-19 in the general population. Hospital populations are one thing, but the general population at home is an entirely different thing.

As this paper published on 26 March 2020 in the New England Journal of Medicine explains,

“If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

How can we know? One country is testing its entire population. According to numbers published by the government of Iceland on 25 March, Iceland has the highest proportion of tests performed by any single country in the entire world. Iceland’s chief epidemiologist, Thorolfur Guðnason, is quoted as saying,

“Early results from deCode Genetics indicate that a low proportion of the general population has contracted the virus and that about half of those who tested positive are non-symptomatic,” said Guðnason. “The other half displays very moderate cold-like symptoms.”

Nevertheless, private practices everywhere have been shut down, leaving many people who were relying on them to manage their health having to wait until further notice. Anything non-essential to the coronavirus emergency is postponed. This means that the very important role of primary healthcare carried out by family doctors and general practitioners (GPs) has effectively shut down. And I’m decidedly more worried about patients whose scheduled consultations were cancelled, for reasons I explain below.

From the Health Trenches

One of my correspondents is a medical doctor who works in one of Italy’s most afflicted hospitals. At first glance, his testimony supported what has been repeatedly highlighted: ‘above-normal’ numbers of people, including young people, in respiratory distress or with extensive pneumonias, etc.

However, something else he said caught my attention: he reported seeing many patients – both hospitalized and non-hospitalized – who present with mild clinical symptoms, and he further clarified that they comprised “most” of his patients.

This bears repeating: MOST hospitalized and non-hospitalized patients present with mild clinical symptoms. No matter how much of a ‘warzone’ doctors in certain hotspots may subjectively feel they are currently in, the numbers they are dealing with are nevertheless going to – with hindsight or contextual data – prove consistent with such data as that coming from Iceland.

Photos and videos circulating online from one hospital show people lying on the floor. As a colleague related in one of the multiple WhatsApp groups created for medics of late:

“I think that this video is very sensationalist… [It’s my hospital] where, unfortunately, the patients in the ER could not sleep on a sofa, and they asked to lay down in the floor, so they could sleep. It was lamentable, but with 120 people pending hospitalization, it was impossible to give them all beds. Nevertheless, the situation got better, and we have doubled the number of beds available, and even though we don’t an excess of material, we aren’t short-staffed…”

What seems to be compounding this largely administrative crisis is that a lot of people who would otherwise be at home with primary healthcare follow-ups are unnecessarily remaining in the hospital. That is a luxury you simply cannot take in countries with a very elderly population, who can go into respiratory failure even with a banal bug. There are also a lot of comorbidities in the general population today.

It’s true that the COVID-19 virus is playing a role in atypical pneumonias seen in younger people who can go into respiratory distress. But according to a paper published in JAMA on 17 March, almost 87 per cent of deaths in Italy have been in patients over 70 years old – as happens during ANY flu season. The chief of Italy’s Superior Institute of Health reported midway through this month that:

“From the medical records examined so far (not much more than 100), the majority of deaths from Covid-19 in Italy have been among the very old. The average age is 80.3 years. The majority of deaths had 3 or more associated serious health issues. Two patients who died did not have any of the most common serious health issues, although other issues may become apparent as further investigation takes place. Just two people under 40 years old have died, both 39 years old – one had cancer and the other one had diabetes, obesity and other health problems prior to the infection.”

The panic combined with the administrative and medical directives are sending ALL emotionally and physically distressed patients to the hospitals. The fact remains, however, that MOST people in the general population will not go into respiratory distress. Perspective should be kept so as to not break the hospital system.

To get an idea of the characteristic issues facing elderly patients, let’s review a fictional but typical case:

Say an 86-year-old patient has a fever. He has been coughing for days previously. A doctor might find he’s approaching respiratory failure. In his medical history you find that he has chronic kidney failure (as most elderly do), heart failure, chronic obstructive pulmonary disease (COPD), diabetes, high blood pressure, atrial fibrillation and hypothyroidism. Such a cluster is not unusual in someone his age, which is why a patient like this could be taking up to 12 medications, including potent blood thinners. A person like this might be labelled ‘COPD – exacerbation’. If he’s hospitalized, they will test for microbes including bacteria and viruses. If he’s not making progress, his organs might start to fail. Or the patient might get better. Some don’t, and – brace yourselves… they die.

European hospitals and clinics are overburdened with such cases because there are many elderly patients with comorbidities. Nevertheless, assistance and pretty good health care is always provided – until the very end. In the past, I was often been pleasantly surprised by just how much Europeans care about their elderly. Now I have gotten used to it. In other countries, they just don’t bother.

Intensive Care Units (ICU) might consider running a ‘common sense filter’. An old patient with an infection, with multiple diseases, and with multiple organ failure might signal to them that it’s time for this person to pass away peacefully, with care taken to minimize their suffering. It is often the case that an elderly patient has expressed officially that when the time comes, he or she will just want to pass away and not be reanimated. It can happen that health staff get so fixated on treating older patients, that a younger person doesn’t have an ICU bed when it’s needed, i.e. in cases of respiratory distress.

In the example I outlined above, each disease and infection found in the patient will have its own international code for labelling purposes. As explained earlier, the coronavirus label has its own codes for statistical purposes. It does NOT mean COVID-19 killed the person. Some people have so many diseases that any banal bug could take them out. The difference between dying WITH coronavirus or DUE to coronavirus is a subtle but important one.

The Shutdown of Regular Medical Visits

Those with diabetes, heart failure, COPD, etc. have to wait out at home, isolated, until they get the green light to recommence their regular medical visits and follow-ups. Too bad if they catch a cold or anything else from the stress this pandemic is engendering. If they end up in the hospital, they will be tested for coronavirus. In the meantime, they are waiting patiently at home and are very understanding of the system that told them to wait at home because it ‘has to deal with more important issues right now’.

I know of a number of hospitalized COVID-19 confirmed cases that could be at home. Most people at home with respiratory symptoms these days have no breathing problems. Nevertheless, as per protocol, and because COVID-19 patients are recovering and then, a week later, it can strike them again, follow-ups are being done after one week.

Before all of this began, up to 60 patients with either the flu or the common cold were showing up at my health center in just ONE morning. It was one patient after the other with respiratory symptoms. But due to the lockdown directives, these patients are either staying at home or they’re all going to the ER and/or to the hospital. For the most, it’s just phone calls to see how they’re doing. Primary healthcare has effectively been shut down. This worries me because GPs do a very important job in avoiding decompensations in people with multiple comorbidities who would otherwise end up in the hospital. Patients with issues like heart failure, cancer, COPD, diabetes, high blood pressure, anxiety, severe depression, etc. need constant follow-ups and reassurance.

If hospitals don’t let go of the MILD cases, they will soon be in very big trouble. I can easily think of 100-300 people in any single doctor’s post covering around 1,500 patients (or 1,900 in some regions, if you count those in elderly residencies) who are at risk of going into respiratory failure or some other emergency if their check-ups are withheld for longer and/or if they catch a cold. Yes, this COVID-19 is highly contagious and it has its peculiarities. But the fact remains that people have multiple comorbidities and life has to continue. COVID-19 is not the only healthcare issue in the world right now:

And, again, MOST people, especially those without comorbidities, will only experience a mild form of it. The rest, which is a large majority of the population, will remain without symptoms.

Most of the medical workforce is located in Primary Healthcare, not in hospitals. Now, anything that happens to anybody has to be dealt with by the emergency services in the hospitals because they can’t come to primary healthcare doctors, nor they can continue with their regular specialized visits at the hospital. People have complex medical histories and tragic lives. Other than medical work, primary healthcare workers are often the substitute for what in the past was the counseling work of the local priests and parishioners. Surely someone should have thought about this? Some hospital doctors often look down on Primary Healthcare providers with disdain, and that is because they don’t have the patience to do that kind of job, in which it’s important to get to know entire families and their tragic suffering.

Media Heroes Now And Then

The work of Primary Healthcare is always important, but you don’t ever see that in the news. The media currently needs hospital heroes and stories of how ER staff don’t have time to eat and how an ICU nurse committed suicide after testing positive for COVID-19. But primary healthcare workers are appreciated by their regular patients, especially now that consultations are limited to phone calls because patient-doctor meetings are discouraged. Unlike before, when they didn’t have time to eat or take bathroom breaks, or were spending up to four consecutive days working non-stop with very little sleep and dealing with four significant emergencies at the same time, few cared much for healthcare providers because they never heard about their hectic ‘wars’ against diseases in the news. Such is life.

I leave you with the considered perspective of Dr. John Ioannidis, professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University. He is perhaps THE most “evidence-based” medical scientist in the world today, and he says of this emergency:

“The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence FIASCO.”

He later added in a separate publication:

“If COVID-19 is not as grave as it is depicted, high evidence standards are equally relevant. Exaggeration and over-reaction may seriously damage the reputation of science, public health, media, and policy-makers. It may foster disbelief that will jeopardize the prospects of an appropriately strong response if and when a more major pandemic strikes in the future.”

Or, as the prime directive of medical ethics goes:

First, Do No Harm

By Lyn Redwood, RN, MSN, President; Mary Holland, CHD General Counsel & Vice Chair; and the CHD Team

The rapidity with which normal life has ground to a halt as a result of coronavirus-related edicts has stunned citizens around the world, generating massive social and economic upheaval. Meanwhile, media coverage of COVID-19 has whipped up unprecedented levels of public anxiety and fear, laying the psychological groundwork for people to eagerly embrace “magic bullet” medical solutions, no matter how experimental. In the U.S., the World Health Organization (WHO) is now compounding the domestic panic, warning that America could become the new coronavirus “epicenter.”

Across the country, a debate is raging about the nation’s medical response and how best to apportion available resources. Many argue, quite reasonably, for the importance of identifying safe, effective and affordable therapies that can provide immediate help to those who are sick. On March 22, The New York Times reported that there are at least 69 existing drugs or compounds that might be effective in treating the coronavirus. In China, researchers are studying intravenous vitamin C as a potential nontoxic treatment, while a paper published by French researchers on March 20 described promising COVID-19 results from the off-label use of hydroxychloroquine (an antimalarial) and azithromycin (an antibiotic).

… investments tend to go toward treatments that are sexy and new and patentable rather than to tried-and-true, classical sort of methods repurposing drugs and strategies that have already been shown to work.

The head of the French team, Didier Raoult, MD, PhD, is one of the world’s top infectious disease and virology experts, with roughly 2,000 peer-reviewed publications and multiple awards to his name. Raoult and coauthors point out that a major advantage of “repositioning” older drugs for this coronavirus is that their safety profile, side effects, dosing and drug interactions are already well documented. However, Ian Lipkin, MD, of Columbia University recently told MSNBC, with a grin, that investments tend to go toward treatments that are “sexy and new and patentable” rather than to “tried-and-true, classical sort of methods repurposing drugs and strategies that have already been shown to work.”

Fauci is a stalwart enthusiast of patentable vaccines, skilled in attracting massive government funding for vaccines that either never materialize or are spectacularly ineffective or unsafe.

Fauci’s tired rhetoric

For biopharma companies that are poised to profit from COVID-19-related misfortune, older drugs that have outlived their patent terms are not terribly helpful for the bottom line. Could this be why leading White House coronavirus advisor Anthony Fauci, MD, long-time head of the National Institute of Allergy and Infectious Diseases (NIAID), recently pooh-poohed the published chloroquine evidence as merely “anecdotal“? Fauci is a stalwart enthusiast of “patentable” vaccines, skilled in attracting massive government funding for vaccines that either never materialize or are spectacularly ineffective or unsafe.

For example, Fauci once shilled for the fast-tracked H1N1 influenza (“swine flu”) vaccine on YouTube, reassuring viewers in 2009 that serious adverse events were “very, very, very rare.” Shortly thereafter, the vaccine went on to wreak havoc in multiple countries, increasing miscarriage risks in pregnant women in the U.S., provoking a spike in adolescent narcolepsy in Scandinavia and causing febrile convulsions in one in every 110 vaccinated children in Australia — prompting the latter to suspend its influenza vaccination program in under-fives.

Fauci is predictably shining a spotlight on risky and uncertain coronavirus vaccines that may not be available for two years, rather than prioritizing the short-term therapies that patients need right now.

In 2010, then-Senator and physician Tom Coburn, MD, called out Fauci for misleadingly touting “significant progress in HIV vaccine research.” Coburn stated , “The study [Fauci] referred to was a clinical trial in Thailand finding a vaccine to be 31% effective at preventing HIV infection. Unfortunately, the results of this study have been found to be statistically insignificant and the findings of the study have received much skepticism. [. . .] Most scientists involved in AIDS research believe that an HIV vaccine is further away than ever . . . and may never be possible. . . .” Senator Coburn also noted that Fauci’s agency had spent over $5.2 million over a four-year period on lavish “HIV vaccine awareness” events.

Without the least hint of embarrassment, however, Fauci reappeared on YouTube in 2016 to once again push his HIV vaccine agenda, even citing the unimpressive Thailand trial. Fauci’s mobilization of billions for a never-completed Zika vaccine followed a similar playbook. And now, Fauci is predictably shining a spotlight on risky and uncertain coronavirus vaccines that may not be available for two years, rather than prioritizing the short-term therapies that patients need right now.

… researchers at Harvard and other medical sciences institutions have issued warnings about the vaccines’ propensity to produce higher rates of side effects, including local and systemic inflammation and worrisome autoimmune responses.

First off the block

According to the WHO, up to 35 COVID-19 vaccines are in the offing, including experimental messenger RNA (mRNA) vaccines and formulations that attach coronavirus to genetically modified measles vaccines. As biopharma companies position themselves to reap blockbuster profits, the first off the block is a vaccine thrown together at record speed by Fauci’s NIAID in collaboration with Massachusetts-based biotech firm Moderna. NIAID and Moderna began developing the vaccine before a single COVID-19 case had appeared in the U.S., completing the first batch of vaccine “within 42 days of the company obtaining genetic information on the coronavirus.”

…researchers recommend taking precautions during preclinical studies and clinical trials. Fauci, on the other hand, praises the “new era of vaccinology”

The vaccine, which bears the ho-hum name of mRNA-1273, uses an unproven mRNA technology platform. mRNA vaccines appeal to industry because of the potential for “rapid, inexpensive and scalable manufacturing,” but researchers at Harvard and other medical sciences institutions have issued warnings about the vaccines’ propensity to produce higher rates of side effects, including local and systemic inflammation and worrisome autoimmune responses. Noting that the “non-native modified nucleotides” used in mRNA vaccines and components of mRNA vaccines’ delivery systems have potentially toxic effects, these researchers recommend taking precautions during preclinical studies and clinical trials. Fauci, on the other hand, praises the “new era of vaccinology” — of which the mRNA-1273 effort is a part — celebrating its use of “atomic level structural information for vaccine design, gene-based vaccine platforms, modern protein engineering and potent adjuvants.”

On March 16, NIAID launched a Phase 1 trial of mRNA-1273 in 45 healthy adults after making the decision — deemed “morally questionable” by some — to sidestep the standard process for vaccine development. That process ordinarily requires “that a manufacturer show a product is safe [in animal models] before it goes into people.” Leading virologist Shibo Jiang, MD, PhD, recently condemned this “quick-fix” approach, arguing that “safety always comes first” and that it is important not to “cut corners” by skipping animal studies. Moderna’s chief medical officer disagrees, saying, “I don’t think proving this in an animal model is on the critical path to getting this to a clinical trial.” For his part, Fauci has expressed willingness to expedite the vaccine’s approval process as soon as NIAID deems the Phase 1 trial successful.

When Hotez observed this immune pathology in his coronavirus laboratory animals, he thought, ‘Oh my God, this is going to be problematic.’

Vaccine-hesitant experts

Ordinarily, vaccine scientists line up in lockstep to pledge their allegiance to the Faucian worldview that vaccination is the “mainstay” of prevention and offers the primary solution for challenges such as the coronavirus situation. In an interesting turn of events, however, some of the pharma-funded media’s favorite vaccine spokesmen — slick, high-level medical professionals that manufacturers ordinarily can count on to endorse any vaccine — are urging caution.

Peter Hotez, MD, PhD, Dean of the National School of Tropical Medicine at Baylor College of Medicine, is no stranger to coronaviruses, having developed a vaccine for an earlier coronavirus in 2016 that stopped just short of commercial development. Despite having “tried like heck” to obtain funding to move his vaccine into clinical trials, Hotez just told a U.S. Congressional Committee (on March 5 ) that coronavirus vaccines are scientifically challenging and have a “unique potential safety problem,” namely a “kind of paradoxical immune enhancement phenomenon.” When Hotez observed this immune pathology in his coronavirus laboratory animals, he thought, “Oh my God, this is going to be problematic.”

Offit expressed worry about the push to ‘rush [a vaccine] through,’ particularly in the absence of ‘any history of making a coronavirus vaccine.’

Paul Offit, MD, of the Children’s Hospital of Philadelphia, another media darling who has profited handsomely from his insider status, stated in a March 10 YouTube interview that influenza deaths are “far worse” than COVID-19 deaths, “yet we don’t quarantine for influenza, we don’t shut down schools for influenza, we don’t cancel meetings for influenza, we don’t cancel schools and churches and synagogues.” Also Offit expressed worry about the push to “rush [a vaccine] through,” particularly in the absence of “any history of making a coronavirus vaccine.” Offit concluded:

And certainly the FDA has got to regulate this product because right now everybody in the United States will probably take it in a second, even if it wasn’t tested.

The PREP Act protects the manufacturers of medical ‘countermeasures’ — including vaccines, medications, medical devices and other products — from the risk of damages in the event of a declared public health emergency such as the currently declared coronavirus pandemic.

A profitable crisis

In early March, Congress passed an emergency coronavirus spending bill, much of which will “directly benefit the drug industry.” Legislators who tried — and failed — to include meaningful affordability provisions in the spending bill worry that “A danger remains that the federal government will simply write a blank check signed to big pharma as a result of this crisis.”

Clues that pharma is embracing the opportunities furnished by the COVID-19 crisis come from the financial markets. Market reports indicate that the health care industry has been able to “withstand” the wider stock market plunge due to big gains by pharmaceutical, biotech and medical diagnostic companies involved in developing coronavirus-related products. After Moderna announced, in late February, that it had shipped off its mRNA-1273 to NIAID for the Phase 1 trial, the company instantly became “one of the hottest biotech stocks on the market.” (Moderna’s NASDAQ ticker symbol is, handily enough, MRNA.) Investment advisors have pointed out that the likely promotion of mRNA-1273 as prevention is a “big deal” that stands to make Moderna a fortune, because “millions” of uninfected people will want to “pre-emptively protect themselves.”

Coronavirus drug and vaccine manufacturers are also sitting pretty because of liability immunity conferred under the 2005 PREP Act (Public Readiness and Emergency Preparedness Act) and a follow-up Department of Health and Human Services (HHS) Declaration specific to COVID-19 published in the Federal Register on February 4, 2020. The PREP Act protects the manufacturers of medical “countermeasures” — including vaccines, medications, medical devices and other products — from the risk of damages in the event of a declared public health emergency such as the currently declared coronavirus pandemic.

…it [PREP Act] could ‘be used to allow manufacturers of virtually any drug or vaccine to escape responsibility for gross negligence or even criminal acts.’

The tort immunity described under the COVID-19 Declaration pertains to “any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures . . . except for claims involving ‘willful misconduct’ as defined in the PREP Act.” The authors of a legal blog point out that while the new HHS declaration “is couched in a lot of administrative word salad,” the “prime takeaway is that the scope of tort immunity being conferred . . . is quite broad.”

In fact, the PREP Act became law over significant consumer and congressional opposition. Senator Ted Kennedy and 20 colleagues in Congress wrote a letter to the Speaker of the House and Majority Leader to repeal the Act, characterizing it as “a travesty of the legislative process” and stating that it could “be used to allow manufacturers of virtually any drug or vaccine to escape responsibility for gross negligence or even criminal acts.” The dissenting lawmakers also accused the Act’s sponsors of creating “an empty shell of a compensation program for injured patients with none of the funding needed to make compensation a reality.”

The government must not allow Big Pharma and biotech companies to cash in on this catastrophe with speculative, patentable vaccines at the expense of the therapeutics needed to save lives now.

Safety first

A look at the response to past influenza and coronavirus epidemics provides little reassurance that safety considerations will come first. In addition to the already mentioned adverse events associated with the 2009 swine flu vaccine, we have witnessed treatments that “may have been harmful” and whistleblower lawsuits against false claims of efficacy.

For the moment, our government is prioritizing vaccine development (with the enticing promise of lucrative patents) over existing therapeutics (such as vitamin C and already-FDA-approved drugs) that do not offer comparable financial windfalls. In light of the immunity from liability guaranteed by the PREP Act during declared emergencies, fast-tracked vaccines are a sweetheart deal for both biopharma and government. A safer and common-sense approach would direct resources toward examining the merits of existing therapeutics that can be put to immediate use. The government must not allow Big Pharma and biotech companies to cash in on this catastrophe with speculative, patentable vaccines at the expense of the therapeutics needed to save lives now.

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Many elders remember being told as youngsters to gargle with saltwater to avoid getting a cold or sore throat. Well, guess what? Grandma may not have known why this was a good idea scientifically, but that doesn’t make it any less effective.

We also know about the cleaning power of bleach and are using it to sanitize surfaces amid the Wuhan coronavirus. Have you ever wondered why this works? A certain chemical, hypochlorous acid (HOCL), in the bleach kills pathogens, including fungus, bacterium, and virus. Obviously, it is not safe to inhale or ingest bleach. However, we do have an easy and safe alternative.

Cells lining the nose and throat can produce HOCL when they are bathed with chloride. One of the easiest ways to accomplish this exposure is using sodium chloride, better known as salt or saline. The more chloride presented to the cells, the more HOCL they generate.

The process was clearly presented in 2018 by Dr. Sandeep Ramalingam and his colleagues, who said, “Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels.” Your white blood cells also produce HOCL, which plays a critical role in the initial immune response to a variety of infections, including COVID-19.

By cleansing your sinuses and breathing passages with hypertonic saline, you augment the natural killing mechanisms of your immune system. Theoretically, regular daily hypertonic saline nasal irrigation and gargle (HSNIG) could be a proactive step to kill the Wuhan coronavirus.

The Science Speaks for Itself

Evidence suggests HSNIG is effective with other respiratory viruses. In a 2019 study published in the peer-reviewed journal Nature, Ramalingam and his colleagues studied 61 people who had developed a common cold. Interestingly, 31 percent of these colds were caused by one of the common coronaviruses.

Half of the people used HSNIG, and the other half did not. The hypertonic saline users had milder symptoms, and the duration of their colds was significantly blunted. More importantly, saline significantly reduced the spread of the virus to others by 35 percent. This is an important finding in the context of trying to contain the spreading of the Wuhan virus.

A somewhat similar study was performed in 400 children 6-10 years old who developed colds and influenza. One-third of the children were treated with conventional medications while the other two-thirds used nasal saline spray.

After 12 weeks of observation, the children who used nasal saline regularly had quicker resolution of infection and less reappearance of illness. These studies indicate HSNIG can generate adequate levels of HOCL to mitigate the severity and duration of respiratory infections, and the HOCL levels are likely high enough to significantly reduce spreading the infections to others.

Recent evidence in COVID-19 biology indicates there is significant reproduction of the virus in the nose and throat during the first five days of symptoms. The research also indicates these newly produced viruses are highly infectious.

Additionally, we now know that patients can be highly infectious even in the absence of symptoms. Therefore, HSNIG might provide an opportunity to curtail the spread by killing these viruses during the initial asymptomatic incubation stage as well as the first five symptomatic days.

Thousands of people likely have occult COVID-19 infection, which means they can unknowingly infect others. Empirically, use of HSNIG by everyone, regardless of symptoms, could assist in stopping the pandemic. This prophylactic use of HSNIG is supported by a study in 46 adults followed for one year, which showed that using saline nasal rinse daily significantly reduced the incidence of upper respiratory infections.

The World Health Organization (WHO) says, “There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.” The WHO is correct in that there have been no double-blind prospective trials of people with the Wuhan virus using HSNIG, and it is not referencing the saline solution concentration mentioned in the previous studies.

However, studies have shown this technique does inhibit all common cold viruses, including the coronavirus (HCoV 229E). It is reasonable to believe HOCL will kill the Wuhan virus. Waiting for a definitive randomized trial to show this safe, simple, inexpensive therapy is effective for the Wuhan coronavirus seems overly cautious in light of the science and danger from the ongoing pandemic.

Our country is taking bold actions to curtail the spread of COVID-19. In light of the tremendous transmission rate of the Wuhan virus, it is our recommendation that everyone practice HSNIG.

While this hypothesis needs to be confirmed, we do not see a downside to implementing this very safe self-care approach now, in addition to the current measures of social distancing and personal hygiene. Within two weeks, grandma may be smiling as she watches her remedy dramatically reduce the spread of COVID-19.

Homemade Hypertonic Saline Solution

Ingredients:

• 4 cups of freshly boiled water (rolling boil for 3 minutes to purify)
• 2 tablespoons of sea salt or table salt (non-iodized salt preferred but not critical)

How to make:

• Wash your hands thoroughly.
• Choose a clean container or flask.
• Add the salt. Pour the freshly boiled water into the container and mix thoroughly until salt completely dissolves.
• Close the container with an airtight lid and store in the refrigerator.
• Make a fresh batch every 24 hours.
• To make a smaller batch, use 1 cup of water with 1 tablespoon of salt.

How to use: Go to this website for complete instructions on how to perform nasal irrigation and gargling.

Frequency of use:

• If you have symptoms or a confirmed case of COVID-19, repeat the usage up to every two hours during the first few days as symptoms are present.
• If you are asymptomatic and do not have known COVID-19, repeat the usage every four to six hours as a preventative measure.
• At the time of publishing this article, we recommend all people in the United States do this hypertonic saline nasal irrigation and gargle.
• We recommend continuation at least until the U.S. Centers for Disease Control no longer considers COVID-19 a serious threat in this country.

Dr. Bale is a professor at Texas Tech University and a specialist in prevention medicine. Dr. Vigerust is the president and chief scientific officer of ZDX Health, an infectious disease-focused health care company.

A high-salt diet is not only bad for one’s blood pressure, but also for the immune system. This is the conclusion of a current study under the leadership of the University Hospital Bonn. Mice fed a high-salt diet were found to suffer from much more severe bacterial infections. Human volunteers who consumed an additional six grams of salt per day also showed pronounced immune deficiencies. This amount corresponds to the salt content of two fast food meals. The results are published in the journal “Science Translational Medicine“.

Five grams a day, no more: This is the maximum amount of salt that adults should consume according to the recommendations of the World Health Organization (WHO). It corresponds approximately to one level teaspoon. In reality, however, many Germans exceed this limit considerably: Figures from the Robert Koch Institute suggest that on average men consume ten, women more than eight grams a day.

This means that we reach for the salt shaker much more than is good for us. After all, sodium chloride, which is its chemical name, raises blood pressure and thereby increases the risk of heart attack or stroke. But not only that: “We have now been able to prove for the first time that excessive salt intake also significantly weakens an important arm of the immune system,” explains Prof. Dr. Christian Kurts from the Institute of Experimental Immunology at the University of Bonn.

This finding is unexpected, as some studies point in the opposite direction. For example, infections with certain skin parasites in laboratory animals heal significantly faster if these consume a high-salt diet: The macrophages, which are immune cells that attack, eat and digest parasites, are particularly active in the presence of salt. Several physicians concluded from this observation that sodium chloride has a generally immune-enhancing effect.

The skin serves as a salt reservoir

“Our results show that this generalization is not accurate,” emphasizes Katarzyna Jobin, lead author of the study, who has since transferred to the University of Würzburg. There are two reasons for this: Firstly, the body keeps the salt concentration in the blood and in the various organs largely constant. Otherwise important biological processes would be impaired. The only major exception is the skin: It functions as a salt reservoir of the body. This is why the additional intake of sodium chloride works so well for some skin diseases.

However, other parts of the body are not exposed to the additional salt consumed with food. Instead, it is filtered out by the kidneys and excreted in the urine. And this is where the second mechanism comes into play: The kidneys have a sodium chloride sensor that activates the salt excretion function. As an undesirable side effect, however, this sensor also causes so-called glucocorticoids to accumulate in the body. And these in turn inhibit the function of granulocytes, the most common type of immune cell in the blood.

Granulocytes, like macrophages, are scavenger cells. However, they do not attack parasites, but mainly bacteria. If they do not do this to a sufficient degree, infections proceed much more severely. “We were able to show this in mice with a listeria infection,” explains Dr. Jobin. “We had previously put some of them on a high-salt diet. In the spleen and liver of these animals we counted 100 to 1,000 times the number of disease-causing pathogens.” Listeria are bacteria that are found for instance in contaminated food and can cause fever, vomiting and sepsis. Urinary tract infections also healed much more slowly in laboratory mice fed a high-salt diet.

Sodium chloride also appears to have a negative effect on the human immune system. “We examined volunteers who consumed six grams of salt in addition to their daily intake,” says Prof. Kurts. “This is roughly the amount contained in two fast food meals, i.e. two burgers and two portions of French fries.” After one week, the scientists took blood from their subjects and examined the granulocytes. The immune cells coped much worse with bacteria after the test subjects had started to eat a high-salt diet.

In human volunteers, the excessive salt intake also resulted in increased glucocorticoid levels. That this inhibits the immune system is not surprising: The best-known glucocorticoid cortisone is traditionally used to suppress inflammation. “Only through investigations in an entire organism were we able to uncover the complex control circuits that lead from salt intake to this immunodeficiency,” stresses Kurts. “Our work therefore also illustrates the limitations of experiments purely with cell cultures.”

The University of Bonn is one of Germany’s leading universities in the field of immunology. It is home to the Cluster of Excellence ImmunoSensation, of which Prof. Kurts is a member of the Executive Board. It is the only Cluster of Excellence in Germany in this field. Researchers from university hospitals in Regensburg, Hamburg, Erlangen and Melbourne (Australia) also participated in the study.

Publication: Katarzyna Jobin, Natascha E. Stumpf, Sebastian Schwab, Melanie Eichler, Patrick Neubert, Manfred Rauh, Marek Adamowski, Olena Babyak, Daniel Hinze, Sugirthan Sivalingam, Christina K. Weisheit, Katharina Hochheiser, Susanne Schmidt, Mirjam Meissner, Natalio Garbi, Zeinab Abdullah, Ulrich Wenzel, Michael Hölzel, Jonathan Jantsch and Christian Kurts: A high-salt diet compromises antibacterial neutrophil responses through hormonal perturbation; Science Translational Medicine; DOI: 10.1126/scitranslmed.aay3850