Dear Patients,

Compression!

If your car engine compression is too high, it will cause the engine to misfire, knock and ping. Over time, high compression will wear down the pistons, burn oil, damage the O-rings, seals, and gaskets.

Pandemic-induced constant compression on us is taking its toll. I see it clinically every day. Poor sleep, loss of appetite, overeating. Previously healthy habits, like going to the gym daily, are being replaced by watching the news. The daily onslaught of information that is filtered and biased based on its origin, is causing high-intensity compression on our brain. This is raising our cortisol and adrenalin levels, which causes our heart rates to be higher, our fingers to feel cold and sweaty, it changes our gut microbiome and, directly and indirectly, impairs our immune system. Our protective T-cell and B-cell functions decline and now we are more vulnerable to disease and deterioration.

The 24/7 news cycle is designed to tease you into watching and keep watching. Scary news gets our attention quickly; it's like candy for our brain, inducing fear. Some become hyper-vigilant and keep watching, strengthening the harmful cycle. Further, can you even trust the news as accurate and true?

This constant compression, for many, ultimately leads to agitation, restlessness, depression, and anger. Daily fear-laden news is contributing to the compression of your brain; fear activates the amygdala that integrates with our hippocampus and causes changes in our limbic system. The limbic system helps control emotions and memory; it regulates autonomic and endocrine function in response to emotional stimuli. Depression of the limbic system causes sadness, anger, hopelessness, repetitive negative thinking, etc.

What is the solution?

Well, if your head hurts because you're banging it against a wall, stop banging your head against the wall. This avoids a cold slap in the face by the news that daily states "Breaking news: COVID cases reach all-time high". Well, of course they have, we are becoming very efficient at testing and we expect the number of positive cases to increase. Maybe the news should state that positive case numbers are up, as expected, but reassuringly, hospital admissions, ICU admissions and fatalities are stable or down, except in certain hot spots.

The numbers:

• The country: Revisit this Murray model and see how continued social distancing, face masks, and hand sanitation can beat COVID down. Florida, Texas and Arizona hot spots are improving

• Maryland: This website continues to show our mitigation techniques are working. Yes, every day we see more cases, but our death rate, hospitalizations, and ICU admissions are stable. As expected, there was a spike after the July 4th holiday due to get-togethers. The fatality rate has fallen significantly; it is now 3.9%.

• Maryland Rt: As of yesterday, it was 1.1. We can and must do better. Wear your face mask, wash your hands frequently and avoid social gatherings with more than 10 people. You may recall the Rt is a measure of how fast the virus is growing; when it is below 1.0, the virus will stop spreading.

The numbers:

• Nationally, yes, case numbers are up. Why? We are testing more. Unfortunately, the increased test numbers are being reported in a fashion that may cause you to panic. Do not! The meaningful information is in the hospitalization numbers, ICU admissions and mortality numbers.

• Maryland reports the fewest new coronavirus cases since March 31; hospitalizations continue to decline.

• The Rt in Maryland as of today is 0.79. You may recall the Rt is a measure of how fast the virus is growing; when it is below 1.0, the virus will stop spreading.

The Science of COVID-19:

• The Oxford vaccine induced a strong antibody and T cell immune response. The US has ordered 300 million doses.

• There are multiple anti-virals on the horizon. This oral drug was developed for Hepatitis C and seems to be very effective for COVID-19 in cell cultures, now in clinical trials.

• This is a respiratory virus most efficiently spread by droplets and aerosols. Air handling, using filters and UV light, will rapidly decrease transmission inside of buildings.

• If everyone wears a mask, the CDC believes it will have a very significant impact on the pandemic within 4 to 8 weeks.

• Wearing a face mask is so important. This study showed a dramatic reduction of spread from this simple intervention. It is the simple things that are really effective!

• A large study from Henry Ford Health System in hospitalized patients who were given hydroxychloro-quine (HC), or HC + azithromycin early on, had a significant reduction in mortality.

• ·A healthy lifestyle reduces your risk, just published.

• Obesity is a major risk factor since this condition promotes aspiration of nasal secretions lower in the lungs. Initially, COVID infects the nasopharynx and replicates. After 2-3 days, nighttime aspiration during sleep may deliver it into the lower respiratory tract; then the problems begin.

• New CDC recommendations suggest that persons with mild to moderate COVID infections remain infectious no longer than 10 days after symptom onset; severe infections, no longer than 20 days.

• As earlier reported, published in The New England Journal of Medicine, a $5 per day low dose steroid (dexamethasone) given to hospitalized patients with respiratory insufficiency reduced mortality significantly.

• Currently, influenza in the South Hemisphere (their winter) is markedly reduced with COVID measures. It makes sense and bodes well for us this flu season.

More on getting healthy:

My co-author of BOOM, Stephen Schimpff, MD, just recently published this article! BOOM! And if you want more information, watch my Instagram/Facebook discussion of BOOM. All profits from the sale of BOOM will be donated to the University of Maryland COVID-19 Research.

What to do now:

• Always wear your face mask when you are out.

• Wash your hands or sanitize frequently.

• Avoid large social gatherings (>10 people).

• Maintain at least 6' of social distancing.

• No hugging, kissing, or shaking hands

On a musical note:

How about Carole King, You've Got A Friend. Do not watch the news; instead, call a friend!

On a lighter note:

Reach out. Stay connected. Stay home. Save lives. The power of one. Be well.

Feel free to forward this on: spread the word, not the virus.

Harry A. Oken, M.D.