Showing posts with label COVID-19. Show all posts
Showing posts with label COVID-19. Show all posts

Monday, November 22, 2021

Plant-based diets, pescatarian diets and COVID-19 severity

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219480/pdf/bmjnph-2021-000272.pdf 

After adjusting for important confounders, participants who reported following ‘plant-based diets’ and ‘plant-based diets or pescatarian diets’ had 73% (OR 0.27, 95% CI 0.10 to 0.81) and 59% (OR 0.41, 95% CI 0.17 to 0.99) lower odds of moderate-to-severe COVID-19 severity, respectively, compared with participants who did not follow these diets. 

Compared with participants who reported following ‘plant-based diets’, those who reported following ‘low carbohydrate, high protein diets’ had greater odds of moderate-to-severe COVID-19 (OR 3.86, 95% CI 1.13 to 13.24).


Neil E. Levin, CCN, DANLA


Wednesday, September 15, 2021

JAMA posted my comment yesterday on a study reviewing vitamin C and Zinc for Covid-19 patients

JAMA edited my comment and changed the final sentence (adding ‘or some other dose’, which doesn’t make sense), but the gist is there.  

Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network

My original submission:

It is unclear what dose of elemental zinc was used in this study from the text provided. Fifty mg of 'zinc gluconate' is described, but that is 50 mg of a compound that is only about 1/7 elemental zinc. PubChem lists the molecular weight of zinc gluconate at 455.7 and of elemental zinc at 65.4; so zinc gluconate contains about 14.35% elemental zinc (a maximum value since 'as is' measurements include impurities, including moisture). If 50 mg. of ‘zinc gluconate’ was used, as described in the text, it would represent only about 7 mg of actual zinc; not a "high dose" since it would be below the FDA's current (and recently lowered) Daily Value of 11 mg. 

If 50 mg of elemental zinc from a much larger amount of zinc gluconate (typically 350- 400 mg) was used, it should have been described more precisely as that to avoid any confusion. The amount of zinc used was either a low dose erroneously described as a high dose or the authors mistakenly used the compound name (zinc gluconate) in place of the element's (zinc) when describing the 50 mg amount. 

Either way, how the supplement was described in this paper leads inevitably to confusion. The amount of actual zinc should be clearly specified, but the authors did not do so; nor did they relate the amount of this mineral to its RDA, Daily Value, or Upper Limit as a relevant reference point. The implication from the description of a ‘high dose’ is that the amount of zinc was 50 mg, not the amount of zinc gluconate, and that the authors misstated the description of the supplement. But they just as plausibly mistook 50 mg of zinc gluconate for 50 mg of elemental zinc, and then inaccurately described both the supplement and the dosing. 

How did this pass peer review without catching this internal conflict of description that would be obvious to chemists who work with mineral compounds and understand how to appropriately label them by either compound or element? And exactly which dose of elemental zinc was used; 50 mg or 7 mg?


Friday, May 07, 2021

Vaccine Mandate Musings

Should vaccine passports, or vaccination itself, be mandatory? I can only share my opinions, which are conflicted. Here are my thoughts:

Because of federal medical privacy laws, vaccine passports would have to be issued only on request of the patient/person waiving such privacy, so disclosure is in one sense inherently controlled by the individual and would be voluntary. Additionally, the state and the CDC are routinely notified of your COVID-19 vaccination, so it is not hidden from them; governments already know if you’ve been vaccinated. Another argument is that apps can track your location, but of course location tracking can be disabled for any app or phone, and mandates can also limit tracking to when the app is opened. Many people post their vaccine status on social media and then inconsistently worry about privacy after sharing it with massive companies that have access to their personal data.

Private companies can already mandate vaccines, including medical and nursing home staff, or college campuses (which now offer remote classes), and require masks and distancing unless such private company requirements are banned by law. Some people may want to show these verifiable proofs and find them useful; for example to travel overseas without needing quarantines or invasive testing.  

There are also issues of whether to restrict private companies from offering incentives for people to show vaccination proof to open cruises, concerts, airline or restaurant seating, etc. A government mandate prohibiting private businesses from doing things that are perceived as helping their sales recover faster and protect public health can also be perceived as anti-capitalist and anti-libertarian. The protection of public health often conflicts with normal civil rights in troubled times; both are mandates of governments. In this case, the government in prohibiting private businesses from using customer safety as a competitive selling point is different from a government mandating essential safety practices. This is actually the opposite of asserting a state mandate to protect public health; by legislating a government monopoly on whether/how to do that, rather than trusting the private sector, as most conservatives would normally prefer. 

As businesspeople, if you felt safer during an epidemic or pandemic by requiring masking and distancing, would you want the state prohibiting you from doing what makes you feel safer or from doing what makes your customers feel safer? In Illinois, the state has said it won’t require a vaccine passport, but did not prohibit local governments or private businesses from doing so, and Chicago may require them short-term for concerts and full restaurant capacity so businesses can reopen faster while protecting public health and safety. Is a business offering incentives discriminating against ineligible customers, or is it a justifiable practice; similar to offering private events or other perks for preferred customers?

I know this is more nuanced than social media and news outlets present the issues to us, but there are both plusses and minuses to government mandates and vaccine passports/proof, and winners and losers. 

It also doesn’t address the issue of some people who can’t get vaccinated: the young, people with autoimmune diseases or other medical conditions, those who have had serious reactions to previous vaccines; even pregnancy is an unknown safety factor. Vaccine mandates without reasonable exemptions are going to harm some people; maybe far fewer than might get seriously ill or die from the disease if everyone was unvaccinated, but they would needlessly sacrifice some people for the perceived greater good instead of fine-tuning to make vaccinations even safer. Vaccines aren’t perfect; why pretend that they are?

My problem with routine vaccinations is that there is no willingness or incentive to track a minority that may be harmed by vaccines in order to make them safer by identifying people or traits that are unsuitable for a particular vaccine. The ingredients are also a problem for some; including mercury and aluminum, preservatives, allergens, and other chemicals. Why is there no good study on the safety of the complete vaccination program of some 16 vaccines; some with additional boosters? Why are vaccine critics quickly attacked as anti-science, rather than honestly assessing their claims? Why are calls to fine-tune the vaccination program to make it even safer quickly shut down as anti-vaxxers? I appreciate the elimination of TB, smallpox, measles, etc. But why ignore a minority for whom some vaccines - or some ingredients - may be contraindicated to reduce the criticism? 

Sorry, but I seem to have more questions than answers.