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Build Muscle, Stay Healthy Blog: Digital Health: Addressing COVID-19 and Moving Beyond

I was careful when it came to selecting the title of this Blog as I wanted to talk about the role that Digital Health Technologies are playing in addressing COVID-19 but I also wanted to give some thought to life beyond COVID-19. We will move beyond COVID-19. There is a light at the end of the tunnel. Trust me. This will end. States such as California and Washington are “flattening the curve,” [1], the Biotechnology company, Moderna, Inc. (modernatx.com) has initiated Clinicals Trials for an mRNA-based COVID-19 vaccine [2] and promising data has been released by Biotechnology giant, Gilead on the potential of remdesivir in addressing the threat from the novel coronavirus [3] that has turned our lives upside down.

This is not the first time that the world has battled a pandemic; ~100 million people around the world perished during the 1918 Influenza Pandemic [4]. However, advances in Science and Technology have made us much better at diagnosing emerging infectious diseases [5], performing contact tracing to rapidly identify and test people that may have been exposed to the disease [6] and developing mathematical models to predict the impact of the disease so that hospitals can ramp up ICU capacity accordingly [7]. Below, I discuss how digital health technologies are helping us address COVID-19 and the role that they will play when we move beyond COVID-19.

Internet-Connected Thermometers:

I never thought of the old school, liquid-in-glass thermometer that my parents used to measure my temperature with when I was feeling under the weather as a kid in the 1980s in the Canadian city of Sarnia as a high tech device. That was long before the days of the internet and Bluetooth wireless technology. We still had a rotary dial phone at our house during those days. Even in a world where self-driving cars are becoming a reality, Doctors and Nurses still take your temperature when you show up at a walk-in clinic in 2020 after you have been feeling down in the dumps for a couple of days as fever is often the first sign that things are heading South.

During a public health crisis, the data provided in real time by hundreds of thousands of internet-connected thermometers can help Healthcare Providers potentially save thousands of lives. Here is a scenario to consider. Suppose hundreds of College Students attend a beach party in Miami during Spring Break while dancing to the song, “Kokomo” by The Beach Boys. (Okay, the “Kokomo” part is not likely in 2020. I am a child of the ‘80s and I am still stuck there.) One of the bartenders is an asymptomatic carrier of COVID-19. She has COVID-19, experiences very mild symptoms and passes on the virus to people that she meets at the beach party. One of those people is a guy from Ames, IA along with a girl from San Diego, CA.

These people return home, completely oblivious of their COVID-19 status and infect dozens of people around them. One week later, there is a spike in fever in both Ames and San Diego. Thanks to wireless technology, high speed internet-connectivity and big data analytics, this spike is rapidly detected and is communicated to Public Health officials in both cities. They can now be on alert for a surge in COVID-19 cases in the coming days with increased Healthcare Workers, ICU beds and ventilators on hand. Thanks to a company called Kinsa Health (https://www.kinsahealth.co/), this is reality not science fiction. Using one of these smart thermometers (Figure 1), it is possible to identify possible hotspots [8] as illustrated in Figure 2.

Contact Tracing Apps:

Two of the countries that managed to respond very well to the COVID-19 pandemic were Singapore and South Korea. These countries managed to learn valuable lessons on dealing with pandemics during the SARS Outbreak (2002-3). In addition to a rigorous testing strategy, both countries practiced aggressive contact tracing. What is contact tracing? Consider the scenario that we discussed earlier involving an asymptomatic bartender serving Mai Tais, Daiquiris and Margaritas to hundreds of party-goers at a beach party in Miami during Spring Break. When the bartender tests positive for COVID-19, it is crucial that she alerts everyone that she had close contact with.

How would one go about determining this information? One could look at credit card transactions to gather the names of the customers that she had served. Of course, many customers may have paid with cash. On the other hand, few people go anywhere these days without bringing their smartphone with them. Using location sharing data, it becomes possible to identify all of the people that the bartender had interacted with over the last 10-14 days. All of these contacts could be alerted instantly by a text message, informing them that they had come in contact with someone that had tested positive for COVID-19 and hence should get tested as soon as possible in order to protect themselves and contain the spread. In order to accelerate the contact tracing process, Singapore developed a smartphone app called TraceTogether [9].

Digital Immunity Passports:

Lockdown will not last forever and eventually the economy will have to open back up. When that happens, it is likely that the process will be one that is gradual. Countries such as Germany have floated the idea of issuing “immunity passports” to their citizens. After people are infected with COVID-19, they develop antibodies that are specific to the virus, SARS CoV-2 that causes the disease. These antibodies can be measured using a type of testing known as serological testing [10]. The development of a serological assay to measure antibodies for SARS CoV-2 was described in March 2020 by Dr. Florian Krammer, Mount Sinai School of Medicine in New York [11]. A schematic of a commercial serological test for COVID-19 developed by Cellex, Inc. that recently received FDA Approval is shown in Figure 3.

Most people that are infected with COVID-19 develop mild symptoms so many people probably have antibodies for SARS CoV-2 and don’t even know it. So if one of these people wants to “make a run for the border” and enjoy a couple of chalupas at Taco Bell with extra Baja sauce (the first thing that I will do when the lockdown is over), it is probably safe. However, “making a run for the border” could be very dangerous for someone without antibodies for SARS CoV-2, particularly if they are older and immune compromised. In Germany, Dr. Gerard Krause, Head of Epidemiology at the Helmholtz Institute for Infection Research, Braunschweig is coordinating the effort to test millions of Germans for antibodies for SARS CoV-2 [12].

I am confident that an effective vaccine for COVID-19 will come to market sometime next year given the progress that companies such as Moderna (modernatx.com), CureVac (curevac.com), BioNTech (biontech.de), Inovio (inovio.com) and Janssen (janssen.com) are making. In the meanwhile, you may need to be prepared to have your digital passport scanned on your iPhone the next time you have a craving for chalupas or gorditas. (Yes, I’m a huge fan of Taco Bell.)

Recovering from COVID-19, Muscle Health and Grip Strength:

We are learning more about COVID-19 everyday as Researchers for around the world upload manuscripts onto preprint servers. How does COVID-19 impact muscle mass and muscle strength? We don’t know right now. Research at the University of Connecticut [13] has shown that aging significantly enhances the muscle damage that is caused by the flu. During the flu, the body responds with a massive inflammatory response to fight the flu. Turning on these inflammatory signals (atrogin1, MuRF1, ubiquitin B, ubiquitin C) to fight the flu inadvertently fights muscle as well. We know that this inflammatory response or “cytokine storm” is very severe in COVID-19 [13]. As a result, Pharmaceutical companies have initiated COVID-19 Clinical Trials involving powerful anti-inflammatory drugs. One example is Regeneron’s Clinical Trial involving Sarilumab, a monoclonal antibody that blocks an inflammatory signaling molecule known as IL-6 [14]. The “cytokine storm” of COVID-19 likely takes a toll on muscle health and rebuilding this muscle is vital due to the importance muscle plays in energy metabolism, balance, bone health and movement.

One of the simplest techniques that Researchers use to gauge an individual’s muscle health is grip strength which is measured using a device known as a dynamometer. Dr. Kate Duchowny, University of Michigan has published that low grip strength is associated with premature death [15]. As people recover from COVID-19, it is essential that they work with their healthcare providers to develop strategies to rebuild their muscle mass and strength through a combination of exercise and nutrition. Digital health can play an important role in monitoring progress as it relates to rebuilding muscle mass and strength. Imagine the potential of tens or hundreds of thousands of dynamometers across the country with internet-connectivity leveraging the power of big data analytics to provide information in real-time to their healthcare providers.

Learn more about how the advanced nutrition product, Fortetropin® in combination with protein and resistance training can help you build muscle mass at www.myoslongevity.com. In the meanwhile, build muscle, stay healthy.

References:

1. Fowler, Geoffrey, A., et al. “Social distancing works. The earlier the better, California and Washington data show.” Washington Post, April 1, 2020. https://www.washingtonpost.com/nation/2020/04/01/lockdown-coronavirus-california-data/

2. Cohen, Jon. "Vaccine designers take first shots at COVID-19." Science, (2020): 14-16.

3. de Wit, Emmie, et al. "Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection." Proceedings of the National Academy of Sciences 117.12 (2020): 6771-6776.

4. Johnson, Niall PAS, and Juergen Mueller. "Updating the accounts: global mortality of the 1918-1920" Spanish" influenza pandemic." Bulletin of the History of Medicine (2002): 105-115.

5. Lan, Lan, et al. "Positive RT-PCR test results in patients recovered from COVID-19." Jama (2020).

6. Hellewell, Joel, et al. "Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts." The Lancet Global Health (2020).

7. Kucharski, Adam J., et al. "Early dynamics of transmission and control of COVID-19: a mathematical modelling study." The Lancet Infectious Diseases (2020).

8. Ehterington, Darrell. “Kinsa’s fever map could show just how crucial it is to stay home to stop COVID-19 spread.” Tech Crunch, March 23, 2020.

9. Singapore Government. “Help speed up contract tracing with Trace Together.” https://www.gov.sg/article/help-speed-up-contact-tracing-with-tracetogether

10. Bedford, Juliet, et al. "COVID-19: towards controlling of a pandemic." The Lancet (2020).

11. Amanat, Fatima, et al. "A serological assay to detect SARS-CoV-2 seroconversion in humans." medRxiv (2020).

12. Proctor, Kate, et al. “'Immunity passports' could speed up return to work after Covid-19.” The Guardian, March 30, 2020.

13. Mehta, Puja, et al. "COVID-19: consider cytokine storm syndromes and immunosuppression." The Lancet (2020).

14. Murphy, Jill. “Global Sarilumab Clinical Trial Program Begins for Patients with Severe COVID-19.” Pharmacy Times, March 17, 2020.

15. Duchowny, Kate A., P. J. Clarke, and Mark D. Peterson. "Muscle weakness and physical disability in older Americans: longitudinal findings from the US Health and Retirement Study." The journal of nutrition, health & aging 22.4 (2018): 501-507.


Figure 1: A State-of-the-Art, Kinsa Internet-Connected Thermometer.

Images reproduced from https://www.kinsahealth.co/products/#buynow.



Figure 2: An Example of Possible ‘Hotspots’ For Fever Provided by a Kinsa Thermometer.

Image reproduced from https://techcrunch.com/2020/03/23/kinsas-fever-map-could-show-just-how-crucial-it-is-to-stay-home-to-stop-covid-19-spread/




Figure 3: A Schematic of a Serological Test for COVID-19 Related Antibodies Developed by Cellex, Inc.

Reproduced from https://www.medpagetoday.com/infectiousdisease/covid19/85772.




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