Victory At Dawn

Tough times don’t last, tough people do, remember?
― Gregory Peck

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The Case for Cautious Optimism

At the time of writing, Omicron is sweeping the world. The evidence to date shows that Omicron is the most infectious SARS-CoV-2 strain we’ve seen (Figure 1).

Fortunately, however, Omicron fatalities are far lower than for any other SARS-CoV-2 variant. For example, in South Africa, Omicron deaths are likely to peak at around 20% of the deadliest second wave caused by the Beta variant (Figure 1).

Thus, despite being highly infectious, the data suggests that Omicron causes a less severe disease than the other variants.

So, what does this actually mean?

Well, the highly infectious nature of Omicron means that we are all likely to be infected by Omicron over the coming weeks. However, although Omicron appears less deadly than other SARS-CoV-2 variants, people nevertheless die from Omicron infection.

Therefore, while we need to accept the inevitability of getting infected by Omicron, we should do everything possible to avoid severe COVID-19 disease.

COVID-19 South Africa
Figure 1. SARS-CoV-2 cases versus deaths in South Africa. The daily number of SARS-CoV-2 cases (i.e. known infections) and deaths due to SARS-CoV-2 infection are expressed as a percentage, with the highest case and deaths scored as 100%. The striking observation from this data is that despite the fourth Omicron wave having the highest daily case number, it has a very low daily death rate compared to the Original, Beta, and Delta variants (waves 1-3, respectively).

Surviving Omicron

I base my Omicron survival strategy on two foundational approaches.

First, optimize your health so that your immune system is functioning at peak capacity. Maintaining your immune system in tip-top shape is crucial for fighting off Omicron and for maximizing your immune response to vaccination.

Second, vaccination.

Now, I’m well aware that the idea of vaccination may trigger the vaccine-hesitant. Nevertheless, there is overwhelming evidence that vaccination is safe and provides robust protection against severe COVID-19.

It is for this reason that I believe that vaccination should be the foundation of your Omicron survival strategy.

However, I’m not a vaccine zealot, and I’m not your mum. So if you hate the idea of getting vaccinated, simply use the lifestyle interventions to strengthen your natural immune response.

Lifestyle Interventions

A healthy lifestyle is vital for three reasons.

  1. A healthy lifestyle supports a healthy immune system. A healthy immune system is essential for you to mount a robust immune response to SARS-CoV-2.
  2. Furthermore, a healthy immune system is required to generate a strong, protective immune response after vaccination.
  3. Finally, a healthy lifestyle helps reduce chronic inflammation. There is good evidence linking chronic inflammation to severe COVID-19 (1). Thus reducing chronic inflammation should reduce your risk of severe COVID.

Intervention One: Sleep

Chronic sleep disruption increases inflammation and reduces anti-viral immunity (2). Thus, obtaining consistent, high-quality sleep is essential for both your anti-viral immune response and your vaccine immune response.

For example, people who report poor sleep are more likely to suffer from respiratory diseases and succumb to pneumonia than those who experience adequate sleep (3).

In addition, those who experience disrupted sleep report experiencing more frequent cold, influenza, and gastro infections than those who sleep well (3).

Further, virus challenge experiments show that people who experienced impaired sleep had an increased chance of developing a cold after receiving cold virus nasal drops (3).

Finally, poor quality sleep negatively impacts the efficacy of vaccines, thus disrupted sleep likely reduces the effectiveness of the COVID-19 vaccine (4).

For these reasons, obtaining consistent, high-quality sleep is essential to maximize your immune response to vaccination and Omicron infection.

Intervention Two: Diet and Supplements

Poor nutrition increases your risk of suffering severe COVID-19 if you become infected (Table 1) (5-7).

StudyNormal Nutrition (Mortality %)Moderate Malnutrition (Mortality %)Severe Malnutrition (Mortality %)
Wei et al0%5%6.5%
Çınar et al1%4.1%25.5%
Zhao et al0%13%43.2%
Mean0.33%7.03%37.23%
Table One. Covid-19 Mortality Rates of Patients with Covid-19 Grouped By Nutritional Status (adapted from (5-7)).

Table 1. The effect of nutritional status on COVID-19 mortality.

The consumption of leafy green vegetables, other vegetables, berries, and nuts provide essential vitamins and micronutrients for your overall health and furnishes fiber for gut health. Fish, poultry, beans, and lean red meat provide protein. In addition, whole grains offer a metabolically friendly source of carbohydrates.

Finally, consistent with our recent article on beer, moderate wine consumption improves the function of your immune system (8).

Vitamins and Minerals

Deficiencies in essential micronutrients increase your risk of disease and death from viral infection (9). The best way of obtaining nutrients is through eating a balanced and healthy diet. Supplementation is only required if you are deficient in one or more micro-nutrients or vitamins. Unfortunately, many people are deficient in vitamin D and zinc, which support proper immune function (9).

It is now clear that there is a trend between people with low serum vitamin D and (i) increased COVID-10 disease severity, (ii) increased need for intensive care, (iii) increased requirement for forced ventilation, and (iv) increased risk of mortality (10).

Collectively, the combined data support vitamin D supplementation as a way for you to (i) avoid infection and (ii) reduce the severity of COVID-19 should you become infected (10).

Adequate zinc levels are also required for your immune system to work effectively. For this reason, zinc deficiency makes people more vulnerable to intestinal and respiratory infections. On the other hand, zinc supplementation shortens the duration of the common cold (11), and there is good evidence that zinc supplementation protects you from severe COVID-19 (12-14).

Analysis of 24 clinical trials showed that vitamin C supplementation helps shorten the duration and severity of colds (15). For example, in marathon runners, skiers, and soldiers on sub-arctic exercises, vitamin C supplementation reduced the incidence of colds by a whopping 52% (15)!

Thus, vitamin C supplementation provides significant protection against COVID-19 and other viruses if you are training hard or competing at a high level in sport.

Intervention Three: Gut Health

A healthy gut microbiome provides the following beneficial functions (16):

• Improved metabolic health
• Produce critical bacterial metabolites, such as short-chain fatty acids (SCFAs), helping to support your immune system
• Preserves the structural integrity of the gut mucosal barrier
• Protects you against pathogens

There is increasing evidence that your gut microbiome affects your lung health (17). For example, several studies indicate that an unhealthy gut can increase the severity of respiratory virus infections, such as influenza (18). Therefore, it’s likely that gut health also influences COVID-19 (19).

Furthermore, new evidence suggests that suffering a SARS-CoV-2 gut infection can lead to dysbiosis (20). Moreover, the dysbiosis caused by COVID-19 disease persists long after the SARS-CoV-2 infection has cleared (21).

Thus, an unhealthy gut is likely a risk factor for severe COVID-19. Fortunately, you can improve your gut health simply by following a nutrient-rich diet with plenty of fiber (22).

Prebiotics are nutrients that preferentially support the growth and proliferation of beneficial bacteria in your gut (23). Foods rich in prebiotics include leek, asparagus, chicory, Jerusalem artichoke, garlic, artichoke, onion, and banana (23). Alternatively, you can supplement your diet with prebiotics to help maintain a healthy gut biome (23).

Finally, you can improve your gut health through probiotic consumption. Some established positive effects of supplementing with probiotics are protection against gastroenteritis, improved lactose tolerance, stimulation of the immune system, and reductions in blood lipids (23).

In summary, maintaining your gut health helps protect you from severe COVID-19. A healthy diet rich in fiber and prebiotics, as well as prebiotic and probiotic supplementation, may help you maintain a healthy gut.

Intervention Four: Exercise

It is now clear that aerobic exercise protects you from severe COVID-19. For example, patients with COVID-19 who were consistently inactive had (i) a 2.26 elevated risk of hospitalization, (ii) a 1.73 increase in the risk of admission to intensive care, and (iii) a 2.49 increase in the risk of death due to COVID-19 compared to COVID-19 diagnosed patients who consistently met physical activity guidelines (24).

Although strength training offers some protection against COVID-19, aerobic fitness is far more effective (24, 25). Specifically, you need to perform at least 150 minutes per week of moderate exercise targeting the cardiorespiratory system (24, 25).

Thus, improving aerobic fitness should become a priority in your training program during the coronavirus pandemic.

Intervention Five: Seek Out Joy

Chronic stress, anxiety, and depression make you more vulnerable to respiratory infections (8). Therefore, try and cut out all the negative influences and seek out the positive in life. For example, ditch the serial killer movie and watch a romantic comedy instead. Likewise, block all the toxic garbage from your social media streams.

In addition, experiencing social integration and support helps you fight off infection (8). In contrast, social isolation is a known risk factor for more severe cold and flu symptoms (8). So now is a great time to reconnect with your family and friends.

An important caveat is that social engagement is both subjective and personal. People of a gregarious and outgoing nature may require greater social integration and support than those naturally inclined towards solitude. For this reason, find the level of social interaction that is right for you.

In short, seek out joy, and reconnect with your people (8).

Vaccination

As discussed in my last article, the Omicron variant can largely avoid the antibody response generated by either vaccine or previous infection. Unfortunately, this means that Omicron can reinfect people who have recovered from an earlier SARS-CoV-2 strain and vaccinated individuals.

Fortunately, cell-mediated immunity generated from either vaccination or a previous SARS-CoV-2 infection still works against the Omicron strain, protecting you from severe COVID-19.

Boosters

Multiple independent clinical studies show that vaccine boosters provide significant additional protection against severe disease and death from SARS-CoV-2 infection (26-28). Moreover, the safety data reported in these studies show that the booster shot is safe and well-tolerated (26-28).

There are two important points regarding boosters. First, boosters improve the immune response across age groups, including adults 60 years and older at high risk from severe COVID-19 (27-29).

Second, there is emerging evidence that booster shots are safe and effective in vulnerable populations, such as cancer patients (30).

Do Boosters Work Against Omicron?

Yes, they do.

Multiple independent studies have shown that boosters improve the antibody response against the Omicron variant (31-35).

What About Vulnerable Individuals?

There are groups of people at exceptionally high risk of severe disease due to Omicron.

High-risk individuals include cancer patients, people with HIV, people with organ transplants, and people with inflammatory diseases such as arthritis. There are two crucial considerations for high-risk individuals during Omicron.

  1. SARS-CoV-2 vaccines are recommended for many immunocompromised groups because they are safe and effective for many high-risk patients (36-40).
  2. However, specific immune-suppressing medicines used to treat certain cancers, inflammatory disorders, and other health conditions can severely compromise the efficacy of SARS-CoV-2 vaccines. Therefore, if you are a high-risk individual, you must work closely with your physician during the Omicron wave.

If you are a high-risk patient, your risk depends on your medication regime combined with your comorbidities. Thus, high-risk individuals should work closely with their doctors during the Omicron wave.

The Crucial Role of Self-Care During Omicron

Finally, I want to highlight the crucial role of self-care in increasing vaccine efficacy and reducing the risk of severe COVID during the Omicron wave.

Vaccination

When you receive your SARS-CoV-2 vaccination or your booster vaccination (which I recommend), you should be well-rested before and after your vaccination. For example, I did not train the day before receiving my booster vaccine, and I also didn’t train for five days post-vaccination.

When I returned to exercise, I started with easy workouts. Then, I gradually resumed my regular training schedule over the next two weeks. I also got at least eight hours of sleep each night during this period, stayed hydrated, and maintained reasonable nutrition given the holiday new year period.

In short, I deliberately kept physiological stress to a minimum before and after my booster vaccination. Hopefully, by reducing stress and staying well-rested, I (hopefully) maximized my immune response. I certainly did not experience any serious adverse events aside from a sore arm and feeling unwell for a few days post-vaccination

Overkill?

Perhaps. But, as a wise human once said, ‘An ounce of prevention is worth a pound of cure’.

Omicron Infection

The same principle holds when you become infected with Omicron. When you first experience symptoms of illness, focus on reducing physiological and emotional stress through rest, staying hydrated, maintaining nutrition, and possibly supplementing with vitamin C.

The bottom line is that if you are healthy, well-rested, and stress-free, you put yourself in the best position to recover from Omicron without experiencing severe illness.

Take-Home Message

There are three things you can do to reduce the risk of Omicron.

The first is vaccination, including boosters. The evidence now overwhelmingly supports vaccine safety and efficacy in reducing the risk of severe COVID-19 disease, including data from high-risk populations such as cancer patients, organ transplant recipients, HIV patients, and people suffering from inflammatory disorders.

Second, stay as healthy as possible by getting sufficient sleep, maintaining good nutrition, engaging in regular aerobic exercise, and maintaining a healthy gut.

Finally, make self-care a priority. When you are vaccinated, you should take care of yourself to maximize your immune response and minimize the risk of experiencing an adverse event. Crucially, take care of yourself if you experience any symptoms of infection to maximize your chance of avoiding severe COVID-19.

References and Further Reading

  1. J. J. Mammen et al., Factors associated with mortality among moderate and severe patients with COVID-19 in India: a secondary analysis of a randomised controlled trial. BMJ Open 11, e050571 (2021).
  2. A. Hamady, J. Lee, Z. A. Loboda, Waning antibody responses in COVID-19: what can we learn from the analysis of other coronaviruses? Infection, 1-15 (2021).
  3. L. Besedovsky, T. Lange, M. Haack, The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev 99, 1325-1380 (2019).
  4. C. Benedict, J. Cedernaes, Could a good night’s sleep improve COVID-19 vaccine efficacy? The Lancet Respiratory Medicine 9, 447-448 (2021).
  5. T. Çınar et al., Is prognostic nutritional index a predictive marker for estimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors? Heart Lung 50, 307-312 (2021).
  6. C. Wei et al., Evaluation of the nutritional status in patients with COVID-19. J Clin Biochem Nutr 67, 116-121 (2020).
  7. X. Zhao et al., Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients. JPEN J Parenter Enteral Nutr 45, 32-42 (2021).
  8. S. Cohen, Psychosocial Vulnerabilities to Upper Respiratory Infectious Illness: Implications for Susceptibility to Coronavirus Disease 2019 (COVID-19). Perspect Psychol Sci 16, 161-174 (2021).
  9. A. F. Gombart, A. Pierre, S. Maggini, A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients 12, (2020).
  10. A. Bassatne et al., The link between COVID-19 and VItamin D (VIVID): A systematic review and meta-analysis. Metabolism 119, 154753 (2021).
  11. H. Hemilä, Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. JRSM Open 8, 2054270417694291 (2017).
  12. D. N. Marreiro et al., Antiviral and Immunological Activity of Zinc and Possible Role in COVID-19. Br J Nutr, 1-21 (2021).
  13. E. Finzi, Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients. Int J Infect Dis 99, 307-309 (2020).
  14. P. M. Carlucci et al., Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients. J Med Microbiol 69, 1228-1234 (2020).
  15. H. Hemilä, E. Chalker, Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2013, Cd000980 (2013).
  16. K. Lee et al., The gut microbiome: What the oncologist ought to know. British journal of cancer 125, 1197-1209 (2021).
  17. K. F. Budden et al., Emerging pathogenic links between microbiota and the gut–lung axis. Nature Reviews Microbiology 15, 55-63 (2017).
  18. V. L. Ngo, A. T. Gewirtz, Microbiota as a potentially-modifiable factor influencing COVID-19. Current Opinion in Virology, (2021).
  19. Y. K. Yeoh et al., Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut 70, 698-706 (2021).
  20. G. L. V. de Oliveira, C. N. S. Oliveira, C. F. Pinzan, L. V. V. de Salis, C. R. d. B. Cardoso, Microbiota modulation of the gut-lung axis in COVID-19. Frontiers in Immunology 12, 214 (2021).
  21. Y. Tian et al., Gut Microbiota May Not Be Fully Restored in Recovered COVID-19 Patients After 3-Month Recovery. Frontiers in Nutrition 8, 182 (2021).
  22. I. Rowland et al., Gut microbiota functions: metabolism of nutrients and other food components. European journal of nutrition 57, 1-24 (2018).
  23. G. E. Walton, G. R. Gibson, K. A. Hunter, Mechanisms linking the human gut microbiome to prophylactic and treatment strategies for COVID-19. British Journal of Nutrition 126, 219-227 (2021).
  24. R. Sallis et al., Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British journal of sports medicine, (2021).
  25. A. Af Geijerstam et al., Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts. BMJ open 11, e051316 (2021).
  26. R. Arbel et al., BNT162b2 vaccine booster and mortality due to Covid-19. New England Journal of Medicine, (2021).
  27. N. Barda et al., Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study. The Lancet 398, 2093-2100 (2021).
  28. Y. M. Bar-On et al., Protection against Covid-19 by BNT162b2 booster across age groups. New England Journal of Medicine, (2021).
  29. M. N. Ramasamy et al., Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. The Lancet 396, 1979-1993 (2020).
  30. R. T. Shroff et al., Immune responses to two and three doses of the BNT162b2 mRNA vaccine in adults with solid tumors. Nature medicine 27, 2002-2011 (2021).
  31. W. F. Garcia-Beltran et al., mRNA-based COVID-19 vaccine boosters induce neutralizing immunity against SARS-CoV-2 Omicron variant. Cell, (2021).
  32. N. A. Doria-Rose et al., Booster of mRNA-1273 Strengthens SARS-CoV-2 Omicron Neutralization. (2021).
  33. K. Basile et al., Improved neutralization of the SARS-CoV-2 Omicron variant after Pfizer-BioNTech BNT162b2 COVID-19 vaccine boosting. bioRxiv, (2021).
  34. H. Gruell et al., mRNA booster immunization elicits potent neutralizing serum activity against the SARS-CoV-2 Omicron variant. (2021).
  35. I. Nemet et al., Third BNT162b2 vaccination neutralization of SARS-CoV-2 Omicron infection. New England Journal of Medicine, (2021).
  36. M. Giannella, L. C. Pierrotti, I. Helanterä, O. Manuel, SARS-CoV-2 vaccination in solid-organ transplant recipients: what the clinician needs to know. Transplant International 34, 1776-1788 (2021).
  37. A. Jena et al., Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: systematic review and meta-analysis. Autoimmunity reviews, 102927 (2021).
  38. N. Bordry et al., Humoral and Cellular Immunogenicity two months after SARS-CoV-2 messenger RNA Vaccines in Patients with Cancer. Iscience, 103699 (2021).
  39. S. A. Madhi et al., Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: an interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial. The Lancet HIV 8, e568-e580 (2021).
  40. G. Rosano et al., COVID-19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, (2021).

Acknowledgments

Images created by kieferpix

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Woman Yoga Nidra

Yoga Nidra for Better Sleep

Disrupted sleep increases anxiety and depression. Yoga Nidra is an effective method that has helped many people overcome insomnia.

Beautiful Woman Running On Treadmill

Low-Intensity Cardio for Metabolic Health

Emerging research shows that low-intensity cardio is the best way to improve your metabolic and cardiovascular health.

Strong bones, strong brain.

Strong Bones, Strong Mind

Regular exercise releases osteocalcin from your bones. Once in circulation, osteocalcin enters your brain to support learning and memory.