22-04-2021

THURSDAY, APRil 22, 2021
5
Covid is providing a new opportunity to understand complications of many common viral
infections.
Photo: Evgeniy Maloletka
Covid research to solve mysteries
of other viruses
Gina Kolata
Barie Carmichael lost her sense of taste
and smell while traveling in Europe.
She remembers keeping a dinner date
at a Michelin-starred restaurant but
tasting nothing. "I didn't have the heart
to tell my host," she said.
It may sound like a case of Covid-19.
But Ms. Carmichael, 72, a fellow at the
University of Virginia's business school,
lost her ability to taste and smell for
three years in the 1990s. The only
respiratory infection she'd had was
bronchitis.
Medical scientists say that although
the complications of Covid have riveted
peoples' attention, many symptoms -
like a loss of smell - are not unique to
Covid. Heart inflammation, lung and
nerve damage and small blood clots in
the lining of lungs occur in a small but
noticeable percentage of patients who
have had other respiratory and viral
infections. And these patients, too, can
also have their own version of "long
Covid."
No one is saying Covid is the
equivalent of, say, the flu that circulates
each year. The usual seasonal flu has
not killed millions worldwide in a single
year, and more than half a million
Americans, while upending society and
ravaging economies. But Covid-19 is
providing a new opportunity to
understand the complications of many
common viral infections.
Before the pandemic, research grants
to study a loss of smell were hard to
come by, said Danielle R. Reed,
associate director of the Monell
Chemical Senses Center, a nonprofit
research group, in Philadelphia.
"It seemed like nobody cared," she
said. But now, "there is an explosive
growth of interest among funders."
(She added that most who say they
have lost a sense of taste have really lost
a sense of smell.) Monell researchers
want to compare how often people lose
their sense of smell after a bout with the
flu versus a bout with Covid-19 - and
how long the loss lasts. Is there a
genetic predisposition to this
complication?
Researchers at other institutions
want to know who is susceptible to
heart infections, blood clots or lung
damage after having a respiratory virus
like the flu. For the most part, little is
known. Part of the problem was that
only a minority of patients with
respiratory viruses were affected with
these conditions, and until the
coronavirus, that tended not to be a big
number. Many of these effects were
noticed but then forgotten.
Heart problems following a viral
infection are among the best studied.
Myocarditis - an inflammation of the
heart muscle - affects as many as 1.5
million people worldwide each year,
most of whom had a prior respiratory
virus infection. Most recover fully.
But symptoms like fatigue are often
not recognized as being related to
myocarditis. And Dr. McManus
suspects that the fatigue that
sometimes follows a bout with Covid-
19 might be caused by this heart
problem."We think of Covid-19 and
influenza as respiratory diseases, and in
fact they are," said Dr. Bruce M.
McManus, an emeritus pathology
professor at the University of British
Columbia. "But the reason many
patients reach their demise in many
instances is myocardial."
Some severely ill Covid patients have
lung damage. That too can also occur
with other viruses, said Dr. Clemente
Britto-Leon, a lung researcher at the
Yale School of Medicine. He lists some
possibilities."You can have lung injury
and scarring with influenza, with
herpes viruses and with
cytomegalovirus infections, for
example," Dr. Britto said, referring to a
common virus that usually causes no
symptoms. All these viruses can wreak
damage on rare occasions, he said.
In the pandemic following
routine is essential
Routine can shield one from chaos.
Jason Diamond
I was laid off in December. I can't say I
wasn't anticipating it. Everything was
falling apart everywhere, including the
media world. But when it happened, the
first thing I worried about - before
questions of how I'd make money or what
I'd do about insurance - was if I'd lose the
routine that I had developed, lost, and
then worked so hard to get back.
We all had our routines before the
pandemic, and so many of them were
upended. Just about any personal
routine, if it wasn't halted outright,
changed somehow, from the mundane
to the essential. The older man I used to
see slowly savoring an espresso every
day at the coffee shop had to take it in a
to-go cup and drink it outside. Until
lockdown, a friend had gone uptown to
see his parents every Sunday morning,
but had to stop. Children stopped going
to school and much of the work force
stopped going to offices. Trying to
maintain a routine was difficult enough
with the world feeling as if it was going
to pieces; trying to set new ones without
any clear indication of what the future
held felt downright impossible.
Photo: Monika Aichele
Life is a series of routines. We go to
sleep, we wake, we work, we play. But
for some, routines and rituals help us
function against the chaos of the world,
and in many cases, our minds. Some
minds just aren't made for routines;
that's why I've had to work extra hard
and discipline myself to live and work a
certain way.
I grew up constantly uncertain,
thanks to an unstable home life as a
child, parents who moved around a lot
and, starting at 16, being without a
home of my own. The trauma from
those experiences began to prey on me,
it wore me down and mingled with my
diagnoses of A.D.H.D., depression and
obsessive-compulsive personality
disorder, making it almost impossible
for me to concentrate, work, and
generally be productive and happy on a
daily basis.
At some point, by chance, I started to
realize that the more I implemented
boundaries and schedules - waking and
eating and meditating at specific times,
working out, writing down the next
day's schedule - the more I started to
feel not only some control, but also
happiness. By setting routines for
myself, I was able to shield myself from
chaos.
"It helps you feel like you're in
control," Charles Duhigg, who wrote
"The Power of Habit," said in an
interview. "It helps you remember how
to do things that - maybe because of
your A.D.H.D. - you'd forget because of
short-term memory." In his book, Mr.
Duhigg explores the sort of ouroboros -
the ancient symbol of a snake eating its
own tail - I was performing on myself. I
needed some sort of cue, a routine and
then a reward. I hadn't thought of
rewards as part of the process, but they
are essential.
For me, I thought the reward was
peace of mind. What I didn't realize was
I was also giving myself other little
trophies: If I went to the gym five days
every week, there was a little voice in
my head that would say "You've earned
two slices of pizza." When I'd clean the
house on Sunday morning, I'd always
crack open a beer by afternoon. And
sometimes you aren't even conscious of
the rewards you're giving yourself for
routine, and I find those are the most
important ones. With those rewards,
I'm being good to yourself, telling
myself I did something, so I earned
something.
"You're forcing yourself to anticipate
rewards," Mr. Duhigg said. "All of that
is really good."For Esme? Weijun
Wang, author of the essay collection
"The Collected Schizophrenias,"
"Routines and rituals are a core part of
maintaining my mental health," she
told me. Ms. Wang's routines include
"my analog planner, where I journal,
manage my appointments and jot
down tasks - that, along with an array
of other notebooks and binders,
organize things in a way that help life to
feel less overwhelming."
Equally important - and perhaps
more challenging - is maintaining your
routines. So, while writing down
appointments is important, reminding
myself to wake up at a certain time.
Sleeping Too Little in Middle Age May
Increase Dementia Risk, Study Finds
Pam Belluck
Could getting too little sleep increase
your chances of developing
dementia?For years, researchers have
pondered this and other questions
about how sleep relates to cognitive
decline. Answers have been elusive
because it is hard to know if insufficient
sleep is a symptom of the brain changes
that underlie dementia - or if it can
actually help cause those changes.
Now, a large new study reports some
of the most persuasive findings yet to
suggest that people who don't get
enough sleep in their 50s and 60s may
be more likely to develop dementia
when they are older.
The research, published Tuesday in
the journal Nature Communications,
has limitations but also several
strengths. It followed nearly 8,000
people in Britain for about 25 years,
beginning when they were 50 years old.
It found that those who consistently
reported sleeping six hours or less on
an average weeknight were about 30
percent more likely than people who
regularly got seven hours sleep (defined
as "normal" sleep in the study) to be
diagnosed with dementia nearly three
decades later.
"It would be really unlikely that
almost three decades earlier, this sleep
was a symptom of dementia, so it's a
great study in providing strong
evidence that sleep is really a risk
factor," said Dr. Kristine Yaffe, a
professor of neurology and psychiatry
at the University of California, San
Francisco, who was not involved in the
study.
Pre-dementia brain changes like
accumulations of proteins associated
with Alzheimer's are known to begin
about 15 to 20 years before people
exhibit memory and thinking
problems, so sleep patterns within that
time frame could be considered an
emerging effect of the disease. That has
posed a "chicken or egg question of
which comes first, the sleep problem or
the pathology," said Dr. Erik Musiek, a
neurologist and co-director of the
Center on Biological Rhythms and
Sleep at Washington University in St.
Louis, who was not involved in the new
research.
"I don't know that this study
necessarily seals the deal, but it gets
closer because it has a lot of people who
were relatively young," he said. "There's
a decent chance that they are capturing
people in middle age before they have
Alzheimer's disease pathology or
plaques and tangles in their brain."
Drawing on medical records and
other data from a prominent study of
British civil servants called Whitehall
II, which began in the mid-1980s, the
researchers tracked how many hours
7,959 participants said they slept in
reports filed six times between 1985
and 2016. By the end of the study, 521
people had been diagnosed with
dementia at an average age of 77.
The team was able to adjust for
several behaviors and characteristics
that might influence people's sleep
patterns or dementia risk, said an
author of the study, Séverine Sabia, an
epidemiologist at Inserm, the French
public-health research center. Those
included smoking, alcohol
consumption, how physically active
people were, body mass index, fruit and
vegetable consumption, education
level, marital status and conditions like
hypertension, diabetes and
cardiovascular disease. To clarify the
sleep-dementia relationship further,
researchers separated out people who
had mental illnesses before age 65.
Depression is considered a risk factor
for dementia and "mental health
disorders are quite strongly linked with
sleep disturbances," Dr. Sabia said. The
study's analysis of participants without
mental illnesses found a similar
association between short-sleepers and
increased risk of dementia.
The correlation also held whether or
not people were taking sleep
medication and whether or not they
had a mutation called ApoE4 that
makes people more likely to develop
Alzheimer's, Dr. Sabia said.The
researchers found no general difference
between men and women.
"The study found a modest, but I
would say somewhat important
association of short sleep and dementia
risk," said Pamela Lutsey, an associate
professor of epidemiology and
community health at the University of
Minnesota, who was not involved in the
research. "Short sleep is very common
and because of that, even if it's
modestly associated with dementia
risk, it can be important at a societal
level. Short sleep is something that we
have control over, something that you
can change."
Still, as with other research in this
area, the study had limitations that
prevent it from proving that inadequate
sleep can help cause dementia. Most of
the sleep data was self-reported, a
subjective measure that isn't always
accurate, experts said.
Technology is not compulsory
for vaccine passports
Shira Ovide
I have been reluctant to write about
whether and how Americans might
provide proof of vaccination against
the coronavirus. It's a political,
cultural, ethical and legal minefield.
Technology is not the point at all.
But if some workplaces, schools,
public gathering spots and travel
companies start requiring a "vaccine
passport," it makes sense for them to
do so in ways that preserve people's
privacy, are simple to use, win
people's trust and don't cost a
fortune.Let me tell you about an
intriguing proposal from PathCheck
Foundation, a health technology
nonprofit. The central premise is
that technology related to our health
should be as minimal as possible.
That philosophy should be our North
Star.
Here is one problem with some
early technology approaches to
digital vaccine credential systems:
They create too many middlemen
that tap into your health records,
The study followed nearly 8,000 people in Britain for about 25 years,
beginning when they were 50 years old. Photo: Karl-Josef Hildenbrand
said Ramesh Raskar, an associate
professor at the M.I.T. Media Lab
who also founded PathCheck.
In the United States, states are
mostly the ones maintaining records
of which residents are vaccinated.
Early efforts to create vaccine
credentials, like the Excelsior Pass in
New York, essentially create a
replica of those state databases with
information including your name,
date of birth, address, the batch
numbers of your shots and so on.
And that's what businesses and
others access when they check
whether people walking in the door
are vaccinated, Dr. Raskar said.
When you add multiple layers of
technology into any system, it
increases the possibility of your
sensitive data leaking out. It's also
expensive and complicated for
everyone involved. "It's completely
unnecessary," Dr. Raskar told
me.PathCheck's idea is to create
simple software code that anyone -
workplaces, schools or airlines - can
incorporate into apps, without the
We need dumb technology that does as little as possible and
knows as little about us as possible.
Photo: Simoul Alva
need to replicate health records.
When you need to show a
vaccination credential, a one-time
code would transmit two pieces of
information: your identity, and that
you're vaccinated. Yes, there's still a
middleman, but the difference is that
the apps would do as little as
possible to access your sensitive
information. The relevant data is
communicated more directly
between your phone and the state
health records. You might have to
show your ID, too.
He compared this proposal to
paying for a sandwich with cash
instead of a credit card. There is no
need for a complicated paper trail
to buy lunch. The metaphor isn't
perfect, but it's useful.Some of the
organizations pitching vaccination
credential technology, including
IBM and the airport screening
company Clear, are making a
similar pitch that their
technologies are as minimal as
possible.Dr. Raskar says that
they're often not, because tech
companies, states and others have
tried to throw a lot of smarts at the
problem. If you hear the word
"blockchain" with vaccine
credentials, know that something
has gone off the rails. The risk is
that we get complicated,
potentially incompatible
technology for people to provide
proof of vaccination.
What we really need is dumb
technology that does as little as
possible and knows as little about us
as possible. "How can we make it
simple, simple, simple as opposed to
what technology companies are
doing, which is to add more?" Dr.
Raskar said.
PathCheck is just one of multiple
companies and nonprofit groups
that are developing fraud-proof
vaccination credentials. It's going to
be confusing for awhile as these
technologies are evaluated and
tested.
But PathCheck deserves credit for
turning the approach to vaccination
credentials on its head. Less and
dumber technology is usually the
best.