Edition #149 – est 3/2020

The Good, The Bad and the Total
Cholesterol is a waxy type of fat, or lipid, which moves throughout your body in your blood. Your body makes cholesterol, but you can also get it from foods. Cholesterol is only found in foods that come from animals. Every cell in the body needs cholesterol, which helps the cell membranes form protective layers. Cholesterol is also needed to make certain hormones and to produce vitamin D. Your liver makes enough cholesterol to meet your body’s needs for these important functions. without getting it from eating foods.

Cholesterol will not dissolve in blood. In order for it to be transported through the bloodstream to various tissues, it must be carried in lipoprotein “packages” which are complex particles made up of phospholipids, protein, cholesterol, and triglycerides. Most blood cholesterol is carried by the LDL (low density lipoprotein) and HDL (high density lipoprotein).

The LDL cholesterol test measures how much blood cholesterol is being carried by LDL lipoproteins. Elevated levels of LDL cholesterol have been strongly associated with increased cardiovascular risk. For this reason, LDL cholesterol is commonly called “bad cholesterol.” LDL can build up on the walls of your arteries and make them narrower. The fatty deposits form plaque that lines your arteries and may cause blockages. This build-up is called atherosclerosis.The fats linked to LDL cholesterol levels are called saturated fats and trans fats. Saturated fats are solid or wax-like when they are at room temperature. You mostly find saturated fats in products that come from animals, such as meat, milk, cheese and butter.Trans fats result when liquid fats are put through the hydrogenation process to become solid. Trans fats are found in fast foods and fried foods and are used to extend the shelf-life of processed foods like cookies, crackers and baked goods.

The HDL cholesterol test is a measure of how much cholesterol is being carried by the HDL lipoprotein, whose main function is to remove excess cholesterol from the tissues and carry it back to the liver for reprocessing. The HDL lipoprotein can be visualized as a scavenger that removes cholesterol from places where it can do harm, such as the lining of blood vessels. The higher the HDL cholesterol, the more excess cholesterol is being removed. This is why HDL cholesterol is commonly called “good cholesterol.” 

High blood LDL is just one risk factor for heart disease. We can control the amount of saturated fat we eat. Other risks for heart disease that you can control are:

  • Not smoking. If you do smoke, quit.
  • Controlling your cholesterol through diet, exercise, and medicines if indicated.
  • Controlling high blood pressure through diet, exercise, and medicines, if needed.
  • Controlling diabetes through diet, exercise, and medicines, if needed.
  • Exercising at least 30 minutes a day.
  • Keeping to a healthy weight by eating healthy foods, eating less, and joining a weight loss program, if you need to lose weight.
  • Learning healthy ways to cope with stress through special classes or programs, or things like meditation or yoga.
  • Limiting how much alcohol you drink to 1 drink a day for women and 2 a day for men.

Good nutrition is extremely important for your heart health and clean eating will help control many of your risk factors.

  • Choose a diet rich in fruits, vegetables, and whole grains.
  • Choose lean proteins, such as chicken, fish, beans and legumes.
  • Choose low-fat dairy products, such as 1% milk and other low-fat items.
  • Avoid sodium (salt) and fats found in fried foods, processed foods, and baked goods.
  • Eat fewer animal products that contain cheese, cream, or eggs.
  • Read labels, and stay away from “saturated fat” and anything that contains “partially-hydrogenated” or “hydrogenated” fats. These products are usually loaded with unhealthy fats.

The American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fat. That’s about 13 grams of saturated fat per day.

Unfortunately, there are still heart disease risks that you cannot change:

  • Your age. Risk of heart disease increases with age.
  • Your sex. Men have a higher risk of getting heart disease than women who are still menstruating. After menopause, the risk for women gets closer to the risk for men.
  • Your genes or race. If your parents had heart disease, you are at higher risk. African Americans, Mexican Americans, American Indians, Hawaiians, and some Asian Americans also have a higher risk for heart problems.

Elevated lipids are just one piece of the heart disease puzzle. The most important thing to prevent heart disease is an overall healthy lifestyle – no tobacco, maintain a healthy weight, stay active, less alcohol, less stress, don’t get diabetes, keep blood pressure normal and enjoy a diet rich in whole foods.

American physiologist Ancel Benjamin Keys can be credited with originating and cementing the saturated fat/cholesterol theory of heart disease. In the 1950’s, Keys produced research that showed perfect correlations between cardiovascular disease and the dietary consumption of fat in several prominent Western countries. Sugar soon became a popular stand-in in low-fat foods to improve taste. Fat was also replaced with carbohydrates in our diets. Now, there’s increasing evidence linking processed carbohydrates and sugary foods with heart disease. In other words, we now know that heart disease risk is not just about your lipids.

Refined sugars found in ultra processed foods are the worst. Products with added sugars represent 75% of all packaged foods and beverages. Sugars occurring naturally in fruits and vegetables pose no increased risk for heart disease. Next week I’ll be writing about the relationship between sugar and heart disease – independent of cholesterol levels!

Have a heart-healthy week!

Why is my rapid test negative, but I’m sick?
How Rapid COVID tests work…

Just because your rapid test takes a while to turn positive ⁠— or doesn’t at all ⁠— it doesn’t mean you’re free of infection or that your test is a fraud. Rapid COVID tests, also called antigen tests, detect bits of proteins on the surface of the coronavirus.

Here’s how rapid tests work and why you can get false negative results when you have COVID, particularly in the early stages of infection:

  1. Rapid tests are only going to pick up virus when you’re at the peak window of the viral load
  2. This window for the viral peak varies widely depending on the person – it could be three days, six days, or even a week or more.
  3. The intensity of that second line on your rapid test is likely an indicator of how infectious you are. The darker it is and the quicker it appears means you have a higher viral load and risk  spreading the virus, and vice versa.
  4. Viral load correlates with contagiousness so if your rapid test is positive (with or without symptoms), isolate yourself from others. If it’s negative, either before you actually feel sick or after symptoms resolve, you’re likely not infectious.
  5. Rapid tests are almost never false positive. No need to confirm with a PCR test
  6. If you have coronavirus symptoms and test negative on a rapid test, you can confirm that result with a PCR test or take another rapid within the next two days.
  7. If you swab your nose incorrectly or drop too much of the liquid onto the test, you can end up with a false negative
  8. Don’t be surprised if your PCR test stays positive for weeks or months after initial infection. It’s normal and common. PCR tests can be positive even though you’re no longer contagious because they can pick up on really low viral loads or pieces of dead virus that can’t make you or others sick.
Think of your viral load like a mountain. It goes up sharply to a peak and then it starts to decline eventually down to zero. Your antigen test will be positive when you are at your peak. This is also when you’re most infectious. The window of peak viral load when rapid tests will appear positive can be relatively short and some people are going to miss it entirely.

Your vaccination status can affect your test results because you will experience symptoms earlier in the infection and at a much lower viral load because your bodies has antibodies to attack the virus. This is good because you want your immune system to react and kill the virus before it does all the tissue damage during its peak viral load. It’s pretty common for vaccinated people to have delayed positive rapid tests despite symptoms. Vaccinated folks can expect to see a positive rapid test result one to three days after symptoms start. However, rapid tests may turn positive earlier in unvaccinated people.

Rapid COVID tests aren’t influenced by symptoms — they only turn positive if your nasal swab has enough virus it can detect. While logically you might think more virus equals more symptoms, that’s not always the case. Your runny nose and muscle aches are just your body’s reactions to it fighting the coronavirus off, and that reaction varies depending on if you’ve encountered the germ before, either from an infection or vaccination. It could take several days after symptoms appear for your body to produce a viral load that a rapid test will pick-upHaving symptoms can be a bonus, however, because they can help you decide when to take your rapid test to ensure you get the most accurate results possible. You can still spread the coronavirus even if you’re symptom-free. This means rapid tests are also helpful tools for asymptomatic people, though it’s harder to tell when to take a test without symptoms to guide you.

It’s unclear how viral load differs between symptomatic and asymptomatic people infected with the Omicron variant, but many early studies found it was comparable among the groups.

An important takeaway: Rapid test results can change quickly as your viral load rises and drops, often within hours, so if you don’t have COVID symptoms, taking a rapid test “right before” you have an event is much better than using it the day or morning before because in 12 hours that test could read positive!!


  • The rate of new infections in Pennsylvania has plunged, with the seven-day average of new infections falling to 6,856 as of Saturday, after reaching about 28,000 in mid-January, according to tracking by SpotlightPa. Pennsylvania hospitals were caring for 3,794 patients with COVID-19 as of Sunday, down from about 7,500 a few weeks ago, according to state data.
  • Pennsylvania last week began opening four regional centers around the state to care for COVID-19 patients well enough to leave the hospital but still in need of long-term care. Hospitals for weeks had described a shortage of nursing home and rehabilitation openings, preventing them from discharging patients and creating hospital bed shortages and log jams.
  • 70% of Americans agreed with the statement that “it’s time we accept Covid is here to stay and we just need to get on with our lives” in a recent poll by Monmouth University. Support for vaccine mandates dropped to 43 percent from 53 percent in September, and support for masking and social-distancing guidelines dropped to 52 percent from 63 percent over the same period.  People are still worried about the virus, but the larger worries about the virus have not translated into greater support for measures to stop its spread. Instead, fears of the virus apparently have been outweighed by mounting frustration with the inconveniences of the pandemic.
  • Pfizer made nearly 37 billion dollars in sales from its Covid-19 vaccine last year – making it one of the most lucrative products in history – and has forecast another bumper year in 2022, with a big boost coming from its Covid-19 pill Paxlovid.
  • Gov. Kathy Hochul dropped New York’s stringent indoor mask mandate on Wednesday, ending a requirement that businesses ask customers for proof of full vaccination or require mask-wearing at all times, and marking a turning point in the state’s coronavirus response. Democratic-led states from New Jersey to California have announced similar moves this week. The moves highlight how even local officials who installed sweeping safety measures early in the pandemic are now preparing to live permanently with the virus. Mayor Kenney…?
  • Better data is painting a more optimistic picture about immunity after a bout of COVID-19. The future of COVID-19 is starting to become clearer: We’re still going to see a lot more infections but markedly fewer hospitalizations and deathsData suggest that, on average, people will be reinfected every year or two with SARS-CoV-2. Of course, if you’re unvaccinated, your risk of a deadly first covid infection exists. If you’re vaccinated and get a breakthrough infection, that risk is negligible. This is what we’ve learned:
  1. If you’re unvaccinated and survived a prior COVID-19 infection then that reduced the risk of future hospitalization by 90% if you got reinfected. These findings, published in the New England Journal of Medicine in December, are consistent with data released by the Centers for Disease Control and Prevention last month.
  2. Antibodies against SARS-CoV-2 persist in the blood for at least 20 months and possibly years after an infection, scientists at the Fred Hutchinson Cancer Research Center and Emory University have reported.
  3. When antibody levels start to stabilize – after an infection or after a vaccination series – the immune system generates special cells, called long-lived plasma cells, that can make potent antibodies against SAR-CoV-2, for decades, possibly even a lifetime.
  4. The immune system will also generate B and T immune cells which kick into action upon reinfection – this is true if vaccinated or if you had a prior covid infection. These cells quickly ramp up antibody levels and destroy infected cells to ensure a mild course of COVID doesn’t turn into a serious one. Several studies, including one published in January, have shown that these cells are durable and likely persist longer than year.
  • In a press briefing Feb. 2, CDC Director Rochelle Walensky said both hospitalization and death rates — as well as vaccination rates — are key to determining whether to lift public health measures such as masking. The issue is hospitals see patients arriving for non-Covid reasons and testing positive during screenings, skewing the national hospitalization covid rates. The goal is to get a more accurate sense of Covid-19’s impact across the country and whether the virus is causing severe disease. Lower hospitalization rates could inform the administration’s thinking on public health measures such as masking. More accurate Covid-19 numbers also could provide a better picture of the strain on hospitals and which resources they might need during surges.
  • A study published January in Clinical Infectious Disease concluded that COVID-19 deaths are rare in fully vaccinated persons. Of 8,084 reported COVID-19 cases among fully vaccinated persons during the surveillance period, 245 (3.0%) died. Among the 245 deaths, 191 (78%) were classified as COVID-19-related. The others were not related to their Covid-19 infection. Those who died were:
  1. Older (median age 82 years)
  2. More likely to reside in a long-term care facility (51%)
  3. More likely to have at least one underlying health condition associated with risk for severe disease (64%)
  • Some public health experts think it’s too soon to celebrate, but most agree that a whole bunch of Covid mitigation measures, many of them introduced in March 2020, seem to have become unnecessarily permanent – from plexiglass barriers in restaurants to the elimination of housekeeping and buffets at hotels to ostentatious “deep cleaning” protocols on airlines. Here’s some mitigation measures Infectious Disease physicians would end right now:
  1. Abraar Karan, infectious disease fellow at Stanford University: “A mitigation measure I would end immediately is restricting visitors to patients who are near end-of-life with Covid-19. We know that many of these patients are actually in the inflammatory state of the disease and are likely at very low risk of transmitting to others around them”.
  2. Amesh Adalja, senior scholar at the Johns Hopkins Institute for Health Security: “I would immediately end the risk averseness of universities. Many universities and colleges have vaccine — and booster — requirements, yet still cling to aggressive masking, social distancing, and testing policies with no off-ramps. College students are low-risk for severe disease and having them fully vaccinated should be sufficient to ensure the resiliency of universities to what will be an ever present virus.”
  3. Megan Ranney, emergency physician and professor at Brown University: “Plexiglass barriers and digital menus should have been dropped a long time ago — we’ve known for more than a year that they’re useless. Outdoor masking is similarly pointless (unless you’re in a very small, crowded area).
  4. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development: “If Omicron continues its downward trajectory, then mask restrictions can lift by the new target dates set by many of the governors.”
  5. Monica Gandhi, infectious diseases expert at the University of California at San Francisco: “I would immediately end digital menus in restaurants, members of the service industry wearing rubber gloves, and deep cleaning anywhere, as Covid is not spread by fomites and such measures spread unnecessary fear (and are non-scientific). I would also end temperature screening, as Covid can spread when asymptomatic.
  6. Syra Madad, infectious disease epidemiologist at the Harvard Belfer Center: We should reevaluate lifting measures like mask mandates based on local context (i.e. hospital capacity, community transmission levels, vaccination rates, access to testing); and remove measures that never really worked in the first place — like plexiglass barriers. 


  • A spillover event occurs when a highly-infected population passes the virus to another species that hasn’t encountered it (or that particular variant) before. In a study published last year, Penn State researchers identified the coronavirus in about one-third of white-tailed deer sampled in Iowa between September 2020 and January 2021. Another research group found the virus in one-third of sampled deer in Ohio from January to March 2021. Scientists worry that deer could serve as a reservoir for the coronavirus, even after COVID-19 becomes endemic in humans. Scientists have detected the virus in cats, dogs, ferrets, mink, pigs, and rabbits. For now, scientists don’t know whether deer can spread the coronavirus to humans – they just know that the virus is quite good at infecting deer populations.
  • Israeli scientists said they found “striking” differences in the chances of getting seriously ill from COVID-19 when they compared patients who had sufficient vitamin D levels prior to contracting the disease, with those who didn’t. The findings suggested vitamin D helped bolster the immune system to deal with viruses that attack the respiratory system. The research doesn’t prove vitamin D protects against COVID-19 and isn’t a green light to avoid vaccines and take vitamins instead. The Israeli researchers cautioned vitamin D was “one piece of the complex puzzle” underlying severe COVID-19, in addition to comorbidities, genetic predisposition, dietary habits, and geographic factors.
  • The World Health Organization says overuse of gloves, “moon suits” and the use of billions of masks and vaccination syringes to help prevent the spread of the coronavirus have spurred a huge glut of health care waste worldwide. The U.N. health agency reported Tuesday that tens of thousands of tons of extra medical waste has strained waste management systems and is threatening both health and the environment, pointing to a “dire need” to improve tho