Edition #147 – est 3/2020

This edition will discuss Cold Weather Health Hazards along with COVID-19 updates

“…The chance that an older, vaccinated person will die of covid is now lower than the risk posed by the seasonal flu…”
Dhruv Khullar, a writer at The New Yorker and an assistant professor at Weill Cornell Medical College.

Thinking about that statement…
What level of disease are YOU willing to accept?
When will you be ready to enjoy an unrestricted life again?

10 Cold Weather Health Hazards
   Whenever temperatures drop below what feels lower than normal to you—and as wind speed increases—heat can leave your body more rapidly and leave you at risk for health problems. For those with chronic medical problems, cold weather can cause even more problems, Here are ten cold weather hazards to watch out for:
  1. Heart Attacks:   When temperatures plummet, your risk of a heart attack or heart problems increases. During cold weather, blood vessels narrow in a process called vasoconstriction and if you have known heart disease then your already narrowed arteries become even more narrower. If your vessels are narrowed, your heart will not get enough oxygen through its blood supply. This makes your heart work harder to increase it’s blood supply and your risk of having a heart attack increases. Especially if you are exerting yourself with shoveling snow or exercising outdoors.
  2. Lung Disease Exacerbations:   Cold air, which is typically very dry as well, can irritate your lungs and cause wheezing, coughing, and shortness of breath, according to the American Lung Association. This is especially true for people with asthma, COPD, or chronic bronchitis. To protect yourself against any potential damage to your airways, experts recommend covering your nose and mouth with a scarf when going out into severe cold temperatures and avoiding outdoor exercises.
  3. Itchy Skin:   During the winter months, when the air is at its coldest and driest, your skin is the most susceptible to drying out. As humidity levels drop, ensuring your skin stays hydrated is a difficult task. In order to limit dryness, the American Skin Association recommends you regularly apply moisturizing creams, use a mild non-soap skin cleanser, always wear gloves and avoid rubbing or scratching the skin.
  4. Frostbite:   This is caused by a lack of blood flow to a part of the body.. Your body will want to concentrate your blood around your core to preserve your heart, lungs, and brain. This leaves your fingers, toes, arms, and legs at risk for frostbite. Frostbite can cause permanent damage, loss of limb, or in severe cases death.
  5. Hypothermia:   This happens when you lose body heat faster than your body can make it. Your core body temperature is 98.6 degrees Fahrenheit. If your core drops to or below 95 degrees Fahrenheit, hypothermia will set in. Symptoms of hypothermia include shivering, numb extremities, loss of dexterity, and feeling extremely cold. If hypothermia is left untreated, it will lead to complete failure of your heart and lungs, causing death.
  6. Arthritis Flares:   Arthritis is an inflammation of the joints that can cause pain, swelling and impaired movement. Cold weather lowers the barometric pressure and can restrict blood flow which leaves joints stiffer than normal. Additionally, this can cause tissue in the body to expand, which puts more pressure on your nerves. Usually it is harder to get outside or exercise as much when it is cold, but those suffering with arthritis should remain active to exercise their joints.
  7. Sedentary Lifestyle:  There’s something about the cold, dark days that just make you want to curl up with a warm blanket and a good book. While this is okay on occasion, you shouldn’t let the change of weather cause a sedentary lifestyle. Being sedentary can have effects on your health, including weight gain, which can put you at risk for conditions such as Type 2 diabetes, high cholesterol and other conditions. It’s important to maintain an exercise routine, but it’s probably best if you choose indoor activities, since exercising outdoors can bring about health concerns of its own.
  8. Uncontrolled Diabetes:   Because of the body’s changes in blood circulation in the cold, blood sugar levels in folks with diabetes can be erratic, mostly in type 1 diabetes, but it’s also possible in type 2 diabetes.  If you’re feeling dizzy or weak when you come back inside, check your blood sugar. If you’re using insulin and you keep it in the car, bring it inside so the medication doesn’t freeze. If you have diabetic neuropathy, or nerve damage, be aware that you may not be able to feel when your feet are getting too cold outside and that you are at higher risk for frostbite.
  9. Harder to fight off infections: Many researchers believe that exposure to cold weather can adversely affect a person’s immune response, making it harder for the body to fight off infections. Reasons for this may include reduced vitamin D levels. During the winter months, many people get less vitamin D due to reduced sun exposure. ResearchTrusted Source suggests that vitamin D plays an essential role in maintaining the immune system. We also spend more time indoors in colder weather and viruses spread more when people are close to each other.
  10. More Falls:  With colder weather comes ice. Outdoor falls increase in the winter, especially for older adults. Watch where you’re walking and especially if sidewalks appear dry because there may be some frozen water you don’t see and before you know it you’ve slipped and broken your hip or arm. Make sure you’re also dressed warmly so you’re not rushing to get inside and end up falling.

The best ways to avoid cold weather health hazards are to dress warnly, take your time walking outside, don’t exert yourself too much while outside (save it for inside workouts) and take appropriate precautions if you have lung problems or you’re diabetic. Dressing in layers is the best way to stay warm – you can shed some layers if you start to overheat and then you won’t perspire. Make sure your hands, ears and head are covered. Also take care to wear warm socks and appropriate footwear for the weather.

  •  Currently, any known exposure to COVID means a US worker has to temporarily quarantine – in the US, an average of @ 800,000 people/day are testing positive for omicron. Workforce disruptions have occurred coast to coast. With COVID-19 testing appointments hard to find and labs inundated with samples, some employees are out even longer than usually necessary, as they search for tests and wait for results. Here’s Philly’s workforce numbers:
  1. Three sources in the Phila Police Department said absences last week were in the hundreds due to quarantining
  2. More than a third of sanitation collection workers have been out quarantining
  3. Workers in Philadelphia’s prisons and juvenile justice service centers have been out in larger percentages.
  4. An average of 600 bus and trolley operators — out of about 2,600 — missed work each day last week because of quarantining
  5. In the Postal Service region that includes most of Eastern Pennsylvania, South Jersey, and most of Delaware, there have been upward of 100 positive cases per day requiring quarantining during the surge
  6. Philadelphia courts are rescheduling cases due to quarantining staff particularly with complex trials that involve multiple parties
  7. Half of the Phila district’s public schools are closed because so many staff are quarantining
  8. Restaurants are closing due to staff out in quarantine
  • It’s been reported vaccination rates for Philadelphia children and children around the United States are low, and lack of access is one of the reasons for the low rate. In addition to vaccination clinics in schools, FEMA will sponsor a mobile van unit for the Black Doctors Consortium to take across the city vaccinating community based organizations, as well as non-school district people during school hours. School District of Philadelphia vaccination events are listed here. Additional information can be found on the City of Philadelphia’s website and at vaccines.gov, sponsored by the CDC.
  • New COVID-19 cases in Philadelphia have begun to drop, according to the city Department of Public Health. Cases appear to have peaked around Jan. 9. Now, they’re falling as quickly as they rose: Cases are 50% lower this week, hovering around 1,980 new cases per day — down from more than 3,500 new cases per day last week.


  • Based on new Centers for Disease Control and Prevention recommendations, the city is adjusting its guidance for those who test positive in Philadelphia schools. Current Philadelphia protocol recommends that students or staff who test positive must remain out of class for a 10-day isolation period. That guidance remains in effect, unless the school is able to implement several layers of protective measures. If the school is able to implement the following, students can return after five days, as long as they continue to wear masks for five more days:
  1. Proper ventilation
  2. Contact tracing for maskless, high-risk exposures
  3. Weekly screening tests for students: At least 10% of the school’s unvaccinated population should be tested weekly
  4. Maintaining a separate area for teachers and students who have returned before 10 days to remove their masks and eat lunch
  5. Strict masking
  6. Teachers and staff members who test negative on a rapid test two days in a row after five days can return to class, with masks.
  7. Schools or education agencies must consult with the city Health Department to demonstrate they can meet all of the above required mitigation layers before switching to the five-day system.
  8. Due to the extremely high amount of community spread, the Philadelphia School District will no longer use overall case numbers as a metric for ending in-person classes. Individual schools may still suspend in-person classes if a substantial number of staff members or students are out with the virus.
  • Tickets to the upcoming Winter Olympics and Paralympics in Beijing won’t be sold because of the “current grave and complicated situation of the COVID-19 pandemic,” said officials in China, where the discovery of the first omicron variant infection Saturday has led to increased efforts to prevent the virus from spreading. Organizers had previously announced no spectators from outside mainland China would be allowed at the Games as a safety measure. In a statement Monday, they said groups of fans who “strictly abide by the COVID-19 countermeasures before, during and after each event” would be invited to watch in person. The Winter Games begin Feb. 4. Athletes, officials, staff and journalists will be required to enter a closed-loop bubble without outside contact and undergo daily testing.
  • The increase in antibodies produced by a fourth shot of COVID-19 vaccine is not enough to prevent infections from the omicron variant, according to preliminary research at an Israeli hospital. The Israeli government says more than 500,000 people have received fourth doses since it started offering them to those age 60 and older weeks ago, and yet the country has endured an outbreak that has caused a record-setting number of cases and rising hospitalizations.
  • The new CDC mask recommendations state loosely woven cloth masks provide the lowest level of protection and that respirator masks that are approved by the National Institute for Occupational Safety & Health (NIOSH) provide the highest level of protection from particles including the virus that causes COVID. “Loosely woven cloth products provide the least protection, layered finely woven products offer more protection, well-fitting disposable surgical masks and KN95s offer even more protection, and well-fitting NIOSH-approved respirators (including N95s) offer the highest level of protection,” the CDC states.
  • The Biden administration will begin making 400 million N95 masks available for free to U.S. residents starting next week. The White House announced Wednesday that the masks will come from the government’s Strategic National Stockpile, which has more than 750 million of the highly protective masks on hand. The masks will be available for pickup at pharmacies and community health centers across the country. They will begin shipping this week for distribution starting late next week, the White House said.
  • Biden this week launched a website for Americans to order four rapid tests to be shipped to their homes for free, with the first tests to ship later this month.  You can now order your free COVID tests from COVIDTests.gov, and the federal government will send them out at no cost to you — including no shipping fees. A half-billion tests will be available for order at first, with an additional half-billion on order. Postal workers at 43 facilities around the country — including in Philadelphia, Harrisburg, and Pittsburgh — will build and label millions of the testing kits for mail delivery.
  • Starbucks told its employees in a memo on Tuesday that they would no longer be required to be fully vaccinated or submit to weekly coronavirus testing. Just two weeks earlier, the company had detailed the requirement and set a deadline of Feb. 9. The Supreme Court’s ruling last week shut down the Biden administration’s effort to enlist large employers in its vaccination campaign. Now Starbucks, with 9,000 U.S. coffee shops and 200,000 workers, has became one of the first major retailers to backtrack on its vaccine plans since the ruling. The company continues to encourage its employees to get the vaccine and booster, and offers two hours of paid time off for getting the shots.
  • To get the most from your rapid test, wait at least 48 hours after symptoms and 5 days after exposure before taking an antigen test. If you’re negative, test again 24 hours thereafter. You can certainly test sooner, but any negative results will be unreliable. A positive antigen test result, on the other hand, is very reliable right now, especially after exposure or with symptoms. The CDC rapid testing website FAQ section advises testing as soon as you begin feeling symptoms, but if you’re using an antigen test, its best to wait the extra 48hrs for accuracy.
  • study compared the sensitivity of the BinaxNOW nasal antigen tests among 731 people in San Francisco from January 3-4, 2022. They first took a PCR lab test and then those that were positive took the antigen test to see if that, too, would be positive:
  1. Those with no symptoms had a sensitivity of 89.8% on the antigen tests
  2. Those who were symptomatic, had a sensitivity of 97.6% on the antigen tests
  • A separate modeling study in the U.K. estimated the impact of leveraging antigen tests to end isolation (something the CDC is not recommending). Specifically, the scientists were interested in how many people would be infectious given different policy recommendations. What did they find?
  1. During a 5-day isolation period (and not using an antigen test), there is a 1 in 3 (31%) chance you’re still infectious.
  2. During a 7-day isolation period (and not using an antigen test), there is a 1 in 6 chance you’re still infectious.
  3. If you use an antigen test on Day 7 of isolation and it’s negative, there is less than a 1 in 10 chance you’re still infectious. This is the same odds as if you isolated for 10 days without testing.
  • For most of the coronavirus pandemic, the loss of smell and taste have been known as signature symptoms, and a study published Monday in the journal Nature Genetics identified a genetic risk factor associated with the loss of smell after a Covid infection. This genetic risk factor increases the likelihood a person infected with SARS-CoV-2 will experience a loss of smell or taste by 11 percent.
  • Have you been trying to remedy the fog on your glasses when you wear a mask? If so, your mask doesn’t fit.  Masks need to fit very snugly — the whole idea is not to let air come in and out around the edges. Try tightening up the nose band or straps, or try another style of mask.
  • Since much earlier in the pandemic, scientists have been busily investigating how patient genetics influence the severity of a SARS-CoV-2 infection and now an international team of researchers has identified a specific gene variant that can confer protection from critical illness. The variants conferred an approximately 23 percent reduced risk of becoming critically ill in cases of SARS-CoV-2 infection. The variant in question – called rs10774671 G – confers protection against COVID-19 severity independently of other associated alleles
  1. Covid passes showing vaccine status or a recent negative test will no longer be compulsory to gain entry to venues and events
  2. Face masks will no longer be compulsory in any public spaces – although they will be still be “recommended” in some places and they will remain mandatory on the tube and buses
  3. restrictions on visits to care homes will be eased
  4. Face masks would no longer be compulsory in secondary school classrooms from Thursday 20 January,
  5. The Department for Education would shortly remove national guidance on face masks in communal areas.
  6. The prime minister wants to scrap mandatory self-isolation for people who test positive for Covid.
  7. People who test positive for Covid can now end self-isolation after seven days instead of the previous 10, subject to two negative lateral flow test (antigen) results on days six and seven
  8. Children and fully vaccinated adults no longer need to take a pre-departure test before traveling to the UK and can now take an antigen test instead of a PCR on arrival.

Bralow Medical Group Office Information

Our first priority is your health and safety

If you are my patient then you know to contact me directly on my cell phone 24/7 if you have any  medical concerns. You can also email me at drbralow@mdvip.com with general questions.

Click here if you’d like to subscribe to this newsletter.

Please stay safe and be smart,
Dr Bralow