Ethnic Disparities in COVID-19

All right, it's great to be with everybody once again today. I would like to talk about a topic that I feel is very important, especially in light of all the events going on in our country right now, and that is COVID 19 and racial disparity. There's something we've definitely seen in the United States literature, hospitalizations, particularly in New York City, where we've seen more of black, Asian and minority groups having severe COVID 19. And so the question, as a physician, I ask myself, why is this? Is this something more or deeper than just ethnicity? Or are there things going on we can actually address and take care of? As a physician, that's my big question. Is there something going on that we can actually address and help improve the outcomes in these groups? And I feel like the answer to this question is yes. Now, unfortunately, there's not a lot of good data coming out of the United States on this. However, the UK again, is a great source for a lot of this data. They put black Asian minority ethnic groups into this grouping called BAME bame. And they've been able to look at this grouping in the UK and actually get some pretty good data points. And that's what I like to talk about today. Are there things that people in these groups can do to improve their outcomes if or when they get exposed to COVID 19? And the big gist is yes, there are. And that's what I like to do, is like to walk through some of this information. So let's do that. So the first thing I'd like to talk about is the concept of vitamin D status as a surrogate marker for nutritional status and inflammation. So vitamin D. I've been talking about vitamin D a lot. It's in the media now a lot. There's up to 71 fold increased incidence of vitamin D deficiency in this group versus, in other words, Caucasian groups in the UK. In the United States, over 80% of African Americans are vitamin D deficient, about 43% of the general population. In my clinic, I routinely see most, pretty much all my patients from India, the Asian subcontinent have low vitamin D levels. And so why is this important? I've been putting lots of stuff on social media, articles about vitamin D. If you're in Indonesia and you're in the intensive care unit and your D level is low, you have a 10.14 fold increased risk of dying from COVID 19. If you're in the UK and you're in the hospital and your vitamin D level is low, you have a 400% increased risk for complications. So these are interesting groups and data points, but I think the point is that you see a correlation with vitamin D deficiency in these groups. Another interesting thing I have actually posted out there on social media is you can correlate there's about a 60, 40 split between complications in males versus females. And that can be accounted for by the difference in vitamin D between these two groups. Now, a lot of things with vitamin D correlation does not equal causation. So just because you see this correlation doesn't mean it's actually the cause, but the science is there. Vitamin D actually helps our body convert and make antibodies. If your D is low, it's harder for your body to make antibodies. Vitamin D also helps improve your natural killer cells, your body's innate immune system, which is part of your body's system for fighting off infections, viruses. If your vitamin D level is low, you have a higher risk for certain cancers like breast, colon, lung, prostate. You also have higher incidence and flu season for actually getting flu. So there's a lot of correlation with vitamin D deficiency. And we tend to see vitamin D deficiency again, over 80% of African Americans in the United States. But in this group, there is almost a 71 full fold increased incidence of D deficiency in one of these studies. So I think that's really pretty strong data. And ultimately vitamin D is a pretty, pretty safe thing to do. So next thing that may help account for some of this population centers. We see that the severity of disease in COVID 19 is mainly in population centers. So New York City in the United States, the northern Italy area of Italy, which is the Lombardy region, London, and then the Wuhan province, which is an industrial center. And you just tend to see more ethnic diversity on population centers. That's just the way big cities, big areas are. They tend to draw a lot of people from around the world. But also in those areas, you have something else which is air pollution. Okay, so we've actually put out some articles about air pollution in the correlation with inhalation of nanoparticles, pollutants that irritate and activate your immune system. Their correlation with disease severity, there's a very close correlation with air pollution and not only COVID 19 disease severity, but severity of Alzheimer's, cardiovascular disease. Some of the research out of noaa, which is the organization that tracks hurricanes, has actually shown what they call, it's called inhalational Alzheimer's, where breathing combusted hydrocarbons is associated with a higher incidence of Alzheimer's, mainly because the inflammatory inflammation response occurs, causes well you know, air pollution. We again, the Wuhan province, which is an industrial center in China, the Lombardy area in Italy, London, the United States, New York. Well, how can we fix that? Well, that's where I love HEPA filters, because HEPA filters will remove 99.99% of all these particles. And actually they will move particles down to 0.3 microns, which means that they remove all the dust. And that's actually where the COVID 19 virus is attached to. But they don't just remove the particles the virus attaches to. They remove these particles that cause inflammation, activate your lung's immune system, and ultimately can be associated with increased risk for lung disease and cardiovascular disease. So cleaning up the air is actually something people can do in their apartments, in their houses, workplaces. In my office, I have help with filters in all my exam rooms as well as my office space to help improve the environment for my patients and my employees. But air pollution, and we see that again, if you're in the city, you're at higher risk for that. And that also includes mold and combustive particles. You tend to see more water damaged buildings in areas that are more poverty. You know, people don't have. It's not much uptake, there's more water leaks, more infestations. There's definitely a correlation with cockroach and bug infestations in the United States with asthma and actually African American kids. So some of these things with severity may have to do with the conditions that are related with the situation as well. Food deserts is something that Dr. Hyman, who's one of the big functional guys in the country, founders for ifm. He helped start the Cleveland Clinic for Functional Medicine. I'm really big into food quality, food access. While these places in the inner cities are food deserts. So what are food deserts? Food deserts are places where you actually have access to food, but it's processed. It's not real food. We know from data from the University of Florida that half of all chronic diseases in our country can be directly related to consuming processed foods. From the Harvard School of Health, we know that 80% of heart disease and 70% of cancer can be prevented by diet and lifestyle alone. So if you have centers, population centers, big cities in Richmond here, it's really interesting. Downtown Richmond. I mean, you literally have to get on a bus and head out of the city or drive 15, 20 miles away to actually find a grocery store that has real food. That's what a food desert is. Well, if you have populations that are kind of trapped in these areas, where they don't have access to real food, it's going to affect their innate immune system. There's data on, I've actually already put this on social media, correlating severity of lung disease and diet. If you actually have a poor diet, you have more severe emphysema and copd. So, you know, these are places where we're seeing the significant outbreaks of COVID 19, where we see lack of access to real nutritious food. There are some genetic issues. The APOE gene we've again talked about a little bit before. Having that gene increases your inflammation and has been associated with more severe COVID 19 as well as severe Alzheimer's, cardiovascular disease. There's some blood typing issues. Certain ethnic groups are more prone to certain blood types as well as the APOE gene. The genes, you know, I don't want to harp on those too much because those are things we can't necessarily change, but we can change the expression of the genes. We know that if you have apoe, for example, with Alzheimer's disease, dietary lifestyle modifications can suppress the expression of that gene, your blood typing. Sometimes people have more or more prone to certain clotting issues. Well, fish oil, that's a simple thing that can actually lower the risk for clotting, vitamin E, especially in people with certain tendencies to clotting. So I think the point is that we do see some reasons for these racial disparities that are actually in our control. We can actually do something about. And so I think that's something important to focus on. What can we actually change? Not just saying this thing's going on, but things like vitamin D status, getting those, that up. That's a simple cheap supplement that, you know, why can't we get that to at risk people? HEPA filters are not expensive. Access to food is a really, really big deal. And clean, a clean environment, clean clean apartments, clean living space where you're not inhaling micro particles that are causing inflammation in your lungs. These are all things that I think make this picture more than just, you know, ethnic disparities and, and illness. But it's a little bigger picture that we need to address, not just from a medical perspective, but from a public health perspective. Every state needs to kind of be involved with this. And my hope is that we can actually address some of these issues and kind of move through this to help with these things. Again, hopefully this is helpful. I am talking to a lot of my patients about these issues, particularly the ones that are in these, such as these risk categories. It's something that I'm applying in my clinic daily to help people kind of navigate so they can improve their risk and decrease improve their health and decrease the risk of severe disease if and when they get exposed to this. So hopefully this was helpful. For more information, please visit our website. We are updating it routinely, putting more educational materials there. Please follow us if you feel like this is helpful. Share with family and friends. Again, one of my goals through these is to educate people, to empower them, to encourage them that they can equip them to actually take charge of their health and not be basically subject to the whims of what's going on around us. Because right now, with all the chaos, I feel like some some good education information will help us to have a little bit of a handle on our health and what's going on around us. Anyway, y' all take care and be safe.