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Should you prescribe Wordle?
By Joe Hannan | Fact-checked by Barbara Bekiesz
| Updated March 31, 2022
- Research suggests that digital and analog games may ward off cognitive decline, which can be common during aging.
- Games may prove useful for clinicians who promote healthy aging among their patients, as the global population over the age of 60 is projected to increase to 2.1 billion by 2050.
- Computerized games designed explicitly for cognitive enhancement, as well as traditional analog games and physical-video hybrids, have all demonstrated mental—and in some cases, physical—efficacy.
Take a moment to look at the patients in your waiting room. Many are likely locked on to their smartphones, and some may be among the millions playing Wordle, a puzzle that gives players six chances to guess a five-letter word.
The rise of Wordle got the attention of The New York Times, which added the game to its suite of brainteasers for a sum estimated in the low seven figures. A game with a massive following has monetary value, but do games like this also have clinical utility?
Promising research on cognitive games
The world’s population increasingly has a touch of gray, according to the WHO. Globally, there were 1 billion people over the age of 60 in 2019. The WHO estimates that there will be 1.4 billion in this age category by 2030 and 2.1 billion by 2050. Efforts to stave off cognitive decline may prove essential for this aging population.
Cognitive games are one way to do it. A 2020 meta-analysis published in Scientific Reports offers some insights.
Researchers reviewed 16 studies comprising more than 1,500 participants to examine whether computer-based games could improve various cognitive measures among a group of people over the age of 60 without cognitive impairments.
Among the findings were statistically significant improvements in processing speed, working memory, executive function, and verbal memory. There was no relationship between the participant’s age and the amount of training required. This suggests that healthy older adults retain the ability to learn as they age.
For clinicians, the researchers suggested including commercial computerized cognitive games among their recommendations to older patients to help them avoid cognitive decline and maintain cognitive abilities. Such games should be used in combination with healthy lifestyle, aerobic exercise, and other methods of brain training, the researchers wrote.
The games assessed in this study were, for the most part, developed explicitly to improve cognitive performance. This is not the case with Wordle. However, other research indicates that more conventional games—and even some classics—have their clinical benefits.Related: The surprising health benefits of this ‘lazy’ pastime
What about board games?
How about a game of chess, bingo, cards, or a crossword puzzle? If your patients aren’t tech-savvy, a 2019 longitudinal cohort study published in The Journals of Gerontology suggests that games of the old school, analog variety are associated with less relative cognitive decline.
This study Included 1,091 people living in Scotland. All were born in 1936 and were living independently in their communities throughout the study. Cognitive function was assessed at age checkpoints starting from age 11 up to age 79, using 14 cognitive tests. The assessments at age 11 served as controls. Later in life, at ages 70 and 76, researchers asked the participants if they were still playing analog games.
Those who gamed more frequently tended to exhibit the following:
– At age 70, elevated cognitive function, the majority of which could not be attributed to control variables.
– From age 70 to 79, less general cognitive decline and less memory decline.
– From age 70 to 76, less of a drop in cognitive speed among those who increased their gaming
The researchers note that, for clinicians, the difficulty lies in the application of these findings. “It will be a challenge to determine how best to apply these findings in practice, as our results suggest that a lifetime of playing games is the best way to capture the benefits,” the researchers wrote.
Acknowledging that evidence is still limited, the researches stated that “there do not appear to be any harmful effects of playing games. Thus, analog games are an affordable and fun activity that could protect against cognitive decline.”
Digital games, real-world benefits
While analog games are helpful, research indicates that asking aging patients to pick up a game console controller may be beneficial for them, too.
A 2020 systematic review published in Games for Health Journal combed five databases to identify articles that could shed light on whether video games promoted physical and mental health among people age 65 and older. Of the 806 articles they found on this topic, 23 met their inclusion criteria.
Among those 23 studies, 20 demonstrated that video games improved physical health, and 14 showed that they promoted mental health.
For physical health, researchers found that video-game interventions improved walking/gait, fitness, strength, mobility, and balance.
Mental-health benefits included better processing speed, executive function, reaction time, and confidence in one’s balance. The most popular intervention was Exergame, a platform that blends physical exercise with digital interfaces, emulating a videogame experience.
The researchers concluded that additional research may firm up a surprising hypothesis:
“We also found that videogame-based interventions could outperform traditional training programs regarding walking performance/gait parameter, balance confidence/fear of falling, and executive functions. However, our review could not find any articles that reported direct social health outcomes.”
What this means for you
Cognitive games may help stave off cognitive declines among an increasingly older population.While the increasingly popular game Wordle hasn’t been studied directly yet for any cognitive benefits, research indicates that digital games are, in fact, effective and that similar benefits can be obtained from traditional analog games. Based on these findings, clinicians can regard games as a useful tool to support healthy aging.
- Altschul DM, Deary IJ. Playing analog games is associated with reduced declines in cognitive function: a 68-year longitudinal cohort study. J Gerontol B Psychol Sci Soc Sci. 2020;75(3):474-482.
- Ageing. World Health Organization. 2022.
- Bonnechère B, Langley C, et al. The use of commercial computerised cognitive games in older adults: a meta-analysis. Sci Rep. 2020;10:15276.
- Tracy M. The New York Times Buys Wordle. The New York Times. January 31, 2022.
- Xu W, Liang HN, et al. Health benefits of digital videogames for the aging population: a systematic review. Games Health J. 2020;9(6):389-404.
A brain expert shares his 7 ‘hard rules’ for boosting memory and fighting off dementia
Published Sun, Nov 13 20229:39 AM EST
caracterdesign | Getty
The average human brain shrinks by approximately 5% per decade after the age of 40. This can have a major impact on memory and focus.
But serious mental decline doesn’t have to be an inevitable part of aging. In fact, certain lifestyle factors have a greater impact than your genes do on whether you’ll develop memory-related diseases.
As a neuroscience researcher, here are seven hard rules I live by to keep my brain sharp and fight off dementia.
1. Keep blood pressure and cholesterol levels in check
Your heart beats roughly 115,000 times a day, and with every beat, it sends about 20% of the oxygen in your body to your brain.
High blood pressure can weaken your heart muscle, and is one of the leading causes of strokes. Ideally, your blood pressure should be no higher than 120/80.
Cholesterol is critical to your brain and nervous system health, too. The American Heart Association recommends getting your cholesterol levels measured every four to six years.
2. Manage sugar levels
Blood sugar is the primary fuel of the brain. Not enough of it, and you have no energy; too much, and you can destroy blood vessels and tissue, leading to premature aging and cardiovascular disease.
Keep in mind that sugar isn’t enemy, excess sugar is. It’s easy for grams of sugar to add up, even if you think you’re being careful — and usually, sugar will sneak in through packaged foods.
Where is the sugar hidden? Look for these in the ingredients list:
And be wary of any product that includes syrup, such as agave nectar syrup or high-fructose corn syrup.
3. Get quality sleep
Studies show that people with untreated sleep apnea raise their risk of memory loss by an average of 10 years before the general population.
For most people, a healthy brain needs somewhere between seven and nine hours of sleep a night.
My tips for memory-boosting, immune-enhancing sleep:
- Keep a consistent bedtime and wake-up schedule.
- Turn off devices one hour before bedtime.
- Do something relaxing before bedtime, like listening to soft music or doing mindful breathing exercises.
- Go outside and get in natural sunlight as soon as you can after waking up.
4. Eat a nutritious diet
One way I keep things simple is to have most, if not all, of these items in my grocery cart:
- Fatty fish like salmon
- Cruciferous veggies like arugula, broccoli, Brussels sprouts and collard greens
When food shopping, I ask myself three questions to help determine whether something is good for my brain:
1. Will it spoil? In many cases, perishable is a good thing. The additives and preservatives that keep food from spoiling wreak havoc on your gut bacteria.
2. Are there tons of ingredients in that packaged food? And for that matter, can you pronounce the ingredients? Or does it look like the makings of a chemical experiment? Also avoid anything where sugar is one of the first few ingredients.
3. Do you see a rainbow on your plate? The chemicals that give fruits and vegetables their vibrant colors help boost brain health.
5. Don’t smoke (and avoid secondhand and thirdhand smoke)
Then there’s thirdhand smoke, which is not actually smoke. It’s the residue of cigarette smoke that creates the telltale smell on clothing or in a room. That residue alone can emit chemicals that are toxic to the brain.
6. Make social connections
In a recent study, people over the age of 55 who regularly participated in dinner parties or other social events had a lower risk of losing their memory. But it wasn’t because of what they ate, it was the effect of the repeated social connection.
To lessen isolation and loneliness, you can also boost brain chemicals like serotonin and endorphins by performing small acts of kindness:
- Wish others well or check in with somebody.
- Give a compliment without expecting anything in return.
- Make a phone call to somebody you don’t usually reach out to.
7. Continuously learn new skills
Maintaining a strong memory is not all about brain games like Sudoku, Wordle and crossword puzzles.
Learning skills and acquiring information are much more effective ways to make new connections in the brain. The more connections you make, the more likely you are to retain and even enhance your memory.
When you think about learning something new, approach it the way you would with fitness training. You want to work out different muscles on different days. The same goes for the brain.
Over the course of this week, try cross-training your brain by mixing mental activities (learning a new language or reading a book) and physical learning activities (playing tennis or soccer) .
Marc Milstein, PhD, is a brain health expert and author of “The Age-Proof Brain: New Strategies to Improve Memory, Protect Immunity, and Fight Off Dementia.” He earned both his PhD in Biological Chemistry and his Bachelor of Science in Molecular, Cellular, and Developmental Biology from UCLA, and has conducted research on genetics, cancer biology and neuroscience. Follow him on Twitter and Instagram.
Is your partner a man-child? No wonder you don’t feel like sex
Published: November 24, 2022 10.09am AEDT
- Emily Harris Postdoctoral fellow in psychology, The University of Melbourne
- Sari van Anders Canada 150 Research Chair in Social Neuroendocrinology, Sexuality, & Gender/Sex, Queen’s University, Ontario
Sari van Anders receives funding from the Canada 150 Research Chair program.
Emily Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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A man sits on the couch, watching TV. His partner, a woman, prepares dinner, while mentally ticking off her to-do list. That includes returning her partner’s shirts she’d ordered online for him last week, and booking a GP appointment for their youngest rint
He walks in and asks her “what’s for dinner?”, then goes back to the TV.
Later that night, he’s surprised she’s not interested in sex.
The people in this scenario are a woman and a man. But it could be a woman and her child. The dynamics are very similar – one person providing instrumental and emotional care, and the other receiving that care while showing little acknowledgement, gratitude or reciprocation.
You’re reading about a man who depends on his partner for everyday tasks that he is actually capable of. Some people call this the “man-child” phenomenon.
Maybe you’ve lived it. Our research shows it’s real.
The man-child is real
The man-child phenomenon (or perceiving a partner as dependent, as we call it) describes the blurring of roles between a partner and a child.
You may hear women describe their male partners as their “dependent” or one of their children.
When a partner starts to feel like they have a dependent child, it’s not surprising if that affects a woman’s sexual desire for him.
We set out to explore whether this might explain why many women partnered with men report low sexual desire.
Surprisingly, until our study, there were no studies that had tried to directly measure the impact of the man-child phenomenon on women’s sexual desire.
What we did
We conducted two studies with more than 1,000 women from around the world, in relationships with men. All our participants had children under the age of 12.
We asked the women to rate their agreement with statements like, “Sometimes I feel as though my partner is like an extra child I need to look after.” We also asked them about the division of household labour in their relationship, and their level of sexual desire for their partner.
We found consistent evidence that:
- when women performed more household labour than their partner, they were more likely to perceive their partner as dependents (that is, the man-child phenomenon)
- perceiving a partner as a dependent was associated with lower sexual desire for that partner.
When taken together, you could say women’s partners were taking on an unsexy role – that of a child.
There could be other explanations. For instance, women who perceive their partners as dependents may be more likely to do more around the house. Alternatively, low desire for a partner may lead to the partner being perceived as a dependent. So we need more research to confirm.
Our research highlights a pretty bleak snapshot of what people’s relationships can involve. And while the man-child phenomenon may not exist for you, it reflects broader gendered inequities in relationships.
Is there a man-child equivalent in same-sex relationships?
Our research was solely about relationships between women and men, with children. But it would be interesting to explore if the man-child phenomenon exists in same-sex or gender-diverse relationships, and what the impact might be on sexual desire.
One possibility is that, in relationships between two women, men, or non-binary people, household labour is more equitably negotiated. As a result, the mother-child dynamic may be less likely to emerge. But no-one has studied that yet.
Another possibility is that one person in the relationship (regardless of gender identity) takes on a more feminine role. This may include more of the mothering, nurturing labour than their partner(s). If that was the case, we might see the man-child phenomenon in a broader range of relationships. Again, no-one has studied this.
Perhaps, anyone could be the “man-child” in their relationship.
What else don’t we know?
Such future research may help explore different types of relationship dynamics more broadly.
This may help us understand what sexual desire might look like in relationships where roles are equitably negotiated, chosen, and renegotiated as needed.
We might learn what happens when household labour is valued like paid labour. Or what happens when both partners support each other and can count on each other for daily and life needs.
Women might be less likely to experience their partners as dependents and feel more sexual desire for them. In other words, the closer we are to equity in actively caring for each other, the closer we might be to equity in the capacity for feeling sexual desire with our partner.
We thank Aki Gormezano, who was a coauthor on the paper discussed in this article.
Glute force: why big, strong bum muscles matter for your overall health
Published: November 7, 2022 6.04am AEDT
- Charlotte Ganderton Physiotherapy lecturer, Swinburne University of Technology
- Adam Semciw Associate Professor in Allied Health, La Trobe University
- Matthew King Postdoctoral Research Fellow, Lecturer, and Physiotherapist, La Trobe University
Charlotte Ganderton receives funding from Arthritis Australia, Physiotherapy Research Foundation, Swinburne University of Technology, National Institute of Circus Arts and La Trobe University. Charlotte Ganderton is a member of the Australian Physiotherapy Association and Sports Medicine Australia.
Adam Semciw is affiliated with Northern Health.
Matthew King receives funding from the Physiotherapy Research Foundation, Australian Physiotherapy Association, La Trobe University and the Transport Accident Commission . He is affiliated with the Australian Physiotherapy Association, Sports Medicine Australia and the International Hip-related Pain Research Network..
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The glutes are the large, powerful muscles in your bum that help support the pelvis, stabilise the hip joint and allow the hip to move.
Countless social media posts extol the virtues of building strong glutes through exercises such as squats. However, most of what you hear from such “gymfluencers” is about how the bum muscles look.
Forget about how they look; what about what they do? Why is having big, strong glutes important for your body to function well?
In fact, having strong bum muscles is crucial to good musculoskeletal health.
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Bum muscles hold your body up and protect the hip joint
The gluteal muscles are a group of three separate muscles, each with unique anatomical structure and function.
The deepest and smallest muscle is called the gluteus minimus, which is very close to the hip joint itself.
Overlaying gluteus minimus is the gluteus medius. This one is relatively large and spans the whole outer surface of the pelvis.
The gluteus maximus is the largest of the three gluteal muscles and overlays both gluteus medius and minimus. This muscle is what gives the the bum its distinctive bum-like shape, but it plays a very important role in the way your body functions.
In combination, the gluteus maximus, medius and minimus gives rise to many hip movements, and provide shock absorption when you’re walking or running.
These muscles work together with your brain to generate a lot of power to hold your body up as gravity tries to pull it down. They also protect the hip joint from impact and from shearing forces that might cause long term damage.
These impairments could reduce the bum muscles’ ability to protect the joint against long term damage and potentially affect a person’s ability to bear weight (for example, when standing on one leg or climbing stairs).
A reduction in muscle size and an increase in non-active tissue such as fat has been reported in hip conditions such as greater trochanteric pain syndrome (a common type of hip pain, also known as gluteal tendinopathy).
The same is also true for hip osteoarthritis, which affects the whole joint.
The rates of osteoarthritis in Australia are increasing, with one in every seven hip joint replacements conducted in people under the age of 55. However, it’s worth noting just because you have signs of arthritis on hip x-ray or MRI, it doesn’t mean you will have pain or develop pain.
Research suggests the way a person moves may contribute to the risk of hip osteoarthritis in young people.
If you do have hip pain, bum muscle strengthening is recommended as the first line treatment.
But strong glutes have also been shown to improve your day-to-day function, especially in those with hip osteoarthritis.
Should I do my bum exercises?
Ultimately, better bum muscle function is likely to be helpful and is often recommended by doctors, physiotherapists and other health-care practitioners.
They may prescribe certain exercises to strengthen your glutes and target problems around the hip area.
Having weak glutes is associated with:
- low back pain
- patellofemoral pain (pain under the knee cap) and
- greater trochanteric pain syndrome (the common type of hip pain we mentioned earlier, also known as gluteal tendinopathy).
Glute strength may even have a role to play in keeping your pelvic floor in good shape (although further research is required).
That’s not to say doing your bum exercises will automatically cure all these ailments; each case is unique and involves a range of factors. But having strong glutes is, in general, very important for hip and pelvis stability and function.
No matter if you are a gymfluencer, a professional sports person, or just a regular bum-owner, having strong glutes will keep you in good stride.
It’s after-hours and I need to see a doctor. What are my options?
Published: November 8, 2022 3.32pm AEDT
- Mahima Kalla Digital Health Transformation Research Fellow, The University of Melbourne
- Feby Savira Alfred Deakin Postdoctoral Research Fellow, Deakin University
- Kara Burns Digital Health Program Manager at the Centre for Digital Transformation of Health, The University of Melbourne
- Sathana Dushyanthen Academic Specialist & Lecturer in Cancer Sciences & Digital Health, The University of Melbourne
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
There are times when medical care can’t wait until 9am or first thing Monday. Perhaps your COVID has worsened and you’re becoming short of breath. Or your baby has a fever that’s worrying you. Or your elderly parent’s pain can’t be relieved with over-the-counter medications.
When last asked in 2020, two-thirds of Australians had accessed after-hours health services in the previous five years. But how do you access health care on weekends and after 5pm in 2022?
Many GP Super Clinics continue to operate beyond business hours, accept walk-ins and provide access to onsite pharmacy services. You can find their locations here, though opening hours and costs vary between clinics.
Search engines such as HotDoc and Healthdirect can help you find local health services such as GPs, COVID testing clinics, emergency departments, and allied health services. You can filter search results by “open now”, bulk-billing and accessibility requirements such as building access ramps.
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The COVID pandemic accelerated investment in virtual care for non-life-threatening emergencies, which can be less stressful for patients and families than attending an emergency department.
Here are some options for in-person and virtual after-hours care.
If you’re not sure whether you need medical care, or if you need basic information or advice, a useful starting point is to call a free nursing helpline such as Nurse-on-Call in Victoria, 13HEALTH in Queensland, or Healthdirect in other states.
In some cases, nurses may offer a call-back from a GP using phone or video consultation.
Getting a doctor to visit you at home
The National Home Doctor service, which can be booked using telephone (13 74 25) or its mobile app, provides bulk-billed doctor home visits.
Telehealth consultations can also be booked through this service, though they may incur a fee.
Video consultation with a GP
A range of companies offer GP telehealth consultation after hours, for a fee. It doesn’t have to be an emergency, and can be used for things like last-minute repeat prescriptions.
Virtual emergency departments
Virtual emergency departments in Victoria, Queensland and Western Australia allow people in these states to virtually connect with emergency doctors and nurse practitioners for treatment and advice on non-life-threatening emergencies.
In Victoria, the establishment of the virtual ED program has decreased wait times, with an easy-to-use platform, triage and waiting room. After the consultation, instructions can be emailed, or e-scripts sent to your local pharmacy. This service is currently covered by Medicare with no out-of-pocket costs, though that may change in the future.
My Emergency Doctor is a private service with a hotline and web-based consultations with expert emergency doctors, for patients across Australia. Typically consultations cost A$250-$280, however people living in certain Primary Health Networks can receive free after-hours telehealth consultations through this platform.
Children’s health services
In South Australia, free paediatric emergency services are available through the Women’s and Children’s Hospital’s Child and Adolescent Virtual Urgent Care Service, though similar services aren’t available across the country.
In Victoria, Supercare Pharmacies are also open 24/7, with nurses available from 6pm to 10pm.
Under the Pharmaceutical Benefits Scheme Continued Dispensing Arrangements, approved pharmacists may supply eligible medicines to a person in time of immediate need, when the prescribing doctor can not be contacted, once in a 12-month period.
Medical chests in remote areas
The Royal Flying Doctor service runs a Medical Chest program, to provide emergency and non-emergency, pharmaceutical and non-pharmaceutical treatments for people in remote areas, such as antibiotics, pain relief and first-aid.
Medical chests are provided for communities which are located more than 80 kilometres from professional medical services and maintained by a designated local medical chest custodian.
Mental health support
Some mental health supports are available after-hours. Free options include:
Indigenous health and wellbeing
Yarning SafeNStrong is a free, confidential, culturally suitable counselling service for Aboriginal and Torres Strait Islander people. This service offers support with social and emotional wellbeing, financial wellbeing, medical support including COVID testing, drug and alcohol counselling and rehabilitation services.
For people with communication needs
Access to after-hours care is often dependent on people’s ability to communicate over a phone.
The National Relay Service can assist hearing- or speech-impaired people with changing voice to text or English to AUSLAN.
Non-English speaking people can access interpreter assistance for telehealth via the National Translating and Interpreting Service. This service is typically free of charge, covers 150 languages, and can be accessed after-hours.
Of course, none of the options above should replace the Triple Zero (000) service for life-threatening emergencies such as difficulty breathing, unconsciousness and severe bleeding.
This handy infographic shows some of your options for after-hours care. Click on the hand icon on top right to activate interactive elements. Then press the + button to learn more:
We would like to acknowledge the following people for their input to this article: Dr Loren Sher (Director of Victorian Virtual ED at the Northern Hospital), A/Prof Michael Ben-Meir (Director of Emergency Department, Austin Health), Ms Karen Bryant (Senior Aboriginal Liaison Officer, Northern Health) and Dr Kim Hansen (Director of Emergency, St Andrew’s War Memorial Hospital).
I have been advocating the use of probiotics for many years. The one I use is Table of Plenty probiotic (Kefir) which is available from Coles and Woollies.You only need about 40 ml daily. This is not the only good and effective probiotic, but I have found it a good one. In case you wonder, I am not being paid to promote this brand.
My wife and I have not had Covid (that we know of). Everyone else seems to have had it., even most of my family members, who are much younger than us. I think this article may be of interest to my readers.
Why haven’t I had COVID yet?
Published: November 11, 2022 6.01am AEDT
- Nathan Bartlett Associate Professor, School of Biomedical Sciences and Pharmacy, University of Newcastle
Nathan Bartlett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Throughout the pandemic, Australia has recorded 10.4 million cases of COVID-19, with the majority occurring this year.
This is without doubt an underestimate, as not everyone tests for COVID-19 or reports their positive results.
The latest survey of donor blood looked at the proportion of people who had antibodies against SARS-CoV-2, the virus that causes COVID-19. It found at least two thirds of Australians have been infected.
That leaves about a third of the population who are yet to have COVID.
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I’m one such “NOVID” – despite multiple confirmed COVID-19 exposures during the pandemic, I’m yet to have symptoms and test positive.
So what do we know about NOVIDs?
First, we might not actually be NOVIDs
Some people claiming they’ve never had COVID-19 might be surprised to learn they have virus-targeting antibodies in their blood that could only have been generated by infection.
The reliance on home rapid antigen tests (RATs), which are less sensitive than PCR testing, will contribute to many people failing to definitively determine whether they have COVID-19.
Under ideal testing conditions, the best tests detect SARS-CoV-2 infection more than 95% of the time. However in the real world, the detection rate is lower.
If you have mild symptoms that don’t last long, you’re less likely to test repeatedly and may miss your window to get a positive result. So some COVID-19 cases will escape detection by RATs.
Read more: Could I have had COVID and not realised it?
At this point, it’s important to distinguish between being infected with SARS-CoV-2 and experiencing the illness (COVID-19) caused by this infection. You can be infected without experiencing COVID-19 symptoms – this is called asymptomatic infection.
So, many NOVIDs will have been infected with SARS-CoV-2, generated antibodies to the virus, but did not experience or notice any COVID-19 symptoms at the time, did not test and have remained unaware of their infection status (and whether they were unknowingly transmitting the virus).
What role does the immune system play?
Everyone’s immune system is different. How your immune system responds to a particular infection is affected by many factors including your genes, gender, age, diet, sleep patterns, stress levels, history of other infections and illnesses, medications, vaccination status, and level of virus exposure.
So are some people less likely to get COVID-19 because of the strength of their immune system?
The status of our immune system at any given moment will impact our susceptibility to disease. So it’s unsurprising the people most susceptible to severe COVID-19 are those with less effective immunity because they have chronic diseases, are immune-suppressed or elderly.
The other key variable is the virus. SARS-CoV-2 continues to evolve with new Omicron subvariants continuing to emerge. This will affect how the virus interacts with us and the relative impact of different factors affecting our immune protection and susceptibility.
SARS-CoV-2 has proven itself to be particularly adept at evolving to generate viral variants that can evade our established immune protection. In addition, our immune protection is not stable and will begin to wane after a couple of months if not boosted by vaccination or infection.
Are my genes protecting me?
Let’s consider something that is relatively stable: your genes.
Scientists looking for associations between specific genes and disease can undertake genome-wide association studies. The effect of individual genetic variations on disease risk is usually very small, so identifying them requires large numbers of people and factoring in other variables that make us all different.
In once such study, researchers compared genomes of nearly 50,000 people with COVID-19 with the genomes of 2 million people without known infection.
They identified regions in the genome (loci) associated with contracting COVID-19 and other genetic regions associated with disease severity. So this is evidence that, like many other diseases, certain genes do modify the risk of COVID-19.
While association is not causation, these types of genomic studies point us in a direction to better understand the biology of COVID-19 to address questions such as who might be at risk of severe disease or long COVID and assist development of new therapies to prevent these outcomes.
Another study identified a small number of critically ill COVID-19 patients with rare gene variants. These could be directly linked to defective antiviral immunity.
So for a very small number of people, it appears their genes make them more susceptible to COVID. But for the vast majority of people, the picture is far more complicated.
Could I have immunity from previous infection with a similar virus?
SARS-CoV-2 is not the only respiratory coronavirus that regularly infects humans. Four others – 229E, HKU-1, OC43 and NL63 – share some similarity with SARS-CoV-2.
Most adults would have been infected by these viruses multiple times throughout their life. This raises the possibility that immunity generated by lifetime and/or recent exposure to these other coronaviruses might generate immunity that provides some protection against SARS-CoV-2 infection and symptomatic COVID-19.
More research is needed to better understand this, but the existing evidence is compelling and it’s certainly plausible.
The bottom line is there are many reasons why people who socialise and inevitably interact with people with COVID-19 believe they’ve never had COVID themselves. For most NOVIDs, it has been a combination of vaccination, leveraging a healthy immune system, sensible decisions and luck that have kept them COVID-free thus far.
Of course, luck eventually runs out, so enjoy your NOVID status while you can.
|Facing surgery? Here’s how to prepare.|
|When a close family member was recently advised by a doctor to have a minor operation, I felt overwhelmed with fear and uncertainty. How could we be sure surgery was necessary? Should we get a second opinion or trust the doctor who recommended it? What should we do to prepare?|
|My family is one of many that have recently faced this scenario, as 15 million Americans undergo surgery every year, according to the American College of Surgeons. To find out how best to think through the issue, I reached out to three physicians who study medical decision-making and health literacy.|
|Here’s what I learned about the types of questions to ask your doctor if they recommend a surgical procedure and, if you decide to move forward, the best way to prepare.|
|Determine whether surgery is the best option.|
|The first thing you should do is to take a deep breath, said Dr. Susan Pitt, a surgeon at the University of Michigan’s Center for Healthcare Outcomes and Policy who studies how treatment decisions are made between patients and doctors. Facing an operation is a lot to digest. If your doctor hasn’t already explained the rationale, ask why the procedure is needed. You should also ask if the procedure is typically recommended for your condition under physician guidelines.|
|Consider asking if you can record the conversation on your phone so you can review the information later when you’re calmer, advised Dr. Harlan Krumholz, a cardiologist who directs the Yale School of Medicine Center for Outcomes Research and Evaluation. Or at the very least, take notes. An app called Abridge records doctor-patient conversations and shares the recording and transcript with the patient while also summarizing the information for the physician to help with record keeping.|
|Even if your doctor makes a compelling case for surgery, you may have other options. Dr. Pitt suggested asking if there are alternative treatments, like other kinds of surgeries that might be less invasive or nonsurgical options. Specify that you’re not just interested in the alternatives your particular doctor could offer but also treatments that could be available to you through other doctors as well.|
|Don’t forget to ask what might happen if you don’t do anything at all, she added. Perhaps the worst-case scenario isn’t all that bad.|
|Understand what to expect afterward.|
|You should ask your doctor about the potential benefits of any procedure, Dr. Krumholz said. Often, doctors do surgeries to increase the chance that someone will feel better or that a future risk will be averted — but some surgeries don’t achieve those goals, he said.|
|When Dr. Krumholz and his colleagues interviewed U.S. adults who were candidates for elective angioplasty — a procedure that opens blocked arteries — 70 percent said they believed the procedure would lengthen their life or prevent future heart complications, even though it typically does not. (It usually just relieves chest pain.) When it comes to understanding the risks and benefits of medical procedures, “there’s lots of common misunderstandings,” he said, so it’s wise to probe.|
|You could, for instance, ask how many people out of 100 with your condition who get this surgery typically feel better afterward or how much the surgery typically reduces the risk of future health problems or death. Some surgeries aren’t even needed and may not be helpful: In a 2017 survey of more than 2,000 U.S. physicians, doctors estimated that an average of 11 percent of medical procedures, including surgeries, are unnecessary.|
|It’s crucial to get a sense for the potential risks, too, Dr. Pitt said — and ask for clarification if what your doctor says sounds vague. (For complicated surgical decisions, you could ask the hospital if it has patient advocates or nurse navigators, both of whom can come to appointments and help make sense of what you’re being told, she added.)|
|Ask, too, about what your recovery from surgery could be like. How long might it last? What will you be able (and not able) to do? How many people never fully recover? “That’s vital information to understand,” Dr. Krumholz said. Ask what costs you’ll be expected to shoulder, too. “Many people don’t realize that they’re going to have a big bill,” he said, even if they are covered by health insurance.|
|Consider getting a second opinion.|
|It may also help to get a second opinion from a different doctor, said Dr. Glyn Elwyn, an expert on shared decision-making at The Dartmouth Institute for Health Policy & Clinical Practice — especially if the first doctor didn’t suggest any alternatives to surgery. He recommended getting that opinion from a general practitioner, such as an internist, who might be more knowledgeable about nonsurgical treatment options. When my family member’s doctor didn’t mention any alternatives to surgery, he sought a second opinion from a different surgeon who pointed out that there were, in fact, several nonsurgical options.|
|Dr. Krumholz agreed. “It’s your body, and you have a right to be able to hear what other people have to say,” he said.|
|Pick a surgeon you trust.|
|If you choose to move forward with surgery, your next big decision is who should do the operation. One guiding principle is that the more surgeries doctors do per year, the better their patients tend to do, Dr. Krumholz said. He suggested asking doctors how many of this particular kind of surgery they have done in the past year and over the course of their careers — and how that rate compares to the threshold that is associated with good outcomes in their field. “If the doctor says, ‘I don’t know,’ that’s revealing,” Dr. Krumholz said, and you may want to find another doctor.|
|You can also ask how the doctor’s surgical outcomes — rates of efficacy and complications for this kind of surgery — compare with those of other surgeons. “Surgeons should know where they sit compared to the national average,” Dr. Pitt said.|
|There’s no national registry where patients can access this information, so asking your doctor directly is the best place to start.|
|If your doctor performs surgeries at a teaching hospital, ask whether a junior physician might be assigned to do the surgery instead, and if so, how much experience they have and what the hospital does to ensure that they provide excellent care, Dr. Krumholz said.|
|If your doctor gets testy that you’re making so many inquiries, that is a red flag, Dr. Elwyn said. “If they’re uneasy answering these questions, I wouldn’t feel comfortable myself as a patient,” he said.|
|On the day of surgery, pack well.|
|If you decide to get surgery, bring an overnight bag with you even if you are just having an outpatient procedure, Dr. Pitt suggested, in case you need to stay longer. Pack comfortable clothes — you may be able to wear them, instead of the dreaded hospital gown, during recovery, depending on where your incision is, she said. And bring a toiletry bag containing anything you would want to have with you for personal hygiene.|
|However, keep your nice jewelry, watch and medications at home. Typically, hospitals and medical centers won’t let patients take outside medications on their watch because they can’t be certain that what’s in the bottle is what is on the label, Dr. Pitt said.|
|After my relative sought out a second opinion and learned about other treatment options, he decided to first try a less invasive procedure that involved a quicker and easier recovery. It has improved his symptoms immensely. Surgery might still be in the cards one day, but maybe — and hopefully — not.|
|“There are all sorts of ways that people are made to feel as if surgery is a done deal and there’s no other option. When, in fact, there are almost always options,” Dr. Krumholz said.|
I have just seen this post, and feel I need to share it with my patients.