What immunocompromised people want you to know

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While many people in the U.S. have abandoned COVID-19 mitigations like vaccines and masking, the virus remains dangerous for everyone, and some groups face higher risks than others. Immunocompromised people—whose immune systems don’t work as well as they should due to health conditions or medications—are more vulnerable to infection and severe symptoms from the virus. 

Public Good News spoke with three immunocompromised people about the steps they take to protect themselves and what they want others to know about caring for each other.

[Editor’s note: The contents of these interviews have been condensed for length.]

PGN: What measures have you been taking to protect yourself since the COVID-19 pandemic began?

Tatum Spears, Virginia

From less than a year old, I had serious, chronic infections and have missed huge chunks of my life. In 2020, I quit my public job, and I have not worked publicly since. 

I have a degree in vocal performance and have been singing my whole life, but I haven’t performed publicly since 2019. I feel like a bird without wings. I had to stop traveling. Since no one wears a mask anymore, I can’t go to the movies or social outings or any party.

All my friends live in my phone now. It’s a community of people—a lot of them are immunocompromised or disabled in some way. 

There are a good portion of them who just take COVID-19 seriously and want to protect their health, who feel the existential abandonment and the burden of all of this. It’s really isolating having to step back from any sort of social life. I have to assess my risk every single time I leave the house.

Gwendolyn Alyse Bishop, Washington 

I was hit by a car when I was very young. I woke up from surgery, and doctors told me I had lost almost all of my spleen. So, I was always the sickest kid in my school.

When COVID-19 hit, I started working from home. At first, I wore cloth masks. I didn’t really learn about KN95 masks until right around the time that COVID-19 disabled me. [Editor’s note: N95 and KN95 masks have been shown to be significantly more effective at preventing the transmission of viral particles than cloth masks.]

I actually don’t get out much anymore because I am disabled by long COVID now, but when I do leave, I wear a respirator in all shared air spaces. My roommate and I have HEPA filters going in every room.

And then we test. I have a Pluslife testing dock, and so we keep a weekly testing schedule with that and then test if there are any symptoms. I got reinfected [with COVID-19] last winter, and a Pluslife test helped me catch it early and get Paxlovid. [Editor’s note: Pluslife is a brand of an at-home COVID-19 nucleic acid amplification test, which has been shown to be significantly more effective at detecting COVID-19 than at-home antigen rapid tests.]

Abby Mahler, California

I have lupus, and in 2016, I started taking the drug hydroxychloroquine, which is an immunomodulator. I’m not as immunocompromised as some people, but I certainly don’t have a normal immune system, which has resulted in long-term infections like C. diff.

I started masking early. My roommates and I prioritize going outside. We don’t remove our masks inside in public places. 

We are in a pod with one other household, and the pod has agreements on the way that we interact with public space. So, we will only unmask with people who have tested ahead of time. We use Metrix, an at-home nucleic acid amplification test.

While it’s not easy and it’s not the life that we had prior to COVID-19’s existence, it is a life that has provided us quite a lot of freedom, in the sense that we are not sick all the time. We are conscientiously making decisions that allow us to have a nice time without a monkey on our backs, which is freeing.

PGN: What do you want people who are not immunocompromised to know?

T.S.: Don’t be afraid to be the only person in a room wearing a mask. Your own health is worth it. And you have to realize how callous [people who don’t wear a mask are] by existing in spaces and breathing [their] air [on immunocompromised people].

People think that vaccines are magic, but vaccines alone are not enough. I would encourage people to look at the Swiss cheese model of risk assessment. 

Each slice of Swiss cheese has holes in it in different places, and each layer represents a layer of virus mitigation. One layer is vaccines. Another layer is masks. Then there’s staying home when you’re sick and testing.

G.A.B.: I wish people were masking. I wish people understood how likely it is that they are also now immunocompromised and vulnerable because of the widespread immune dysregulation that COVID-19 is causing. [Editor’s note: Research shows that COVID-19 infections may cause long-term harm to the immune system in some people.]

I want people to be invested in being good community members, and part of that is understanding that COVID-19 hits the poorest the hardest—gig workers, underpaid employees, frontline service workers, people who were already disabled or immunocompromised. 

If people want to be good community members, they not only need to protect immunocompromised and disabled people by wearing a mask when they leave their homes, but they also need to actually start taking care of their community members and participating in mutual aid. [Editor’s note: Mutual aid is the exchange of resources and services within a community, such as people sharing extra N95 masks.]

I spend pretty much all of my time working on LongCOVIDAidBot, which promotes mutual aid for people who have been harmed by COVID-19.

A.M.: An important thing to think about when you’re not disabled is that it becomes a state of being for all people, if they’re lucky. You will become disabled, or you will die. 

It is a privilege, in my opinion, to become disabled because I can learn different ways of living my life. And being able to see yourself as a body that changes over time, I hope, opens up a way of looking at your body as the porous reality that it is. 

Some people think of themselves as being willing to make concessions or change their behavior when immunocompromised people are around, but you don’t always know when someone is immunocompromised. 

So, if you’re not willing to change the way that you think about yourself as a person who is susceptible [to illness], then you should change the way that you consider other people around you. Wearing a mask—at the very least in public indoor spaces—means considering the unknown realities of all the people who are interacting with that space.

This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • How To Prevent And Reverse Type 2 Diabetes

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    Turn back the clock on insulin resistance

    This is Dr. Jason Fung. He’s a world-leading expert on intermittent fasting and low carbohydrate approaches to diet. He also co-founded the Intensive Dietary Management Program, later rebranded to the snappier title: The Fasting Method, a program to help people lose weight and reverse type 2 diabetes. Dr. Fung is certified with the Institute for Functional Medicine, for providing functional medicine certification along with educational programs directly accredited by the Accreditation Council for Continuing Medical Education (ACCME).

    Why Intermittent Fasting?

    Intermittent fasting is a well-established, well-evidenced, healthful practice for most people. In the case of diabetes, it becomes complicated, because if one’s blood sugars are too low during a fasting period, it will need correcting, thus breaking the fast.

    Note: this is about preventing and reversing type 2 diabetes. Type 1 is very different, and sadly cannot be prevented or reversed in this fashion.

    However, these ideas may still be useful if you have T1D, as you have an even greater need to avoid developing insulin resistance; you obviously don’t want your exogenous insulin to stop working.

    Nevertheless, please do confer with your endocrinologist before changing your dietary habits, as they will know your personal physiology and circumstances in ways that we (and Dr. Fung) don’t.

    In the case of having type 2 diabetes, again, please still check with your doctor, but the stakes are a lot lower for you, and you will probably be able to fast without incident, depending on your diet itself (more on this later).

    Intermittent Fasting can be extra helpful for the body in the case of type 2 diabetes, as it helps give the body a rest from high insulin levels, thus allowing the body to become gradually re-sensitised to insulin.

    Why low carbohydrate?

    Carbohydrates, especially sugars, especially fructose*, cause excess sugar to be quickly processed by the liver and stored there. When the body’s ability to store glycogen is exceeded, the liver stores energy as fat instead. The resultant fatty liver is a major contributor to insulin resistance, when the liver can’t keep up with the demand; the blood becomes spiked full of unprocessed sugars, and the pancreas must work overtime to produce more and more insulin to deal with that—until the body starts becoming desensitized to insulin. In other words, type 2 diabetes.

    There are other factors that affect whether we get type 2 diabetes, for example a genetic predisposition. But, our carb intake is something we can control, so it’s something that Dr. Fung focuses on.

    *A word on fructose: actual fruits are usually diabetes-neutral or a net positive due to their fiber and polyphenols.

    Fructose as an added ingredient, however, not so much. That stuff zips straight into your veins with nothing to slow it down and nothing to mitigate it.

    The advice from Dr. Fung is simple here: cut the carbs. If you are already diabetic and do this with no preparation, you will probably simply suffer hypoglycemia, so instead:

    1. Enjoy a fibrous starter (a salad, some fruit, or perhaps some nuts)
    2. Load up with protein first, during your main meal—this will start to trigger your feelings of satedness
    3. Eat carbs last (preferably whole, unprocessed carbohydrates), and stop eating when 80% full.

    Adapting Intermittent Fasting to diabetes

    Dr. Fung advocates for starting small, and gradually increasing your fasting period, until, ideally, fasting 16 hours per day. You probably won’t be able to do this immediately, and that’s fine.

    You also probably won’t be able to do this, if you don’t also make the dietary adjustments that help to give your liver a break, and thus by knock-on-effect, give your pancreas a break too.

    With the dietary adjustments too, however, your insulin production-and-response will start to return to its pre-diabetic state, and finally its healthy state, after which, it’s just a matter of maintenance.

    Want to hear more from Dr. Fung?

    You may enjoy his blog, and for those who like videos, here is his YouTube channel:

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  • When the Body Says No – by Dr. Gabor Maté

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    We know that chronic stress is bad for us because of what it does to our cortisol levels, so what is the rest of this book about?

    Dr. Gabor Maté is a medical doctor, heavily specialized in the impact of psychological trauma on long term physical health.

    Here, he examies—as the subtitle promises—the connection between stress and disease. As it turns out, it’s not that simple.

    We learn not just about the impact that stress has on our immune system (including increasing the risk of autoimmune disorders like rheumatoid arthritis), the cardiovascular system, and various other critical systems fo the body… But also:

    • how environmental factors and destructive coping styles contribute to the onset of disease, and
    • how traumatic events can warp people’s physical perception of pain
    • how certain illnesses are associated with particular personality types.

    This latter is not “astrology for doctors”, by the way. It has more to do with what coping strategies people are likely to employ, and thus what diseases become more likely to take hold.

    The book has practical advice too, and it’s not just “reduce your stress”. Ideally, of course, indeed reduce your stress. But that’s a) obvious b) not always possible. Rather, Dr. Maté explains which coping strategies result in the least prevalence of disease.

    In terms of writing style, the book is very much easy-reading, but be warned that (ironically) this isn’t exactly a feel-good book. There are lot of tragic stories in it. But, even those are very much well-worth reading.

    Bottom line: if you (and/or a loved one) are suffering from stress, this book will give you the knowledge and understanding to minimize the harm that it will otherwise do.

    Click here to check out When The Body Says No, and take good care of yourself; you’re important!

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  • Reasons to Stay Alive – by Matt Haig

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    We’ve previously reviewed Matt Haig’s (excellent) The Comfort Book, and now it’s time for his more famous book: Reasons To Stay Alive. So, what’s this one, beyond the obvious?

    It narrates the experience of anxiety, depression, and suicidality, and discovering how to find beauty and joy in the world despite it all. It’s not that the author found a magical cure—he still experiences depression and anxiety (cannot speak for suicidality) but he knows now how to manage it, and live his life.

    You may be wondering: is this book instructional; is it reproducible, or is it just an autobiography? It’s centered around his own experience and learnings, but it gives a huge sense of not feeling alone, of having hope, and it gives a template for making sense of one’s own experience, even if every person will of course have some points of differences, the commonalities are nonetheless of immense value.

    The writing style is similar to The Comfort Book; it’s lots of small chapters, and all very easy-reading. Well, the subject matter is sometimes rather heavy, but the language is easy-reading! In other words, just the thing for when one is feeling easily overwhelmed, or not feeling up to reading a lot.

    Bottom line: whether or not you suffer with anxiety and/or depression, whether or not you sometimes feel suicidal, the contents of this book are important, valuable insights for everyone.

    Click here to check out Reasons To Stay Alive, and see through the highs and lows of life.

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  • Reading As A Cognitive Exercise

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    Reading, Better

    It is relatively uncontroversial to say that reading is good for cognitive health, but we don’t like to make claims without science if we can help it, so let’s get started:

    There was a 2021 study, which found that even when controlling for many other factors, including highest level of education, socioeconomic status, and generalized pre-morbid intelligence:

    ❝high reading activity, as defined by almost daily reading, was associated with lower odds of cognitive decline, compared to low reading activity❞

    ~ Dr. Carol Chan

    Source: Can reading increase cognitive reserve?

    However, not all reading is the same. And this isn’t just about complexity or size of vocabulary, either. It’s about engagement.

    And that level of engagement remains the key factor, no matter how quickly or slowly someone reads, as the brain tends to automatically adjust reading speed per complexity, because the brain’s “processing speed” remains the same:

    Read more: Cognitive coupling during reading

    Everyone’s “processing speed” is different (and is associated with generalized intelligence and executive functions), though as a general rule of thumb, the more we practice it, the faster our processing speed gets. So if you balked at the notion of “generalized intelligence” being a factor, be reassured that this association goes both ways.

    Read more: The unique contribution of working memory, inhibition, cognitive flexibility, and intelligence to reading comprehension and reading speed

    So is the key to just read more?

    That’s a great first step! But…

    The key factor still remains: engagement.

    So what does that mean?

    It is not just the text that engages you. You must also engage the text!

    This is akin to the difference between learning to drive by watching someone else do it, and learning by getting behind the wheel and having a go.

    When it comes to reading, it should not be a purely passive thing. Sure, if you are reading a fiction book at bedtime, get lost in it, by all means. But when it comes to non-fiction reading, engage with it actively!

    For example, I (your writer here, hi), when reading non-fiction:

    • Read at what is generally considered an unusually fast pace, but
    • Write so many notes in the margins of physical books, and
    • Write so many notes using the “Notes” function on my Kindle

    And this isn’t just like a studious student taking notes. Half the time I am…

    • objecting to content (disagreeing with the author), or
    • at least questioning it, or which is especially important, or
    • noting down questions that came to my mind as a result of what I am reading.

    This latter is a bit like:

    • when you are reading 10almonds, sometimes you will follow our links and go off down a research rabbit-hole of your own, and that’s great!
    • sometimes you will disagree with something and write to tell us, and that’s great too (when this happens, one or the other or all of us will learn something, and yes, we have published corrections before now)!
    • sometimes what you read here will prompt a further question, and you’ll send that to us, and guess what, also great! We love questions.

    Now, if your enjoyment of 10almonds is entirely passive, don’t let us stop you (we know our readers like quick-and-easy knowledge, and that’s good too), it’s just, the more you actively engage with it, the more you’ll get out of it.

    This, by the way, was also a lifelong habit of Leonardo da Vinci, which you can read about here:

    How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb

    a very good book that we reviewed last year

    How you read (i.e. what medium) matters too!

    Are you reading this on a desktop/laptop, or a mobile device? That difference could matter more than the difference between paper and digital, according to this study from 2020 that found…

    ❝The cumulation of evidence from this and previous studies suggests that reading on a tablet affords different interactions between the reader and the text than reading on a computer screen.

    Reading on a tablet might be more similar to reading on paper, and this may impact the attentional processes during reading❞

    ~ Dr. Ugo Ballenghein et al.

    Read more: Cognitive engagement during reading on digital tablet: Evidence from concurrent recordings of postural and eye movements

    What if my mind wanders easily?

    You can either go with it, or train to improve focus.

    Going with it: just make sure you have more engaging reading to get distracted by. It’s all good.

    Training focus: this is trickier, but worthwhile, as executive function (you will remember from earlier) was an important factor too, and training focus is training executive function.

    As for one way to do that…

    Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering

    If you’d like a primer for getting going with that, then you may enjoy our previous main feature:

    No-Frills, Evidence-Based Mindfulness

    Enjoy!

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  • Are Brain Chips Safe?

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    Ready For Cyborgization?

    A bar chart showing the percentage of people who use social media, emphasizing its safety.

    In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.

    We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!

    However, of the answers we did get…

    • About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
    • About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
    • About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
    • One (1) person said “Electrode outside the skull are good; chips on the brain are bad”

    But what does the science say?

    We’re not there yet safetywise: True or False?

    True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.

    The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.

    • Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
    • Bad news: to say it did not go well would be an understatement

    The Gruesome Story of How Neuralink’s Monkeys Actually Died

    The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.

    Electrodes outside the skull are good; chips on/in the brain are bad: True or False?

    True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:

    How the Utah Array is advancing BCI science

    The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:

    • The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
    • The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.

    In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.

    I am right to be a little worried about giving companies access to my brain: True or False?

    True or False, depending on the nature of your concern.

    For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.

    For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.

    Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.

    Take care!

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  • Putting a Halt to Feeling Lost, Anxious, Stressed & Unhappy

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Starting From the Middle

    Today’s video (below) dives straight into the heart of the issue, examining the victim mindset, with Dr. Gabor Maté immediately, and quite vulnerably, sharing his personal experiences conquering feelings of despair and anxiety.

    As one of the comments on the video says, Dr. Maté is a “person who teaches about something because they experience it themselves”. And it shows through his approach.

    With raw honesty, Dr. Maté empathizes with those grappling with inner turmoil, offering hope by emphasizing the power of healing in the present moment.

    What is His Method?

    Explained simply, Dr. Maté urges individuals to seek trauma-informed care and therapies that address underlying wounds; he emphasizes the pitfalls of relying solely on medication, and instead highlights the idea that triggers can be seen as opportunities for self-reflection and growth. He urges individuals to approach their triggers with compassionate curiosity rather than self-judgment.

    In short, Dr Maté’s empathetic approach immediately calms the viewer, whilst providing knowledge crucial to self-improvement.

    Let this video act as a reminder that we should take our mental health as seriously as our general health.

    How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!

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