COVID Insights from Dr. Hooman Yaghoobzadeh

In the midst of unease surrounding the COVID crisis, we’re looking for solutions. What can we actually do to support immunity, and how do we find the silver linings in a stressful situation like this? Our founder Nadja sat down for a virtual Q&A with Dr. Hooman Yaghoobzadeh to discuss how COVID has impacted his work and what we can do to support immunity. Dr. Yaghoobzadeh is a Cardiologist and Associate Professor of Medicine at the Weill Cornell Medical College, New York-Presbyterian Hospital, and Plantable’s Chief Medical Advisor.

How are you doing? What are you and your colleagues seeing at New York Presbyterian?

It is a challenging time in Cornell for everyone. We are privileged to feel like we're doing something and being active in the fight. The hospital is extraordinarily busy. We have increased the capacity for inpatients by significant amounts. From a hospital with 1,700 total beds, there are now over 2,200 admitted patients and about 600 ventilated patients. So we've surged our number of ICU beds by multiples, and the hospital is giving tremendous care. From an outpatient perspective, my practice has also been significantly affected just like every other part of the country. I have about 70 to 80 outpatients that I'm actively managing, trying to keep them out of the hospital.

Today we have about 350,000 cases in the U.S., 20% of those in NYC. Tell us about your inpatient experience and what you are doing to keep them out of the ICU and the ER. What can actually be done?

So the first thing is to know that most folks that come down with the illness do perfectly fine. Out of my 80 patients that I'm following as outpatients, there's only a very small handful that have ended up in the hospital - about four actually. And all four of them have been discharged now, which is great. Most patients that I've taken care of have avoided the hospital.

What are your thoughts on taking Tylenol?

I tell patients that fevers are the body's way to slow the virus down. So as long as the fever is not above 102, leave it alone. If you need to take something, take Tylenol. People may end up needing to take an anti-inflammatory like Motrin or Advil because of really bad headaches. Headaches can be a major issue with this - I tell patients that they could take Advil if they want, although we try to avoid it.

It's a lot of trying to prevent pneumonia by doing some incentive spirometer exercises and deep breathing exercises. If people are coughing we're using steam, physical therapy, clapping on the chest to create vibration to break up sputum, and things like that.

When would you predict that we’re going to have immunity testing available? Where are we on this timeline?

Well, it's taking so long because everything else has also taken long, and has not been adequately addressed from the federal level all the way down to the district levels. There are several companies that now have private-based finger stick tests for immunity. I believe there’s one as of yesterday morning that is FDA approved - and even this one is based on a very small sampling of a population and it's hard to know how sensitive, specific, and accurate the tests are.

There are better blood tests, serologic tests, that are being developed. And New York hospital, for example, has been developing a serologic test the same way that you could check for immunity against chicken pox or hepatitis or pneumonia to see if you've had it or if the vaccine is active for it.

Those serologic tests have now been perfected. We're in the late stages of figuring out how to do it mass-produced for hundreds, thousands, even tens of thousands of people. I think within the next two weeks we're going to have availability to that as well.

So hopefully two weeks from now, there will be a lot more available PCR testing to look for active shedding and more available serologic testing to look for immunity. And then some basic things like if you're over the age of 80, stay isolated. If you're immunocompromised, stay isolated. But other folks come out with masks and gloves, keep social distance but go back to work.

Let’s talk about the immune system and what we can do to stay strong.  A recent report, pre-published in The Lancet, examined the data coming out of Chinese hospitals on those that went on to develop severe respiratory issues and those that did not. Weight appears to be one of the contributing factors. Can you speak to that academic article and, based on your experience, explain if there is validity behind it?

Sure. So obesity appears to be a very relevant factor from the literature; study after study has shown that to be the case. And we know for example that obesity is a risk factor for many modern diseases including hypertension and cardiovascular disease. However, what’s unique about COVID is that in other illnesses, obesity usually is seen almost as a protective factor. For example, if you come to the hospital with cancer or really bad pneumonia, folks who are heavy tend to actually do better than those folks who are light. The thinking behind this is that folks who are not obese only present illness at a hospital only when the illness is very, very severe. When somebody who's healthy and active and doesn't have the risk factor of obesity or diabetes and comes in with a pneumonia, the pneumonia has to be more relevant to have effected that person. So maybe those who have the risk factor of obesity get affected a little bit earlier, so you're catching them earlier.

But in this disease, not only are you more apt to come into the hospital if you're obese but once you're in the hospital, obesity appears to be a significant negative predictor - maybe the strongest predictor after age. And we know that a lot of people get sick not just from the virus but from the inflammatory cascade that comes with this virus. So it’s something that is somewhat unique and peculiar. Some of it also may have to do with folks who are very heavy and the mechanics of ventilation that happen with the weight and the chest circumference.

You’ve been an advocate for a plant-based diet for a long time in your practice. From a medical perspective, can you tell us a little bit more about how a plant-based diet contributes to maintaining an equilibrium weight and the reduction of inflammation?

Sure. So a plant-based diet has been shown in multiple studies to maybe be the most effective way to lose weight and keep weight off long-term. It does that through many different mechanisms. One of them is the significant amount of fiber in a plant-based diet. Fiber is the food for gut bacteria, the prebiotics for the probiotics that keep our guts healthy. And keeping the gut healthy may be one of the most important things that we can do for our immunity, because the immune system lines that gut. The main place where "outside comes in" is the gut. And the immune system is waiting like soldiers, surrounding the gut to make sure that bad actors don't make it into our body – like bacteria and viruses and so on, so forth.

When the gut bacteria are healthy, they make certain foods called short chain fatty acids that feed the gut lining. And then the gut lining creates something called mucin that creates a barrier between the bacteria and the gut. When the bacteria don't have a lot of fiber, the gut cells don't make the short chain fatty acids for food. Then they don't make the mucin, and the barrier breaks down. Bacteria and lining then start to interact and cause inflammation. And then the immune system gets dysregulated and inflamed and causes a whole bunch of other problems.

A plant-based diet also lowers average blood sugars and insulin levels. And a plant-based diet is robust with all of the micronutrients, the co-vitamins, vitamins and antioxidants that exist in plants.

How quickly can one see the benefits of eating a plant-based diet?

We know that scientifically within four days of eating a plant-based diet, you see a change in gut bacteria. Within one month of a plant-based diet you can see measurable changes in the blood of inflammatory markers and immune function. This has been shown multiple times. We've shown it specifically with the Plantable diet, with high-sensitivity C-reactive protein, as well as changes in average blood sugars.

Have you experienced any silver linings coming out of this crisis?

For me personally, I have become more mindful of everything that I do. And because we've had to become some mindful of the microbiology of it all, the social distancing and washing your hands, you start to understand that our everyday activities - things that we would never have thought twice about - have such profound implications. And when you start to think about that concept, you realize that every single thing that we do has profound implications, which often are not seen or appreciated or measured. And if anything this has made me even more excited about and invigorated by the choices that we make around food and around exercise. I've started to meditate again which has been helpful. So I think hopefully for others that silver lining will come out as well. I've had lots of patients get in touch with me, saying very much the same thing. You know, “thank God that I started to eat a plant-based diet a year ago. I feel in a very different physical and mental state to have to tackle this challenge.” I'm hopeful that after a tremendous amount of pain and anger and suffering for a lot of people, this will also leave some positive implications.