HoldsUp

DavidPerlmutterMD · 2020-04-02 · David Perlmutter, Michelle Norris (host)

Coronavirus Conversations - Day 21

30 research-tied claims examined: 1 contradicted 2 overstated 5 context 20 supported 1 corroborated online 1 unverified

20

Supported by research

0:00:15Michelle Norris (host)supportedhigh

Having the ApoE 3/4 or ApoE 4/4 genotype confers a higher risk of developing Alzheimer's disease than the average person.

"Keith and I both found out recently that we are both ApoE 3/4, and this is a gene snip for early onset Alzheimer's. And so you can either be ApoE 3/4 or 4/4, and both of these have a slightly higher risk of getting Alzheimer's than the average person." (said at 0:00:15)

The host claimed that having an ApoE 3/4 or ApoE 4/4 genotype confers a higher risk of developing Alzheimer's disease compared to the average person. Large meta-analyses confirm that carrying one or two copies of the APOE ε4 allele significantly increases the risk of Alzheimer's disease across multiple populations. In a landmark meta-analysis (Farrer et al., JAMA 1997, PMID 9343467) as well as subsequent updated multi-ancestry meta-analyses (Belloy et al., JAMA Neurol 2023, PMID 37930705), the APOE ε3/ε4 genotype confers roughly a 2- to 4.5-fold increased odds of Alzheimer's disease depending on ancestry (e.g., OR = 3.2 to 3.5 in White/Caucasian populations), while the APOE ε4/ε4 genotype increases risk roughly 8- to 15-fold (OR = 14.9 in White populations). Note that while the host described this as a 'gene snip for early onset Alzheimer's', APOE ε4 is actually the primary genetic risk factor for late-onset Alzheimer's disease rather than deterministic early-onset AD caused by APP/PSEN mutations; however, the core assertion that ApoE 3/4 and ApoE 4/4 confer a higher risk than average is well-supported by robust meta-analytic evidence.

0:06:20David Perlmuttersupportedhigh

Prebiotic fiber is derived from foods such as garlic, onions, leeks, Mexican yam, Jerusalem artichoke, and broccoli.

"meaning a diet that's very rich in fiber, and especially what we call prebiotic fiber. That means fiber derived from garlic, onions, leeks, Mexican yam, Jerusalem artichoke, broccoli." (said at 0:06:20)

The speaker's statement accurately reflects well-established nutritional science. Prebiotic dietary fibers, such as inulin and fructo-oligosaccharides (FOS), naturally occur in significant quantities in allium vegetables (garlic, onions, leeks), Jerusalem artichoke, root vegetables (such as Mexican yam/jicama), and various other vegetables including broccoli.

0:21:25David Perlmuttersupportedmoderate

Fisetin is a supplement derived from strawberries that acts as a senolytic.

"Having said that, this is a science called senolytics—seno meaning old, lytic meaning getting rid of or lysis—and there are actually some nutritional supplements that are purportedly able to do that. One of them is called fisetin, F-I-S-E-T-I-N, available online, many brands out there, and it is derived from strawberries." (said at 0:21:25)

The claim is supported. Fisetin is a naturally occurring flavonoid polyphenol found in high concentrations in strawberries (as well as apples and other plant sources) that is widely marketed as a dietary supplement. In preclinical and clinical research, fisetin has been characterized as a senotherapeutic and senolytic agent capable of selectively inducing apoptosis in senescent cells across various murine and human tissue models.

0:29:20David Perlmuttersupportedhigh

The coronavirus is enveloped in a lipid bilayer with protein, which is disrupted by soap.

"Why? Because the virus is enveloped in fat. It's a fat bilayer with protein, and we know that soap disrupts fat. That's why we use dishwashing liquid to cut the grease." (said at 0:29:20)

Coronaviruses, including SARS-CoV-2, are enveloped viruses surrounded by a lipid bilayer membrane embedded with viral proteins. Soaps and detergent surfactants act by interacting with and disrupting lipid structures, thereby inactivating enveloped viruses. In vitro studies demonstrate that soaps effectively inactivate enveloped viruses such as SARS-CoV-2, influenza A virus, and respiratory syncytial virus (RSV), whereas non-enveloped viruses lacking a lipid membrane (such as encephalomyocarditis virus) are resistant to soap-mediated inactivation.

0:02:30David Perlmuttersupportedmoderate

In COVID-19, inflammation around day 10 of symptoms can be a critical turning point known as a cytokine storm.

"moving along in terms of symptoms with COVID-19, that inflammation around day 10 can be a turning point either in one direction or the other. We call that the cytokine storm" (said at 0:02:30)

The clinical progression of COVID-19 is well documented to follow a biphasic course. While early disease (the first week) is dominated by viral replication, the second week of illness (around days 7 to 10) frequently represents a critical turning point where excessive host immune activation and pro-inflammatory signaling (a hyperinflammatory response or cytokine storm syndrome) can drive clinical deterioration, acute respiratory distress syndrome (ARDS), and multiorgan failure, or alternatively resolve as patients clear the infection.

0:33:59David Perlmuttersupportedhigh

Chronic inflammatory conditions such as coronary artery disease and diabetes are the leading cause of death on the planet according to the World Health Organization.

"We're talking about coronary artery disease and diabetes and the rest of the inflammatory conditions that are, according to the World Health Organization, the number one cause of death on our planet." (said at 0:33:59)

According to the World Health Organization (WHO) and the Global Burden of Disease (GBD) systematic analyses, noncommunicable diseases characterized by chronic systemic inflammation—specifically cardiovascular diseases such as coronary/ischaemic heart disease and stroke, along with diabetes—are the leading causes of death globally. Ischaemic heart disease alone consistently ranks as the single leading cause of mortality worldwide.

0:35:51David Perlmuttersupportedmoderate

According to CDC data, obesity rates are approximately 32% in rural America and approximately 27% in urban America.

"We know that overall obesity rates in America are really high, that, you know, obesity rates are around 32% in rural America and about 27% in urban America." (said at 0:35:51)

CDC surveillance data consistently demonstrate a significant disparity in adult obesity prevalence between rural (nonmetropolitan) and urban (metropolitan) areas of the United States. An analysis of 2016 Behavioral Risk Factor Surveillance System (BRFSS) data published by the CDC found that adult obesity prevalence was 34.2% in nonmetropolitan counties compared to 28.7% in metropolitan counties, closely aligning with the approximate rates (~32% rural vs. ~27% urban) cited.

0:36:01David Perlmuttersupportedmoderate

Having a body mass index greater than 40 dramatically increases the risk of dying from COVID-19.

"Recent reports indicate that if your body mass index is greater than 40, you have a dramatic increased risk of dying from this experience." (said at 0:36:01)

Extensive epidemiological data and meta-analyses published during the pandemic confirm that severe or class III obesity (body mass index ≥ 40 kg/m²) is associated with a substantially increased risk of COVID-19 mortality. Dose-response meta-analyses show that the risk of death increases progressively with higher BMI, with severe obesity (BMI 40–45 kg/m²) carrying a roughly 1.5- to nearly 3-fold higher risk of COVID-19 mortality compared to individuals in the normal weight range.

0:37:36David Perlmuttersupportedmoderate

Before COVID-19, the average time an ICU patient spent on a ventilator was 3 to 4 days, whereas COVID-19 patients spend 11 to 21 days on mechanical ventilation.

"typically before COVID-19 a person in an intensive care unit having been in an accident or having had a heart attack or stroke, whatever it may be, the average time on a ventilator was 3 to 4 days. Now we're seeing people on ventilators for somewhere between 11 and 21 days" (said at 0:37:36)

Observational and cohort studies of mechanical ventilation in the intensive care unit (ICU) confirm that patients intubated for general medical, trauma, or neurological reasons typically spend a median of 3 to 4 days on mechanical ventilation, whereas critically ill patients with COVID-19-associated severe acute respiratory distress syndrome (ARDS) experience markedly prolonged courses of invasive mechanical ventilation, commonly averaging or ranging between 11 and 21 days due to severe lung injury and difficult weaning.

0:43:43David Perlmuttersupportedmoderate

The prior year's influenza vaccine was approximately 30% effective.

"It's about, you know, last year I think was about 30% effective because we don't know which flu is going to appear next year" (said at 0:43:43)

Surveillance and test-negative case-control data from the U.S. Influenza Vaccine Effectiveness Network show that overall seasonal influenza vaccine effectiveness frequently hovers around 30% to 40%, particularly during seasons with circulating strain mismatches. For example, during the 2018–2019 season, interim estimates of 47% declined to an overall end-of-season effectiveness of approximately 29% due to late-season emergence of mismatched influenza A(H3N2) viruses. Pooled multi-season assessments also report overall product vaccine effectiveness of approximately 30% to 37% against symptomatic outpatient influenza.

0:44:15David Perlmuttersupportedmoderate

The common seasonal flu has a mortality rate of approximately 0.1%.

"in comparison to the common flu, which has a mortality rate of about 0.1%." (said at 0:44:15)

Public health surveillance data and epidemiological benchmarks (such as those from the US Centers for Disease Control and Prevention and World Health Organization) estimate the symptomatic case fatality rate / mortality rate of seasonal influenza to be approximately 0.1% (about 1 death per 1,000 cases), though the exact rate varies by season, circulating strain, and age group.

0:47:22David Perlmuttersupportedmoderate

Reports from China indicate that SARS-CoV-2 continues to be shed in stool even after patients test negative on consecutive throat and nasopharyngeal swabs.

"We're now seeing reports out of China—two of them, actually—indicating that people, even when their throat swabs and nasopharyngeal swabs are negative twice in a two-day period, which is the standard for saying you're no longer shedding virus, that there's still virus being shed in the stool" (said at 0:47:22)

Multiple observational cohort studies and subsequent systematic reviews have confirmed that SARS-CoV-2 viral RNA frequently persists in stool and rectal swabs after respiratory specimens (pharyngeal/nasopharyngeal swabs) convert to negative. Early clinical studies from China showed that a substantial portion of COVID-19 patients continued shedding viral RNA in feces for several days to weeks after consecutive negative respiratory swab results. A systematic review and meta-analysis of 46 studies found that among patients with fecal RNA positivity, 55.4% continued shedding viral RNA in feces after respiratory samples tested negative.

0:53:36David Perlmuttersupportedhigh

Remdesivir was originally developed as a treatment for Ebola.

"Was originally developed for treatment of Ebola, so there are some good things happening." (said at 0:53:36)

Remdesivir (originally designated GS-5734) was initially developed by Gilead Sciences as an antiviral agent targeting Ebola virus and related filoviruses. Preclinical discovery work demonstrated that it suppressed Ebola virus replication and protected infected nonhuman primates, leading to its clinical testing during Ebola outbreaks before it was later repurposed during the COVID-19 pandemic.

0:55:17David Perlmuttersupportedlow

Convalescent plasma therapy was used during the 1918 Spanish flu pandemic and demonstrated approximately a 23% reduction in mortality.

"You know that this was done in 1918 for the Spanish flu, for example, and did demonstrate about a 23% reduction in mortality." (said at 0:55:17)

A systematic review and meta-analysis of historical studies from the 1918–1925 Spanish influenza era (Luke et al., 2006) evaluated the use of convalescent blood products (serum, plasma, and whole blood) for influenza pneumonia across 8 studies involving 1,703 patients. The pooled absolute risk difference in mortality between treated patients and untreated controls was 21% (95% CI, 15% to 27%), with crude case-fatality rates of 16% in treated patients versus 37% in controls (an absolute reduction of 21 percentage points). Because these historical studies lacked randomization, blinding, and placebo controls, the certainty of evidence is low.

0:55:38David Perlmuttersupportedhigh

Hydroxychloroquine can cause cardiac rhythm disorders as well as permanent, irreversible visual changes.

"For example, hydroxychloroquine is not risk-free. It can cause a cardiac rhythm disorder and also cause visual change, which is permanent, that doesn't resolve." (said at 0:55:38)

Both components of the claim are well established in clinical literature. Systematic reviews and meta-analyses show that hydroxychloroquine can cause cardiac rhythm disorders, notably corrected QT (QTc) prolongation and conduction abnormalities, increasing the risk of arrhythmias (PMID: 38922589, PMID: 33772933). Additionally, chronic hydroxychloroquine use is a known cause of toxic retinopathy affecting the retinal pigment epithelium and photoreceptors; once established, this structural damage and associated visual field deficits are permanent and can continue to progress even after the medication is discontinued (PMID: 41397859, PMID: 41504875).

0:55:48David Perlmuttersupportedlow

Azithromycin is associated with liver and kidney damage and has negative interactions with approximately 62 other medications.

"And then the azithromycin is also associated with liver damage, kidney damage, gastrointestinal issues in and of itself, and interacts quite negatively with around 62 other drugs" (said at 0:55:48)

Azithromycin is associated with gastrointestinal side effects (such as nausea, abdominal pain, and diarrhea) and liver injury ranging from mild transaminase elevations to rare, severe hepatotoxicity including jaundice and liver failure (PMID: 25111234, PMID: 8280403). While serious hepatic and renal events (such as acute interstitial nephritis or drug-induced liver injury) are documented rare adverse reactions, macrolides like azithromycin are generally considered to have lower GI and hepatotoxic incidence compared to older agents like erythromycin (PMID: 8280403). Common drug interaction databases categorize dozens of known drug interactions with azithromycin (including major interactions with QT-prolonging drugs, antacids, and warfarin), which aligns with the speaker's claim of gastrointestinal effects, liver/kidney toxicity, and approximately 62 drug-drug interactions.

0:58:16David Perlmuttersupportedmoderate

A ketogenic diet is an effective treatment for diabetes and for lowering elevated blood sugar levels.

"and ketogenic diet is effective in reducing our risk for high blood sugar and a treatment for diabetes" (said at 0:58:16)

Multiple systematic reviews and meta-analyses of randomized controlled trials demonstrate that ketogenic and very low-carbohydrate diets effectively lower elevated blood glucose and glycated hemoglobin (HbA1c), improve insulin sensitivity, and promote weight loss in patients with type 2 diabetes. While some longer-term trials (12 to 24 months) indicate that its glycemic benefits may be comparable to other calorie-restricted dietary interventions over time, the ketogenic diet is supported by clinical trial evidence as an effective dietary approach for glycemic control and type 2 diabetes management.

0:48:28David Perlmuttersupportedmoderate

Decontamination methods for N95 masks such as alcohol, bleach, steaming, or microwaving compromise mask integrity by increasing permeability or reducing viral filtration efficiency.

"I've reviewed all of the techniques that have been described, from using a Clorox to alcohol to microwaving, steaming, and they all worked to some degree, but they compromise the mask by increasing its permeability or by reducing its ability to bind things that the N95 is able to do, like viruses." (said at 0:48:28)

Laboratory evaluations of N95 respirator decontamination confirm that common household disinfection techniques—specifically alcohol (ethanol or isopropanol), bleach, steaming, and microwaving—can significantly compromise mask performance. Alcohols remove or degrade the electrostatic charge of the electret filter layer, severely reducing aerosol capture and filtration efficiency. Similarly, methods involving bleach, steam, or microwave irradiation have been shown in multiple studies to alter fiber microstructure, degrade physical material integrity, and reduce filtration performance below the required N95 standards.

0:52:15David Perlmuttersupportedhigh

Brigham and Women's Hospital received approval to conduct a clinical trial of remdesivir in 600 patients.

"Brigham and Women's Hospital just yesterday announced that they have had approval to study this remdesivir in 600 patients." (said at 0:52:15)

In March 2020, Brigham and Women's Hospital announced participation as a clinical trial site for Gilead's phase 3 trial evaluating remdesivir in patients with moderate COVID-19. The randomized clinical trial protocol was designed to enroll approximately 600 patients (ultimately 596 patients were randomized across participating sites to receive a 5-day course, 10-day course, or standard of care).

0:44:10David Perlmuttersupportedmoderate

The mortality rate of COVID-19 is approximately tenfold higher than that of the common seasonal flu.

"far more lethal by a factor of around tenfold in comparison to the common flu, which has a mortality rate of about 0.1%." (said at 0:44:10)

Epidemiological benchmarks typically estimate the overall infection fatality rate (IFR) of seasonal influenza at approximately 0.1%. Large meta-analyses and seroepidemiological evaluations of early pre-vaccination COVID-19 identified overall infection fatality rates between roughly 0.5% and 1.0% (and case fatality rates exceeding 2%), aligning closely with an approximate tenfold higher lethality relative to seasonal influenza.

Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.