A chill is in the air, and you all know what that means — it’s time for cold and flu season, when it seems everyone you know is suddenly sneezing, sniffling or worse. It’s almost as if those pesky cold and flu germs whirl in with the first blast of winter weather.
As respiratory viruses strain US health care systems, Biden administration tells states how it’s ready to help. Yet germs are present year-round — just think back to your last summer cold. So why do people get more colds, flu and now Covid-19 when it’s chilly outside?
In what researchers are calling a scientific breakthrough, scientists behind a new study may have found the biological reason we get more respiratory illnesses in winter. It turns out the cold air itself damages the immune response occurring in the nose.
“This is the first time that we have a biologic, molecular explanation regarding one factor of our innate immune response that appears to be limited by colder temperatures,” said rhinologist Dr. Zara Patel, a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California. She was not involved in the new study.
In fact, reducing the temperature inside the nose by as little as 9 degrees Fahrenheit (5 degrees Celsius) kills nearly 50% of the billions of virus and bacteria-fighting cells in the nostrils, according to the study published Tuesday in The Journal of Allergy and Clinical Immunology.
“Cold air is associated with increased viral infection because you’ve essentially lost half of your immunity just by that small drop in temperature,” said rhinologist Dr. Benjamin Bleier, director of otolaryngology translational research at Massachusetts Eye and Ear and an associate professor at Harvard Medical School in Boston.
“it’s important to remember that these are in vitro studies, meaning that although it is using human tissue in the lab to study this immune response, it is not a study being carried out inside someone’s actual nose,” Patel said in an email. “Often the findings of in vitro studies are confirmed in vivo, but not always.”
A hornet’s nest
To understand why this occurs, Bleier and his team and coauthor Mansoor Amiji, who chairs the department of pharmaceutical sciences at Northeastern University in Boston, went on a scientific detective hunt.
Here’s how to know when your child is too sick for school. A respiratory virus or bacteria invades the nose, the main point of entry into the body. Immediately, the front of the nose detects the germ, well before the back of the nose is aware of the intruder, the team discovered.
At that point, cells lining the nose immediately begin creating billions of simple copies of themselves called extracellular vesicles, or EV’s.“EV’s can’t divide like cells can, but they are like little mini versions of cells specifically designed to go and kill these viruses,” Bleier said. “EV’s act as decoys, so now when you inhale a virus, the virus sticks to these decoys instead of sticking to the cells.”
Those “Mini Me’s” are then expelled by the cells into nasal mucus (yes, snot), where they stop invading germs before they can get to their destinations and multiply. “This is one of, if not the only part of the immune system that leaves your body to go fight the bacteria and viruses before they actually get into your body,” Bleier said.
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Once created and dispersed out into nasal secretions, the billions of EV’s then start to swarm the marauding germs, Bleier said.
“It’s like if you kick a hornet’s nest, what happens? You might see a few hornets flying around, but when you kick it, all of them all fly out of the nest to attack before that animal can get into the nest itself,” he said. “That’s the way the body mops up these inhaled viruses so they can never get into the cell in the first place.”
A big increase in immune power
When under attack, the nose increases production of extracellular vesicles by 160%, the study found. There were additional differences: EV’s had many more receptors on their surface than original cells, thus boosting the virus-stopping ability of the billions of extracellular vesicles in the nose.
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“Just imagine receptors as little arms that are sticking out, trying to grab on to the viral particles as you breathe them in,” Bleier said. “And we found each vesicle has up to 20 times more receptors on the surface, making them super sticky.”
Cells in the body also contain a viral killer called micro RNA, which attack invading germs. Yet EVs in the nose contained 13 times micro RNA sequences than normal cells, the study found. So the nose comes to battle armed with some extra superpowers. But what happens to those advantages when cold weather hits?
To find out, Bleier and his team exposed four study participants to 15 minutes of 40-degree-Fahrenheit (4.4-degree-Celsius) temperatures, and then measured conditions inside their nasal cavities.
“What we found is that when you’re exposed to cold air, the temperature in your nose can drop by as much as 9 degrees Fahrenheit. And that’s enough to essentially knock out all three of those immune advantages that the nose has,” Bleier said.
It seems like everyone’s getting sick this winter. Parents and health care workers, how are you coping? In fact, that little bit of coldness in the tip of the nose was enough to take nearly 42% of the extracellular vesicles out of the fight, Bleier said.
“Similarly, you have almost half the amount of those killer micro RNA’s inside each vesicle, and you can have up to a 70% drop in the number of receptors on each vesicle, making them much less sticky,” he said.
What does that do to your ability to fight off colds, flu and Covid-19? It cuts your immune system’s ability to fight off respiratory infections by half, Bleier said.
You don’t have to wear a nose sock
As it turns out, the pandemic gave us exactly what we need to help fight off chilly air and keep our immunity high, Bleier said. Wearing a mask can protect you from cold air that can reduce your immunity, an expert says.
“Not only do masks prrhinologist Dr. Benjamin Bleierotect you from the direct inhalation of viruses, but it’s also like wearing a sweater on your nose,” he said. Patel agreed: “The warmer you can keep the intranasal environment, the better this innate immune defense mechanism will be able to work. Maybe yet another reason to wear masks!”
In the future, Bleier expects to see the development of topical nasal medications that build upon this scientific revelation. These new pharmaceuticals will “essentially fool the nose into thinking it has just seen a virus,” he said. “By having that exposure, you’ll have all these extra hornets flying around in your mucous protecting you,” he added.
Yuri Popovich had watched his neighbours’ houses burn down to the ground in Kyiv and he needed a safe place to put his money. So he did what millions of amateur investors have done in recent years: he turned to cryptocurrency. “It was impossible and unsafe to store funds in the form of banknotes. There was a big risk of theft, we also had cases of looting. Therefore, I trusted a ‘stable and reliable’ cryptocurrency. Not for the purpose of speculating, but simply to save,” he says.
The digital asset that Popovich chose in April was terra, a “stablecoin” whose value was supposed to be pegged to the dollar. It collapsed in May, sparking a rout in the cryptocurrency market whose victims include Popovich. He lost $10,000 (£8,200). Popovich says his losses were “devastating”, although donations from sympathetic onlookers on social media have helped make up some of the shortfall. He says: “I stopped sleeping normally, lost 4kg, I often have headaches and anxiety.”
Popovich is one of many experiencing the deep chill of the current crypto winter, more than four years after the market’s cornerstone, bitcoin, marked the first digital freeze by tumbling from its then peak. It went on a long tear after that but it has come to a juddering halt, with bitcoin falling below the $20,000 mark at one point this month – far below its peak of nearly $69,000, which it hit last November.
The fall has been sharp and spectacular: an overall market that was estimated to be worth more than $3tn barely six months ago is now worth less than $1tn.
The beginnings of the latest crypto boom held all the hallmarks of being another instance of the “Robinhood economy”, named after the popular American stock trading app. Bored white collar workers, stuck at home because of pandemic lockdowns but awash with disposable income, turned to day trading as a way to pass the time. Subscribers to the r/WallStreetBets forum on the popular online discussion site Reddit doubled over the course of 2020 and then quadrupled in the first month of 2021, as a small army of retail investors flooded into assets as varied as the then bankrupt car rental company Hertz, the troubled video game retailer GameStop and the electric car manufacturer Tesla, pushing the latter from $85 at the beginning of the pandemic to a high of $1,243 towards the end of 2021.
Cryptocurrencies also benefited from the surge in day trading. Bitcoin soared from a low of $5,000 in March 2020 to more than $60,000 a year later. The currency has had that sort of precipitous increase before: in 2017, it had risen 20-fold, to its then peak of $19,000. But in the latest boom, ethereum, the number two cryptocurrency, had an even more impressive climb, from just $120 to a high of almost $5,000 in 2021.
Cryptocurrency is the name for any digital asset that works like bitcoin, the original cryptocurrency, which was invented in 2009. There is a “decentralised ledger”, which records who owns what, built into a “blockchain”, which secures the whole network by ensuring transactions are irreversible once made. In the years since then, a dizzying amount of variations have arisen, but the core – the blockchain concept – is remarkably stable, in part because of the social implications of truly decentralised networks being immune to government oversight or regulation.
Where, 10 years ago, people simply spoke of trading in bitcoin, the space has ballooned. As well as cryptocurrencies themselves, , the sector has developed in a complex ecosystem. It encompasses Web3, a broader selection of apps and services built on top of cryptocurrencies, DeFi, an attempt to bootstrap an entire financial sector out of code rather than contracts, and non-fungible tokens (NFTs), which use the same technology as cryptocurrencies to trade in objects rather than money.
The flood of money washing into the world of crypto did more than simply inflate the paper wealth of pre-existing shareholders. Instead, it led to a surge of interest in, and funding for, the vast array of projects that aimed to capitalise on the underlying technology of cryptocurrencies. For a generation of new investors, the “decentralised finance” opportunities of the sector were appealing. Built on top of the “programmable money” of the ethereum cryptocurrency, the “DeFi” [decentralised finance] sector is an attempt to expand bitcoin’s anti-establishment ethos to cover the entire economy.
Take the comparatively small sector of the crypto market known as NFTs. A product dating back to 2014, NFTs take the tech used to create cryptocurrencies, but let creators link unique assets to the blockchain, instead of money-like currencies. That means NFTs can be traded that represent works of art, virtual collectibles, or even function as tickets to events or membership of clubs. And like cryptocurrencies, they can be bought or sold in open exchanges, held pseudonymously, and packaged up or securitised in complex financial instruments.
One token, representing years of work by the digital artist Beeple, sold for $69m; another, linked to the first tweet sent by the Twitter founder Jack Dorsey, was bought for $2.9m. Individual NFTs in the Bored Ape Yacht Club collection – the most consistently desired examples of “profile pic” NFTs, designed to be used as pre-packaged online identity – regularly sold for $1m-$3m apiece. But by the beginning of 2022, the NFT bubble appeared to have already popped. “Floor” prices for large NFT collections had plummeted, and, while many large NFT acquisitions have stayed in private collection, those that have been put back on the market have fared poorly: the Dorsey tweet was withdrawn from sale after achieving a top bid of just $14,000.
And then: the crash
The crypto crisis has played out against the backdrop of wider market problems, as fears over the Ukraine conflict, rising inflation and higher borrowing costs stalk investors. Some market watchers play down the prospect of a crypto crash triggering serious problems elsewhere in the financial markets or the global economy. The total value of all cryptocurrencies is about $1tn currently (with bitcoin accounting for about 40% of the total), which compares with approximately $100tn for the world’s stock markets.
Since November the value of all cryptocurrencies has fallen from $3tn, meaning that $2tn worth of wealth has been wiped out, with no serious knock-on effects to the broader stock market – so far. Teunis Brosens, the head economist for digital finance at the Dutch bank ING, says the traditional financial system is relatively well shielded because established banks – the cornerstones of the financial world that buckled in 2008 – are not exposed to cryptocurrencies because they do not hold digital assets on their balance sheets, unlike during the financial crisis when they held toxic debt products related to the housing market.
“What has happened in the crypto market has caused great losses for some investors and it’s all very painful and not something I want to downplay,” he says. “But it would be overplaying the role that crypto currently has in the economic and financial system if you were to think there could be systemic consequences for the wider financial system or even a global recession directly caused by crypto assets.” To date, the turmoil has been limited to the crypto sector. Digital assets have been hit by some of the same economic issues that have affected the wider global economy and stock markets. Bitcoin and other cryptocurrencies have been affected by concerns over rising inflation and the ensuing increases in interest rates by central banks, which has made risky assets less attractive to investors. This meant that as stock markets declined, so too did crypto assets.
But the collapse last month of terra also hit confidence in cryptocurrencies. In June, a cryptocurrency lender, Celsius, was forced to stop customer withdrawals. And a hedge fund that made big bets on the crypto markets slid towards liquidation. Crypto investors and firms that had made bets on the crypto market using digital assets as collateral were forced into a selling spree. Kim Grauer, the head of research at the cryptocurrency data firm Chainalysis, says: “It was a combination of the stock market plus the kind of excessive reaction that is typical of crypto markets because of these cascading liquidations. In this case the key event was terra.”
She added: “Crypto is not going away. And it has experienced crashes more severe than this crash.” Regulators and various government agencies are looking closely. Harry Eddis, the global co-head of fintech at Linklaters, a London-based law firm, says recent events in the crypto asset market will strengthen regulators’ determination to rein in the industry.“nI think it will certainly stiffen the sinews of the regulators in saying that they’re more than justified in regulating the industry, because of the obvious risks with a lot of the crypto assets out there,” he says.
In the UK, the financial watchdog continues to expand safeguards on crypto products. Its latest proposals on marketing crypto products to consumers could lead to significant restrictions on crypto exchanges operating in the UK. Consumers reported 4,300 potential crypto scams to the Financial Conduct Authority’s website over a six-month period last year, far ahead of the second place category, pension transfers, which had 1,600 reports. The FCA has 50 live investigations, including criminal inquiries, into companies in the sector.
The terra collapse has also heightened regulatory concerns about stablecoins, because they are backed by traditional assets and therefore could pose a risk to the wider financial system. In the UK, the Treasury wants a regime in place for dealing with a stablecoin collapse, saying in May that a terra-like failure could endanger the “continuity of services critical to the operation of the economy and access of individuals to their funds or assets”.
“Even just the top three stablecoins hold reserves totalling $140bn in traditional assets, much of this being in commercial paper and US treasuries. A run on redemptions of the largest coin (tether) could destabilise the entire crypto asset system and spill over into other markets,” says Carol Alexander, the professor of finance at University of Sussex Business School.
Elsewhere, the EU is drawing up a regulatory framework for crypto assets with the aim of introducing it by 2024, while in the US Joe Biden has signed an executive order directing the federal government to coordinate a regulatory plan for cryptocurrencies including ensuring “sufficient oversight and safeguard against any systemic financial risks posed by digital assets”. The Federal Trade Commission, the US consumer watchdog, says 46,000 people have lost more than $1bn to crypto scams since the start of 2021.
In general, regulators have been talking tough about cryptocurrencies. The chair of the FCA has called for “strong safeguards” to be put in place for the crypto market, while the head of the US financial regulator has warned consumers about crypto products promising returns that are “too good to be true”, while Singapore has said it will be “brutal and unrelentingly hard” on misbehaviour in the crypto market.
‘I’m sure crypto will bubble again’
Where crypto goes from here is an unanswerable question. For proponents, such as Changpeng Zhao, the multibillionaire owner of the Binance cryptocurrency exchange, the sector is sure to recover – though it might take some time. “I think given this price drop … it will probably take a while to get back,” he told the Guardian last week. “It probably will take a few months or a couple of years.”
For sceptics, however, the plummet could be a lasting wound. “Bitcoin will be around for decades,” says David Gerard, author of Attack of the 50-Foot Blockchain. “All you need is the software, the blockchain and two or more enthusiasts. Unless there’s new stringent regulation, I’m sure crypto will bubble again. But if there’s a genuine consumer bubble, it may not reach the heights of this one. The 2021-22 bubble made it to the Super Bowl. As many a dotcom found out 20 years ago, there’s nowhere to go from there – you’ve reached every consumer in America.”
But one thing both sides agree on is that the dividing line between “survivable downturn” and “cryptoapocalypse” is likely to involve neither bitcoin nor ethereum, but the third biggest cryptocurrency: a stablecoin called tether. Stablecoins are a foundational part of the crypto ecosystem. Their value is fixed to that of a conventional currency, allowing users to cash out of risky positions without going through the rigamarole of a bank transfer, and enabling crypto-native banks and DeFi establishments to work without taking on a currency risk.
In essence, stablecoins function like the banks of the crypto economy, allowing people to park their money safely in the knowledge that it is not exposed to wider risk. Which means that when a stablecoin collapses, it has a very similar effect to a bank failure: money disappears across the ecosystem, liquidity dries up, and other institutions begin to fail in a domino effect. The beginning of the latest crisis in crypto was sparked by exactly that: the failure of the terra/luna stablecoin. The algorithmic checks and balances put in place to keep it stable broke – triggering a death spiral.
And so on 9 May, a stablecoin called UST “depegged”, dropping from $1 to $0.75 in a day, and then falling further, and further and further. Within four days, the luna blockchain was turned off entirely, the project declared dead. A domino effect took out other crypto establishments. Some of the “contagion” has been prevented, in part through huge loans made by Alameda Ventures, the investment arm of 30-year-old crypto billionaire Sam Bankman-Fried’s empire. Drawing comparisons to JP Morgan in the panic of 1907, “SBF” has stepped in to support the crypto bank Voyager and the embattled exchange BlockFi, and been loudly calling for support from others.
Unlike terra, tether is a “centralised” stablecoin, maintaining its value through reserves which, the company says, are always redeemable one-to-one for a tether token. The model means it cannot enter a “death spiral” like terra, but also means the stability of the token is entirely a function of how much one trusts tether to actually maintain its reserves. That trust is not a sure thing. Tether once claimed to hold all its reserves in “US dollars”, a claim that the New York attorney general’s office concluded in 2021 was “a lie”.
Tether, and Bitfinex – a bitcoin exchange that shares an executive team with, but is legally distinct from, Tether – “recklessly and unlawfully covered-up massive financial losses to keep their scheme going and protect their bottom lines”, Letitia James, the New York attorney general, said at the time. The two companies had transferred money back and forth to cover up insolvency, she said, and had failed to ensure tether was “fully backed at all times”, the investigation concluded.“Te ther has been the timebomb under the market since 2017,” says Gerard.
“It has reduced its market cap by 15bn USDT in the last month, and has claimed that these are redemptions, or a reduction in their holdings of ‘commercial paper’,” she says, referring to one of the key assets that Tether uses on its balance sheet: commercial paper, short-term debt issued by banks and corporations to cover immediate funding needs. Tether, for its part, remains extremely bullish – and has even suggested it may publish a formal audit of its reserves, something it said was “months away” in August 2021.
In late June, Tether announced another expansion: the introduction of the first GBP stablecoin. “We believe that the UK is the next frontier for blockchain innovation and the wider implementation of cryptocurrency for financial markets,” says Paolo Ardoino, the chief technology officer of Tether and Bitfinex. “Tether is ready and willing to work with UK regulators to make this goal a reality.” More regulation, and further market volatility, are a given. Popovich says he is still receiving donations. “I’m extremely embarrassed. Yesterday an anonymous person sent me $50 in the form of cryptocurrency. And I’ve never borrowed anything from anyone in my life. I’m scared and restless.”
It was only a matter of time before the Centers of Disease Control and Prevention (CDC) added to this list. For a while, the “Symptoms of Coronavirus” list on their Coronavirus Disease 2019 (COVID-19) website stayed at three symptoms: fever, cough, and shortness of breath or difficulty breathing. Not anymore. The CDC has now added six more to bring the total to nine.
The six new additions are:
Chills
Repeated shaking with chills
Muscle pain
Headache
Sore throat
New loss of taste or smell
So if you have any of the nine listed symptoms, you may have a COVID-19 coronavirus infection. Or you may not. Unless you do. Such symptoms could be due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), except when they aren’t and something else is causing them. Got it?
Is all of this giving you a headache? Or is your headache from COVID-19? Probably not, if it just started from looking at the list. But if it continues, then maybe.
At least, if you have another diagnosis like an influenza, respiratory syncytial virus (RSV), or some other respiratory virus infection that can cause some of the above symptoms, you can be rest assured that you don’t have a COVID-19 coronavirus infection. Except when you have both types of infections at the same time.
A research letter published in JAMA revealed that 20.7% of specimens that tested positive for SARS-CoV-2 also tested positive for one or more other pathogens as well. For the study, David Kim, MD, PhD, James Quinn, MD, MS, Benjamin Pinsky, MD, PhD, Nigam H. Shah, MBBS, PhD, and Ian Brown, MD, MS, from the Stanford University School of Medicine reviewed result from 1217 specimens from 1206 patients who were tested for SARS-CoV-2 and other respiratory pathogens with 116 (9.5%) of these turning out to be positive for SARS-CoV-2. Of the 24 specimens that had SARS-CoV2 and at least one other respiratory pathogen, 6.9% tested positive for rhinovirus/enterovirus, 5.2% for respiratory syncytial virus (5.2%), 4.3% for other coronaviruses besides the SARS-CoV-2, and a little over 3% for some type of influenza. So if you have another respiratory virus infection, you could still have COVID-19. In the words of Bill Lumbergh from the movie Office Space, “that’ll be great.”
How’s that for freaking confusing? As more and more reports emerge of people having different groups of symptoms, it has become increasingly clear that fever, cough, and respiratory symptoms are not the only things that you should be looking for if you are worried about COVID-19. It’s also becoming increasingly clear that the course of COVID-19 can be very variable and reminiscent of that Michael Scott quote from the television show The Office: “Sometimes I’ll start a sentence and I don’t even know where it’s going. I just hope I find it along the way.” Your course of symptoms, of course, may make sense, except when it doesn’t.
It would certainly be a lot easier if COVID-19 had a clear classic symptom like the measles (a rash), the chicken pox (vesicles, which are fluid-filled little sacs on your skin), or foreign accent syndrome (take a wild guess). But the lack of such a clear symptom means that making COVID-19 coronavirus testing much more widely available is all the more important. The CDC does provide an online Coronavirus Self-Checker to help you determine whether you should contact your doctor. However, this is not a way to diagnose COVID-19. Neither is an app nor asking other people on Facebook. The only way to really diagnose COVID-19 is to get the cotton swab up the nose and to the back of your throat test to check the gunk for the RNA of the virus.
So far, other things on the CDC Symptoms of Coronavirus website haven’t really changed. It still indicates that you may begin experience symptoms two to 14 days after being exposed to the virus. And the list of emergency warning signs still includes trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, and bluish lips or face. If you have any of these symptoms, you may have severe COVID-19 that requires immediate medical attention. Unless of course, something else is causing these symptoms and you don’t have COVID-19. Either way get real medical attention as soon as possible.
I am a writer, journalist, professor, systems modeler, computational and digital health expert, avocado-eater, and entrepreneur, not always in that order. Currently, I am a Professor of Health Policy and Management at the City University of New York (CUNY) School of Public Health, Executive Director of PHICOR (@PHICORteam), Professor By Courtesy at the Johns Hopkins Carey Business School, and founder and CEO of Symsilico. My previous positions include serving as Executive Director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Associate Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, and Senior Manager at Quintiles Transnational, working in biotechnology equity research at Montgomery Securities, and co-founding a biotechnology/bioinformatics company. My work has included developing computational approaches, models, and tools to help health and healthcare decision makers in all continents (except for Antarctica) and has been supported by a wide variety of sponsors such as the Bill and Melinda Gates Foundation, the NIH, AHRQ, CDC, UNICEF, USAID and the Global Fund. I have authored over 200 scientific publications and three books. Follow me on Twitter (@bruce_y_lee) but don’t ask me if I know martial arts.
Watch the Osmosis Video here: https://osms.it/covid-19 What is COVID-19 (Coronavirus Disease 19)? The coronaviruses that circulate among humans are typically benign, and they cause about a quarter of all common cold illnesses. But occasionally, coronaviruses, like COVID-19, circulate in an animal reservoir and mutate just enough to where they’re able to start infecting and causing disease in humans. Find our complete video library only on Osmosis Prime: http://osms.it/more. Hundreds of thousands of current & future clinicians learn by Osmosis. We have unparalleled tools and materials to prepare you to succeed in school, on board exams, and as a future clinician. Sign up for a free trial at http://osms.it/more. Subscribe to our Youtube channel at http://osms.it/subscribe. Get early access to our upcoming video releases, practice questions, giveaways, and more when you follow us on social media: Facebook: http://osms.it/facebook Twitter: http://osms.it/twitter Instagram: http://osms.it/instagram Our Vision: Everyone who cares for someone will learn by Osmosis. Our Mission: To empower the world’s clinicians and caregivers with the best learning experience possible. Learn more here: http://osms.it/mission Medical disclaimer: Knowledge Diffusion Inc (DBA Osmosis) does not provide medical advice. Osmosis and the content available on Osmosis’s properties (Osmosis.org, YouTube, and other channels) do not provide a diagnosis or other recommendation for treatment and are not a substitute for the professional judgment of a healthcare professional in diagnosis and treatment of any person or animal. The determination of the need for medical services and the types of healthcare to be provided to a patient are decisions that should be made only by a physician or other licensed health care provider. Always seek the advice of a physician or other qualified healthcare provider with any questions you have regarding a medical condition.
