New More Infectious Variant = More Covid

We may be distracted by all the violence going on in the world and the circus show which is our political landscape today, but the issue of infectious diseases of various types is very much a serious issue we are ignoring. And yes, despite our desperate desire to put Covid in our rear view mirror, it is very much still in the driver’s seat.

I certainly don’t want to downplay the issue of our violent culture. Gun violence in the US is at an all-time high.  The conflict in Ukraine rages on and the situation in the Middle East continues to deteriorate but I heard a sobering fact the other day. Worldwide, there are 110 active armed conflicts going on today! There is a lot of hatred and lack of compassion out there.

These wars also have significant impact on the global infectious disease scene as well. In Ukraine, for example, multi drug resistance bacterial outbreaks are rampant. Many people are dying not from lack of access to doctors and medicine, but because the medicines no longer work. The issue of drug resistance is certainly not limited to Ukraine. It’s happening here in the US as well. Although partly driven by overuse of antibiotics in medicine, where as much as 70% of prescriptions are estimated to be inappropriate, the majority of the antibiotics people consume come from the meat and dairy people eat. 80% of the antibiotics produced in the world are fed to animals, to help prevent infections because of the squalid conditions they are raised in, but mostly to stimulate more rapid growth. Studies show that just one serving of meat provides enough antibiotic residues resulting in the development of drug resistant bacteria in the colon. 

I won’t comment on the political landscape, but obviously it’s a shitshow and as sad as the road is we are heading down, it will be interesting to see how our next election plays out. Either way, the crazies win!

FLU.

Many US states report high or very high levels of Influenza and the most affected victims are kids and those over 65. Kids in particular are getting hit the hardest. The sad part is that only 38% of kids are vaccinated against the flu. This is significant when you consider that 50% of the deaths in the pediatric population this year so far and all of last year involved kids who were healthy and had no risk factors, other than not being vaccinated. Vaccination works! It may not prevent you from getting sick, but it really does reduce the risks of serious symptoms or side effects.

COVID

The same goes for today’s Covid vaccine booster. The most recent studies show significant reduction in illness, hospitalization and death if you are updated on your vaccination. And just like the flu, the numbers are sad. Only 17% of US adults are boosted or vaccinated, unchanged from my last post. And the nursing home data remains pathetic with only 32% of residents being boosted and only 17% of nursing home workers being boosted or vaccinated. This is how we care for the most vulnerable in our society? 

Why is this important? Because the numbers are rising significantly, probably impacted mostly by the newest variant JN1, an Omicron variant. It demonstrates the greatest ability to evade our immune systems and greatest potential for spread than any previous variant. In addition, poor vaccination rates and “back to normal” pre-covid behavior is the norm, all facilitating Covid spreading rapidly once again.

The CDC reports significant increases in hospitalizations, ER visits and Covid positivity, particularly with the JN1 variant. Deaths are on the rise slightly, but they are concerned by what the next few weeks will reveal. The last few weeks, the daily average has been ~ 185 deaths from Covid. That’s 67,000 deaths a year. Still! It has crept back up to #3 cause of death in the US, after heart disease and cancer. Just as an FYI, sadly, dementia keeps climbing and is now #4, followed by strokes, chronic pulmonary disease, diabetes, other respiratory infections like the flu and kidney disease.

Wastewater testing shows almost record high virus counts, especially in the Midwest and Southern states. Counts there are higher than at any peak during the pandemic.

And there is NO seasonality to Covid. In Australia and New Zealand, where it is summer right now, they are having record increased rates of Covid infection and hospitalizations. 

Looking back over the last 4 years, most of the surges worldwide have occurred in warmer months. And they all tended to occur about 6 months apart, right around the time that immune protection from vaccination or previous infection really starts to wane.

Another disturbing trend is that many Covid infections today are occurring in people who had never had Covid before. Again, not too surprising given the reduced protection both from poor immunization rates, lack of protective behavior (masking, distancing…) and generally poor health with many risk factors for disease (being overweight, generally inflamed physiology, insulin resistance…). That last point about insulin resistance is important. This is the fundamental problem leading to diabetes and the estimates are not that almost 1/3rd of the US population is diabetic or pre-diabetic. If you include those with insulin resistance, usually having normal screening blood work, that accounts for 80% of the population. This is lifestyle, primarily poor diet, driven. And it is not about eating too many carbs or too much sugar. It’s the fat.

LONG-HAUL COVID. A recent study of many thousands of people with long lasting post-Covid infection symptoms revealed some risk factors. These include:

• Being over 50 with rates increasing with each decade of life.
• Female more than male
• Being overweight or obese
• Have pre-existing conditions like COPD or heart disease
• Having multiple symptoms while ill with Covid
• Being hospitalized for any reason within 30 days of infection.

Protective factors included:

• Vaccination, which was strongly linked to reduced risks of long-haul symptoms. This affect was magnified with even just one booster.
• Lack of other health issues.

With the upcoming Holidays, we will be getting together with lots of family and friends. Many of those people may have significant risk factors for having bad outcomes, be it from Covid, Influenza, RSV, Pneumococcal pneumonia or many of the other viruses and bacteria we are constantly bombarded with.

1. Test, don’t guess. It would be wise to have people test themselves before gatherings to make sure they are not harboring early or asymptomatic Covid infection. Today’s tests remain pretty accurate but keep in mind that positive tests may not develop for a few days even after symptoms start given the fact that so many people have low level antibodies floating around. So repeat a few days later if still symptomatic.
2. Stay away if you are sick with anything else. No one wants to be Typhoid Mary!
3. Do what you can to prevent illness before the holidays.
   1. Mask properly (N95)
   2. Shop during low-traffic times.
   3. Distance
4. Vaccinate and/or Boost. It’s never too late.
5. Start your New Year’s resolution to get healthier earlier! Like NOW.
   1. Move more.
   2. Eat better, focusing on whole plant foods.
   3. Work on your stress levels.
   4. Sleep better. I have lots of tips on how to improve sleep on my website doctorchuma.com
   5. Love more. We all need each other. Don’t be afraid to socialize, just do it carefully.

Enjoy the Holidays.

Stay safe and be well.

AC

Ok, I have to admit that the title was click bait!

There is an outbreak of respiratory issues, including significant pneumonia in China, especially in kids. MAny of these cases are from COvid, but there is no NEW variant of concern nor is there a NEW virus or outbreak to worry about. 

What China is experiencing is a significant rise in respiratory infections, but it is from a combination of Covid, RSV, the Flu as well as a bacterial infection we do see here as well, Mycoplasma. Now, unlike here in the US where we really did not have any significant lockdown relatively speaking (more on that below), China’s “0” Covid policy led to draconian lockdowns, unfortunate avoidable deaths from such things like appendicitis because of those policies. They truly have what is now called “immune debt”. With all of these bugs not circulating the way they normally do during non-pandemic lockdowns, providing some degree of local immunity, their population is now overwhelmed with little to no protection. Add to that that their Covid vaccination policy was and remains surprisingly very loose and a significant proportion of their population remains unvaccinated. During the lockdowns, kids also failed to receive their routine vaccinations, making them more vulnerable.

Did that happen here? We yes we did have a reduction in the cases of Flu, RSV and other infections, but it was not because of any lockdown. What the US experienced as a lockdown was comparatively speaking pretty minimal. At the start of the pandemic, 40 states did impose some kind of restrictions, but they were mostly lifted within 2 months. In addition, “essential workers”, who were exempt from any restrictions in some states, accounted for as much as 82% of the entire workforce. The rampant spread of Covid and the number of deaths in the US, a rate higher than any other country in the world, is proof of that.

So what accounted for the drop in infections? It is not clear. But it is strongly felt to be actually related to all the Covid we saw. We do know that the chances of getting Covid is low within a few months of having the flu and vice versa. This probably has to do with a boosted immune system, while the body was trying to combat the first infection. The same phenomenon is thought to account for the reduced rates of dementia, particularly Alzheimer’s Dementia, in those who regularly got the flu vaccines. Increased immune activity clears more amyloid plaque from the brain. Increased immune activity protects us from other pathogens.

OVER RUN HOSPITALS? Or understaffed with fewer open beds? Our healthcare system is the most expensive in the world, easily doubling the nearest developed country. Reimbursement drives services and the fact remains that even the best run hospitals all lose money. The result is fewer beds, increased stress and a shrinking workforce from all the stress. Take nursing numbers for example. Before the pandemic, there was about a 10% early retirement rate amongst nurses, a result of an already taxed and over demanding system. The number doubled to 20% during the pandemic and remains at that rate. Physician provider attrition rate is also very high. The chances of you seeing a non MD/DO provider in any emergency room is very high. Now many of these providers may be great, there are some clinical situations that require a level of decision making that should be reserved for doctors. I experienced this exact situation over Thanksgiving. I was on call and got called to see a patient with a potentially lethal throat infection more than 18 hours after they were admitted. I should have been called immediately. Fortunately the patient did fine, but things could easily have gone the other way.

COVID. As far as this is concerned, numbers are once again on the rise in the US and CANADA, 2 countries who can provide at least accurate and reliable hospital numbers. In the US, Covid related hospital admissions went up from 15,000 a few weeks ago to 18,000 cases per week but ICU admissions remain stable. The Covid death rate is still about 1200/week. ER visits for respiratory issues represent ~ 2% of cases, but Covid accounts for 1.8%. Wastewater testing is elevated in every single area in the US except for the south, where it remains high, but stable. In Canada, hospitalizations are high and in fact are higher than where they were during the Delta wave in 2021. As is the case here, ICU admissions remain low however.

In Europe, Italy and the northern European countries are experiencing significant uptics in cases, hospitalization but deaths remain stable and low.

Worldwide, reporting is a shitshow. The WHO reports that only 44 of countries who are even bothering to report identified only 1 case of Covid between October and November. And only 18% reported a single death. Only 13% are providing any hospitalization data. So who knows what the heck is going on worldwide.

As much as people want to deny it, Covid is here and it’s not going anywhere. 

We can make a dent in this disease and protect the most vulnerable, but it takes vaccination, testing and isolation if positive.

As far as vaccination is concerned, the numbers are pathetic.

• Only 15% of adults have received the most recent booster
• More significantly, only 17% of nursing home residents, the most vulnerable, are up to date with their vaccines.
• Even more pathetic is that only 2% of nursing home employees, those charged with caring for the most vulnerable, are up to date.
• 40% of surveyed adults report that they will never get another Covid vaccination.

We CAN control this disease, but it takes being responsible and doing what we know works.

1. Get updated with all your vaccinations. Flu, RSV, Shingles, Pneumococcal and of course Covid.
2. If you are sick, Covid or not, stay away.
3. Test, Test, Test. You can get free tests from Covid.com/tests. As far as timing is concerned, if you are fully waxed or have had Covid in the last 6 months, you may have some protection and positive tests may not develop for up to 5 days after developing symptoms. So re-test if you are concerned.

Protecting our loved ones in the upcoming holiday season is crucial so please look out for yourselves and all those around you.

Have a great weekend.

Stay safe and Be Well.

AC