STATE OF THE PANDEMIC and a SHAMELESS PLUG

A SELFISH ASK. A beautiful weekend is coming up. I will be attending a charity event with former Phillies players participating in a baseball game tomorrow. Proceeds are going to my brother-in-law’s family. He suffered a pretty major stroke a year and a half ago and needs some renovations which will dramatically improve their lives. If you are interested, click here for a link to the site. 

Next week,on May 11th the official pandemic emergency measures will be lifted across the US. Although in the public eye this pandemic is over and many facilities have already removed various restrictions including mask mandates (which includes my own office), Covid-19 as a disease is not gone, nor will it be gone for a long time, if ever. Just like the Spanish Flu in 1918 became a less severe but persistent, yearly infection, Covid-19 will likely evolve into something similar, but with a few notable and very important differences I’ll review below.

Today, in the US, case rates seem to be going down but numbers are unreliable since there is no longer any official reporting.

Death rates and hospitalizations are easier to track. Hospitalization rates are also lower but stable. Deaths from Covid hover around 150/day in the US. That amounts to a little over 55,000 a year, rivaling some of the worst flu death seasons we’ve had. It remains in the top 10 leading causes of death and will likely stay there.

Outbreaks continue to occur across the globe, another one surfacing in India again, XBB1.1.16. It appears just as “mild” as the last variant. It is not a “variant of concern”.

Although most Covid infections are still considered mild, the long-haul case rate is 10%. All viral infections can develop long-term symptoms and problems, but Covid-19 has a much higher rate than any other respiratory infection. And I continue to see numerous combinations of post Covid symptoms on a daily basis. I’ve been surprised by how some people have just come to accept their symptoms as normal and they move on. Just like people accept they have diabetes, vascular disease or obesity, and they just live with it, managing symptoms with medications rather than trying to reverse their chronic conditions with lifestyle changes.

So have we just gotten to a point where we now accept this rate of infection, chronic disease and death as part of life? It appears so.

What makes Covid-19 different from other respiratory infections? Here is a refresher.

1. It is NOT seasonal. Flu can reliably be predicted to occur during the colder months, when people are in closer proximity with less ventilation. We don’t give the flu vaccine once a year because it lasts all year. It’s because we only need to be protected for 4-6 months. Covid outbreaks were just as bad in the summer months as in the winter months.
2. It is spread by just breathing. Even if you do not have a cough or sneeze, the SARS-Cov-2 virus spreads, suspended in the air. The same way you can smell smoke from someone’s exhalation meters away, you can inhale the virus.
3. It is much more infectious. In addition to having an easier mode of spread, once it is in you, it has a greater capacity to actually infect you and avoid our immune defenses. This is partly related to how this virus works and that it binds to a receptor (the ACE-2 receptor) which is quite concentrated in the upper airway.
4. Because the ACE-2 receptor is on almost all cells and in all organs in the body, it can affect those organs more readily.
   1. The pancreas cells (beta cells) which make insulin are destroyed by the virus leading to diabetes.
   2. The heart has these receptors so heart issues like myocarditis or serous and even life threatening arrhythmias can occur. The arrhythmias and inflammation which occur as a result of the vaccine are minimal compared the incidence of those problems if you get Covid
   3. The brain has receptors. Brain fog, memory loss, headaches… It also appears that long-term smell and taste issues are more of a brain-processing issue than an actual taste bud receptor problem. How our present generation of kids will be cognitively impacted by infections is still to be seen. The social impacts of the pandemic have been well documented with at least 50% of not only kids, but adults expressing severe loneliness and depression as a result of the Pandemic.
   4. The kidney has lots of these receptors. It’s where we learned about this receptor in the first place given its important role in blood pressure management. Kidney disease can result from Covid. Some have had such fast deterioration that they have needed transplants already and many will need them in the future.
   5. Lungs. Even in completely asymptomatic young people, the incidence of permanent scarring is ~10%. As with the kidneys, lung transplants have been needed in some, and many more will need them in the future with continued deterioration.
   6. The eyes have receptors and are not only a site of infection entry, but eye problems can develop long-term.

We have learned a lot about this virus, how it’s transmitted, how to treat it… For example, unlike the flu which is much more infectious by contact, the SARS-Cov-2 virus seems to be less infectious this way. SO, we don’t have to let our mail sit in the garage for a few days or windex our bananas to decontaminate them anymore.

We have also learned that just about any chronic condition significantly raises your risks of getting infected and/or having a much more serious case of Covid. The most common chronic condition associated with Covid ICU admissions is simply being overweight, not even obese. Since 75% of Americans fall into this category with nearly half being obese, it’s not surprising that the US had the highest per capita Covid-related infection, hospitalization and death rate of, not only industrialized countries, but even many third world countries. Sadly, weight issues have worsened during the pandemic and rates of all other chronic diseases have increased. Today, 50% of Americans are known to have diabetes or pre-diabetes (I hate that term because it gives the false sense of security that things are “not that bad” yet). Add to that all those who don’t know they have diabetes as well as the people who have insulin resistance, the fundamental underlying problem, and the number is closer to 80% of Americans have some degree of glucose dysregulation. 

I’m rambling again.

What to do?

Just be smart and practical to the best of your ability. Think about not only your safety, but the safety of everyone around you. If you have symptoms, test and stay home. Remember that Covid is not the only transmissible respiratory disease out there.

Wear a mask where it makes sense. It amazes me that even in our local ER, where I had the unfortunate opportunity to spend time yesterday with a patient suffering a severe allergic reaction with tongue swelling, how few patients and even healthcare workers are wearing masks. Of all places! It’s where sick people go! Shopping at Wegmans at 8 am is probably pretty safe without wearing a mask, but not at 4 PM on a friday.

Avoid tight crowds and spaces if possible. I certainly have enjoyed a few events last year where the risks were high, but it was a calculated risk.

Part of that calculation is if and how vaccinated you are. 

Even without any of the boosters, getting vaccinated significantly reduces the incidence of severity of disease. Maybe we can’t avoid catching it, but we can avoid getting really sick or dying from it. Unvaccinated people are 5x more likely to die from Covid. 10x more if you are over 50. Getting boosted reduces those risks even further.

The data is clear on the overall safety of the vaccines and boosters. In comparison to commonly used drugs like aspirin (which kills more people worldwide than any other drug), motrin (which contributes to more joint replacements than it spares since it kills off cartilage producing cells) or acid reducers (chronic use of which increases risks for a heart attack or stroke by 30%), vaccines are incredibly safe.

Presently, the bivalent mRNA booters are only allowed for first time boosters, immunocompromised kids and some adults, as well as all those over 65, regardless of health status. I tried to get mine about a month ago but was sadly denied. Since the change in the approvals, I will be getting it ASAP.

Stay Safe and Be Well

AC

Covid continues to kill ~ 260 people a day in the US and it remains in the top10 leading causes of death. Despite that, this number is the lowest since the start of the pandemic and it has been on a slow but steady decline. Case numbers and hospitalizations continue to drop as well. But just as there seems to be some sense of normalcy in the medical community, something is going on in India.

India has seen its share of devastating Covid surges in the last 3 years. It is a massively overcrowded, mostly rural and poor population with poor medical infrastructure. It is a breeding ground for infectious disease. And once again, it appears to be the hotspot for another Covid surge. Just in the last 24 hours, over 6000 new cases have been reported, and that’s in a country with very poor reporting capabilities to begin with.

The cause of this surge appears to be a new SARS-Cov-2 variant (let’s not forget the original name of the virus). This new variant is XBB 1.1.6. It is still very early in this surge but there is concern that it is more infectious and more virulent than the last few variants we have been dealing with. The most recent variants have gotten zero press because they have not caused any uptics in cases or deaths. Infections seem mild. The news cycle is focusing on the “Trump Circus”, more gun violence and climate-change related tornados and storms causing death and destruction. Even the continued raging war in Ukraine gets much less press these days. 

These are all important issues (except the Trump soap opera), but we can’t ignore what is going on in India since it could easily reach our shores in no time flat. And given the loosened travel requirements, poor booster adoption rate and continued lack of interest in basic protections such as masking, distancing and improving health, we are extremely vulnerable.

This weekend is another big holiday. Soon, we will be getting into the graduation party season. Mother’s Day. Long weekends… It is important to see family and friends, but please do so carefully. I would recommend that before gathering, especially if there are vulnerable people (which quite honestly is most of us), test yourself. Especially if you have any symptoms. If you are really symptomatic, re-test since false positives are more likely with the variants. It is the start of tree allergy season, and allergy symptoms can mimic those of infection easily but a nasal swab is cheap and simple to perform. But even if you are negative but have clear symptoms of some kind of viral illness (and there are many still out there), just stay home.

Shop early. Mask if the store is crowded. I do think there is some value in doing a nasal rinse after being in a crowd. Washing out nasal secretions embedded with viruses before the virus can take hold in your nasal tissues could be the difference between getting sick and not. Spend as much time outdoors as you can. It looks like a nice weekend and sunlight and fresh air really do help.

I have 

If you have not been vaccinated, or boosted. Please do so. After 6 months, protection against this virus wanes significantly. As soon as I can, I plan to get another booster. I continue to see significant long-covid symptoms. And there are weird ones out there. In addition to loss and alteration in taste and smell and chronic coughs, I had a patient this week who became aphasic, meaning she lost the ability to speak. She knew what she wanted to say, just couldn’t get the words out. I saw someone else with a severely worsening diabetic state. Both brain and pancreatic cells are potential targets for the virus. You DO NOT want to get this virus, or spread it, if you can avoid it.

Enjoy being with your family and friends. Enjoy the beautiful weekend.

Stay Safe and Be Well.

AC