New Variant, New Covid Spike, Same Pandemic

Just when I was looking forward to maybe posting a few things about nutrition and improving lifestyle habits rather than doing COvid updates, Covid appears to be rearing its ugly head once again. I was never in denial that it was no longer around, but even I became somewhat cavalier about my approach to life in the midst of an obviously persistent pandemic. Should we even still be calling it a pandemic? Probably not. This virus is here to stay. It’s now endemic. But how we deal with it will need to adapt, as the virus adapts.

BA.2.86 nicknamed “Pirola”, has mutations which might represent more than just another variant but an evolutionary jump on par with the emergence of the Omicron variant in 2021. 

Just a reminder that the “spike protein” on the surface of the virus is where it attaches to the ACE-2 receptor found on the surface of a myriad of cells throughout our organs and cells. Most Sars-Cov-2 variants have 1-2 mutations, mostly on this spike protein. BA.2.86 has 36 mutations! To make matters worse, its mutations include changes at key parts of the virus that could help the variant dodge the body’s immune defenses from prior infections or vaccinations. Omicron had a few similar mutations.

It has been identified in many countries around the world and numerous states in the US. But it is not clear however that it is solely responsible for the 20% increase in US hospitalizations related to Covid in the last week or two. PArt of the reason we don’t know is that there is significantly less testing going on and even less sequencing of the genetic code of the variants. Fortunately, despite the increase in hospitalizations, the rate of ICU admissions or deaths has not notably increased. At least not yet. Remember that those other 2 metrics lag behind infection cases numbers, which are not accurate today, and hospitalization numbers, which are.

There are already school closures in elementary, high and even college level institutions in the US. Certainly not to the degree we have seen in the past, but it’s happening, again. Signs about masking are starting to pop up in some hospitals.

I continue to see patients struggling with post-Covid long-haul symptoms. I recently heard the new term post Covid “lingering” symptoms, those which started after a Covid infection and are more of a nuisance, like stuffiness and throat clearing, rather than significant life-impacting symptoms, like breathing issues, heart problems, significant taste and smell alterations and brain fog. 

I have recently been getting a lot of questions about whether to get the vaccine or not, mostly from people who have had some kind of symptom which they attribute to the vaccine. These symptoms are usually after a booster after an initial vaccination went uneventfully or after they had Covid once before. Mostly, the symptoms start a few weeks or even months after the shot, but they still attribute it to the vaccine. Almost all of these symptoms and health issues I have seen develop spontaneously or after some other kind of illness long before Covid or Covid vaccines came on the scene. For example, one patient absolutely attributed his tinnitus (ringing) to the vaccine. The symptoms appeared 3 weeks after his second shot. The incidence of tinnitus in the general American population is 10%, normally. I have seen patients for over 25 years who one day wake up with tinnitus for no explainable reason other than they are old, have blood pressure issues, hearing loss or noise damage, or in some cases, no explanation or risk factor at all. Is there a link to the vaccine? Possibly, but the link between getting Covid and tinnitus is much greater. Can the vaccine induce some inflammation which can make tinnitus apparent? Probably, but so can stubbing your toe or getting bit by a mosquito, or more commonly, not caring for your hearing protection or general health. 

The point is that sh*%t happens, sometimes randomly, and we can’t assume everything that ills us is vaccine related. I had 2 patients who insisted that the vaccine caused their hearing loss, and there are reported cases of this, but in this situation, they simply had wax impaction! Q-Tip vs Covid?

The complication rate after vaccination remains extremely low. MUCH lower than the complication rate from getting sick. But as I have mentioned many times, a small percentage of a large number is still a large number. Millions of people got the vaccine. It stands to reason that we would be aware of more complications simply because we are hyper acute to this new disease and its evolving treatment along with the vastly increased numbers of people dealing with it.

Are vaccines, including the Covid vaccine, perfect and free of risks? Absolutely not. But everything in life is about mitigating risk. The risks associated with a Covid infection still far outweigh the risks from the vaccine against it. Aspirin is a miracle drug for some people, but it still causes more complications and kills more people worldwide than any other drug. People still take it readily, often misguidedly.

All that having been said, even I have recently questioned whether the vaccine caused some heart problems I have been dealing with. I started experiencing an increase in palpitations 2 summers ago. I have had such palpitations most of my life. Those turned out to be not a big deal but by coincidence, I was diagnosed with a new rare arrhythmia which can be quite serious. It was monitored closely with a very small implanted device called a loop monitor but at the start of this summer, the arrhythmia changed a bit, becoming less regular and more dangerous, necessitating that I have a defibrillator/pacemaker implanted. This condition is rare, can be inherited and associated with congenital heart defects but usually occurs for no obvious reason. Although inflammation of the heart muscle (myocarditis) can cause it, and this condition is rarely associated with the Covid vaccine, the incidence is much higher if you have a Covid infection. In fact, any vaccine and any viral infection, even the common cold, can cause myocarditis and subsequent heart problems. But most cases of myocarditis occur without any cause whatsoever and most resolve without any residual heart problems.

So, am I going to boost when the 6 months is up. Yes. I want to do everything I can to avoid getting Covid and if I do get it (it’s amazing that I have not yet had it), I want to minimize the risks of having a serious case of it which can make my heart issues even worse.

Despite the new variant emerging, the present available vaccine does provide some protection against it so I continue to recommend that people get vaccinated and/or boosted. Especially if you are over 65 or have any kind of chronic condition, especially anything which impairs your immune function (that includes regularly taking any drugs that affect your immunity, which includes NSAIDS like motrin). 

Also, get your flu shot. The flu still kills. Wait until October to maximize coverage through the majority of the flu season, which can extend into April.

Test, don’t guess. Home Covid tests do pick up this latest variant.

If you’re sick, Covid positive or not, stay away for a few days. Be responsible.

Masks are starting to surface again. I have a few trips coming up in the next few months and I plan to wear an N95 at the airport and on the plane. I am starting to be selective about masks in the office and the hospital after a few months of not wearing them other than in the operating room.

And please continue to work on your health overall. Your best defense is a healthy body and immune system.

Your diet. Your sleep. Your stress. Your exercise. Your social interactions. ALL these things are important for overall health.

Have a great Labor Day weekend.

Enjoy your family and friends.

Stay safe and be well.

AC

 

Although everyone seems to have put covid in the rearview mirror, it is certainly not gone and we need to keep looking ahead for dangers. It is very hard to get accurate numbers of cases since no one is testing anymore and the reporting systems have all been dismantled, but there are some recent reports of surges in the US. There are certainly hot spots all over the world where Covid is still very much in the limelight. Hospitalization and deaths, much more reliable statistics, remain down in the US, although Covid-19 still remains in the top 10 causes of death.

I am certainly still seeing many long haul Covid symptoms.

What many are calling a “late summer cold” is in many cases Covid. It remains just as infectious, still transmitted by simply breathing, but fortunately it is still causing less severe disease. The majority of the hospitalizations and deaths are in those over 65 and/or with some other kind of underlying condition. Being overweight or obese remains the most common risk factor. And that metric has worsened significantly in the general population during the pandemic.

Lack of vaccination or not staying up to date with boosters is also a significant risk factor so please get your shot, especially if you have any risk factors.

The mutation rate of this virus remains extreme and new variants continue to develop. In the US, the current dominant variant is XB1.1.6 and is causing a spike. The largest increase in cases is in Nebraska. In Europe, the latest variant, accounting for almost 30% of cases, is EU11, a close relative of XBB.

All of this is important since it clearly shows that Covid is still very much with us and continues to mutate at a rapid rate.

What does that mean? We just need to be vigilant and continue to be mindful of those around us, especially if you are the one who is sick. Don’t just assume it’s a “summer cold” or allergy exacerbation. 

TEST!  Don’t GUESS.

And Covid is not the only infectious disease to be concerned about.

MALARIA. Malaria is caused by a protozoan carried by mosquitoes. An interesting factoid is that the Center for Disease Control, the CDC, was founded in 1946 to deal with the Malaria problem which was much more rampant at the time in the US. In recent decades, native cases of Malaria are very rare. In fact, there have not been any native cases in over 20 years, until now. Typically, around 2000 cases of Malaria are identified in the US but they are all associated with travel to Malaria-endemic regions. Although there have only been a handful of this mosquito-borne disease in Texas and Florida, they are the first native cases in over 20 years and can easily spread. Why is it reappearing? Warmer climate. More humidity and rain. In other words, climate change. And mosquitoes love it. Other microbes like Zika virus, West Nile virus are also seen in the US. Watch for standing water in your yard and use mosquito repellant.

I think you have to have your head stuck pretty far up you-know-where to deny that climate change is occurring. Record setting heat all over the world. Premature tornado seasons. Extreme flooding. Hot-tub like oceans with dying reefs. How much proof do we need? 

I think that as the fall and start of the next school year approaches, we are likely to see a much clearer new Covid spike. We are certainly going to see other typical conditions like the flu, and other common upper respiratory infections caused by such common viruses like adenovirus and rhinovirus. It will be interesting to see how our health care organizations and governmental bodies respond and what their recommendations will be.

In the meantime, work on your health. A healthy body is your best defense.

Eat well. Push the plants (the only source of fiber) and avoid animal products (the only significant source of saturated fats not to mention hormones and other drugs like antibiotics).

Move as much as possible. 

Get vaccinated. Covid, Flu, Shingles. These are all a must for adults. Keep your kids up to date. I’ve seen more than a few measles-related permanent hearing losses.

If you are sick, get tested and stay away from other people.

The days are getting shorter so enjoy the end of the summer with your friends and families as much as you can.

Be safe and stay well.

AC