Flu & Covid Vaccine Timing and Covid Update

The CDC has been promoting the latest Covid vaccine, encouraging people to get boosted while simultaneously getting the annual flu vaccine. Although I am still very much in favor of vaccination and I think getting both simultaneously is perfectly safe, I question the timing.

We know that the protection all the Covid vaccines provide wanes over time, with vaccine boosters being encouraged every 6 months or so. Well the same waning immunity occurs with the flu vaccine. The estimates are that protection against getting the flu and/or having severe symptoms decreases by a little more than 10% each month. We also know that although the majority of the flu season is in the winter, there is often also an early spring spike in cases. Given that, to maximize coverage, I would encourage people to wait until mid October to get the shot. It is only a matter of a month, but that month may mean the difference between getting sick or not, early in 2023. Unlike Covid, flu vaccine boosters are not available as of now.

If you are past 6 months after your last Covid booster, I would get that now and the flu shot next month.

As far as Covid goes, numbers keep slowly dropping. Compared with 2 weeks ago, both ICU admissions and death have dropped by 8% and hospitalizations overall have dropped by 10%. That having been said, this disease is still with us and remains the 4th leading cause of death, but you would not think that given our general attitude about it. Which is that it no longer exists and we should just go about our lives like there is no Covid. 

I am shocked by the number of patients I am seeing every day with long haul Covid symptoms and by how many people report Covid infections in the last 2-3 months. I was just at a meeting where I attended a lecture about this very topic. There is a significant incidence of odd smell and taste symptoms which are developing months after infection, even in those who did not have any initial smell and taste complaints when infected. Parosmias, which are distorted smell perceptions, and phantosmia, perception of odors which do not exist, like dirty socks, burnt coffee or rotting meat, are starting to be seen more commonly. I spoke with a cardiologist a few months ago who was reporting on studies showing continued inflammation in the hearts of people infected with Covid who had no cardiac complaints presently nor at the time of infection. He is concerned that years from now, the cardiology community will be dealing with an outbreak of heart failure from the slow, unrecognized damage this virus continues to cause in the heart. The same concerns should be appreciated in other organ systems like the brain, pancreas and kidney, all of which have been identified as targets of the virus. The lungs are the obvious site, but it really affects every part of our bodies. And who knows how this virus will impact the developing brains and bodies of our children.

There is a new variant out there, BA 2.75.2. It is very early in its appearance and we know very little about how it behaves, but it is a reminder that this virus continues to evolve. But we have stopped evolving and have returned to our regular, arguably oblivious and distracted lives.

The bottom line is that this virus is still with us and you do NOT want to get it if you can avoid it. Masking, distancing, avoidance of crowded social situations, vaccination… These are all strategies we must continue to think about and employ if we want to remain healthy. Yes we need to live, but if we want to do so healthfully, not only now but in the future, we need to re-think habitual, daily behavior. 

Stay safe and be well.

AC

Despite all our wealth and notions of having such a great health care system, the life expectancy in the US has been the lowest of almost all developed countries for many years. Although life expectancy had been gradually rising since such statistics have been tracked in the early 1900’s, for the first time, it started to decrease during the 3 years in a row before the pandemic and this generation of kids is expected to be the first not to outlive their parents. Sadly, the Covid pandemic has significantly accelerated this decline, particularly in the US.

We now have the lowest life expectancy since 1996! And it is not just because all the older and sicker people are dying from Covid. For life expectancy to drop, deaths across all age categories must see a decline. Although Covid has certainly had an impact since it remains the 4th leading cause of death in the US, younger people have died at significant enough numbers to impact the overall statistics. Deaths from all leading causes, especially cardiovascular disease, cancer and neurological disorders like Alzheimer’s Dementia have also steadily increased. Certainly our general continued deteriorating health has impacted on this the most. People have simply gotten fatter and sicker.

COVID UPDATE.

Although hospitalizations and ICU admissions in the US continue to slowly decline (by 10% and 8% respectively in the last few weeks), the death rate remains stable at ~ 450 a day, and in some pockets in the US, deaths are starting to creep up. To put that into perspective, that is equal to the worst flu season on record (other than 1918). As mentioned above, Covid-19 remains the 4th leading cause of death in the US. In other parts of the world however, Covid is once again on the rise. In China, where a draconian “zero Covid” policy has been enforced, for the first time, new cases have been identified in every single Chinese province simultaneously. In Japan, they are experiencing the highest death and case rates from Covid since the start of the pandemic!

There are lots of potential contributing factors, but the bottom line is lack of vaccination and boosting. Although today’s vaccinations only decrease infection rate with BA 5 slightly compared with previous versions of the virus, they continue to protect against severe disease, hospitalization and death. And both Japan and China actually have pretty poor vaccination rates, as well as China’s vaccine being significantly less effective than the ones we have, since the start of the pandemic.

As far as vaccinations go here in the US, we are about to launch the latest vaccine, including protection against BA 5. Protection from the first round is waning and boosting has fallen way behind. Fewer than 11% of people over 50 years of age have been boosted and the boosters have definitely shown protection against severe illness. 1/3rd of Americans have still not received even their first dose of vaccine! And the numbers are significantly lower in kids under 20, especially under 5.

I plan on getting it when it becomes available and I think everyone should also.

We are ALL vessels of transmission and the longer this virus is around, the more opportunities it has to mutate into something more ominous. The previous version of SARS was much less transmissible, but much more lethal, upwards of 10%. SARS-Cov-2 is much less lethal, but much more transmissible. With SARS, a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, only 774 died. With SARS-COv-2, We are surpassing 610 million cases and 6.4 million deaths worldwide. Imagine what would happen if SARS-Cov-2 even slightly increases its lethality!

REBOUND COVID AFTER REMDESIVIR

After many administrations of this medication, the bottom line is that there are just as many cases of rebound Covid in people who did NOT take remdesivir as there were in those who took it so it’s a non issue. If you are older and/or have comorbid conditions, take it ASAP as it will reduce risk of severe disease. It’s easy to get. Even pharmacists are authorized to give it out.

In addition, what this means is that you just can’t rely on the 5 day isolation recommendation. Around half of people are still infectious at 9 days. Add to that the rebound potential, and people can spread this for a lot longer. BE CAREFUL and RESPONSIBLE!

MONKEYPOX. Now identified in almost 100 countries, the numbers have improved here in the US due to a combination of vaccination and some behavior modification (less sex with fewer people!!!). Just like with Covid however, vaccination rates remain low even in high risk populations where vaccines are available.

POLIO. It has now been isolated in wastewater from Sullivan county, in addition to Orange and Rockland. This virus remains an issue of great concern. Once again, mild infection today can and will lead to delayed symptoms, even decades from now. Other than the one isolated case of neurologic problems, cases remain elusive but it is clearly spreading. Just like the other counties, vaccination rates are very low in Sullivan, probably accounting for the spread of the disease.

Please continue to be careful.

We will not vaccinate our way out of this pandemic. There are too many people who refuse to do it. So you can take a chance, or get vaccinated to mitigate the damage. 

We will not mask and isolate ourselves out of this pandemic. So you can throw caution to the wind and go to a packed club, or even a packed grocery store, shoulder to shoulder with loud, unmasked people, or you can take some caution and avoid those situations, or at least wear a proper mask. You can eat inside a packed restaurant, or choose to eat outside on the patio with fresh air. 

It’s all about mitigating risk but please remember that you are not just making decisions for yourselves, but for everyone else around you.

Have a great Labor Day weekend.

Stay Safe and Be Well.

AC