Covid, Polio, Monkeypox and Poor CDC Guidance

COVID.

All over the world, the BA5 variant-driven surge has been diminishing significantly. But not here in the US. Our numbers of infections and deaths are nowhere near any previous peak, but they are still significant. We are not having major spikes anywhere, just a steady state. Covid deaths are still #4 after cardiovascular disease, cancer and accidents. ALL of these are preventable. And again, as I have said numerous times, it’s all about the numbers. A small percentage of a big number is still a big number. There are a LOT of BA 5-driven Covid infections out there going undetected or unreported. And just to keep it in perspective, deaths from Covid today are greater than the worst flu season in modern times. We are numb to it.

Long-Haul symptoms remain a significant concern. Studies suggest that as many as 15% of infections, symptomatic or not, result in at least one long term symptom. New studies also show that there is underlying, simmering inflammation in the hearts of even asymptomatic infected people. There is animal evidence that this virus attaches directly to and damages heart muscle cells independent of the ACE-2 receptor. This will likely lead to a significant rise in cardiac issues in the future. As an aside, cardiologists I speak to are not seeing any significant rise in Covid vaccine-related myocarditis. Just heart issues from Covid infections themselves. There are also human studies revealing persistent viral inflammation of internal organs including pancreas, liver kidneys, heart and brain, even months after infection and resolution of acute Covid symptoms. We are likely to see a significant rise in chronic disease in the years to come.

YOU DO NOT WANT TO GET INFECTED OR RE-INFECTED IF YOU CAN AVOID IT!

New variants are on the horizon. BA 2.75 and 4.6 are ones which have started to surface although how much they are spreading and the degree of disease they cause is still unclear.

CDC guidance remains vague and confusing. Despite more than 50% of infected people remaining contagious at day 5 and 35% at day 9, the CDC still recommends going back to work at day 5 if “feeling better”. They do emphasize wearing a mask for a full 10 days but do not specify the quality of the mask. They are all ineffective except for N95! They have removed distancing guidelines, but don’t say anything about the fact that this is an airborne disease. If you can smell a smoker’s smoke from across the room, you’re inhaling their particles, including SARS-Cov-2 viruses! 

Lastly, their definition of “fully vaccinated” remains completely inadequate. They still consider 2 shots (or 1 with J&J) to be “fully vaccinated” without mention of boosting. That is completely ridiculous and contrary to the science which clearly shows that boosting is effective at not only preventing disease, but more importantly, reducing severity. The US has only a 35% booster rate with most other developed countries being in the 60s-70s. We are 70th of developed countries and are behind such countries as Panama, Rwanda, Sri Lanka, Uzbekistan and Iran. PLEASE get boosted.

MONKEYPOX

I saw a patient this week for hearing loss who came in like she just left a level 4 viral research lab. Double masked (including an N95), gloves and covered head to toe with almost no exposed skin. I asked her why, expecting to hear fears of Covid, but she said she was afraid of catching Monkeypox. This IS a virus of concern and you can transmit it through bodily fluids of any kind but the the vast majority, >95% of cases, are a result of unprotected sex, particularly in people with multiple partners. This has primarily hit the gay community and continues to spread with the US leading the way in cases. Deaths are rare, but they do occur. The CDC has once again failed in appropriate messaging stating pretty loose vaccination recommendations but this will just lead to fewer vaccinations being available to the community at greatest risk. In addition, rather than promoting restraint, espetially in high risk areas, they just promote how to have sex safer. Important of course, but it’s the wrong message.

POLIO 

Polio is a virus which lives primarily in the mouths and intestinal tract. Although you can spread it by sneezing, its primary mode of transmission is through, even minute amounts of infected feces. Infected people can be contagious for up to 2 weeks. This virus has been identified in one patient in NY state as well as in the wastewater in Rockland and Orange counties. What this means is that there are MANY other people out there spreading this virus. By the way, monitoring wastewater, especially at college campuses, is one of the main ways we are monitoring for Covid outbreaks. Those 2 counties happen to have very poor polio vaccination rates, which is actually pretty good nationally at over 93%. Although most people have at most only a mild flu-like syndrome, if anything, as many as 2% may develop permanent paralysis. Much more concerning is what happens long-term. As late as 40 years after infection, up to 40% of those infected will develop a post-polio syndrome of muscle weakness, fatigue and joint pain. That’s nearly half of the infected people with “long-haul” symptoms. If you’re not vaccinated, get it! There are 2 kinds of vaccines in the world, both based on varying degrees of inactivated live virus. Fortunately in the US, we use exclusively the killed version so the chances of actually getting the disease from the vaccine is not possible.

All of these spreading viruses suggest a few things. We must be compassionate towards each other. We need to continue to be vigilant. We need to continue to encourage vaccination and boosting. We also need to live our lives, but it must be in a way different from how we lived before the pandemic since this virus, and many other viruses, ain’t goin’ anywhere anytime soon.

1. Vaccinate, vaccinate, vaccinate. AND Boost. Fully vaccinated is not fully vaccinated if not boosted. Risks are extremely small and the benefits can be dramatic. ALL ages. As I mentioned in a previous post, the rates of vaccination of kids under 5 is pathetically low. I personally would not want to risk the future physical and mental health of my child or grandchild if they were unfortunate enough to get Covid with long-term symptoms because of unfounded fears of the vaccine.
   
   And don’t forget to get your flu vaccine before the fall!
   
2. People need to be careful. Not paranoid like the patient I saw with the monkey pox get-up or some people who have not even eaten in a restaurant since the start of the Covid pandemic, but careful. Outside, where there is a breeze and small crowds, you’re probably fine. In a jam-packed arena or crowded, closed off pub, maybe not so much. Shopping at 8 am, you’re probably OK without a mask. 4 pm on a Friday, maybe wait till the next morning or at least wear a proper mask.
   
3. Wear a good mask. N or KN95 whenever possible. Double surgical or multi layer cloth is good. I remain surprised that despite the findings of how poorly regular surgical masks are, how many hospital workers continue to wear them, rather than N95. All other “face coverings” are almost useless other than acting as a symbol of this pandemic and maybe the wearers lack of knowledge, or level of concern not only for their health, but the health of others. I wear an N95 just about everywhere. To protect me, but more importantly, to protect everyone else. I am at high risk of getting exposed because of what I do and again, am astounded I have not yet contracted this virus.
   
4. GET HEALTHY. Your BEST defense against getting really sick is having a good defense system. Barriers (masks, distance and vaccines) and Physical/Immunological. Once again, the single most important risk factor is merely being overweight, often a surrogate marker for underlying insulin resistance and inflammation. Second most significant risk factor is mental well being. Fear and anxiety are the second most common risk factors identified in ICU admitted patients. Work on your body and your mind.
   1. Focus on eliminating sugar, processed foods, animal products and adding more fruits and vegetables. 70-80% of our immune system resides in our GI tract and the single most important predictor of gut health is the amount and variety of plants you eat. It’s where the fiber comes from. And gut bugs love fiber. There is no fiber in animal products.
      
   2. Exercise. Whatever you like, do it. It improves cardiovascular function, muscle tone, bone health, reduces weight and improves mental health.
      
   3. Get better sleep. The benefits are dramatic.
      
   4. Relax. Stress is not what happens to you, it’s how you respond to what happens to you. Chronic stress puts your immune system on alert, causing it to over react. Chronic stress also increases generalized inflammation and increases weight gain.
      
5. Socialize. We are social creatures and need each other.
   

I’m off for a week. Moving my youngest into his new dwelling at college in Ann Arbor this weekend and spending the rest of the week at my happy place (Wildwood Crest) with many of my favorite family and friends. I’m missing some of my Canadian clan but hope to be up there in the fall.

Слава Україні (glory to Ukraine) 🇺🇦 🌻 

Stay Safe and Be Well.

AC

I have recently been reminded (not that I need to be because of what I do) that the Covid pandemic is still alive and well, not only in other parts of the world, but here at home also. Looking around at people’s behavior, you wouldn’t think that we are still in the midst of a pandemic, but we are. And its impact continues to be far reaching. I recently had a significant exposure, and it was not at work. I was a little worried about myself since I have a few medical issues which put me at risk, but moreso, I was worried about my family, my partners, who would need to cover for me if I did get sick, as well as the approximately 100 patients I would need to reschedule since my ability to do remote work is extremely limited. That’s 100 people who made plans and arrangements to see me or to have surgery. Patients with head and neck infections of all kinds, cancer… That is a lot of disrupted lives, all because of one exposure.

Once again, your behavior and concern about your own personal potential risks is not a decision that only impacts you. You are making a decision for all those around you, and subsequently, all those around them. 

The Omicron 5 variant is spreading like wildfire and along with it, more patients suffering short, and long-term symptoms, simply because of the sheer large number of people getting infected. Most are still getting through OK, but many aren’t. Vaccination and boosting is still important because it helps to minimize the degree of illness, and does reduce infection rate, particularly the boosters. Vaccine protection against Omicron 5 is admittedly much less than with previous versions, but any reduction is important with such an infectious virus. And if your last shot or booster was more than 6 months ago, you need an update.

Death rates have remained stable in the US for the last few weeks, at ~ 450/day. But projected over a year, that would make Covid-19 the 4th leading cause of death in the US after heart disease, cancer and accidents. At its peak, it was second. Once again, we have become numb to this disease, which continues to spread and re-spread in our population. This virus continues to evolve so the notion of a “steady state” is very short sighted.

COVID REBOUND.

Recently, this issue has been given a lot of attention because of our President’s infection, and re-appearance after 3 days of negative testing. This happened to Dr. Fauci as well. Our knowledge of this phenomenon is evolving. Although some immediately blame Paxlovid, the antiviral given to both men very early in their infection, rebound is also occurring in people who never got the drug. In fact, a large study done by the drug company which makes Paxlovid (I agree that we can’t trust drug companies but this is all we have now) indicated that the rate of rebound was ~ 2% in those taking Paxlovid, but that the rate was the same in those taking the placebo as well. Newer numbers suggest that the rate of rebound is nearer to 5%.

Paxlovid is actually a combination of two drugs and essentially works by preventing the virus from replicating. It is an important tool in treating Covid infections, but it needs to be used judiciously in people with significant symptoms or significant risk factors.

The argument that Paxlovid is triggering “resistant” mutations has not been supported since genetic testing shows that the rebound virus is exactly the same as the original infecting virus.

Longer courses of Paxlovid are now being prescribed by some doctors (the present course is 5 days) but this is not supported by any studies. The thought is that the 5 day course knocks the virus back a lot, but not all the way, suppressing but not killing all the virus, which then re-emerges once the drug is gone. Not a proven theory.

The reality in my opinion is that we have once again tried to get away with whatever we can. The recommendation that you can stop isolating after 5 days has caused more damage than good. There is no study showing that the duration of contagiousness has changed at all despite all the mutations and variants which this virus has produced. At least 50% of people remain contagious at 9 days. That’s it. The only reason this recommendation was even suggested had to do with the fear of losing too many critical workers. And even with them, you had to continue wearing an N95 for an additional 5 days and be fever free for at least 48 hours. Not even a surgical mask would cut it. But, as is human nature, we took these recommendations, loosened them and now it is accepted as the norm.

You can’t cheat this virus!

PEDIATRIC VACCINATIONS. Approval for Covid-19 vaccination for kids under 5 (down to 6 months) has been approved for months now, but despite that, fewer than 3% of kids in that age bracket have been vaccinated. Although kids are a little better protected against contracting Covid, primarily because of a more robust innate immune system, they are not completely immune. In fact, the numbers of new cases and hospitalization in this age bracket has been larger during the Omicron surge, than in all other surges combined since the start of the pandemic. We have no idea how this virus will affect the developing brains of these young children. Of course we do not know how the vaccine will affect kids long-term either, but we do know how some of these kids end up. Really sick, with complications or sadly, dead. PLEASE get yourselves and your children vaccinated. 

MONKEYPOX. This is an RNA virus, similar to smallpox and was first discovered in the 1950s in African monkeys. Many other animal hosts have been identified. The most recent outbreak has been blamed on deforestation and more human-wild animal interactions leading to infections. Hunting bushmeat (monkeys) is also implicated. 

Although the numbers of cases of this viral infection aren’t even remotely close to those of Covid-19, this is still a very significant issue to be concerned about. The most recent outbreak originated in Africa and although only 2 months ago, cases were limited to that continent, it has now spread to over 90 countries and almost a quarter of the cases are in the US. 

It is a respiratory virus in that if an infected person with lung symptoms coughs directly in your face, you could become infected, but it is not spread by simple breathing, as SARS-Cov-2 can. It is spread by any body fluids and this is primarily spread through sexual contact. But touching open sores or blood can also lead to transmission.

Numbers are not tremendously high, with just over 27,000 cases being reported worldwide, but again, with only 4% of the world’s population, the US has over 6000 cases, 22%. Worldwide deaths are only just over 10 so far.

Anyone born in North America after 1972 is out of luck when it comes to any form of natural immune protection since it was at that time that smallpox vaccination was discontinued in the US as the disease was considered eradicated. Those who received this vaccine have some overlap protection. There is only 1 company which makes the very fragile Monkeypox vaccine and there is a massive shortage as countries are starting to panic. I mentioned in a previous post that our public health messaging has been pathertic, focusing on safe sex practices, rather than abstinence in any situation where there is concern of infection.

It’s a crazy world out there and we need to be careful and thoughtful about others.

Continue to mask where there are large groups of people indoors. 

Use an effective mask, preferably N95.

Distance in those environments the best you can as well.

Get vaccinated or boosted.

Get healthy! It’s your best defense.

Have a great weekend.

Stay safe and be well.

AC