Covid Management Strategies

Covid Management Strategies

Andrew Chuma No Comments

I haven’t posted much recently about Covid. 

Quite honestly, there is not all that much new to talk about. In addition, headlines have been dominated by the war in Ukraine, politics, Johnny Depp and now the horrific mass shooting in Texas. 

Case numbers are slowly on the rise. Because of home testing, which is unreported, the true number of infections is likely much higher. It seems like everyone recently has had Covid or knows someone who has. 

Much to my surprise, despite my daily exposure, I have not been infected. Recent blood work shows that I have not been exposed enough to the actual virus to have developed antibodies. Without question, I have been exposed multiple times, but I attribute the lack of actual infection to vaccination (I am double vaccinated and double boosted), being careful with constant N95 masking at work and in most other public places, as well as a healthy vegan lifestyle along with daily exercise. My sleep and stress management could be tuned up a bit. Actually a lot, but no one is perfect. As an aside, studies of thousands of healthcare workers have shown that being plant-based dramatically reduces the risks of getting Covid or having significant disease if contracted. I have no delusions that I won’t get infected eventually.

Vaccination rates have dropped, with only 48% of Amercans over 12 now being fully vaccinated with either one or two boosters, if appropriate. Although we are behind every other developed country, quite honestly, we are not that far behind. For example in Canada, they have only 55% of their over 12 population fully vaccinated. Most European countries are at least in the 60%s with adults being even much higher. Some Asian countries are in much better shape but interestingly, China is not (only 61% of their adult population is fully vaccinated. If you include over 12, the rate is much lower). In China, people just don’t trust their vaccine, and they have cause for concern. It is just not as good, and almost useless against Omicron and its sublineages. Same goes for the Russian Sputnik vaccine.

Clearly, I am a proponent of vaccination, however, just like “hoping you don’t get sick” won’t protect you, vaccination is not the strategy which will rid us of this disease. I don’t think anything will. We can only hope to manage it and minimize the degree of disease. No one can predict how this will all settle out. It would be great if it ultimately turned into another seasonal flu-like illness, with an annual Covid shot being adequate. But unlike Influenza, the SARS-Cov-2 virus does not respect seasons and is much more infectious. The Covid vaccine wanes in its efficacy after 4-6 months, but so do the Flu and Pneumonia vaccines. It DOES however lower severity of disease, risk of hospitalization, deaths as well as occurence of long-haul symptoms.

Clearly, people are not willing to do the things we know are safe like prudent, quality masking and distancing. At this stage, it seems to be a free for all.

And it is not only in the US. From what I have heard from others who have travelled, many other European countries seem to have returned to regular activity, behaving as if there is no pandemic, which is clearly still going on.

Our government policies and recommendations are conflicting and also seem to have bent to the will of the masses, recommending what is likely to be followed, which is nothing, rather than what is prudent. This is like doctors not telling patients not to quit smoking or lose weight because they know they won’t do it anyway! It’s unethical.

Take the recommendation for quarantining. The original strain of SARS-Cov-2 was contagious for up to 2 weeks. As mutations occurred, the duration dropped to 10 days. Recent studies suggest that Omicron and its sub variants remain contagious, and to a greater degree than the original form, for the same 10-day duration. So why drop isolation requirements to 5 days? CONVENIENCE! I understand the inconvenience that being sick imposes on us, but it’s no excuse. We must do what’s best for everyone and not just the individual.

I was surprised that the CDC actually recently recommended that NJ residents start masking indoors given the uptick in cases all over the state. But I was not surprised that the NJ authorities ignored this recommendation. This was clear when I was down in Wildwood recently. Not a mask in site.

For all the Covid travel restrictions, I must say that I have had a pretty amazing travel schedule these last couple of years, mostly a result of having to use up some travel funds before they expired. My wonderful wife planned an epic trip for our family which was supposed to occur just as lockdowns were initiated a few years ago. The trip was canceled but our deposit was non-refundable. Sadly, Toronto, Canada was not one of the places I visited, but I promise to get up there soon. I have many great friends I grew up with and really miss up there. I was however in Mexico (Pacific side), Costa Rica, Peru (our original epic trip destination) as well as a few domestic ski trips. In addition to the amazing sights we have seen and people we met, it has been very interesting comparing how different places have dealt with this pandemic. 

In Peru for example, a month ago, there was still a national mandate to wear either an N95 or 2 surgical masks, indoors and out, all the time. None of this loosey-goosey “face covering” ridiculousness we have had here. Now, Peru got hammered with Covid at the start of the pandemic so their paranoia was understandable. Despite the lifting of outdoor mandates the day after we got there, even after a week, most people were still walking around outside with masks. Even in the Amazon. In Mexico, we had to wash our hands and pass a “smell test” before entering the resort. It was ridiculous because you could hear people announce “coffee beans” from yards away so it wasn’t much of a challenge to pass since there was only one option to smell. Before entering all the outdoor restaurants, we had to apply hand sanitizer. In Costa Rica, even while being wheeled around in an open air golf cart, we had to wear a mask. Masks were not required on the beach, but they were to enter the outdoor restaurants 5 feet away. 

All over the world, including the US, there are inconsistencies of policy and practice. But at least in those countries we visited, there wasn’t the anger and resistance we see here, where quite honestly, rules have been pretty lax comparatively.

We have no idea how this pandemic will continue to evolve, but it will evolve. As long as the virus is allowed to spread, anywhere in the world, the rest of the world is at risk. Elimination is likely an impossibility, short of it mutating itself out of existence. But as the Influenza virus which caused the 1918 pandemic, resurfacing as H1N1 in the 80’s has shown us, nothing is gone forever. Polio may be one of very few exceptions, and that’s because everyone was forced to be vaccinated!

What we do know is that careful and responsible behavior lessens the spread and the severity of this disease.

Please get vaccinated and boosted. You may still get sick, but you have a much better chance of getting over it more easily. If you can avoid it by additional masking, distancing and being careful, do it. I am seeing more and more long-haul symptoms.

Speaking of long-haul symptoms, this concept is by no means new. Long-term side effects have resulted from every kind of infection which has existed, not to mention drug side effects. In fact, the loss of smell seen with Covid is much less permanent and problematic than the loss of smell which is more often permanent as a result of the other 4, very common coronaviruses which have existed for decades causing the common cold. Endocarditis, neurologic symptoms like brain fog, as well as many other symptoms have existed long before Covid-19. We are focussing on it more simply because Covid-19 has affected so many more people than any other previous infection. It looks like there are a lot of long-haulers, but proportionately, there aren’t.

Stay safe and Be well.

AC

SAD MILESTONE

Andrew Chuma No Comments

Well, we’ve surpassed 1 million official deaths in the US from Covid-19. There are likely many more that have gone unreported so the number is likely higher. Worldwide, there have been 6.3 million deaths and that number is even more significantly underestimated given the lack of medical and administrative infrastructure many countries experience, not to mention some countries’ lack of willingness to be transparent with their actual numbers. N. Korea is a great example. They claimed NO cases of Covid, let alone deaths, until the last few weeks when they finally started to admit that they are under siege with the Omicron variant.  

The US represents 4% of the world’s population, but ~16% of the cases and deaths. Pretty sad in a country with the riches, opportunities and amazing healthcare support systems we have, not to mention the availability of vaccines. But it’s not surprising given that we are also the fattest and least healthy population on the planet. And it keeps getting worse.

What is even sadder is that many of these Covid deaths could have been prevented. Most of the deaths occured before vaccination was available but over 650,000 deaths have occurred after vaccines were out. The estimates are that if more people were willing to get vaccinated fully, more than 300,000 of those deaths could have been prevented in the US. Almost half the deaths!

The daily numbers are still significant. 300 deaths a day. It’s a far cry from over 4000 a day at the hight of the pandemic, but if it’s your loved one, each death is devastating. How many are dying from the flu today? ZERO! Why? Because it disappears with warmer weather. Covid is NOT becoming the flu. It is not seasonal. It respects nothing and continues to evolve and mutate. South Africa may be getting over their most recent outbreak of the Ba 4 and 5 variant surges, but it’s just starting in Europe and will likely hit our shores soon. A more infectious virus, in a population whose immune status is dropping off is not a good combination. There have been no inroads made with the number of people fully vaccinated or boosted. Less than 30% of kids over 5 have been vaccinated. Talking about their recent approval for boosting is useless if most have not even received one dose to begin with. A recent study showed that unvaccinated kids were 10x more likely to need hospitalization.

And although most do OK, many don’t and I am seeing more and more long Covid patients in my office. Ringing, pressure in the head, brain fog, fatigue… Lots of symptoms which in some are quite debilitating. Not much to offer them other than recommending vaccination, which has been shown to alleviate symptoms in some cases. Even the Long-Haul Covid clinics are starting to close because of lack of funding and reimbursement, not to mention being overwhelmed with patients.

I had a conversation with a confrontational patient the other day because he was upset that he was still required to wear a mask in our office. I’m an ENT doc. Would you go into an office where many patients are being evaluated for coughing, sneezing, sore throats, changes in smell and taste and hoarseness without protecting yourself? In addition I see a lot of immunocompromised patients with cancer and autoimmune conditions. Are you so selfish that you would put them at risk? This person had no answer other than stating vehemently that masks do nothing. Although I agree with him that the piece of crap mask he was weaning was not protecting anyone, a proper mask does and we left it at that.

Despite the semblance of normality in many places, this pandemic is definitely still with us. The numbers are on the rise. So much so  that the CDC recommended indoor masking in many parts of NJ.

No one can predict how this will evolve. However we know certain things for sure. The virus is still with us and it continues to evolve. Getting sick may be inevitable however, vaccination definitely reduces your chances of having a severe case, needing to be hospitalized or potentially dying.

Please continue to be careful to protect yourself and all those around you. Mask properly when in risky situations.

Please continue to vaccinate and boost as necessary.

Have a great weekend.

Stay safe and be well.

AC

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