Reality Check – Are we Really Coming Out of The Pandemic?

I was not going to write another blog this week but my last one seemed to me to be a little defeatist, and after a conversation with a relative, I was snapped out of my funk. This switch was also fueled by listening to a podcast about how we are destroying the oceans and are decimating massive numbers of animals, especially fish and how this is also impacting on global warming and the resultant climate change we are experiencing. I have learned a lot about all of this of course in the last few years, but just like anything, there is an element of overwhelm leading to apathy. 

You might think that these issues: the pandemic, the oceans, climate change, animal welfare… are not related, but the bottom line is that convenience, complacency, selfishness and indifference is why we are in this mess to begin with. All of this is linked to our arrogance and behavior. We are in a global pandemic caused by a virus, originating in an animal (a bat), captured and sold for food along with some of the animals it infected (the pangolin and civet cats) which were raised for meat and then the virus was isolated and manipulated by humans. How it actually got out is irrelevant. ALL developed countries are playing these genetic “gain of function” games with pathogens. We are destroying the life on our planet in order to feed ourselves with animal products which we don’t need and are unhealthy to eat anyway, quickly making the planet uninhabitable and condemning our future generations to who knows what, if they even survive. We have a political system which fosters division, violence and greed. It’s all related.

We keep talking about going back to “normal”. It’s our “normal” patterns of behavior which is killing our species, all the other species and the planet itself. We will never be “normal” or at least what we perceive as normal. If we don’t change, this will not be the last pandemic and the destruction of our species and the planet will march on. The planet will survive since Mother Nature always wins. But humans just won’t be part of that future.

Enough of that, and let’s look at some Covid numbers just to keep things in perspective.

We keep hearing about how we are heading out of this pandemic. Although the numbers in general are trending down, it’s all relative.   2 years ago, 1000 deaths a day was catastrophic. Today, dropping from over 4000 deaths a day a few weeks ago to 3200 deaths, yesterday’s total, seems optimistic???? The most recent 7-day average in the US is still 2600 deaths a day!

The average 7-day new Covid case count is 204,000 a day in the US, much higher than during most of this pandemic. But again, compared with the record shattering average of over 800,000 a day just a few weeks ago, 204,000 seems pretty darn good.

Our healthcare system was strained before the pandemic. 400,000 healthcare workers have left healthcare in the US since the start of the pandemic and 18 states report critical shortages in staff in hospitals. 24% of US hospitals with an ICU are over 95% capacity. ER waits are well over 10 hours in many places. This is a bad time to have a heart attack or appendicitis! People have died recently from these, and many other treatable conditions, because of delays in treatment.

Israel, one of the most vaccinated countries which is also taking some of the most aggressive anti-Covid measures, is having 70k new cases a day. The previous high at any point in the pandemic was only 10k a day. They are having much fewer hospitalizations and deaths, but again, it’s all about the numbers. More cases inevitably leads to more illness and death. The vast majority of those hospitalizations and deaths are in unvaccinated or incomopletely vaccinated people. Their hospital systems are also being overrun.

The BA.2 Omicron subvariant is now in 67 countries and 42 US states.

It accounts for 2% of worldwide cases, 3.6% in the US

The BA.2 subvariant is at least 30% more infectious than BA.1 (original Omicron).

It appears to cause milder disease, but as mentioned above, it’s about the numbers.

We recently went over 400 million worldwide cases of Covid.

It took the entire first year of the pandemic to reach 100 million cases.

7 more months to reach 200 million,

6 months later we got to 300 million,

And now with the introduction of Omicron, we hit 400 million in just 1 month!

It took only 30 days to infect as many people as were infected in the first 365 days of this pandemic. It’s crazy.

The point is, we are nowhere near out of the woods, in any aspect of our modern day lives. We’ve simply adjusted our pain threshold and our expectations. Despite all the interest in plant-based eating, the average American consumes even more meat than ever before. Global warming marches on. And this pandemic is far from over. Our waistlines continue to expand with obesity rates continuing to go up, despite the warnings of weight being the #1 risk factor for a bad case of Covid. We might eventually achieve some kind of endemic state here in the US, but we have to keep in mind that there are plenty of places in the world where variants continue to develop because of their lack of vaccination and standard practices like proper masking (stress the proper). Given how quickly Omicron has spread worldwide, there is nothing to support that another variant won’t develop and wreak havoc once again.

We have better treatments available to treat Covid, but good luck getting them if you really get sick and need them. It’s like hoping that someone will come along and develop some new technology to reverse climate change. As renowned epidemiologist and pandemic specialist Dr. Osterholm puts it, “Hope is NOT a strategy”.

Please consider getting vaccinated, and boosted if you have not yet done so. Again, the US ranks somewhere in the 60s when it comes to full vaccination. Iran is ahead of us for goodness sake!

Please continue to wear a mask but wear a good one (see my last post for what is good and what is not) and wear it effectively.

Take care of yourself as well as all of those around you.

Stay Safe and Be Well.

AC

Unfortunately, the mixed, and in some cases frankly wrong and biased messaging some of our governmental and medical bodies have been putting out, or in some cases ignoring and not putting out,  have understandably made many people very leery and untrusting. This just fuels the polar, and almost religious fervor with which people entrench themselves in their beliefs when it comes to this pandemic, vaccines, medications and masking. Even as we gather information and experience, people have difficulty accepting those changes and newer recommendations. This occurs on both sides of the stethoscope, patient and doctor.

In a recent post, I mentioned the incidence of myocarditis (heart inflammation) with vaccination and Covid-19. It’s an issue I have read and heard a lot about. As a father of 2 boys in the most affected age bracket, it’s an important issue to me. I wanted to share some “newer” information. I put “newer” in quotes, because some of this is actually not that new, it has just not garnered the press and attention it deserves. We are all influenced by our biases, myself included.

It is absolutely true that myocarditis has been around for a long time and the vast majority of cases worldwide are idiopathic, meaning, no specific cause has been identified. In some cases, it is related to viral infections of many types, including the common cold, flu and, yes, Covid-19. It is also true that it has been associated with various vaccines, including the Covid-19 vaccine. Basically, any process which triggers our immune system which causes inflammation, can cause inflammation anywhere in the body, including the heart. In most cases, it is self limiting, and results in no long term ill-effects, however it can rarely be lethal as well.

As far as Covid and the vaccines are concerned, myocarditis has been seen with both situations. Some studies are showing that rates may be higher with vaccination. This may also be simply a matter of numbers since 212 million Americans have been fully vaccinated (64%) whereas only 78 million have contracted Covid. That number is certainly an underestimate given the number of people who home-tested positive and were not reported. Just as an fyi, we, in the US, are at 933,000 dead from this disease. The degree of severity has supporters on both sides of the fence as well. The type of inflammation may be different from the inflammation caused by actual infection. Some say myocarditis from Covid is worse, and some say that the vaccine induced heart inflammation is worse. In either case, the vast majority resolve quickly and without complication. Overall, the numbers of cases from vaccination are still very small.

As far as which vaccines are more implicated, the mRNA vaccine, specifically the Moderna one, seems to have the highest rate of incidence of myocarditis. It is highest after the second shot and it appears that the risk goes down with the booster. In the EU, the recommendation now is to not use Moderna in males, 15-25 years of age, the demographic most affected by this condition.

I still firmly believe in vaccines and feel that everyone should get vaccinated, however today, I would tailor recommendations to specific situations, including which vaccine to take and when to take it. Young men should avoid the Moderna vaccine if possible. Young women should avoid J&J. If you don’t have the option of choosing, I would still get whichever vaccine is available. If you had Covid, wait a few months, up to 6, but still get vaccinated. And consider how lucky we are to have such options! In China, all they have is Sinovac which is really quite poorly protective against Omicron. In other countries, they have nothing.

One of my boys received the Moderna vaccine, along with the booster, and he did fine. In hindsight, would I have guided him to get the Pfizer vaccine? Probably, but hindsight is 20:20 and there are a LOT of things I would have done differently in my life “if I knew then what I know now!” I certainly would not have dyed my hair blond with lemon juice back in the 80s!

Many people talk a lot about suppression of information accusing the CDC of censorship of outspoken doctors and scientists who are not “vaccine at all costs” advocates. This sounds a little “conspiracy theorist” but there may be some elements of truth in this. Certainly, news outlets report on items that conform to their biases (CNN vs FOX…). An example is the use of the drug fluvoxamine (Fluvox) in treating Covid as an outpatient. It is a great, cheap and safe drug used for anxiety and OCD. The mechanism of action of its benefit when it comes to Covid, has to do with an antiinflammatory effect it has, decreasing the severity of symptoms. This is similar to how dexamethasone, an antiinflammatory steroid, works. Studies have shown a 91% reduced severity of symptoms on this medication. There is barely any mention of it however in the press.

On the flip side, as far as Ivermectin and Hydroxychloroquin go, studies seem to be showing more and more that these drugs are really not providing any real Covid benefit, and in the case of hydroxy, they may have caused more harm than good. Overall. Are there individuals who took these meds and had improvement, sure, but they may have gotten better regardless. I had a vaccine hostile patient recently who was angry that Ivermectin is used routinely en masse in India and is ignored here in the US. I pointed out to her that, despite many vaccines being produced in India, the average Indian doesn’t have access to any vaccines. In addition, their water sucks and is polluted with parasites, which Ivermectin, an amazingly effective antiparasitic drug, treats. If I lived in India, I would take Ivermectin daily as well, but more so I wouldn’t poop myself to death from the parasite.

I updated some mask information earlier, some of which I was surprised to learn, but felt important to pass along. The absence of efficacy of many types of materials used to make masks is disturbing, but the benefit and increased availability of others is encouraging. How necessary are they? Well it all depends on the situation. You can’t be against vaccination, masking and any kind of restrictions all at the same time. If you are vaccinated and are in a safe environment with people you know, don’t wear a mask. If you are vaccinated and go into the grocery store which is not too busy, you’re probably safe. But in situations where you don’t know who is around you, with a population where at best 1 in 3 people around you is not vaccinated at all, with many vaccinated people no longer being “fully vaccinated” because of missing boosters, you may be at greater risk. Personally, I wear a mask all the time in public. It’s easy, not a big deal and I admit to a certain level of paranoia which I can’t shake, no matter how much I run and meditate. 

I agree that what our kids are going through with schools and lack of socialization is very concerning and damaging. In most European countries, kids in schools are not masked, but in those same countries, their vaccination rates are much better than ours, as is their capacity and willingness to test. The US  ranks somewhere around 60th when it comes to rates of vaccination! Let the kids go to school unmasked, but the price of that is better vaccination rates of all those around them. Again, you can’t have everything you want. In order to have freedom, you must also demonstrate responsibility.

Early on, Sweden was held up as a country where there were no mandates and life continued almost as usual, except it didn’t. People there are more vaccinated. They distance themselves more in public. They behave in more responsible ways, staying home when sick. They are overall slimmer and healthier than our obese population. They did also have a slightly higher rate of death early on, but the numbers overall have leveled off and ALL of their metrics are better than those in the US. They have a lot more freedom, but they also behave much more responsibly.

Perspective is also important. The death rate from cardiovascular disease, which in most cases is preventable with some simple lifestyle changes, kills more than twice as many people annually than does Covid. Why aren’t we freaking out about that? Kids are developing heart disease in their teens and even pre-teen years. In kids and young adults, the death rate from many other preventable causes are also quite striking.

This is a table showing the increased annual rates of death of car accidents (MVA) as well as suicide, homicide and drug overdose relative to Covid in different age categories:

AGE        <5    5-14    15-24    25-35

MVA        11x    10x    10x    2x

Suicide    –    6.5x    10x    2x

Homicide    10x    5x    10x    2x

Drug OD    2x    =    10x    6.5x

To clarify, the drug ODs in kids under 5 is usually related to accidental poisoning. After that, it’s all “recreational” drugs. We need to focus more on these issues when it comes to our younger, especially school and college age population, rather than have violent debates about masking and vaccines. 

I’m rambling a bit, as usual, but the lack of responsible behavior, not only by the public, but by those who we are supposed to trust to give us complete information and guidance, has been pretty disappointing.

All we can do is the best we can, given the overall amount of information and experience we have. Covid has been around now for over 2 years and we have a lot of experience and know how to prevent it and treat it, but we are still working on how we will need to live with it.

Vaccination is still our best defense against this virus as well as it’s complications, but which one you take and when you get it, is evolving information. We are fortunate we have options.

Masking is still very important but which one we wear, how we wear it and where we wear it is important. We are fortunate we have options.

Distancing continues to be important. Picking where we go and how and with whom we interact, is important. We are fortunate we have options.

Getting healthy is STILL an extremely important goal. Clearly, the more you weigh, the more anxious you are and the more chronic diseases you are dealing with, the greater your risks of contracting this virus and having a worse course if you do. Risks of long-haul symptoms are also greater. We are fortunate to have the option to improve our health. All we have to do is choose to do so.

Overall, despite this crazy pandemic and the crazy times we are living in, we are fortunate to have what we have and fortunate to have options. 

Be grateful. Live compassionately.

Stay safe and be well.

AC