Ivermectin revisited.

Ivermectin revisited.

Yesterday, there were over 140,000 hospitalized Americans with Covid, a new record. And almost all of them are not vaccinated. Furthermore, 25% of hospitals are experiencing critical staff shortages. This is a deadly combination, and not just for Covid patients, but for all patients who are ill with various conditions.

I have yet to have a clinic day where there isn’t at least one patient who is not yet vaccinated against the SARS-Cov-2 virus. Often there are 3-4. As an ENT specialist, they are usually not seeing be for a Covid talk (although some of my patients are there for Covid-related symptoms), but as a physician, I feel compelled to discuss their vaccination status in the hopes of possibly clarifying some concerns they may have, encouraging them to please get vaccinated. Their reasons for holding off are varied, but almost always, they are based on misconceptions and falsely believed rumors. Many don’t think beyond their 2 foot radius and when I ask them about concerns about spreading it to others, they never have a response. Silence. They don’t care. Although I do not get into politics, I often get the impression that their beliefs are reinforced by non-medical influences.

So far this week, I had 2 middle aged people who had Covid over a year ago, who believed that they were still protected because of it. I explained to them that , although natural infection provides good future protection, that wanes, just like it does with vaccination, and that a booster shot was still strongly recommended. I don’t have a lot of time, but I try to explain the science behind memory cells such as T and B cells and antibodies and how they differ. Maybe I convince them. Who knows. 

This week, I had an obese, hypertensive 82 year old who already had Covid twice, both times hospitalized, who now struggles with pulmonary fibrosis (permanent scarring in the lungs which not only leads to breathing problems, but also heart failure because of the scarring which also impacts on blood flow through the lungs forcing the heart ot beat harder to move blood through). Despite that, he was firmly against vaccination because he “did not trust the pharmaceutical companies and did not believe the science”. It was interesting that he was on a slew of other pharmaceutical products for his numerous other chronic conditions, but he did not “trust the drug companies”. Furthermore, when he was hospitalized, although he was willing to take other pharmaceutical products like the monoclonal antibodies and antivirals, he had presented to the hospital so late, they were not offered since they would no longer be effective. Ironic that he doesn’t trust them enough to take the vaccine but trusts them enough to take their drugs when he can’t breathe in the ER! He also brought up how no one would prescribe Ivermectin for him, another product of non-trustworthy drug companies. He commented on studies showing how in countries where it was used endemically because of contaminated water, there were lower Covid cases and lower death rates from Covid, and how these studies are suppressed by our media. This drug was in the news months back dubbed the “horse pill”. That label was not really fair since this drug has been life saving for many humans infected with parasites and the scientists who developed it did win the Nobel Prize in medicine for their discovery of this drug. There have been some very small, limited studies showing some benefit of this drug which does inhibit the virus somewhat. There were also many studies which were retracted because of seriously flawed and manipulated data. 

As for the places where Ivermectin is used preventatively because of parasite-contaminated water, I did come across some online articles suggesting lower Covid cases and a smaller percentage of death. These are primarily poor African countries where trustworthy data and demographics are hard to come by. There were many criticisms of these studies. 

My personal examples are anecdotes, as are the studies showing some possible benefit from Ivermectin. The same day I saw the above-mentioned gentleman, I had another patient, a local ER doctor, who was exhausted. His ER is packed every shift. Not just with Covid, but the flu as well as all the “other usual things” like heart attacks, strokes and urinary tract infections. Covid, however, predominates. There is an area in his ER dedicated to patients who can’t get a bed in the hospital because it also is packed. He describes having to navigate around beds with Covid patients in the hallways so he can get to the ER rooms. He just had a 26 year-old die within 48 of admission from cardio-pulmonary complications of Covid. Unvaccinated. In fact he said that he has seen “0”, that is ZERO, vaccinated patients. They are ALL unvaccinated. That is not anecdotal. That is day in and day out.

I have had conversations with other ER doctors who have similar experiences. Similar overflow situations. Similar sad outcomes. And sadly, mostly preventable if they simply got vaccinated.

These are not second or third hand recounts, over the web, from some blog. These are direct, first hand experiences. I have had my own. Trust who you want. Big-mouthed, misinformed, ignorant social media personalities and conspiracy theory websites and organizations, or, trust the doctors and other healthcare providers who are doing the work directly. Daily. Until they too get sick, or burn out, and can’t take care of you.

Please get vaccinated and continue to do all the important things which protect you, and everyone else around you. Mask, distance, avoid crowds and get healthy.

Stay safe and be well.

AC

Is it Omicron or Delta? Does it matter?

As we have heard, and many of us have sadly experienced, the Omicron variant is quickly spreading through communities like wildfire. Fortunately, the degree of disease it causes still appears to be more mild, especially if you have been vaccinated. But again, it’s all about the numbers. This week, in one day, there were 1.7 million new cases worldwide, almost double any previous day during the last 2 years. Pediatric cases are hitting record highs, just as are pediatric hospitalization from Covid. A small percentage of a large number is still a large number.

Is it important to know which variant you have if you have the misfortune of contracting Covid? From an epidemiological and scientific standpoint, it absolutely is. Not only can we track the progression of these variants, but we will also be able to identify newer, potentially more problematic variants faster.

In many places, the issue isn’t worth even debating since most labs in the US, especially if outside of a  hospital, are not doing genomic testing anyway so you won’t find out which variant it is whether you want to know or not. Why aren’t they? Either because they don’t have the ability to do this specialized testing, called genomic testing, or they don’t want to spend the money.

Practically, it doesn’t matter. We are STILL in a pandemic with a very infectious virus. Whether we know it is 2 or 5, or at this stage 20x more infectious than the original strain, is irrelevant since in all cases, you need to continue to be vigilant, protecting not only yourself, but all those around you. The more it spreads, the more it mutates and the greater the chances of developing the worst case scenario of a highly transmissible and highly lethal variant. Presently, it’s highly transmissible but not very lethal. The sheer numbers are resulting in a lot of disease and death however. As I have mentioned above, a small percentage of a large number is still a large number.

It is also irrelevant from a treatment standpoint. The same treatments are available for all variants although presently, some of the monoclonal and antivirals seem to be less effective against Omicron. The vaccines may be a little less effective as well, but they are still very effective at not only preventing disease but also minimizing the degree of disease, while essentially eliminating the risk of death. The exception to that statement however are the vaccines which China (Sinovac) and Russia (Sputnik) have developed. These seem to be significantly ineffective against Omicron which is scary given the number of people who have received these vaccines, not only in those countries, but all the countries they have shipped those vaccines to.

From a quarantine standpoint, there may be some benefit in knowing since Omicron may hit faster, but become less infectious faster as well. In addition, vaccination reduces the degree and duration of contagiousness. But this information is dangerous and inappropriately used and taken advantage of by most people. Give people an inch, and they take a foot. It’s human nature.

Although many locations were initially reporting extremely high rates of Omicron infections, in retrospect, when the dust started to settle, the rates were a little less prevalent than initially thought. Still high, over 70%, but don’t think that Delta has been replaced completely. A friend of mine sent me a report of a patient actually being infected with both Omicron and Delta simultaneously. Rare, but in areas where both are still active, not impossible. And then there is the flu. And other coronavirus colds. And adenovirus. And rhinovirus. And croup. And strep… There are a lot of bugs out there to be cautious of contracting, and passing along to others.

In my opinion, the CDC has failed in their quarantining messaging. I can see isolating for only 5 days for specific, crucial workers, but the following MUST also be in effect:

1. Symptoms must have been minimal initially and remain minimal or resolved at day 5.
2. You must mask and maintain distancing for another 5 days. In addition, I think the mask must be an N95 or equivalent mask. Cloth or even surgical masks won’t do.
3. You should avoid any vulnerable contacts for the full 10 days.
4. I also think that you must have been vaccinated beforehand. Although being sick does provide significant protection moving forward, that protection doesn’t develop for 2 weeks after initial infection, well past the quarantine period. Whereas if you were vaccinated and boosted if appropriate, there is already some built in protection. Then why did you get sick in the first place if you were vaccinated? Because they are not perfect. Stop it with that stupid argument already.
5. Isolated antigen tests should NOT be used as an indicator of contagiousness. There are too many false negatives. Negative SERIAL tests, separated by a few days, maybe of value. 

Ultimately, you are sick and can get others sick. You are most contagious the 1-2 days before symptoms begin and 1-2 days afterwards but you can still transmit the virus for up to 2 weeks.

Please don’t be selfish and cut your isolation short if you contracted Covid. If for some reason you must wander out, mask and distance appropriately.

We are still in the throes of a pandemic. Media comments about this latest Omicron surge heralding the end of the pandemic is wishful thinking and way too premature. To me, it is starting to look like the virus ebbing and flowing may be the norm for a long time.

We have to learn to live with this virus and it will only happen if we remain careful and vigilant and look out for each other. I heard a great Ben Franklin quote this morning (and I am paraphrasing a bit) “We must, indeed, all hang in there together or assuredly, we shall hang separately”.

It’s been a while since I sait my mantra.

VACCINATE. And remember that “full vaccination” means boosted after 6 months from the last dose. Even if you had Covid, still get vaccinated or boosted.

VENTILATE. It is still a respiratory virus.

DISTANCE. 6 feet if you can. The 3 foot rule used by most schools is not enough. 

MASK. They work, although some are much better than others.

HYGIENE. Although less of an issue for Covid, it is still very pertinent for the flu.

GET HEALTHY! Being in good shape is still your best plan to weather what is likely to be an inevitable Covid infection. I read a study looking at the severity of Covid symptoms based on the diet people followed. No surprise to me, those who followed a whole food, plant based diet did the best with 73% fewer severe symptoms as compared to people who ate a standard American diet. Pesco-vegetarians (without dairy) did second best with a 59% risk severity reduction. Those on an animal based ketogenic diet fared the worst. EAT MORE PLANTS!

Have a great weekend. Enjoy your family and friends safely.

Stay safe and be well.

AC