WARNING, this is a long post with some rambling! But it’s the last one for a bit since I am taking a break for a couple of weeks and there was some important information and thoughts I wanted to pass along if anyone is still interested.
With the recent elections, there has been a little less focus on Covid and politics have dominated the news feeds. One negative vicious ad after another. Sadly we live in a continuous political cycle now. Social upheaval, political battling, environmental disasters, Covid… The news is depressing. In most places in the world, the proportion of negative to positive news items in the media is 60% bad and 40% good. In the US, we thrive on conflict. “If it bleeds, it leads”. Our proportion is 90% negative news and only 10% positive. Sad.
As far as Covid goes, the significant new information out there is vaccine approval for kids and rising numbers.
Once again, Covid cases are on the rise in various places around the world, as well as here in the US. In most of Europe, especially essentially all Eastern European countries, including my native country Ukraine, numbers are really on the rise. In the East, it is primarily because of lack of vaccination. Most of those countries, including Russia which was the first country to approve and use a Covid vaccine, the immunization rates are in the 30% range. Those countries have a deeply ingrained mistrust of authority and governing bodies. Because of such low numbers, their hospitalization and death rates are very high. Britain is in the midst of another wave however their hospitalization and death rates are very low, attributable to the fact that almost 80% of their eligible population is vaccinated fully. Their pediatric infection rate is lower than ours, despite no mask mandates in schools. They test much more regularly, including at school. They separate kids more at school. They have mandatory quarantine if there is even suspicion of exposure or infection. They contact trace as well. They do all the right things we here in the US are not willing or tolerant enough to do. Other European countries experiencing rises include Germany, the Netherlands and Belgium, all with vaccination rates in the high 60-70s% ranges. In those countries also, despite rising numbers of new cases, they are having fewer hospitalizations and deaths proportionately than we do. They also test and trace more effectively.
Although most of the US has plateaued at the lowest level since June with respect to Covid numbers overall, there are areas which are still being ravaged by the disease, their healthcare systems being over-run. The numbers are far from insignificant and last week’s daily deaths were ~ 1800/day with 74,000 new cases per day being reported. 23 states are reporting rising numbers by 20-30%, in the last 2 weeks. Our trends follow those of Europe, so it is likely, especially with the colder weather, that our numbers will continue to increase as well. Although, one consistency with this virus is that it’s behavior has not been consistent, or predictable. Remember that it is a new virus causing a new disease. We’ve been studying HIV and EBOLA for over 40 years and both are still a real mystery with no headway with respect to a vaccine.
The Covid vaccine has been available for use in the US since December 14th of 2020, almost one year ago. We have the vaccine available just about anywhere. Although 67% of the US population has received at least one vaccine shot, only 57% of the US population have been fully vaccinated, significantly poorer than many other developed countries where drug availability is much more limited. 14 states still have vaccination rates under 50% and not surprisingly, their new case, hospitalization and death rates are higher than in those states with better vaccination rates.
As a country, our illness, hospitalization and death rates remain the highest worldwide. We represent only 4% of the world’s population but almost 20% of the Covid disease burden. Lower vaccine rates, poor testing, no tracing of any significance and careless, selfish behavior are to blame. Simple as that.
As far as eligibility goes, we now have full approval for vaccine use in kids 5 and up. The CDC, NIH and American College of Pediatrics all approve. That is a large, vulnerable and highly infectious part of the population which can now take advantage of the benefits of the vaccine and be protected. Some parents will be concerned about issues such as heart inflammation but the myocarditis which occurs from an actual Covid infection is far more common and far worse than the rare instance from vaccination, a rate which is no higher than what occurs after any other vaccination or, after just common viral colds as well.
I have daily discussions with various patients about Covid related issues. The most common concerns are 1) the vaccine is too new and we don’t know what long term effects might be and 2) if I am vaccinated, why should I wear a mask? A third one is the argument that vaccinated people are still getting sick.
Yes, we do not have long term data. We can’t because this is a new disease and a new vaccine. What we do have is relatively real-time data from around the world, from over 7 billion covid vaccine doses. It is the most scrutinized drug ever. And the data clearly shows that overall, it is safe and effective. Is it perfect? No. If it is 95% effective, that still means that 5 people out of 100 will get sick. That’s 50,000 out of 1 million. But as I have said before, if you give a million people an apple, 50,000 (5% also) will have an allergic reaction and some will die. That doesn’t mean we should never eat apples. They are super healthy for you and the vast majority of people should eat them regularly. The vaccine is super protective against getting infected and, if you do get infected, the disease course is significantly less severe.
We also have data on how prevalent the disease is in both vaccinated and unvaccinated people. Once again, the facts are clear that, even though vaccinated people can still contract Covid, the vast majority of hospitalized patients and Covid related deaths are in unvaccinated people. The more severe cases and deaths in vaccinated people are in people who are older with weakened immune systems and have many medical issues.
ALL decisions in life are about balancing risks and benefits. It is quite possible that in 5 or 10 years, we will look back on this time and think how stupid we were because it turns out that the vaccines cause cancer or turned us into aliens or made us sterile (and NO, there is no evidence today that the vaccine affects fertility!!!). There are some, but rare, examples of drugs removed from the market within a few years of use because of unpredicted side effects. Examples are the antibiotic Avelox, which turned out to cause liver failure and Seldane, a common antihistamine, which was found to cause lethal heart arrhythmias. At the time of their introduction, the standard safety and benefit studies indicated that they seemed safe, but the long term data showed too much risk. Did some people benefit from these drugs? Of course, and the vast majority of people who took them were fine. But over time, it was found that the balance of risks and benefits, along with the availability of safe and effective alternatives, led to their removal from the market. And again, the drug which causes the most complications and deaths worldwide is Aspirin. It really is a helpful drug, but for specific indications. Plenty of people take it “as a preventative measure” without any thought to its potential side effects. Sadly, plenty of ill informed physicians recommend it for the same, ill advised reasons. There is a saying in medical school that by the time you graduate, half of what you learn is wrong. Most docs don’t keep up with new information. It takes 15 years for a new medical discovery to trickle down to general medical awareness and implementation.
It would be great if we had the luxury of waiting 5 years, the time it would take to do longer, more exhaustive tests, and see what potential side effects may or may not arise, but we do not have that luxury. This disease is here now. It is spreading rapidly. Because of the sheer numbers, many people are getting really sick and many are dying. And vaccines are remarkable at what they do and have undoubtedly saved many lives and much disease. The predictions are that if all Americans got the vaccine, just since June alone, we could have saved over 90,000 deaths already in the US alone.
All we can do is make the best decisions we can with the information we have TODAY and continue to learn and adjust. As of today, just under 2 years since the start of this pandemic, we know that millions have died from this disease (770,000 in the US). The official worldwide numbers are that just over 5 million have died, but given the problems with reporting in many places because of such things as poor infrastructure and politics, the unofficial estimates are that over 16 million, more than 3x the official number, have probably died from Covid-19. Almost 250 million infections have been reported, again, most likely a significant underestimation. And many millions have suffered irreversible health problems because of this disease. The pandemic has devastated business and whole economies and disrupted the education of our kids. But millions more people however, have been spared the disease altogether or significant courses of Covid because they were vaccinated.
We also know that, although some side effects can occur from the vaccine, they are significantly less common than the side effects of the disease and the vast majority of those vaccinated have had no side effects reported to date at all. I’m an example. 3 doses of Pfizer, and other than a sore arm for a couple of days, I did fine.
There have been studies showing that the protection from infection is superior to that which is provided by vaccination. Those same studies also showed that vaccination after infection actually provided the best protection. More recent studies have contradicted that, showing a 5x increase in protection after vaccination as opposed to natural protection from infection alone. Every study about anything will always be followed up with a contradicting study. In this case, so far, getting the vaccine is clearly MUCH safer than getting the disease.
There is almost violent debate about medications to treat and/or prevent Covid-19, a disease, which as a reminder, is caused by the SARS-Cov-2 virus. There are some FDA-approved antiviral treatments, like remdesivir, which do help some patients after they get infected, but they need to get them ASAP since the main way they work is by inhibiting viral replication. If the virus replicates too much, the cat’s out of the bag and the disease will develop. There are some studies showing that some people benefit from other, non FDA-approved medications such as Zithromax (an antibiotic), Hydroxychloroquine (an antimalarial which is also an anti inflammatory), Ivermectin (an anti parasitic, not just used in horses, but also humans). These medications are FDA-approved to treat their respective types of diseases, but not Covid-19. They may be effective in some cases, but they are not effective in more people than they help, and they can have significant side effects, much more than side effects reported from vaccination. There is some intriguing data showing that the anti anxiety/OCD medication fluvoxamine (Fluvox) can be quite effective to treat Covid. All of these are options IF you get infected. It would be crazy to take them as a preventative measure. There are some supplements which help to boost your immune system. Some of these include Vitamin D, melatonin, zinc, quercetin and vitamin C.
The rationalization that I won’t take an FDA approved vaccine because I don’t know what the long term side effects are but I will take a non-FDA approved (not for Covid) medication to protect me or if I get sick and risk well established, known side effects is nonsensical. Kind of like the patient I saw the other day who had horrible oral hygiene, smoked a pack a day of cigarettes, looked emaciated but claimed to be an “herbalist” but did not trust the vaccine and wouldn’t get vaccinated.
And then there is getting healthy. The number 1 associated risk factor with getting Covid and having a significant course or dying, is simply being overweight. Pile up all the other chronic diseases, and your risks go up a lot. Although a few of my patients have taken the opportunity of increased time at home to work on their health, most have not. Comfort food, alcohol, disrupted routines… All has led to more apathy, poorer habits, weight gain and downwardly spiraling health. The US was already the heaviest and least healthy developed country in the world before the pandemic and it has only gotten worse. Again, let’s not do some basic things to improve our health and chances of living better and surviving Covid because of the hope that a medication will swoop down and save us.
Environmentally, early on in the pandemic, we had glimpses of what the world could be like once the smog lifts and the streets and skies clear. The air was cleaner. You could hear the birds. Mountains were visible. Animals roamed the streets. Well, all that is back to “normal”. Business as usual and climate change and global warming continue to march on. Many world leaders just attended the Cop 26 conference. The number 26 indicates that this is the 26th annual meeting of the Conference of Parties (COP), world leaders, to discuss strategies to address global warming. Yet, 2 of the world powers and largest polluters, China and Russia, didn’t even attend. And the issue of animal agriculture, the single biggest culprit in global warming, the one we can most easily address, is not even mentioned. Despite the rise in veganism awareness and the interest in plant-based alternatives, the average American’s meat consumption continues to go up. As of 2020, the average American consumed 274 pounds of meat and that is excluding seafood. It was 120 pounds in 1900. Healthy soil, forests and oceans are the best solution to global warming. Animal agriculture uses and destroys 41% of the habitable land on Earth. Cut back or stop eating animal products, allowing the land to re-wild, and the planet will fix itself. And this effect is fast and significant.
I’ve digressed. Getting back to Covid.
Ultimately, you do not want to get this disease in the first place. Most get through it just fine, but many don’t. Do you want to take a chance? Although proper masking, ventilation and distancing are important, vaccination is the most important means to prevent and minimize infection.
When it comes to the unknown future, I again appreciate that we don’t know what may happen, but the same can be said for long haul symptoms. Brain fog and memory issues are well documented consequences of Covid-19. There are some scientists and physicians who are concerned that contracting Covid may put you at significant risk for early dementia and impact on kids’ brain development. Is that worth the risk for you personally, but more importantly, for our future generations? I mentioned above that you do not want to get this disease. More importantly, you don’t want to pass this disease along to someone else. AGAIN, this is a PANdemic. A Societal, not an individual problem. Make the best decisions for yourself but remember, that you are not making a decision only for yourself, but for everyone you come into contact with.
I was about to post this when a news item popped up about football quarterback legend Aaron Rodgers, who just tested positive for Covid. I hope he does well, and given how healthy he is, he probably will. But he should get kicked out of the NFL for lying about his vaccine status (he implied that he was vaccinated by replying to a direct question “… Yeah. I’m immunized.”). More importantly, he should be kicked out for endangering all his teammates, competitors, and everyone he interacted with and was interviewed by, all while never wearing a mask. He should be kicked out because he is an example to others, especially kids, who look up to him as a role model. He’s a liar and a cheat and whoever in the NFL or his team who knew about this and let it slide, should also be removed. He stated during his press conference when he lied about his being vaccinated that he supported vaccination but that it was an “individual decision”. Well, that individual decision impacts on everyone else. Just like the personal decision to drive drunk, or to have sex with someone if you are HIV or Hepatitis C positive. Others’ lives are affected. I know this is a strong statement, but his behavior is selfish, irresponsible and despicable.
We are all in this TOGETHER. The whole planet. And we will not get through it, or be able to deal with it effectively moving forward, if we continue to behave selfishly. We are all connected. People, animals, the environment and the planet. It’s all the same thing.
Have a great couple of weeks. I’ll be in the Costa Rican rainforest with my lovely wife. Sort of a second honeymoon. We’ll be communing with the howler monkeys, sloths and avoiding the myriad of creepy crawlers.
VACCINATE PLEASE. If it’s been more than 6 months and you can get one, get a booster. Waning protection is definitely being seen.
MASK UP. Wear a good one and wear it properly.
DISTANCE and VENTILATE
Follow proper and practical HYGIENE measures.
GET HEALTHY! Eat better, Move more, Love more and Stress less (Dr. Dean Ornish)
Stay Safe and Be Well.
AC