The Danger of Calling this the “Post-Pandemic” Era

The prevailing attitude about Covid is that it has now evolved into just another virus which causes a cold. Most people get a mild infection. Most people are not even testing since the symptoms are so mild and in many cases, mimic exactly seasonal allergy symptoms.It comes, and it goes, just like any other cold.

The problem with this attitude and approach is that it conveniently ignores a few basic facts which distinguish the SARS-Cov-2 virus from all other cold and flu viruses.

1. It is spread by simply breathing. Sneezing and coughing spread it more, but just being around someone infected breathing quietly puts you at risk. No other cold or flu virus or other pathogen for that matter is spread that way. The same way you can smell smoke many yards away from a smoker, you can inhale viral particles.
2. It is NOT seasonal. The flu is very predictable in terms of its time frame of occurrence and disappearance from our day to day lives. Mid fall to early spring. As soon as it gets warm, the flu goes away. Not SARS-2. It sticks around year round.
3. It is very contagious, much more so than any other respiratory virus. 
4. It is also contagious much sooner after exposure than other viruses.
5. It is also contagious for much longer. Even at 10 days, 15% of infected people can still spread it. 
6. The SARS-Cov-2 virus attaches, infects and manipulates just about every type of cell and organ system in the body. Not just the nose and lungs, but the heart, pancreas, brain bone marrow, skin… And it can impact those organs permanently. It has led to pancreatic insufficiency, resulting in diabetes. It has caused heart damage leading to arrhythmias and heart disease. It causes brain abnormalities such as fatigue, brain fog, alteration in various senses including smell, taste, pain perception and it has even caused skin rashes.
7. It mutates at a rate significantly greater than any other virus we contend with annually. And although the mutations at this point seem to have become more innocuous, all it takes is one bad mutation and we are right back into the thick of things once again.

As far as numbers today go, there is no question that we are at the lowest point with respect to cases, hospitalizations and deaths since the first wave/surge of the pandemic over 3 years ago. Since all the reporting systems, both domestically and abroad, have been dismantled, it is difficult to get accurate numbers of actual cases. In addition, most people are not even testing anymore. The best estimates of the state of the pandemic is to use hospital records like ER visits, hospital admissions and deaths. All these measures are way down, but have plateaued. In the last month or so, the average number of deaths in the US has been as low as 700 but averages to about 1000/week. A significant improvement over that same number on a daily basis earlier in the pandemic, but still significant. It remains in the top 10 causes of death. The numbers still translate into about 50,000 deaths a year, a bad flu year, which averaged ~ 12,000-52,000 deaths/year between 2010-2020. Sadly, despite our wealth and potentially amazing healthcare system, compared with the worldwide numbers, we continue to lead when it comes to per capita Covid deaths. Despite only representing 4% of the world’s population we continue to have close to 25% of the daily worldwide deaths. We are simply a very unhealthy population. The single biggest health measure which increases the risks of getting Covid and dying from Covid is weight. 75% of Americans are overweight with more than half of those, 42% of all Americans, being obese. Only 4% of Japanese are obese. The explosion of interest in diabetes medications like Ozempic for weight loss has focused even more light on how rampant diabetes is in the US. 30% of the population takes metformin, the most commonly used diabetes medication. As many as 80% have disrupted insulin sensitivity, the first stages of what ultimately goes on to become diabetes.

Our office recently went “mask optional”, one of the last to do so in our area. It has been 2 weeks and although it was tough initially for me, after 3 years of wearing a mask almost continuously, I am now comfortable with seeing most patients without a mask. I still do depending on why they are coming in or their symptoms. If I am going to wear a mask, I make one that makes sense, an N95. I even went into the hospital yesterday for the first time without a mask! WEIRD!!! 

BUT, I am healthy (I have some health issues but they are under very good control). I eat a whole foods plant-based diet (shown in many studies to lower Covid risks as compared with omnivorous and even vegetarian diets). I exercise routinely and I have been vaccinated. I recently got my second bivalent booster, my 6th covid vaccine overall. I have not had Covid, and I have tested both with swabs and blood work, routinely so I am confident in this.

Vaccination remains crucial to avoid the more serious illnesses and risks of deaths. Sadly only 40% of people have received even their first booster. It is approved for all over 65 and for those with certain immune compromising medical conditions. I admittedly had to exaggerate some of my legitimate issues to get approved for the booster this time around, but got it about a week ago with negligible side effects. I disagree with the CDCs recommendation to make this an annual shot. They will probably recommend it at the same time as the next flu vaccine this fall. Studies clearly show that by 6 months, there are virtually no antibodies left. There are plenty of T and B cells, the ones which orchestrate our immune response and make antibodies, but there is a delay in protection. 

Are you better off having had any vaccines? Yes. But you are better protected if you get boosted. Are you protected if you have had Covid? Yes. But again, getting vaccinated helps. Plenty of people have had Covid multiple times so those natural antibodies also wane. There is a Covid outbreak today in China, but this is felt to be a consequence of their lockdown practices with few people getting Covid and their poor vaccination rates with a poorly functioning vaccine. Despite all that, they are a healthier population and their death rate is dwarfed by ours!

I am done with writing about Covid for now. I’ll resume if there are any major developments. Back to more lifestyle and nutrition writing. I like that better.

In the meantime, be smart and be safe. Not just for yourself, but for everyone else.

Enjoy the outdoors and the sunshine. Better to enjoy it with someone else.

Stay Safe and Be Well.

AC

A SELFISH ASK. A beautiful weekend is coming up. I will be attending a charity event with former Phillies players participating in a baseball game tomorrow. Proceeds are going to my brother-in-law’s family. He suffered a pretty major stroke a year and a half ago and needs some renovations which will dramatically improve their lives. If you are interested, click here for a link to the site. 

Next week,on May 11th the official pandemic emergency measures will be lifted across the US. Although in the public eye this pandemic is over and many facilities have already removed various restrictions including mask mandates (which includes my own office), Covid-19 as a disease is not gone, nor will it be gone for a long time, if ever. Just like the Spanish Flu in 1918 became a less severe but persistent, yearly infection, Covid-19 will likely evolve into something similar, but with a few notable and very important differences I’ll review below.

Today, in the US, case rates seem to be going down but numbers are unreliable since there is no longer any official reporting.

Death rates and hospitalizations are easier to track. Hospitalization rates are also lower but stable. Deaths from Covid hover around 150/day in the US. That amounts to a little over 55,000 a year, rivaling some of the worst flu death seasons we’ve had. It remains in the top 10 leading causes of death and will likely stay there.

Outbreaks continue to occur across the globe, another one surfacing in India again, XBB1.1.16. It appears just as “mild” as the last variant. It is not a “variant of concern”.

Although most Covid infections are still considered mild, the long-haul case rate is 10%. All viral infections can develop long-term symptoms and problems, but Covid-19 has a much higher rate than any other respiratory infection. And I continue to see numerous combinations of post Covid symptoms on a daily basis. I’ve been surprised by how some people have just come to accept their symptoms as normal and they move on. Just like people accept they have diabetes, vascular disease or obesity, and they just live with it, managing symptoms with medications rather than trying to reverse their chronic conditions with lifestyle changes.

So have we just gotten to a point where we now accept this rate of infection, chronic disease and death as part of life? It appears so.

What makes Covid-19 different from other respiratory infections? Here is a refresher.

1. It is NOT seasonal. Flu can reliably be predicted to occur during the colder months, when people are in closer proximity with less ventilation. We don’t give the flu vaccine once a year because it lasts all year. It’s because we only need to be protected for 4-6 months. Covid outbreaks were just as bad in the summer months as in the winter months.
2. It is spread by just breathing. Even if you do not have a cough or sneeze, the SARS-Cov-2 virus spreads, suspended in the air. The same way you can smell smoke from someone’s exhalation meters away, you can inhale the virus.
3. It is much more infectious. In addition to having an easier mode of spread, once it is in you, it has a greater capacity to actually infect you and avoid our immune defenses. This is partly related to how this virus works and that it binds to a receptor (the ACE-2 receptor) which is quite concentrated in the upper airway.
4. Because the ACE-2 receptor is on almost all cells and in all organs in the body, it can affect those organs more readily.
   1. The pancreas cells (beta cells) which make insulin are destroyed by the virus leading to diabetes.
   2. The heart has these receptors so heart issues like myocarditis or serous and even life threatening arrhythmias can occur. The arrhythmias and inflammation which occur as a result of the vaccine are minimal compared the incidence of those problems if you get Covid
   3. The brain has receptors. Brain fog, memory loss, headaches… It also appears that long-term smell and taste issues are more of a brain-processing issue than an actual taste bud receptor problem. How our present generation of kids will be cognitively impacted by infections is still to be seen. The social impacts of the pandemic have been well documented with at least 50% of not only kids, but adults expressing severe loneliness and depression as a result of the Pandemic.
   4. The kidney has lots of these receptors. It’s where we learned about this receptor in the first place given its important role in blood pressure management. Kidney disease can result from Covid. Some have had such fast deterioration that they have needed transplants already and many will need them in the future.
   5. Lungs. Even in completely asymptomatic young people, the incidence of permanent scarring is ~10%. As with the kidneys, lung transplants have been needed in some, and many more will need them in the future with continued deterioration.
   6. The eyes have receptors and are not only a site of infection entry, but eye problems can develop long-term.

We have learned a lot about this virus, how it’s transmitted, how to treat it… For example, unlike the flu which is much more infectious by contact, the SARS-Cov-2 virus seems to be less infectious this way. SO, we don’t have to let our mail sit in the garage for a few days or windex our bananas to decontaminate them anymore.

We have also learned that just about any chronic condition significantly raises your risks of getting infected and/or having a much more serious case of Covid. The most common chronic condition associated with Covid ICU admissions is simply being overweight, not even obese. Since 75% of Americans fall into this category with nearly half being obese, it’s not surprising that the US had the highest per capita Covid-related infection, hospitalization and death rate of, not only industrialized countries, but even many third world countries. Sadly, weight issues have worsened during the pandemic and rates of all other chronic diseases have increased. Today, 50% of Americans are known to have diabetes or pre-diabetes (I hate that term because it gives the false sense of security that things are “not that bad” yet). Add to that all those who don’t know they have diabetes as well as the people who have insulin resistance, the fundamental underlying problem, and the number is closer to 80% of Americans have some degree of glucose dysregulation. 

I’m rambling again.

What to do?

Just be smart and practical to the best of your ability. Think about not only your safety, but the safety of everyone around you. If you have symptoms, test and stay home. Remember that Covid is not the only transmissible respiratory disease out there.

Wear a mask where it makes sense. It amazes me that even in our local ER, where I had the unfortunate opportunity to spend time yesterday with a patient suffering a severe allergic reaction with tongue swelling, how few patients and even healthcare workers are wearing masks. Of all places! It’s where sick people go! Shopping at Wegmans at 8 am is probably pretty safe without wearing a mask, but not at 4 PM on a friday.

Avoid tight crowds and spaces if possible. I certainly have enjoyed a few events last year where the risks were high, but it was a calculated risk.

Part of that calculation is if and how vaccinated you are. 

Even without any of the boosters, getting vaccinated significantly reduces the incidence of severity of disease. Maybe we can’t avoid catching it, but we can avoid getting really sick or dying from it. Unvaccinated people are 5x more likely to die from Covid. 10x more if you are over 50. Getting boosted reduces those risks even further.

The data is clear on the overall safety of the vaccines and boosters. In comparison to commonly used drugs like aspirin (which kills more people worldwide than any other drug), motrin (which contributes to more joint replacements than it spares since it kills off cartilage producing cells) or acid reducers (chronic use of which increases risks for a heart attack or stroke by 30%), vaccines are incredibly safe.

Presently, the bivalent mRNA booters are only allowed for first time boosters, immunocompromised kids and some adults, as well as all those over 65, regardless of health status. I tried to get mine about a month ago but was sadly denied. Since the change in the approvals, I will be getting it ASAP.

Stay Safe and Be Well

AC