New Years Finale

I started to write my last update of the year and it became a little philosophical, and as a result long-winded. I tend to do that, if no one has noticed, so I deleted it and restarted and will make it as short and to the point as I can. 

COVID. The stats from the last 2 weeks are both discouraging and encouraging at home and abroad.

• Hospitalizations are up 10% in the US. We are at the highest level since early 2022. This trend is universal all over the world. In some countries like Denmark and the Netherlands, hospitalization numbers are the highest since the pandemic started!
• US emergency room visits for Covid are up by 6% in the US.
• Although the death rate remains stable worldwide, it is still significant, accounting for 1300 deaths a week in the US. In Canada, the weekly average is now ~500/week. It remains the 3rd leading cause of death and rivals the worst flu seasons we have seen in decades.
• Wastewater viral measurements in some US states remain the highest we have seen since the start of the pandemic. It is hard to interpret these numbers other than to say that there is much more virus out there. Are infected people shedding more virus or are more people getting infected? It’s not clear but it is probably the latter.
• Despite over 70% reduction in risks of hospitalization and death they provide, vaccination booster rates remain pathetically low. 1% better in adults than 2 weeks ago, but still at only 18%.
• Amongst children, the numbers are even lower and the pediatric death rate is the highest it’s been since the start of the pandemic.
• It is NOT seasonal like the Flu or RSV. In New Zealand, where it is summer, their hospitalization rate today is also the highest since early 2022.

FLU and RSV.

• The RSV rates are a little lower than they were 2 weeks ago, but still significant.
• Flu is a little up but fortunately remains relatively low as compared to the last few years. By almost 1/3rd.
• That is not to say they are not causing significant disease so vaccination is still very important, for everyone including kids.

The WHO has come out with a vague statement stating that they were once again recommending masking and social distancing. Their comments are unfortunately not very clear, but the studies are. Masks DO work, assuming you are wearing a good mask and wearing it correctly. Cloth and even surgical masks are not enough. Only N95, or their equivalents, and worn properly (not under the nose) are effective against the Covid virus. This data is clear and it shocks me that even in hospitals, Emergency rooms and operating rooms, very few people are wearing them.

I urge everyone to consider getting vaccinated for COvid and the flu. It is fine to get them together. If over 65, also get the RSV vaccine. If over 50, get the shingles vaccination. I saw someone just this week whose face is paralyzed as a result of shingles. That sucks! Fortunately his hearing is not affected, which it often is when the face is involved. I am also seeing a lot of HPV related tongue and tonsil cancers so get your teens vaccinated against HPV!

Please also practice setting appropriate masking and distancing. Going to the grocery store at 7 am is probably safe without a mask, but at 4 pm, when it is crowded and hundreds of people have passed through all day long, I would certainly wear a mask.

Get together with people this New Years but not if you are ill, with anything, not just Covid. If you have a sore throat, are sneezing or coughing, for everyone else’s sake, stay home!

And test, don’t guess. Remember that false negatives are far more common than false positives, which are very rare. If you have symptoms with a negative test, repeat it the next day. But if you have symptoms, you still have SOMETHING so again, stay home, have vegetable soup and watch Dumb and Dumber, my favorite movie!

Be well and have a safe and prosperous New Year.

AC

We may be distracted by all the violence going on in the world and the circus show which is our political landscape today, but the issue of infectious diseases of various types is very much a serious issue we are ignoring. And yes, despite our desperate desire to put Covid in our rear view mirror, it is very much still in the driver’s seat.

I certainly don’t want to downplay the issue of our violent culture. Gun violence in the US is at an all-time high.  The conflict in Ukraine rages on and the situation in the Middle East continues to deteriorate but I heard a sobering fact the other day. Worldwide, there are 110 active armed conflicts going on today! There is a lot of hatred and lack of compassion out there.

These wars also have significant impact on the global infectious disease scene as well. In Ukraine, for example, multi drug resistance bacterial outbreaks are rampant. Many people are dying not from lack of access to doctors and medicine, but because the medicines no longer work. The issue of drug resistance is certainly not limited to Ukraine. It’s happening here in the US as well. Although partly driven by overuse of antibiotics in medicine, where as much as 70% of prescriptions are estimated to be inappropriate, the majority of the antibiotics people consume come from the meat and dairy people eat. 80% of the antibiotics produced in the world are fed to animals, to help prevent infections because of the squalid conditions they are raised in, but mostly to stimulate more rapid growth. Studies show that just one serving of meat provides enough antibiotic residues resulting in the development of drug resistant bacteria in the colon. 

I won’t comment on the political landscape, but obviously it’s a shitshow and as sad as the road is we are heading down, it will be interesting to see how our next election plays out. Either way, the crazies win!

FLU.

Many US states report high or very high levels of Influenza and the most affected victims are kids and those over 65. Kids in particular are getting hit the hardest. The sad part is that only 38% of kids are vaccinated against the flu. This is significant when you consider that 50% of the deaths in the pediatric population this year so far and all of last year involved kids who were healthy and had no risk factors, other than not being vaccinated. Vaccination works! It may not prevent you from getting sick, but it really does reduce the risks of serious symptoms or side effects.

COVID

The same goes for today’s Covid vaccine booster. The most recent studies show significant reduction in illness, hospitalization and death if you are updated on your vaccination. And just like the flu, the numbers are sad. Only 17% of US adults are boosted or vaccinated, unchanged from my last post. And the nursing home data remains pathetic with only 32% of residents being boosted and only 17% of nursing home workers being boosted or vaccinated. This is how we care for the most vulnerable in our society? 

Why is this important? Because the numbers are rising significantly, probably impacted mostly by the newest variant JN1, an Omicron variant. It demonstrates the greatest ability to evade our immune systems and greatest potential for spread than any previous variant. In addition, poor vaccination rates and “back to normal” pre-covid behavior is the norm, all facilitating Covid spreading rapidly once again.

The CDC reports significant increases in hospitalizations, ER visits and Covid positivity, particularly with the JN1 variant. Deaths are on the rise slightly, but they are concerned by what the next few weeks will reveal. The last few weeks, the daily average has been ~ 185 deaths from Covid. That’s 67,000 deaths a year. Still! It has crept back up to #3 cause of death in the US, after heart disease and cancer. Just as an FYI, sadly, dementia keeps climbing and is now #4, followed by strokes, chronic pulmonary disease, diabetes, other respiratory infections like the flu and kidney disease.

Wastewater testing shows almost record high virus counts, especially in the Midwest and Southern states. Counts there are higher than at any peak during the pandemic.

And there is NO seasonality to Covid. In Australia and New Zealand, where it is summer right now, they are having record increased rates of Covid infection and hospitalizations. 

Looking back over the last 4 years, most of the surges worldwide have occurred in warmer months. And they all tended to occur about 6 months apart, right around the time that immune protection from vaccination or previous infection really starts to wane.

Another disturbing trend is that many Covid infections today are occurring in people who had never had Covid before. Again, not too surprising given the reduced protection both from poor immunization rates, lack of protective behavior (masking, distancing…) and generally poor health with many risk factors for disease (being overweight, generally inflamed physiology, insulin resistance…). That last point about insulin resistance is important. This is the fundamental problem leading to diabetes and the estimates are not that almost 1/3rd of the US population is diabetic or pre-diabetic. If you include those with insulin resistance, usually having normal screening blood work, that accounts for 80% of the population. This is lifestyle, primarily poor diet, driven. And it is not about eating too many carbs or too much sugar. It’s the fat.

LONG-HAUL COVID. A recent study of many thousands of people with long lasting post-Covid infection symptoms revealed some risk factors. These include:

• Being over 50 with rates increasing with each decade of life.
• Female more than male
• Being overweight or obese
• Have pre-existing conditions like COPD or heart disease
• Having multiple symptoms while ill with Covid
• Being hospitalized for any reason within 30 days of infection.

Protective factors included:

• Vaccination, which was strongly linked to reduced risks of long-haul symptoms. This affect was magnified with even just one booster.
• Lack of other health issues.

With the upcoming Holidays, we will be getting together with lots of family and friends. Many of those people may have significant risk factors for having bad outcomes, be it from Covid, Influenza, RSV, Pneumococcal pneumonia or many of the other viruses and bacteria we are constantly bombarded with.

1. Test, don’t guess. It would be wise to have people test themselves before gatherings to make sure they are not harboring early or asymptomatic Covid infection. Today’s tests remain pretty accurate but keep in mind that positive tests may not develop for a few days even after symptoms start given the fact that so many people have low level antibodies floating around. So repeat a few days later if still symptomatic.
2. Stay away if you are sick with anything else. No one wants to be Typhoid Mary!
3. Do what you can to prevent illness before the holidays.
   1. Mask properly (N95)
   2. Shop during low-traffic times.
   3. Distance
4. Vaccinate and/or Boost. It’s never too late.
5. Start your New Year’s resolution to get healthier earlier! Like NOW.
   1. Move more.
   2. Eat better, focusing on whole plant foods.
   3. Work on your stress levels.
   4. Sleep better. I have lots of tips on how to improve sleep on my website doctorchuma.com
   5. Love more. We all need each other. Don’t be afraid to socialize, just do it carefully.

Enjoy the Holidays.

Stay safe and be well.

AC