General Wellness

Covid, TB and Syphilis! What’s the connection?

Focusing on the Covid pandemic the last few years has resulted in the global healthcare community paying a little less attention to other common infectious diseases. 

Tuberculosis is still alive and well! In fact, it is the leading infection worldwide and causes the most deaths of any infection with over 10 million people a year getting sick and over 1.6 million dying in 2021. Covid-19 took over for a bit, but TB is back on top. And although about 30 countries, all low income and poor, account for the vast majority of TB cases, it does pop up occasionally here in the US. In fact, there is a small outbreak in Kansas right now.

Diarrheal diseases are among the most common causes of death, especially in children. Not surprisingly, the majority of cases occur in those same 30 poorer countries. In 2019 around 1.5 million people died from diarrheal diseases. Around half a million of these deaths were among children. Sadly about 1/3rd of the world’s population lives in areas with lack of access to clean water. That is 2.34 billion people who can’t just turn on the tap or go to the nearest store to get some drinking water. And we kick and scream over people in the entertainment industry not making enough money? Perspective and gratitude is sorely lacking in our society.

As an FYI, the absolute leading cause of death overall worldwide is cardiovascular disease. And this can be prevented or in most cases reversed with a healthy, plant-based diet and other good lifestyle measures like continuous movement and daily exercise, proper sleep, stress management and good social support.

Another Covid related issue is diversion of healthcare funds. The Covid pandemic has caused so much disease and has soaked up so many resources that there is a shortage in infrastructure to deal with TB. The estimate is that there are more than 4 million undiagnosed cases out there right now. And the rise of multidrug resistant TB is not helping much.

As far as SYPHILIS goes, in 2021, there were over 177,000 cases diagnosed in the US. This is the highest level since 1948! Congenital syphilis caused 220 stillbirths in the US in 2021. Congenital syphilis is when an infected pregnant mother transmits the disease to their developing fetus.

In addition, the most important antibiotic (penicillin) used to treat congenital syphilis is in extreme shortage. This shortage is also impacted by the fact that 80% of the antibiotics produced worldwide go to feeding, preventatively treating animals and promoting growth (yes, antibiotics stimulate muscle growth). Chicken is the biggest culprit. Studies have shown that within only 3 days of eating a mostly meat diet, antibiotic resistance in the gut microbiome of human subjects starts to develop.

POLIO, which had a small resurgence in a few NY state townships 2 summers ago, also still has a worldwide presence. In 2022, there were over 900 polio cases, significant for a disease most people thought was eradicated. Add to that the fact that many infections go undiagnosed until nerve problems develop decades later, polio becomes a persistent infection of concern.

With respect to COVID-19, new cases and hospitalizations due to Covid continue to rise steadily but fortunately, ICU admissions only slightly up and deaths remain plateaued, presently ~ 200 a day, or 70,000 a year, and again, comparable to the worst flu season in decades! Nothing to sneeze at (pardon the pun).

There is continued concern for long-haul Covid disease. There is a prevalent feeling in the population that if you had an unremarkable previous Covid infection that your body can handle it and long-haul symptoms are unlikely. That would be WRONG! In fact, second or third infections pose an even greater risk of such prolonged problems. 

The CDC has just approved the newest Covid-19 booster for everyone over 6 months of age. I would urge everyone to get either the first series, if not yet vaccinated, or the booster, if it has been over 6 months since your last booster or active infection. It is fine to get it along with the flu vaccine simultaneously. There is no issue.

Just as I was feeling comfortable in crowds, I am now starting to feel less comfortable. I have not yet progressed to wearing a mask indoors, but have certainly given second thought to meetings and events I am planning on attending in the next few months. Airtravel will definitely be masked.

As we head into the cold and flu season, it’s important to be careful and respectful of others. A relative of mine was recently on a trip and was guilted and ridiculed for wearing a mask. They let down their guard and sadly, they got Covid. Fortunately, it was a mild case and they’ve recovered. The point is, if you don’t feel comfortable and want to wear a mask, do it. If you don’t want to wear a mask, don’t, but consider it, not for you, but for everyone else around you, especially if you’ve recently been exposed or have any symptoms suggesting ANY kind of infection. Or just stay away and don’t risk getting others sick.

In the meantime, keep working on improving your overall health. It’s your best defense.

Have a great weekend. Hopefully you’re somewhere with family and friends and out of the rain.

Stay safe and be well.

AC

Despite the significant reduction in Covid-19 testing, both on an individual and institutional level, it is clear that Covid case numbers continue to grow, all over the US. How do we know? Our POOP!

More specifically, monitoring the levels of virus in community wastewater. The SARS Cov-2 virus does attack the gastrointestinal cells and we do poop out the virus out. In fact, viral genetic material can be identified in our waste even months after infection. This has been a standard way to monitor how much virus there is in the community since the onset of the pandemic. It is routinely used at school dormitories. This technique was also used to monitor the fortunately small polio outbreak in some NY townships a few summers ago.

In my last post, I mentioned how despite increases in hospitalizations for Covid-19 related problems, there was no noted increase in ICU admissions. That is no longer the case. Numbers of very serious, life-threatening cases are also rising leading to increased ICU admissions. As of now, death rates have not increased significantly, but that can change since there is often a lag between hospitalizations, ICU admissions and deaths.

The lack of deaths may be a result of protection provided by broad T Cell immunity in the community from the number of people who were vaccinated and those who actually got Covid-19. Despite antibody levels waning in both situations the T Cells, which we create as a result of exposure either to the virus itself or the proteins the vaccine provides, are permanent. Unfortunately, with viral re-exposure, T Cells are not activated as instantaneously as antibodies and take a few days to come online. Antibodies are what matters in preventing infection in the first place but T Cells are involved in mitigating the severity of the infection. 

Time will tell what happens with death rates.

Despite the numerous variants emerging, the T Cells seem to be keeping up and continue to provide some protection. In addition, with each exposure to a new variant, we generate even newer, more specific T Cells.

The present circulating variant is EG5. The XBB variants are also common. These are accounting for the vast majority of hospitalizations. Other variants are still circulating but to a much lesser degree. BA 2.86 (Parola), the one with the 30 mutations that we were concerned about possibly leading to a new dramatic Omicron-like variant surge in 2022, has not panned out. Fortunately.

The most recent vaccines continue to provide significant antibody production shown to be effective against the most recent variants, despite being developed for other variants which are still circulating but dropping off. 

As far as vaccine risk goes, they continue to remain very low, and once again, much less common than the side effects and long-term complications of actually getting sick. There is a 0.007% risk of myocarditis with the Moderna vaccine, particularly with boosters. Other vaccines have a risk of myocarditis but it is much less. The risk of getting myocarditis remains significantly higher if you actually get Covid-19 infection! 35x greater incidence compared with post vaccine myocarditis. Once again, it’s all about mitigating the risk.

We are quickly getting into the cold, flu and now, Covid-19 season (although Covid-19 is not a seasonal disease like all other cold viruses). And once again as a reminder, Covid is spread by simply breathing whereas the flu and other viral colds are spread by larger particulates created by sneezing and coughing. I remain a strong advocate of vaccination, as well as all the other important mitigation strategies like distancing, masking and most importantly, isolation and avoiding infecting others if you are sick.

As far as timing is concerned, it’s best to wait until early October, to make sure you are covered, at least with respect to the flu. If it’s been more than 6 months since your last Covid booster, it’s time to get it. If you have never gotten it, please consider getting it.

Have a great weekend.

Stay safe and Be well.

AC