General Wellness

The biotech company Regeneron just got emergency approval for their antibody cocktail drug Regen-Cov-2. What this essentially consists of is a number of lab engineered antibodies against various surface proteins on the SARS-COV-2 virus. We generate these naturally (actually naturally we generate many many more different kinds of antibodies against the virus when infected) but the problem is that by the time we generate them, the virus has spread too extensively and the disease Covid-19 takes hold. This drug essentially gives our immune system a head start with identifying and attacking it. In some ways, it is like an artificial vaccine. With a vaccine, you get injected with parts of a microbe and we naturally generate antibodies. Regen-Cov-2 gives us these antibodies in advance of our immune system.

But therein lies the problem with this new “miracle cure”. You need to get it soon enough after infection for it to be of any significant benefit. The same goes for the other “miracle cure” touted by our outgoing president Remdesivir, another drug which got emergency use authorization. The WHO just announced that they no longer recommend getting it since some recent studies show no real benefit, unless you get it soon enough.

By the time most people are in the hospital with Covid, it’s too late. Our president got these drugs faster than 99.9% of us would be capable of, which is why they worked so fast. His manic behaviour afterwards was also a result of the early treatment with the steroid dexamethasone, well known to cause a constellation of emotional issues. Every patient to whom I give this drug, I also give the advice to pull out a broom and get ready to clean the house because you will be amped up and won;t be able to sleep. It works.

As far as the great news about the efficacy of 2 upcoming vaccines, that is great but again, it is no “miracle cure”. Enough people need to take it and presently only ~50% say they would. For herd immunity to occur, all those who do get immunized would have to get it within a fairly narrow timeframe. Presently, even if the most optimistic view is taken that one will be available by the new year, it would take many months for those who want immunization to actually get it. I plan to take it when it is available but I have no delusions that I will be 100% protected nor that I can’t get re-infected and spread it to others. Standard PPE practices will continue. Indefinitely.

We need to stop looking for a cure. An easy way out. 

It doesn’t exist.

Other than the obvious one. 2 weeks of isolation.

That is literally all it would take. Just 2 weeks. The virus, as it is spreading now, would die out.

If everyone on the planet could just isolate for 2 weeks, this present pandemic would go away. Of course if, in addition, if we do not change our ways, something else will just take its place very soon. There is already the next version of bird flu H9N7, much more contagious and much more deadly than previous bird-flu viruses. Where do they come from? Chicken farms. We’re killing ourselves. I like to point out to people that we like to blame the Chinese wet markets on this pandemic but they are shocked to learn that at the same time as this virus started to spread, New York City had over 80 wet markets throughout the city.

It won’t happen though because humanity is lazy, selfish and can’t help itself.

While we need to keep working on treatments and vaccines, we can’t continue to ignore the obvious. The disease is spreading fast. People are getting sick. People are dying and the only way past all this is through. It will be long and slow but if we want to minimize the cases of significant disease and death, not only from Covid itself but the myriad of other diseases people are dying from both directly and indirectly because of Covid, we must do the basics.

MASK UP. wear a good one. Wear it correctly. Cover your nose. Stop touching it.

DISTANCE.

WASH YOUR HANDS. Use hand sanitizers if necessary.

DON’T TOUCH YOUR FACE.

COVER YOUR EYES.

VENTILATE.

VACCINATE.

GET HEALTHY.

CHECK IN ON YOUR FAMILY AND FRIENDS. We need each other.

Stay safe and be well. 

AC

TEMPERATURE CHECKING. Used as a cheap screen, everywhere you go, you get your temperature checked. However, as an isolated tool, it is pretty useless. Temperature checking is neither sensitive or specific for Covid infection. Plenty of people infected with SARS-Cov-2 who are not yet symptomatic have normal temperatures. Our local hospitals have even stopped doing it as a screen for incoming staff. We have instituted a symptom screening procedure using a website we need to check in with every day. One more thing to add to the daily list of things to do!. This is also not perfect since it relies on you being honest with your symptoms. In addition, some of the symptoms are experienced pretty regularly in situations which have nothing to do with Covid. An example is shortness of breath which can also occur with allergy flare-ups but if you mention it, everyone gets excited and they run for the hills. Are we still doing it in the office? Yes. It makes people feel like we’re doing something!

WHEN SHOULD I TEST AFTER AN EXPOSURE?. Complex question with variable answers. After an exposure during which you get infected, 97% of people will have a positive test within 5-7 days. Not sooner. It can be as long as 14 days but most will be within a week.

Context however is important. Was the person only symptomatic with tests pending or did they actually have Covid? Was the person themselves exposed to someone so you are 1 person removed? Family close contact is different from casual exposures.

The general rule of thumb is that:

1. If you have symptoms, then test right away. If you don’t have symptoms, wait -7 days. While waiting for results, self-isolate. The list of symptoms has grown from the traditional fever, cough and shortness of breath. We now also include:
   1. loss of smell or taste, 
   2. loss of appetite, 
   3. vomiting or diarrhea,
   4. rash on fingers or toes,
   5. unusual fatigue
   6. Chills and/or body aches
   7. Sore throat
2. If you do not have symptoms but the exposure was significant, wait a minimum of 5 days before testing. Testing earlier will likely be negative, even if you contracted Covid from that specific exposure. As a word of comfort, within the first 2-3 days of contracting Covid, you will not be infectious since there is not enough virus to spread. This is the same reason testing is useless this early. If you were exposed and saw Grandma the next day, she will be fine.

If you turn out to be positive, the recommendation is to self isolate for 10 days after onset of symptoms. If you still have symptoms at the end of 10 days, that is probably OK since some symptoms like cough and alterations of smell and taste can persist for many weeks and even months. I have seen a few very long-term issues with taste and smell in my practice. If you have a fever, you should be fever free for a minimum of 48 hours as well.

For sicker people, like if you had a stint in the ICU, you need to quarantine for 20 days after symptom onset.

TESTING AFTER INFECTION. In general, this is not necessary and can be confusing. Depending on the test, you can remain positive for months after infection. You are NOT infectious, but there is still some genetic material from the virus which tests are picking up on. HOWEVER, if you develop symptoms again, you may be re-infected and you may need to be re-tested. In this situation, you really should consult with your doctor or an infectious disease specialist for the latest on recommendations.

NEGATIVE TESTS. I wrote a quick note about this earlier. Although helpful, they are by no means a “pass”. You could test positive as soon as 12 hours after a negative test because of rapid viral replication.

IMMUNITY AFTER INFECTION. There is no such thing. First of all, although there is some protection after an infection, or upcoming vaccination and that the chances of catching it again in the months after infection are lower, there are no guarantees. There have been numerous cases of re-infection. Not a tremendous number but there definitely are some. Most have had a less significant infection the second time around but some have been worse. If other coronavirus infections are any indication, within a year, there is no more protection. Including from the T Cells which are permanently in your system. This may be because of viral mutation or simply, levels of immune cells which are too low. Add to that your overall health status. You MUST continue vigilance with respect to the basics of protection.

Remember that this is a new virus. Even though we have been dealing with it for 9 months, like a pregnancy, we are still learning. For example, the WHO just came out with recommendations about NOT using the antiviral Remdesivir. According to some of their studies, it may not actually do much of anything. More on this later.

In the meantime, do all the things you need to do to stay safe and protect all those around you.

I heard a great Budhhist quote from a podcast interviewing vegan activist Dr. Melanie Joy. She coined the term “Carnism” which is the belief system that eating certain animals is “Natural,normal and necessary” while eating others is not. It is very culturally driven. 

“We all have within us the seeds of GREED, HATRED and DESIRE. We also have within us the seeds of LOVE, COMPASSION and EMPATHY. Our job is to simply water the right seeds in ourselves and in others”.

We need more of the later qualities to not only get through the Covid epidemic, but to survive our own extinction.

Stay safe and be well. 

AC