General Wellness

Well, we’ve surpassed 1 million official deaths in the US from Covid-19. There are likely many more that have gone unreported so the number is likely higher. Worldwide, there have been 6.3 million deaths and that number is even more significantly underestimated given the lack of medical and administrative infrastructure many countries experience, not to mention some countries’ lack of willingness to be transparent with their actual numbers. N. Korea is a great example. They claimed NO cases of Covid, let alone deaths, until the last few weeks when they finally started to admit that they are under siege with the Omicron variant.  

The US represents 4% of the world’s population, but ~16% of the cases and deaths. Pretty sad in a country with the riches, opportunities and amazing healthcare support systems we have, not to mention the availability of vaccines. But it’s not surprising given that we are also the fattest and least healthy population on the planet. And it keeps getting worse.

What is even sadder is that many of these Covid deaths could have been prevented. Most of the deaths occured before vaccination was available but over 650,000 deaths have occurred after vaccines were out. The estimates are that if more people were willing to get vaccinated fully, more than 300,000 of those deaths could have been prevented in the US. Almost half the deaths!

The daily numbers are still significant. 300 deaths a day. It’s a far cry from over 4000 a day at the hight of the pandemic, but if it’s your loved one, each death is devastating. How many are dying from the flu today? ZERO! Why? Because it disappears with warmer weather. Covid is NOT becoming the flu. It is not seasonal. It respects nothing and continues to evolve and mutate. South Africa may be getting over their most recent outbreak of the Ba 4 and 5 variant surges, but it’s just starting in Europe and will likely hit our shores soon. A more infectious virus, in a population whose immune status is dropping off is not a good combination. There have been no inroads made with the number of people fully vaccinated or boosted. Less than 30% of kids over 5 have been vaccinated. Talking about their recent approval for boosting is useless if most have not even received one dose to begin with. A recent study showed that unvaccinated kids were 10x more likely to need hospitalization.

And although most do OK, many don’t and I am seeing more and more long Covid patients in my office. Ringing, pressure in the head, brain fog, fatigue… Lots of symptoms which in some are quite debilitating. Not much to offer them other than recommending vaccination, which has been shown to alleviate symptoms in some cases. Even the Long-Haul Covid clinics are starting to close because of lack of funding and reimbursement, not to mention being overwhelmed with patients.

I had a conversation with a confrontational patient the other day because he was upset that he was still required to wear a mask in our office. I’m an ENT doc. Would you go into an office where many patients are being evaluated for coughing, sneezing, sore throats, changes in smell and taste and hoarseness without protecting yourself? In addition I see a lot of immunocompromised patients with cancer and autoimmune conditions. Are you so selfish that you would put them at risk? This person had no answer other than stating vehemently that masks do nothing. Although I agree with him that the piece of crap mask he was weaning was not protecting anyone, a proper mask does and we left it at that.

Despite the semblance of normality in many places, this pandemic is definitely still with us. The numbers are on the rise. So much so  that the CDC recommended indoor masking in many parts of NJ.

No one can predict how this will evolve. However we know certain things for sure. The virus is still with us and it continues to evolve. Getting sick may be inevitable however, vaccination definitely reduces your chances of having a severe case, needing to be hospitalized or potentially dying.

Please continue to be careful to protect yourself and all those around you. Mask properly when in risky situations.

Please continue to vaccinate and boost as necessary.

Have a great weekend.

Stay safe and be well.

AC

South Africa, the origin country of the Covid Omicron variant, along with its subsequent sub-variants, is in the midst of its 5th wave of Covid-19 infections. Almost 90% of the cases are from the newer BA-4 and 5 Omicron sub-variants. Similar to BA-2, they appear to be causing milder disease than the original strains, but they are also more evasive of immune protection from both previous Covid infection and vaccination. This is quite concerning.

What is unique about the present wave is that the infected patients who are doing the best are those who were previously infected, but also vaccinated. New infections in unvaccinated people do the worst, followed by those who had Covid before since they have some minimal immune protection and an earlier response to the foreign invader. Those who never had Covid before and were vaccinated do better, but fare a little worse than those who had Covid AND were vaccinated.

The bottom line, get vaccinated. It’s only a matter of time before BA-4 and 5 arrive in N. America. Vaccination may not prevent you from getting Covid, but it certainly lessens the amount of suffering you may experience, not to mention reducing the risks of long-covid symptoms.

In addition, don’t assume that the 2 shot regimen, or one with J&J is protective. You MUST get boosted. Rates of boosting continue to hover below 30%, surprising to me since I was reporting less than 30% boosting rate 2 months ago!.

Paxlovid rebound/failure. There have been many reported cases of Covid patients treated with the antiviral Paxlovid, developing rebound Covid symptoms after the end of their course of treatment. The exact cause is not known but is concerning. The 3 most common theories are:

1. Overlooked drug interactions causing lesser efficacy of Paxlovid.
2. Resistance of the newer strains to this drug. Most of the other antivirals are not as effective as Paxlovid.
3. Not a high enough dose and/or not for long enough. Although unlike with antibiotics where suboptimal treatment can lead to bacterial resistance, the same does not appear to be happening with Covid. It’s just that the treatment duration is just too short and not enough of the virus is killed off.

We seem to have become comfortable with this virus being in our midst. Hearing of someone who gets Covid is no longer a concern, just an inevitability. It’s a dangerous attitude. Just like delaying the Shingles vaccine just long enough to get shingles, not getting vaccinated and hoping you don’t get sick, or worse, assuming you’ll do fine if you get it because your friend did, can lead to unnecessary suffering and possibly tragic results. People are still getting really sick and some are still dying. And Lord help us if a more aggressive variant is allowed to develop.

Please continue to be careful and please get vaccinated and/or boosted.

Stay safe and be well. 

AC