General Wellness

Spoiler alert, Covid ain’t goin’ anywhere anytime soon.

The confusing information from many outlets continues to march on. Last week there were numerous reports that some scientists and infectious disease specialists feel that there are signs that this pandemic may be nearing its end. Comparisons are made to the pandemic of 1918, when there were similar patterns of disease worldwide, followed by a lull, and then another resurgence, and then it disappeared. Until it naturally reappeared in the 1949-1950 season but then resurfaced again, after a lab leak in Russia, in 1977 (sound familiar?). There are various reasons we know it was a lab leak. First of all, the lab was known to be messing around with that virus and secondly, there were almost no genetic differences when it was compared to the virus from 1950, a virtual impossibility if the virus simply evolved and reappeared naturally. It was put on ice in 1950, thawed out for experimentation in the mid 70s, and escaped. Lest you think this can only occur in other countries, there have been many hundreds of well documented “incidents” reported in US labs over the decades, including a number of deaths from infection. We experiment on pathogens just like every other country does.

Although there are signs in some places that this most recent Omicron variant surge may be slowing down, the overall pattern on a national and certainly a global scale, is still very concerning. Surges are spiking all over the place, including in the US. Hospitals are overwhelmed, and not only with Covid. In our local hospitals where I practice, we are starting to see the overwhelm impacting on the care of all patients, including those with non-Covid medical issues. Our own patients have had 10+ hour waits in emergency rooms and EMS services are strained, having also to prioritize patients. It also isn’t helping that one local hospital just closed and another is closing at the end of January, the Pandemic being the last nail in the coffin of an already struggling healthcare system.

As for comparing the Covid pandemic to the 1918 flu, there are more differences than similarities. First of all, the influenza of 1918 was a typical flu in that it was seasonal. It spread year round but both peaks occurred in the cold weather and lessened in the warmer weather. This is NOT happening with SARS-Cov-2. It’s a year-round virus with many large outbreaks in the warmer seasons. Secondly, our ability to travel, allowing the virus to spread as quickly, was nowhere as efficient back then than it is today. Thirdly, the 1918 pandemic was caused by a “naturally” occurring virus. Certainly, human activity, specifically animal agriculture and domestication for meat consumption, caused it to develop and jump to humans, as do almost all epidemics. Although the coronavirus which causes Covid-19 probably originated in bats, as many other coronaviruses do, the SARS-Cov-19 was likely manipulated by humans in ways that nature would never have, making it much less predictable. Lastly, they had no cure and medical care in general was significantly more primitive. Today, we have amazing treatments available, including the vaccine.

As epidemiologist Dr. Michael Osterholm has repeated many times, anyone who makes any kind of definitive prediction about what is going to happen with this virus, doesn’t know what they are talking about.

Although many more people worldwide still need, and will get vaccinated, our rates here in the US seem to have stalled at under 70%. Those last holdouts are too entrenched in whatever beliefs they have and will likely never get the vaccine. In addition, as time passes, protection from either vaccination or natural infection wanes and we have seen an even lower rate of booster doses being received, essentially making even the vaccinated people more vulnerable. All this allows the virus to continue to spread and replicate increasing the chances of an even more concerning variant to emerge. Could it mutate itself out of existence? Possibly. But sitting around hoping when we have treatments and strategies to limit transmission available to us now, is misguided.

The reason we only get one annual vaccine for the seasonal flu, is because it is seasonal, peaking in the middle of the winter, when we are all cooped up and in closer contact with each other. And just like with Covid-19, the flu virus mutates and changes, so each year the vaccine changes a bit to try to predict the upcoming variant. With Covid-19, we may be headed toward twice-a-year boosters, since this is a year-long transmissible infection and antibody levels drop off significantly by 6 months, in both natural infection and vaccination. It’s also way too early for us to be able to predict mutations, and make a protective vaccine in anticipation. We can’t even keep up with what is emerging today. It is what it is.

Results take work. Not wishful thinking. We can’t rely on someone else to come up with something to get the job done. It takes everyone to work together for us to beat, or more likely to co-exist, with this virus in some semblance of a normal way.

Appreciate what you have (we still live in the most peaceful, free and prosperous time in human history) but please continue to be careful and look out for everyone around you. 

If you have not yet been vaccinated or boosted, please do so. Even if you got Covid, you still need a booster. Most recommend waiting 3-6 months, but it still adds protection beyond what natural protection you may have.

Continue to distance and wear the best mask you can when out in public.

Work on your own personal health. It’s your best protection if you do contract the virus.

Ss

AC

Ivermectin revisited.

Yesterday, there were over 140,000 hospitalized Americans with Covid, a new record. And almost all of them are not vaccinated. Furthermore, 25% of hospitals are experiencing critical staff shortages. This is a deadly combination, and not just for Covid patients, but for all patients who are ill with various conditions.

I have yet to have a clinic day where there isn’t at least one patient who is not yet vaccinated against the SARS-Cov-2 virus. Often there are 3-4. As an ENT specialist, they are usually not seeing be for a Covid talk (although some of my patients are there for Covid-related symptoms), but as a physician, I feel compelled to discuss their vaccination status in the hopes of possibly clarifying some concerns they may have, encouraging them to please get vaccinated. Their reasons for holding off are varied, but almost always, they are based on misconceptions and falsely believed rumors. Many don’t think beyond their 2 foot radius and when I ask them about concerns about spreading it to others, they never have a response. Silence. They don’t care. Although I do not get into politics, I often get the impression that their beliefs are reinforced by non-medical influences.

So far this week, I had 2 middle aged people who had Covid over a year ago, who believed that they were still protected because of it. I explained to them that , although natural infection provides good future protection, that wanes, just like it does with vaccination, and that a booster shot was still strongly recommended. I don’t have a lot of time, but I try to explain the science behind memory cells such as T and B cells and antibodies and how they differ. Maybe I convince them. Who knows. 

This week, I had an obese, hypertensive 82 year old who already had Covid twice, both times hospitalized, who now struggles with pulmonary fibrosis (permanent scarring in the lungs which not only leads to breathing problems, but also heart failure because of the scarring which also impacts on blood flow through the lungs forcing the heart ot beat harder to move blood through). Despite that, he was firmly against vaccination because he “did not trust the pharmaceutical companies and did not believe the science”. It was interesting that he was on a slew of other pharmaceutical products for his numerous other chronic conditions, but he did not “trust the drug companies”. Furthermore, when he was hospitalized, although he was willing to take other pharmaceutical products like the monoclonal antibodies and antivirals, he had presented to the hospital so late, they were not offered since they would no longer be effective. Ironic that he doesn’t trust them enough to take the vaccine but trusts them enough to take their drugs when he can’t breathe in the ER! He also brought up how no one would prescribe Ivermectin for him, another product of non-trustworthy drug companies. He commented on studies showing how in countries where it was used endemically because of contaminated water, there were lower Covid cases and lower death rates from Covid, and how these studies are suppressed by our media. This drug was in the news months back dubbed the “horse pill”. That label was not really fair since this drug has been life saving for many humans infected with parasites and the scientists who developed it did win the Nobel Prize in medicine for their discovery of this drug. There have been some very small, limited studies showing some benefit of this drug which does inhibit the virus somewhat. There were also many studies which were retracted because of seriously flawed and manipulated data. 

As for the places where Ivermectin is used preventatively because of parasite-contaminated water, I did come across some online articles suggesting lower Covid cases and a smaller percentage of death. These are primarily poor African countries where trustworthy data and demographics are hard to come by. There were many criticisms of these studies. 

My personal examples are anecdotes, as are the studies showing some possible benefit from Ivermectin. The same day I saw the above-mentioned gentleman, I had another patient, a local ER doctor, who was exhausted. His ER is packed every shift. Not just with Covid, but the flu as well as all the “other usual things” like heart attacks, strokes and urinary tract infections. Covid, however, predominates. There is an area in his ER dedicated to patients who can’t get a bed in the hospital because it also is packed. He describes having to navigate around beds with Covid patients in the hallways so he can get to the ER rooms. He just had a 26 year-old die within 48 of admission from cardio-pulmonary complications of Covid. Unvaccinated. In fact he said that he has seen “0”, that is ZERO, vaccinated patients. They are ALL unvaccinated. That is not anecdotal. That is day in and day out.

I have had conversations with other ER doctors who have similar experiences. Similar overflow situations. Similar sad outcomes. And sadly, mostly preventable if they simply got vaccinated.

These are not second or third hand recounts, over the web, from some blog. These are direct, first hand experiences. I have had my own. Trust who you want. Big-mouthed, misinformed, ignorant social media personalities and conspiracy theory websites and organizations, or, trust the doctors and other healthcare providers who are doing the work directly. Daily. Until they too get sick, or burn out, and can’t take care of you.

Please get vaccinated and continue to do all the important things which protect you, and everyone else around you. Mask, distance, avoid crowds and get healthy.

Stay safe and be well.

AC