There has been a dramatic increase in the number of advertisements for diabetes drugs as well as the use and availability of CGMs, continuous glucose monitors. This is not surprising since most Americans are fat and have diabetes. Not that the two are necessarily linked… but they are! 10% of Americans have type 2, formerly called “adult-onset” diabetes. It’s no longer an adult disease. We see it in kids all the time, not surprising since 40% of 5-11 year old American kids are already obese! There are many more people walking around who don’t know they have diabetes. Another 30% of Americans have pre-diabetes, again with an even greater number of people not knowing they have it. The diagnosis of “pre-diabetes” is idiotic to me because it makes it sound like you don’t have a problem YET, but that is absolutely wrong. Diabetes is a spectrum. It starts with insulin resistance (IR), where your insulin is not working well but well enough that you get by, which can go on for decades before routine blood work starts to give clues that there is a problem. The cause of IR is simple; crappy, fatty diet and being overweight. It’s not because of too much fruit!! There is no question that crappy sugar, in the form of hyper processed foods also contributes, but it’s mostly the fat, which impairs insulin’s function and the cellular signaling required for insulin to work. If you want to dive deeper into this, check out www.masteringdiabetes.org. The estimates are that if you add all these three conditions together, diabetes, pre-diabetes and insulin resistance, ~80% of Americans are actually affected. That’s insane. Although I think CGMs can give you great information about the impact of the food you eat has on your blood sugar levels, the commercials promoting them suggest that if you simply know your level, and that it’s not too bad, you can go ahead and eat that piece of cake or french fries at the restaurant! That’s not what they are for! They are not to check your present blood sugar so you can decide if you can continue to eat junk! The medical establishment needs to do a better job teaching the public about how to reverse diabetes rather than how to better treat it!
What does this have to do with Covid? Well, diabetes is a significant risk factor for getting a bad case of Covid but the point is that the messaging is wrong. These commercials send the wrong message, and I think that the news of a single dose vaccine being developed may be too early to suggest, or even talk about.
Although simplifying treatment protocols for any disease is a great goal, I think it is dangerous to do so if it dilutes the importance of proper behavior and the emphasis on prevention and diminishes the impression of the potential severity of a disease. At this stage, given how much this virus mutates along with the fact that protection wanes significantly by 6 months, this unhelpful messaging is what hoping for a yearly Covid vaccine would do.
The CDC argues that a yearly shot, based on a prediction of what the virus might look like, as we do with the Flu, would do the following:
- Simplify the product, making administration less complicated,
- Decrease administration errors.
- Encourage more people to get it and improve compliance.
- Let’s start with the first issue. We have plenty of diseases which are treated with a variety of medications and protocols. Just look at how many blood pressure and diabetes meds are on the market. If we can’t handle a few different types of vaccines given twice a year, we shouldn’t be in practice. We don’t need to simplify, just educate and promote the importance of getting the shot in the first place.
- As a doctor who tests for and treats allergies, I am well aware of the fact that “user error” is the most frequent cause of severe and lethal reactions when administering allergy tests or shots. Wrong dose… wrong patient… mixing errors… poor attention to other risk factors at the time of giving the shot… all things that careful people review before giving shots. Compared to that complexity, giving a vaccine in the arm is not rocket science! Decreasing administrative errors is an irrelevant reason to give a vaccine in a less than ideal regimen.
- People will not change. The information is out there. There is a lot of confusing information admittedly, but there is a big difference between listening to a social media influencer and a medical institution or a quack trying to sell you a supplement and someone without an agenda other than helping people. Telling people that now they only need one shot a year will not make much difference in convincing them to get it.
In addition, Covid is NOT the flu. It is not seasonal. When do you time the shot? It mutates at a significantly greater and less predictable rate. It is evolving all over the world. We know that even the effective bivalent booster’s efficacy wanes. Antibody levels can measurably drop even a few weeks after vaccination. They remain elevated enough for at least 90 days and we do develop permanent B and T cells, but efficacy wanes, certainly by 6 months, to a point where boosters are necessary, at least for now.
MEASLES. Speaking of vaccines, with the decreasing routine vaccination of children by ill-advised parents, it’s not surprising that we are seeing measles outbreaks. In Ohio, there is an outbreak of measles presently which has affected at least 85 kids, 32 of which had to be hospitalized. 74 of these kids were not vaccinated at all and the rest were only partly vaccinated (it’s a multi dose vaccine). The rest just didn’t trust the doctors or the science. Less than 1% of all unvaccinated kids have a legitimate vaccine exemption and this group was no exception. The rate of vaccination may seem high (93%) but this is below the threshold believed to be important for herd immunity (95%). The same decreasing rate has been seen for other vaccines like those for Pertussis, Chicken pox and sadly Polio, and we’ve seen a recent Polio outbreak in NY last summer. In NY in 2018, there was a measles outbreak of 650 cases. These are not benign diseases and can have many complications, whereas the very effective vaccine is extremely safe. Don’t gamble with your child’s health. Get them vaccinated.
GONORRHEA. Admittedly, this was mostly a click-bait issue, however, there is a real problem. Drug resistance. In Massachusetts, there were 2 recent cases of multi-drug-resistant gonorrhea. An STD for which there is no cure. And in addition to the pain one experiences you-know-where when you pee, there is a serious risk of infertility and joint destruction from this infection. The issue of drug resistance in general is continuing to increase worldwide. I deal with it every day when trying to treat even run of the mill sinus and throat infections. Most of the time, I try to get people to just ride it out with conservative measures but we are an impatient and drug-obsessed society, and increasingly, a drug resistant and overmedicated one as well. Although overuse of antibiotics is a significant contributor to this problem (estimates are that 70% of all antibiotic prescriptions in the US are inappropriate), an even greater and more insidious cause is eating animal products, which are laced with antibiotics, used to promote growth and decrease risk of disease, all to increase profits. You don’t just eat the animal. You also eat what the animal eats. And animals, land, air and sea, all consume massive amounts. 80% of all antibiotics produced worldwide are given to animals. It’s in their flesh and it makes its way into their waste, eventually making its way into the water system.
CHINA and COVID. As the “official” toll starts to be acknowledged (73,000 Covid deaths and what they estimate is over 80% of the country being infected), the statistics from more reliable sources are also coming out. This along with eyewitnessed scenes and an assessment by independent organizations paints an even grimmer picture. If they are accurate, that 80% of the country really has had Covid, their dead should count over 2 million, not just 73k. Their numbers don’t jive. The estimates, based on Western organizations, is that about 35,000 Chiese are dying a day, with a total thus far of 880,000. This is an insane amount, but would not be surprising based on how poorly they have prepared for this inevitable outbreak, once the draconian “zero-covid” policies were lifted, along with the Lunar New Year occurring with over 2 billion trips expected. These trips are predominantly from the big cities to more rural areas where medical facilities are significantly less sophisticated and robust.
If one includes the situation in China, the number of new cases and daily death rate today dwarfs the previous worldwide peak in January 2021.
China is not the only hotspot. Japan is just coming out of their worst wave since the start of the pandemic. Hong Kong is also emerging from, not the worst, but a pretty bad wave nonetheless. Sweden’s numbers are on a significant rise.
Back home in the US, test positivity (i.e. reported cases) and hospitalizations are on a slow downward trend but deaths remain stable at 540/day, again, 3rd leading cause of death, almost tripling gun deaths.
California has been rocked recently by numerous mass gun shootings. These are tragic and we see these way too often in the US. More than anywhere else in the world by an order of magnitude. But we must also keep things in perspective. The last year we have accurate gun data is 2020 when there were just over 45,000 gun deaths in the US. 45% were murders, 54% were from suicide and 3% were accidental. This amounts to 124 deaths a day. Covid continues to kill over 500 people a day. Both terribly sad. Both preventable.
The main Covid strain in the US is the XBB1.5 subvariant, accounting for just over 50% of cases. Unlike most of the other variants we have contended with, this one developed in the US, and like all of our other bad habits, we exported it out to the rest of the world.
Vaccines, especially the bivalent booster, remain a very effective way to avoid serious disease, hospitalization and death. Adoption of the bivalent booster has been the lowest of all the boosters thus far unfortunately, and I see so many cases of people getting covid, despite receiving the first shots, but who neglected to get boosted.
Lewis Carroll said “When you don’t know where you are going, any road will get you there”. Covid is like this. There is a lot we know, like how to protect ourselves from getting the disease and a lot we don’t, but are learning about.
Sometimes doctors don’t bother telling people about how to heal themselves because they are convinced that people won’t bother doing it, and in most cases, they are correct. I read a survey of people with various chronic conditions who were asked whether or not they were willing to make lifestyle changes if it meant getting rid of their disease and being able to stop their medications. Sadly, 70% said they’d rather take the pill. Can’t help those people but we should not let that sad statistic impact our desire to try to help the remaining 30% who are willing to change. I’ve seen it.
Keep being careful out there.
MASK UP where appropriate.
DISTANCE where appropriate.
PRACTICE PRACTICAL HYGIENE.
GET HEALTHIER.
ENGAGE WITH OTHERS.
GET VACCINATED.
Have a great weekend.
Go EAGLES!!!!!
Stay Safe and Be Well
AC