2020 Covid-19 Reality Check!

 Vaccine Update and other critical news:

"The death of one man: this is a catastrophe. Hundreds of thousands of deaths: that is a statistic!" This is a quote often attributed to Stalin but he was apparently quoting someone else. It supposedly points out that when there are a few deaths we can comprehend the horror of it but once there are too many it just becomes numbers. I think America is on its way to that point.

Do you remember in the summer when I told you that there could be up to 300,000 deaths by the end of the year? Well so far, we have passed that number by 35,000.

With more than 20 million people in this country having been infected with the virus SO FAR.

Despite reports that 200 million Americans would be vaccinated before the end of the year, so far only 1% of that number i.e 2 million have been vaccinated. There are only 3 days left in the year.

There were more people than that passing through Reagan National airport last weekend! They must not have got the memo yet.This is why I persist in writing these emails.

We doctors are past the point of exasperation now. What does it take to get the message across? I hate to say it but you are not special (even though you are to me), and you could die if you do not keep up your guard.

Right now the number of additional deaths projected for the US by April is up to 250,000.

The numbers are huge but they are true. Do not become so numb to the numbers that you allow yourself to become vulnerable. It is nice to think and talk about the vaccine but the vaccine will not help those people who got infected last weekend nor those who hang out for the New Year.

When the vaccine is closer to reality for most people I will once again explain the difference between them for you.

Meanwhile just relax and watch the senators and congress get their vaccines and be consistent with your prevention methods. Your turn will eventually come, make sure you are still around when it gets here.

Some bright news:

Just in time for Xmas all my face products are buy one get the second one half off!!! You will need to call the office for this offer as it is not available on line. The face and hair serums make great gifts and the ‘facial’ cleanser can be used by the whole family (all over the body). Your friends and family will thank you!

Please be safe and hang in there the holidays should be back to normal next year if we all do our part.

Covid vaccine update, new strain of Covid, and Hepatitis A outbreak

 Almost 320,000 deaths from Covid so far in the US and now there is a new mutant strain!

The number of Pfizer vaccines promised don’t seem to be arriving on schedule and many supply numbers so far are short. Some states are still waiting to receive their first shipment! So much for ‘army precision’.

As I mentioned before, do not put too much stock in getting the vaccine in the next month. Prevention methods are much more effective at this point.

Moderna will start to ship their vaccine next week, 200 million of theirs has been ordered and will be delivered over the next 3 months. That will take care of 100 million people. There are officially 328 million people in the US, so some areas will come up short! (Plus more of the ‘unofficial’ people are affected). Fortunately the Moderna vaccine does not require the deep freeze that the Pfizer vaccine does.

PLEASE NOTE: A new mutant strain of the Covid (SARS 2) virus

 has been detected in the UK.

Tests have not been done yet to determine if the strain is in the US.

Why do you care? Well, first it is said to multiply much quicker than the current strain and is therefore more contagious.

Second, no one is sure if the vaccines will be effective against it.

Third, if there is already another mutant strain what is to stop us having 4 strains by next winter?

It is very common for viruses to mutate. That is why you have to get a new flu vaccine every year and even then it contains just what the scientists best guess of what strain might be more prevalent that year. The ‘good news’ is that this new strain doesn’t seem to cause any more severe illness than the first one, the bad news is: that one is bad enough!

The price of the Pfizer vaccine in the USA costs 24% more than anywhere else in the world. No, it doesn’t have direct bearing on you getting the vaccine but it just reflects the state of the market for medicinal products in the US i.e. intentionally over priced.

The death rate continues to rise including in Maryland. Some hospitals in other states are at 270% capacity (with 100% being full!). They have patients sleeping in the corridors and waiting room.

Rethink that trip to see the family. It really can wait.

Maryland has a serious outbreak of Hepatitis A at the moment, be especially careful eating out or eating food that you did not prepare yourself. If your urine is bright yellow or your eyes yellow (jaundice) you should seek care. Generalized itching can be a sign of high bilirubin (jaundice) levels. Don't assume every fever is Covid.

I used to see three cases of shingles a year. In December so far I have seen 3 cases!

Fortunately Shingles does not kill you.

Covid is affecting us in many ways. Shingles outbreak is usually due to high levels of stress. Please remember to work on stress management techniques and take our “True Calm” herbal supplement.

Spousal abuse and drug overdoses have also increased during Covid.

Some bright news:

Just in time for Xmas all my face products are buy one get the second one half off!!! You will need to call the office for this offer as it is not available on line. The face and hair serums make great gifts and the ‘facial’ cleanser can be used by the whole family (all over the body). Your friends and family will thank you!

Please be safe and hang in there the holidays should be back to normal next year if we all do our part.

Why you will not get a Covid vaccine this year! But there is some good news.

 Good news and bad news. 

The good news is that people are starting to get vaccinated with the Pfizer vaccine and the Moderna vaccine will be available by next week. The bad news is that you will not be getting the covid vaccine in the next 3 months.  Let’s look at why. It’s all in the numbers.

100 million doses of Pfizer vaccine was ordered. It is arriving in shipments but let’s say it all arrives at once, tomorrow, that is still only 50 million people vaccinated if every last dose is used and delivered.

Moderna will start to ship their vaccine next week, 200 million of theirs has been ordered and will be delivered over the next 3 months. That will take care of 100 million people. There are officially 328 million people in the US, so some areas will come up short! (Plus more of the 'unofficial people' are affected but that’s a different discussion).

There are 1 million people in nursing homes in this country they get first priority.

If you are not in healthcare there are a lot of people in the line ahead of you.

18 million healthcare workers and 1.5 million home health employees. Then we come to the essential workers who keep the economy running but risk their lives everyday like bus drivers and grocery store employees and so on and so forth down the line. Then come the teachers etc.

Now let’s say ideally everyone got the shot tomorrow morning, they still would not build adequate immunity until after the second shot at least 30 days later.

My point here is that, for those of you who were thinking of having a jolly merry Xmas just because the ‘vaccine is here’, actually it is not !

Once again you need to wrap your mind around the fact that this Xmas must be like no other. You cannot let your guard down.

As I predicted in June, we have already crossed the dreaded 300,000 mark. And if people relax the rules we could lose another 100,000 people in the United States before this pandemic is all said and done.

Please keep up your social distancing, masks, hand washing and vitamin C. Remember even if someone tells you they have received the vaccine, they are not yet immune.

When 70% of the population is vaccinated we may achieve ‘herd immunity’.

It is going to be very interesting to see what the antibody levels are in people who were vaccinated 3 months prior.

Some bright news:

Just in time for Xmas all my face products are buy one get the second one half off!!! You will need to call the office for this offer as it is not available on line. The face and hair serums make great gifts and the ‘facial’ cleanser can be used by the whole family (all over the body). Your friends and family will thank you!

Please be safe and hang in there the holidays will be back to normal next year.

Breaking News! Monoclonal Antibody alone and in combination available for covid positive patients

 A patient called me today covid positive and coughing.

“When did you start to feel sick?” I asked innocently

“On November 9^th” was the response.

I am proud to say I was calm “ Really? that's Interesting” .

Oh dear, here comes another email I thought to myself.

And so when I decided to write this email today I had not yet read today’s communiqué from the Maryland State department of health. But it is truly a coincidence because it emphasizes why it is important to immediately notify me if you test positive for covid.

We have had a few tools in our toolkit for treating covid-19 as an outpatient but as of today we have an even bigger one.

Get excited! You may be eligible to receive the same Regeneron monoclonal antibody that President Trump received before going to Walter Reed hospital when he discovered he had covid-19.

The bottom line is: I want you to talk with me if you have a positive covid test ASAP.

The sooner, the better chances of success and of keeping you out of the hospital. Why? The hospitals are full, there is not enough room for everyone and you don’t want to be there anyway.

This is the real motivation behind the news that came out from the health department today. The FDA approved an EUA (read my last email if you don’t know what that is) for this antibody treatment. We can now treat high risk individuals with mild to moderate covid-19 cases and keep them out of the hospital and prevent mild cases from worsening.

There are five initial regional infusion locations across the state that have been designated to allow geographic equity distribution for this scarce therapeutic. Future plans for additional subsidiary sites will be based on available supply from the USG. As of today's letter, the five sites include the following:

● Region 1: University of Pittsburgh Medical Center (UPMC) Western Maryland

● Region 2: Meritus Health

● Region 3: Baltimore Convention Center Field Hospital

● Region 4: Tidal Health Peninsula Regional

● Region 5: Adventist HealthCare Takoma Park Alternate Care Site

If I have a patient who may benefit from this COVID-19 therapeutic antibody I can refer the patient to one of these currently available infusion sites.

The FDA authorizes use of the aforementioned investigational mAbs for treatment of high-risk COVID-19 outpatients (ages Version 01 December 1, 2020 ≥12 y/o, weight ≥40 kg) with mild-to-moderate symptoms at risk for progressing to severe disease or hospitalization based on the following criteria:

● Direct SARS-CoV-2 test (e.g., PCR, rapid antigen test) must be positive

● Administered as soon as possible after positive test result and within 10 days of symptom onset

● Provider to review EUA fact sheet, including risks and benefits, with the patient

● Patient/caregiver to be provided with EUA fact sheets

● Administered in a setting where healthcare providers have direct access to medications to manage severe reactions

Please note that these monoclonal antibody infusions: bamlanivimab and Regeneron mAbs are not authorized for use in patients:

● who are hospitalized due to COVID-19; or

● who require oxygen therapy due to COVID-19; or

● who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity

High-risk summary definitions are as follows

All Patients (who meet at least 1 of the following criteria):

● BMI ≥35

● Chronic kidney disease

● Diabetes ● Immunosuppressive disease

● Receiving immunosuppressive treatment

● Age ≥ 65 years

● Age ≥ 55 years AND have any of the following: cardiovascular disease, hypertension, COPD/other chronic respiratory disease; are eligible.

Adolescents (age 12-17 years) who meet at least 1 of the following criteria:

● BMI ≥85th percentile for age/gender

● Sickle cell disease

● Congenital or acquired heart disease

● Neurodevelopmental disorders (e.g. cerebral palsy)

● Medical-related technological gastronomy, or positive pressure ventilation (not related to COVID-19)

● Asthma, reactive airway, or other chronic respiratory disease that requires daily medication for control; are also eligible.

The infusion is given into the vien in one of the centers as an outpatient and takes about 60 minutes to infuse. You must be referred by your doctor.

I have summarized the information to try and make it easier to read but for those who would like to know more please read the communiqué from the Maryland state department of health.

Here is the link to the letter:

https://content.govdelivery.com/attachments/MDMBP/2020/12/01/file_attachments/1614374/Clinician%20Letter_Monoclonal%20Antibody%20Treatments%2012012020%20final%20signed.pdf

One of the appendices to the link above is frequently asked questions.

Go Maryland strong, cutting edge!

There may be a light at the end of this long tunnel.

Of course it’s better not to catch covid in the first place (one patient told me on Monday that 9 members of her family got covid, one died on Friday). Do everything you can to avoid catching it, even though it is inconvenient.

But at least now we have something to offer to those who could get a lot sicker.

Information is crucial and that’s why I write these emails. Now you can be treated like a president if you want to (smile).

Which Covid-19 vaccine would you choose? Covid vaccines, let's look under the hood :)

 FOLLOW THE MONEY and other controversies about the Covid vaccine.

Behind the scenes in the Covid vaccine business!

When you read about vaccines and corona virus remember everything can be spun. When people don’t like the spin, its labeled one way and when it suits their purposes it is labeled differently. It is d particularly difficult as a lay person to cut through the spin to the facts.

But do you have questions about the new vaccines that are coming? Here are some to consider:

Where will the vaccine be made? Where is it made now? Where was the vaccine tested and on whom? Why does the FDA have a definite date for approval (December 10) when supposedly the data is still being evaluated? Is approval automatic? Is that why Pfizer is already flying in millions of vaccine on dry ice from Brussels? Who paid for what? Why did one company claim they did not get government funding? Who is confirming that the ‘not for profit’ vaccine really is the case? What is the cost of each vaccine, which costs the most which costs the least? Based on the information we have so far which is the best vaccine for my community? Why are people spinning information (you know the answer to that :). And on and on……………

I know it seems a little overwhelming and I will not attempt to answer all of them. If I did, this email would become so long no one would read it. I would however like to spark some curiosity, enough that you research some of the answers to your own satisfaction, well in advance of having a needle stuck in your arm.

There are many Covid-19 vaccines under development, over 30 have moved to clinical trial and are being tested on humans. Research and development of new vaccines can take on average 10 years under normal circumstances, although some have been developed faster as seen with some previous outbreaks such as SARS and Ebola. There is good reason why it takes so long to develop a new vaccine, basically they have to be safe and effective. It is clear that right now we cannot wait for business as usual and all eyes are on the scientists and their amazing contributions. Of course it makes sense to throw everything at them to build on their capacity to get a successful vaccine. And then once they get it to make sure those who need it get it as quickly as possible.

Although normal vaccine development takes years, lucky for us, researchers aren't starting from scratch to develop a COVID-19 vaccine. Past research on SARS and MERS vaccines identified potential approaches and so they were able to build on this research fairly quickly.

So let’s look at a few of the controversies surrounding the earliest corona vaccines. There are three so far: Pfizer/BioNtech (PF), Moderna and Oxford University/AstraZeneca (AZ).

Money

A friend of mine told me last night, she would take the Pfizer vaccine “because Pfizer didn’t take government funds ” to make the vaccine. Hmmm, yes and no! Pfizer got a $1.95 billion deal with the government’s Operation Warp Speed (the multiagency effort to rush a vaccine to market) to deliver 100 million doses of the vaccine. The arrangement is an advance-purchase agreement, meaning that the company won’t get paid until they deliver the vaccines. Pfizer did not accept federal funding to help develop or manufacture the vaccine, unlike the other two front-runners Moderna and AstraZeneca.

“Although it’s true that Pfizer and BioNTech had been working on a vaccine all year before the companies struck their deal with the U.S. government in July, a $1.95 billion deal is nevertheless a significant incentive to keep going. In fact, international health organizations have long used such market guarantees to encourage for-profit manufacturers to supply vaccines to the developing world”.

The other thing is that if you do not take money to ‘create’ the vaccine, in the free market you can set the price of your vaccine wherever you want it. Pfizer is talking about selling their vaccine starting at $20 per dose. Multiply that by however many millions you want and the distribution will be through the warp speed deal.

Oxford/AstraZeneca (AZ) said they would not make any profit from their vaccine until the pandemic is controlled. Sounds good, but Doctors Without Borders (MSF) are demanding that in writing, and that there be an oversight body to make sure this really happens. They want the vaccine to be free in the developing world as well as the US.

"MSF welcomes AstraZeneca's commitment to sell the vaccine at a 'no-profit' price during the pandemic, but the reality is that it's an empty promise unless we're able to substantiate these important claims with data," said Roz Scourse of medical group MSF, also known as Doctors Without Borders.

The money is also an issue with Moderna:

 Moderna now says it will charge $32 to $37 per dose for smaller volume sales agreements, the highest price yet announced for a potential vaccine. Public Citizen and Knowledge Ecology International (KEI) wrote to the federal government Friday, noting that Moderna has been ignoring public disclosure provisions in its vaccine development funding contract. Public Citizen also found the U.S. government may co-own the vaccine candidate with Moderna. 

“Moderna is taking taxpayers for a ride – and the Trump administration is doing nothing about it. Taxpayers are paying for 100% of Moderna’s COVID-19 vaccine development. All of it. Yet taxpayers may wind up paying tens of billions more to Moderna to buy our vaccine back, if it proves safe and effective.The so-called Moderna vaccine belongs in significant part to the people of the U.S. We paid for it. Federal scientists led the way. It ought to be the people’s vaccine, not a new taxpayer burden”                                                                                      

Statement by Peter Maybarduk Director, Public citizens access to medicines.

Price

Remember: The prices for the vaccines are moving targets, dependent upon the amount ordered.

All three vaccines require 2 doses, 28 days apart.

Moderna is talking about selling the vaccine for $25 to $37 per dose. Compared to the $20 for Pfizer, and Astrazeneca will cost $3 a dose and can be made very quickly and in bulk.

Johnson and Johnson is working on a vaccine that only requires one shot and is predicted to cost $10 per dose.

The vaccines

The AZ vaccine is different from the other two. It is made (via chimpanzees) from an adenovirus like the common cold virus. So we know it is very safe because this is the technology that has been used for decades for other vaccines. Pfizer and Moderna use recombinant RNA technology which is very new.

The Pfizer vaccine has a major problem. It must be stored at -70 degrees. There are very few facilities including hospitals that have the capability of storing something at this temperature. If the cold chain is broken along the transport route the efficacy of the vaccine cannot be guaranteed. For example, in my office, our vaccine suppliers know that on Fridays I may be in the Laurel office and they cannot ship vaccines to me after Wednesday. This is for regular vaccines that are stored in a simple refrigerator. If Fedex drops off a shipment with my neighbors on a Friday, we come in on Monday and return it to the distributors who understand it is their fault, pay for return shipping and ship us out another batch. This is routine for regular vaccines, how much more a vaccine that is supposed to be kept 3 times colder than your freezer. It’s a problem, even on dry ice, I think the logistics will be difficult.

Distributing Pfizer's vaccine to larger population centers is problematic, not just because of its temperature, but because the smallest amount you can order is 975 doses (usually its 100 doses or fewer) which cuts down the size of the facilities that will order it.

Statement of Peter Maybarduk, Director, Public Citizen’s

The efficacy of the vaccines and approval

On November 16, a week after Pfizer’s announcement, Moderna issued a preliminary data readout out of its COVID-19 vaccine, suggesting an efficacy rate of 94.5%. Unlike the PF vaccine, however, the Moderna vaccine is stable at 36 to 46 degrees F, about the temperature of a standard home or medical refrigerator, for up to 30 days and can be stored for up to six months at -4 degrees F. It is expected to go to the FDA for consideration for an EUA within days.

On November 23, AstraZeneca and the University of Oxford announced high-level results from an interim analysis of their COVID-19 vaccine, AZD1222. The analysis was from the trials in the UK and Brazil and demonstrated efficacy of up to 90%. The vaccine was effective at preventing COVID-19, with no hospitalizations or severe cases in people receiving it. The AstraZeneca vaccine can be stored, transported and handled at normal refrigerated conditions for at least six months and administered within existing healthcare settings.

But the devil is in the details: 28 days after the first shot immunity was 62% and after the second shot it went up to 70% but…. Wait, before you jump for a different vaccine: if the person got only half a dose as the first dose then the efficacy increased to 90% with the second shot! Go figure. No one knows why this is the case. The thought is that the half dose ‘primes the pump’ so to speak and then the body responds really well to the second shot. I am really pleased that AZ was honest enough to share this detail as opposed to just stating the “efficacy is up to 90%”. More transparency is always good. Two advantages of the half dose approach: The body has an opportunity to acclimatize and the cheapest vaccine becomes even cheaper because it only needs 1.5 dose to get 90% immunity.

Pfizer was the first to announce their vaccine and they have already applied to the FDA for Emergency Use Approval (EUA).

Pfizer said their vaccine was 90% effective but when Moderna came out the following week with their 94.5% figure, Pfizer changed its press release to 95%.

The FDA approval decision will be announced on December 10 and Pfizer is poised to start delivering vaccines on the 11^th.

Here’s the problem I have with that: How did the FDA come up with a fixed date? Usually they let you know when they are satisfied after scrutiny, then they deliver an approval. Scrutiny usually includes going back to the applicant with questions and sometimes requests for additional testing. You normally cannot predict how long that should take. I almost feel like it is a ‘done deal’. A rubber stamp if you will. Elements of the FDA have been suspect for quite a while now. I think they should always maintain professional decorum irrespective of political pressure. Is anyone else with me here? (please let me know).

Meanwhile: United Airlines Holdings Inc. on Friday began operating charter flights from Belgium to position doses of Pfizer Inc.’s Covid-19 vaccine for quick distribution if the shots are approved by regulators, according to people familiar with the matter. If PZ is incurring all that expense (the planes had to carry more dry ice than aviation rules usually allows) they must be pretty confident they will have approval. I understand they want to be first in line since the early bird usually catches the worm.

So currently there are 3 vaccines on the table. Do we know everything about them? The short answer is No. I may have made it more confusing so here’s a summary:

Pfizer/BioNtech Covid vaccine is a recombinant vaccine, efficacy 95%, will cost $20, EUA already requested from FDA, must be kept at minus 70 degrees centigrade (-94 degrees farenheit).

Moderna has a recombinant vaccine, efficacy 94.5%, will cost $32 to $37 can be kept at normal refrigeration temperature. Funded by the federal government. Poised to request EUA.

Oxford/AstraZeneca has a vaccine based on Adenovirus (like a cold virus), efficacy up to 90%, will cost $3, can be kept at normal refrigeration temperatures. Will apply for EUA possibly January 2021

All these three require 2 shots one month apart. Lastly there is another vaccine in the pipeline:

Johnson and Johnson, vaccine based on Adenovirus also. EUA date March or April 2021, normal refrigeration. Costs $10, needs only one shot.

Hopefully this information helps you to understand the ins and outs of the vaccine issues. Meanwhile watch this space

Love

Dr. Tuakli

Thanksgiving and gratitude in spite of the horror

 When I first came to this country I used to say "I don't celebrate Thanksgiving, its not a tradition I grew up with" and other ignorant statements.

I didn't see how this holiday, which is supposedly based on the kindness of the native Americans, related to me. So for a while it had as much significance to me as the UK 'Bank Holidays' basically, just a day off.

But over the years I have come to understand and appreciate the uniqueness of this American holiday.

I used to say to my American friends "well, you know in England Christmas is the biggest holiday, that's when we all get together". But it isn't the same. The exchange of gifts and all the shopping and the glitter, take front and center stage at Christmas.

Thanksgiving is a day when family and friends gather and share food and love. Nothing more, nothing less.

It is interesting that the whole world has taken on the concept of 'Black (read money) Friday' but not the essence of the day before. The day, when Americans of all stripes go any distance to be with their families and all their family members show up warts, family tension and all. 

It used to amaze me when I would hear on the TV how, 3 times more people travel in the US for Thanksgiving than Christmas. But now I understand it and its significance, it is truly the best holiday and worthy of celebration. Even if this year it has to be done by zoom.

This morning a patient touched me deeply when she thanked me for my emails and my work. It made me realize that I too should say thank you. This kind of encouragement keeps me churning these out.

I truly appreciate and am honored by all the trust and support I have received over the past 30 years.

I am deeply grateful that I have a loving and supportive husband. He always allows me to do what I feel I need to, for my patients (it's his birthday today :).

I am grateful to be alive when many of my colleagues and nearly 1.5 million people have died from Covid. People who had no idea that they would not be here this Thanksgiving.The depth of this plague is mind boggling but it is up to us to defeat it, hopefully sooner than later.

Enjoy the festive season and let's hope 2021 is better for the whole world. I will certainly try to do my part.

Love 

Dr. Tuakli

 

Do not be blindsided by the news of a Covid vaccine!

 Don’t get blindsided by the news on the vaccine. Here is the inconvenient truth!

In the last 24 hours in Maryland 26 people died and there were 2152 new cases. Bringing the number of dead in our state to 4201 and total cases 171,823. There are 1144 people in the hospital with covid-19 here in Md as you read this, what a huge change from July.

Over the past week, the country has been averaging 158,265 cases per day, an increase of 79 percent from the average two weeks earlier.

11.5 million cases and a quarter of a MILLION people dead nationwide.

These numbers sound like they come from a war zone in  a third world country but even then they would be shocking. If you can sit home and let these numbers sink in and still not be shocked then nothing will shake you.

If you do, in fact understand the gravity of this situation, are you sure you do not want to rethink your Thanksgiving plans? I suggest you do.

Even if you don’t catch covid-19, Thanksgiving is not the time you want to end up in the ER with hundreds of infected people who have it.

Plus the medical staff is now beyond the point of exhaustion. When you think YOU have 'covid fatigue' try putting yourself in the place of those who have been serving for these 9 months.

Now that the election is over and the news cycle is slowing down TV anchors are pouncing on the news put out by Moderna and Pfizer last week about having a vaccine that is over 90% effective.

 Last week Monday, Pfizer said their vaccine was 90% effective but then Moderna said this week theirs was 94.5% effective. So today Pfizer revised their figures and it suddenly became 95% effective. Maybe if we wait another week the number will be even higher.

But all jokes aside, we are in the midst of a pandemic like no other and the whole management of it has been a comedy of errors. The only thing you can rely on is your own social behavior. That is the only thing under your control.

The earliest you will see (or want to take) a vaccine is March and a lot can happen between then and now.

Taking solace in the idea that there is a vaccine on the horizon is, in my opinion, a fool’s paradise. You are not guaranteed to still be here when it is finally available to you!

Somehow people are getting a false sense of security because “there is a vaccine” even though it is not available.

Please reread the email I wrote on how vaccine trials are conducted and what kinds of vaccines there are. Do you realize that a vaccine may be 95% effective today and show no efficacy 2 months later?

I know I am a party pooper and that is by design. The parties must wait, as inconvenient as it sounds.

There is, however, a glimmer of hope. The home test that I wrote about 5 months ago has just been approved. This means that home testing and possibly weekly testing at home with testing of contacts may soon be possible. As I wrote in April, testing is in some ways more critical than the vaccine at getting the pandemic under control.

The last piece of good news is that we will have a new corona virus task force with dedicated individuals determined to save lives and create a workable solution.

I don’t suggest traveling for the holidays or having out of town visitors but if you are determined to be ‘special’ please look at the Hot Spot maps on line. They are truly illuminating.

Please be safe, be well. Be a good citizen.

Pray for the essential workers who are already extended beyond their limits.

New face products for winter dryness.

 Check out our 2 new face products for dry winter skin:

Biopeptide Growth Factor Cream

to enhance production of elastin and collagen. It contains growth factors and antioxidants to combat signs of aging. Hydrates and protects.

Hydro Essence SPF 40 with antioxidants and hyaluronic acid to boost the skin's moisture content. A gentle product ideal for sensitive skin and post procedures.

We still have L-hydra for all over the body for people with very dry skin.

Remember to minimize the use of hot water on your face in the winter.

Yesterday we celebrated change, now we need to get back to work. 240,000 deaths in the US. 10 million cases.

 The United States could soon report more than 200,000 coronavirus cases per day as infections continue to surge across the country, according to CNN.

The US reported 100,000 new cases 7 days in a row last week, and that total will likely continue to increase.

"We are watching cases increase substantially in this country — far beyond, I think, what most people ever thought could happen," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN.

Osterholm and his team have created accurate forecasts for COVID-19 cases throughout the pandemic. He was named to President-elect Joe Biden's Transition COVID-19 Advisory Board on Monday.

"It will not surprise me if, in the next weeks, we see over 200,000 new cases a day," he said.

On Monday, the national 7-day average of new cases was nearly 120,000, which is triple the average from mid-September.

The number of hospitalizations in the United States are up as well, according to The COVID Tracking Project. On Monday, 59,275 people were in hospitals for COVID-19, marking the country's highest total since July and slightly lower than the April 15 peak of 59,940.

Deaths are on the rise, too, CNN reported. Last week, more than 1000 COVID-19 deaths were reported for 5 days in a row, which hasn't happened since August.

"We're going to see, by far, the darkest days of this pandemic between now and next spring when the vaccine becomes available," Osterholm told CBS This Morning on Tuesday.

"We have a perfect storm coming together," he said. "We have pandemic fatigue...we have pandemic anger...we just are not taking this virus seriously."

WebMD Health News © 2020 

Cite this: Carolyn Crist. US Could Hit 200,000 Daily COVID-19 Cases Soon - Medscape - Nov 10, 2020.

This article should cause you to sit up and take notice. The number of cases are rising throughout the country again, including Maryland.

Current hospitalized cases in Maryland 761, in total we have had 156,709 cases. Our positivity rate is back up to 5.24% total death count 4084.

One of my biggest worries is that this is happening BEFORE Thanksgiving and the onset of the flu season. In a few weeks it could be way worse. Please do not allow “Covid fatigue” to let your guard down. It is not in your best interest and all it takes is being careless.

Maybe things will start to improve now but only if everyone plays their part. We haven’t even begun to turn the corner yet but maybe we can in January now that all the crazy rallies are over.

2 positive things: A new presidential task force (which includes people from my alma mater, yay!) and the imminent release of a vaccine.

Pfizer released their report yesterday that their new recombinant vaccine is 90% effective. Unfortunately there hasn’t been the usual time for ‘peer review’ because they said they would not have been able to keep it secret for the usual month it takes for that process. None-the-less the numbers still have to be examined and then cleared by the FDA. I worry that the media attention will pressurize the FDA to allow emergency clearance which will lead to distrust on the part of the public.

Anyway, as I have said many times, this is not when you need to be focusing on the vaccine. Focus on your life style choices which is something you have control over.

So “Happy Thanksgiving!” is in words only. I really don’t mean it literally.

If it makes you feel better, they plan on using the vaccine on us (medical workers) first. Whoopee!

A closer look at Joe Biden Jr's medical record

 For the record, let's take a closer look at Joe Biden Jr’s health status.

80 is the new 60 if you take care of yourself and Joe Biden is 77.

A review of the former vice president’s health record shows:

He has had his gall bladder removed along with several skin cancers.

He has seasonal allergies and acid reflux.

The biggest medical issue is that he has had atrial fibrillation which is controlled and he is on blood thinners.

He maintains a perfect weight 178 pounds for his 5 feet 11 inch height and exercises 5 days a week. His blood pressure is 128/84.

He takes his medicine and believes in science.

He is fit enough to be president.

I bring  this up because I believe he is not in denial like some others and as such he is probably healthier than they are. When you acknowledge your health issues and take care of them the sky is the limit.

With good anti-aging maintenance Mr. Biden will be fine. He has my vote!

We should all spend more time on our health and less time listening to misinformation. 

Why you may want to rethink your flu shot this year and the Anxiety epidemic

 The health community is on the look out for a “Twindemic” and reports are beginning to surface about patients who have tested positive for both the flu and Covid. There were reports last week as far apart as California and Tennessee. Obviously it is just a matter of time before Maryland reports as well, especially after Thanksgiving.

If we are lucky it will be a light flu season because the same measures that prevent Covid also prevent the flu. But if we are not it could be disastrous.

The most glaring difference between prevention of the two conditions is that there is a vaccine for the flu which is as specific as possible for this season’s flu.Sadly, we don't have one for Covid.

The commonest reason people tell me they won’t take the flu shot is because “I’ve never had the flu.” You’ve never had Covid either!

I would like to suggest that those who haven’t had their flu shot for this season yet, rethink that decision.

Symptoms of the flu can be like early symptoms of COVID-19, so people with these symptoms may require a COVID-19 test and then will have to stay home from work and isolate from the family until they get their results.

When you have influenza, which is a respiratory illness, in addition to COVID, which also impacts the respiratory tract, it only makes sense that you are going to have a serious respiratory component with shortness of breath and the potential for respiratory failure is very high.

Vaccination not only reduces the risk of catching the flu, it also reduces the chance that you will be hospitalized. In other words, the flu vaccine will provide some protection and reduce your chances of needing a ventilator if you do get sick with Covid.

A word to the wise, rethink the flu shot and get it as soon as possible.

There is another epidemic going on that is not much talked about and that is Anxiety. The whole nation is gripped by anxiety and many are embarrassed to admit it. Please if you feel it is affecting your quality of life, reach out and seek help. I am here to help you.

For those of you who like the outdoors remember to get out there now, winter is coming. There are still lots of places you can go and still have social distancing.

I was in Rehoboth today, the beach is amazingly clean and there was almost no one out there. https://youtu.be/gWNJP5e6Wkg

Get creative, there are so many outside places you can go before it gets too cold.

No Covid -19 vaccine this year, the darkest days may still be ahead of us

 

Why we will not have a Covid-19 vaccine this year and why the darkest days of the pandemic may still be ahead. Do you have Covid fatigue? We all do, and the level of anxiety in my patients is higher than I have ever seen it in 30 years. Be that as it may we have to handle it, and quickly. The darkest days of the pandemic may still be ahead. The second wave is just beginning. In Maryland in the summer the numbers in the hospital had been steadily decreasing, now they are static. We currently have 455 people in the hospital and almost a quarter of them are in the ICU. In the West and Mid West numbers are rising exponentially, hospitals are being overrun. My guess is after Thanksgiving the numbers here, will rise even higher. Added to this, immediately after Thanksgiving the flu season starts, what a cocktail for disaster. People are still refusing flu shots because “I never get the flu”. Please re-read the email I wrote on what it takes to make a vaccine and what kind of trials have to be done to make a safe vaccine. There are over 100 vaccines in the works but that doesn’t mean we will get one anytime soon. Even with “Warp speed“ and all. It has been proven that people have to have a significant illness to produce significant amounts of antibodies. But it appears that even those antibodies may only provide partial immunity at best. This is just one concern that vaccines need to overcome. When “the vaccine” for Covid finally gets here, it is going to be a logistical nightmare to get it to the billions of people in the world who need it. Anyway suffice to say this is NOT something that is going to be available this year to ordinary citizens like you and I. You don’t believe me? All I will say is: HIV/AIDS has been around 30 years and there still is no vaccine. That tells you something: you can’t just pull a vaccine out of thin air or on an artificial deadline. If anyone tells you otherwise it is political rhetoric (or as the Scottish say malarkey!). So forget about the vaccine! Spend your goals and energy on prevention elsewhere.  Please rethink your Thanksgiving plans, get creative. I am going to have a zoom Thanksgiving with my family. It takes some planning but most importantly, it is safe! My next email will discuss “Covid fat” and tips for working at home. For those of you who like the outdoors remember to get out there now, winter is coming. There are still lots of places you can go and still have social distancing. https://youtu.be/WSErlYsnGSA

Ecotherapy. A must to stay sane with covid-19!

Yesterday's shocking display. Sets us back on road to pandemic recovery

  Just for the record!

What happened yesterday was outrageous and disgraceful and I hold the doctors completely responsible. Being quarantined and in isolation does not mean going for a joy ride as a photo op!

The doctors are trained to manage patients with infectious diseases with a responsibility to both the patient and the community. They failed miserably. I question their principles and medical ethics.

Any patient can sign out of hospital AMA (against medical advice) that is their right. If this occurs with someone who is harmful to others the doctors should then notify the health department and seek  legal recourse with law enforcement up to and including a legal injunction.

Please understand, this is NOT “Ha Ha, look what just happened!”

It is nonsensical and should be condemned but the entire medical and public health community.

For the record that is how I would handle any of my patients who are ridiculous enough to behave in that manner.

Strategies for prevention and a presidential Covid cocktail

 

Stand back! .... at least 6 feet or more to be precise. Remember to step back and stand firm. Cleveland clinic has a rule that everyone on their campus must wear a mask but they did not enforce these rules on the day of the presidential debate because people get intimidated by power and celebrity. My colleagues should have known better and now we see what happens, an outbreak. 11 of the staff at the clinic so far plus, not to mention the president and his team. I’ll tell you what doesn’t get intimidated: the corona virus! If the most protected person on the face of the earth got Covid what does that tell you? I told you back in the spring it is an equal opportunity virus, anyone can get it, let alone ordinary people on the street like you and me. I am hoping that this will now motivate people to do the things they need to and finally overcome this pandemic. More people should be wearing masks, washing their hands and staying home. Each week I hear of people who thought they would take a quick trip out of state for the weekend and they come back with Covid. Please be consistent and who knows? If everyone does their part we could get this over with by the end of the year. Especially now that we have proven that even people in high places can get sick. Then again, if you recall Boris Johnson had Covid in May and now England is going through a second wave because things are opening up and people are continuing to go to pubs and resist wearing masks. Let’s talk about therapies for Covid: We know that taking Hydroxychloroquine as a preventative doesn’t work. The president has proven that. Now we hear about a cocktail under investigation that was administered to the president. What is it, who makes it and what is the motivation for promoting it and/or the company? Why didn’t they just give him Remdesivir? What is a monoclonal cocktail? So, the president’s physician announced that he gave him vitamin D, Zinc, Pepcid, aspirin and a Monoclonal antibody cocktail. As for zinc and vitamin D I have written about them ad nauseam this year so I assume you are taking them (in my opinion they should have added a mega dose of vitamin C as well). Aspirin is because he is high risk and a lot of people who get seriously ill with Covid develop a blood clotting problem. I assume the Pepcid is to protect his stomach from the aspirin. Back to the cocktail: it is a combo of two antibodies which are thought to have shortened the recovery time and amount of virus in the nasal cavities of a small number of volunteers. I’m not sure why the doctor felt it appropriate to mention the company by name. Particularly since this product is not authorized by the FDA, even for emergency use, and they knew people would start asking for it. Interestingly, the CEO of the company is a member of the president’s golf club in Westchester and has known him for a long time. His company was awarded more than 500 million dollars by the federal government to develop its product.. Also the company has an arrangement with the department of defense to distribute the first 300,000 doses once it is available. Before you run over to my office requesting this cocktail, remember that even if it was available (which it is not), any medicine that is made to affect the immune system is probably going to cost more than half your year’s salary.  It's much cheaper to wear your mask and keep social distancing. Stay well. Take special care of the seniors.

Don't pretend you are not angry, 200,000 lives lost to Covid and counting

The Upsides of Bioidentical Hormones

Should you get a covid test right now?

I get asked this question quite a lot and I invariably say: unless you have had a proven Covid exposure or you are sick the answer is No. Here’s why:

Scenario One.

Let’s say you could get every single member of a church congregation to get a Covid test at exactly the same time you could then quarantine the positives and all the other members could hug and kiss and wouldn’t have to wear masks. 2 issues with this scenario: They would all have to stay in a bubble like the NBA players and two, they could not associate with anyone outside of the bubble. Not even family members and housemates who didn’t get tested on the same day as everyone in the church.

Hopefully you can start to see why it’s a complicated issue and logistically difficult.

If you get randomly tested today it tells you nothing about last month and nothing about what may happen next week. So until we have access to daily home tests for everyone random tests are not helpful.

Scenario Two: another option would be to quarantine every single person in the country for two weeks and then we would all be free. Why not? Well, for one thing essential workers still need to do their essential work. You get the picture I am sure, its not so easy to shut down a country. Babies will still be born!

Theoretically as a country we could use the mightiest military in the world to coordinate testing of 90% of the people on one day and manage them accordingly.

This apparently is too heavy handed for the US. I should point out that heavy handed tactics did work in China.

Anyway, I digress. Random tests in terms of time and location are not helpful. Your best bet: don’t get Covid-19 in the first place.

Remember to get your flu shot. If you get a fever or are sick from anything else you will still need to quarantine for 10 to 14 days while you ARE being tested for Covid! Quest lab has a 7 to 10 business day turn around at the moment.

For those who are interested here is my latest video: (You can subscribe for more tales from the trenches)

https://youtu.be/4FGGOF0MBGg

And here is a prior video about Kids and Covid-19 as a reminder (from April!).

https://youtu.be/DRGGwygPHnA