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).