September 26th, 2022
Volume 12, Letter 41
North Carolina is in a good place.
No Multi Inflammatory Syndrome cases in our clinic.
In NC, we are at 4% of admitted patients needing a ventilator and 11% needing an ICU bed for Covid.
The 7 day moving average of cases for the US in recent weeks is 50,000 although we all know that this is vastly less than accurate with most people getting, using and not reporting positive home tests.
The risk of death is 0.000033 once vaccinated with a two dose series or survived natural infection.
As it stands today, the United States has had 1.05 million deaths. The case numbers will continue to vastly underestimate true case volume so I will stop reporting the number as it is meaningless now.
If you did not read the newsletter about an Integrative approach to proper health in the COVID era and frankly all future infectious diseases, read this link and this link.
As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us regardless of vaccination. However,
mathematically, you now have a 99.9998% chance of survival once vaccinated and the vaccine safety for the mRNA vaccines continues to look good.
Omicron US strains: as of September data - variants make up: BA.4 is 1%, BA.4.6 is 12%, BA.2.75 is 1%, BF.7 is 2%, BA.5 is 83%.
BA 4.6, B.2.75 and BF.7 are gaining ground against BA.5. BF.7 is very interesting as it is apparently more infectious than BA.5. That is amazing.
BF.7 has mutations in the spike and nucleotide regions of the RNA genome giving it potential for both infectiousness and immune evasion. Time will tell. No higher level of morbidity noted.
None of these VOC's are showing no signs of increased disease morbidity.
Little else to report here. (CDC Variants)
Quick Hits and other musings -
1) Women during the pandemic. "Sustainable, inclusive growth will require changing the workplace to maximize the contributions of all people. In the COVID-19 era, women across all sectors have shouldered more household responsibilities, and more women report feelings of burnout. These problems can be more acute for women in healthcare, who have fewer opportunities to work remotely and report feeling greater pressure to prioritize work over family. In spite of these challenges, healthcare continues to outperform other sectors in the representation of women, who make up more than two-thirds of entry-level employees and 53 percent of employees in roles at the senior-manager level or above, which is 18 percentage points higher than the average across all sectors." (McKinsey Covid19 Briefing Note #100)
This is especially concerning to me during the post pandemic time. Are we looking at this specific segment of society and checking on them? Or have we forgotten the countless hours of dedicated service to the millions of sick Americans? Nurses gave so much in the name of Covid to our friends, family and loved ones. They will continue to give most definitely as the statistics bear out. Let us make sure that we are in gratitude for them and all of their non female colleagues. The person matters and their dedication to their craft and us, nothing more.
2) In a very thorough article in Nature, we see a deep analysis of lockdowns and pandemic mitigation measures under a spotlight. The end result of the analysis is a lot more of the same. More questions than answers. According to this report, we have limited direct evidence for or against them on a global scale. There is a constant struggle of the data's validity by the opposing camps. (Lewis D. 2022)
My opinion after over 2 years of writing about the pandemic is that they have limited value and a high cost. The justification to use lock downs again is a high bar to cross. It would be extraordinary to use this tool in the future.
3) Long Covid - PASC is associated with pre-illness diagnosis of a mental health issue. A cohort study found that depression, anxiety, perceived stress, loneliness, and worry about COVID-19 were associated with a roughly 1.5X increased risk of self-reported PASC symptoms including increased daily life impairment. Symptoms included fatigue, difficulty breathing, persistent cough, muscle/joint/chest pain, smell/taste problems, confusion/disorientation/brain fog, memory issues, depression/anxiety/changes in mood, headache, intermittent fever, heart palpitations, rash/blisters/welts, mouth or tongue ulcers, or other symptoms that lasted for over 4 weeks. (Wang et. al. 2022)
Since I believe that the state of science is showing us that mental health disorders are inflammatory in nature, it is of little surprise that preceding mental health issues would portend a higher risk of PASC. I believe that the stressed out individual's immune system is hypofunctioning leading to poor viral killing and thus secondary Covid responses that are not immune solvent.
4) From a recent article, we see a 10 point series of mitigation measures for a future pandemic based on rational thought: "A more realistic public health approach is to adjust current mitigation goals to be more data-driven and to minimize unintended harms associated with unfocused or ineffective control efforts."
a) Accelerate vaccinations, b) ease restrictions as fast as possible based on science, c) emphasize education and harm reduction, d) Encourage outdoor activity, e) reopen schools, f) avoid lockdowns, g) deemphasize ineffective mitigation measures, h) reassess testing, i) expand treatment and prophylaxis, j) prepare for future pandemics. "Vaccination and other mitigation efforts must focus on protecting the most vulnerable through prioritizing the elderly, HCWs, and other essential workers. Additional criteria for determining which persons should be prioritized due to existing medical conditions must be evidence-based."(Halperin et. al. 2022)
The key points here remain strongly rooted for me. Schools have to be a priority to remain open in the future. Education should never be left in the lurch again like it was in this pandemic. The loss of education for the most marginalized children will set society and the children back far too much each and every time we fall down this path. Vaccinations were the best route to death and morbidity avoidance for the at risk groups. Each time a pandemic occurs these narratives could change. The next one could affect the youngest among us. We need to keep our eyes on the prize of health with effective and truthful messaging about the reality of vaccine benefit and who really needs them and at what time. This did not occur correctly in this pandemic. Lockdowns still leave a bad taste in my mouth overall. Is the current state of the employment, inflation and general worker discontent a reflection of lockdown hangover in part? Maybe. We absolutely need to avoid continuing any ineffective mitigation measure as soon as the science shows it to be useless. i.e. washing groceries, masking to the bathroom or seat only to sit for hours unmasked, wearing a cloth mask, etc... We need to have a supply chain for PPE and all of the pandemic preparedness needs in this country.
5) Dementia is associated with poor dental health according to a new meta analysis study in the Journal of the American Geriatrics Society. Poor periodontal health and tooth loss appear to increase the risk of both cognitive decline and dementia. This is association and not correlation. However, the mechanisms underlying both disorder sets is inflammation driven by excessive consumption of foods known to drive inflammation. Sugar in a refined form will be fermented by oral bacteria leading to acid production damaging your teeth and gums. These same foods also drive many pathways of inflammation including uric acid induced inflammasome activation, lipid inducing inflammatory cytokines and excessive release of NFKb and IL6. All of which is tied to poor mental health in susceptible individuals. The take home point is simple: food drives disease based on volume, type, host genetics and length of life time exposure.
6) Vaccination offers at best 15% reduction of long covid post infection according to a massive study in Nature Medicine. The study looked at 13 million cases of illness. The current rate of Long Covid or PASC is between 5% and 30% depending on the study. A Veterans Affairs study noted 7% risk in a 4.5 million person Study. (Al-Aly et. al. 2022) (Xie et. al. 2021) The issue remains a tricky affair to say the least. These data sets were pre Omicron, leaving new questions moving forward.
As always, control what you can control. Diet, sleep, exercise, toxin avoidance and so much more.
7) Neurological sequelae are becoming the second major problem for individuals post Covid. "Our results show that in the postacute phase of COVID-19, there was increased risk of an array of incident neurologic sequelae including ischemic and hemorrhagic stroke, cognition and memory disorders, peripheral nervous system disorders, episodic disorders (for example, migraine and seizures), extrapyramidal and movement disorders, mental health disorders, musculoskeletal disorders, sensory disorders, Guillain–Barré syndrome, and encephalitis or encephalopathy. We estimated that the hazard ratio of any neurologic sequela was 1.42." (Xu et. al. 2022)
This is a large Veterans Administration data set with a population that is white and older with higher co-morbid disease issues. That skews the data somewhat. However, what remains clear with each and every study is that Covid is effecting a large swath of the population with severe long term neurological disorders after disease recovery. Covid is going to be a trouble maker for years to come in this category of post disease consequences.
That's all this week,
Dr. M
McKinsey Briefing Note
Lewis Nature
Wang JAMAPsychiatry
Halperin BMC Public Health
Asher J Amer Geriatrics Society
Al-Aly Nature Medicine
Xu Nature Medicine
Xie Nature
Franchi BMJ Open Diab Res Care
CDC MMWR
CDC Variants Page
CDC Covid Deaths
The Provider's Lounge at my local hospital has taken to leaving the workers food during breaks. It is a smorgasbord of inflammatory foods. We used to have the opportunity to go into to the cafe and get real food as veggies and fruits and the like. Ah, we are better off with nada.
