COVID-19

OCT 21

The Latest on COVID-19

I am following the many studies on COVID-19 and posting summaries regularly on my website. Here are my most recent entries.

Family Herd Immunity: To stop this pandemic of COVID-19 with herd immunity, more than 80 percent of the world’s population would have to be vaccinated or have had the disease. However, having even one member of your family immunized will help to protect you from getting the disease and possibly dying from it. A study of 1,789,728 people from 814,806 families in Sweden (JAMA Internal Medicine, October 11, 2021) found that:
• Family members without immunity had a 45-97 percent reduced risk of contracting COVID-19 as the number of immune family members increased.
• In families with two people living together, having one of them immunized reduced the rate of infection in the other person by 45 percent.
• In two to five-member families, each additional immunized person reduced the rate of infection in the non-immunized members dramatically.
• In five-member families, having four members immunized reduced the chances of the fifth member developing an infection by 97 percent.

Long COVID Syndrome: More than half of the 236 million people diagnosed with COVID-19 worldwide can be expected to suffer from Long COVID Syndrome, with symptoms lasting for six months or longer (JAMA Network Open, October 23, 2021;4(10):e2128568). Researchers conducted a review of 57 studies that included 250,351 unvaccinated adults and children diagnosed with COVID-19 between December 2019 and March 2021. The participants in these studies had an average age of 54, and 79 percent had been hospitalized. Symptoms of long COVID syndrome can include weight loss, fatigue, fever, pain, decreased mobility, difficulty concentrating, anxiety, abnormal chest X rays, shortness of breath, chest pain, palpitations, hair loss, rashes, stomach pain, loss of appetite, diarrhea and/or vomiting.

Booster Doses for Pfizer and Moderna: Advisors to the Food and Drug Administration (FDA) voted unanimously to approve Moderna or Pfizer booster shots for people over 65 or with underlying health problems, or those with jobs or living situations that put them at increased risk for exposure to COVID-19 (FDA Briefing, October 14, 2021).

J&J Recipients Get Better Booster Response from Moderna or Pfizer: An NIH study compared the response to booster shots with the same or different vaccines than were received from their first shots from Pfizer, Moderna, or Johnson & Johnson, the three COVID-19 vaccines currently authorized in the U.S. (MDRXiv, October 14, 2021, not yet peer reviewed). The study found that using different vaccines as boosters appears to induce the same or increased antibody response, compared to using the same booster dose. People who had received the J&J single-dose vaccine and then received a Moderna booster had antibody levels rise dramatically higher than those who received a J&J booster. Mixing and matching booster shots of different vaccines appears to be safe, and the FDA has authorized use of a different vaccine as a booster than the type people initially received (New York Times, October 20, 2021). 

Unlikely to Get COVID-19 from Contaminated Surfaces: A study from Canada found that your chances of getting COVID-19 from surfaces at the grocery store are very low. Researchers cultured surfaces for COVID-19 at four grocery stores for a month and had no positive cultures (Current Research in Food Science, Oct, 2021;4:598-602). They cultured handles of grocery carts, payment terminals, conveyor belts, deli counter surfaces and plastic and metal handles in frozen food sections. This study refutes earlier studies that found the virus on shopping carts and freezer doors. It does not show that the virus cannot live on surfaces, and suggests that following the rules such as sanitizing surfaces and wearing masks can help to keep the surface areas of grocery stores relatively free of COVID-19 virus. It now appears that COVID-19 is primarily a disease that is acquired from breathing virus-infected droplets indoors in places where lots of people congregate.

Differences in COVID Antibody Responses in Natural Infection Versus Vaccination: Both natural COVID-19 infections and vaccinations help to protect you from infections by causing you to produce:
• antibodies that bind to the virus, and
• protective memory B cells that can help you to make antibodies if you are infected later on.
Having an infection with COVID-19 appears to be more effective in giving you memory B cells that can continue to make antibodies for more than a year afterwards (Nature, Oct 7, 2021). Both vaccination and natural infection caused similar increases in memory B cells. After six months, a vaccinated person starts to lose memory B cells, so their body could then lose its ability to make protective antibodies. One year after having been infected with COVID-19, recovered patients continue to make new and potent memory B cells. However, the virus that causes COVID-19 can still cause disease if you are infected in the future, so it is safer to get the vaccination than it is to get an infection with COVID-19. Memory B cells for smallpox have lasted at least 60 years after vaccination, and those for Spanish flu may last for 100 years.

Note: I did another radio show last week on WRTA in Altoona PA. You can listen here: https://www.lightnercommunications.com/episode/podcast-links-dr-gabe-mirkin-october-2021-wrtas-the-11th-hour-with-doug-herendeen/

The Latest on COVID-19

  September 24  

I am following the latest developments on COVID-19 and our efforts to control the pandemic. I will update this page regularly, so if you are interested, check back often. As of September 20, 2021:

• An FDA advisory panel recommended a third (booster) dose of COVID-19 vaccine only for people over 65 or otherwise vulnerable people.

• Side effects of third injections of COVID-19 vaccine (booster shots) are same as for the second shot: 63% felt fatigue, 48% had a headache, and 39% had muscle pain.

• Both COVID-19 disease and vaccination may provide long-term immunity. One year after recovering from COVID-19, most people have high levels of protective antibodies, and those who have been vaccinated after recovering from the disease have up to 50 times higher blood levels of certain antibody levels to protect them against re-infection, particularly against the delta variant (JAMA, 2021;326(5):376-377). This study described a one-year follow up of 63 people who had recovered from COVID 19 disease, ages 26 to 73, of which six were hospitalized. Another study showed that vaccination after suffering a COVID-19 infection gives 100 times the antibody levels of just suffering the infection only (Science, June 2021).

• As of September 20, 2021, more than 673,000 people have died in the United States from COVID-19, making this the deadliest pandemic in U.S. history and surpassing the number of U.S. deaths in the 1918-1919 flu pandemic. One in every 500 people in the U.S. have died of COVID-19.

• The CDC recommends wearing masks indoors in areas where people congregate. The virus is spread primarily in air-suspended droplets (large and small), and masks catch these droplets.

• About 76.5% of U.S. adults have received at least one shot, and 64% are fully vaccinated. Of adults over age 64, 83% are fully vaccinated and 93% have received at least one shot (New York Times, September 20, 2021).

As of September 14, 2021:

• Unvaccinated people are about 29 times more likely to be hospitalized with Covid-19 than those who are fully vaccinated (CDC Los Angeles study, August 24, 2021)

• A study of 6.2 million persons who received 11.8 million doses of an mRNA vaccine, found that the incidence of the following serious reactions to the vaccine were not greater than in the general population Reactions studied included heart attacks, Bell’s palsy (nerve damage), strokes, Guillain-Barré syndrome, heart damage, lung clot, and “thrombosis with thrombocytopenia syndrome.” (JAMA, Pub online September 3, 2021).

• Long COVID-19 symptoms can persist for more than a year, including pain, tiredness, anxiety, depression, fatigue, muscle weakness, shortness of breath (The Lancet, August 26, 2021)

• COVID-19 is most contagious from two days before symptoms appear to three days after symptoms appear (JAMA Internal Medicine, Aug 23, 2021).

As of September 6, 2021

• Nobody has shown that ivermectin is effective or safe for prevention or treatment of COVID-19.  See Does Ivermectin Treat COVID-19?

• If you have been treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.

• Get vaccinated for both flu and COVID-19, even if you have had COVID-19. Unvaccinated people who already had COVID-19 are more than twice as likely than fully vaccinated people to get COVID-19 again (MMWR Morb Mortal Wkly Rep, 2021;70:1081-1083).  A flu shot will not protect an unvaccinated person from suffering COVID-19, but it may reduce the chance of developing severe COVID-19 disease.

As of August 29, 2021:

• Long COVID symptoms can persist for more than one year. The largest study yet found that almost half of people hospitalized for COVID-19 continue to suffer one or more symptoms one year later: pain, excess time lying in bed, anxiety, depression, fatigue, muscle weakness, shortness of breath, and overall loss of life quality (The Lancet. August 26, 2021). Those who had the most severe acute disease appear to be most likely to suffer long-term symptoms.

• Some states have set up free infusion centers for the monoclonal antibody cocktail, Regeneron, that appears to reduce hospitalization rates for people at high risk of severe COVID-19. The U.S. government will pay for Regeneron.

• By mid-September, 2021, the U.S. government is expected to approve a third COVID-19 dose (booster) for fully vaccinated adults. A booster means that your immune system starts to lose the benefits of a vaccine over time, and you get a higher immune response to a third dose.

• The Delta variant is primarily responsible for the more than 100,000 U.S. hospitalizations for COVID-19. This is the highest number of cases since January 2021.

• Johnson and Johnson says that a booster dose 28 days after first J&J injection raises antibody levels nine times. A single injection raises antibody titers for at least 8 months (NEJM. July 22, 2021). On rare occasions, the J&J vaccine has been associated with increased risk for forming clots.

• Side effects of a third dose of messenger RNA vaccines (Pfizer and Moderna) are similar to those of the second dose, possibly milder, and usually resolve in 2-3 days: headache, tiredness, low-grade fever, muscle aches.

• A CDC study in Los Angeles found that unvaccinated people were 29.2 times more likely to be hospitalized with COVID-19 than those vaccinated— an efficacy of about 97 percent (J of Virological Methods).

• COVID-19 is most contagious from two days before symptoms appear to three days after, and infected individuals are more likely to be asymptomatic if they acquire COVID-19 from an asymptomatic person (JAMA Intern Med. Published online August 23, 2021).

As of August 22, 2021:

  • Federal health officials are recommending that fully vaccinated people should get booster shots eight months after their second shot. A final determination from the Food and Drug Administration (FDA) on boosters for everyone is expected in a few weeks. The U.S. now has nearly 169 million people fully vaccinated. An Israeli study found that a third dose of Pfizer COVID-19 vaccine helped to block the highly-contagious Delta variant and was 86 percent effective in people aged over 60 (Reuters, August 18, 2021).
  • Studies from Massachusetts, India and Finland have shown that the Delta variant of COVID-19 can grow in the noses of both vaccinated people and unvaccinated people, so both vaccinated and unvaccinated people can transmit the virus to others, even if they have no symptoms. The CDC Director, Dr. Rochelle Walensky, said this explains why the CDC is once again recommending that even vaccinated people wear masks indoors.
  • The FDA has already authorized a third dose of the mRNA (Pfizer or Moderna) vaccines for immunocompromised patients. These booster shots are now available at many pharmacy chains by appointment or walk-in. According to the U.S. Centers for Disease Control and Prevention (CDC), individuals will need to self-attest that they are severely to moderately immunocompromised but do not need to show proof of their condition to receive a booster.
  • Should you be vaccinated if you have already had COVID-19? Having had COVID-19 in the past offers some protection from reinfection, but the CDC reports that vaccination offers better protection against COVID-19 than a prior infection. Having had both an infection plus vaccinations gives you more and higher levels of antibodies. Reactions to the vaccine are more common in people who have had COVID-19 (JAMA Intern Med, published online August 16, 2021). People who have a reaction to their first injection of Moderna or Pfizer vaccines are likely to have had previous exposure to COVID-19 and thus have a high antibody response to the vaccine.
  • A study from Stockholm found that patients infected with COVID-19 can have an elevated heart rate for many months after they develop symptoms (The American Journal of Medicine, August 11, 2021). This is very important because COVID-19 increases risk for clotting that can cause heart attacks, strokes, and swollen legs. The researchers note that 25-50 percent of the patients had a rapid heart rate and/or chest palpitations that lasted 12 weeks or longer, and nine percent still had palpitations six months later. Palpitations are a feeling of having a fast-beating, fluttering or pounding heart. The authors recommend a basic heart workup for people with COVID-19 and palpitations or a resting heart rate greater than 80.

As of August 5, 2021:

• COVID-19 in the U.S. has caused more than 35 million infections and more than 600,000 deaths. COVID-19 deaths have risen by nearly 48 percent over the past week and now average 239 per day.

• Nearly two-thirds of the counties in the U.S. have vaccinated fewer than 40 percent of their populations.

• The highly-contagious Delta variant accounts for 93 percent of current COVID-19 Cases.

• For up to 13 months after being infected, most people have high levels of protective neutralizing antibodies to SARS-CoV-2 (J Gen Int Med, Aug 3, 2021). The sicker a person was, the higher the protective antibody titer. Ninety percent of infected people had positive antibody tests six months post-infection, and 83 percent had positive antibody tests 13 months post-COVID-19. Antibody titers were relatively stable over 13 months post infection.

• An English study found that 50 to 60 percent of people who received two shots of the Pfizer or Moderna vaccinations were fully protected against the highly contagious delta variant of COVID-19. That includes people who had no symptoms of the infection whatever when they were infected. The delta virus also increases risk for more serious disease and hospitalization.

• People who have been infected with COVID-19 should still get vaccinated as the vaccination will more than double the protection from reinfection (CDC’s Morbidity and Mortality Weekly Report, Aug 6, 2021) Even just one vaccination injection was not associated with reinfection.

• Moderna reports that their COVID-19 vaccine remains 93 percent effective six months after it is administered. However, there may still be a need for a COVID-19 booster shot.

• More than 19 percent of COVID-19 cases in the U.S. occur in children.

• Currently there is an uncontrolled pandemic in Southeast Asia (Vietnam, Malaysia, and Thailand)

• One UK study says COVID-19 infection rates are now three times lower for double vaccinated people . This suggests that you should get two and possibly three injections.

• Many physicians and other health care workers in Israel, Germany, France, and the U.K. are getting third booster doses because of their increased exposure to COVID-19. They recommend third doses for people over 65, those with decreased immunity and those who have low blood antibody titers that markedly increase risk for disease.

• The CDC has recommended that everyone get a COVID-19 vaccine, even if they have had the virus before, yet many skeptics have held off getting the shots, believing that immunity generated by their previous infection will protect them if they should encounter the virus again.

SEPT 16

The Latest on COVID-19

  

I am following the latest developments on COVID-19 and our efforts to control the pandemic. I will update this page regularly, so if you are interested, check back often. As of September 14, 2021:

• Unvaccinated people are about 29 times more likely to be hospitalized with Covid-19 than those who are fully vaccinated (CDC Los Angeles study, August 24, 2021)

• A study of 6.2 million persons who received 11.8 million doses of an mRNA vaccine, found that the incidence of the following serious reactions to the vaccine were not greater than in the general population Reactions studied included heart attacks, Bell’s palsy (nerve damage), strokes, Guillain-Barré syndrome, heart damage, lung clot, and “thrombosis with thrombocytopenia syndrome.” (JAMA, Pub online September 3, 2021).

• Long COVID-19 symptoms can persist for more than a year, including pain, tiredness, anxiety, depression, fatigue, muscle weakness, shortness of breath (The Lancet, August 26, 2021)

• COVID-19 is most contagious from two days before symptoms appear to three days after symptoms appear (JAMA Internal Medicine, Aug 23, 2021).

As of September 6, 2021

• Nobody has shown that ivermectin is effective or safe for prevention or treatment of COVID-19.  See Does Ivermectin Treat COVID-19?

• If you have been treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.

• Get vaccinated for both flu and COVID-19, even if you have had COVID-19. Unvaccinated people who already had COVID-19 are more than twice as likely than fully vaccinated people to get COVID-19 again (MMWR Morb Mortal Wkly Rep, 2021;70:1081-1083).  A flu shot will not protect an unvaccinated person from suffering COVID-19, but it may reduce the chance of developing severe COVID-19 disease.

As of August 29, 2021:

• Long COVID symptoms can persist for more than one year. The largest study yet found that almost half of people hospitalized for COVID-19 continue to suffer one or more symptoms one year later: pain, excess time lying in bed, anxiety, depression, fatigue, muscle weakness, shortness of breath, and overall loss of life quality (The Lancet. August 26, 2021). Those who had the most severe acute disease appear to be most likely to suffer long-term symptoms.

• Some states have set up free infusion centers for the monoclonal antibody cocktail, Regeneron, that appears to reduce hospitalization rates for people at high risk of severe COVID-19. The U.S. government will pay for Regeneron.

• By mid-September, 2021, the U.S. government is expected to approve a third COVID-19 dose (booster) for fully vaccinated adults. A booster means that your immune system starts to lose the benefits of a vaccine over time, and you get a higher immune response to a third dose.

• The Delta variant is primarily responsible for the more than 100,000 U.S. hospitalizations for COVID-19. This is the highest number of cases since January 2021.

• Johnson and Johnson says that a booster dose 28 days after first J&J injection raises antibody levels nine times. A single injection raises antibody titers for at least 8 months (NEJM. July 22, 2021). On rare occasions, the J&J vaccine has been associated with increased risk for forming clots.

• Side effects of a third dose of messenger RNA vaccines (Pfizer and Moderna) are similar to those of the second dose, possibly milder, and usually resolve in 2-3 days: headache, tiredness, low-grade fever, muscle aches.

• A CDC study in Los Angeles found that unvaccinated people were 29.2 times more likely to be hospitalized with COVID-19 than those vaccinated— an efficacy of about 97 percent (J of Virological Methods).

• COVID-19 is most contagious from two days before symptoms appear to three days after, and infected individuals are more likely to be asymptomatic if they acquire COVID-19 from an asymptomatic person (JAMA Intern Med. Published online August 23, 2021).

As of August 22, 2021:

  • Federal health officials are recommending that fully vaccinated people should get booster shots eight months after their second shot. A final determination from the Food and Drug Administration (FDA) on boosters for everyone is expected in a few weeks. The U.S. now has nearly 169 million people fully vaccinated. An Israeli study found that a third dose of Pfizer COVID-19 vaccine helped to block the highly-contagious Delta variant and was 86 percent effective in people aged over 60 (Reuters, August 18, 2021).
  • Studies from Massachusetts, India and Finland have shown that the Delta variant of COVID-19 can grow in the noses of both vaccinated people and unvaccinated people, so both vaccinated and unvaccinated people can transmit the virus to others, even if they have no symptoms. The CDC Director, Dr. Rochelle Walensky, said this explains why the CDC is once again recommending that even vaccinated people wear masks indoors.
  • The FDA has already authorized a third dose of the mRNA (Pfizer or Moderna) vaccines for immunocompromised patients. These booster shots are now available at many pharmacy chains by appointment or walk-in. According to the U.S. Centers for Disease Control and Prevention (CDC), individuals will need to self-attest that they are severely to moderately immunocompromised but do not need to show proof of their condition to receive a booster.
  • Should you be vaccinated if you have already had COVID-19? Having had COVID-19 in the past offers some protection from reinfection, but the CDC reports that vaccination offers better protection against COVID-19 than a prior infection. Having had both an infection plus vaccinations gives you more and higher levels of antibodies. Reactions to the vaccine are more common in people who have had COVID-19 (JAMA Intern Med, published online August 16, 2021). People who have a reaction to their first injection of Moderna or Pfizer vaccines are likely to have had previous exposure to COVID-19 and thus have a high antibody response to the vaccine.
  • A study from Stockholm found that patients infected with COVID-19 can have an elevated heart rate for many months after they develop symptoms (The American Journal of Medicine, August 11, 2021). This is very important because COVID-19 increases risk for clotting that can cause heart attacks, strokes, and swollen legs. The researchers note that 25-50 percent of the patients had a rapid heart rate and/or chest palpitations that lasted 12 weeks or longer, and nine percent still had palpitations six months later. Palpitations are a feeling of having a fast-beating, fluttering or pounding heart. The authors recommend a basic heart workup for people with COVID-19 and palpitations or a resting heart rate greater than 80.

As of August 5, 2021:

• COVID-19 in the U.S. has caused more than 35 million infections and more than 600,000 deaths. COVID-19 deaths have risen by nearly 48 percent over the past week and now average 239 per day.

• Nearly two-thirds of the counties in the U.S. have vaccinated fewer than 40 percent of their populations.

• The highly-contagious Delta variant accounts for 93 percent of current COVID-19 Cases.

• For up to 13 months after being infected, most people have high levels of protective neutralizing antibodies to SARS-CoV-2 (J Gen Int Med, Aug 3, 2021). The sicker a person was, the higher the protective antibody titer. Ninety percent of infected people had positive antibody tests six months post-infection, and 83 percent had positive antibody tests 13 months post-COVID-19. Antibody titers were relatively stable over 13 months post infection.

• An English study found that 50 to 60 percent of people who received two shots of the Pfizer or Moderna vaccinations were fully protected against the highly contagious delta variant of COVID-19. That includes people who had no symptoms of the infection whatever when they were infected. The delta virus also increases risk for more serious disease and hospitalization.

• People who have been infected with COVID-19 should still get vaccinated as the vaccination will more than double the protection from reinfection (CDC’s Morbidity and Mortality Weekly Report, Aug 6, 2021) Even just one vaccination injection was not associated with reinfection.

• Moderna reports that their COVID-19 vaccine remains 93 percent effective six months after it is administered. However, there may still be a need for a COVID-19 booster shot.

• More than 19 percent of COVID-19 cases in the U.S. occur in children.

• Currently there is an uncontrolled pandemic in Southeast Asia (Vietnam, Malaysia, and Thailand)

• One UK study says COVID-19 infection rates are now three times lower for double vaccinated people . This suggests that you should get two and possibly three injections.

• Many physicians and other health care workers in Israel, Germany, France, and the U.K. are getting third booster doses because of their increased exposure to COVID-19. They recommend third doses for people over 65, those with decreased immunity and those who have low blood antibody titers that markedly increase risk for disease.

• The CDC has recommended that everyone get a COVID-19 vaccine, even if they have had the virus before, yet many skeptics have held off getting the shots, believing that immunity generated by their previous infection will protect them if they should encounter the virus again.

SEPT 9

The Latest on COVID-19

I am following the latest developments on COVID-19 and our efforts to control the pandemic. I will update this page regularly, so if you are interested, check back often. As of September 6, 2021:

• If you have been treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.

• Get vaccinated for both flu and COVID-19, even if you have had COVID-19. Unvaccinated people who already had COVID-19 are more than twice as likely than fully vaccinated people to get COVID-19 again (MMWR Morb Mortal Wkly Rep, 2021;70:1081-1083).  A flu shot will not protect an unvaccinated person from suffering COVID-19, but it may reduce the chance of developing severe COVID-19 disease.

As of August 29, 2021:

• Long COVID symptoms can persist for more than one year. The largest study yet found that almost half of people hospitalized for COVID-19 continue to suffer one or more symptoms one year later: pain, excess time lying in bed, anxiety, depression, fatigue, muscle weakness, shortness of breath, and overall loss of life quality (The Lancet. August 26, 2021). Those who had the most severe acute disease appear to be most likely to suffer long-term symptoms.

• Some states have set up free infusion centers for the monoclonal antibody cocktail, Regeneron, that appears to reduce hospitalization rates for people at high risk of severe COVID-19. The U.S. government will pay for Regeneron.

• Johnson and Johnson says that a booster dose 28 days after first J&J injection raises antibody levels nine times. A single injection raises antibody titers for at least 8 months (NEJM. July 22, 2021). On rare occasions, the J&J vaccine has been associated with increased risk for forming clots.

• Side effects of a third dose of messenger RNA vaccines (Pfizer and Moderna) are similar to those of the second dose, possibly milder, and usually resolve in 2-3 days: headache, tiredness, low-grade fever, muscle aches.

• A CDC study in Los Angeles found that unvaccinated people were 29.2 times more likely to be hospitalized with COVID-19 than those vaccinated— an efficacy of about 97 percent (J of Virological Methods).

• COVID-19 is most contagious from two days before symptoms appear to three days after, and infected individuals are more likely to be asymptomatic if they acquire COVID-19 from an asymptomatic person (JAMA Intern Med. Published online August 23, 2021).

As of August 22, 2021:

  • Federal health officials are recommending that fully vaccinated people should get booster shots eight months after their second shot. A final determination from the Food and Drug Administration (FDA) on boosters for everyone is expected in a few weeks. The U.S. now has nearly 169 million people fully vaccinated. An Israeli study found that a third dose of Pfizer COVID-19 vaccine helped to block the highly-contagious Delta variant and was 86 percent effective in people aged over 60 (Reuters, August 18, 2021).
  • Studies from Massachusetts, India and Finland have shown that the Delta variant of COVID-19 can grow in the noses of both vaccinated people and unvaccinated people, so both vaccinated and unvaccinated people can transmit the virus to others, even if they have no symptoms. The CDC Director, Dr. Rochelle Walensky, said this explains why the CDC is once again recommending that even vaccinated people wear masks indoors.
  • The FDA has already authorized a third dose of the mRNA (Pfizer or Moderna) vaccines for immunocompromised patients. These booster shots are now available at many pharmacy chains by appointment or walk-in. According to the U.S. Centers for Disease Control and Prevention (CDC), individuals will need to self-attest that they are severely to moderately immunocompromised but do not need to show proof of their condition to receive a booster.
  • Should you be vaccinated if you have already had COVID-19? Having had COVID-19 in the past offers some protection from reinfection, but the CDC reports that vaccination offers better protection against COVID-19 than a prior infection. Having had both an infection plus vaccinations gives you more and higher levels of antibodies. Reactions to the vaccine are more common in people who have had COVID-19 (JAMA Intern Med, published online August 16, 2021). People who have a reaction to their first injection of Moderna or Pfizer vaccines are likely to have had previous exposure to COVID-19 and thus have a high antibody response to the vaccine.
  • A study from Stockholm found that patients infected with COVID-19 can have an elevated heart rate for many months after they develop symptoms (The American Journal of Medicine, August 11, 2021). This is very important because COVID-19 increases risk for clotting that can cause heart attacks, strokes, and swollen legs. The researchers note that 25-50 percent of the patients had a rapid heart rate and/or chest palpitations that lasted 12 weeks or longer, and nine percent still had palpitations six months later. Palpitations are a feeling of having a fast-beating, fluttering or pounding heart. The authors recommend a basic heart workup for people with COVID-19 and palpitations or a resting heart rate greater than 80.

As of August 5, 2021:

• COVID-19 in the U.S. has caused more than 35 million infections and more than 600,000 deaths. COVID-19 deaths have risen by nearly 48 percent over the past week and now average 239 per day.

• Nearly two-thirds of the counties in the U.S. have vaccinated fewer than 40 percent of their populations.

• The highly-contagious Delta variant accounts for 93 percent of current COVID-19 Cases.

• For up to 13 months after being infected, most people have high levels of protective neutralizing antibodies to SARS-CoV-2 (J Gen Int Med, Aug 3, 2021). The sicker a person was, the higher the protective antibody titer. Ninety percent of infected people had positive antibody tests six months post-infection, and 83 percent had positive antibody tests 13 months post-COVID-19. Antibody titers were relatively stable over 13 months post infection.

• An English study found that 50 to 60 percent of people who received two shots of the Pfizer or Moderna vaccinations were fully protected against the highly contagious delta variant of COVID-19. That includes people who had no symptoms of the infection whatever when they were infected. The delta virus also increases risk for more serious disease and hospitalization.

• People who have been infected with COVID-19 should still get vaccinated as the vaccination will more than double the protection from reinfection (CDC’s Morbidity and Mortality Weekly Report, Aug 6, 2021) Even just one vaccination injection was not associated with reinfection.

• Moderna reports that their COVID-19 vaccine remains 93 percent effective six months after it is administered. However, there may still be a need for a COVID-19 booster shot.

• More than 19 percent of COVID-19 cases in the U.S. occur in children.

• Currently there is an uncontrolled pandemic in Southeast Asia (Vietnam, Malaysia, and Thailand)

• One UK study says COVID-19 infection rates are now three times lower for double vaccinated people . This suggests that you should get two and possibly three injections.

• Many physicians and other health care workers in Israel, Germany, France, and the U.K. are getting third booster doses because of their increased exposure to COVID-19. They recommend third doses for people over 65, those with decreased immunity and those who have low blood antibody titers that markedly increase risk for disease.

• The CDC has recommended that everyone get a COVID-19 vaccine, even if they have had the virus before, yet many skeptics have held off getting the shots, believing that immunity generated by their previous infection will protect them if they should encounter the virus again.

Masks Do Not Block Breathing

  AUG 8 

Researchers showed that “wearing a surgical face mask did not cause gas exchange abnormalities in healthy adults or even in adults with lung function impairment” (Annals ATS, March 2021;18(3):539-541). The authors measured carbon dioxide exchange and oxygen saturation before and after wearing a surgical mask in physicians with healthy lungs and in people with severe chronic obstructive lung disease. They state that, “It is important to inform the public that the discomfort associated with mask use should not lead to unsubstantiated safety concerns as this may attenuate the application of a practice proven to improve public health.”

Article on Face Masks Blocking Breathing Retracted
A study that seemed to show that masks block air exchange (JAMA Pediatrics, June 30, 2021) was retracted by the JAMA editors because of criticism of the study’s methodology, the device used to assess carbon dioxide, and the accuracy of the measurements of carbon dioxide in inspired air (JAMA Pediatrics, published online July 16, 2021). Many other studies show that wearing a mask helps to prevent people with COVID-19 infections from spreading COVID-19 to others when they cough, sneeze or talk loudly. I recommend continuing to wear masks in indoor public places when you are around people who don’t live in your household. Masks are a minor inconvenience that may help to prevent infections with flu and other viruses as well as potential variants of COVID-19.

Delta Variant Accounts for 83 Percent of New COVID-19 Cases
In a U.S. Senate committee hearing on July 20, 2021, CDC Director Dr. Rochelle Walensky said that:
• The Delta variant of COVID-19 is up from 50 percent of cases on July 3, 2021 to 83 percent on July 20, 2021.
• Nearly two-thirds of the counties in the U.S. have vaccinated fewer than 40 percent of their residents.
• COVID-19 deaths in the U.S. have risen by nearly 48 percent over the past week and now average 239 per day.
Make sure that you are vaccinated this year against influenza and pneumonia as well as COVID-19. The CDC expects a marked upturn in cases of all three infections this coming winter.

JULY 12

Almost All U.S. COVID-19 Hospitalizations and Deaths Are Now In Unvaccinated People

The Centers for Disease Control and Prevention (CDC) list of cases, hospitalizations, and deaths shows that of more than 18,000 people who died from COVID-19 in May 2021, only 150 deaths occurred in fully vaccinated people (Associated Press, June 26, 2021). That’s less than one percent. Furthermore, of the 853,000 reported hospitalized COVID-19 cases, fewer than 1200 occurred in vaccinated people, or 0.14 percent. These deaths and hospitalizations are a senseless tragedy because we have enough vaccines for everyone. People who have not already had COVID-19 and refuse vaccination are harming their fellow humans as well as themselves. The only way that we can stop the pandemic is to have herd immunity, when about 80 percent of the population is immune to COVID-19 either by having been infected with the disease or by being vaccinated. Every day we do not reach herd immunity brings more needless deaths.

The Available COVID-19 Vaccines are Highly Protective
At the end of June, more than 180 million Americans have received the COVID-19 vaccines from Moderna, Pfizer-BioNTech or Johnson & Johnson. The CDC has recommended one injection of the Johnson and Johnson vaccine and second doses of Pfizer’s vaccine 21 days after the first, and 28 days after the first for Moderna. About 67 percent of the population over 18 years of age has received at least one dose, while 58 percent are fully vaccinated.

After just one injection, the Pfizer vaccine has been 80 percent effective in preventing disease and nearly 100 percent effective at protecting against hospitalization or death. One dose of the Moderna vaccine has been at least 80 percent effective at preventing COVID-19, while the one-dose-only Johnson & Johnson vaccine is at least 72 percent effective (NEJM, June 30, 2021). So far we know that one injection of either the Pfizer or Moderna vaccines provides robust protection for at least 12 weeks, and two injections are expected to provide protection for at least a year (Nature, June 28, 2021).

My Recommendations
If you have not had COVID-19 and are not yet vaccinated to protect you from the disease, please get your vaccination as soon as possible. If you are already vaccinated, thank you.

JULY 9

Almost All U.S. COVID-19 Hospitalizations and Deaths Are in Unvaccinated People

The Centers for Disease Control and Prevention (CDC) list of cases, hospitalizations, and deaths shows that of more than 18,000 people who died from COVID-19 in May 2021, only 150 deaths occurred in fully vaccinated people (Associated Press June 26, 2021). That’s less than one percent. Furthermore, of the 853,000 reported hospitalized COVID-19 cases, fewer than 1200 occurred in vaccinated people, or 0.14 percent. These deaths and hospitalizations are a senseless tragedy because we have enough vaccines for everyone. People who have not already had COVID-19 and refuse vaccination are harming their fellow humans as well as themselves. The only way that we can stop the pandemic is to have herd immunity, when about 80 percent of the population is immune to COVID-19 either by having been infected with the disease or by being vaccinated. Every day we do not reach herd immunity brings more needless deaths.

The Available COVID-19 Vaccines are Highly Protective
At the end of June, more than 180 million Americans have received the COVID-19 vaccines from Moderna, Pfizer-BioNTech or Johnson & Johnson. The CDC has recommended one injection of the Johnson and Johnson vaccine and second doses of Pfizer’s vaccine 21 days after the first, and 28 days after the first for Moderna. About 67 percent of the population over 18 years of age has received at least one dose, while 58 percent are fully vaccinated.

After just one injection, the Pfizer vaccine has been 80 percent effective in preventing disease and nearly 100 percent effective at protecting against hospitalization or death. One dose of the Moderna vaccine has been at least 80 percent effective at preventing COVID-19, while the one-dose-only Johnson & Johnson vaccine is at least 72 percent effective (NEJM, June 30, 2021). So far we know that one injection of either the Pfizer or Moderna vaccines provides robust protection for at least 12 weeks, and two injections are expected to provide protection for at least a year (Nature, June 28, 2021).

My Recommendations
If you are not yet vaccinated to protect you from COVID-19, please get your vaccination as soon as possible. If you are already vaccinated, thank you.

MAY 18

COVID-19 Update – Vaccines Are Very Effective

An Israeli study followed 596,618 people who were newly vaccinated with the Pfizer-BioNTech mRNA vaccine during a six-week period from December 20, 2020, to February 1, 2021, and a matched group of the same number of unvaccinated controls (N Engl J Med, April 15, 2021;384:1412-1423). The researchers found that the vaccine offered a high degree of protection, similar to the results shown in the clinical trials. Of 41 deaths from COVID-19 during the follow-up period, 32 occurred in the unvaccinated group and nine in the vaccinated group. Among the documented cases of COVID-19, there were more than three times as many severe cases in the unvaccinated group as in the vaccinated group (174 vs 55).

Of the 4460 documented cases of COVID-19 in the vaccinated group:

• 96% had no symptoms

• 93% of obese subjects had no symptoms

• 92% of people over 70 years of age had no symptoms

• 88% of those who had three or more existing conditions or illnesses had no symptoms

• 86% of those with diabetes had no symptoms

• 84% of immuno-suppressed individuals had no symptoms

• 80% of those with heart disease had no symptoms

• 80% of those with chronic kidney disease had no symptoms

These numbers show that even with the significant protection offered by the vaccine, people with co-existing conditions and the elderly are still at higher risk for complications of COVID-19 than the general population.

Monoclonal Antibodies for Early Treatment

The vast majority of people infected with COVID-19 virus will recover with no treatment whatever. However, certain conditions (listed below) put a person at high risk for serious disease and possibly even death. The U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization to permit the use of monoclonal antibodies (casirivimab, imdevimab, etesevimab) to treat people at high risk for serious complications of COVID-19. When you are infected or receive a vaccination against COVID-19, you produce protein antibodies that can attach to and kill the virus. Monoclonal antibodies are laboratory-made proteins that are similar to the antibodies that you produce to rid yourself of the virus. The FDA limits the use of monoclonal antibodies to adults over 12 years of age, weighing more than 100 pounds, with positive results of direct SARS-CoV-2 viral testing and with mild to moderate symptoms. People who are at significant risk for severe disease and could benefit from receiving monoclonal antibodies early in the course of COVID-19 include those who:

• are obese (body mass index (BMI) over 34)

• are diabetic

• have chronic kidney disease

• have any immuno-suppressive disease

• are currently receiving immuno-suppressive treatment

• are over 65 years of age or

• are over 55 years of age and have heart or blood vessel disease, high blood pressure, chronic obstructive pulmonary disease or other chronic respiratory disease.

The FDA notes that monoclonal antibodies may worsen symptoms in patients who are hospitalized due to COVID-19 or who require oxygen therapy.

Obesity Increases Risk for Severe COVID-19

A study of 150,000 US adults diagnosed with COVID-19 from March to December 2020 showed that half of the patients were obese and about 28 percent were overweight, based on their body mass index or BMI (JAMA, 2021;325(16):1603).

The COVID-19 patients who were significantly overweight (BMI between 30 and 34.9) had:

• 7% increased risk of hospitalization

• 35% increased risk of mechanical ventilation

• 8% increased risk of dying

The COVID-19 patients who were obese (BMIs greater than 45) had:

• 33% increased risk of hospitalization

• twice average mechanical ventilation rate

• 61% increased risk of death

Most Cases of COVID-19 are Acquired by Breathing Indoor Air

A study from the Massachusetts Institute of Technology found that the risk of suffering COVID-19 indoors is as great at 60 feet as it is at six feet (PNAS, April 27, 2021;118(17)). They report that the amount of time spent in an enclosed area is more important than how far you are from an infected person. The MIT mathematicians calculated indoor risk of COVID-19 based on:

• time spent inside,

• air filtration,

• air circulation,

• immunizations,

• different viral strains,

• use of masks, and

• viral spread by breathing, eating, speaking, singing or other activities.

They found that COVID-19 is far more likely to be spread by breathing infected indoor air than by touching infected objects. Outdoors, the virus is rapidly dispersed after a person talks, breathes, coughs or sneezes, so infection is unlikely and your exposure may depend on how close a person is to you when he spews virus into the air. Indoors, the concentration of virus in the air continuously increases when infected people repeatedly breathe, so you can become infected with COVID-19 by people who are 60 feet or more away from you.

• How long you stay indoors is far more important than how far you are from an infected person because the longer people are there, the more virus remains in the air.

• An infected person breathes out heated viral droplets into warm indoor air that causes the droplets to rise and stay up in the air for a long time. Outdoors the air circulation is better and droplets are likely to fall to the ground far more quickly.

• Masks worn by both infected and susceptible persons can reduce the risk of transmission.

The authors of the study conclude that “to minimize risk of infection, one should avoid spending extended periods in highly populated areas. One is safer in rooms with large volume and high ventilation rates. One is at greater risk in rooms where people are exerting themselves in such a way as to increase their respiration rate and pathogen output, for example, by exercising, singing, or shouting.”

Vaccines Offer the Best Protection

The mathematical model from MIT did not focus on vaccines, but its conclusions about transmission of the virus should encourage people to have all members of their household vaccinated as soon as possible. It is still remotely possible to become infected after being vaccinated, and to infect other people even if you have no symptoms, but a report from the U.S. Centers for Disease Control and Prevention (CDC) on April 26, 2021 shows only about 9000 breakthrough cases of COVID-19 after vaccination, out of 100 million people fully vaccinated, or 0.009 percent.

APRIL 8

Quebec City gym linked to more than 400 cases of COVID-19, health authorities say

Wed, April 7, 2021, 4:07 PM

QUEBEC — A gym in Quebec City has now been linked to 419 cases of COVID-19 after staff and clients got infected and unknowingly carried the virus to grocery stores, homes, and workplaces, the regional health authority said Wednesday.

A spokesman for the CIUSSS de la Capitale-Nationale said that as of Wednesday morning, 195 clients and staff of the Mega Fitness Gym, which authorities shut down last week, have tested positive for the virus.

Those primary cases are believed to have spread the virus to some 36 workplaces, including restaurants, grocery stores, offices, retail stores and construction sites, ultimately infecting another 224 people, the authority said in an email.

While the regional health authority has not confirmed any deaths linked to the outbreak, on Wednesday the sister of a 40-year-old man who was a client of the gym told The Canadian Press via Facebook that her brother had died after catching the virus. It’s not clear whether his illness was linked to the business.

Another of the gym’s clients said he caught COVID-19 after working out there, even though he wore his mask the whole time and kept his distance from others.

But Dominic Lelievre said it was clear some clients weren’t respecting health measures. At one point, he said, he turned to his spouse and commented on the lax mask-wearing in the gym.

“They’re not wearing them well,” he said his spouse told him.

“They’re not wearing them at all,” Lelievre replied.

While there were signs outlining the rules as well as Plexiglas barriers and hand sanitizer, Lelievre said in a phone interview that there were hardly any employees on the floor to enforce the rules.

The 43-year-old began feeling tired in late March, which he attributed to starting to work out again after a few months of gyms being closed. When he saw the gym post about a COVID-19 case, he went to get tested and received a positive result. His spouse became infected too, he said, as did one of his two young children.

While he feels lucky not to have been seriously ill, his symptoms included fever, chills, a loss of taste and a lung infection. “You climb the stairs and you’re out of breath,” he said.

As case numbers linked to the outbreak have climbed, so has anger toward the gym’s owner, Dan Marino. Marino defended himself on Facebook last week, saying he’d followed all the government health measures.

But that hasn’t stopped accusations from people such as Quebec City Mayor Regis Labeaume, who has described him as “irresponsible” and noted that Marino had been an outspoken critic of the government’s shutdowns of gyms.

Gabriel Hardy, Quebec spokesman for the Fitness Industry Council of Canada, said Wednesday he believes the government’s decision to close gyms in Quebec’s red zones as of Thursday is connected to the Mega Fitness Gym outbreak, even though most gyms are operating safely.

“There’s one case in Quebec that brought us all down,” he said.

The regional health authority said that while the gym outbreak is “significant,” it is not solely responsible for the spike in cases in Quebec City, which has prompted the provincial government to impose special lockdown measures on the region, including closing schools and non-essential businesses and a return to an 8 p.m. curfew.

“We are faced with a situation where dozens of community-type outbreaks, linked to a slackening of the compliance with health instructions, each feed the rapid growth of new positive cases,” the health authority wrote in an email.

Lelievre said he understands the anger toward Marino and some clients who allegedly refused to get tested, despite developing symptoms or being exposed.

But he said he blames the situation on a combination of factors, including general societal complacency with safety measures, an insufficiently strict owner and variants of COVID-19 that spread easily.

“(The owner) is one guilty party but he’s not the only one,” he said. “The virus is everywhere.”

This report by The Canadian Press was first published April 7, 2021

— By Morgan Lowrie in Montreal with files from Caroline Plante and Jacob Serebrin

The Canadian Press

MARCH 24

MARCH 24

Guidelines for COVID-19 Fully Vaccinated People

The U.S. Centers for Disease Control and Prevention (CDC) released recommendations for fully vaccinated people who are two weeks past their second injection of the Moderna or Pfizer COVID-19 vaccines, or have had the one-dose Johnson & Johnson vaccine (JAMA, March 10, 2021). As of March 8, 2021, more than 31 million people (9.4 percent of the U.S. population) had completed these vaccines. Fully-vaccinated people may continue to shed the virus, even though they are protected from blood-borne infections, and so may still be able to infect others. Fully vaccinated people may still acquire the virus, but are at markedly reduced likelihood to suffer severe disease, be hospitalized, or die, or to transmit the virus to unvaccinated people. The CDC estimates that approximately one third of U.S. adults do not want to get vaccinated. It likely that, as with polio and smallpox, the pandemic will persist until a large percentage of the population are immunized.

Most people who have recovered from COVID-19 appear to gain immunity for more than six months (Science, 2021;371(6529):eabf4063). As vaccination helps to prevent infection from the SARS-CoV-2 variants that have been found so far, the CDC recommends that individuals who have recovered from COVID-19 should receive at least one injection of a COVID-19 vaccine.

At this time, CDC recommends that fully vaccinated people:

• can share gatherings in their private residence with vaccinated family and friends, without masks or physical distancing, but should wear masks and practice physical distancing if any unvaccinated people are present or if multiple households with unvaccinated people are mixing together

• will, with a few exceptions, no longer have to be tested for SARS-CoV-2 infection or quarantine if they are exposed to someone with COVID-19, allowing them to go to work, take care of their families, and continue their daily lives (exceptions to this recommendation include patients and residents of congregate settings)

• should continue to wear a well-fitted mask when in public or with people at risk of severe COVID-19, avoid large gatherings, and postpone travel

• should observe local mask mandates and restrictions on occupancy of indoor spaces or the size of social gatherings. Once vaccinated people make up a greater proportion of the general U.S. population, these community-level restrictions will be readdressed, but not yet.

MARCH 5

Johnson & Johnson’s COVID-19 Vaccine Approved

The Johnson & Johnson COVID-19 vaccine has been approved for emergency use in the U.S., and millions of doses are now being shipped. We already have mass immunizations underway with the Pfizer and Moderna vaccines, which look better and better as we keep getting new reports of their benefits and minimal side effects. Widespread distribution of the J&J vaccine should speed up our progress toward herd immunity to end this pandemic.

Different Types of Vaccines
Before COVID-19, vaccines were typically made by using either dead viruses, live inactivated viruses or parts of viruses. The Pfizer and Moderna vaccines are different from traditional vaccines because they contain lab-manufactured copies of human genetic material called messenger RNA (mRNA) that teaches your immune system to destroy the spike protein of the COVID-19 virus. The spike protein is the “key” that allows this virus to enter human cells, so if you are exposed to the virus that causes COVID-19, your immune system keeps you from being infected.

The J&J vaccine differs from the Pfizer and Moderna vaccines because it uses a harmless adenovirus that has not been shown to cause human disease, instead of mRNA. The J&J vaccine developers attached the spike protein of the virus that causes COVID-19 to the harmless adenovirus. When this vaccine is injected into you, your immune system learns to recognize and destroy the spike protein. Without the spike protein, the invading virus cannot get into your cells, so it will quickly disintegrate and you will not be infected with COVID-19.
• The adenovirus used in the J&J vaccine has been repeatedly shown to be safe; it does not cause human disease (Molecular Therapy, Nov 4, 2020;28(11):2303-2304).
• The spike protein attached to the adenovirus in the vaccine causes humans to develop very high levels of antibodies that destroy the spike protein and help to prevent COVID-19.
• Usually only one injection will cause very high protective levels of antibodies.
• Adenovirus-based vaccines are very stable, so they do not have to be stored at very low temperatures that are required for the Pfizer and Moderna vaccines.

More Vaccines On the Way
Another vaccine that is expected to be approved soon, the Oxford/AstraZeneca vaccine, uses the same principle as the J&J vaccine. It is made with a modified chimpanzee adenovirus. Trials of a fifth vaccine, from Novavax, show that it is safe and effective, and approval of this vaccine is also expected soon.

My Recommendations
Which vaccine should you try to get? I recommend that you take any vaccine you can get as soon as possible. All three of the approved vaccines have good safety and effectiveness records. In addition to protecting yourself and your loved ones, you will be doing a service to your fellow humans, since this COVID-19 pandemic will not end until about 85 percent of the population become immune. This will require a large percentage of the population to receive vaccines.

FEB 23

People Who Have Had COVID-19 Are Protected for Three Months, Probably More

Two studies suggest that you can get long-term immunity after being infected with COVID-19. People who previously had COVID-19 have high protective antibody titers for at least three months, and at six months still had persistent parts of the COVID-19 virus in their intestines that continued to cause high protection antibodies.

• One study showed that after you are infected with the virus or are vaccinated, you develop lasting B and T lymphocytes with viral neutralizing properties that can protect you for at least three months, and additional data with time will probably show much longer protection (Cell, Jan 7, 2021;184:169).

• The second study followed 87 patients who had proven COVID-19 infections (Nature, Jan 18, 2021). At 40 days they all had full protecting antibodies against COVID-19. After six months, they had 20 percent of the amounts of antibodies that were found at 40 days, but the six-month antibodies were more potent and could be more protective. At six months, seven of 14 patients also had COVID-19 virus remnants in their intestines.

Vaccinated People Can Skip Quarantine for Exposure to COVID-19

The U.S. Centers for Disease Control and Prevention (CDC) said on February 10, 2021 that those who have received the full course of COVID-19 vaccines can skip the standard 14-day quarantine after exposure to someone with the infection, as long as they remain asymptomatic. However, be aware that it may be remotely possible for a vaccinated person to transmit COVID-19 and infect someone else, even though they have no symptoms.

Data on Allergic Reactions to COVID-19 Vaccines

From December 14, 2020 through January 18, 2021, 66 allergic reactions occurred from 17,524,676 doses of the Moderna and Pfizer COVID-19 vaccines. That is an allergic reaction rate of about 6.6 cases per million doses administered (JAMA, February 12, 2021). Thirty-two percent of the 66 allergic reactions were in people who had had a prior episode of an allergic reaction to:

• vaccines (rabies, influenza A[H1N1], seasonal influenza, or unspecified)

• X-ray contrast media (gadolinium-based, iodine-based, or unspecified intravenous)

• unspecified injections

• sulfa drugs, penicillin, prochlorperazine, latex, walnuts, unspecified tree nuts, jellyfish stings

Current recommendations are that everyone should wait for 15 minutes after receiving a vaccine to see if an allergic reaction occurs, and those who have had previous allergic reactions to anything should wait for 30 minutes (MMWR Morb Mortal Wkly Rep, 2020;69(42):1522-1527). Common signs and symptoms in anaphylaxis cases include hives, diffuse red rash, swelling, difficulty breathing, or nausea. The personnel giving vaccines are always prepared to treat allergic reactions.

FEB 9

Johnson & Johnson’s COVID-19 Vaccine is Coming

The soon to be approved vaccine for COVID-19 from Johnson & Johnson requires just one injection, instead of the two required for the previously-approved vaccines from Pfizer and Moderna. The J&J vaccine can be stored with ordinary refrigeration and does not need the extremely cold storage required for the Pfizer or Moderna vaccines.

The J&J vaccine is reported to have an efficacy rate of 66 percent for preventing moderate and severe COVID-19 cases in 43,783 world-wide volunteers. This is less than the 95 percent efficacy rate reported for the Pfizer and Moderna vaccines. However, the J&J vaccine was tested in Africa where a mutated COVID-19 virus is more common and may be more resistant to the vaccines, so the difference in effectiveness may be due to resistant viruses and not due to differences between the vaccines. Flu shots given over many years typically have only up to 50 percent efficacy rates.

The J&J vaccine had an 85 percent rate for preventing severe cases of COVID-19, and none of the vaccinated participants who contracted the disease were hospitalized or died. Of more than 75,000 people who have received one of the vaccines in a research trial, not a single person has died from COVID-19, and only a few people have been hospitalized, none for more than 28 days. Compare that to the fact that of 75,000 people infected with COVID-19, 150 will die and hundreds will be hospitalized. Ordinary flu kills 15 out of every 75,000 infected adults and hospitalizes more than 100 of them.

• The J&J vaccine might be more effective if given as a two-shot vaccine, but it was tested with just one dose. A fourth vaccine, from Novavax, appears to be effective also and approval of this vaccine is expected soon.

• People who have had COVID-19 usually do not need more than one dose of a vaccine. They get extremely high antibody response from just one vaccination (medRxiv, preprint, Feb 1, 2021).

FEB 5

Johnson & Johnson’s COVID-19 Vaccine is Coming

The soon to be approved vaccine for COVID-19 from Johnson & Johnson requires just one injection, instead of the two required for the previously-approved vaccines from Pfizer and Moderna. The J&J vaccine can be stored with ordinary refrigeration and does not need the extremely cold storage required for the Pfizer or Moderna vaccines.

The J&J vaccine is reported to have an efficacy rate of 66 percent for preventing moderate and severe COVID-19 cases in 43,783 world-wide volunteers. This is less than the 95 percent efficacy rate reported for the Pfizer and Moderna vaccines. However, the J&J vaccine was tested in Africa where a mutated COVID-19 virus is more common and may be more resistant to the vaccines, so the difference in effectiveness may be due to resistant viruses and not due to differences between the vaccines. Flu shots given over many years typically have only up to 50 percent efficacy rates.

The J&J vaccine had an 85 percent rate for preventing severe cases of COVID-19, and none of the vaccinated participants who contracted the disease were hospitalized or died. Of more than 75,000 people who have received one of the vaccines in a research trial, not a single person has died from COVID-19, and only a few people have been hospitalized, none for more than 28 days. Compare that to the fact that of 75,000 people infected with COVID-19, 150 will die and hundreds will be hospitalized. Ordinary flu kills 15 out of every 75,000 infected adults and hospitalizes more than 100 of them.
• The J&J vaccine might be more effective if given as a two-shot vaccine, but it was tested with just one dose. A fourth vaccine, from Novavax, appears to be effective also and approval of this vaccine is expected soon.
• People who have had COVID-19 usually do not need more than one dose of a vaccine. They get extremely high antibody response from just one vaccination (medRxiv, preprint, Feb 1, 2021).

JAN 21

Two New COVID-19 Vaccines Coming Soon

The Pfizer\BioNTech and Moderna messenger RNA (mRNA) vaccines are already available for some people. They require two injections and look better all the time, with very few serious reactions so far and good antibody response for prevention of COVID-19.

Two more vaccines appear ready to be available soon for public immunization. These not-yet approved vaccines, Johnson & Johnson/Janssen and AstraZeneca/Oxford, are different from the Pfizer and Moderna vaccines:
• The Johnson & Johnson/Janssen uses a virus called Adenovirus 26 that causes colds or flu-like symptoms (NEJM, Jan 13, 2021), while
• The Astra/Zeneca/Oxford vaccine uses a chimpanzee common cold virus (Lancet, Jan 9, 2021;397(10269):99-111).

Both of these new vaccines will help to protect you from COVID-19 because they contain the same gene (as the Pfizer and Moderna vaccines) for the spike protein that gets the COVID-19 virus into human cells. However, they have the spike protein added to two different viruses, while the Pfizer and Moderna vaccines contain no viruses whatever.
• The advantage of using viruses is that the virus vaccines are far more stable because they work through DNA instead of the less-stable mRNA for the spike protein.
• They are also more stable than the mRNA vaccines because the virus’s outer protein coat helps to protect the genetic material inside the cells, so they do not need to be frozen and can be refrigerated for three months at 36–46 degrees Fahrenheit (2–8 degrees Celsius). The mRNA vaccines are very unstable and have to be frozen at low temperatures.
• The viruses used in the Johnson & Johnson and AstraZeneca vaccines can enter human cells but cannot reproduce and therefore will not cause an infection.
• After the viruses enter a human cell, they then go inside the cell nucleus.
• The viruses contain the gene for the coronavirus spike protein and the invaded human cell makes copies of the coronavirus mRNA to make lots of new spike proteins.
• Then the human cells recognize that the spike protein is a foreign protein and treat it like an invading germ and destroy it.
• After you receive the vaccine, your immune system will work to destroy the spike protein when and if it tries to get into your own cells in the future.

Current Status of the Johnson & Johnson Vaccine
J&J has reported the results of their trial that included 402 people, ages 18 to 64, and 403 people over age 65. Some of these subjects also received a second dose 56 days later. Side effects included: injection site pain which usually resolved within 24 hours, fever, fatigue, headache, and muscle pain. By day 57, all volunteers had detectable antibodies, regardless of vaccine dose or age group, and remained stable for at least 71 days in the 18-to-55 age group (NEJM, Jan 13, 2021). The vaccine appears to be effective as both low and high doses caused a lasting high rise in protective S-binding and neutralizing antibodies in more than 90 percent of the trial subjects, for at least 71 days.

J&J expects its single dose vaccine to be available in March 2021. The Department of Health and Human Services announced it already has a deal with Janssen, J&J’s pharmaceutical subsidiary, worth about $1 billion for 100 million doses of its vaccine. The government has an option to buy an additional 200 million doses.

Current Status of the AstraZeneca Vaccine
The AstraZeneca/Oxford vaccine appears to be safe and effective (Lancet, Jan 9, 2021;397(10269):72-74). Four randomized, controlled trials conducted in the UK, South Africa, and Brazil report safety and benefit of the AstraZeneca chimpanzee adenovirus vaccine for adults aged 18 years and older (Lancet, 2020; 396: 313-319). The vaccinated people had:
• No COVID-19-related hospital admissions
• Short term protection for a single dose, with protective antibodies after 21 days
• Protective antibodies 14 days after the second dose in the two dose group
• No deaths from the vaccine
• The same number of serious side effects in the vaccinated and placebo groups
• Serious events included one case of transverse myelitis occurring 14 days after booster vaccination. However, two additional cases occurred in a control patient and a patient with pre-existing multiple sclerosis.

The AstraZeneca vaccine is expected to be given in two doses 28 days apart. Data to receive emergency use approval in the U.S. has not yet been submitted, but may be ready in late Spring 2021.

My Recommendations
At present, there is a shortage of available vaccines, but more than 200 different companies are working hard to develop new vaccines to help prevent COVID-19. While you are waiting your turn to be vaccinated, make sure that you follow all the rules for keeping yourself protected from becoming infected: restrict being in indoor places where people congregate as indoor air is the main source of infection, wear a mask, keep at least six feet away from people who are not in your immediate household and wash your hands frequently.

JAN 7

Safety of the Messenger RNA Vaccines for COVID-19 (Pfizer and Moderna)

Results from clinical trials of the Pfizer-BioNTech and the Moderna COVID-19 vaccines showed about 95 percent effectiveness in preventing COVID-19 infections, and they were given Emergency Use Authorizations (EUA) by the U.S. Food and Drug Administration (FDA) on December 13 and December 20, 2020. The U.S. Centers for Disease Control and Prevention (CDC) says that the clinical trial data “demonstrate that the known and potential benefits of these vaccines outweigh the known and potential harms of becoming infected with the coronavirus disease 2019 (COVID-19). However, we cannot say that the vaccines are safe until we have vaccinated millions and have had longer follow-up periods.”

Reported Vaccine Side Effects

So far, minor side effects from the vaccine are common, but they last for just a day: fatigue, headaches, chills, fever, muscle or joint pain, swelling, redness, heat or hardness at the injection site. Now that the vaccine is being widely distributed, data on side effects and complications are being collected and analyzed through CDC’s Vaccine Adverse Event Reporting System (VAERS).

These vaccines contain no virus or parts of the virus. Both contain messenger RNA (mRNA) that was manufactured in the laboratory. The mRNA that is injected into you in the vaccine enters some of your cells, where the cells’ machinery uses that RNA to make copies of the spike protein of the virus that causes COVID-19. The mRNA itself is destroyed within a few hours after it enters your body. The spike protein of the coronavirus that you made is a foreign protein, so your immune system recognizes that it is different from you. From then on, if the coronavirus enters your body, your immune system does not attack the coronavirus; instead, it attacks and destroys the spike protein of the coronavirus. The spike protein is the key that lets the virus get into your cells. If your immune system destroys the spike protein, the virus cannot get into your cells and disintegrates very quickly.

Everything that you have gotten from the vaccine, including the spike protein copies that your body makes, is gone except the memory of the spike protein for which you are now immune. It looks like this vaccine is safer than all previous vaccines. There is no dead virus. There is no live virus. There is no weakened virus. There is only your immunity against the spike protein.

False Rumors of Side Effects

• There is no evidence to show that mRNA in a vaccine can cause cancer. The mRNA is destroyed soon after it enters your body.

• mRNA does not change your genes. All it does is teach your immune system to recognize and attack the spike protein of the coronavirus if it ever enters your body.

• No fetal tissue is used in the vaccine.

• The vaccines do not cause infertility.

• mRNA cannot cause COVID-19. The vaccine does not contain the virus that causes COVID-19 or any part of the virus.

Who Should Receive a Vaccine?

• People who have diabetes, heart disease, lung disease and similar conditions need to get the vaccine as they are most vulnerable to serious complications from COVID-19.

• People with suppressed immune systems from cancer chemotherapy or immune diseases should be vaccinated.

• At this time, the CDC recommends that those who have had COVID-19 should still get the vaccine.

• After you have been vaccinated, you still should wear a mask and practice all precautions against developing COVID-19 for at least eight weeks. Watch for further guidance from the CDC on this.

CDC Guidance for COVID-19 Vaccination in People with Various Medical Conditions

The CDC has said that “mRNA COVID-19 vaccines (Pfizer and Moderna) may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine.”

• We do not have good data on people with immune defects, an overactive immunity, or certain diseases or conditions.

• We have no data yet on the safety of the vaccines for people with HIV, weakened immune systems, or autoimmune conditions such as Guillain-Barre syndrome. People with HIV and weakened immune systems “may receive a COVID-19 vaccine, but they should be aware of the limited safety data . . . People with HIV were included in clinical trials, but safety data specific to this group are not yet available at this time.”

• Bell’s palsy, a temporary facial paralysis, was reported in one person receiving the Pfizer and Moderna vaccines in clinical trials. There is no evidence that the vaccine caused the temporary paralysis of the facial nerve, and at this time, the CDC says that “People who have previously had Bell’s palsy may receive an mRNA COVID-19 vaccine.”

How Rare Side Effects Get Detected

No one in the Pfizer or Moderna trials developed Guillain-Barre syndrome (GBS), a rare disorder in which your own body’s immune system attacks your own nerves. Statistically, one person in 100,000 can be expected to develop Guillain-Barre syndrome, so if a million people are vaccinated, you would expect to see perhaps 10 cases. However, if you have 30 people out of a million who develop Guillain-Barre after vaccination, you may suspect a link to the vaccine. This is why rare side effects may not be identified until after huge numbers of people have received a vaccine. In this example, Guillain-Barre syndrome usually starts as weakness and tingling in your arms or legs and can spread, in extreme cases, to paralyze the whole body. If this happens, the person must be hospitalized immediately, but the vast majority will recover completely.

Severe Allergic Reactions (Anaphylaxis)

Britain has reported several cases of anaphylaxis among people who have received the Pfizer vaccine. In the U.S., 11 cases have been reported since the vaccine rollout began earlier this month, according to the CDC. Most followed receipt of the Pfizer vaccine, but a Boston doctor with a shellfish allergy developed a severe allergic reaction after receiving the Moderna vaccine. If and when other COVID-19 vaccines are authorized for use, health authorities will be watching closely to see whether anaphylaxis may be linked to all COVID-19 vaccines or only to those such as the Pfizer and Moderna vaccines that are made using mRNA.

A three-year review of adverse reports logged into a U.S. national vaccine database found that anaphylaxis after any type of vaccination is rare, occurring at a rate of about 1.31 per million doses of vaccine administered. Of those cases, 85 percent were in people with a history of allergies. None of the 33 cases — out of 25 million vaccinations in this database — died. Some were given epinephrine, the drug in EpiPens, while others recovered after treatment with antihistamines.

My Recommendations

The COVID-19 vaccines from Pfizer and Moderna contain no virus particles whatever. They contain mRNA that so far appears to be even safer than previous vaccines that contained live, dead or weakened viruses. However, we can make absolute claims of safety only after millions of people have been vaccinated, and we have years of follow up. Realize that this pandemic will not end until about 85 percent of the population is immunized, mostly through vaccinations. Getting a vaccine is always a personal decision, but I believe that the risks of having the disease are far greater than the risks of having the vaccine.

JAN 1 2021

Low Vitamin D Increases COVID-19 Risks

If your vitamin D level is below 30 ng/mL, you are at increased risk for contracting COVID-19. A review of 40 studies showed that adequate vitamin D reduced the frequency and severity of COVID-19 infections and hospital admissions, and lowered the death rate (BMJ, Oct 5, 2020;371:m3872). Another review of 86 papers showed the benefits of vitamin D for all aspects of COVID-19 infections (Front Public Health, Sept 10, 2020;8:513). Several studies show that vitamin D deficiency has been associated with increased death rate from COVID-19 (Scientific Reports, Nov 19, 2020;10:20191; Eur J of EndomedRxiv, May 7, 2020; JAMA Netw Open, Sept 3, 2020;3(9):e2019722).

The most recent studies suggest that you should take vitamin D pills to raise blood levels above 30 ng/mL, and most people can do this by taking 1000 IU pills each day. There is no evidence that higher doses of vitamin D offer greater protection from COVID-19 than moderate doses. Blood levels higher than 60ng/mL can cause serious tissue damage.

Vitamin D Strengthens Your Immune System
Vitamin D helps your immune system to fight off the effects of COVID-19. Doctors are treating severe COVID-19 with dexamethasone, which has a similar steroid structure to that of vitamin D. COVID-19 can kill by causing an overactive immune system called “cytokine storm, ” and vitamin D helps to reduce cytokine storm by decreasing the production of T helper cells and inflammatory cytokines (APMI, 2019;127:681-687), and by increasing anti-inflammatory cytokines (Nutrients, 2020;12:E236).

Vitamin D deficiency is associated with other risk factors for severe COVID-19, such as obesity, diabetes, older age or darker skin (NFS Journal, Aug 2020;20:10-21; BMJ Nutrition, Prevention & Health, May 13, 2020).

How Common is Vitamin D Deficiency?
About 42 percent of North Americans have low levels of vitamin D, including 82 percent of African-Americans and 70 percent of Hispanics (Nutr Res, Jan 2011;31(1):48-54). You need to get vitamin D from sunlight exposure, the foods that you eat, or vitamin D pills. Foods that contain some vitamin D include cold-water fish such as salmon, herring, sardines or mackerel, and red meat, liver and egg yolks. Many North Americans get enough vitamin D in the summer, but need pills or fortified foods in the winter months. In warmer weather, you can usually get enough vitamin D with 10 to 20 minutes of sunlight exposure of a small area of skin 3-5 times a week.

Do Not Overdose on Vitamin D
You cannot be poisoned by vitamin D through sun exposure or diet alone, but vitamin D poisoning can occur when people take high-dose supplements for an extended time. Unless your doctor prescribes higher doses, you should not take more than 2000 IU/day. Vitamin D is harmless in your body when it is bound to vitamin D receptors and carrier proteins. (J Clin Endocrinol Metab, 1986 Oct;63(4):954-9). However, having extra vitamin D floating in your system overwhelms vitamin D receptors to cause a marked increase in calcium to be absorbed from your gut (Am J Clin Nutr, 2004 Dec;80(6 Suppl):1689S-96S) and removed from your bones (Oman Med J, 2011 May;26(3):201-4) to cause high blood calcium levels that can bind to and damage every cell in your body.

High blood calcium levels from excess vitamin D can cause bone loss, brittle bones and bone pain. People who took high doses of vitamin D (4000 and 10,000 IU/day) for three years lost far more bone than those who took the recommended 400 IU/day (J Bone and Mineral Research, September 11, 2020). High levels of vitamin D also cause low levels of vitamin K2, with resultant loss of bone (Med Hypotheses, 2007;68(5):1026-34). Vitamin K2 helps to keep calcium in bones.

After several months of having high blood calcium levels and having no symptoms at all, you can develop kidney failure and not even know it. You may develop nausea, vomiting, diarrhea, constipation or muscle weakness. You can also develop high blood pressure, kidney stones, or calcium in your arteries to increase risk for a heart attack. Since vitamin D accumulates in and is released very slowly from fat, it can take months for blood levels of vitamin D to return to normal.

My Recommendations
I think that everyone should get a blood test for hydroxy vitamin D, particularly in the winter months when your levels are likely to be lowest. During this pandemic, you should not let blood levels of hydroxyvitamin D drop below 20 ng/mL and most recent papers now recommend 30 ng/mL or more. Unless your doctor recommends higher doses, you should not try to get levels much higher than 30 ng/mL, since very high levels can harm you.

If your blood levels of hydroxy vitamin D are below 30 ng/mL, take vitamin D3 pills of at least 1000 IU/day for one to two months. If your blood levels of vitamin D do not return to normal, check with your doctor about taking higher doses or getting a medical evaluation for the cause of your deficiency.

Anyone suspected of being infected with COVID-19 should get a hydroxy vitamin D blood test and immediately start taking vitamin D3 supplementation if the blood level is below 30 ng/mL.

DEC 24

Long COVID-19 Syndrome

Most people who develop COVID-19 recover in 2-6 weeks, but between 10 percent (BMJ, Aug 11, 2020;370:m3026) and 70 percent (JAMA, 2020;324(6):603-605) of recovered COVID-19 patients develop “Long COVID-19 Syndrome,” suffering at least one symptom for many weeks or months after their initial infection. In a study from China, 16 percent of COVID-19 patients still suffered from significant symptoms three months after they had appeared to recover (EClinicalMedicine, Aug 25, 2020:100463). Young children are least likely to develop severe COVID-19, but 66 percent of recovered children had some sign of organ damage four months after their initial symptoms (BMJ, Nov 17, 2020;371:m4470).

The U.S. Centers for Disease Control and Prevention (CDC) lists the following Long COVID-19 symptoms:
• chest pain
• shortness of breath
• irregular heartbeats
• fatigue
• muscle weakness
• fever
• difficulty concentrating
• forgetfulness
• irregular periods
• impotence
• diabetes
• hair loss
• mood changes
• insomnia
• headaches
• diarrhea
• vomiting
• loss of taste and/or smell
• sore throat
• difficulty swallowing
• skin rash

Lungs: A three-month follow up of mildly infected people found that more than 70 percent had abnormal lung scans (EclinicalMedicine, Aug 25, 2020:100463). More than half of infected people had “ground glass” opacities in their lungs, a sign of lung damage that can lead to long-term breathing problems (Radiol CardioImag, Mar 17, 2020;2(2)).

Heart: Up to 30 percent of people hospitalized with COVID-19 have signs that the illness has affected their heart muscle (JAMA Cardiol, Mar 27, 2020;5(7):831-840). These researchers speculate that in some people, COVID-19 may also cause an inflammation of the heart muscle called myocarditis. Lasting damage to the heart muscle can occur even in people who experienced only mild COVID-19 symptoms.

Impotence and irregular periods: Testes and ovaries both have ACE2 receptors, through which the COVID virus enters human cells. The virus can damage endothelial cells lining your blood vessels (Eur Heart J, Aug 21, 2020;41(32):3038–3044), a common cause of erectile dysfunction. Men hospitalized for COVID-19 are at increased risk for having low levels of testosterone (medRXiv preprint, Dec 20, 2020), and low testosterone is associated with more severe COVID-19 disease (Andrology, published online May 20, 2020) and future infertility (Eclinical Med, Nov 1, 2020;28:100604). Almost 30 percent of women infected with COVID-19 had menstrual cycle changes, primarily decreased blood flow or prolonged cycle time (Reprod Biomed Online, Sep 29, 2020).

The nervous system: People who have had severe COVID-19 were significantly more likely to suffer nerve damage including dizziness, nerve pain, and impaired consciousness (JAMA Neurol, Apr 10, 2020;77(6):683-690).

Mental health: People who have been infected with COVID-19 often suffer stress, anxiety, depression, and sleep disturbance, and are at increased risk for psychiatric disease (Lancet, November 09, 2020).

Diabetes: There has been a significant increase in the diagnosis of diabetes during the pandemic (N Engl J Med, Aug 20, 2020; 383:789-790). COVID-19 can damage every organ in your body including your pancreas.

Chronic fatigue syndrome: Many people with lasting COVID-19 symptoms report episodes of what is now called myalgic encephalomyelitis, a long-term condition that can follow any viral infection: severe physical fatigue and pain during exercise, difficulty breathing, joint pain, chest pain, loss of memory and usual ability to think clearly, difficulty sleeping, and muscle pain after trying to exercise (JAMA, 2020 Aug 11;324(6):603-605).

My Recommendations
As the COVID-19 pandemic continues, we are learning more about the long-lasting or possibly permanent damage the virus can cause. The apparent frequency of Long COVID-19 Syndrome makes getting a vaccination even more important. The pandemic will last until we have herd immunity, when about 80 percent of the population is immune. This could occur within a year now that widespread distribution of effective vaccines has begun. Watch the news in your area for information on local vaccine availability.

Meanwhile, I remind you once again to protect yourself and help limit spread of COVID-19:
• Wear a face mask any time you expect to be close to people who are not members of your household.
• Try to stay at least six feet away from other people.
• Avoid anyone with respiratory symptoms.
• Use 20-second soap hand washes frequently throughout the day.
• If you feel sick, stay home.
• If you decide to travel, go by car if possible. Personally, I am still avoiding group travel such as trains, planes, buses and ships.
• Spend lots of time outdoors. Transmission of the virus occurs most often in closed spaces, particularly crowded places or rooms with poor air circulation.

COVID-19 Vaccine: Common Side-effects You Should Know About

Thu, November 26, 2020, 4:39 AM EST·2 min read

Medical researchers around the world are on a war footing to develop effective vaccines against the COVID-19 virus, which has devastated healthcare systems, economies and life in general. Many of the vaccine candidates which are at different stages of trials have shown promising results. The frontrunners include Pfizer, Moderna, Oxford-Astrazeneca and Sputnik V among several others.

While different vaccines have exhibited high efficacy rates of over 90 per cent, the concerns surrounding their usage is also crucial to understand. Doctors and specialists have cautioned that getting inoculated can be a complicated process as several side-effects have been observed during the trials of the vaccines.

These side-effects have not been found to be too dangerous and at any rate no vaccine that creates life-threatening complications would be approved. It is, however, advisable for the general public to know about the potential side-effects to be better prepared. Here are some of the side-effects of COVID-19 vaccines:

1. Headaches

Headaches are very common with over 50 per cent of people who were vaccinated during trials experiencing varying levels of pain.

2. Fever and chills

Fever and chills are among the most common side-effects observed in Moderna vaccine trials. One participant developed a fever up to 102 degrees Fahrenheit following a dose, which subsided within a few hours without any medical assistance.

3. Nausea and vomiting

Trials have shown that the vaccine can affect the gastrointestinal system resulting in nausea and vomiting. One of Moderna’s participants who received a high dose was left feeling “down and out” for hours. The shot may also induce abdominal cramps and fatigue.

4. Migraines

The COVID-19 vaccine can induce migraine pain, especially in individuals having a history of the disease. One of Pfizer’s trial participants reportedly felt a debilitating migraine pain which left her exhausted. People are advised to take suitable rest following the vaccination. Taking a day off from work would be a good idea.

5. Muscle pain and soreness

Getting a vaccine injected can also cause soreness, muscle pain and rashes. These can be due to the immune response of the individual. Pfizer, Moderna and Oxford-Astrazeneca trials have found these symptoms in several participants.

NOV26

Three Effective COVID-19 Vaccines Should Be Available Soon

We now have three apparently safe and effective vaccines to help stop the current COVID-19 pandemic. The latest estimates are that the pandemic will not end until 70 to 90 percent of the North American population has some degree of immunity(JAMA, 2020;324(8):732). Since natural infections will never get us to that level, everyone should be immunized against COVID-19 as a civic responsibility to help protect the people who are most vulnerable to serious consequences from this disease.

AstraZenica (with the University of Oxford) says that it will have three billion doses of its vaccine available in 2021, and Moderna and Pfizer/BioNTech are expected to have 20 million doses ready by Jan 1, 2021. We do not yet have the full data to prove that the vaccines are safe, but so far the trials have shown no real concerns. The main reason that I think the vaccines are safe is that they do not contain the coronavirus. AstraZenica’s vaccine contains a safe adenovirus, and the Moderna and Pfizer vaccines contain no living viruses whatsoever. All three of these vaccines cause your own immune system to produce antibodies against the coronavirus’s M-spike protein, which is the key that gets the virus into human cells. If your immune system destroys the M-spike protein, the virus cannot get into human cells and dies quickly after it enters your body.

We are hearing that the vaccines will be given free of personal charge, with governments covering the costs. The AstraZeneca vaccine will cost $3 to $4 per shot and can be stored in regular refrigerators. The Moderna and Pfizer vaccines are expected to cost between $15 and $25 per dose. Both require cold storage, with Moderna’s needing to be kept at -4F but stable for 30 days in ordinary refrigerator temperatures, while Pfizer’s needs long term storage at -94 F, with five days at refrigerator temperatures.

My Recommendations
It is likely that vaccines will be available in your area by early January. Watch for news from your local authorities about availability and priorities so that you can get vaccinated as a service to your family and other members of your community.

Get Your Flu Shot During the COVID-19 Pandemic

OCT 23

Herd Immunity With Vaccines

We are in the midst of a serious pandemic in which more than 34 million people have been infected and more than one million have already died worldwide. Before 2019, no human had been infected with the coronavirus SARS-CoV-2, that causes the disease called COVID-19. The pandemic is so extensive and deadly because this coronavirus is highly transmissible and all humans who are exposed to SARS-CoV-2 will become infected. The only way that the pandemic will end is when a sufficient percentage of people become immune to COVID-19, most by being vaccinated plus a lesser number of people who have been infected with the virus and recovered. This is called herd immunity. Researchers tell us that in the U.S., the pandemic will not end until about 40 to 70 percent of the population is immune. We do not know how long vaccinated people will be protected from getting COVID-19, but recent studies look very encouraging.

People Who Recover from COVID-19 Appear to Have Lasting Immunity
Scientists from the University of Arizona, College of Medicine -Tucson, followed more about 6000 people who developed COVID-19 infections and found that most were immune to that virus seven months after infection, because their blood contained two potent antibodies to protect them (Immunity, October 13, 2020). There are reports of people who were thought to have recovered from COVID-19 appearing to have been infected a second time, and there is one report in which a person died from his second infection. However, the authors of the Arizona study feel that most people who recover from COVID-19 may be protected against getting the disease again for a long time. Details of this study include:
• Viruses are not living units; they must get into cells to stay alive. If they cannot get into cells, they die very quickly. The coronavirus has a spike protein that is the key that lets it enter human cells. If that spike protein is damaged, the virus cannot get into human cells and it dies very quickly.
• About 14 days after you are infected with the coronavirus, your immune system’s plasma cells produce short-term IgM and IgA antibodies to attach to and kill the virus. Later your immune system produces long-term IgG antibodies that can last up to a lifetime against some viruses and can prevent you from getting a second infection.
• The authors developed a very accurate test to measure these long-term IgG antibodies against the regions that contain the spike protein that lets the virus enter human cells.
• Their research found that most people who recovered had high levels of long-term IgG antibodies against the spike protein regions of the coronavirus for at least five to seven months after infection, the time they collected their data to write this report. They believe that future data will show that these antibodies will last much longer than that.
• Several papers already show that long-lasting IgG antibodies against a similar virus called SARS-Cov-1 last at least 17 years, the longest that data has been collected so far.
• Of 5,882 tests completed in the Arizona study, there was only one false positive. The U.S. Food and Drug Administration granted emergency use authorization for this test in August 2020.

Reaching Herd Immunity with Vaccines
Herd immunity will not be achieved by waiting for everyone to become infected “naturally”; it will only occur when we have an effective vaccine for the virus. For example, polio recurred “naturally” every year in the United States for more than 40 years, from 1916 to the mid 1950s, until the Salk vaccine was developed and administered in more than 90 countries. Vaccines have controlled polio, smallpox, diphtheria, rubella, and many other infectious diseases. For some of these diseases, a single course of vaccination protects for a lifetime, while others such as influenza require more frequent vaccines.

For a graphic explanation of how herd immunity works, study this demonstration from the Washington Post. Run the simulations several times, and go all the way to the end to see how many deaths would occur if “natural” spread of COVID-19 were used to try to reach herd immunity, without vaccines. Note that herd immunity does not require that everyone get vaccinated. Only about 40 to 70 percent of the population needs to be immune, which will include both people who have been vaccinated and a smaller number of people who have been infected with the disease. Whether or not you get vaccinated will always be a personal decision.

Coping Until the Pandemic Ends
The COVID-19 pandemic will continue until we have herd immunity, which should occur within a few years after widespread distribution of an effective vaccine. We do not yet know how long a vaccine will protect a person, and whether vaccination will be needed just once or more often, as with yearly flu vaccines. Future studies will tell us how long the protection lasts, either from a vaccine or from having been infected.

Until vaccines become available, my rules to live by include:
• Wear a face mask any time you expect to be around people who are not members of your household
• Stay at least six feet away from other people
• Avoid anyone with respiratory symptoms
• Use 20-second soap hand frequently washes throughout the day
• Try not to touch your eyes, nose or mouth, the primary sources of viral entry into your body
• If you feel sick, stay home
• If you decide to travel, go by car if possible. Personally, I am avoiding group travel such as trains, planes, buses and ships.
• Spend lots of time outdoors. Transmission of the virus occurs most often in closed spaces, particularly crowded places with poor air circulation.

I will continue to report to you about the development and testing of vaccines. See my earlier articles on:
Making Vaccines to Stop the COVID-19 Pandemic
Inhaled COVID-19 Vaccine Being Tested

  September 25, 2020   

A flu shot will help to protect you from this year’s flu viruses. A flu shot will not protect you from developing COVID-19, but a study of more than 92,000 Brazilian patients with COVID-19 showed that the odds of severe disease, ventilatory support requirement, and death were reduced in people who had a recent trivalent flu vaccine (MedRxiv, June 2020, preprint).

You can get a flu vaccine at your doctor’s office, health department, pharmacies, drive-through immunization services, curbside clinics, mobile outreach units, or home visits. You can use VaccineFinder.org to find where flu vaccines are available near you. I always recommend that you should get a flu shot in the fall each year, but this year it is particularly important because the combination of flu and COVID-19 cases during the winter could overload medical facilities. You may find it difficult to get doctor’s appointments, certain medications or hospital space.

  • It takes two weeks for the flu vaccine to protect you, so get your flu shot now.
    • Flu and COVID-19, individually, can cause serious illness, including hospitalization and death.
    • Doctors have tests for both flu A and B viruses and for SARS CoV-2, the virus that causes COVID-19.
    • You can be infected with the flu and SARS-CoV-2 viruses at the same time.
    • People at high risk for COVID-19 complications (such as having high blood pressure, obesity, diabetes, heart disease, lung disease or organ damage, and anyone over 65 years of age) should get their flu vaccine as soon as possible.
    • Everyone over six months of age should be immunized, with few exceptions.
    • Do not get a flu vaccine if you think you may have COVID-19.
    • There is no evidence that flu vaccination increases risk for COVID-19 (Clin and Trans Sci, Sept 21, 2020).

High-Dose Flu Vaccines For People Over 65
The newer special high-dose vaccines for those over 65 appear to be about 25 percent more effective than the standard-dose vaccines. Fluzone High-Dose Trivalent is composed of three flu strains most likely to cause the flu this winter. Fluzone High-Dose Quadrivalent has just been approved and is made up of four flu strains. Both vaccines contain four times as much flu virus antigen as the other vaccines and produce a much greater immunity. Since many people over 65 have lower levels of immunity, these vaccines offer better levels of protection against getting the flu and having serious side effects from the flu. Be aware that these vaccines are more likely to cause minor side effects such as a fever or a sore arm after you receive the injection.

AUG 28

How Would I Treat Myself If I Got COVID-19?

I have received many emails asking me how I would treat myself if I developed COVID-19.

If I had COVID-19 and was not very sick, I do not know if I would take anything. Today there are no drugs or treatments proven to prevent or cure COVID-19, and the U.S. Food and Drug Administration (FDA) has not licensed any treatment specifically for the virus, but has allowed emergency use for some treatments. Since a successful drug will bring billions of dollars to the company that develops it, you have to be very cautious about many of the press releases put out by companies racing to find treatments. If I had only mild symptoms, I would probably just take it easy (as I would with the flu or a bad cold) and not take any drugs. However, new controlled studies are being reported daily so my opinion may change at any time. People with heart disease, lung disease, diabetes, auto-immune disease, cancer or obesity and those over 65 are at increased risk for complications, so their doctors may elect to prescribe some of the treatments listed below.

If I was very sick: COVID-19 kills people by 1) forming clots throughout their bodies, particularly in their lungs and heart, and 2) creating a “cytokine storm,” an overactive immune system that uses the same cells and proteins that kill germs to turn around and attack the person’s own body. The treatment for very sick COVID-19 patients should include drugs to dampen down an overactive immune system and possibly drugs to prevent clots. If I was very sick with COVID-19, I would probably request:

• Vasoactive Intestinal Polypeptide (VIP, brand name Aviptadil). The FDA and the National Institutes of Health (NIH) have fast tracked an old drug called VIP for further studies because it has been around for more than 20 years, appears to be safe, is not too expensive, and may be effective in treating COVID-19. COVID-19-related death is usually caused by lung failure, and more than 100 studies over more than 20 years have shown that VIP is very safe for humans suffering from lung diseases such as sarcoidosis, pulmonary fibrosis, asthma, and pulmonary hypertension. Patients who survived being on ventilators for COVID-19 have had much higher levels of VIP in their blood than those who died of respiratory failure. VIP dampens down inflammation, an overactive immune system called “cytokine storm.” VIP has caused critically-ill COVID-19 patients to gain: 1) rapid clearing of pneumonia on X rays, 2) a marked improvement in blood oxygen saturation, and 3) a more than 50 percent decrease in laboratory test markers of inflammation. VIP inhibits the growth of SARS-CoV-2 (the virus that causes COVID-19) in human lung cells and in monocytes that help to regulate immunity.

• Dexamethasone or other corticosteroids, or other immune suppressants. Data show that these drugs help to stop the body from attacking itself (“cytokine storm”) so patients who are close to dying can recover from COVID-19. They help to shut down an overactive immune system but can harm you if they dampen your immune system too much and allow the virus to spread further through your body.

• Remdesivir, a drug that has been reported to prevent some viruses from reproducing in humans. One study showed that remdesivir shortened hospital stays from 15 to 11 days in very sick COVID-19 patients (N Engl J Med, May 22, 2020).

• Convalescent plasma, serum taken from the blood of people who have recovered from COVID-19, because it has antibodies specific to kill the virus that causes COVID-19, has been given to thousands of patients with diseases other than COVID-19, and may have helped patients with serious influenza symptoms. Antibodies taken from the blood of recovered patients have been used for more than 100 years to treat more than 80 diseases, including AIDS, and appear to be safe. Many companies are working to show that blood from recovered COVID-19 patients will help to treat the disease. We do not yet have any controlled studies to show that convalescent plasma is effective for COVID-19; I will continue to watch for study results.

• Interferons are produced normally by your immune system when you have an infection, and SARS-CoV-2 somehow reduces your body’s production of interferons. They have been shown to prevent infections in both animals and humans and have been given to many hundreds of thousands of people with various other infections, but we have very few controlled studies in COVID-19 patients. One British study showed that inhaled interferon helped hospitalized patients recover from COVID-19.

• Anticlotting drugs: Clotting is a major cause of death in COVID-19 and there is no doubt that anticlotting agents can save lives. However, a serious concern is that they can also cause bleeding, so we do not know how safe anticlotting agents are in treating COVID-19.

Other Treatment Options for Very Sick COVID-19 Patients
• Blood filtration systems: The FDA has granted emergency use for several devices that filter the immune chemicals called cytokines from the bloodstream.
• Ventilators: These are machines that help people breathe in more oxygen.

The following treatments may have some potential, but I would probably not take them because so far there is no strong data to show benefits.
• Favipiravir has been shown to be of some benefit in treating serious cases of influenza, but I know of only one small study to show benefit in treating COVID-19.
• Recombinant ACE-2 helps to prevent the virus from getting into human cells in tissue cultures, but I know of no published human studies.
• Lopinavir, Leronlimab and Ritonavir are HIV drugs that stop tissue culture growth of the coronavirus, but I have not found any controlled studies that show that they are effective in treating COVID-19.
• Ivermectin helps to rid humans of parasitic worms and blocks the coronavirus from growing in tissue cultures. I can find no controlled human COVID-19 studies. It has lots of side effects.
• Hydroxychloroquine and chloroquine have been around for more than 60 years to treat malaria and some auto-immune diseases. They have been shown to stop SARS-CoV-2 from reproducing in tissue culture, but so far no controlled studies have shown that they help to treat COVID-19 in humans, seven controlled studies showed that they are not effective, and at least one study failed to show that they are effective in treating COVID-19 in monkeys. The FDA has cautioned that hydroxychloroquine or chloroquine, alone or with the antibiotic azithromycin, should not be used outside a hospital or clinical trial because of the risk of irregular heartbeats that can be fatal.
• Oleandrin is an extract of the oleander plant, a common garden shrub that is highly poisonous. It can cause irregular heartbeats and kill you. I have found no controlled studies on humans showing that it is safe or effective. This deadly plant should definitely not be used for self-medication.

My Recommendations Are Likely to Change
Since the virus first showed up in significant numbers in January 2020, companies all over the world have mobilized at an incredibly fast rate to be the first to produce studies to show that their drugs are effective. The rewards for success are huge, so we should expect successful treatments soon. Even more important for ending the pandemic will be the vaccines that are currently being tested.

AUG 7

Making Vaccines to Stop the COVID-19 Pandemic

The only way that scientists are going to end this current pandemic is to develop vaccines and immunize enough people to reach immunity in about 40 percent of the population from the vaccines or by having been infected with the disease (Science, June 23, 2020). To make previous vaccines, scientists took the offending virus and weakened or killed it so it would be less likely to harm humans. It used to take five or more years to make the vaccines and test them for benefit and safety on cell cultures, on animals and finally on humans.

A Magnificent Breakthrough
Six months ago, Chinese researchers worked out the map of the genetic sequence of the coronavirus and published their results (Nature, Jan 2020;579(7798):265-269). This brilliant and tedious work opened the door for a fast way to make effective vaccines to help stop the current pandemic. Now, less than five months after this incredible breakthrough, researchers have developed vaccines that are being tested to see if they can stop the pandemic. So far, the new type of vaccine has been shown to produce a strong antibody response and virus protection in Rhesus monkeys (Nature, July 30, 2020). Vaccines are being tested by:
• NIAID (National Institute of Allergy and Infectious Diseases) and Moderna
• Oxford University and Astra Zenica
• Harvard Medical School and Johnson & Johnson
• CanSino, a collaboration between China and Canada
• and several others

The New Vaccines Do Not Contain the Whole Virus
SARS-CoV-2 is the name of the coronavirus that causes the disease called COVID-19. The new vaccines are likely to be safe in humans because they do not contain killed or weakened SARS-CoV-2. Instead, researchers take a virus known to be safe in humans, such as a chimpanzee flu virus, and attach the genetic information on the spike protein from SARS-CoV-2. The immune systems of humans then make antibodies to kill the spike protein so that when people are exposed to SARS-CoV-2, their immune system destroys the spike protein so the virus cannot get into human cells.
• SARS-CoV-2 gets into human cells through a “key” called the ACE2 receptor.
• Scientists take just the part of SARS-CoV-2 spike protein that opens the ACE2 door to let them inside of human cells.
• They attach the “key” to another relatively harmless virus like a chimpanzee flu virus to make the vaccine.
• Then they give humans the vaccine with the attached “key” spike protein that lets the coronavirus into human cells.
• Then your immune system responds to the “key” by making antibodies against the “key,” not to other parts of SARS-CoV-2.
• When vaccinated humans are exposed to SARS-CoV-2, their immune systems make IGG antibodies that will destroy the “key” so the virus cannot get into human cells, and it dies instead of multiplying in the vaccinated person’s body.

Mass Production of the Vaccines
The next challenge will be producing and distributing the vaccines, once they are approved. The U.S. and many other countries have already started work on distribution, well before anyone knows whether the vaccines will work. For example, The Serum Institute in Puno, India, is already producing 720,000 doses per day of the Oxford vaccine, long before tests for safety and benefits have been completed (New York Times, August 1, 2020).

What This Means For Us
This current COVID-19 pandemic has spurred scientists to make major breakthroughs in which they can produce vaccines at an incredibly fast rate that was previously impossible. These vaccines made by attaching a part of SARS-CoV-2 to relatively harmless viruses appear to be safer and may even be more effective than many previous types of vaccines. If studies being done right now show effective protection against COVID-19, we should be able to start immunizations in the fall of 2020 and gain herd immunity to stop this pandemic in 2021.

High Blood Sugar Increases Risk for Complications in COVID-19

  July 18, 2020   

A study from Wuhan, China showed that non-diabetic COVID-19 patients with high blood sugar levels on admission to the hospital were more than twice as likely to die within a month and four times more likely to suffer the most serious complications caused by that disease (Diabetologia, July 10, 2020). The authors concluded that on admission for COVID-19, a fasting blood glucose level higher than 125 mg/dL (7.0 mmol/l) is an independent predictor for death within 28 days in patients with COVID-19 without a previous diagnosis of diabetes.

A study from the U.S. also showed an increased death rate for COVID-19 patients admitted to hospitals with high blood sugar levels (J Diabetes Sci Technol, May 9, 2020). Several previous studies show that diabetics are at markedly increased risk for dying from heart attacks, strokes, cancer and infections (Lancet, 2018;391(10138):2430–2440), and people who have high blood sugar levels on admission to a hospital for pneumonia are at increased risk for dying in the hospital (BMJ, 2012;344:e3397).

How High Blood Sugar Increases Risk of Death
COVID-19 can cause clots to form in and destroy the lungs, heart, kidneys, brain, liver and other parts of your body. High blood sugar can also cause clots, increasing the risk of this complication in patients with COVID-19. High blood sugar can prevent blood vessels from widening so the clots are more likely to block the flow of blood. High blood sugar can also cause the immune system to produce inflammatory cytokines, leading to “cytokine storm” where the body attacks its own cells and tissues rather than just fighting off the virus. The cytokine storm can eventually kill a patient.

My Recommendations
We do not completely understand why COVID-19 is a relatively benign disease for many people and very serious or even deadly for others. We do know that you are at risk for complications if you have any defect in your immune system, such as diabetes, heart disease, an auto-immune disease, lung disease, kidney disease, cancer, high blood pressure, a chronic infection and so forth.

You are at increased risk for serious complications from COVID-19 if you have high blood sugar after meals or have an obese belly, which specifically causes high blood sugar levels. This is one risk factor that you can improve immediately just by avoiding the foods that cause high rises in blood sugar: sugared drinks and sugar-added foods, and any processed food made with refined carbohydrates. See my report Restrict Added Sugars to Reduce Heart Attack Risk.

JULY 17

High Blood Sugar Increases Risk of Complications in COVID-19 

A study from Wuhan, China showed that non-diabetic COVID-19 patients with high blood sugar levels on admission to the hospital were more than twice as likely to die within a month and four times more likely to suffer the most serious complications caused by that disease (Diabetologia, July 10, 2020). The authors concluded that on admission for COVID-19, a fasting blood glucose level higher than 125 mg/dL (7.0 mmol/l) is an independent predictor for death within 28 days in patients with COVID-19 without a previous diagnosis of diabetes.

A study from the U.S. also showed an increased death rate for COVID-19 patients admitted to hospitals with high blood sugar levels (J Diabetes Sci Technol, May 9, 2020). Several previous studies show that diabetics are at markedly increased risk for dying from heart attacks, strokes, cancer and infections (Lancet, 2018;391(10138):2430–2440), and people who have high blood sugar levels on admission to a hospital for pneumonia are at increased risk for dying in the hospital (BMJ, 2012;344:e3397).

How High Blood Sugar Increases Risk of Death
COVID-19 can cause clots to form in and destroy the lungs, heart, kidneys, brain, liver and other parts of your body. High blood sugar can also cause clots, increasing the risk of this complication in patients with COVID-19. High blood sugar can prevent blood vessels from widening so the clots are more likely to block the flow of blood. High blood sugar can also cause the immune system to produce inflammatory cytokines, leading to “cytokine storm” where the body attacks its own cells and tissues rather than just fighting off the virus. The cytokine storm can eventually kill a patient.

My Recommendations
We do not completely understand why COVID-19 is a relatively benign disease for many people and very serious or even deadly for others. We do know that you are at risk for complications if you have any defect in your immune system, such as diabetes, heart disease, an auto-immune disease, lung disease, kidney disease, cancer, high blood pressure, a chronic infection and so forth.

You are at increased risk for serious complications from COVID-19 if you have high blood sugar after meals or have an obese belly, which specifically causes high blood sugar levels. This is one risk factor that you can improve immediately just by avoiding the foods that cause high rises in blood sugar: sugared drinks and sugar-added foods, and any processed food made with refined carbohydrates. See my report below on the link between sugar-added foods and heart attacks.

JULY 12

Why Obesity Increases Risk of Death from COVID-19 or Influenza

  

A review of 4,103 patients found that obesity and its resultant inflammation, heart disease and diabetes are the most common conditions found in patients requiring hospitalization with COVID-19 (Physician’s Weekly, pre-print, April 14, 2020). Another study of 3,615 patients found that in patients under 60 years of age, being obese more than doubled the chance of needing to be hospitalized (Clinical Infectious Diseases, April 9, 2020). Other studies show that obesity (body mass index or BMI greater than 30) is a major risk factor for dying from COVID-19 (Lancet, April 1, 2020), and the more you weigh, the more likely you are to need to be put on a ventilator which markedly increases your chance of dying (Obesity, April 9, 2020). This should scare you into action because more than 40 percent of North Americans are obese.

The 2009 Influenza A virus pandemic was caused by a virus very similar to the one that caused the 1918 Flu pandemic, and obesity was associated with increased risk of severe disease, hospitalization and death (PLoS ONE, 2010; 5:e9694). During the 1957-1960 Asian flu and the 1968 Hong Kong flu, both obesity and diabetes were associated with a marked increase in prolonged illness and death (Prev Med, 2013;56(2):118-123), even in those who were apparently healthy before they got the flu (Influenza Other Respiratory Viruses, 2019;13:3-9).

How Does Obesity Increase Risk for Death from COVID-19?
Obese people suffer increased risk for complications from infections because obesity leads to an overactive immune system called inflammation (Adv Nutr. 2016;7:66-77) that interferes with their body’s ability to kill invading germs (Epidemiology, July 2015;26(4):580-589). An article in Acta Diabetologica (April 5, 2020) explains how obesity causes inflammation:
• A major cause of obesity is inability to respond to the hormone, leptin (Am J Physiol Regul Integr Comp Physiol, 2009 Mar; 296(3):R493–R500), just as type II diabetes is caused by insulin insensitivity.
• Leptin is a hormone made by fat, intestinal cells and red blood cells.
• Leptin inhibits hunger by telling your brain that you are full so that you stop eating, don’t take in too many calories, and therefore do not fill up fat cells with excess fat.
• Obese people have very high blood levels of leptin because they do not respond to leptin (leptin insensitivity), and keep on eating long after they are full.
• High levels of leptin turn on your immune system to cause inflammation, and reduce levels of adiponectin, a hormone that reduces inflammation.
• Obesity-related chronic inflammation prevents your immune system from producing cells and cytokines to kill invading viruses (Environ Toxicol Pharmacol, 2015;40(3):924-930).
• People who have high levels of leptin and low levels of adiponectin suffer from inflammation to cause diabetes (insulin insensitivity), infections (high white blood cell counts), and heart, liver and kidney damage (Nat Rev Immunol, 2011;11(2):85-97).

Lack of Exercise
Lack of exercise causes the same harms as obesity. Each of the changes listed above are also promoted by lack of exercise (Nature Medicine, 2019;25:1761-1771). Lack of exercise increases risk for insulin resistance (Acta Physiol, 2019;226:1-16), and prevents your body from responding to infections and mounting a full attack on invading viruses (Cell Physiol Biochem, 2015;37:735-746).

My Recommendations
The COVID-19 pandemic is probably keeping you at home more and away from many group activities, so you are stuck with lots of food and limited opportunities for exercise. Eating more food and exercising less sets you up to gaining extra fat weight.
• Try to exercise at home or outdoors as long as you are not close to other people.
• Avoid bringing the foods that are most likely to make you fat into your home, particularly those with added sugars and refined carbohydrates (breads, crackers, cookies, and other foods made from flour).
• Drink water or other fluids that contain no calories.

Protecting Yourself from COVID-19

  July 5, 2020   

As businesses and activities are re-opening, many people have decided to relax their precautions to avoid infection with COVID-19. If you are a person who is at high risk for complications from this virus, I believe that you should continue to be on guard. You are at increased risk for complications if you have any defect in your immune system: a history of heart attacks or heart disease, cancers, diabetes, auto-immune disease, kidney disease, obesity, high blood pressure, a chronic infection or any other serious illness. People with an existing lung disease (asthma, bronchitis, COPD, emphysema, and so forth) are at high risk for complications.

The vast majority of COVID-19 infections are caused by breathing respiratory droplets indoors. A study from China found that only two of 1245 cases were acquired outdoors (MedRxiv, published online April 7, 2020). The remainder were transmitted in various indoor environments — homes, public transportation, shopping and so forth. Another study from China showed that family members of an infected person are at very high risk for infection (Lancet Infect Dis, May 2020;20(5):534-535). Coughing, sneezing, and talking can spew infected droplets into the air from people who may have no symptoms whatever. The droplets spread usually for 3-6 feet, but some reports have extended the distance as far as 30 feet.

Contaminated Surfaces in a Hospital
Detailed analysis of contamination in hospitals during the COVID-19 epidemic can teach us a lot about how the virus spreads in other indoor spaces. A study reported in Emerging Infectious Diseases (July, 2020;26(7)) found that:
• The virus was widely distributed on floors, computer mice, trash cans, sickbed handrails and other surfaces, and was detected in the air 12 feet from patients.
• The highest concentration of virus was in the intensive care unit.
• Floors of the entire hospital were loaded with virus, because gravity settles the respiratory droplets there.
• Fifty percent of the shoe soles of medical personnel were covered with virus.
• Masks were loaded with virus — a sign that they are working, but need to be washed or discarded after every use.

Try to Avoid Public Restrooms
Restrooms can be a major source of infection, and the highest concentrations of virus in a hospital were found in toilets (Nature, April 27, 2020;582:557–560). The virus can live in stool and aerosol droplets can rise three feet above a toilet when it is flushed (Physics of Fluids, June 15, 2020). If the toilet has a lid, close it before flushing and get away from the toilet immediately after flushing. If you have to use a public restroom:
• Wear a mask.
• Carry a paper towel or tissue and use it to open doors or touch any handles or anything else.
• Flush with your foot if possible.
• Leave as quickly as you can. This is not the place to comb your hair, fix your make-up, chat with friends or anything else.

Rules to Live By (For Now)
• Wear a face mask any time you expect to be around people who are not members of your household. Masks protect others from your secretions, but they do collect virus droplets, so you have to wash your mask after you use it (or use a disposable mask). See Should You Wear a Mask When You Exercise Outdoors?
• Stay at least six feet away from other people.
• Avoid everyone with respiratory symptoms.
• Use 20-second soap hand washes after you touch anything (if you can), and frequently throughout the day.
• Try not to touch your eyes, nose or mouth, the primary sources of viral entry into your body.
• If you feel sick, stay home.
• If you have to travel, try to go by car. If possible, avoid group travel such as trains, planes, buses and boats.

My Recommendations
These are times that will pass when we have a vaccine early next year. For now, realize that you can become infected anywhere an infected person has breathed or coughed out the virus. I am using the good news about low rates of infection outdoors to inspire me to spend lots of time riding my bicycle.

JULY 4

Covid-19

Protecting Yourself from COVID-19

As businesses and activities are re-opening, many people have decided to relax their precautions to avoid infection with COVID-19. If you are a person who is at high risk for complications from this virus, I believe that you should continue to be on guard. You are at increased risk for complications if you have any defect in your immune system: a history of heart attacks or heart disease, cancers, diabetes, auto-immune disease, kidney disease, obesity, high blood pressure, a chronic infection or any other serious illness. People with an existing lung disease (asthma, bronchitis, COPD, emphysema, and so forth) are at high risk for complications.

The vast majority of COVID-19 infections are caused by breathing respiratory droplets indoors. A study from China found that only two of 1245 cases were acquired outdoors (MedRxiv, published online April 7, 2020). The remainder were transmitted in various indoor environments — homes, public transportation, shopping and so forth. Another study from China showed that family members of an infected person are at very high risk for infection (Lancet Infect Dis, May 2020;20(5):534-535). Coughing, sneezing, and talking can spew infected droplets into the air from people who may have no symptoms whatever. The droplets spread usually for 3-6 feet, but some reports have extended the distance as far as 30 feet.

Contaminated Surfaces in a Hospital
Detailed analysis of contamination in hospitals during the COVID-19 epidemic can teach us a lot about how the virus spreads in other indoor spaces. A study reported in Emerging Infectious Diseases (July, 2020;26(7)) found that:
• The virus was widely distributed on floors, computer mice, trash cans, sickbed handrails and other surfaces, and was detected in the air 12 feet from patients.
• The highest concentration of virus was in the intensive care unit.
• Floors of the entire hospital were loaded with virus, because gravity settles the respiratory droplets there.
• Fifty percent of the shoe soles of medical personnel were covered with virus.
• Masks were loaded with virus — a sign that they are working, but need to be washed or discarded after every use.

Try to Avoid Public Restrooms
Restrooms can be a major source of infection, and the highest concentrations of virus in a hospital were found in toilets (Nature, April 27, 2020;582:557–560). The virus can live in stool and aerosol droplets can rise three feet above a toilet when it is flushed (Physics of Fluids, June 15, 2020). If the toilet has a lid, close it before flushing and get away from the toilet immediately after flushing. If you have to use a public restroom:
• Wear a mask.
• Carry a paper towel or tissue and use it to open doors or touch any handles or anything else.
• Flush with your foot if possible.
• Leave as quickly as you can. This is not the place to comb your hair, fix your make-up, chat with friends or anything else.

Rules to Live By (For Now)
• Wear a face mask any time you expect to be around people who are not members of your household. Masks protect others from your secretions, but they do collect virus droplets, so you have to wash your mask after you use it (or use a disposable mask). See Should You Wear a Mask When You Exercise Outdoors? 
• Stay at least six feet away from other people.
• Avoid everyone with respiratory symptoms.
• Use 20-second soap hand washes after you touch anything (if you can), and frequently throughout the day.
• Try not to touch your eyes, nose or mouth, the primary sources of viral entry into your body.
• If you feel sick, stay home.
• If you have to travel, try to go by car. If possible, avoid group travel such as trains, planes, buses and boats. 

MAY 31

As the coronavirus pandemic unfolds, health experts are finding interesting connections between low vitamin D levels and severe COVID-19 symptoms.

Researchers out of Northwestern University in Illinois looked at countries with high COVID mortality rates, such as Italy, Spain and the UK., and found, on average, patients had lower levels of vitamin D in these counties when compared to patients in other areas of the world that were less affected.

Another study done in the UK backed this claim. Researchers there found that Finland, Norway, Denmark, and Sweden had higher levels of vitamin D and lower rates of COVID-19.

Vitamin D is a common supplement many people take due to insufficient levels. Now many are paying even more attention to the recommended dose.

“Vitamin D has been shown to have different roles,” says Dr.Montano-Loza, the Associate Professor of Medicine at the University of Alberta. “Specifically, it has an immunomodulatory role, that in one way helps our immune system to fight infections, [and] at the same time, it also has an anti-inflammatory role. So that means it regulates the immune response, so we do not have a state of acute inflammation.”

VITAMIN D CAN PREVENT A ‘CYTOKINE STORM’

Severe inflammation has been noticed in many patients with COVID-19. Doctors believe that low vitamin D levels can trigger a cytokine storm in a patient fighting a virus.

“A cytokine storm can happen in some patients who have COVID-19” explains Dr. Montano-Loza. “It’s an acute state of inflammation — it’s basically an excessive release of molecules that exacerbates inflammation. This can then trigger several organ dysfunctions. These patients are in the hospital with advanced support.”

When vitamin D levels are normal, the presence of this vitamin can regulate the body’s response to a virus.

RESEARCHERS EAGER TO START STUDY IN CANADA

Since researchers are keen on the idea of low vitamin D levels being a problem, it’s now time to test regulating levels in patients who are deficient and are suffering from COVID-19. This type of testing is scheduled to happen in Alberta.

“In Alberta, we are going to measure vitamin D levels in all patients who have infections with COVID-19,” says Dr. Montano-Loza. “In the patients who have low vitamin D levels in their blood, we are going to give them a higher dose. We are aiming to normalize the vitamin D level in a short period of time — between one to two weeks. We will be monitoring if this has a positive impact on clinical outcomes.”

In order to complete the study, the university needs at least 70 patients that fit their criteria. The medical team at the University of Alberta hopes to have preliminary results by fall.

SHOULD I BE TAKING A VITAMIN D SUPPLEMENT?

For Canadians looking to boost their own vitamin D levels Dr. Montano-Loza suggests the following:

“I think all Canadians should be taking a vitamin D supplement. The current recommendation is to take from 600-800 international units every day. I think during a situation like this one, during a pandemic, I think it is a good idea to increase to 1000-2000 international units a day, no more than that.”

Vitamin D deficiency - check list

Why Obesity Increases Risk of Death from COVID-19 or Influenza

A review of 4,103 patients found that obesity and its resultant inflammation, heart disease and diabetes are the most common conditions found in patients requiring hospitalization with COVID-19 (Physician’s Weekly, pre-print, April 14, 2020). Another study of 3,615 patients found that in patients under 60 years of age, being obese more than doubled the chance of needing to be hospitalized (Clinical Infectious Diseases, April 9, 2020). Other studies show that obesity (body mass index or BMI greater than 30) is a major risk factor for dying from COVID-19 (Lancet, April 1, 2020), and the more you weigh, the more likely you are to need to be put on a ventilator which markedly increases your chance of dying (Obesity, April 9, 2020). This should scare you into action because more than 40 percent of North Americans are obese.

The 2009 Influenza A virus pandemic was caused by a virus very similar to the one that caused the 1918 Flu pandemic, and obesity was associated with increased risk of severe disease, hospitalization and death (PLoS ONE, 2010; 5:e9694). During the 1957-1960 Asian flu and the 1968 Hong Kong flu, both obesity and diabetes were associated with a marked increase in prolonged illness and death (Prev Med, 2013;56(2):118-123), even in those who were apparently healthy before they got the flu (Influenza Other Respiratory Viruses, 2019;13:3-9).

How Does Obesity Increase Risk for Death from COVID-19?
Obese people suffer increased risk for complications from infections because obesity leads to an overactive immune system calledinflammation (Adv Nutr. 2016;7:66-77) that interferes with their body’s ability to kill invading germs (Epidemiology, July 2015;26(4):580-589). An article in Acta Diabetologica (April 5, 2020) explains how obesity causes inflammation:
• A major cause of obesity is inability to respond to the hormone, leptin (Am J Physiol Regul Integr Comp Physiol, 2009 Mar; 296(3):R493–R500), just as type II diabetes is caused by insulin insensitivity.
• Leptin is a hormone made by fat, intestinal cells and red blood cells.
• Leptin inhibits hunger by telling your brain that you are full so that you stop eating, don’t take in too many calories, and therefore do not fill up fat cells with excess fat.
• Obese people have very high blood levels of leptin because they do not respond to leptin (leptin insensitivity), and keep on eating long after they are full.
• High levels of leptin turn on your immune system to cause inflammation, and reduce levels of adiponectin, a hormone that reduces inflammation.
• Obesity-related chronic inflammation prevents your immune system from producing cells and cytokines to kill invading viruses (Environ Toxicol Pharmacol, 2015;40(3):924-930).
• People who have high levels of leptin and low levels of adiponectin suffer from inflammation to cause diabetes (insulin insensitivity), infections (high white blood cell counts), and heart, liver and kidney damage (Nat Rev Immunol, 2011;11(2):85-97).

Lack of Exercise
Lack of exercise causes the same harms as obesity. Each of the changes listed above are also promoted by lack of exercise (Nature Medicine, 2019;25:1761-1771). Lack of exercise increases risk for insulin resistance (Acta Physiol, 2019;226:1-16), and prevents your body from responding to infections and mounting a full attack on invading viruses (Cell Physiol Biochem, 2015;37:735-746).

My Recommendations
The current COVID-19 pandemic is probably keeping you at home and away from group activities, so you are stuck with lots of food and limited opportunities for exercise. Eating more food and exercising less sets you up to gaining extra fat weight.
• Try to exercise at home or outdoors as long as you are not near other people.
• Avoid bringing the foods that are most likely to make you fat into your home, particularly added sugars and refined carbohydrates (breads, crackers, cookies, and other foods made from flour).
• Drink water or other fluids that contain no calories.

APRIL 23

Potential Drugs, Treatments and Vaccines for COVID-19

We have no drugs yet proven to prevent or treat COVID-19, although one drug, Remdesivir, appears promising, as do transfusions of blood donated by people who have recovered and are now immune. The virus is spread from one person to another; it has not been shown to be spread from animals or food. Until we have a safe and effective vaccine, the only way we have to slow down the pandemic is to keep infected people away from those who have not yet been infected. To do this, we need to develop antibody tests to find who has already been exposed to the virus and may be immune.

We Need Both Antibody Blood Tests and a Vaccine
Antibody blood tests tell if a person has antibodies in his bloodstream from having been infected with COVID-19. Many companies are working to develop these tests, and so far the FDA has approved four of the tests. After a person is infected with the virus, his immune system produces antibodies that help him kill the virus now and in the future. We don’t yet have studies to show that people with antibodies in their bloodstream are protected from getting the infection again, or how long that protection will last. However, based on our knowledge of other coronaviruses, the odds are very strong that having antibodies will prevent re-infection. When we are able to tell who has been infected and recovered and has the antibodies that may prevent re-infection, we will be able to send people who have recovered from COVID-19 back to work, to treat and help sick people, and be safely out in society.

However, we can’t wait for everyone to get COVID-19. Most of all, we need a vaccine to help people develop antibodies that will make them immune without getting sick and possibly dying from COVID-19. Normally it takes as long as five years to develop a new vaccine. Researchers have to spend months trying the vaccine in culture bottles to see if it harms and damages cells. Then they have to spend time trying the vaccine in animals to see if it harms them. Only after the vaccine has been shown to be safe in animals can the vaccine be tried in humans to see if it is safe in humans and effective in preventing the disease. The government is now in the process of speeding up research and relaxing restrictions so we can have a vaccine as soon as possible. Eleven companies have been approved by the FDA to start developing potential vaccines, and according to the World Health Organization, more than 70 different vaccines are already being tested.

Drugs Being Tested for Treatment of COVID-19
The U.S. federal government has approved more than 424 different clinical trials to find effective treatments for COVID-19. Treatments being investigated include blood pressure drugs, immune suppressants, immune stimulants, antiviral drugs, anti-malarial drugs, supplemental oxygen, nitric oxide to widen blood vessels, many different antibiotics, stem cells, anti-cancer drugs, nasal washes, steroids, vitamins C and D, zinc, honey, Chinese herbs, breathing machines, CPAP machines, anti-clotting medicines, anti-flu drugs, anti-HIV drugs, bone marrow transplants and many others.

So far, no controlled scientific studies have proven that any drug helps to prevent or treat COVID-19.
• Several recent papers show that the leading drug is Remdesivir made by Gilead in Israel. We still have no studies with placebo controls because the drug is being given on a compassionate basis and not compared to placebos.
• Temple University has just started a clinical trial to evaluate gimsilumab, an artificially synthesized monoclonal antibody that suppresses an overactive immunity that causes cytokine storm in which a person’s own immunity destroys a person’s own body instead of just attacking invading germs.
• Hydroxychloroquine (Plaquenil), chloroquine and azithromycin: Studies from France and Brazil found that these anti-malarial drugs have not been effective in killing COVID-19 and they can cause deadly irregular heartbeats. Chloroquine has been shown in 62 patients to shorten the course of disease. Chloroquine and hydroxychloroquine both suppress immunity, so they may help a person who is at risk of dying of cytokine storm (Journal of Zhejiang University, March,2020 ). Some uncontrolled studies show that hydroxychloroquine and azithromycin reduced viral load in sick patients (International Journal of Antimicrobial Agents, preprint April 2020).
• Antiviral Lopinavir-Ritonavir has not been shown to be effective for COVID-19 (N Engl J Med, Mar 18, 2020).

What Can We Expect in the Next Two Years?
Social distancing and isolation strategies are likely to continue off and on until a significant percentage of the population has antibodies either from having had the disease or being immunized. Some of the habits we are learning in this traumatic period may become permanent as protection against future epidemics. For example, hand-shaking and cheek-kissing of strangers are likely to be replaced with other greeting gestures. Variations on working from home and remote schooling may become more popular options for people who have found that they prefer them.

We already have some blood tests, and will have many more, to see who has had COVID-19 and may be immune so they can most likely return safely to society. We could have a vaccine in a year because companies have been given permission to speed up the testing process, and the winners of this race are likely to make a lot of money.

APRIL 10

Okay, so I know I said I wasn’t going to talk about it anymore, but Covid 19 is in the news and most everywhere you look it’s bad and worse.

So here is some good news and something that every doctor who is working is this area should really consider.

Dr. Eric Berg is a good friend and associate. This video is very compelling on what should be done.

Please watch it now: https://www.youtube.com/watch?v=zer6omW0vnU

Also, I received this update regarding Ozone Therapy treatments in Italy, from another colleague of mine. The data is from an Italian article and was originally translated using Bing Translate by Dr. Antonio Gaspari. He warns that the translation is not perfect, but you’ll get the main points:

From the first report of the first two hospitals that started therapy (to date we are at 15 hospital facilities), where Oxygen Ozono Therapy is being practiced according to the Protocol of the Scientific Society of Oxygen Ozono Therapy (SIOOT) 11 patients in condition ”serious” and ”very serious” have had a rapid and decisive improvement.

After just five treatment sessions, one of the five intubated has improved to the point where it is exhumed and the others are improving significantly. The patient with the least serious conditions, after a few sessions of oxygen ozone therapy, healed and returned home.

The only one who died in the group was in a largely compromised condition. As an extreme attempt, only two sessions of ozone oxygen were practiced, but his condition was too compromised.

In the technical report, doctors wrote that after 5 treatments with Oxygen Ozono Therapy, as per SIOOT protocol, patients are all much better off.

Doctors observed after practicing Oxygen Ozono Therapy:

  1. General improvement of clinical conditions.
  2. Normalization of body temperature.
  3. Reactive C Protein Reduction (PRC)
  4. Heart rate normalization
  5. Improved saturation and reduced oxygen support
  6. Normalization of kidney function (creatine).

To better understand the significance of this data, we interviewed Prof. Marianno Franzini, President of SIOOT International and promoter together with Prof. Luigi Valdenassi of the treatment protocol..

According to Dr.Franzini the most important fact is that the improvements are remarkable and have occurred in only five days of therapy.

To try to better assess, Franzini asked his four colleagues who work directly in the care of Covid-19 patients, and all confirmed that these are very important results, because in five days no one among the people affected by Covid-19 has an improvement as fast and so stable as that seen in patients treated with Oxygen Ozone.

“A doctor who is treating Covid-19 patients,” Franzini said, “has revealed to me that no treatment protocol is giving results like those of Oxygen Ozono Therapy.”

When asked why Oxygen Ozono Therapy is so effective, Franzini explained that autopsies of the deceased due to Covid–19, show that the virus immediately attacks the microcircle causing a scattered thrombosis.

And it is there, in addition to the antiviral effect, that ozone oxygen is even more decisive precisely because it reactivates and strengthens the microcircle.

“Considering the goodness of these early data, it would be very important, Dr.Franzini stressed, to ensure that the therapy was practiced at the beginning, when the test proves positive, so that we can cure them before they get worse, thus managing to shorten hospitalizations.”

Dr. Antonio Gaspari

Source: [http://www.ossigenoozono.it/IT/News/3506/PRIMO_REPORT_-_OSSIGENO_OZONO_SIOOT_NEI_PAZIENTI_RICOVERATI_CON_COVID-19?fbclid=IwAR0QbmXV7PeYEKkmLw093_PlpCejWAm1QTUBNjLs6WDcnonVcUozOlOkUxY](http://www.ossigenoozono.it/IT/News/3506/PRIMO_REPORT_-_OSSIGENO_OZONO_SIOOT_NEI_PAZIENTI_RICOVERATI_CON_COVID-19?fbclid=IwAR0QbmXV7PeYEKkmLw093_PlpCejWAm1QTUBNjLs6WDcnonVcUozOlOkUxY)

APRIL 10

Joe Diffie and Many Other Musicians Have Died from COVID-19

I have no data to show that popular musicians are at greater risk of death from COVID-19 than the general population, but we note the headlines marking the passing of many beloved artists just in the past few days:

Joe Diffie, a Grand Old Opry country music singer and songwriter who had been voted best all-around male athlete in high school (football, baseball, golf and track) but chose music over sports and his planned career in medicine. He had 35 singles on the Billboard Hot Country Songs. He died in Nashville on March 29, 2020, at age 61, two days after he tested positive for the coronavirus.
Adam Schlesinger, 52, Emmy and Grammy award–winning musician, died of COVID-19 complications at a hospital in Poughkeepsie, New York. He had been hospitalized and placed on a ventilator for a week prior to his death on April 1.
Ellis Marsalis, Jr., 85, a New Orleans legend as a jazz pianist and teacher, died on April 1. Of his six sons, four became noted musicians: Branford, a saxophonist; Delfeayo, trombonist; Jason, drummer; and Wynton, trumpeter and composer

APRIL 10

Why You Should Exercise During the COVID-19 Pandemic

Committed exercisers should try to continue to exercise during this COVID-19 pandemic, but they should realize that both too much exercise and exercising while sick increase risk for medical complications, such as irregular heartbeats, and death (Brit J of Sports Med, Sep 4, 2009;43(9):722-725). We have strong evidence that even a single workout improves your immune system (Med Sci Sports Exerc, 2004;36(8):1321–7), which will help you fight off COVID-19, as long as you don’t exercise too much (Brain Behav Immun, Sept 2005;19(5):377-80), or increase your risk for exposure to a COVID-19 infection by going to a gym used by other people, exercising too close to people, breathing air breathed out by infected people, or touching equipment used by others. Remember to wash your hands before and after you exercise, don’t exercise near anyone else (particularly one who is sneezing or coughing), and rub an alcohol wipe over exercise equipment before and after use. Skip your workout completely if you feel sick.

Don’t Exercise If You Feel Sick
COVID-19 can be a very dangerous virus that starts in your mouth and nose and then can travel down into your lungs with potentially severe consequences, so it is not a good idea to exercise if you have symptoms of a COVID-19 infection, particularly any evidence of lung involvement such as coughing, wheezing or shortness of breath. With this virus and most other upper respiratory infections, you may be able to exercise when you have a stuffy nose or sneezing, but it is very risky to exercise when the infection has passed down into your lungs. If you try to exercise and don’t feel better in 5 to 10 minutes, you should take the day off. Whatever you do, when you are sick, you should not exercise intensely. Take off if you have any of the following: feeling sick or weak, coughing, being short of breath, having muscle aches and pains, having a fever higher than 98.6°F or 37°C, nausea, diarrhea, vomiting or stomach cramping.

Evidence that Exercise Benefits Your Immune System
As long as you are healthy and are not experiencing symptoms of a possible infection, any form of exercise will be beneficial.
• Working out regularly has been shown to decrease the risk of many chronic diseases (Compr Physiol. Apr, 2012;2(2):1143–1211) such as diabetes (Diabetes Care, Dec 2010;33(12)) or cancer (Exerc Immunol Rev, 2013;19:120-43).
• Elite marathon runners report fewer days lost from work than non-exercisers (J Sports Sci Med, 2014 Dec 1;13(4):929-33).
• A study of 25,000 Chinese who died during the 1998 Hong Kong flu epidemic found that those who exercised moderately three times a week were far less likely to die (Exercise Immunology Review, December 2019;26:8-22; PLoS ONE, 2008;3(5):e2108).
• Rats that ran moderately on a treadmill for 30 minutes a day for several weeks were far more likely than non-exercising rats to survive rat influenza (Brain Behav Immun, Sept 2005;19(5):377-80).
• Exercise-trained mice injected with germs immediately after running on a treadmill are less likely to become sick and die than those who do not exercise, because vigorous exercise causes immune cells to surround and attack invading germs, rather than having their immune cells scattered throughout their bodies and not attacking the invading germ (Eur J Physiol, May 20, 2020;472:235–244).
• Mice that exercised regularly for three months prior to an induced infection suffered significantly less severity and duration of illness and lower blood virus levels than non-exercising mice (J of Infect Dis, Oct 2009;200(9):1434–1442). The same results occurred for both obese and normal weight mice.

Don’t Exercise Too Much
A large increase in exercise intensity or duration can reduce your immunity (Exerc Sport Sci Rev, Oct 2009;37(4):157–164) and increase risk for severity and death when you have respiratory disease (Scand J Med Sci Sports, 2006;16(4):287–93). Exercising improves your immune system, but too much exercise increases risk for infections. For example, over a five-month period, people who did not exercise suffered twice the rate of upper respiratory infection suffered by recreational exercisers, but elite athletes training near their maximum suffered the most upper respiratory infections of all — three times the rate of upper respiratory infections that recreational exercisers did (Med Sci Sports Exerc, Apr 2007;39(4):577-86). You may be stressing your immune system when you take workouts that:
• last longer than 90 minutes, especially without taking food and fluids,
• are of very high intensity, greater than 85 percent of your maximum effort, and
• fail to allow adequate recovery periods between intense workouts (Journal of Applied Physiology, Aug 1, 2007;103(2)).

How Fast Will I Lose My Fitness If I Don’t Exercise?
Within two weeks after healthy, young people reduced their walking steps from more than 10,000 steps a day to fewer than 2,000 steps, they had higher blood sugar levels and cholesterol levels, and lower insulin sensitivity (Diabetologia, 2018 Jun;61(6):1282-1294). Four weeks after marathon runners reduced their mileage after a marathon, they had lower blood volume and reduced ability of their hearts to pump blood, which markedly slowed their ability to run fast on a treadmill (J of Appl Physio, April 1, 2018;124(4)). On the other hand, after just six weeks of running up and down stairs for 20 seconds three times a day, people increased their aerobic fitness by about five percent (Appl Physiol Nutr and Metab, Jan 16, 2019;44(6):681-684).

My Recommendations
Most healthy people, particularly those who exercise regularly, should try to exercise during stay-at-home periods of the current pandemic. You can exercise in your home or yard, and most of these orders allow for outdoor exercise as long as you maintain the required distances from other exercisers. You should not:
• exercise within six feet of other people
• exercise in a gym used by other people
• share exercise equipment with people other than those in your household
• use any exercise equipment without first cleaning it off with alcohol wipes
• share drinks or eating utensils
• overdrink fluids (it is not possible to “flush out toxins”)
• exercise to exhaustion
• exercise when you have flu-like or other symptoms of illness (described above)

Latest Advice on the COVID-19 Pandemic

  April 4, 2020   

  1. Tight restrictions in the United States will continue. The president has announced that federal guidelines requiring most Americans to avoid non-essential travel, non-essential work, eating at bars and restaurants, and gathering in groups of more than 10, would be extended at least through April 30, 2020. Many states and local governments have stricter directives that take precedence over the federal guidelines. When restrictions are removed, the rate of new infections may start going back up.
  2. Stay away from people as much as you can. The primary route of infection is person-to-person. The most common source of the virus is the air that you breathe near an infected person, since a sneeze or cough can carry respiratory droplets six feet away, and the virus can remain in the air up to three hours before dropping to the ground or the nearest surface.
  3. Wash your hands every time you touch something. The virus lives longest on hard surfaces such as metal, glass, cardboard or plastic. One study showed that it can live on most metals for about 3 hours, copper-4 hours, cardboard-24 hours, stainless steel-13 hours, and plastic-16 hours (NEJM, Mar 17, 2020). However, most virus particles break down in minutes or hours outside a living host, and you are far more likely to acquire the virus directly from another person. The most effective way to get the virus off your hands is to use soap and water and wash for at least 20 seconds every time you touch surfaces such as a door handle, ATM machine, toilet flusher, shopping cart and so forth. Do not wash your hands with very hot water or alcohol as they can damage your skin.
  4. Wear homemade face masks in public places. Most face masks will not prevent the virus from entering your mouth or nose, but they can discourage you from touching your face with hands that may be contaminated. They can also help to keep you from infecting other people, since they will block your coughs or sneezes from becoming airborne. Medical-quality masks are in short supply and should be reserved for health care workers, so ordinary citizens are now being encouraged to make their own cloth masks, which can be washed in soap and water after each use. A variety of designs and instructions for making masks are available on YouTube, and even a bandana is more effective than nothing. The CDC may soon issue new guidelines for wearing homemade masks whenever a person is out in public. Plastic or rubber gloves and disposable gloves are not very practical since they need to be washed or changed every time you touch something that might be contaminated with the virus, but you may want to use them in high-risk environments.
  5. At this time there are no drugs that have been proven to cure COVID-19. The FDA has authorized use of the anti-malarial drugs, chloroquine phosphate and hydroxychloroquine (Plaquinil, also used to treat rheumatoid arthritis), even though they have not been proven effective or safe for COVID-19. More on studies of these drugs below.  Pain medicines such as Tylenol or ibuprofen can help patients feel better but do nothing to hasten healing, and some studies suggest that they may hinder the person’s immune system in its fight against the virus (BMJ, March 17, 2020;368:1086).

Many other drugs and combinations are being studied. For one of the best reviews I have seen on what we know so far about drugs to treat COVID-19, go to Management of Patients with COVID-19. The World Health Organization (WHO) maintains an “Outline of designs for experimental vaccines and therapeutics“, which lists drugs currently being tested.

Intravenous hyperimmune globulin injections from the blood of recovered persons, and monoclonal antibodies, look like they will be very effective and will be available very soon (JAMA, published online March 27, 2020). Blood from patients who have recovered from COVID-19 contains IgG and IgM antibodies that can kill the virus (JAMA editorial, March 27, 2020) Blood tests will soon be approved to see if a person has been infected with COVID-19 and is therefore now immune. These people may then be able to treat people who are currently infected, and to donate blood with the antibodies that could be helpful in treating COVID-19 patients.

Trials for a vaccine for COVID-19 will start in May 2020 (NIH News, March 16, 2020), and we should have a vaccine to prevent infections in 12 to 18 months.

Symptoms and Progression of COVID-19
• When you are infected, you may have no symptoms at all. Symptoms usually develop 2 to 10 days after you acquire the virus. Symptoms may begin like the flu but go on to develop fever, cough, and shortness of breath. The virus lives in your nose and throat and then can go down into your lungs. You may also suffer belly cramps and diarrhea, and the virus can be transmitted in the stool (Gastroenterology, accepted Feb 27, 2020, not yet published).
• COVID-19 is dangerous because it can infect your lungs and fill them up with mucus to smother you. It can cause your immunity to become so active that the same cells and chemicals that attack germs can attack you (called “cytokine storm”). The people most likely to suffer severe consequences from this infection include people over 65 and those who have diabetes, high blood pressure, heart disease, lung disease, kidney disease, asthma, immune defects, HIV, bleeding or clotting defects, or auto-immune diseases. Possible effects on pregnancy or unborn children are not yet known. Some patients appear to suffer long term heart damage after COVID-19 infections (Lancet, March 28, 2020;395:11054-1062).
• Infected people keep the live virus for an average of 20 days (Am J of Resp and Crit Care Med, Mar 23, 2020), and can continue to be contagious for up to 37 days, even if they have no symptoms (The Lancet, March 11, 2020). Sputum samples remain positive up to 39 days and stool samples for 13 days (Annals of Internal Medicine, March 30, 2020).

More on the Studies of Drugs to Treat Serious Cases of COVID-19: Six studies now show that three of the drugs currently being tested are helping to save lives in some of the most dificult cases of COVID-19:
• chloroquine, discovered in 1843 and used to treat malaria,
• hydroxychloroquine (Plaquenil), approved in 1955 for various autoimmune diseases as well as malaria, and
• azithromycin (Zithromax) approved in 1980 and used to treat bacterial infections.

1. Dr Stephen Smith, of East Orange, NJ, reports that he has treated 72 COVID-19 patients, most of whom were morbidly obese (over 300 pounds), diabetic or prediabetic, with hydroxychloroquine and azithromycin for five days. None of the patients required intubation (a ventilator). This followed a Seattle study of 40 patients, of whom half were diabetic or prediabetic, using the same drug combination. None had to be put on a ventilator, but two of the 40 patients developed irregular heartbeats.

2. A French study found that five days of this same drug combination completely eliminated the virus from the nose and throat in 30 patients, compared to 10 percent in the control group and 50 percent of those receiving only chloroquine (J of Antimicrobial Agents, March 17, 2020).

3. Chloroquine has been reported to reduce symptoms and hasten recovery in several small studies (Biosci Trends, Mar 16, 2020;14(1):72-73).

4. A Chinese study of 62 patients showed a marked reduction in fever and cough in patients receiving hydroxychloroquine. This is a preprint and has not yet been published.

5. Hydroxychloroquine was found to be significantly more potent than chloroquine in killing COVID-19 (Clinical Infectious Diseases, March 9, 2020). A loading dose of 400 mg twice daily of hydroxychloroquine given orally, followed by a maintenance dose of 200 mg given twice daily for four days, reached three times the potency of chloroquine given 500 mg twice daily for five days

6. Unpublished work by Dr. Vladimir Zelenko of Monroe, NY, reports that he has successfully treated patients with a five-day course of hydroxychloroquine 200 mg twice a day, azithromycin 500 mg once a day, and zinc sulfate 220mg once a day.  I am concerned that both hydroxychloroquine and azithromycin can cause irregular heartbeats, and close to 10 percent of North Americans are at risk for irregular heartbeats. We will await future studies on the effectiveness and safety of this combination of drugs.

APRIL 5

During this time of social distancing where our health and fitness facilities are shut down please remember to STAY ACTIVE You can still walk or run or ride ar bike,Kettlebell ,swim  For any of the folks who attend my classes (or any friends)if you want a workout or two to do at home with no needed accessories,  message me and I will be happy to send you some challenging yet doable workouts. You can just pretend I am on your shoulder pushing you through your paces!

And we all should be moving our bodies to keep our immune system strong!

March 17, 2020 (Extra)Good News: Healthy People Can Recover from COVID-19 in Three Days

Researchers tested the immune response to COVID-19 in an otherwise healthy woman in her 40s, who required hospital admission (Nature Medicine, March 16, 2020). Three days after the patient was admitted, her immune system produced huge amounts of several immune cells that are used to show that a person will recover from a seasonal influenza infection. This indicates that she had recovered in three days. Even though COVID-19 is caused by a brand-new virus never seen before, an otherwise healthy person was able to develop a healthy and normal immune response that signifies recovery. This helps to explain why more than 80 percent of COVID-19 cases are mild-to-moderate. However, other studies show that people can continue to shed the virus for 10-37 days (The Lancet, March 11, 2020), so they may still be contagiousDr Mirkin