November 22nd, 2021

North Carolina remains in relative normalcy in most places. The northern states entering winter like conditions are seeing significant increases. Europe is also seeing similar spikes in the colder climate countries.

The next few weeks will show us if wave 5 is truly starting, The good news is that hospitalization and deaths are still uncoupled for the vaccinated individuals as Delta remains the main COVID 19 variant.

If you have had 2 doses of an mRNA vaccine, you have a very very small risk of a significant hospitalization and therefore death from the Delta variant based on statistics overall.

Being Unvaccinated now is the greatest risk factor for a negative outcome. Advancing age and co morbid disease add layers of risk on top of the vaccination status

Latest numbers google/CDC

We are continuing to see that all other variants are not an issue yet and likely will not be in the United States as delta is outcompeting them.

As it stands today, the United States has had 47.7 million known cases and almost 770,000 deaths.

If you did not read the newsletter about an Integrative approach to health in the COVID era, read this link and this link.

As with the first newsletter on this topic, keep solace with the fact that there is a 99+% chance of survival for all of us regardless of vaccination. However,
mathematically, you now have a 99.9998% chance of survival once vaccinated and the vaccine safety for the mRNA vaccines continues to look good.

Why take on that extra risk?

 

Dr. Danny Benjamin is back on the podcast discussing Covid, schools and the new vaccine age indication. That podcast will be live this week.

Apple Podcast Link
Amazon Amazon Music
Weblink for home website of WACF

Let food be thy medicine and thy medicine be thy food.

Hippocrates

 

Free Thoughts
Happy Thanksgiving to all of you!

Dr. M

 

 In This Issue

 Apple Podcast Link
Weblink for home website of WACF

The multi part series on the gut microbiome and maternal child health is live with Dr. Aagaard's and Dr. Shafizadeh's interviews. I am very excited to share with you the vast knowledge of the guests. really interesting stuff.

Most Popular podacasts so far are #2 with Danny Benjamin and #3 with Dr. Randy Jirtle.

If you have not listened to the Insulin Resistance Podcast from a few months ago, I highlyrecommend it for the coming podcasts and newsletters.

As always, the Coronavirus newsletters audio version can be found at this link.

Dr. M

 Here is a cool youtube video on how the mRNA vaccine works in video form. Link

 

Quick Hits -

1) Diet and death - finally someone writes a quality article after 21 months of time gone by. In a well written article, Helena Evich tackles a topic at the national level that I have been waiting for for a long time. She writes: "In Washington, there has been no such wake-up call about the link between diet-related diseases and the pandemic. There is no national strategy. There is no systemswide approach, even as researchers increasingly recognize that obesity is a disease that is driven not by lack of willpower, but a modern society and food system that’s almost perfectly designed to encourage the overeating of empty calories, along with more stress, less sleep and less daily exercise,setting millions on a path to poor health outcomes that is extremely difficult to break from." "Glickman noted that the country’s leading voices on coronavirus, including Anthony Fauci, don’t focus on underlying conditions and what could be done about them long term. Instead, the focus is solely on vaccines, which have been proven to be safe and effective. “They hardly ever talk about prevention,” Glickman said. “It’s missing. It’s a gigantic gap in the discussion about how health care relates to Covid and how it relates to the prevention of disease.”"

This article is a start, but we need more public messaging about the risks of food and disease risk.

In our race to control an uncontrollable pandemic, we allowed our heads of medicine, including Dr. Fauci, to flip flop around on the science, get themselves tied to untruths and scandals which in effect torpedoed an amazing vaccine effort that has saved countless lives. Trust evaporated rapidly among many laypeople and medical providers alike. There were a lot of intelligent people asking serious questions that needed to be met with science and understanding but instead were met only with censorship and more distrust. I have so much sadness for those that got stuck in the misinformation gap and paid the price with their lives. The science was there, but politics ruined the clear science and the truth.

Most importantly - the government needs to stop subsidizing the staple crops of corn, soy and wheat which drive the engine of cheap mass produced poor quality food and instead pay farmers to produce high quality vegetables, fruits and meats for mass consumption. Let's make soda 6$ per can and an apple 30 cents. Wouldn't that be a step towards health!

I hear many say that we don't want a nanny state telling us what too eat. I agree. We already have a nanny state funding all of the garbage food that is driving us in the wrong direction. Two options exist for me. No subsidies at all or preferably subsidize high quality food for all children aged 0 to 21.

My 2 cents!

2) What are the antecedent risk factors of COVID induced disease in young children? "Approximately 30% of hospitalized children had severe COVID-19 and 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR=2.2, CI: 1.1–4.3), neurologic disorders (aRR=2.0, CI: 1.5‒2.6), cardiovascular disease (aRR=1.7, CI: 1.2‒2.3), prematurity (aRR=1.6, CI: 1.1‒2.2) and airway abnormality (aRR=1.6,CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2‒17 years, feeding tube dependence (aRR=2.0, CI: 1.5‒2.5), diabetes mellitus (aRR=1.9, CI: 1.6‒2.3) and obesity (aRR=1.2, CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100,000 children aged <18 years, and was highest among infants, Hispanic children, and non-Hispanic Black children."(Woodruff et. al. 2021)

This group of children should absolutely line up for a covid vaccine based on the current data stream.

3) How useful is masking? In a new study from MedRxIV, we see that masks show benefit at reducing SARS2 transmission when they are utilized in indoor prolonged exposure settings (>3 hours), i.e. work or school environments with poor ventilation. (Andrejko et. al. 2021) Masking and social distancing remain a useful tool during high volume outbreaks fo SARS2. The overall benefit remains modest based on most studies to date.

4) "The SARS-CoV-2 pandemic is now better controlled in settings with access to fast and reliable testing and highly effective vaccination rollouts. Several studies have found that people who recovered from COVID-19 and tested seropositive for anti-SARS-CoV-2 antibodies have low rates of SARS-CoV-2 reinfection. There are still looming questions surrounding the strength and duration of such protection compared with that from vaccination. We reviewed studies published in PubMed from inception to Sept 28, 2021, and found well conducted biological studies showing protective immunity after infection. Furthermore, multiple epidemiological and clinical studies, including studies during the recent period of predominantly delta (B.1.617.2) variant transmission, found that the risk of repeat SARS-CoV-2 infection decreased by 80·5–100% among those who had had COVID-19 previously. The reported studies were large and conducted throughout the world. Another laboratory-based study that analysed the test results of 9119 people with previous COVID-19 from Dec 1, 2019, to Nov 13, 2020, found that only 0·7% became reinfected. In a study conducted at the Cleveland Clinic in Cleveland, OH, USA, those who had not previously been infected had a COVID-19 incidence rate of 4·3 per 100 people, whereas those who had previously been infected had a COVID-19 incidence rate of 0 per 100 people. Furthermore, a study conducted in Austria found that the frequency of hospitalisation due to a repeated infection was five per 14,840 (0·03%) people and the frequency of death due to a repeated infection was one per 14,840 (0·01%) people. Due to the strong association and biological basis for protection, clinicians should consider counseling recovered patients on their risk for reinfection and document previous infection status in medical records."(Kojima et. al. 2021)

Again we see data that the medical system should be tracking and documenting natural infection as a risk reduction factor for the nation in SARS2 transmission and severe disease. The persistence of the policy makers in not recognizing natural infection as a sign of immune recognition and resolution for most is again driving more governmental mistrust and poor understanding of correct messaging.

5) Covid vaccine for the 5 to 12 year old age range - what do we know?

The Pfizer study was very very small and had only 2268 children in it with 1518 receiving vaccine doses three weeks apart while the remainder received placebo. Remember that we need to have north of 50 to 100,000 patients vaccinated before we can see side effects like the myocarditis signal for the teenagers. This, we have a way to go to answer the side effect question, however, that will change within in the next 2 months as many doses are being rolled out now. 2 million doses have been given by 11/21/21 By 2 months, we will see any signals of side effects if they exist.

"Adverse effects were similar to those reported among older children and adults in frequency and severity, including pain at the injection site (71%), fatigue (39.4%), and headache (28%). The study, however, was insufficiently large to assess risks of rare adverse events such as myocarditis and pericarditis that have been observed in young men 18 to 25 years of age after receiving mRNA vaccines. In these young men, cardiac risks were highest within the first week following the second mRNA dose, and most cases were clinically mild and resolved quickly. The cardiac risk in teenaged individuals varies but is estimated to be 180 cases per 1 million fully vaccinated males 12 to 15 years of age and 200 cases per 1 million for fully vaccinated males 16 to 17 years of age." (Moss et. al. 2021)

Again, this is just data as I am no longer giving my opinion on taking this vaccine. (A review article by Dr. knight and colleagues has shed a bright spotlight on disease risk. Knight et. al. 2021)

6) Health care is in a crisis as staffing is a widespread problem across the nation. In a recent article in the Atlantic we read: "Morning Consult, a survey research company, says that 18 percent of health-care workers have quit since the pandemic began, while 12 percent have been laid off. Stories about these departures have been trickling out, but they might portend a bigger exodus. Morning Consult, in the same survey, found that 31 percent of the remaining health-care workers have considered leaving their employer, while the American Association of Critical-Care Nurses found that 66 percent of acute and critical-care nurses have thought about quitting nursing entirely." (Yong E 2021)

This is issue is likely to worsen before it gets better as hospital systems have prized the financial bottom line over staff health and salaries akin to the major health insurance giants prizing their bottom line over reasonable provider reimbursement and patient services. Witness the 2021 revenues of Atrium Health Care at $8.67 billion dollars and 2020 United Healthcare at $55 billion dollars as two examples of profits driving all decisions.

7) Dr. Danny Benjamin hâs a few comments to share on this weeks podcast:
a) Masking works in schools full stop to help reduce the spread of infectious disease and especially Covid when circulating virus level are high. Each community's risk tolerance will dictate the choice on their clarity of what to do with regard to masking in the context of vaccination and community viral prevalence
b) The Pfizer mRNA vaccine is approved for 5 to 11 year olds. This allows kids to get fully vaccinated by January 1, 2022 if they and their parents so choose to do so preparing for the second half of the school year
c) The vaccine is super safe, super immunogenic and super effective that works at the three week designed interval. We do not have data based on the regulatory framework in order to push the second vaccine out to 12 weeks like some studies have shown to be more beneficial

8) New information about SARS2 origins based on some research from Michael Worobey in the Journal Science is available to read. They are seeing a cluster of initial cases in the Wuhan Animal Market which appears to possibly be the pandemic's ground zero. (Worobey et. al. 2021)

9) From the JAMANetwork paper: During the COVID-19 pandemic, the mean number of daily cases was 68,468. The incidence of COVID-19 peaked on January 8, 2021, with an estimated 295,121 US individuals receiving a diagnosis of confirmed COVID-19. COD or chronic (ie, >6 months) olfactory dysfunction due to SARS-CoV-2 emerged in August 2020, 6 months after the pandemic began. There was a steady increase in the cumulative number of US individuals with COD through April 2021. Starting in May 2021, the analysis predicted a near exponential increase in the slope of the cumulative number of US individuals with COD through August. Based on intermediate estimates, the number of US individuals expected to develop COD by August 2021 was 712,268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170,238, and based on the highest estimate, the number is 1,600,241. (Khan et. al. 2021)

This data set falls inline with what I am seeing in clinic. A large number of teenagers and their parents have either not developed a normal taste and smell response post illness or have no taste and/or smell at all. The disruption of the vitality of the support cells of the olfactory nerves by SARS2 appears to be long lasting. Many of my patients are reporting well over a year without normal sensory function.

This is yet another really good reason to get vaccinated if you are a teenager or older as this event does not occur with the mRNA vaccines to my knowledge.

10) Breastmilk obtained from mothers post natural infection and post mRNA vaccine show SARS2 specific antibody responses that offer neutralizing benefits. From JAMA Pediatrics, Dr. Young reported these results: 77 women/child dyads were divided into 2 groups, 47 (61.0%) in the infection group and 30 (39.0%) in the vaccinated group . "Infection was associated with a robust and quick IgA response in human milk that was stable out to 90 days after diagnosis. Vaccination was associated with a more uniform IgG-dominant response with concentrations increasing after each vaccine dose and beginning to decline by 90 days after the second dose. Vaccination was associated with increased human milk IgA after the first dose only. Human milk collected after infection and vaccination exhibited microneutralization activity. Micro-neutralization activity increased throughout time in the vaccine group only but was higher in the infection group vs the vaccination group. Both IgA and non-IgA (IgG-containing) fractions of human milk from both participants with infection and those who were vaccinated exhibited micro-neutralization activity against SARS-CoV-2." (Young et. al. 2021)

The benefits of breast milk continue to astound. Both vaccination and natural infection are adequately priming maternal immunity against SARS2 for her babe.

Get back to living with spunk and vigor,

Dr. M

Evich Politico
Andrejko MedRxIV
Remmel Nature
Kojima Lancet Infectious Disease
Moss JAMANetwork
Knight J Clinical Investigation
Yong The Atlantic
Worobey Science
Khan JAMANetwork
Young JAMA Pediatrics
CDC MMWR
CDC Variants Page