Covid Update in between bigger updates for timeliness
December 13th, 2021
1) Omicron is outcompeting Delta based on early evidence from Europe and South Africa. It also appears to be as much as twice as contagious as the Delta variant. How it interacts with the US population is coming online in the next 2 weeks. I am quite fascinated by the reality that the new reproductive rate could have jumped to the land of measles. Quite amazing for an organism to mutate this quickly and so effectively to make itself omnipresent in the globe. Thank God this almost always portends a weaker kill rate!
2)There is very good early evidence that it is likely less deadly as the early reports out of South Africa and elsewhere show a younger infected population and less hospitalization and death. It is primarily infecting the under 45 year old age group because they are the least vaccinated group and most interactive. However, the morbidity and mortality reality for the US will only be understood when we have a few weeks of Omicron induced disease in our population. Early data out of the midwest and Northern states is that 80+% of all admitted patients and north of 90% of ICU patients are yet unvaccinated, however, most of this disease is still delta.
3) A study just published in MedRxIV and discussed in Science states that there was a massive increase in infections in South Africa as soon as Omicron hit. South Africa had a high rate of previous natural infection but not a large vaccinated population. Thus, they can only teach us that Omicron is evading natural immunity well. (Vogel K. 2021) Studies in labs are showing us that vaccine evasion is strong as well.
4) Pfizer and Moderna's mRNA vaccines are much much much less effective against Omicron based on early studies from the manufacturers. Pfizer is stating that the 3rd dose, booster, is increasing antibody levels by 25x and this is leading to better immunity against omicron. How effective this is in vivo remains a mystery as these are lab based tests. However, despite this data there is zero evidence that the two dose primary series or illness plus one dose of mRNA vaccine is leading to worse or more serious disease.
5) Remember that Omicron shares mutations with the variant delta, but it has a dozen novel mutations on its spike protein, including 32 mutations in this region overall. It seems now that these mutations have significantly reduced the ability of our current infection or vaccine induced antibodies to neutralize it, making our mRNA vaccines much less effective based on the initial 2 dose study data. These mutations are all in the locations of spike antibody binding sites. (Mishra S. 2021) There clearly is a mechanism behind the findings at Pfizer's lab.
6) To get a booster now is a big question mark for me as we are likely to need an omicron based vaccine next year and maybe in 100 days to stem the true tide of this pandemic assuming death and hospitalization remain static or reduced. If death and hospitalization remain very low for the vaccinated at 2 doses, there may be a really good case for skipping dose three, giving it to unvaccinated people and then finally wait for omicron based vaccines that are coming. This is only for the low risk population as discussed in many previous newsletters. If you have a co-morbid disease, advanced age or immune suppression or any other known risk for a bad outcome, then boosting makes prudent sense now. It remains incredibly likely that the 2 dose mRNA series is still completely protective against severe disease which is what really matters in the end. All hypothetical at this moment. There are many options here. Each person must weigh and measure their respective risks and benefits based on the data to date. Most major medical organizations believe that it is prudent to boost all persons now. I am yet on the fence as it is highly likely that our T and memory B cell immunity remains quite potent against severe disease risk which is what we have been fighting this entire time. However, If you have not vaccinated and not been sick to date, please vaccinate.
Marty Makary MD, MPH states: "The immediate reflex to give young healthy people a 3rd vaccine dose to protect against Omicron is not supported by data, nor is it necessary for anyone who has natural immunity based on the studies we have to date". Time is the only answer to this question. Each teenager and/or adult must decide on their own what makes the most sense for them and their family.
For more information there is a really good article by Derek Thompson in the Atlantic - link
11 Years Gone by!
What have we learned in 2021?
1) Covid is truly remarkable and also a major pain in the .... Messaging and political policies have been mostly dysfunctional and persist in many places today. The vaccine effort has been nothing less than heroic and saved countless lives. Media companies and the CDC continue to avoid the elephant in the room, poor quality nutrition, obesity and metabolic self induced derangements. Life continues for most of us while we mourn the loss of those that have succumbed to COVID. Getting significant COVID illness portends high death risk acutely and during the first year after recovery by a significant margin. Vaccination for high risk groups is the only chance of reducing this risk. See this mortality Graph (Manious et. al. 2021)
2) Excess ingestion of fructose, fat and refined carbohydrates in general are the main drivers of disease risk. Insulin resistance and obesity are becoming the main risk factors for all cause mortality from metabolic disease. We are finally understanding the why this is true mechanistically. Immune activation from these processes are turning out to cause most pathology. We are truly mismatched between our individual genetics and the environment of modern American food coupled to sedentary behavior, chronic stress and chemical exposure. The coming years will be a major test for the United States. Can we change policy to avoid the government inducing disease in humans by subsidizing poor quality foods? Can we finally change school nourishment to be actually nourishing and not fattening? Will our leaders finally listen to reason and promote health prevention over disease treatment? Time will tell, but I know where I stand.
3) Parents continue to spend too much effort pleasing their children and their whims and not enough time spent with authoritative decision making especially with regard to food choices and sleep time. These decisions are leaving children happy that they are getting their way, but physiologically dysfunctional and prone to disease. Roughly 2 out of 3 parents that I speak to states that their child/ren will not eat healthy food therefore they are given processed foods leading to constipation, obesity, worsened allergies, mental health challenges and so much more.
4) Dairy is now officially the most irritating food to infants and children. We are seeing incredible physiological problems from dairy consumption. Newborns and infants are colicky, eczematous and prone to excess mucous production driving ear infections. Toddlers and children who persist with milk protein intolerance are showing up with constipation, congestion, ear infections, skin rashes including eczema and keratosis pilaris and generalized abdominal irritation. The exact cause of the immune overreaction is still debated but the problem is here. Avoiding dairy is curative. we are not baby cows. Let it go.
5) Most Americans that I run into contact with are good and wholesome people. The truth that we all know is that most people around the world are good and wholesome people. The narrative in the popular press remains division and negativity promotion which has had a great negative toll on our children and society. The best decision that I made in the last year was to avoid the standard news feed that promoted discord and siloed my reading to science and positive sources of information. I have promoted the same positive view of the world to my children and patients alike. This country is a beautiful place and we all should cherish our gifts as given.
6) Podcasting is as enjoyable for me to produce as it is to listen to others that produce content. I appreciate the ability to further generate consumable health material in a format that many people seem to enjoy and some prefer over written text. I plan to continue this endeavor for the foreseeable future. New topics will be medical student journal club episodes, more parenting guests, and book reviews. Stay tuned.
7) The pandemic has really hurt the average child in the weight gain category as well as the mental health state. These two issues are linked through the microbiome and hormonal/neurological/immunological pathways. We have to make a concerted effort to reduce poor quality food from entering our children's mouths through not purchasing them, having them in the house and packing quality lunch for schools in place of the poor quality nourishment that is provided.
8) School closures have dramatically increased the prevalence and exacerbated existing mental health issues, such as anxiety and depression, among students. School closures place vulnerable children at higher risk of food insecurity, lack of access to education and abuse at home. More and more of these net negatives for our children will show up over time based on our political desire to rush to school closure. We need to remain hyper vigilant to their needs over the coming years and vow to never repeat this process again.
9) Monitors of health are very valuable. CGM, continuous glucose monitors are hopefully going to become common place to help us all understand our individual responses to certain food types with regard to glucose and insulin. Sleep monitors will help people understand the antecedent variables to poor sleep, i.e., stress, drugs, food, exercise/lack off, etc.... All of the tools coming on line will become added value narratives for individualized healthcare/medicine. One caveat: over monitoring can become a psychosis in itself.
10) Machine learning is coming now and in the future to help us provide better care for all children.
11 years of wonderful time spent,