June 21st, 2021

Latest numbers google/CDC

The United States is now past 65% of its over 18 year old population having been vaccinated with at least one dose and 45% of all Americans fully vaccinated. The number of vaccinated and or previously infected Americans is now a very large number and cases continue to be flat lined nationally. We have had no positive cases in our office for weeks which is a first since the pandemic began.150 million Americans are fully vaccinated with most being higher risk. 177 million have had at least one dose. The vaccines continue to drastically reduce the risk of death and hospitalization.

North Carolina now has 81% of individuals over 65 years of age fully vaccinated and 41% of the total population. It has stalled here.

The vaccines continue to be effective against all of the variants.

As it stands today, the United States has had 33.5 million cases and almost 601,000 deaths. That is a significant slow down to 4000 deaths in 2 weeks.

There is still no change in the knowledge that more than 80% of deaths are skewed toward the over 55 age group and 94% of all deaths occurred in a person with a co-morbid chronic health disease. More biological antibody medicines are on the horizon that may along with a mixture of vitamin A , D, zinc, quercetin and melatonin be employed for a safe resolution to COVID19. 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.

 Mathematically, you now have a 99.9998% chance of survival once vaccinated.

This is much safer than driving a car!

Happy Father's Day to all of the men that give of their time while they muster the courage to practice temperance and provide for the protection and mental nourishment of their children's souls.

 Coronavirus #37 audio version can be found at this link.

 Dr. M

Coronavirus Update 38

If you would like to share some silver linings from COVID 2020 for us all to reflect on, please send them to This email address is being protected from spambots. You need JavaScript enabled to view it.

Just when you think that the information on SARS2 Covid19 is slowing to a crawl with new discovery, a favorite researcher publishes a truly remarkable bit of scientific discovery. Dr. Alessio Fasano is featured below in Number 6 and his work is really important. A little science heavy but critical for children. There is a take home summary as well. Don't miss this information.

 

Quick hits

1) CDC data on adolescent hospitalizations: COVID-19 adolescent hospitalization rates from COVID-NET peaked at 2.1 per 100,000 in early January 2021, declined to 0.6 in mid-March, and rose to 1.3 in April. Among hospitalized adolescents, nearly one third required intensive care unit admission, and 5% required invasive mechanical ventilation; no associated deaths occurred..... Most (70.6%) adolescents in this study whose primary reason for hospitalization was COVID-19–associated illness had at least one underlying medical condition, which is lower than the percentage of hospitalized adults with an underlying medical condition (92%) (7). Nearly 30% of these adolescents had no reported underlying medical condition, indicating that healthy adolescents are also at risk for severe COVID-19–associated disease. In addition, approximately two thirds of adolescents hospitalized with COVID-19 were Hispanic or non-Hispanic Black persons, consistent with studies showing an increased incidence of COVID-19 among racial and ethnic minority populations and signifying an urgent need to ensure equitable access to vaccines for these groups .... First, the primary reason for hospital admission was not always clear, and some (45.7%) adolescents who met the COVID-NET case definition were hospitalized for reasons that might not have been primarily related to COVID-19, despite a positive SARS-CoV-2 laboratory test result; these hospitalizations were included in rate calculations. Thus, rates of hospitalizations for COVID-19 might be overestimated.(CDC MMWR June 4, 2021)

There is a lot to unpack here, so let's do just that.

When you dive deeper into the data, we see that 70+% of the at risk adolescents were obese and/or asthmatic which is again leading us to understand that inflammation is a primary driver of a negative COVID reaction. The median length of hospital stay was 2.4 days with some intensive care unit activity but zero deaths and the absolute number is small. They did not break out which groups ended up in the ICU, however, based on the adult data, most if not all were likely suffering from an underlying condition. We cannot rule out that adolescents with genetic mutations in viral surveillance, killing and immune expansion were in this at risk group.

My take home point from this data is this: 1) SARS2 is worse than influenza for adolescents but the absolute number is still very low. 2) If your adolescent children are obese, have asthma, cancer, diabetes, neurological disease, blood disorders, immune deficiency or metabolic dysfunction, please have them vaccinated. 3) This is absolutely the time to start getting your family entrenched in improved lifestyle choices specifically targeting inflammation as discussed in these links one and two.

2) Variants - SARS2 Version B 1.617.2 delta is emerging as a new trouble maker. First seen in India in December of last year, it is rapidly spreading in the United Kingdom and the western states of the United States. Early data for the delta variant is showing increased transmissibility (maybe 40% higher than the original strain) and maybe slightly more morbidity in the unvaccinated which is yet under study. The mRNA vaccines appear to be working quite well with the Pfizer-BioNTech vaccine showing 88% efficacy against symptomatic disease from the delta variant after 2 doses. (UK.Gov)

So far the trouble is only increased transmission against the unvaccinated and the poor responders to the vaccine. However, the vaccine still appears to be incredibly useful against hospitalization and death. I have not seen any data that children are at any significant increased risk. There are still no SARS2 variants of high concern leading to reductions in vaccine function or significantly increased mortality.

3) Long Covid - "of 9751 total participants, 5266 (54.0%) were male; 30 of 45 studies reported mean or median ages younger than 60 years. Among 16 studies, most of which comprised participants who were previously hospitalized, the median proportion of individuals experiencing at least 1 persistent symptom was 72.5%. Individual symptoms occurring most frequently included shortness of breath or dyspnea 36.0%, fatigue or exhaustion 40.0%, and sleep disorders or insomnia 29.4%.(Nasserie et. al. 2021)

The male predominance is interesting and aligned with the higher frequency of autoimmune antibodies to gamma interferon and lower testosterone levels being associated with increased risk for men of worse Covid disease than females. The more robust the inflammatory response, the more cellular damage follows increasing the risk for auto immune antibody production which is likely tied to chronic covid disease symptoms.

4) German panel recommends COVID19 vaccine only for children with pre existing conditions based on all of the current vaccine data. (Reuters) This is in direct contrast to the United States recommendation to vaccinate all over the age of 12 years. (CDC webpage) The disparity follows from different perspectives on risk for children and the pandemic as whole. The German approach clearly feels that children are low risk in general and not worth taking the risk of a vaccine side effect whereas the CDC feels the opposite. I tend to agree with the German approach as long term safety data is years away.

For an excellent look at this topic, see the article by Dr. Martin Makary in Medpage Today. He states: "Returning to the discussion of the COVID-19 risk to kids (ages 0 to 12 years) right now, it's worth aggregating the best available data to date. In reviewing the medical literature and news reports, and in talking to pediatricians across the country, I am not aware of a single healthy child in the U.S. who has died of COVID-19 to date. To investigate further, my research team at Johns Hopkins partnered with FAIR health to study pediatric COVID-19 deaths using approximately half of the nation's health insurance data. We found that 100% of pediatric COVID-19 deaths were in children with a pre-existing condition, solidifying the case to vaccinate any child with a comorbidity. Given that the risk of a healthy child dying is between zero and infinitesimally rare, it's understandable that many parents are appropriately asking, why vaccinate healthy kids at all? To those parents, I would say the primary reason to give a healthy child the vaccine may not be to save their life, it's to prevent the multisystem inflammatory syndrome (MIS-C), which can be painful and have long-term health sequelae. According to the CDC, there have been 4,018 cases of MIS-C after COVID-19 with the average age being 9 years old. A total of 36 children died. Cases of MIS-C were heavily skewed toward minority children (62% were Hispanic/Latino or Black), likely due to the disproportionate rates of childhood obesity and chronic conditions in these populations. This finding again supports COVID-19 vaccination in any child with a medical condition, including being overweight." (Makary M. 2021)

Take home point: if your child has a chronic health condition including obesity, diabetes, asthma/lung disease, hypertension, any type of cancer, immune defect, kidney disease, neurological disease, cardiac disease or any other known chronic health condition, then I would highly recommend the mRNA vaccine for MIS-c and general mortality possibility,

Another opinion piece by Dr. Makary in the Wall Street Journal on post infectious immunity.

5) The Cleveland Clinic Health System studied their employees over a 6 month period from December 2020 to May 2021 for COVID infections. They had them grouped by previous infection to SARS2 with and without vaccine as well as no previous infection with and without vaccine. "Among the 52238 included employees, 1359 (53%) of 2579 previously infected subjects remained unvaccinated, compared with 22777 (41%) of 49659 not previously infected. The cumulative incidence of SARS-CoV-2 infection remained almost zero among previously infected unvaccinated subjects, previously infected subjects who were vaccinated, and previously uninfected subjects who were vaccinated, compared with a steady increase in cumulative incidence among previously uninfected subjects who remained unvaccinated. Not one of the 1359 previously infected subjects who remained unvaccinated had a SARS-CoV-2 infection over the duration of the study."(Shrestha et. al. 2021)

Having had the virus prior and/or vaccinated is a key to why we are seeing a flatlined pandemic in the United States.

6) MIS-C, multi inflammatory syndrome - c., in children is associated with poor intestinal function from a microbiome perspective. Research from the lab of Dr. Alessio Fasano has shown direct evidence of intestinal permeability in children with multi inflammatory syndrome - c:
• They looked at 100 children: 19 children with MIS-C, 26 with acute COVID-19, and 55 controls.
• They analyzed the stool for SARS2 presence by PCR, polymerase chain reaction.
• They analyzed the blood for zonulin and other chemicals that indicate intestinal mucosal breakdown.
• They further analyzed the blood for the spike protein as well as the markers of the immune inflammatory response which when elevated is the chemical hallmark of MIS-C.
• The paper notes that there is increasing knowledge that the intestine serves as ground zero for SARS-2 COVID disease in adults and that in severe cases, microbial dysbiosis(abnormal bacterial makeup) and disruption of the gastrointestinal barrier drive inflammatory activation.
• MIS-C in children is delayed for weeks after initial infection when the virus is no longer found in the nose/respiratory tract making the source of the virus a different replication location in MIS-C.
• They showed that weeks after initial infection, they could isolate RNA for SARS2 in the intestine. There the virus causes intestinal inflammation and permeability leading to spike proteins leaking into the blood stream triggering the inflammatory immune response leading to system wide damage.
• Most therapies including steroids and IVIG (pooled immune globulin) are not clearing the spike protein from the blood pointing to the inability of current therapies to address the virus at the gut level as they are only addressing the downstream inflammation not the upstream generator of inflammation.
• In the study, in one 17 month sick child, they used Larazotide, a zonulin antagonist, an investigational therapy used in this case to block the zonulin peptide that was increasing the intestinal tight junction permeability looking for a reduction in spike protein in the blood and a corresponding inflammatory reduction. This occurred as hoped and clinical resolution occurred. (Yonker et. al. 2021)

Remember this from 2 weeks ago: After listening to a discussion by Dr. Ed Behrens from the Children's Hospital of Philadelphia regarding multi inflammatory syndrome in children, it appears to be the case that certain individuals have genetic mutations putting them at risk for immune dysregulation whereby the chemokine CXCL9 response to gamma interferon after being infected with SARS2 is up regulated due to missing repressive proteins in this inflammatory cascade. This leads to elevated immune activation very reminiscent of macrophage activation syndrome. In other words, many children will respond to SARS2 with normal and appropriate gamma interferon proteins to attack and kill the virus. CXCL9 is one signaling molecule in this process that recruits the white blood cells to enter the fray and fight SARS2. When the virus is killed, there are repressive proteins that are called in to stop this whole inflammatory process. This is the normal state for 99.99% of our children. The rare child with this genetic mutation can not shut off this process leading to all of the inflammatory sequelae seen in COVID19.

Unpacking all of this for MIS-C:
• This is clearly a disease occurring in individuals with prior co-morbidities putting them at risk for baseline inflammation.
• There is a genetic predisposition in some individuals to be missing a gene to suppress the immune inflammatory response once it starts.
• Dysbiosis, poorly balanced intestinal bacteria, is a risk factor for MIS-C and dysbiosis is caused by chronic poorly chosen lifestyle decisions, especially diet.
• We cannot change a genetic risk for a negative outcome but we can absolutely change our decisions that promote dysbiosis and chronic health decay.

Yet again, we see data pointing to our own personal control of our health outcomes. We can as parents make the following decisions to reduce our risk of MIS-C for our children:
1. No matter what has happened in the past, clean up your child's diet by switching to anAnti inflammatory diet,  Whole 30 diet or at the least a no processed whole food diet of predominantly fruits and vegetable matter. A highly processed modern diet is the most important antecedent trigger of dysbiosis and intestinal permeability.
2. If you plan to have a child soon, breastfeed your infant from birth and practice healthy weight gain during pregnancy to set the stage for a healthy child's microbiome. The prepregnant time is a perfect time to practice an anti inflammatory diet.
3. Get adequate sleep based on age requirements. For most kids, that is 8 to 10 hours nightly. This will help reduce sleep deprived immune activation.
4. Practice chemical and toxin avoidance by avoiding the consumption of unnecessary drugs that affect the gut including antacids, antibiotics, non steroidal medicines. These medicines will negatively affect intestinal microflora balance promoting dysbiosis.
5. Practice mental health stress reduction through prayer, meditation, art therapy, counseling and more.
6. Exercise and move often stimulating gut motility and evacuation which prevents constipation and small intestinal bacterial overgrowth.
7. Link to many articles on healing the gut biome: link

7) Sars2 MIS-C incidence was noted to be: MIS-C incidence was 316 persons per 1,000,000 SARS-CoV-2 infections in persons younger than 21 years of age. Black, Hispanic/Latino, and Asian persons had higher risk as well as younger persons compared to older persons. (Payne et. al. 2021) The reasoning behind the ethnicity difference is likely poverty based but not yet completely proven. The younger age predilection is similar to Kawasaki's and other inflammatory viral based diseases of childhood. The immune system must be more prone to dysfunction of the inflammatory type at the less than five year old age range. This is very interesting. We learned from #6 above that dysbiosis is a main driver of risk and dysbiosis increases with age making this issue unsettled. Genetic mutations in chemokine suppression activity are associated but that is not age dependent. Gut dysbiosis is associated and partially causal but cannot be the main issue based on the age predilection. More to come with time.

8) More evidence that surviving Covid, if you had severe disease, becomes an arduous journey. In the journal Nature we see a large sampling of post covid sequelae from the Veterans Affairs database. Many organ systems remain compromised following infection including the lungs, brain and kidneys. (Ziyad et. al. 2021)

The mounting data supports the belief that being unhealthy pre covid equals more unhealthy post covid.

Sars2 - covid19 has been the best eye opener in recent decades to the negative effects of our behavior on our long term health.

 

Dr. M

CDC MMWR
CDC Variants Page
UK Government COVID
Nasserie JAMANetwork
Reuters German Panel
Makary Medpage Today
Makary Wall Street Journal
Shrestha MedRxIV
Yonker J Clinical Investigation (full article)
Payne JAMANetwork
Ziyad Nature