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Covid Blog- Herd Immunity Orange County

By editor
April 19, 2021

A farmhand was helping the farmer with his herd of cows. The farmer asks, "How many cows are in my herd?"

“49,” says the farmhand.
"Ok then; round them up!"
"Ok,fine! You have 50," says the farmhand.
 
Now that I have you trying to figure this out, I will do something totally out of character for me. 
 
I will make a prediction. About Covid. 
 
This is risky because all the predictions about Covid by experts, epidemiologists, the CDC, WHO, and even the Geico Lizard have proven wrong.
 
For example: 
-It wasn't like the flu. 
-It didn't end in warm weather. 
-It didn't burn itself out after a year. 
-It didn't only kill frail seniors and diabetics.
-And the vaccine was not at all a piece of cake.

 
So here is the senior cynical doctor’s prophecy:

We will reach herd immunity this year. In 2021.
 
As a matter of fact, I see it by Halloween. Maybe even Labor Day.
 
When I say herd immunity, I mean enough people will become immune to Covid, rendering its spread unlikely. As a result, the entire community will be protected, even those who are not themselves immune.
 
A disclaimer, I am not the only forecaster to make this projection. But I do firmly believe it.
 
In January, as I was couch bound recovering from Covid, I spent time with my iPad aimlessly surfing. I started doing the math, and as the data is now more solid, the facts speak for themselves.
 
It seems the government experts are trying hard to downplay this scenario. It makes sense-they don't want us complacent. Ripping our masks off. Filling up restaurants. Just in case we NEVER reach herd immunity. 
 
Remember, these are the same people that said antibodies will not protect us.
And no test of cure is needed.
And only get tested if you have symptoms.
And that we need to close our schools,,.no I mean open the schools,,.no close...no....you get the idea. 
 
Now I have an alternate theory. 
First, I would like to pay homage to Monty Python and the genius of John Cleese. If you haven't seen it, please You Tube the “Pythons Ann Elk” skit on the theory on Brontosauruses.
 
Here is my theory  
AHEMMMM!
 
My theory--which belongs to me--is as follows...
 
This is how it goes--
 
The next thing I will type is my theory...
 
Ready???
 
My Theory by Dr Gregg DeNicola will begin now...
AHEMMMM!
 
We will reach herd immunity via natural antibodies against Covid, with additional antibody protection from vaccine programs.
 
That is my theory, which is mine, and belongs to me, and I own it. 
 
For any viral disease, immunity is afforded by antibodies. 
There are only two ways to get these gems in your system. You can make your own, however that would require you to actually contract Covid.
 
The antibodies are also obtained via a vaccine. 
Which are better? I refer you to hours of research on the WWW where you will find no clear answer. 
 
"Natural" antibodies appear to keep you Covid free 99% of the time you have them. 
Vaccine antibodies also appear to be working at a 99% clip. 
 
So, as your bartender says---"Pick your poison."
 
Although if you have had Covid, odds are you are protected- we just do not know how long the protection lasts. We've seen it last a month. We have seen it last 11 months. 

With the vaccine the CDC is hoping for a year efficacy but we don't have the data to support that. A yearly booster is likely.
 
So let’s do some math to validate my theory.
 
To achieve Covid herd immunity as defined earlier, the numbers vary from 50-80% by epidemiologists. Because of potency, penetrance, geographic spread, and different strains, each virus has a different percent.
 
Measles needs 90% herd immunity. Polio only 80%. 
 
Remember herd immunity does not eradicate the virus from the face of the earth. That has only happened once in history. The wonderful Dr. Edward Jenner and his Smallpox vaccine destroyed the Smallpox virus, with the last known case reported in 1977.
 
Since we do not know the exact percentage for Covid yet, let’s pick a reasonable 75%. 
 
In 2020 the US population was 331 million. Let’s say the 2021 US population will be 333 million.
 
That includes infants and children, who notoriously do not have antibodies, so this will require a higher number of adults to have antibodies.
 
333 million Americans, times 75%, means we need 250 million of us with antibodies at one time to achieve the Holy Grail of herd immunity.   
 
On April 1, we had 56 million Americans vaccinated.  
 
The CDC reports in the US, we average 3.1 million new vaccines a day (not the second shot). So by May 1, we should be at 150 million Americans vaccinated. 
 
Now let’s say for various reasons, we do not hit 150 million until July 4th. We also have to count the number of post-Covid patients with antibodies.
 
Sloan Kettering did a study on "seroprevalence" to estimate that in March we had up to 120 million Americans immune due to post-Covid antibodies. 
 
December 2020 had over 20 million documented Covid cases in the US. We are averaging 70,000 new cases a day currently. That means between April 1 and May 1 alone we will have around an additional two million Americans antibody protected. (Yes, nearly all Covid cases make antibodies.)
 
The wild card here is that these numbers are only for swab POSITIVE cases. Experts estimate that there are at least three additional cases never tested or reported for every swab positive patient.
 
You get it. The Mrs. has symptoms, gets PCR tested positive. The Mr. also has symptoms and says “no need for testing, I know I have it. I’ll just hunker down until I feel better.” Then their 2 kids with fevers refuse that "brain biopsy" swab. Four cases but only one positive swab.
 
The "untested" immune help offset the fact that of the 150 million vaccinated Americans we will get to by the summer will include a fair number of people who ALREADY have antibodies from a prior Covid infection.
 
So the math says of the 150 million people that will soon be vaccinated, perhaps only 66% had no antibodies. 
 
That makes 100 million protected from getting the vaccine.
 
NOW add the 120 million people the experts say are protected from natural antibodies post-Covid 
 
Add 30 million people who are protected but don't know it because they haven't (or won’t) be tested.
 
VOILA! 250 million protected Americans, the number for herd immunity. 
 
This doesn't even count continuing at three million vaccines a day, and the 70,000 new cases that are still occurring across the country getting natural antibodies.  I postulate herd immunity by Halloween is not only possible, but probable.
 
An example is the DeNicola Thanksgiving dinner in 2020. There were nine at the table. All tested PCR and antibody negative days before.  All nine were negative.
 
Today, just four months later, six of the nine have had Covid and have antibodies. Six of the nine also have had the vaccine. All nine are currently protected, either by natural or vaccine antibodies. This is happening all over the country.
 
The more people that contract Covid, the more protection we achieve.
The more people that get the vaccine, the more protection we achieve. 
 
Want to hear a joke about immunity?
Never mind, you've already “herd it.”
 
What herd immunity should mean is no more masks. Eating at a restaurant that has tables three feet apart. Salad bars back. Stadiums and concert halls full again.
 
We will know there is herd immunity when the 14 day rolling average of new cases and deaths take a sharp drop to below what a typical flu season has.
 
Yet, I suspect public health experts will still want masks and distancing practiced long after herd immunity has kicked in. Immunity is invisible, and our paranoia over any possible Covid spread will make returning to normalcy difficult. 
 
Yet my math says that we are far closer to herd immunity than the public health officials want to acknowledge. 
 
Yes, new mutations and strains may not respect the vaccines or antibodies.
Yes, some vaccines may wear off in three months without our knowledge.
Yes, natural antibodies may disappear in two months, leaving the post-Covid patient unprotected.
 
Yet despite those concerns, there will still be a steady flow of both natural antibodies and vaccines offsetting them. 
 
And we will reach herd immunity by Halloween.
 
That is my theory. Which is mine and belongs to me.
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth


On-site Covid Testing for Your Business, School or Organization in Orange County

By editor
March 16, 2021


For the first time since last November, Orange County is back in the less restrictive red tier of the state’s COVID-19 monitoring system and we are happy to announce at Caduceus, we have ALSO resumed taking on new clients! 

The shift means many local businesses and activities in Orange County can resume operations or expand their capacity, impacting gyms, restaurants and movie theaters. It also means middle and high schools that didn’t open previously can begin to offer on-site instruction and sports with modifications. It is now more important than ever for businesses, schools, and other organizations to schedule Covid diagnostic and/or antibody testing for your employees/students.

Our corporate wellness mobile testing team is available to come to your business or school Tuesdays and Thursdays for on-site testing. 

We also offer a Covid-19 continuity program to re-test/screen employee/student health status, including ongoing access to telehealth video visits to help maintain staffing and productivity levels.

Learn more and review our corporate Covid-19 testing options and pricing packages.

If preferred you can refer your employees or students to one of our testing sites. Currently we offer testing at our Yorba Linda, Orange, Irvine, and Laguna Beach locations. 

If you are interested in more information about our corporate Covid-19 testing programs or would like to arrange testing for your employees, email or call 714-646-8058.  


Covid Blog 2021 Physicals Orange County

By editor
March 16, 2021

With apologies to Gilbert and Sullivan, this is for all you Pirates of Penzance fans who have had to deal with the pandemic over the last year.
 
Pirates of Pandemic Patter
(to be sung at a rapid tempo)
 
After all the quarantine it’s time to move around, even dance
Ask Gilbert and Sullivan; sing along to Pirates of Penzance
 
You are the very model of a novel coronavirus
You ruin health, economy, and holidays are quite the fuss
 
Sneaky how you incubate, 2 weeks ‘til you rear your ugly head
Some folks don’t even know they’re sick while others can’t get out of bed
 
You mimic every symptom out there, what a tangled web you weave
So many “experts,” self-appointed, hard to know whom to believe
 
CDC just cracks us up, thinks it knows exactly when you’ll leave
You come and go without reservation, offering no reprieve
 
 
Time to take a break from the patter
Let’s talk important next steps that really do matter.
 
Whether you’ve had COVID or not, you’ll need a checkup in 2021.
 
It will be different than any physical you’ve ever had before.
 
In fact, at Caduceus there are three categories of checkups for 2021. As we introduce HUEY, DEWEY and LOUIE, see to which one you relate.  Call us quacks if you like, however Caduceus may be the only medical group with COVID specific checkups for 2021!!!
 
 
HUEY-
 
HUEY has not had COVID.  He mostly stayed home, wasn’t able to exercise, packed on the COVID 19 pounds, may have consumed more than his usual amount of cheeseburgers and does recall daily happy hour.  Diabetes runs in his family however he’s sure he’s fine.  HUEY schedules his annual checkup which includes:

  • Lab work to check on diabetes, high cholesterol, fatty liver and more
  • If female, mammogram and Pap, depending on date of last test
  • COVID antibody testing.  Huey may have been an asymptomatic case and already have protection.  Or Huey many have gotten the vaccine(s) and have antibodies

If over 50, HUEY meets criteria for:

  • Colon cancer screening
  • PSA if male
  • Bone density testing
  • Shingles vaccine

If over 65, HUEY meets criteria for pneumonia vaccine.
 
HUEY is still nervous to go out in public, so the good news is HUEY DOESN’T HAVE TO COME INTO THE OFFICE.  We can start the 2021 checkup from the comfort of your home or office.
 

  • Curbside lab draws
  • Video Visits to review the tests
  • We’ll go from there – some things will require an office visit as we haven’t figured out how to biopsy a mole, pierce an ear, or do a Pap remotely.

 
 
Can’t resist the urge to rhyme
Let’s indulge the patter one more time
 
Virus analogy is a dragon, with a very long tail
Ignore bedrest and do too much, the symptoms come back without fail
 
Docs try and try, I don’t know why, as we all know there is no cure
Despite Hydroxychloroquine and Ivermectin, you endure
 
Z-Pak, zinc, lots of vitamins, then Decadron and Tylenol
Trying any and everything, like throwing pasta at the wall
 
Has convalescent plasma become the ultimate gift to give?
Will sharing antibodies be the thing that helps others to live?
 
Prone position, oxygen, Remdesivir flowing through the vein
As soon as something starts to work it transforms into a new strain
 
 
DEWEY-
 
DEWEY did have COVID last year, not a bad case.  DEWEY took a Z-Pak, some cough medicine, and had an inhaler, just in case.  He feels pretty lucky to have been out of commission only a short time.  He’s pretty sure he’s back to 100%.
 
In addition to EVERYTHING COVERED in HUEY’s physical, DEWEY’s checkup will include some additional post COVID labs.  Studies show that even people with asymptomatic or mild cases may have post-COVID Syndrome, affecting their organs.  Labs may include:
         

  • Tests double checking your heart, lung, kidney, and liver function
  • Additional labs looking for post-COVID inflammation
  • Antibody testing monthly

 
 
OK, it’s time
A little more rhyme…
 
IgM and IgG – antibodies are talk of the town
Everybody wants a bunch, to last and last and never go down
 
Pandemic rocked our world so hard and now the aftershocks we feel
Enter Moderna, Pfizer, J& J – is vaccine the real deal?
 
You are the very model of a novel coronavirus
You ruin health, economy, and holidays are quite the fuss
 
Learning more each day; using science and common sense best we can
Let’s hope virus this mutates out, and leaves as fast as it began!
 
 
LOUIE has survived the monster virus, had a severe case, may or may not have been to the hospital and may or may not be feeling back to 100%.  LOUIE may still be experiencing fatigue, occasionally still needs inhalers, sometimes can’t sleep, and his head feels a little foggy.  Oh, and LOUIE’s gut is still bothersome.  LOUIE is not alone.  We are shocked at the number of patients who still have lingering post Covid symptoms.  Post-Acute Sequelae of Sars-CoV-2 infection (PASC) is a thing.  Worldwide, reported incidence ranges from 10-30%.  LOUIE has won the war, however the battleground may have sustained some damage and needs time to repair.  LOUIE’s annual checkup will include everything that HUEY’s and DEWEY’s did, and can also start from the comfort of home or office. We may run a few additional tests or labs to specifically check on LOUIE’s heart, lungs, kidneys and brain depending on the severity of LOUIE’s post Covid symptoms.  Tests may include:
 

  • EKG
  • Echocardiogram
  • Pulmonary Function Studies
  • Pulmonary Rehab
  • Antibody testing monthly
     
    So, for 2021, are you HUEY, DEWEY or LOUIE?
     
    We recommend antibody testing regularly for everyone and will offer monthly antibody options for all categories.
     
    We’ve instructed staff not to giggle if they receive a call asking to schedule a HUEY/DEWEY/LOUIE physical!

    Gregg DeNicola MD CMO, Caduceus Medical Group, PDQ Urgent Care & More, & PDQ Telehealth
    Mary DeNicola DNP PDQ Operations Officer 

 

 

 

 

 


So What Now Orange County...Covid PCR, Antibody, Vaccine FAQ's

By editor
February 18, 2021

Sometimes, trends change just because that's what trends do....think -popcorn ceilings. We like them (ok, our parents liked them) then we don't - and prefer a different trend. 

Other times, the new trend is due to a change in circumstances---think -gas powered SUV’s replaced by electric cars as being in vogue to reduce carbon footprints as well as avoiding gas stations.

Let’s revisit 1953 and the film The Wild One.  Pogo sticks were featured and before you could say Tutti Frutti Ice Cream, Pogo sticks were all the rage. For those unfamiliar with the 20th Century, a pogo stick was a device for jumping off the ground in a standing position, consisting of a pole with a handle at the top and footrests near the bottom, and a spring located somewhere along the pole. Ok, I agree it sounds underwhelming, but if you were a ten year old in a housing tract in the Eisenhower 50's, and had a Pogo Stick, you were “King of the Neighborhood.”

 Yet, by 1960, Pogo sticks started rusting in the back of the garage next to the linseed green linoleum leftover from the kitchen floor remodel. (Yes, another trend that didn't last; thank God!) Although Pogo sticks still had a lot going for them, in 1958, the Wham-O Corporation started production of a plastic hoop, inspired by a bamboo exercise hoop popular in Australia. To use it, you pretended you were doing the Hula with the hoop around your waist....a Hula Hoop! This began one of the largest fads America has seen, before or after.

They were much less expensive than Pogo sticks. And anyone, from a kindergartener, to an adolescent, to a teen, and even Mom and Dad--heck, even Grandma and Grandpa, had their own Hula Hoop. They could be used to exercise, have endurance contests, and- once you learned the trick- even toss it away, and it would "walk" itself back to you.

Sometimes, a new fancy needs a little boost-especially when it can improve the health and well-being of our community. That is where today’s blog comes in.

In 2020, testing for Covid was all the rage---we promoted it here with the “TEST TEST TEST” mantra. And it became more and more essential as the numbers rose toward the last three months of the year.

We had the rapid test. The gold standard PCR test. The saliva test. The expedited test, all with different accuracies, prices, and difficulty in finding somewhere to do it.

At Caduceus and PDQ we were militant about getting enough tests for our patients, not requiring symptoms to test, and demanding a test of cure (a negative test after a positive one) to be cleared.

People used the PCR to get back to work, travel, gain entrance to a family party, and even be reassured visiting the seniors in their lives. People would wait in their cars for hours, plead on Facebook for sites they could get a Covid test, TODAY!

Now, in 2021, it is still important to keep an eye on whether your contagious ---and by all means, check a PCR if you have symptoms of Covid. But we have a candidate for a new Covid fad--the forgotten antibody tests.

First, we must clear up one falsehood about Covid antibodies. They DO protect against catching Covid. Somewhere, social media picked up on the CDC’s and the WHO’s advice that said we weren't sure. But we are. Antibodies fight off Covid; period. How would a millennial type it?

Antibodies. Do. Work.

That's what antibodies do. It would be like saying, we aren't sure that blood carries oxygen, or the kidneys don't filter our blood... They work, well, because they are antibodies.

If they didn't, we just wasted trillions of dollars and time developing and giving vaccines. Because that's how the vaccine works; it stimulates Covid antibodies which in turn fight off the Covid virus.

But when we discuss commercially available antibody tests, we are talking about checking the antibodies we form after exposure or an infection. What about the antibodies we form from a vaccine? As they say in OZ, "That's a horse of a different color!"

The experts told us the antibodies from the vaccine are a different type of antibodies, which probably don't show up on normal antibody testing. So no need to check antibodies after a vaccine, right?

Well....a lot of people did anyway, and guess what? A lot of them have antibodies. What do we do with this info? No one has any idea.

At Caduceus, we have diagnosed over 3,000 patients with current or past Covid infections. Only ONE was diagnosed with a positive PCR swab with positive antibodies, but he had no symptoms. A new study in progress will show NO Covid infections with 11,000 patients with antibodies. We are not saying antibodies are 100% protective. However, looking at available data, it is highly unlikely you will contract Covid if you have Covid antibodies.

If you look it up, the CDC as well as all the major research centers in the US, will say something like-

"We don’t have enough information yet to say how protected someone might be from being infected if they have antibodies to the virus.”

That's fair. Also cowardly.

Sometimes you have to tell the Emperor he has no clothes on. 

We get many FAQ’s....I will post a few here and forewarn you we have the same answer for all of them...

Q: I have had Covid. Do I still need the vaccine?

A: Not sure.

You should definitely check for antibodies. If you have them, you may want to save the vaccine for those without antibodies.

It is apparent we have no idea if Mother Nature’s antibodies are "better" than vaccine antibodies.

In most other viruses, Mother Nature’s antibodies are always better--or at least as good- as vaccine induced antibodies.

Remember Chicken Pox? "Natural and wild" antibodies were much more protective than the vaccine.

But some studies are telling us the vaccine is more protective than simply testing positive for antibodies post-Covid.

Yours truly just had an antibody test, and I paid extra to get a "quantitative" number, and I was off the chart.

I have so many antibodies I swear I saw a couple crawl out of my ear last night. Am I going to get the vaccine?

Not sure.

I need more data, which will be forthcoming as more people get both natural antibodies as well as vaccine antibodies.

Q: I have had the vaccine. Do I need to check my antibodies?

A: Not sure.

It appears the vaccine may trigger antibodies not picked up by the conventional testing done by commercial labs. No "expert" has officially advised checking antibodies. The concern is you will test negative and conclude the vaccine failed, when in fact it worked perfectly; the antibodies just need a different test. Since we do not know how long the vaccine lasts, just stay tuned and the WHO/CDC/Dr. Fauci will let us know if and when we need a booster.

Q: How about Mother Nature’s antibodies? If I have them , how long will they last?

A: Not sure. (See a trend here?)

We have had patients lose IgG in a month. Others are still IgG strong seven months from their infection. The only way to know is “TEST TEST TEST.”

So do we have any specific advice for you?

You're darn tootin’. (Recovering from Covid, I saw a lot of old Westerns)

There is a 100% chance you fit into one of these five buckets. Follow along for your fortune…I mean advice...  feel free to pass it along to friends or family who may be in a different bucket.

BUCKET #1

You have not had Covid, not been exposed, nor had any Covid type symptoms over, say, the past year. You have not been vaccinated.

ADVICE- No antibody test necessary. Find a way to get a vaccine. Then just sit back and wait as we find out how long the vaccine lasts.

BUCKET #2

You were exposed to Covid--through a roommate-partner-coworker etc., at any time over the past year. I'm talking about a close exposure.

ADVICE- If the exposure is recent, start with a PCR swab. Otherwise, check your antibodies. You may be surprised to find out you are IgG positive. Then check your antibodies monthly through 2021 to confirm your (probable) immunity. If the IgG disappears, or your antibody test is negative, take the vaccine.

BUCKET #3

You have had Covid in the past year (but not currently).

ADVICE- Check your antibodies, now and monthly through 2021. Same logic. Since we do not know how long they will protect you, keep a close eye on them, and get vaccinated as soon as they disappear.

BUCKET #4

You currently have Covid, or have symptoms of Covid. You have a positive PCR swab.

ADVICE- Wait at least a month from when your symptoms started, then check your antibodies. Check your PCR regularly also, to be sure your clear of the virus. Check your antibodies monthly through 2021, using the same logic from Buckets 2 and 3.

BUCKET # 5

You have been vaccinated (apply this advice even if you also are a member of Buckets 1-4).

ADVICE- Sit back, relax, and read this blog for advice as to a possible booster. Of course, still wear a mask, social distance, and avoid super spreader events. If your personality allows for it, you may want to check antibodies, but do not be concerned if they are negative, even after the vaccine.

PCR Covid testing?

That is SOOOO 2020.

In 2021, Let’s make antibody tests all the rage. It’s good data to know.

 Oh!  Also... as long as we are discussing fads, a Hula Hoop on Amazon goes for $29.99. Just in case you are feeling nostalgic.  (I swear my Mom got mine at Zody's for a dollar!)

Gregg DeNicola MD, Chief Medical Officer

PS. I again want to thank all of our loyal readers and patients for their prayers, cards, gifts, and messages of goodwill as I continue the slow recovery from a serious Covid pneumonia.

It is a slow daily fight, but I am getting slowly better, as the doctors predicted. If you are post-Covid yourself, you are aware of the danger of blood clots, long term lung damage, and a continuing cytokine storm to keep you alert.

It would be a lonely road if not for all the support, and I want to thank you from the bottom of my heart.

And yes, I still enjoy a shot of Kahlua.


CMO Covid Orange County Blog- Shares his story

By editor
January 26, 2021

It was 3 PM on my second day in the hospital--Christmas Eve- and was due to have a half hour IV infusion of Remdesivir for my Covid pneumonia. 

I looked up at the IV bottle.

It was a dark glass container, looking identical to an upside down Kahlua bottle. More bothersome - there were three heads coming off the bottle, each looking like a Satanic face.

Scared, I assumed I was dreaming. But squeezing myself, I knew I was totally awake. I closed my eyes, and looked up again at the bottle being hung. Same vile image. I noted one of the faces looked identical to the character "Anonymous.”

As a physician I knew I was hallucinating.  I knew hypoxia or high flow oxygen, of which I was having both, can cause hallucinations.

Yet it was as surreal as it comes, physician or not.

I decided to not look up until the infusion was done, and not ask my nurse about the unorthodox IV she hung.

The next day on Christmas, at 3 PM it was time for my second dose. The nurse came in to hang the IV bag. It took all I could do to look up as she hung it. It was a small clear vinyl bag, used for all IV meds. I was relieved the devilish Kahlua bottle was nowhere in sight.

I summoned the courage to ask my nurse, “was yesterday’s dose put in a different bottle?” “No,” she said, “it was the exact same small clear IV bag.”

I asked her if I had been napping when she hung the first dose. “No,” she said, “you were wide awake; why?”

I decided if I ever wanted to get released, I’d best keep my hallucinations to myself. “Just wondering,” I answered.

This falls into the category of "you know you are sick when.”

I can boil my experience into three unexpected memories. That bottle was obviously number one.

The second was my activities during my nine day stay. I had brought some books to read, planned on watching classic movies, brought a shaver and toothbrush, and some shampoo if I had a shower in my room.

Ok, I had never been hospitalized before. What did I know?

I spent eight days laying on my right side-flat, which produced the best oxygen readings.  Flat on my right side, 24/7.
 
Realize all of my adult life, I was a multi-tasker. Running a busy practice.... Running a business.... Working as a Medical Director.... Husband and raising three boys into men.... Cooking and wine tasting.... And recently I took up gardening and boating, weaving those into the hours I had in a week. The idea of lying down in my bed for even 30 minutes during the day would be my biggest nightmare.

Yet here I was, lying flat for 200 consecutive hours. This wasn't a bad dream;  it was torture.

There were a few exceptions. I could sit up to eat. But that dropped my oxygen so it had to be done quickly. One day physical therapy visited and stood me up. To achieve that, they had to crank my high flow oxygen even higher. I had one quick sponge bath. No shower, no shaving, no reading, no TV, and no visitors. My only view was of the nurse’s call button on the rail next to my face.

I knew that position was the only way my oxygen number would stay in the 90’s, allowing the nurses to try to wean the high flow oxygen from the 100% they started me on to the 30% goal-- when they could convert me from high flow to regular low flow.  They had mentioned if they couldn't wean me in two weeks, I may be transferred to a "higher level of care". I knew what that meant-- the ICU for possible intubation.

To keep from going crazy, I tried to think of as many bad doctor jokes as I could ...you know, like-

“I’m sorry,” said the doctor to his patient. “You have Covid.  We must quarantine you, and you’ll only be fed sliced cheese and bologna.”

“Will that cure me?” the patient asked.

“Well, no,” the doctor replied, “but it’s the only food that will fit under the door.”

OR

“Doctor, there’s a patient in room one who says he’s invisible.”

“Well, tell him I can’t see him right now.”

OR

How did the doctor cure the invisible man?

He took him to the ICU.

That took up about half hour before I realized I’d rather be hallucinating than thinking up bad jokes.

By day eight, they finally managed to wean me from high flow to low flow, but I was still confined to lying flat on the right side position. On day nine, they tried to sit me up. My numbers held in the 90’s. Not only could I read, eat, and watch TV from a sitting up position, but also they said they were sending me home. There were too many people in the ER as sick as I was the week earlier with no beds available. My Italian guilt took over as I realized I was glad there were enough sick people to force them to kick me out of my prison.
 
That leads to the third unexpected experience being home.

I imagined sitting on the couch watching Netflix, catching up on my medical reading, chatting on the phone with friends and family, and being back to normal in a week or so.

You can stop grinning now.

I was still on 24/7 oxygen, so my nurse/wife Mary was in charge of the slow steady wean. I am still on oxygen now, so I learned this will be a long-term project.

I was given exercises to help build up my strength. Problem is they drop my oxygen numbers plus they exhaust me. I need to use an incentive spirometer every 10-15 minutes to expand my lungs.

So I found recovering from Covid pneumonia is a lot of work. I should have believed my doctors who warned me to measure my recovery month to month, not week to week.

Yet as I recover, I find myself wanting to resume previous activities. When I was first came home, I told my staff I was retiring from blogging. Yet three weeks later, I know I want to go back to some sense of normalcy.

Believe me, writing this blog today is much more therapeutic for me than you.

One of our patients in Laguna Beach is the glass blower from the Sawdust Festival. 

He isn't going to believe the special commission I have for him this summer.

I just need to empty out a bottle of Kahlua.
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group, PDQ Urgent Care and More, PDQ Telehealth 
 
P.S.  It is an understatement to say I am overwhelmed by the hundreds of cards, emails, and calls from our amazing patients and skilled staff wishing me healing. I tried answering everyone personally, then realized it was an impossible goal.

Reading these well wishes was stronger healing than the Remdesivir. I am truly humbled. Reading them made me realize I have had a career blessed by the heavens and the very best patients in the universe. Believe me the love goes both ways.
 
Remember to get tested with ANY symptoms and stay home as much as possible. I have been asked where I contracted Covid and I am sure it was from some asymptomatic person I came in contact with at work. I was still seeing patients in the office four days a week and masks are only 80-95% effective. It was a matter of time that a Covid particle sneaked around the masks we were wearing.

In retrospect, I should have stayed home doing video visits only when the numbers exploded after Thanksgiving. Do not repeat my mistake.

Caduceus will not be receiving the vaccine soon, so make best efforts to get vaccinated where you can. If you have had Covid, we advise a monthly antibody test through 2021.

We are now researching what a 2021 check up should entail and will be publishing that in a future blog.


CMO Covid Blog Orange County- Latest numbers from the Caduceus Covid Treatment Team

By editor
December 15, 2020


Last week, we gave a special bulletin on five items relating to the pandemic. To update this week, we enlisted the help of one of the most famous doctors of all time. He did this by eavesdropping on Annie, a young adult who sported a "good Annie" on one shoulder, and a "bad" Annie on the other. 
 
#1- A new symptom, diarrhea, had taken over as the most common symptom for Caduceus patients. That has not changed in a week, with the proviso that headache has now become the second most common. And those that have diarrhea typically do not have headache, and vice versa. Yes, we still have a lot of respiratory presentations. 
 
The issue is the raw volume. It is very difficult to keep up. The first 12 days of December we accepted 208 new positive patients into our treatment program.  It took four months in the spring to hit 250 cases. Today as I type this, we just assumed an additional 36 new cases.
 
In one day. 
 
A new issue is the challenge hiring new staff and doctors fast enough to take on this volume. So if you interact with our staff, realize many are putting in 12 hour days, 7 days a week with no vacation this year. 

The current spike was predicted by many (including this blog), with the Thanksgiving holiday being the main culprit. But another culprit has emerged- most new cases were due to invalid quarantining.  Far too many patients went back to work, went to gatherings, and went out with friends despite not confirming a negative test after a positive one, or after a close contact. 
 
Let’s ask our guest doctor, Dr. Seuss, about the conversation with Good Annie vs. Bad Annie---Bad Annie has lost her sense of taste and smell...Good Annie advises to quarantine while being tested.
 
BAD ANNIE:   
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE: 
Would you, could you in your house?
Maybe even with a mouse?
 
BAD ANNIE:
Not in my house
Not with a mouse
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you with a mask?
Maybe if we fill a flask?
 
BAD ANNIE:
Not with a mask, not a flask
I can’t believe you’d even ask
I do not like Covid 19
I do not want to Quarantine!
 
#2- We mentioned that tests were becoming scarce last week. We are pleased that we now have collected enough swabs to resume our usual testing advice.  Many labs are still warning about low supplies, so if you try to find tests close to Christmas at other facilities it may be difficult without symptoms. 

We have more PCR tests than the rapid antigen tests. But we do NOT advise rapid antigen tests in most cases, so try to ask for the more accurate PCR. We still offer same day or overnight results with the expedited test for a fee. We will continue to work hard to always have enough tests for our loyal patients.
 
So bad Annie, while you wait for your result; be sure to quarantine!
 
GOOD ANNIE:
Would you, could you play a game?
Pick up Stix is not that lame
Oh! I know a real fix
Find a series on NetFlix!
 
BAD ANNIE:
I do not play Pick up Stix
I don’t have NetFlix
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you in a car
Maybe you could drive real far
Or better yet on a fancy train
Enjoy the view, out of the rain
Or better yet in a tree
Way up high, where no one can see!
 
#3 We mentioned last week that saliva testing may become available with another choice for a rapid result. We are still researching this. It still isn't ready for prime time.  We will keep you posted on social media and our website. 
 
BAD ANNIE:
Not in a car, not on a train, not in a tree, just let me be
I do not like Covid 19
I do not want to Quarantine!
 
GOOD ANNIE:
Would you, could you wearing socks?
Would you, could you with some Crocs?
 
BAD ANNIE:
Not with socks, not with Crocs
And I don’t want to hear from any docs!
 
GOOD ANNIE:
Here’s an idea, a fancy hotel
With food a plenty – just ring the bell
 
BAD ANNIE:
I cannot taste! I cannot smell!
I don’t want a fancy hotel!
You can keep your food a plenty
I’m so sick of Twenty Twenty!!
 
#4- Vaccine questions---Here is what we know now:
 

  • The Pfizer vaccine is FDA approved for all persons 16 and older to prevent Covid 19 
  • Our Federal government has allocated 6.4 million doses to be shipped now intended for hospitals and government health systems (eg. VA, etc). Their intent is to vaccinate health care workers, high risk seniors, residents of nursing homes, and assisted living residents. 
  • As supplies increase, the wider population will be able to obtain them at no charge at urgent cares, pharmacies, and physician offices. We are told this can optimistically occur in February or March.

We are on it.

 
Only the Pfizer messenger RNA vaccine has been approved. Found to be 95% effective, side effects were uncommon, naming the usual site pain, fatigue, headache, and chills. These were more common after the second dose that is required with the Pfizer vaccine. More traditional antibody vaccines are also asking for approval, and may become available through the spring. Patients could then pick their personal choice. 
 
We DO NOT know the duration of the immunity from the vaccine. An annual vaccine, much like the flu shot should be planned for most likely. 
 
The vaccine does nothing once the virus infects you. 
 
WHAT?  I’M POSITIVE???
Quarantine???
If you make me, if I must
For the better good I trust!
 
I’ll wear a mask, bring on the flask
I will take Covid to task!
 
I’ll take my meds and stay away
And quarantine all night and day!
 
I’ll nest and rest and then re-test
Because Caduceus says it’s best!
 
#5- How to reach us--We mentioned in last blog the issues with our phones. And with the huge spike this last weekend, answering calls timely is a challenge. However, we have hired more staff and will continue to make answering the phones a top priority.

On the positive side, we have seen a much higher volume over our website and app live chat feature and the email feature we call Mousecalls. Those continue to be the fastest way to talk to us.  With hundreds of tests a week, even calling back all the negative tests is challenging. 
 
WHAT?  I’M NEGATIVE???
 
I still don’t like Covid 19
But I survived the quarantine!
 
Hooray, hooray I’m finally free!
 
Now to build  IgG……
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group

(With special thanks to Mary DeNicola, DNP, and Theodore Seuss "Ted" Geisel helping provide smiles in the midst of the worst part of the pandemic.)


CMO Covid Patient Bulletin Orange County December 2020

By editor
December 8, 2020

Special Bulletin-
 
We want to alert our Caduceus and PDQ patients to new developments regarding Covid ---the usual disclaimer-

These apply ONLY to our patients, other health systems may be experiencing different scenarios, or perhaps not reporting them.
 
1. New presentation of Covid
2. Testing shortage looming
3. New saliva testing update
4. News on vaccinations
5. How to reach us
 
1. New presentation of Covid
 
Like most of the country, we have had an explosion of new cases. So many that we have a difficult time to keep up with the pace. Our aggressive treatment program has been successful in reducing admissions, ventilators, and we are now at 1000 cases treated with no deaths. However, we postulate another mutation has occurred. 
 
For the past two weeks, a large percentage of new cases present with diarrhea as the only symptom. Because they have no fever, or respiratory symptoms, many patients feel it’s a bad burrito and do not seek care. The only other symptom they have is a definite fatigue, even the loss of taste/smell has been rare. Some of these patients do progress on to a full blown Covid picture, so it’s important to get tested if you experience a new onset diarrhea, DESPITE WHAT YOU MAY HAVE RECENTLY EATEN. 
 
 
OUR ADVICE-
 
Contact us for a telehealth visit at the first sign of diarrhea. Do not try to ride it out with some Kaopectate. Isolate immediately. 
 
2. Testing shortage-
 
As we have informed you previously, Caduceus does NOT run the tests ourselves, we swab and send them to a number of different labs to perform that function. The swabs themselves are NOT simply Q-tips , they are specialized swabs provided by the labs.
 
Due to the holiday rush, and the enormous increase in new cases, we have been warned by all labs that there may be a shortage of swabs, both PCR and rapid antigen. Although they cannot give us a time frame, we are hoping this is temporary until the “powers that be” can invest in more testing. 
 
OUR RESPONSE-
 
We will be testing close contacts and symptomatic patients as a first priority. We will not routinely test for every positive antibody. We suggest waiting 10 days in between swabs for patients under active treatment. We ask private companies that have been requiring weekly tests on their staff to temporarily change that to every two weeks.
 
Do not hold off on testing if you need it. We have sufficient swabs currently. But we may have to begin rationing if swabs become harder to come by. This is true for ALL medical centers that are testing. Be prepared to find it more difficult to obtain testing without symptoms. Of course we will give priority to our own loyal patients. 
 
3. Saliva testing-
 
Just in the nick of time, it appears there has been improvements of the saliva tests for Covid. Recall we initially did not advise saliva tests due to the lack of good studies and the fact the virus appears to prefer the nasal cavity, leading to many false negatives.

We have kept up with the studies and there may be new saliva tests that are a little more accurate than the rapid antigen test, but not as accurate as the PCR. If it passes our vetting, we will announce it via our website and social media, and begin using them quickly.
 
DO NOT fall for the “do it yourself” saliva tests. There are far too many errors with this. 
 
OUR ADVICE-
 
Consider saliva testing only once we have thoroughly investigated it for efficacy. Follow us on Facebook, Instagram, and check our websites daily for updates. 
 
4. Vaccination questions-
 
Hard to believe but we know about as much as you do from the news media. We have put in for an order, but that is just a formality. We have contacted the manufacturers directly, and their tersely worded responses are a bit disappointing. They basically say “no comment.”
 
Sources at higher levels have shared with us that both seniors and health care workers will come first.
 
But will it be no charge and administered by the government? 
No comment.

Will they sell it to doctors to give in their offices?
No comment.

Will it be the technology of messenger RNA developed by Pfizer and Moderna or will a more typical antibody vaccine being developed by other labs be offered?
No Comment.

Will it be mandatory?
No comment.
 
Will it really get us to herd immunity?
No comment.
 
Did we really ask the authorities all these questions?
No...oops I mean absolutely. Very frustrating.
 
OUR ADVICE-

Any rumors you hear about the vaccine are just that--rumors. Check with our social media and website for updates as we get them. Our past performance on Covid tells you Caduceus been on the cutting edge, and ahead of the game from the beginning. That will continue with the vaccine.
 
DO NOT sign up for, or pay money, or visit an unfamiliar medical office to get in line for the vaccine. There are many hoaxes and scams going around, and NO ONE can or should be taking any money from you at this time for the vaccine or for a waiting list.
 
5. How to reach us-

This last weekend, we had over 2,000 phone calls, mostly about Covid. It obviously overwhelmed our staff, and we apologize if your voice mails were not answered. We are still a local doctor owned small business and would need a staff of dozens of operators to handle what we are experiencing now.
 
Hands down the easiest way to reach is is via email, either the patient portal or Mouse Calls on our website for medical questions. We commit to a same day answer.  Our live chat feature on the websites or apps is a great way to make appointments for testing or any other appointments.
 
OUR ADVICE?
 
If you call and do not get an immediate answer, use the email or live chat options instead of calling again.
 
We would appreciate not leaving negative reviews on Yelp or Google saying we don't answer our phones. This is our first pandemic and we are really using every resource we have to serve our patients. We want to stay in business as much as all other small business owners. 
 
Steve Jobs said this as part of his Apple strategy, but it applies to us now more than ever...
 
Everyone here has the sense that right now is one of those moments when we are influencing the future. 
 
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group
 


CMO Corner- Orange County Covid Updates for December

By editor
December 1, 2020

Did you know Flintstone Vitamin D is only sold in one city in the United Arab Emirates?

Citizens in other cities refuse to eat them.

But Abu Dhabi Do!
 

As the Covid numbers spike, I feel it may be time for a little humor…yes, I know what you're saying…very little!
 
There are three questions I am continually asked, so feel it’s worth addressing in this blog.
 
1. "Check my Vitamin D level. If it’s low will I have a bad case of Covid?”
 
ANSWER: Yes and No.
 
Yes: some studies, most sources quote one from Spain---show a poorer prognosis in Vitamin D deficient people. Vitamin D may help with macrophage activity to destroy the virus. It may help fight the cytokine storm responsible for many Covid deaths.  It helps "modulate" the immune system, so important in fighting off a bad viral infection. So start taking Vitamin D, right?
 
Well......wait.
 
No: Vitamin D deficiency is more common in older age groups, smokers, obesity, and in those with chronic diseases such as diabetes, hypertension, and also some racial and ethnic groups are more predisposed to deficiencies including African Americans.

The high-risk groups that have more complications and higher mortality rates in COVID-19 coincide with groups that have a high incidence of vitamin D deficiency. So we may just be saying "If you are an older diabetic smoker you will have a poorer prognosis from Covid,” without bothering to check a Vitamin D level.

Will correcting a low Vitamin D level help with Covid? No study shows that, since you should also correct the blood sugar, blood pressure, etc. at the same time.
 
The venerable Mayo Clinic, in a bulletin to physicians, concludes, "To the best of our knowledge, there is no data on the effects of vitamin D in SARS-CoV-2 infection.”  They then opine, “we suggest it would be reasonable to supplement vitamin D in sub-populations at risk of vitamin D deficiency and unfavorable COVID-19 outcomes.” 
 
In other words, those patients we mentioned in the preceding paragraph. I could not find studies controlling for high risk Vitamin D deficient patients.
 
Our interpretation?
 
We do not have good evidence Vitamin D will help, but it’s safe so what the heck; give it to seniors, smokers, diabetics, and any other high risk groups just in case.
 
Another issue is what constitutes Vitamin D deficiency?
 
Most labs list the lower limit as a level of 30. But most experts define true deficiency as under 15. It makes a difference since most articles quote “80% of severe symptoms with Covid are Vitamin D deficient.”

But when we check Vitamin D levels as part of a yearly checkup, I'd estimate 80% of all our patients are under a level of 30, not 15. Despite heavy research, I couldn't find studies on Vitamin D levels under 15 and percentages of a Covid prognosis.
 
Our conclusion?

Taking 2000 units of Vitamin D3 a day will not hurt. If you are a senior, smoker, obese, diabetic, African American, or have hypertension, it may help but be aware evidence is weak.
 
 
What's ultraviolet light’s favorite animal?
 
A lamb, duh!
 

Geesh! Tough crowd!
 
2. Should I use ultraviolet germicidal lighting?
 
If you own a large building, yes. In your home....read on.
 
UVC units look like your mosquito zapper on the patio in the summer, but these rays zap viruses. They have been used to fight viruses since a measles epidemic in Philadelphia in 1937. Numerous studies show when used correctly, UVC produces the same result as replacing the air in a large room 10 times in an hour. It is safe and effective to add a layer of protection against most viruses.
 
Cost? For large buildings, where it is most useful, about $6 a square foot. So for the Yorba Linda packing house at 77,000 square feet, about a half a million dollars. They are already in use in many colleges, as well as certain high traffic areas of LAX.  They definitely add a effective layer of protection.
 
Go on Amazon, you will find portable UVC wands for about $50. You wave it over your body and your friends and family. They have room sanitizing UVC lights for under $100. Perfect right?
 
Well… in fact there are no studies revealing how much or how long to use these devices, or that they even work.
 
The biggest issue is that these zap viruses IN THE AIR floating around, just waiting to zip into your nose and infect you. They have NO effect for viruses already in your body, or if they aren't floating around.
 
Our conclusion?

Installing UVC devices in indoor public spaces would cost a fraction of the budget our elected officials have spent to mitigate the economic impact of this virus. As far as buying a wand or a room unit for your family room? Might be better to open a window....
 
The lab report said I had blood Type A.

But it was a Type-O.

 
Hey, these are the jokes!
 
3. Will knowing my blood type predict the severity of a Covid infection?
 
From a study recently published at Harvard Medical School and Massachusetts General,
"Blood type is not associated with a severe worsening of symptoms in people who have tested positive for COVID-19."
 
When you try to research this in the medical literature, there are two different searches.
 
First, studies that look at IF you have Type O blood. Then perhaps you may have a lower risk of getting infected.  The data is very anecdotal. And weak. Most of it falls into what doctors call the "letter to the editor" category. Interesting to read, but not nearly enough data to substantiate the claim.
 
Then there are the studies that look into IF you have Type O blood.  Then  you're less likely to get very sick and less likely to need a ventilator in the ICU than if you have Type A blood.  Same; interesting theory but the data is just weak.
 
For both categories they are retrospective studies. They look back, and analyze the cases after the fact.  Much preferred would be prospective, randomized clinical trials. Those are lacking, in fact, I could not find even one.
 
Our conclusion?

We are not at the point where we can say, "You have Type O blood so don't wear a mask," or, "even though your oxygen level is low, you don't have to stay in bed with Covid, since you are Type O." It is possible a certain blood type makes better antibodies. We just need more--and better --data.
 
Questions I cannot address yet are the multitude of rumors about the upcoming vaccine.
 

•   Most insurances will not cover
•   It will be free
•   It will be given to seniors first
•   It will be given to hospitals first
•   It may wear off after three months
•   It will have few side effects
•   It will have many side effects
•    It will only be given to certain assigned centers in each county
•    It will not stop the pandemic
•    It will get things back to normal

 
Those are all possible scenarios. We need a month or two to find the answers.
 
I also have a vaccine joke.
 
But a lot of people won’t get it.
 
I’m here all week.

 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group


CMO Corner- Covid Facts vs. Shiznit

By editor
November 10, 2020


“There was truth and there was untruth, and if you clung to the truth even against the whole world, you were not mad.”
George Orwell
 
 

In the novel 1984 (written in 1949) George Orwell predicted that technology would develop and allow corrupt governments to manipulate and spy on their population. In the book, the dangers of false information were warned of repeatedly. 
 
In an earlier blog we played "Fact or Shiznit?" a true or false exercise regarding Covid myths. There was some constructive criticism of the blog, feeling we were "playing games" with a deadly disease. 
 
Duly noted.
 
So let’s clear up some false information out there; this time, no games.
 
We will tell you the Shiznit and then give you the facts.
 
SHIZNIT #1
 
The CDC and health departments say Covid positive patients are no longer contagious and can stop isolation after 10 days of no symptoms.
 
FACT 
It is true that evidence exists suggesting the virus loses its penetrance after 10 days. No debate there. Yet it takes 7-21 days to re-swab negative once symptoms appear. Negative means no virus is found. Many infectious disease experts are showing evidence it’s safer to release a patient from isolation with a negative swab than just using the 10 days benchmark.
 
Let’s look closer at why the "10 day rule" is Shiznit.
 
Exhibit 1- For starters, the CDC states that there is evidence to release a patient at 10 days with no symptoms. Unfortunately, there has been insufficient time to do a broad scale prospective or double blinded study to show this definitively. That study will not be able to be published for many months. To allow a cessation of isolation in the middle of a pandemic is no time to be using "evidence exists" as your defense. 
 
Exhibit 2- The European version of our CDC has gone on record that there is uncertainty about the requirement of a negative re-swab (also called "test-of-cure") although they also concede a 10 day wait is reasonable. 
 
Exhibit 3- Johns Hopkins -a respected medical source- endorsed the CDC guidelines, yet also points out there is no way to tell if a swab positive test indicates an infectious or non-infectious virus. They also state a large number of Covid cases are spread by asymptomatic people who are swab negative. 
 
So let's try to understand this---if you swab positive without symptoms, you may be able to spread the virus.  But if you are positive 10 days after your last cough, you won’t spread the virus. At least "there is evidence" you won’t. 
 
If this is how our health leaders are planning on stopping the virus, we have trouble. Right here in River City.
 
Fortunately, you have a choice. 
 
TEST. TEST. TEST.
 
Reading the literature, what appears to be the "truth" is that the contagiousness is related to "viral load.”  The higher your viral load when you contract the virus, the longer you are contagious after the infection. Since we have no way to measure viral load, the prudent course is to assume everyone has a high viral load.
 
Hence our advice is to swab negative prior to stopping your quarantine if you are positive.
 
So why are the health departments and CDC sticking with the 10 day advice?
 
In the spring, the CDC admitted the lack of tests in the country played a part in their position. They aren't saying that now. 
 
Yet we know test availability has been a problem in our country, as well as Europe. But if that's the reason, just tell us. We can take it.
 
More facts to dispute the 10 day strategy---cases are raging both in the US and Europe. A large number--up to 40 % in some studies- are coming from asymptomatic people. If the 10 day rule was working, shouldn't we be seeing a DECREASE in new cases? 
 
Would you go to a restaurant where the cook had a fever and swabbed positive 10 days ago, and is now flipping your burger?
 
Would you sit at a table at a wedding where the person next to you swabbed positive 11 days ago but stopped coughing ten days ago but did not re-swab?
 
Would you visit your elderly frail uncle if you had swabbed positive 10 days ago without knowing you are swab negative?
 
Of course not. And I suspect the head of the CDC wouldn't either. 
 
CADUCEUS RECOMMENDS A NEGATIVE SWAB AFTER THE INITIAL POSITIVE SWAB IN A COVID INFECTION.
 
It may be 7 days, or 10, or 20. 
Know if you're contagious.
Don't assume. 
Don't guess.
And don't listen to the health department when they give you Shiznit.
 
SHIZNIT #2
 
If I feel sick between November and February, a Covid swab is sufficient. And a flu shot is optional.
 
FACT-
It is very conceivable to have both the flu and Covid at the same. And if you have only one, it’s important to know which one it is. There is an antiviral medication for the flu.
 
Yet both during the last flu season as well as this one, many of our beloved patients balk at having both. Some say they are really only worried about Covid. They don't want two tests. Although covered by virtually all health plans, they bring up cost. 

Since Covid and flu symptoms are quite similar, and this is the flu season, it is important to see if you have one, or the other, or heaven forbid both. The flu shot is more important this year than ever before. We cannot yet prevent Covid with a vaccine, but we can help prevent the flu and you really don't want to get both this winter.
 
FACT-

CADUCEUS ADVISES BOTH A FLU SWAB AND A COVID SWAB FOR ANY FLU SYMPTOMS THIS FLU SEASON.
 
AND A FLU SHOT FOR ALL ITS PATIENTS. 
 
 
“The best books… are those that tell you what you know already.”
George Orwell, 1984

 

Although this seems counterintuitive, it makes sense when you read Shiznit #3.
 
SHIZNIT #3-
Newer saliva, rapid antigen, and self-administered swabs are accurate.
 
FACT-
 
Yes; some studies do show a five percent false negative and positive rate for the saliva test, which is acceptable. However, those numbers have not been borne out by true randomized peer reviewed studies.
 
In one Yale study, saliva testing was MORE accurate than nasal swabs. Number of patients tested? 76.
 
Yet, another study from South America showed the saliva tests had more false negatives than nasal swabs. It was just published in the journal "The Scientist.” 
 
Sample size? 776 subjects.
 
The fact is for a study to be credible, there must be THOUSANDS of subjects. Different races, ages, and other demographics. Better yet, make that TENS OF THOUSANDS of subjects, with the testing done blinded. 
 
Saliva tests are far from proving themselves.
 
The rapid antigen tests are still running around a 10-20% false negative rate. No real improvement has been seen here, and the data keeps getting more accurate. 
 
Nonetheless, our most popular test to do at a patient’s request is the rapid “while-you-wait” test.  Even if they have to pay for it.
 
Many patients are seeking the test where you do your own swab, mail it in and wait for the result. I am confused as to the logic.
 
First, there is user error. A timid patient will not swab as accurately as a trained professional. Then we are relying on the US mail, whereas a curbside PCR test is no charge - back in a day or two- and very accurate.
 
As Mr. Orwell said...”the best book is the one that tells you what you already know.”
 
You already know the PCR test is the best. Don't fall for the slick sales pitch for rapid tests. Don't be tempted by saliva tests. At least wait until more studies can confirm their accuracy.
 
 
CADUCEUS ADVISES THE CURBSIDE NASAL SWAB VIA PCR TO DETERMINE THE PRESENCE OF COVID. AVOID SALIVA TESTS, RAPID TESTS, AND SELF ADMINISTERED TESTS.
 
This is too important to take a short cut. A possible fatal shortcut.
 
SHIZNIT #4-
Once I recover from Covid, I am out of the woods, just like getting over the flu.
 
FACT-
 
Beware of post-Covid Syndrome, or as we call it-“PCS.” 
 
This is being described in the literature, but the data here is only from our own patients....our sample size is the 600 plus patients we have treated from the start of their infection until turning swab negative.
 
The scenario is becoming more common and more disturbing. You have exposure or a fever. You go curbside for the swab and it does come back positive.
You start in our treatment program. Meds. Pulmonary hygiene. Bedrest. Isolation. 
 
10 days later, you feel better and swab negative. All is great---right?
 
Wrong.
 
A few weeks later, you feel more fatigue. Your cough returns and you can’t walk up the stairs. Your sense of smell, which never totally came back, goes away entirely. 
 
You may actually feel sicker a month after you "recover" than you did while you had Covid.
 
Sounds like a nightmare, right? Welcome to the “Wonderful World of Covid,” the virus that is writing its own rules.
 
For our patients, about 15% of our more recent cases qualify as having “PCS.”
 
Average age of “PCS” is 45.
Male/female -50/50
First and most common of PCS is by far fatigue. Very bad fatigue.
And it’s more likely if they did not practice strict bedrest when they were fighting Covid initially.
 
Most worrisome and bothersome are the symptoms revolves around the lungs-- Shortness of breath. Cough. Air Hunger. Poor exertion. Mucus.
 
For lung symptoms, we use Budesonide, Albuterol, and Decadron if necessary. We follow pulse-ox frequently, and encourage incentive spirometry and pulmonary hygiene. Unfortunately, some cases have not improved even after several months. 
 
We pray it's treatable. 
And prepare for it being permanent. 
For other symptoms, e.g. the lack of taste/smell, muscle and joint aches, headaches and palpitations, TOT (Tincture of Time), bedrest, and plenty of fluids appear to be helping.
 
We have seen new cases of significant hypertension appear shortly after Covid recovery.  These cases require medication and the long term prognosis is unknown.
 
“PCS” is becoming a true disease and deserves more research and alertness on the doctor’s part.
 
Nationally, new diagnoses of  autoimmune diseases post-covid (Hashimoto’s, Lupus, and Sjogren’s) have been noted, but we have not seen that at Caduceus---yet.
 
CADUCEUS ADVISES CONTACTING YOUR COVID DOCTOR IF YOU HAVE NEW OR PERSISTENT SYMPTOMS AFTER YOU TEST NEGATIVE FOR COVID.  TREATMENTS CAN HELP.
 
You all know the drill.
 
- Know if you're contagious---get swabbed before any social gathering and insist the others do the same. 
- Have swabs regularly---every two weeks if you are out and about or working.
- Get regular antibody tests to see if you're immune.
- Wear your masks.
- Stay as far away from others as situations allow.

 
Locally, statewide, nationally, and globally--cases are skyrocketing. One of the solutions is more testing, not less. We are happy to help provide that curbside for you.
 
Still not sold on testing?
 

We offer a complimentary online assessment that is actually kind of fun to take on our website. Go to caduceusmedicalgroup.com or pdqurgentcareandmore.com and hover over the “Individual Covid-19 Testing” button and choose the drop down “Are You Actively Contagious with Covid-19?” It only takes about ten minutes and a staff member will contact you with your results within 24 hours.  

 
Consider taking that test to determine your risk level.
 
Do mandatory masks and testing take away our freedoms? Let’s again look to the novel 1984 and the words of Mr. Orwell.
 
“The choice for mankind lies between freedom and happiness- and for the great bulk of mankind, happiness is better.”
 
Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group


Orange County Exclusive Caduceus Interview with "Cov"

By editor
October 22, 2020

(The author directs readers to watch the films Blazing SaddlesYoung FrankensteinHigh Anxiety, and The Producers prior to reading this blog. Failure to do so may cause credit-or blame- to be given to the author when it should be directed to Mr. Brooks.)
 
"Life is a play- We're unrehearsed"--Mel Brooks
 
Our loyal patients probably know Caduceus was the first medical group in the area to offer curbside services and flu tests in February, curbside and telehealth Covid testing in March, and higher complexity Covid antibody testing in April.
 
Now we are proud to announce our newest achievement.
 
By taking mucus from a Covid positive patient, isolating the RNA, charging it with 1.21 gigawatts of nuclear power, and putting it through a 3D printer, we have been able to convert a Covid particle into human form! Tweaking the uploading process using Epson microchips, the virus was converted into an exact life-sized replica of Mel Brooks!
 
Best of all, Caduceus has secured exclusive rights to an actual face to face interview with the virus, who has asked to be referred to as "Cov.”  As CMO I am honored to be the interviewer.  FYI-I am no Carl Reiner.
 
CMO: Welcome Cov, full disclosure- I have been trying to destroy you over the past 7 months. So tell me- How are you feeling today?
Cov: (Singing) High anxiety ... it's always the same; high anxiety ... it's you that I blame.
 
CMO: Sorry. Oh I get it!! You're programmed with Mel’s brain. Reminiscent of one of my favorite movies of yours, Young Frankenstein.
Cov: Ummm...remember, I am NOT actually Mel Brooks- I simply took on his form.
CMO: Oh, of course- I should have known...
Cov: Besides it’s pronounced "Fronkensteen."
 
CMO: Let’s get right to what our readers want to know; Did you come through bats in China? Or were you a lab-made conspiracy to affect the US Elections?
Cov: Sorry to disappoint everyone, but we are just an old- fashioned mutation from the plain vanilla Coronavirus that causes the common cold.
 
Our first mutation was in bats, a favorite host of Coronavirus.  But we got tired of hanging upside down all day, plus have you ever had to live right over piles of guano? We wanted a new host, and humans were perfect. Nice big nostrils to invade, and better yet, they flush the toilet.. well most of them anyway.
 
CMO: So was it your plan on taking over the entire planet?
Cov: Hey, we were happy in China. I mean, what’s to not love about Peking Duck? But one day one of the viruses said "let’s get Italian,” so we infected Italian tourists, not realizing all he wanted was a plate of marinara!

It was an honest mistake. So a few Italians get infected, and POW! Next thing you know we are global. We are thinking since Italians won’t keep quiet, always laughing and singing, it kept spreading.
 
CMO: Is it true you live in the nasal and oral cavities?
Cov: Well DUH! We are Coronaviruses. That's our hood. Oh, we produce cytokines that do damage in all parts of the body, but inside the nose for us is like your Malibu beach house.
 
 
CMO: So masks should keep you from infecting other humans then?
Cov: Oh masks are a huge pain. Nothing worse than floating through the air looking for some place to land, and all we see are masks! It’s like you humans using a Club on your new car’s steering wheel. A good thief can get it off, but why not just go to the car next to it without a Club? We see someone without a mask and we say BINGO! If we try, we get through most masks 20% of the time. But then we have to get past the mask of the person nearby so it’s just not worth it.  Especially with so many people anti-maskers. They make our job really easy.
 
CMO: So how does Covid get around? Can you guys fly?
Cov: For a CMO you don't know your virology very well! No we don't have wings. We depend on a good cough or sigh to get us out of one oral cavity and into another.

If God wanted us to fly, he'd have bought us tickets!
 
CMO: And you can only float for about six feet? So the X's on the floor do work?
Cov: Well our best athletes can make it 10 feet with a good breeze. But with us being able to aerosolize, we can actually travel over 40 feet in a small area with good air pushing us. We just look for someone without a mask, naturally. But the closer together humans are the easier our job is.
 
CMO: So will you share what's your "Kryptonite?” Does Plaquenil scare you?
Cov: Ok you seem like a nice guy. I’ll level with you...yes, Plaquenil was a problem for us. See, we survive by replicating in the human host. Plaquenil does inhibit our replication. Thank God Trump praised us, that made everyone hate it.  By the time studies were started we had mutated against it.
Same with Remdesivir. It was killing us off, but now we know a mutation to counteract it.  Fact is, nothing kills us.
 
CMO: So there's nothing you guys fear? You are just going to infect the entire planet?
Cov: Wellll....ummm.
CMO: Come on Co....spill it; just between us.
Cov: (Mumbling) antibodies.
CMO: What was that mumble?  Antibodies? Like IgG?
 
Cov: You didn't hear it from me...But it’s DEVASTATING! We float into a nice warm nose, start replicating and then WHAM! The IgG eats us whole! Its barbaric!
CMO: It’s called Phagocytosis. A well known immunologic mechanism. So it DOES work against Covid! The CDC and WHO are wrong?
Cov: Yeah we cut a deal. They cast doubt that antibodies work and we stay out of their headquarters. They know we don't stand a chance against IgG. It’s like trying to break into a sailboat surrounded by 100 Navy Seals!  Thank Heaven only 10% of the people we try to infect have it.
 
 
CMO: Wait! Was it part of the deal that the CDC not advise repeat swabs on known infections?
Cov: No comment. (Whistling....)
 
CMO: So you must be worried about a vaccine coming soon? After all, a vaccine is simply a lot of antibody in a syringe.
Cov: Naw. We figure there are enough anti-vaxxers to infect to keep us in business for many years. We find them refusing vaccines as showing no respect, right? So those are our first targets.
 
CMO: So why did you infect President Trump?
Cov: The guy with the big hair and red hat? Yeah, we targeted him. He was always dissing us. Saying we are no threat. Not encouraging masks.  Having super spreader events. Viruses have feelings too!
 
CMO: How did you get in? Was the Secret Service a problem?
Cov: Are you kidding me? We just went in the nostrils of a couple of White House interns. A Rose Garden ceremony, and the rest was like taking acorns from a blind squirrel!
 
CMO: Looks like you got the whole White House staff?
Cov: Once we had Trump, we figured why not settle down in the White House? The West Wing is totally cool, and the Situation Room is a trip! We even got a few top secret passwords I can share with you later!
 
CMO: But did he really have a pretty mild case like he claimed?
Cov: Yeah, we didn’t send out the Big Boys. I mean he is the President after all. Just some of our lower level guys to scare him a bit.
 
CMO: Would you say you are political?
Cov: Don't be stupid; be a smarty! Come and join the Democratic party!
CMO: I think you mean NAZI Party?  In the...
Cov: Whoa! Be careful! We are in a blue state! You'll get boycotted!
CMO: No, No - I mean in The Producers that line went...oh never mind.
 
CMO: You realize Covid has caused over a million deaths globally? Don't you feel just a little guilty?
Cov: Does a bear feel guilty when he catches a salmon swimming upstream? Does a shark feel guilty swallowing a seal whole? It’s what we do. If it bothers you so much, invent an antiviral agent to combat us like you did with HIV.
CMO: Well perhaps Caduceus is in its lab every day doing just that?
Cov: Don't make me laugh---we are Covid and we will just mutate away from anything you invent.
 
CMO: Well, Co, Thanks for the interview. I learned a lot. Say, since we have kind of bonded here, before you turn back into 125 nanometers, want to hang out awhile? What do you like to do?
Cov: Sure. 2 things. I like chess.
 
 
CMO: A virus knows how to play chess?
Cov: Yeah - it was uploaded from one of our mutations--I think when we visited Magnus Carlsen.
 
CMO: Chess sounds kind of dull. What's the other thing you like to do?
Cov: Kill people.
CMO: Let’s play chess.
 
 
Gregg DeNicola MD
Caduceus Medical Group
Chief Medical Officer
 
-KNOW IF YOU'RE CONTAGIOUS.
-KNOW IF YOU'RE IMMUNE.
-SET UP A REGULAR TESTING PROGRAM FOR SWABS AND ANTIBODY TESTS. 
-STAY HUNKERED DOWN FOR NON-ESSENTIAL ACTIVITIES.