Achives from Author

Quantitative Antibody FAQ's Orange County

By editor
November 24, 2021

Since the blog last week advising antibody counts to help predict vaccine failures, we have had many questions. Let’s answer a few now.

-Caduceus and PDQ Urgent Care and More can draw the counts during an office visit of any type or at their draw stations. Due to high demand, we have specific times we are drawing total antibody counts. They are as follows:

-Caduceus at the Packing House 18200 Yorba Linda Blvd. - 

  • Caduceus Family Physicians (Red Cross tent)- 8:30-5
  • Caduceus for Women and Caduceus 4 Kids (Candyland)- 8-5


-Yorba Linda PDQ Urgent Care & More 18220 Yorba Linda Boulevard, Suite 301-

  • Mon-Fri 8-8 Sat/Sun 9-5


-Orange PDQ Urgent Care & More 7630 E Chapman Ave, Suite B.-

  • Mon-Fri 8-8 Sat 9-3


-Irvine- Caduceus Jamboree and PDQ Urgent Care and More 19742 MacArthur Blvd. Ste 100-

  • Mon-Fri- 8-5


-Laguna Beach- Caduceus on Thalia 333 Thalia 

  • Mon-Fri 8-6 Sat 9-3


-If you are a registered Caduceus or PDQ patient, you do not need a doctor’s order. If not, a quick video visit will give the order. 

-The tests are sent to Labcorp, which uses a different system than Quest.  The readings for counts cannot be compared against the two. Our ranges are for Labcorp only.

-We are aware there are many different types of antibody tests at Quest, Labcorp, and other labs. Our recommendation is ONLY for the TOTAL antibody count through Labcorp. It is the best way for us to compare apples to apples.

-We have NO affiliation with Labcorp, and do NOT receive any type of financial reward to use them. They were the first to offer the test to our patients, and with thousands of their tests to study and review that we have ordered, we continue to use them. 

-If just the total antibody screen is ordered, and insurance doesn't pay, the cost has been $40-50 for most patients. Caduceus simply sends the blood to Labcorp, which bills the patient or insurance.  Caduceus is not liable or responsible for billing questions or disputes with Labcorp.

-What Caduceus data shows are that if the TOTAL count from Labcorp is over 400, it is highly unlikely you will contract Covid, and if you do it would be a mild case.
Almost all our positive PCR tests are in patients whose antibody counts are under 300, even if vaccinated or having recovered from Covid.
We are NOT making a scientific conclusion, simply sharing our data. 

• It is a reasonable assumption that keeping your antibody count over 400 will help protect you against contracting Covid. 

• If you are under 300, we advise a vaccination or a booster.

-From our data, it does not seem to matter how you get these antibodies. There are only two ways to have anti-Covid antibodies in your blood.
1. Recover from a Covid infection
2. Receive a Covid vaccine or booster

-We do not profess a strong opinion which antibodies are "better.” Our data tells us natural antibodies last longer in our patients than vaccine antibodies. But both fade in time, thus our advice to check antibody counts regularly.

-The experts seem to agree that high antibody counts are protective, but do not agree on the best values. We anxiously await their research to be published.  Until that time, we stand by our data to help guide our patients. 


Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Antibody Quantitative Testing- Orange County CMO Covid Blog

By editor
November 19, 2021


In a world that keeps on pushin' me around  
I'll stand my ground 
And I won't back down. 
 
Tom Petty 
 
Let’s present the actual real-life case of a Caduceus married couple I will call Donald and Daisy.  (It’s real except their names of course.) 
They are both in their 60’s. 
Both were vaccinated in Feb/March (the brand isn't important). Being fully vaccinated, they assumed they were safe to travel to the Caribbean in late September. 
They needed to show proof of vaccination, which of course they had. 
 
They were gone two weeks, returning early October.  
On their second day at home they both began coughing. Coming to our Caduceus drive through curbside testing, they both tested positive for Covid in Mid-October. Daisy was moderately sick for two weeks.  Donald developed Covid pneumonia and was hospitalized and is still on home oxygen.  But both survived, thank God. 
 
Daisy's antibody level on diagnosis? 269. 
And Donald's?  27. 
 
What happened? Easy. The antibodies produced by the vaccine faded. Went away. Disappeared.   
In Donald's case, it was as if he wasn't vaccinated at all.  
 
Donald had "Mouse Called " Caduceus in mid-September asking if it was ok to travel. We advised to have an antibody count. They declined due to a busy schedule. Had they checked the levels BEFORE the trip they could have had boosters or perhaps postponed the trip. 
 
We continue to advocate for regular antibody level testing. When we began offering this in early summer, it was purely data gathering. But now, after several thousand tests, we can tell you our findings, and make reasonable assumptions. 
 
A disclaimer--we will be simply giving you data from our own Caduceus patients. We will not draw scientific conclusions. We won't claim proof or speculate on data from other groups. 
 
For example, if I tell you the street corner by my house has intersecting traffic stopping when the signal light is red, every day I drive by it, I'm just giving you factual data. I am NOT concluding red lights prevent accidents. That's for the statisticians and scientists to do their thing.  
 
Yet, it IS a reasonable assumption. But it's not valid proof. All I can say with certainty is all traffic stops at the red light by my house.  
 
So, Mr. Petty I am taking your advice.  
 
I’ll stand my ground. 
 
At Caduceus we have been advocating to check antibody levels monthly, since that appears to be an accurate way of telling if you are protected. 
 
Antibodies work.  
 
No matter how you get them- vaccine or natural. Whether Moderna is better than J&J or a vaccine is better than natural isn't the point. It doesn't matter. What DOES matter is how high your antibody count is. At least that's a reasonable assumption based on our numbers. 
 
Over 400, good shape. 
Under 300, beware---mask, avoid large gatherings, and get vaccinated and/or get a booster. 
300-400 appears to be the dreaded gray zone. 
 
More data to chew on; if the antibody count is over 400, we have had ONE symptomatic  Covid infection. Mind you, some patients do not allow us to check their antibody level when they are first diagnosed, but that is what our data is telling us. 
 
What about an antibody level under 300? Dozens of new cases. In fact, ALL but one of our new Covid cases who had been vaccinated had levels under 300. 
 
Again, I caution that this is just Caduceus data. It has not been analyzed by a Chi square, confidence interval, or signed off by Dr. Fauci. 
 
And there IS good data from our medical researchers showing a definite link to high antibody levels and Covid protection.  
 
However, a recent JAMA article called antibody testing a "flawed science.”  They acknowledged high levels appeared to be protective, but the exact thresholds were still in question. We agree. That is why we give our data here, without making a conclusion. 
 
About six months ago I made a prediction- we will reach herd immunity by Halloween. I rarely make predictions, since I feel NO ONE can look into the future. Yet in this case I had a good feeling. 
 
Since both Caduceus and California are experiencing a surge in new cases, it’s easy to say---I was wrong. But was I?  
I'd say yes and no. 
 
Explanation- People think herd immunity is having Covid go away. 
Not at all. 
 
Herd immunity occurs when a significant portion of a population is immune to an infectious disease, thereby limiting disease spread. For those who are not immune, they are indirectly protected because the ongoing disease spread is small.  
With herd immunity, masks, social distancing and even showing proof of vaccines should all go back to normal- whatever that was. 
 
In California, our numbers tell us 2/3 of adults are vaccinated. And another 20% have had Covid but not yet vaccinated. That's 86% protected, and we are thus at herd immunity.  So I was right, and you can pay me your losing bets when next see me. 
 
But wait. Cases are RISING. Especially in states with the HIGHEST vaccination rate. Pretzel logic, right? (That's for you, Steely Dan fans.) 
 
To explain we need to get three things straight. 
 
1. Vaccines work (by producing antibodies.) 
At Caduceus, 60% of our recent new Covid cases were in vaccinated people. That's right. Over half. So, do vaccines work or not? 
 
Answer: Vaccines do not prevent Covid infections. Look at Donald and Daisy -they were two of many vaccine failures.  Neither does having previous Covid infections.  
 
ANTIBODIES work. 
 
Now in fairness, the vaccines do trigger the antibodies. And a Covid infection also triggers antibodies. So how does that explain the lack of herd immunity? 
 
Think of guns. To quote an old political argument...Guns don't kill people. Actually people don't kill people either.  
BULLETS kill people.  
Saying I am going to protect my house by buying a gun means nothing if you don't have bullets.  
To illustrate- Just ask Alec Baldwin. The gun didn't kill Halyna Hutchins. A bullet did. 
 
Now work with me on this analogy. What if bullets actually let’s say, melted after a while? Or turned into blanks? Some in three months, others in a year. You would not be able to defend yourself until you checked for this and then got MORE BULLETS!  Not more guns! 
 
So, in my weird analogy, the bullets are the ANTIBODIES. No bullets, no protection. Vaccine or not. Previous infection or not. 
 
2. The CDC says that those with natural antibodies are five times more likely to be hospitalized with a second Covid infection than those that are vaccinated. Yet at Caduceus, you want to guess how many new infections were in patients with natural antibodies over 400? 
 
One. 1. Uno. 
 
And that patient had no symptoms. She had a PCR in hopes of attending a friend’s wedding.  
 
What about "natural antibodies"? Our data show with a low viral load (mild case) natural antibodies last three-six months. But a high viral load (as in hospitalized and ICU patients)? OVER a year.  
 
Caduceus data would suggest you are much better off -i.e. have more antibodies- having been in the hospital in January than having the vaccine in January. 
So why is our experience so much different than the CDC’s? 
 
Well, many more people have had mild cases of Covid, i.e. low viral load. And this is word for word from the study: 
 
"The study only examined adults who had tested positive more than three months ago.” In other words, they stacked the deck against natural antibodies by picking patients whose antibody counts would be lower. No such restriction was placed on the vaccinated group, however. They also excluded the J&J vaccine! 
 
Could it be the CDC and others want to downplay the efficacy of natural antibodies so that more people will vaccinate?  (I am asking for a friend.)  
 
Now let’s address #3. 
 
"I have an immune system, thus do not need a vaccine," or in the case of Aaron Rodgers, "I bolstered my immune system using a technique championed by that famous immunologist Shailene Woodley.” 
 
The problem with that is that all your immune system does is produce antibodies AFTER the alarm goes off to your ADT alarm system.   
  
Once your body sends out the troops, Covid may have already made it into your lungs (speaking from personal experience). Having a "good “immune system doesn’t mean you have anti-Covid antibodies already in the house waiting to attack the Covid perpetrators as soon as they enter your nose.  
 
But wait----is there any way we CAN have the troops already there--waiting to neutralize (kill) the infamous spike protein without needing to first send an alert to your immune system? 
Yes!!! 
Can we Have antibodies ALREADY in our system -Designed to kill Covid right off! That'd be so cool if we can arrange that! 
But how? OMG, I know! Take a vaccine -it produces anti-Covid antibodies!   Or actually recover from Covid and let those antibodies you sent out hang around and protect you from a second Covid infection. 
 
This is immunology 101. Taught accurately in every high school, college, and medical school in the country for decades. But for some reason, between politics, and stupidity, antibodies are not recognized as what is needed for herd immunity. Or to get into a venue for that matter. 
 
In some diseases, antibodies (either vaccine or natural) last a long time...maybe even a lifetime such as Measles and Chicken Pox. 
In other cases, maybe five-ten years, such as Tetanus. And in other viruses only one year---like the annual flu vaccine we take.  
 
Here is what we have found at Caduceus.  
 
Vaccine antibodies last 3-10 months. 
Moderna- 6-10. 
Pfizer- 4-9. 
J&J- 3-6. 
Then they are gone. As in- you have NO antibodies once they disappear. 
 
This is how previously vaccinated people are getting Covid now. If they were vaccinated in early 2021, there is a good chance their antibody count is low or zero. 
Here's the irony. To get into a concert tonight at the Performing Arts Center, I must show my proof of vaccination. But if I was vaccinated in the spring, there is a good chance I'm NOT immune. Yet I am welcomed into the venue. 
But if I bring my trusty antibody count I do every month showing tons of good anti Covid antibodies (from BOTH my infection plus my vaccine), I would be banished to return home. Although I am VERY protected.  
 
For this I blame our leaders and giant organizations such as the CDC and WHO for not doing the simple research that will prove this.  
 
To summarize:  
1. Antibodies work. Whether from vaccines or natural immunity. 
 
2. Having no or low antibodies puts you at high risk of contracting Covid. No matter if you have been vaccinated or had a previous Covid infection. 
 
3. We advise all Caduceus patients to check their antibody counts every four-six weeks, regardless of vaccination status or past Covid infection, at least until we do reach herd immunity. 
 
I advise to not get hung up on whether you need a booster. Or if you had J&J in March. Or if you have natural immunity from your Covid infection in 2020. Or if it’s safe to travel if you’ve had the vaccine. 
 
Just check your antibodies.  
 
If your count is under 300, we advise full vaccination, including receiving boosters as needed. 
 
Caduceus can draw your antibody level anywhere they draw blood. Most insurance covers this; if not the cost is reasonable. No visit is needed if you are a registered Caduceus patient. To discuss the findings with a doctor, a video visit can be easily arranged from the comfort of your home or office. 
 
We won't back down. 


Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Long Haul Covid Treatment Orange County

By editor
October 19, 2021


I am Dr. Gregg DeNicola and I am a Covid Long Hauler.
I had my first positive PCR on December 13, 2020.
I entered the hospital with double Covid pneumonia December 22, 2020 and was transferred to the Covid ICU.
I was discharged December 31, 2020.

I tested negative January 25, 2021.
I was unable to leave the couch and walk around the house freely-still on oxygen - until January 30, 2021.

I was able to stay off oxygen for 24 continuous hours for the first time on February 28, 2021. Yes, 10 weeks tethered to a plastic tube up the nose.
I was able to leave my home and run errands unattended March 13, 2021.
Exactly three months after testing positive for Covid.

I felt I had been given my life back.

On Christmas Eve and Christmas Day 2020 I knew I was truly fighting for my life. New Year’s Day I couldn't walk or even stand up by myself.
But by St. Patrick’s Day, I was able to shop alone for the corned beef, make Reubens unassisted for dinner and even enjoy a green beer "or two!"

I was cleared of blood clots, cardiac, or lung complications in April.

Life was good, God was great, and I could finally start planning the next chapter of my life.

What do "they" say about if you want to make God smile, tell Him your plans?
"They" are so right.

My first sign of Long Haul Covid was a mid-day fatigue, a new thing I experienced in April. I didn’t think much of it- I just needed an afternoon nap. I should have known something was up, since I had never taken an afternoon nap, even as a kid. It got worse. I was ok for 3-4 hours, then BOOM- I needed to lie down and snooze. Totally out of character for me.

In May, I noticed short anxiety episodes. Less than 10 minutes. Once or twice a week. In June they were 2-3 times a week, and morphed into agitation, and even anger.

The symptoms have continued unabated. On three occasions, I lashed out in anger so severe I had to formally apologize to my colleagues and family. Not for what I was angry about- I meant what I said. But loud outbursts complete with cussing was not my style and I was concerned and ashamed by them. They were totally spontaneous and unpredictable.

Even at their worst, these agitation attacks were short, rarely over 45 minutes, then -Boom-back to normal.

In June I noticed I was tearing. I thought it may be pink eye. But since I also felt hopeless and sad, I knew it was another Long Haul finding- Depression. Instead of two times a week, like the agitation, these episodes were daily. But less than an hour, sometimes only 10-15 minutes. I called them "depression attacks,” and once passed, all was good again. In my years of practice, I was unfamiliar with depression being an "attack.” But we are now finding with Long Haul PTSD, they are relatively common. They could come morning or evening, whether I'm alone or at work, and in response to nothing. They resolve spontaneously, even if I am just sitting looking at the floor.

In July, the third Long Haul symptom appeared- insomnia. Sometimes it took three hours to fall asleep. Other times, I'd awaken at 3 AM and lie there until sunrise- eyes wide open the whole time.

Turns out, mental health complaints are the becoming most common form of Long Haul Covid. Experts are calling it a type of PTSD. It is linked to how severe your Covid case was. Mild cases, mild Long Haul. More severe cases, more severe Long Haul.

Overall, if you have had Covid, you have a 20% chance of having a Long Haul case.
Hospitalized patients have a 50% chance of getting Long Haul Covid.
ICU patients? Up to 90% in some studies.

Short attacks of agitation, anger, depression, and brain fog are a common presentation. It appears to be linked to neurotransmitters that have gone haywire from the spike protein in Covid.
Besides anxiety, depression, and insomnia there are two other PTSD symptoms noted with Long Haul Covid.

It figures the “Man Upstairs” chose not to give me the one I actually wanted - anorexia and weight loss. I’d have traded all of my symptoms for a good 10 pound trim.

And the last symptom may be the most common- the "brain fog" or memory loss. My brain still has its fast ball, and I am fortunate to have avoided this one since hanging on to your brain was my most important goal post Covid.

Long Haul Covid has several definitions from the experts. A consensus indicates symptoms are 12 weeks past a negative test and lasting anywhere between 2-12 months. It does not appear to be a permanent condition.

Treatment is individualized. For the cardiac, pulmonary, and blood clotting issues, medications are available and work well. For the fatigue and mental issues, especially brain fog, no therapies are proven successful, except anecdotally.

So simply taking a Xanax for anxiety, Zoloft for depression, and Ambien for sleep is not currently advised.
Bedrest, psychotherapy, and anger management? Nah.
The best and safest treatment is simply “TOT”-Tincture of Time.
Yup, just waiting for those pesky neurotransmitters to fall in line and quit bouncing around.

At Caduceus, we diagnose Long Haulers often daily. We even found ourselves creating a protocol and treatment algorithm specially for Long Haulers.
To be sure, our “Long Haul Clinic” is growing rapidly.
Many times, patients are surprised to finding out other Post Covid patients have the same weird issues. Depression attacks, memory loss, appetite loss, heart palpitations or a persistent cough can be symptoms to start a support group.

Despite increasing numbers, health care providers don't know the long-term answer. Since Long Haul has only been a "thing" this year, we don't have a lot of data on it. As more people recover from Covid, the data will increase exponentially. Until then, "Long Haul Clinics" such as the one at Caduceus will be working hard to accumulate that data.

Of note, the NIH has just been granted $1.5 billion to study and make recommendations about Long Haul Covid.

In Summary:

  • "Long Haul Covid" is diagnosed when symptoms appear 12 weeks or longer from testing negative
  • Symptoms of Long Haul are:
    • Fatigue
    • Blood clotting 
    • Cardiac symptoms, especially palpitations 
    • Pulmonary symptoms, especially cough and shortness of breath       
    • Mental health issues, i.e. PTSD symptoms
  • These can last 2-12 months
  • Neurotransmitter errors are involved
  • Treatment currently is trial and error


And regarding PTSD symptoms are:

  • Anxiety/agitation/anger
  • Depression
  • Insomnia
  • Anorexia/weight loss
  • Brain fog/memory loss
  • Typical medications for these symptoms are probably not effective.
  • Unlike non Covid anger and depression conditions, these can be daily, appear suddenly without provocation, and last under an hour.
  • These symptoms appear to be strongly linked with high intelligence and good looks. (OK OK… just seeing if you're paying attention!)

I share my story in hopes other Long Haulers -who have been hiding their symptoms- will talk about them. Yes, it is difficult. Yet in many ways, friends and family support can be healing. In fact, I am feeling a little better just writing this blog.

In my case, the PTSD symptoms have not changed since they peaked in August. I was pretty excited this week when I had not had a depression attack in three days! But yesterday and today it returned and now I am back to square one. This year I'm hoping for the best Christmas present God can give me- no more Long Haul symptoms by Christmas Day. Considering the scare I had last Christmas, it would be fitting.

Maybe Jerry Garcia was being prophetic about Long Haul Covid when he sang:

Sometimes, the lights all shining on me
Other times- I can barely see!
Lately it occurs to me
What a long, strange trip it’s been!

Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

Learn more about Long Haul Covid treatment and how we can help.

Blog- Monthly Covid Antibody Testing

By editor
August 11, 2021


Yesterday I bought a new Koi for the Caduceus 4 Kids koi pond. I named him "Jeopardy". That way when people ask me his name I can say in a booming voice: "This! Is! Jeopardy!"
 
Since the passing of Alex Trabek there has been an increased interest in the Jeopardy TV show, with multiple guest hosts. Since we attempt to be on the leading edge of what is popular, let’s try using that format to impart important information to our patients. 
 
Remember, each response must be in the form of a question.
 
Answer #1:
Over 300
 
Question #1:
How many cases of Covid were diagnosed and/or treated at Caduceus or PDQ Urgent Care in the past 4 weeks?
 
That may not seem too bad. But it is more than we had in April, May, or June COMBINED! Compared to June there was over a 1000% increase in cases.
 
In the last week alone we are averaging 20 new cases a day, compared with 5 a WEEK in the Spring. 
 
So we are not yet ready to be talking about herd immunity. I will stick to my prediction of herd immunity by Halloween. 
 
Of these acute cases only 5 were hospitalized.  None had been vaccinated.  All developed pneumonia. None had been diagnosed with Covid previous thus no antibodies.
 
In the past month we have had over 60 pediatric cases, from 9 months of age up to 15 years old.  None needed hospitalization, most recovered quickly.  None of the pediatric cases had antibodies or vaccines. 
 
So far we have not had single documented case of Covid in a patient who had Covid previously documented. A victory for natural immunity.  Luckily, most past Covid victims that checked their antibodies and found them gone, went ahead and took the vaccine. 
  
Many of our new cases were diagnosed just after a trip out of town. There are simply too many places to catch Covid while traveling- airports, planes, taxi/Uber, restaurants, crowds, shopping, parties, etc.
 
At Caduceus, we are actively discouraging all non-essential travel until herd immunity has kicked in. 
 
This advice is sage even if vaccinated. 
 
Answer #2:
 
Ivermectin and Hydroxychloroquine (Plaquenil)
 
Question #2:
 
What therapies have not shown beneficial effects treating Covid after initially showing promise? (This data is Caduceus data only.)
 
In 2020, hundreds of patients contacted us for help prescribing Plaquenil for their Covid. 
 
In 2021, that paradigm has switched to Ivermectin, a known treatment for worms and scabies. Initial data looks hopeful, but just not enough of it. And now, with increased usage, over the objection of the FDA, CDC, and WHO we receive requests for Ivermectin daily. However, it may not be any more effective than placebo. 
 
I see 2 possibilities with these drugs.
 
1. There was definite initial improvement, but mutations and variants caused resistance to both of them.
 
Or
 
2. We just got lucky at first, and they have no effect.
 
Since March 2020, Caduceus and PDQ have diagnosed and treated over 4000 cases. Not as many as large medical centers, but enough to give us some expertise in what works and what doesn't for our patients. 
 
And here is what we have found.
 
Outpatients: Oral Decadron if we suspect an evolving pneumonia. 
 
Aggressive Pulmonary Hygiene especially with incentive spirometry.  We work hard to minimize pneumonia or any fluid in the chest. 
 
Yes we still use Zpaks, Zinc, and Vitamin D.  But the real winners are Decadron plus pulmonary hygiene -hands down in the presence of worsening lower respiratory congestion.
 
Inpatients: High flow oxygen. And Remdisivir with Decadron. Plus one more wild card: Baricitinib
 
On August 2, the FDA authorized administering Baricitinib (Olumiant) by itself to treat COVID-19 in hospitalized patients age 2 and older who require supplemental oxygen or mechanical ventilation. The emergency use authorization previously required administering Baricitinib with Remdesivir (Veklury). 
 
Convalescent serum, monoclonal antibodies, a slew of experimental anti inflammatory meds as well as other random therapies have not shown to be effective over a broad scale.
 
However the FDA on August 2 did approve monoclonal antibodies for use in certain patients who cannot mount an antibody response from the vaccine- for prevention, not treatment. 
 
Answer #3:
No or minimal symptoms
 
Question #3:
If I am vaccinated, and then still contract Covid, how ill will I become?
 
We hear a lot about people, especially celebrities and politicians, that had 2 doses of the vaccine, yet still tested positive for Covid later on. Many of these are incidental pickups, and were tested only attempting to travel or work. Some have a mild sore throat and low-grade fever for a day or two, and test as a precaution. 

At Caduceus, about 25% of our new Covid patients WERE vaccinated. But all either had no symptoms, or mild sneezing and sore throats, with minimal fever. 
 
As mentioned above, NONE of the vaccinated patients who contracted Covid had been diagnosed with Covid previously. 
 
In our opinion, the CDC should stop flip flopping on masks, and concentrate on getting the country vaccinated. Masks will not bring on the end of this nightmare, but vaccines will.
 
Answer # 4:
Because the country and big companies are not run by doctors.
 
Question #4:
"I have recent proof of natural immunity to Covid with antibody testing. They still demand proof of a vaccine! Why wont the government or large companies recognize this?"
 
This opens the door to the question: Which is more protective against Covid if exposed? Vaccines or natural immunity?
 
Some studies support natural immunity as superior to vaccine immunity. Others show vaccines are superior. Yet NO official agency has endorsed natural immunity as protective against Covid.
 
Our experience at Caduceus shows both to be effective, with a large edge given to natural immunity. The accurate answer probably is related to how high your antibody level is, no matter the source of the antibodies. 

A high antibody load is very protective. A low one, not so much. Typically, antibodies will drop slowly months after recovering from Covid or receiving the vaccine. 
 
This is why.
 
It is assumed that both natural antibodies and vaccine antibodies have approximately a one-year life to them. We will not know for sure until 2022. But when Covid occurs in either a vaccinated or past covid patient, the odds are the antibody count fell below a critical level.
 
Nonetheless, we are constantly being contacted by angry patients that have natural antibodies but still must show proof of vaccine to travel, enter certain venues, or even ironically enter an ER. We have done letters "certifying" that their antibody levels are equally protective as a vaccine, but that only occasionally works.
 
It is about time that natural immunity is recognized by all regulatory agencies as being protective against Covid.
 
Answer #5:
Antibody testing
 
Question #5:
I believe I need Covid testing. What is the most important Covid test to ask for?
 
During this current Delta surge, we are overrun by requests for the Rapid in-house swab and the more accurate PCR swab.
 
Yet as we have pointed out, the antibody test is equally or even more necessary. If it is positive, you know you will either have a negative PCR or if that is positive, at least a minor case. We have been advising a monthly antibody test to our patients and that advice hasn't changed
 
Antibody testing does not require a video visit and is an important tool in navigating through the pandemic as we are close to herd immunity.

It isn't always paid by insurance but both Caduceus and PDQ have reasonable cash prices for it. You can walk into any PDQ and ask for it.
 
To summarize:

1. Caduceus and PDQ are experiencing a surge in Covid cases at this time. Avoid all non-essential travel. Mask and social distance until further notice.
 
2. In lieu of Ivermectin and Plaquenil, early treatment is crucial to avoiding hospitalizations and death. Caduceus has an experienced Covid team; let them guide you. 
 
3. Vaccines work.
 
4. Natural immunity works, despite being ignored by the WHO, CDC and FDA
 
5. Check your antibodies regularly, whether you have had Covid or a vaccine. They will allow us to better guide you through herd immunity.
 
Ok, one more:

Answer:
Hickory Dickory Dock
 
Question:
Where do you go if your Hickory Dickory is hurting?
 

Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

The Deets on Delta- FAQ's on Covid Variant

By editor
July 15, 2021

I have been asked when, as CMO, I would "declare" herd immunity for Covid and we can then move ahead and party like it’s 2019.
 
I earlier announced we should see herd immunity by Halloween, or even Labor Day, and I’m sticking with that forecast. Yet I fear I must announce another "surge" in cases, at least within Caduceus and PDQ Urgent Care & More as well as most of Orange County.
 
We were down to around 5-10 new Covid cases a week, compared to 25 or more per DAY last December. But now we are averaging 5-10 new cases a DAY, so clearly something is up. The Delta variant explains what we are seeing throughout California. 
 
Let’s review five things to know about Delta in our culture, and then five things to know about this variant.
 
1. In 1972, country songwriter Alex Harvey wrote a song for country music diva Tanya Tucker called "Delta Dawn." It was immediately covered by Helen Reddy to become a massive early 70's hit. It told the story of a long ago rejected southern Belle who could not shake the memory of a suitor who jilted her. As the song goes, “In her younger days they called her Delta Dawn.”
 
“Prettiest woman you ever laid eyes on,” who paired up with the wrong type of guy. It was actually based on his mother who committed suicide over this failed relationship. 
 
The Delta variant (mutation) was first noted in India in December 2020.  It spread like wildfire primarily because India was very poorly vaccinated. Yet, it has been found to be much more contagious and transmissible, and its "penetrance" very high. Almost as if Covid knew it was being "rejected" by masks and social distancing.
 
So Fact #1 is that it is VERY contagious.
 
2. Two years previously, a backup singer with singer Leon Russell's band became the muse for a song he wrote called "Delta Lady.”  Ironically, that singer, Rita Coolidge, sang backup vocals on the actual song. A year later, Leon left her, yet always referred to her as "My Delta Lady."  Why that name? Hard to say, but in chemistry a delta reaction is one where you add heat to the reaction.
 
Hey, do you have a better guess? 
 
With the Delta variant, we are seeing "regional outbreaks" in areas of the country with low vaccination rates. So it’s adding "heat" to those areas. If you visit or live in one of these regions, beware.  Orange County is NOT one of these regions, yet we are definitely seeing a surge.
 
It brings up the question of whether a third "booster" of Moderna or Pfizer would help keep Delta away. There is not enough data to support that theory. It does appear the antibody levels will fall off around the 11-12th month mark, so a 2022 booster will be advised I suspect. If you are immunized, no need to worry about another shot, but you may want to mask up and social distance until we know more about the Delta variant. 
 
3. In 1928, a new airline was founded in the Mississippi delta region, hence the name "Delta.”  It grew rapidly and went through several mergers and acquisitions, always as the surviving entity.
 
But in 2005, Delta was forced to declare a Chapter 11 bankruptcy.  Unlike its competitors, Delta did not lock in long term fuel contacts when prices were low. In 2005, fuel prices skyrocketed, and Delta was unprepared. Needless to say, Delta learned its lesson and now locks in lower fuel prices whenever able.
 
With the Delta variant, it has also caught certain patients unprepared- namely those unvaccinated. Even more specifically, kids and young adults are the main victims now.
 
At Caduceus, over 80% of our new cases are in patients under 35. Very few seniors are catching the Delta variant, presumably because they are vaccinated. One wonders if, like Delta Airlines, the youth will learn its lesson and get vaccinated.
 
4.In 1980, David Crosby wrote his last song as a part of Crosby, Stills and Nash. Its name? One guess. 
 
"Delta" was an escape song, revealing his weariness over the fast paced world of music executives and big cities. He longed to be in a boat drifting down the Delta (presumptively the Mississippi Delta).  As the lyrics say, "It seems as if time stops on the Delta."
 
For those researching, investigating, and treating Covid daily, it is easy to get weary of the "authorities" who downplay the protection of natural antibodies- obtained by actually contracting Covid. At Caduceus, we have had two out of over 3500 cases in patients who had Covid previously. But neither allowed us to check antibodies. Conversely, we have had over a dozen cases of Covid diagnosed in patients who were vaccinated. Even that comes to a less than 1% failure rate, mirroring what is being seen across the country.
 
So do antibodies---either natural or via vaccines-protect from the Delta variant? 
Yes.
 
There is concern Delta is more contagious, thus more likely to infect even the vaccinated. But so far, the local outbreaks and surges appear to be mostly in the unvaccinated or un-antibodied. (Yes, it is permissible for writer’s privilege to allow making up new words.)
 
And like David Crosby-once things calm down-I want to escape to the Delta, where time stops.
 
5. How can we leave out the most famous Delta of all???
 
In 1977, Harold Ramis told us a story we would never forget.  In the year 1962, two freshmen seek to join a fraternity. Finding themselves out of place at the prestigious Omega Theta Pi house's party, they visit- next door- the chaotic, grungy and irreverent "Delta House.” 
 
The frat they joined was made up of rejects, nerds, IQ challenged, and the heaviest partiers in the history of fraternities.  All on academic probation, riding motorcycles up stairs, engaging in toga parties, wild food fights, and destroying the homecoming parade.  They wreak havoc on everyone in their way.
 
Sound familiar? The Delta variant is THE "Deltas" of viruses. If John Belushi were a virus, he would be the Delta Variant. But is it really that different than the plain vanilla Covid?
 
Yes.
 
Where Covid was known for a cough and loss of taste and smell, the Delta presents more with headaches, sore throat, and fever. It appears equally likely to cause pneumonia and death however. So far, mortality rates have not been proven to be higher with Delta. 
 
In summary, here is what you need to know about the Delta variant:
 

  1. It is more contagious, especially in younger people and children. In areas with low vaccination rates, be aware of regional outbreaks.

 

  1. It may not present the way Covid did last year.  Headache, sore throat, and fever are now the main symptoms to watch for.

 

  1. Antibodies appear to be effective, but remember, nothing except total quarantine is 100%. If you are unvaccinated, or have no natural antibodies, you are at high risk.

 

  1. If you are vaccinated, you do not need another booster. If you have natural antibodies, vaccination is reassuring but may give more side effects since there are plenty of natural antibodies already in the blood stream. A booster now will not protect you more against Delta. 

 

  1. If you are high risk (Lung disease, cancer, immunocompromised) please continue to mask and social distance.  It might save your life.

 
 
Herd immunity is close. But will that mean Covid is over? Remember the words of the most notorious Delta of all:
 
“What? Over? 
Did you say over? 
Nothing is over until we decide it is! 
Was it over when the Germans bombed Pearl Harbor? Hell no!”
 
-Bluto the Delta 
 

Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

New Cholesterol and Alzheimer's Drugs

By editor
July 6, 2021

FROM THE DESK OF THE CMO
 
We have two items to discuss with our loyal patients:
 
1. New lipid drugs

2. New Alzheimer's drug
 
New Lipid Drugs-

1. Although not exactly breaking news, over the last year or so, forgotten during Covid, two different types of medications for lowering lipids were FDA approved. They are only now being marketed heavily.
 
First, Nexletol is NOT a statin, simply put, it reduces the amount of cholesterol made in your liver. Like statins, unfortunately it may increase your liver function tests.  And give muscle aches.  It is otherwise safe.

The catch? It is expensive, many health plans will not cover easily, and it is only approved for familial hyperlipidemias or known cases of Atherosclerotic vascular disease. In other words, not for low-risk patients to prevent heart attacks. In fact, it has not been shown to reduce heart attacks or strokes. It also may trigger gout attacks.

Second, Repatha (Evolocumab) Injection is a human monoclonal immunoglobulin used as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease. It is a shot that is self- administered once or twice a month. It does not replace statins; it requires that statins be tried and failed.

Like Nexletol, it is expensive, poorly covered, and not indicated for primary prevention. Unlike Nexletol, it does not mess with your liver function tests or cause muscle aches.  
 
Caduceus’ Conclusion?

These new lipid drugs may help a small percentage of our patients who need an alternative to statins. Because neither are shown to reduce heart attacks or strokes, and are very expensive, we do not envision our doctors advising them widely.

If you have not had your lipids checked in the past 12 months, please pop in for a lipid panel. No office visit required.
 
 
2. New Alzheimer's Drug-
 
Last week, after initially rejecting Biogen's application, the FDA reversed course and approved Aduhelm (Aducanumab) salvaging literally billions of dollars in research and development.

It works by reducing a sticky brain substance called amyloid, which should benefit Alzheimer patients.
 It was not without controversy.

One example is a panel of Alzheimer's experts advised rejecting the drug, asking for more and better studies. 

Once their advice was rejected, three of the panel resigned. 

“This might be the worst approval decision that the F.D.A. has made that I can remember,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, who submitted his resignation Thursday after six years on the committee.

He said the agency’s approval of the drug, a monthly intravenous infusion that Biogen has priced at $56,000 per year, was wrong “because of so many different factors, starting from the fact that there’s no good evidence that the drug works.”

The approval comes as a possible grand slam homer for Biogen, who was struggling lately for lack of new drugs. 

The last new Alzheimer's drug that was FDA approved was way back in 2003.

The trouble Biogen will have been that it is indicated only for mild cognitive impairment--in other words, early cases. Or have documented amyloid in their brain. Worse, it requires a monthly IV infusion at an infusion center.

AND monthly MRI tests to look for brain bleeds, a known side effect.
 
Caduceus’ Conclusion?

Being limited to early Alzheimer's cases only, poor health plan coverage due to a very high price point, and IV infusion requirements, make this drug unattractive. But in the right patient, it may afford hope for symptom improvement.

If you or a loved one is experiencing memory or depression symptoms post Covid, please schedule a check for an in-office Alzheimer's screening.

Caduceus CMO Nomination My Hero Project

By editor
June 24, 2021

Big congrats to Caduceus CMO Gregg DeNicola MD who received a prestigious nomination from the MY HERO Project. The MY HERO Project uses media, art and technology to celebrate the best of humanity, one story at a time and operates worldwide in 197 countries. Dr. DeNicola was nominated in the Coronavirus Community Heroes Multimedia Contest -- Spring Finalists 2021. Read the full nomination below from our patient:

Gregg DeNicola is my hero. I have known Dr. DeNicola for many years as a community member and a patient of Caduceus on Thalia in Laguna Beach. I decided to nominate him as My Hero of the Year for the category of local heroes who have done magnificent work for the community during COVID. Over the last 15 months, Dr. DeNicola and his staff have worked double and triple shifts and booked double appointments to meet the demand of patients concerned that they had contracted COVID-19. I’m sure their early and aggressive treatment of COVID-19 symptoms saved hundreds of Laguna residents from hospitalization or worse. They were one of the first to test in OC on March 12th, first to offer curbside exams and testing, and promoted the “KNOW IF YOU’RE CONTAGIOUS, KNOW IF YOU’RE IMMUNE” from the very start. Their COVID treatment team has diagnosed and treated over 2000 cases, now emphasizing long-haul COVID cases at Caduceus locations across Orange County.

I remember when I first met Dr. DeNicola, the Chief Medical Officer for Caduceus Medical, I asked if he would be a model for a “Pin the Shot on the Doctor” for the Laguna Playhouse children’s play “Treasure Island” event. He laid on an examining table and I took a photo of him, and then my daughter drew him and that became the illustration used for the game at the Playhouse event for children. The kids were given a paper shot, and blindfolded, they tried to place the shot on his behind on the illustration. It was pretty funny!

Dr. DeNicola wrote a blog which first introduced the extraordinary virus that was spreading at a rate he had never seen before. He wrote: “Stephen Stills had it right, There’s something happening here... What it is ain’t exactly clear.”

Over the past year, he used his blog to share regular updates from the WHO, the CDC, Governor Newsom and the State Health Department, the Department of Insurance, and others. He created “Mousecalls,” “Testing 101,” “Video Visits,” “PDQ” Pretty Darn Quick clinic visits, and curbside video visits. In fact Caduceus was one of the first medical practices to offer COVID-19 screenings and curbside testing in Southern California.

Dr. DeNicola used humor to warn of false information common to social and news media, and to explain the myriad characteristics and extreme risks of COVID-19. He explained the types of tests, the range of symptoms, false negatives, treatment options, etc. 

The Caduceus treatment protocol details four steps to take, including trying a COVID cocktail: “NO, not that kind...A twist is optional.” One could perform “Aggressive Pulmonary Toilet”... you’ll need to read the blog to get the full picture on this one! 

I also related to Dr DeNicola, because like me, he had never been hospitalized – until he was. After spending nine days in the ICU with COVID pneumonia last December, this first line worker would say he definitely dodged a bullet.

His blog incorporated quotes from authors, musicians, statesmen, and poets to cleverly illustrate serious points he made relative to this pandemic and to the virus itself. A verse in a song by Bob Dylan became “Everybody must get swabbed,” and from Yogi Berra, “We made too many wrong mistakes.” “That sums up my viewpoint on our response to the COVID pandemic, both nationally and here in California.” And then there is Dr. DeNicola’s view on “only test if you have symptoms?"

“Hooey. Poppycock. Horse feathers.”

Covid Blog OC Dinner with the Docs Series

By editor
April 29, 2021

To all of our very special patients and blog readers:

Since our last communication, there have been three developments that I wanted to let everyone know about.

First,
I wanted to alert everyone to a observation we’ve had here at Caduceus the past few weeks.

Yes, we are still doing PCR testing. We still are getting back positive results. We still have a ways to go before herd immunity.

However, the past few weeks we have discovered 50% of our new cases have been in the pediatric population. This is a major shift from previous analyses. It breaks down to exactly 50% teenagers and 50% under the age of 10.

I cannot find evidence that this is a trend nationally, or even in California, but history tells us that we tend to see trends early on, and this may be a trend we see here before it becomes apparent elsewhere.

I recently had a patient in her 30's decline my suggestion that she have the vaccination. Her logic is that she is young and healthy so would not be very sick if she did contact Covid. My attempts at pointing out the errors in that position were unsuccessful.

But a bigger concern is that she is a single mother of a little girl. I told her she should be vaccinated to assure her daughter does not become Covid positive. Her comment was the kids aren’t really getting Covid and if they do they have very few symptoms.

I am here to tell everyone that this is blatantly not true-not now in any case.

If the mother were to contract Covid, our current data suggests it is very likely she will pass it on to her daughter who can become very ill. Children have been known to progress to a severe inflammatory disease which could be life-threatening.

As CMO, I am strongly recommending to all of our patients to keep a closer eye than normal on your children. Cough, fever, sore throat, fatigue, diarrhea, or even body aches should be investigated immediately. We would start with a telehealth visit, and then proceed to testing. If an exam is required we will do it curbside. If your child has had exposure to either another child or adult, please report that to us at once.

If you need immediate attention, PDQ Urgent Care and More in Orange handles all age groups. And PDQ Urgent Care and More for Kids in Yorba Linda is a pediatric urgent care that can serve your pediatric needs immediately. In Laguna Beach, Caduceus on Thalia also handles all ages.

Secondly,
After a lot of of thought, we are reinstituting our Dinner with the Docs series. We obviously suspended it last spring with Covid necessitating public gatherings be avoided. We were asked to consider reinstituting it as a Zoom conference, but we just did not have a good feel for that.

Although we are not yet there, as we approach herd immunity, we feel it would be safe to reinstitute the series, with obvious concessions made to the pandemic.

For starters, all attendees will need to show either proof of vaccination, proof of recent antibodies, a negative PCR test within 72 hours of the event, or a negative rapid antigen test the day of the event.

Antibody testing and rapid antigen testing will be available for those not having any of the necessary admission criteria.

Once inside the lecture hall, attendees can sit next to their immediate family or guests, but we will obviously space out the seating accordingly.

Instead of a buffet, your dinner will be a bento box handed to you, but with sandwiches and not sushi. Bottled water will be offered and wine will be available, but not self-serve.

The Dinner with the Docs event will resume with a three part series.

Part One will discuss Covid 101; its diagnosis, characteristics, as well as addressing several controversies about the virus.

Part Two will discuss the treatment of Covid. This will NOT be discussed in part one.

Part Three will discuss the prevention and future course of Covid. This will NOT be addressed in parts one or two.

We will video the lectures so that you can check them out on our You Tube Channel if you were unable to be present.

This will be a ticketed event only so please RSVP seriously.

Thirdly,
I received many comments after the last blog that I was not emphatic enough to encourage all of our patients to receive the vaccine. Let me fix that right now.

As Caduceus and PDQ Chief Medical Officer, we strongly advise all patients to take the vaccine, either the single or double dose variety, as soon as possible.

Any dangers of the vaccine far outweigh the serious consequences of Covid. I’m sure all of you know I’m speaking from personal experience.

The only exception that I can fathom is if you had Covid recently and your blood test show high levels of antibodies, it is likely you are as safe as if you were vaccinated. The studies are not definitive but that’s what they appear to be showing. But as we recommended earlier this year, everyone should check for antibodies monthly and once the antibodies disappear, the vaccine should definitely be given.

You can ask for a monthly order in your chart and there is no visit necessary.

Unfortunately, Caduceus has not been able to procure vaccines to give it our office. There are a variety of centers throughout Orange County where you can take the vaccine, in many cases on a walk-in basis.

To achieve the immunity we need, at least 3/4 of the population need to have antibodies or be vaccinated.

Although the vaccine has caused significant side effects such as aches and pains and fevers, we have not seen any serious reactions from the vaccine within the Caduceus population. However we continue to see new cases of Covid every day.

In summary:
1. Consider getting vaccinated and coming to our Dinner with the Docs series. It’s always been very popular and a lot of fun and we will even feed you and wine and dine you.
2. Keep a very close eye out for your children and have them seen and tested immediately for any fevers or symptoms.
3. Don't vacillate--VACCINATE!!

Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth

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

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 

 

 

 

 

 

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