CMO Covid Blog Orange County Natural Antibodies "Get No Respect"

Natural Immunity- The Rodney Dangerfield of Covid

"When I was born the doctor came out to the waiting room and said to my father, “I’m very sorry. We did everything we could…but he pulled through.”

"My mother had morning sickness AFTER I was born."

Rodney Dangerfield was born Jacob Cohen in New York in 1921. His first job was writing jokes for standup comics under the name Jack Roy.  Making a living was hard so to support his wife and family he sold aluminum siding and finally quit show business altogether at age 30.

He was so little known he once said, "At the time I quit, I was the only one who knew I quit."  At age 40, he tried comedy again. No one would book him. He was puzzled; he felt his jokes were good, so what was the problem?  "I played one club—it was so far out; my act was reviewed in Field & Stream."

Then- an epiphany. His whole life he never had been shown respect--from his parents to his teachers, and then in his job. He was a 40-year-old loser. And this was in real life.  He changed his name to Rodney Dangerfield and based his new act on a self-apparent truth- that he was a loser who got no respect.

The rest is comedy history. 
For the rest of his life, he would start off his act with four words that sent the crowd into hysteria--"I get no respect.”

"My mother never breast fed me. She told me that she only liked me as a friend."
"My father carries around the picture of the kid who came with his wallet."

So now to discuss the Rodney Dangerfield of the Covid pandemic--Natural Immunity ("NI").  It's what you have in your blood to help prevent future Covid infections-IF you have had Covid. 

Natural Immunity gets no respect.
Multiple Studies show it is superior to vaccination immunity- But no one asks for proof of it.
Concert Halls? The fat lady sings on NI. Ballparks? You're OUT, NI.
Airlines? Take a flyin’ leap.
Cruise Ships? Take a long walk off a short pier, natural immunity.
They want to see your vaccine card.
Natural Immunity? That and $2.50 will buy you a cup of coffee.

"My natural immunity test result fell in a sandbox--and the cat kept covering it up." 

Even more disrespectful is when you go to events such as concerts and ball games. If you do not have your full vaccine card, they WILL accept a negative "rapid" test---which is useless. It is not even indicated in people without symptoms. In fact, it may be harmful, giving a false sense of security when in fact you are actively spreading Covid with a meaningless false negative test in your pocket.
But try showing proof of natural immunity--you may as well be showing your Amazon gift card.

Clearly, being fully vaccinated AND the proud owner of natural antibodies would be ideal-but arguably unnecessary.

Teachers-doctors-pilots-and even the critical truck drivers and longshoremen we need for the supply chain have been fired despite having good proof of protection from natural immunity.  Illustrating further the lack of respect for natural immunity - a booster six months old is considered protective-despite loads of evidence it may be worn off by then.  Our public health officials and government have not even approved a needed 4th dose of the vaccine-- here is a CDC quote from a few days ago:

"At this time, CDC does not have a recommendation for a fourth dose/second booster for most Americans," said Scott Pauley, a CDC spokesperson, referring only to people who are not immunocompromised.
Yet we see thousands of people contracting Covid with three doses, especially if the third dose is over four months old.

The CDC told natural immunity they weren't as good as vaccine immunity to prevent Covid.  Natural immunity said, "I want a second opinion!"
"Ok, you’re ugly too!" said the CDC.

Natural immunity gets no respect.
NI works because the immune system works.
Working as an alarm system that sends out soldiers when the alarm is sounded, the soldiers stay around after they neutralize the perpetrator. This is true of a true intruder (like Covid), or an impostor that tricks the alarm company to send out soldiers (like vaccines).
In both cases they are sitting in your blood stream awaiting a new infection--making it difficult to get infected once the antibodies are in your system.
The facts are that the soldiers are bigger and better from an actual Covid infection than the soldiers that responded to the imposter antigen. And yes, I have proof.
Yet the natural immunity gets no respect. Just like Rodney.
It makes sense that the antibody response is linked to length and severity of a Covid infection.
A moderate to severe case, lasting two to three weeks with possible ICU admission will give a much higher level of natural immunity than a mild case lasting a few days.
Hence the need for a blood level. Our public health systems have not yet come up with a number you should stay over to proclaim your protection.

Natural immunity--it gets no respect.
CDC director Rochelle Walensky signed the John Snow Memorandum last fall which stated: "There is no evidence for lasting protective immunity to Covid following natural infection." Evidence? You say you want evidence??
Oh, I got your evidence!!!
At the respected Johns Hopkins, a 2021 study showed 99% of post-Covid cases had antibodies TWO YEARS after infection. They also found natural immunity from prior mutations DID protect against Omicron.
Meanwhile, Kaiser Southern California published a study showing Moderna antibodies fell to 60% and just 16% against Omicron only 6 months after the vaccine.
For an unknown reason the CDC refused to release their data on reinfection from natural immunity ----
until now. It revealed natural immunity THREE times more effective of preventing hospitalization and almost FIVE times as effective in preventing Covid infections when compared to vaccination. 
The data is there- and it shows natural Immunity gets no respect.
"Last night my wife met me at the front door. She was wearing a sexy negligee. The only trouble was, she was coming home."
If you are still not convinced, we have good data to support using natural immunity as "protective," I will submit a list of studies that DO give natural Immunity the respect it deserves at the end of this blog -so as not to bore those of you who are believers. What is interesting is that all the studies showing the positive effect of natural immunity do NOT post "levels" as we have been advising since last year.
At Caduceus and PDQ Urgent Care & More we increased the protective level to 500, but that appears to be more important in assessing the length of time the antibodies stay in VACCINATED patients.
Except for very mild cases, natural immunity appears to always be over 500 for at least 6 months. (Our data only.)
Why the cold shoulder from our public health officials and government?
One may be the goal to have EVERY American vaccinated, and by giving credence to natural immunity, this goal may not be achieved.
Which is noble, but not scientifically accurate.
A second theory is that because there is no "number" to call the cutoff on antibody testing, and the liability so high if they get it wrong, they need to do much more research to allow for that magic number to be arrived at.
Sounds reasonable-other than the fact that we now have TWO YEARS of data to determine an accurate number. Plus, ALL natural immunity appears to produce high antibody levels for quite a while, so in most cases of NI, the antibody count itself is less important.
Also, the CDC does not even advise a second booster, no matter how long from the third shot it is. And our numbers show many of those patients suffered serious Covid infections this last December and January. Even cases that had to be admitted.
To be logical, public health authorities should hold boosters and natural immunity to the same standard.
Why the lack of respect for NI?
Could it be that the government--who bought and distributed all the vaccines, and even all the monoclonal antibodies, are hesitating to advise anything they can't control and monitor?
Ok -that one is for the conspiracy theorists among you.

Dr. Aaron Kheriaty, a professor of Psychiatry and Human Behavior at the medical school and director of the Medical Ethics Program at UCI Health, was termed in December because he declined to be vaccinated, citing his natural immunity was at least equal to the vaccine.  Dr Kheriaty, as well as thousands of similar teachers, doctors and nurses should be reinstated -assuming they show proof of natural Immunity.
There is precedent--Connecticut has suspended its vaccine mandate for state employees with natural immunity and Starbucks is rehiring staff that was terminated for being unvaccinated allowing natural immunity to do its job.
Led by Dr. Marty Makary, a group of esteemed Johns Hopkins physicians have called on public health officials to recognize the data on natural immunity.
The notion that ONLY the unvaccinated can spread the virus and ONLY the vaccination can prevent its spread is wrong.

We call on those in a position to do so - to research and give natural immunity the respect it deserves- -right up there with vaccinations.

We call on those states with vaccine mandates to recognize natural immunity as protective.

We call on our Military to restore full rank to soldiers dishonorably discharged because they only showed natural immunity.

It's time to give natural immunity the respect it deserves.

As Spike Lee would say--"Do the right thing."

As Rodney Dangerfield would say: "I told my doctor, “Doctor every morning when I get up and look in the mirror, I feel like throwing up. What’s wrong with me?" He said, “I don’t know, but your eyesight is perfect.”

Natural immunity asked the Public Health Official if it could go ice skating on the lake.

“Wait ‘till it gets warmer!” They said.


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

Epidemiological studies- 

  • Lancet 2021 in a population-level observational study, people who had had COVID-19 previously were around 85% protected against reinfection.
  • Eur J Clin Invest. 2021 in a retrospective observational study using national Austrian SARS-CoV-2 infection data, people who had had COVID-19 previously were around 91% protected against reinfection.
  • Clin Infect Dis. 2021 In a retrospective cohort study in the USA, people who had had COVID-19 previously were 88% protected against reinfection.
  • MedRxiv. 2021 In a retrospective observational study in Israel, SARS-CoV-2-naive vaccines had a 13·- times increased risk for breakthrough infection with the delta (B.1.617.2) variant compared with those who had had COVID-19 previously.
  • MedRxiv. 2021 In a retrospective observational cohort of laboratory staff routinely screened for SARS- CoV-2, people who had had COVID-19 previously were 100% protected against reinfection.
  • Clinical studies- Lancet.2021 In a large, multicenter, prospective cohort study, having had COVID-19 previously was associated with an 84% decreased risk of infection.
  • Lancet Respir Med.  2021 In a prospective cohort of US Marines, seropositive young adults were 82% protected against reinfection.

Latest Covid Treatment FAQ's Orange County

ANNOUNCEMENT from CMO-


A woman calls a law firm,
"This is Schwartz, Schwartz, and Schwartz. How may I help you?"
"I would like to talk with Mr. Schwartz."
"Oh sorry; he is in court all day."

"OK, in that case let me speak to Mr. Schwartz."
"Apologies. He is on vacation."

"Then let me speak to Mr. Schwartz." "Speaking!"

(With thanks to Henny Youngman.)

As this story illustrates, there are times you really don't want to answer a question. But eventually, you have no other choice.

You have a sore throat. Cough. Maybe a fever. You test positive for Covid. You contact us and ask, "What can you give to treat it?"

A very legitimate question. But not so fun to answer.

Because it is frequently followed by a request for Hydroxychloroquine. Or Ivermectin. Or a Vitamin combination.
Lately, CoQ10 is a popular request.

You may be tempted to mimic the formula unsuccessfully used by
quarterback Aaron Rodgers. He declined to disclose his secret formula, but did state in an interview prior to his positive PCR he was taking a cocktail of Hydroxychloroquine, Ivermectin, CoQ10, zinc, Vitamin C, and D.

NONE of these treatments have been shown through ANY valid study to prevent or treat Covid. Hence Rodger’s recent Covid infection.

So what DOES prevent Covid?
Only one thing...a vaccine. And unlike vaccines we are used to, it has a relatively high failure rate. Their main advantage is they DO prevent severe cases, hospitalizations, and my personal favorite thing, to prevent-death.

And what DOES treat Covid? Well, none of those modalities mentioned above. Going into our third year of dealing with this virus, five therapies appear to have passed the tests of efficacy (working) and safety.

  • 4 of the 5 have FDA authorization, either emergency or standard approval.
  • 2 of the 5 are indicated only in hospitalized patients with severe cases.
  • 1 of the 5 is not currently available, at least in Orange County.
  • 1 of the 5 is very difficult to access, at least in Orange County.
  • 0 of the 5 "cure" Covid; they all reduce symptoms, and risk of death.

Here they are:

1. Remdesivir and 2. Baricitinib.
They are only given in the hospital. They are very effective in reducing days in the hospital, days on high flow oxygen, chance of needing intubation, and of course risk of death. So, unless you are tucked into your hospital bed, 2 of the 5 are off the list.

3.  Paxlovid and Molnupiravir, oral outpatient anti-viral agents just approved by the FDA. So why not prescribe these to our patients calling?

  • They are NOT to be used for prevention.
  • They must be used within five days of symptoms starting, which is a very narrow window to get a positive test, which is also required.
  • They are ONLY indicated in cases with a high likelihood of progressing to severe disease, hospitalization or death. Which limits to whom they can be prescribed.
  • But the biggest issue--it simply isn't available. We have called dozens of local pharmacies - nada. Some expect to not have it in common use until spring.

4.  Which leads us to the only other FDA approved (emergency use) treatment- Monoclonal Antibodies (MAB).

So far, they appear to be game changers. Safe, few side effects, and a very high success rate.

In fact, almost every case we have followed up on were improving. We do not specifically check for Omicron, but the MAB’s appear to be working in current strains we are seeing in Orange County.

And they are free, thanks to our federal government cutting a deal with Regeneron labs to supply the country with them. (A reasonable administration fee is allowed to be charged.)

Monoclonal antibodies are laboratory-produced molecules that act as substitute antibodies that can restore, enhance, or mimic the immune system's attack on viruses--in this case Covid.

A fair analogy is vaccines have the SWAT team waiting for the Covid perpetrators and neutralize them on entering the nose--I mean house. With MAB’s the SWAT team rushes the house once the perps have already entered. Either way, antibodies are doing the work.

PDQ Urgent Care, in partnership with Infusion IV Hydration & Injection Therapy, in conjunction with Caduceus- has been approved to administer MAB’s and has given approximately 50 doses in the last few weeks. However, allocations are sparse, and we run out quickly. We never know if more allocations are coming, since it is in short supply nationwide.

Recently it was reported the entire Houston area would run out of MAB’s and unsure if they can get a new allocations soon. With no other proven therapies, demand is far ahead of supply.

(Conspiracy theorists: I have been unable to verify the head of Houston MAB distributions is a Dodger fan.)

To answer the many questions about receiving MAB, let’s skip the questions and go straight to the answers:

  • To receive the MAB’s, you need to be referred by a PDQ provider. This is done via a video visit. Easiest way to do this is via the PDQ app, or live chat on the website at pdqurgentcareandmore.com. If they are closed, I suggest a Mouse Call, also available on the app or website.
  • You also agree to a follow-up video visit a few days after the MAB infusion.
  • (Advice- download the PDQ app. You can do all your Covid stuff anywhere your phone is via live chat. PDQ is then literally in your pocket.)
  • You will need to be positive by either a PCR or Antigen test and present the test at the time of the infusion.
  • You will need to be mildly to moderately ill, with a high likelihood that you may progress to a hospitalization. If you already have a severe case, you should go to the ER for possible admission to receive Options 1 and 2 above.
  • If you have Covid but are relatively healthy and improving, you should not receive MAB’s.
  • With supplies so limited, we are giving priority to our own loyal patients. It is not required to be a preexisting PDQ or Caduceus patient, however.
  • Your costs for MAB’s are modest. The two video visits are billed to your insurance. If you do not have insurance, they are under $50. The infusion fee is paid at the time of administration and is NOT billed to insurance. It is currently around $200-300.

What if you qualify for MAB’s but cannot find it? Or you are sick, but do not meet the criteria for MAB’s? We have looked and found one other therapy to replace MAB’s if needed.

Enter Option 5- Fluvoxamine aka Luvox. This is actually a type of psychiatric medication, meant for OCD in the category of drugs known as "SSRI’s.”

Luvox acts by increasing levels of the brain chemical serotonin. In addition, the drug has other biological properties that could quell inflammation triggered by COVID-19.

Why is this different than the other off label drugs touted by social media?

Well, this one has actual peer reviewed studies to support it. Yes studies--as in multiple ones. Its main claim to Covid fame is it prevents the cytokine storm responsible for the severe double pneumonias, ARDS, ventilators, and even the “long hauler” symptoms. 
And the studies are not in obscure journals. It was given passing marks from both
JAMA and The Lancet.

It is not FDA approved, and at least one local pharmacy told us they will not fill prescriptions for it until it is. But it has been taken by millions of patients over the last 30 years with a good safety profile.

Since it is an off-label use, many physicians will be resistant to use it, given the drama of Plaquenil in 2020. But our Covid team will consider it if all other options hit a dead-end.

Again, you will need a positive Covid test, and a video visit. It is NOT for prevention, and only for higher risk patients.

That's about it.

Five treatments with decent supporting data. But to review, only MAB’s are a realistic treatment to prevent hospitalizations and death.

Of course, having the antibodies ALREADY lying in wait for the dreaded spike protein is much preferred--and that means taking the vaccine, AND a booster OR check your antibody counts every 4-6 weeks as we have been advising. (Ok, nagging.)

In summary:

  1. There is no treatment shown to prevent Covid
  2. There are only five treatments showing respected data on treating Covid successfully.
  3. Only one is a current viable option for outpatients- Monoclonal Antibodies. And they work.
  4. Get vaccinated and boosted, or at least check a total antibody count regularly as your best bet to stay out of the hospital -or worse.
  5. PDQ, in partnership with Infusion IV Hydration & Injection Therapy and Caduceus, is an approved site for MAB’s. Allocations are sparse and there is no guarantee they will continue.

Just ask Houston.

We began with Henny, let’s end with Henny.

A man goes to his doctor and says "Doctor, I have Covid and I'm afraid I am going to die!"
The doctor says, "Nonsense! You'll live to be 80!"
"But I AM 80!" says the man.
"See? What did I tell you!!!!" 

Sincerely,

Gregg DeNicola MD Chief Medical Officer
Caduceus Medical Group

Monoclonal Antibodies Now Available Through PDQ Urgent Care & More Orange County

ANNOUNCMENT from CMO-


Caduceus Medical Group’s urgent care PDQ Urgent Care & More, in partnership with Infusion IV Hydration & Injection Therapy, have arranged for monoclonal antibodies from Regeneron (Casivirimab/Imdevimab) to be available to its eligible patients with Covid-19.

As they say on Channel 13, supplies are limited; we are optimistic we can continue to replenish our allotment when needed.

This is an important addition to our regime against Covid-19. As we strive for best outcomes during the current large spike in cases, these antibodies may mean the difference between home and hospital.

Perhaps even life and death. Here is what you need to know.

  1.  Monoclonal antibodies are FDA authorized via emergency use, but not yet FDA "approved.” Our experience at Caduceus has shown excellent results to date.

  2.  Strict criteria must be followed. There are quite a few, but the Big 3 are:

  • Age 12 or over.
  • Given no more than 10 days from start of symptoms.
  •  For mild to moderate PCR positive cases that have a strong likelihood of progressing to a severe cases.

   3.  Two telehealth visits are required- one prior to treatment to qualify, and a second a few days after treatment for follow up.

   4.  The antibodies themselves are at no charge. The telehealth visits are billed to insurance (or charged a reasonable cash price). The actual infusion is performed through Infusion, (makes sense right?), at PDQ Urgent Care & More and incurs an administration fee. Insurance is NOT billed for the infusion fee.

   5.  The antibodies are delivered through IV infusion, or via injection. Most experts feel the IV infusion is preferred.
 
It has been very difficult for our Covid-19 team to find centers offering the antibodies within that 10 day window. We are pleased to offer this Christmas present to our loyal patients, although hopefully it’s a present you won’t have to open.

Remember it is important to get your vaccination, or booster, or at least check your antibody counts before your holiday gatherings. It is no coincidence this current surge is three weeks from Thanksgiving. Let’s not see a January surge among ourselves. It’s easy to get protected.

But now, should you be unfortunate enough to test positive, we may be able to treat you with monoclonal antibodies at PDQ and keep you out of the hospital.

To arrange for this treatment, go to Live Chat on the PDQ Urgent Care & More website or PDQ app or email our Covid team.

To ask any medical questions about this therapy, send us a MouseCall.


Sincerely,

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

Quantitative Antibody FAQ's Orange County

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


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


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


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

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

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

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.”