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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.”

Covid Blog OC Dinner with the Docs Series

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

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

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

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

If over 50, HUEY meets criteria for:

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

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

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

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

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

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

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

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

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Antibodies. Do. Work.

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

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

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

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

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

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

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

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

That's fair. Also cowardly.

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

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

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

A: Not sure.

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

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

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

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

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

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

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

Not sure.

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

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

A: Not sure.

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

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

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

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

So do we have any specific advice for you?

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

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

BUCKET #1

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

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

BUCKET #2

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

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

BUCKET #3

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

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

BUCKET #4

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

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

BUCKET # 5

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

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

PCR Covid testing?

That is SOOOO 2020.

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

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

Gregg DeNicola MD, Chief Medical Officer

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

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

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

And yes, I still enjoy a shot of Kahlua.

CMO Covid Orange County Blog- Shares his story

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

I looked up at the IV bottle.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Will that cure me?” the patient asked.

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

OR

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

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

OR

How did the doctor cure the invisible man?

He took him to the ICU.

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

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

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

You can stop grinning now.

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

We are on it.

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

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

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