Posts Tagged ‘ covidfacts ’

CMO Corner- Orange County Covid Updates for December

By editor
December 1, 2020

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

Citizens in other cities refuse to eat them.

But Abu Dhabi Do!

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

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

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

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

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

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

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

But it was a Type-O.

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

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

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

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

Gregg DeNicola MD
Chief Medical Officer
Caduceus Medical Group

Covid Facts About Transmission- A Message from our CMO

By editor
June 19, 2020

In a very different era, before the Jimmies and even Jay, we had Johnny. And my favorite version of Johnny was “Carnac the Magnificent.” Carnac was a seer who, in full turban, would give the answers to a sealed question. Confused? It went something like this....
Covid-19, Al Capone, and Plaquenil.
(The envelope tears open....)

"Name an evil bug, an evil thug, and an evil drug!”
(We will use Plaquenil on the right patient but wanted to give equal time to the Anti-Plaq readers in the audience)
Ok, let’s try a few more… 
Houston Astros, Disneyland, and the World Health Organization.
(Tear the envelope.....)
Name three places that run a Mickey Mouse organization.
(That's for all the Dodger fans in the crowd)
OK, OK I’ve got a million of ‘em....
Household contacts, traveling, and large gatherings.
Name the top three sources of Covid exposure in the Caduceus Covid-19 Program.
(I know, not funny. But true.)
One more…
A barista, a doorknob, and a salad bar.
Name three sources NEVER named as the exposure to Covid in the Caduceus Covid Program.
In looking into how people catch Covid, we think back to the famous quote of the convict Willie Sutton. When asked why he robbed banks, he said "Because that’s where the money is.”

With our Covid numbers climbing in the wake of reopening our cities, we should look to where the virus is. The evidence shows clearly:
-You stand a very high risk of contracting the virus if you have close exposure to an active case. 
-Your chance of catching it using an unsanitized public restroom is very low. 
Studying cases in China, Europe, New York and California, all the data tells us it is close up, person to person exposure that spreads the virus. That is why cases dipped with stay-at-home orders. Assuming your household was free of virus, you had little risk with no exposure to infected individuals. Now with the lockdown relaxed, why are we seeing the current spike, where in other counties no spike was seen with reopening?
What we have now is accurate data we did not have in March. The experts identify "droplet contact" as the main mode of transmission. The virus primarily lives in the nose and mouth (and lungs of course). If the microscopic droplets carry from an infected person’s nose/mouth to your nose/mouth, it is VERY easy to catch.
If they fall to the ground or other surfaces they die pretty quickly. This is new data different than what we first thought.
What is bothersome is that if the droplets are very small they can travel far, much more than 6 feet. Remember that feather at the end of Forrest Gump, that fluttered for nearly a city block before landing? Covid is lighter and more mobile than that- you get the idea.

More worrisome is we now know Covid can be expelled just by normal talking and breathing, not only by sneezing and coughing. That is why we have seen large numbers from concerts and church services where crowds shout and sing loudly, expelling the virus many rows over. In fact singing turns out to be a major culprit, since they breath in deeply and expel the air forcefully. Add to the equation that the viral load of Covid is much higher than a virus such as the flu, and you see how quickly it can spread.
The literature tells us that if you live with someone Covid-infected your risk of contracting it is roughly 20%. The CDC sets parameters of 15 minutes of unprotected contact with someone less than 6 feet away as a very high risk situation, hence the need for masks, plexiglass, and distancing. Fist bumps and elbow bumps are not going to keep you from being infected. Neither will being young and healthy. Distance will.
And I know this is blasphemy but wiping surfaces with Lysol, taking away the soda fountain, removing the office coffee pot, and leaving your shopping bags at home are most likely doing very little to prevent the spread. In fact, probably nothing. Instead, preventing close contact in break rooms, locker rooms, group bathrooms, and elevators is much more critical. 
Of course for maximal effect, it helps to know who is actually infected. In Denmark, Covid testing has been offered free of charge to every citizen. Germany combined massive testing with contact tracing, a very sensitive subject here in the US.

And you know what they found? Schools were never the primary source of Covid despite what was believed. In contrast to California's schools being closed, Denmark immediately re opened theirs, with no increase in Covid cases. In California the effect of online classes has been less than ideal, while our new cases keep climbing despite school closures.
One major issue is that when someone is diagnosed with Covid here, isolation and quarantine appear to be mere suggestions. Many of our cases diagnosed still leave the home for errands, one gentleman even returned to work, against medical advice of course. If they live with their partner or roommate, they assume isolation means sitting on the far side of the couch without a mask.  But in New Zealand which has declared themselves free of Covid, total isolation was mandated. They required a test-of-cure, whereas in the US we do not. (Caduceus does, within legal and ethical limits.)
We do not have to look abroad, we have data right here in the USA. A county of Ohio reopened with a DECREASE in cases recently. How did they do that? They made an aggressive effort to markedly increase testing. And when new cases were found, they were put in strict isolation. I’m not aware if they did contact tracing, but it wouldn't surprise me. And even with INCREASED testing, they now see LESS cases. So much for blaming more testing for any higher cases reported, right?
So where are the new cases coming from? Data tells us household work and other close person to person contacts. Nursing homes. Public travel, especially boats and planes. And large gatherings such as parties and yes, protesting. Basically anywhere where lots of people are in prolonged, close contact.
Where do we NOT see the newer cases coming from?  Amazon boxes. Shopping bags. Light switches. Buffets. Dry cleaners. Hiking trails. Sunbathing on the sand. 
So perhaps we need to intensify prevention of close contacts without masks, and relax a bit on how often a counter is wiped down. Even if churches reopen consider doing online worship until the cases drop. But as long as your beach towel is a safe distance from others, you are most likely safe enjoying a Laguna sunset from the sand.  Want to take a quick trip to Napa? Renting a car poses little risk. Flying or train---beware. 
At Caduceus, we are guilty of disinfecting our rooms and cleaning our doorknobs. Yet we also created lobbyless offices. Patients are taken directly to the exam room or texted when the room is ready.  Our staff is tested regularly for Covid, and have their temperature taken at the start of their shift. We treat patients with a fever or infection via telemedicine only. All of our Covid testing is done curbside. Even routine labs are drawn curbside. And we offer every patient having blood drawn a Covid test. We urge our patients to continue to come in for their routine health care needs. We commit to them the lowest risk to Covid exposure possible. 

-Avoid person to person close contact for greater than 15 minutes whenever possible
-Avoid large gatherings especially where there is shouting, singing, speeches, and heavy breathing. Special areas of concern are karaoke, clubs, bars, gyms, and churches.
-Avoid visiting nursing homes and hospitals unless essential
-Avoid plane, bus, boat, train, Uber travel unless essential. 
-For any close contact wear your mask, respect the plexiglass, wash your hands.
-If you test positive for heaven’s sake ISOLATE. That means your own bedroom, your own bathroom, and do not engage with any other housemates. If you must leave your room and go to the kitchen, everyone should wear a mask. Do not leave the house until you test negative. If your meals are being prepared for you, they should be left outside your door. You should not watch TV in the family room unless you are alone.
-If you test positive, think hard of all your close contacts in the previous 14 days. Implore them to get tested. If you are not infected, but know someone who is positive and had contact with them, YOU should get tested.

For the last conclusion let’s revisit Carnac…
Test. Test. Test.

(Envelope please)
Name three ways you will know if you’re contagious--or immune. 
Know if you're contagious.
Know if you're immune.
Gregg Denicola MD
Chief Medical Officer 
Caduceus Medical Group