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.
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.
Ivermectin and Hydroxychloroquine (Plaquenil)
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.
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.
No or minimal symptoms
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.
"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.
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.
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:
Hickory Dickory Dock
Where do you go if your Hickory Dickory is hurting?
Gregg DeNicola MD
Caduceus Medical Group, PDQ Urgent Care & More, PDQ Telehealth
August 11, 2021