Dr. Charles Hurbis

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My public battle with COVID took a personal turn last month.   My 87-year-old father, who lives at home in Ann Arbor, Mich., was diagnosed with COVID.  As I write this column, I am having him admitted to the University of Michigan Hospital. Just this morning, nearly two weeks into his infection, his condition abruptly changed, that’s COVID. It’s very unpredictable. I don’t think that any single person will get through this pandemic without some personal toll. I was hoping to be an exception, clearly that won’t be the case.

Here’s an eye opener for you.  Historically, we’ve had some pretty horrific days on our continent, The Civil War, Pearl Harbor, The Trade Towers, etc. Still, the statistics from these tragedies are soon to be buried by COVID data. Listed are the 12 most deadly days on our continent (and these will be beaten come press time):

1) Galveston Hurricane (August 1900) - 8,000 deaths

2) Battle of Antietam (September 17, 1862) - 3,600

3) Trade Centers (September 11, 2001) - 2977

4) Pea,rl Harbor (December 7, 1941) – 2404

COVID,:

5) Dec 16 - 3,611

6) Dec 17 - 3,293

7) Dec 22 - 3,239

8) Dec 23 - 3,411

9) Christmas Eve - 2824

10) Dec 29 - 3,629,

11) Dec 30 – 3,809

12) New Year’s Eve – 3,460

I’ve been writing a monthly column on COVID now since March.  I’ve given very specific safety guidelines to my family members. Still, families always feel safer around each other (which makes any situation even more dangerous). This virus does not allow you to let your guard down, not for a second. It takes only one mistake to change the course of your, or someone else’s life, possibly forever.  

Seamingly safe behavior is now even more necessary since the new, much more infectious strain of COVID from the UK has reached our shores. This new variant of the coronavirus can spread much more quickly than prior strains of the virus. The mutation represents a variation in the virus spike protein which controls viral replication.  A collection of evidence suggests the new strain “has a significant, substantial increase in transmissibility,” says Professor Chris Whitty, England’s chief medical officer. “But, there’s no evidence so far to suggest it causes more severe disease, a higher risk of hospitalization or limits coronavirus treatments and vaccines”, he said. This new strain has already been detected in places as far flung as Denmark, the Netherlands, Belgium, Italy, Iceland and Australia. Now it has also surfaced in Colorado, San Diego and New York.

So how do we protect ourselves at this juncture in the Pandemic? At the risk of being horribly repetitive the old safeguards are masking and social separation. We know these can be almost 100% effective when used properly.  Doctors and nurses work daily with COVID patients. Their properly fitted high quality masks (no you cannot wear it under your nose), eye protection and strict hygiene protocols keep the risk of infection relatively low, even with the huge exposure. Also, consider Melbourne, Australia. Melbourne (a city of five million) underwent an economically painful prolonged shutdown, enforced masking and separation policies with teeth and had a vigorous contact tracing program. The results, near the end of 2020 Melbourne had a 50-day stretch without one single case. Ponder that for just a second, not one case.  Yes, it is possible to control a pandemic. 

But, we live in America, right? We can’t be expected to sacrifice, give up our civil liberties or have our rights restricted like the Aussies.  Unfortunately, because of who we are, we’ll clearly never control the virus the same way. Our only option out of this is mass vaccination.

Here’s what you need to know about the available vaccines:

1) Current U.S. population survey: 4 of 10 Americans are not planning on being vaccinated (that’s not going to work).

2) Four companies are currently producing a COVID vaccine: Moderna, Pfizer, AstraZeneca and Novavax.

3) Vaccines function by targeting the virus spike protein, a surface protein which determines how contagious the virus is (depending on its stickiness to target cells).   All COVID variants are similar enough to allow vaccines to still be effective thus far.

4) Vaccination protocol - the currently available vaccines require 2 doses separated by 4 weeks to be effective.  Interestingly though there are thoughts of switching to a one dose regimen because of overall shortages. Two is better.

5) Time to immunity will be about 2 weeks after the second dose or about 6 weeks.

6) Side effects - as with all vaccines we can expect some mild immediate side effects.  These include fatigue 36%, headache 36%, muscle aches 20% and chills 10%.  These tend to be worse after the second injection and are not as bad in the elderly. There have been rare severe allergic reactions. These have occurred in people with a propensity for anaphylaxis and are more common with severe shellfish allergies. There have been reported cases of Bell’s palsy (or temporary facial paralysis) at a rate of 1/7000. There was some initial concern about the vaccine temporarily affecting fertility due to similarities between the spike protein and placental proteins. This has not panned out.   Serious side effects would occur within the first few weeks. So far, the safety profile has been better than other vaccines of the same type over a similar time period.

7) The vaccine is currently designed for those over the age of 16. Those with the following conditions shouldn’t be vaccinated:  pregnancy, during lactation, people with severe allergies (OK with monitoring), HIV or other forms of immunosuppression. Also, there should be no other simultaneous vaccines given.

8) The vaccines are known to impart a 95% protection to COVID infection. They produce a strong IgG antibody and cellular immunity response, but less of an IgA response. IgA is the antibody secreted by mucus membranes which protects against initial viral surface colonization. Without IgA induction, the vaccine doesn’t necessarily prevent people from carrying and spreading the virus even though they personally are protected. The vaccination may protect only the vaccinated. Therefore, masks will still be needed initially to prevent spread. The vaccine is another arrow in our quiver towards controlling the pandemic, but not likely the bazooka we’d hoped for.

One question that arises is:  Should I refuse inoculation now hoping for a better vaccine in the future? The answer is no, at 95% effectiveness to you it’s unlikely anything better will be developed in short order, and with this new strain out there you need protection.

During this pandemic many COVID treatments have been touted as “effective,” but in reality, only a few have any real value.  I’m listing these below:

Within the first 14 days

Antivirals: Remdesivir +/- Baricitinib (an anti-inflammatory) - reduce recovery time and accelerate improvement in clinical status among patients with Covid-19, notably those receiving high-flow oxygen or noninvasive ventilation.

Monoclonal antibodies: REGN-COV2 antibody cocktail Casirivimab/Imdevimab (Regeneron),  Bamlanivimab (Eli Lilly) - reduce viral load.  These have a greater effect in patients whose immune response had not yet been initiated or who had a high viral load at baseline.

After 14 days

Decadron - steroid treatment, modulates excess immune response lessening complications.

Convalescent Plasma - plasma pooled from blood type matched donors that have recovered from COVID and show high antibody titers.  These extrinsic antibodies speed overall resolution in more chronic cases.

I have a very good friend who is a professor of cardiology at the University of Michigan.  In the early days of the pandemic he volunteered to work as an intensivist in the understaffed, expanded intensive care units during the last peak. He said that all of his patients were elderly, exceptionally sick and most with multiple co-morbidities. Many required intubation with ventilator assist at some point.  During those 2 months, every single one of his patients eventually walked out of the hospital. Here’s where luck may have a place. Also, you need a damned good doctor and a good dose of faith.

Doc H

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