The Medical News Report

#101

COVID-19-Part 3

June, 2020

www.themedicalnewsreport.com

Subjects on COVID19:

1. Introduction

2. New symptoms added to CDC list

3. When to seek immediate attention

4. Transmissibility in asymptomatic people

5. Nursing home dilemma

6. Infections in immunocompromised people

7. Infections in the homeless

8. Virus in semen and feces

9. Changing protocols to treat COVID-19

10. How infection affects people with underlying disease

11. Medications approved and in clinical trials

12. Testing value

13. Unintended consequences of the virus

14. Will the virus return in the fall with the flu

15. Vitamins and minerals and the virus

16. Recovery

17. Vaccine development

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thank you, Dr. Sam

Dear Readers,

  Since COVID-19 occupies our minds, I am limiting the June report to several important reports on this virus.

  As the medical effects have been felt throughout our country, the unintended consequences and economic destruction has outdistanced the infection, in my opinion, and I will discuss this. It is time we save our country! Also, if the previous outbreaks (Ebola, SARS, MERS) had carried through on research using randomized clinical trials, we might have been better prepared. JAMA, May 17, 2020

  If we want to recover, we must put partisan politics aside and get back to work, but that is clearly not the case.  

  For those sitting at home because they are making more money from the government than their normal paychecks, please get to back to work or your job might not be there when the money runs out.

  We can be safe, take care of our families, protect those at high risk, and get our economy going all at the same time. Also, everyone must be patient with each other and just be nice. Not everyone perceives this pandemic through the same lens.

  Of course, there will be viral outbreaks as we reopen, so don’t let the media freak you out, because they will exploit every little viral incident trying to stall progress in reopening. We all know their agenda!

  Our leaders can balance the medical experts’ guidance with sound economic planning to refuel the economy. Remember the rules are not made by medical experts….only advice and they play from a very cautious playbook and never want to underestimate disease outbreaks.

  As the more credible research is coming out, it is becoming apparent that the medical community including the public health gurus were wrong in their assessment of harm from changing the way most patients are being treated in the ICU to now hearing from the CDC that surfaces are probably not as infectious as preliminary studies cited.

  These mixed messages will make it more difficult for the public to know what to believe and thus might tend for them to become lax in protecting themselves and others in public venues.

  I have many important updates in this report. As the medical journals are starting to provide peer reviewed articles on COVID-19, we will see how many early medical approaches taken were in error. That is why they call it the “practice” of medicine.

  Doctors can only treat patients based on sound evidence-based information, and COVID-19 is teaching medical professionals some new lessons. Crises always teach doctors about what works and what doesn’t in uncharted territory.

  For those who think we can wait on a vaccine, get real.  It will be at least the first of next year before a vaccine will be available and it may not be offered to everyone until a large numbers of volunteers have time to be followed.  

  Please stay healthy, safe, and well! Dr. Sam

Updates on COVID-19—No Fear!!

From Axios alerts

Sneeze, cough, speak

1. Introduction

  My last update was April 24. New information is coming out daily, however, there are many interesting facts that are new. And what was recommended a month ago is now no longer used.

  Dr. Anthony Fauci, Director of NIAID (National Institutes of Allergy and Infectious Diseases, and Presidential Coronavirus Advisory Task Force stated that the fall will see some cases, but will be far better prepared with immediate mobilization of public health and medical needs. The public will have to be ready to isolate quickly and follow guidance from authorities to stop the virus in its tracks. Ultimately the vaccine will stop this virus but may not be available for many months, the latest early estimate being the first of 2021

  Dr. Fauci did say that the companies will start stockpiling doses of any vaccine that gets to the final stage of approval, so that there will be no time lost once the FDA approves it.

Dr. Anthony Fauci

]

Dr. Deborah Birx

Here are some important recent numbers:

  As of Memorial Day, there are 1.6 million cases in the U.S. and 97,000 deaths. Georgia-43,000 cases and 1800 deaths; Florida 50,000 cases and 2200 deaths.

  According to Worldmeter, 40+% of U.S. deaths come from skilled nursing facilities. New York, New Jersey, and Connecticut combined account for over half of the deaths in the U.S.

  Consider 95% of deaths from COVID-19 are people over 65 (and 95% of them have one or more risk factors), one wonders why the whole country has been in lockdown when the sick and aged are the only groups really at high risk and should be isolated. This is the first time the country has ever isolated the healthy to protect the sick.

  With strong support from the public health official’s worst case metrics, the leaders had no choice but execute stay at home orders. Dr. Fauci and Birx, public health and infectious disease experts predicted 100-250,000 deaths (currently 97,000 deaths as of may 26).

  The CDC now estimates the death rate to be much lower than the models predicted. It is estimated to be 0.26% overall in the U.S. (Flu is 0.1%), 35% infected will be asymptomatic, 0.4% death rate for those who become symptomatic, and excluding nursing home deaths, the rate will be the same as flu (0.1%).

  If under 50 years of age, the chance of death is 1 in 5000. To keep this in perspective, if a person has heart disease, the risk of dying in 1 in 7, COPD is 1 in 28.

  Make no mistake, if a person is high risk, this virus can kill them, but for the rest of the population, with proper hygiene, masks where appropriate, and physical separation of 6 feet, we are protected.

  Since the country never faced such a countrywide  pandemic (since the Spanish Pandemic of 1917) as this one, it may have taken scaring people enough to get them to comply with state orders. Now, people need confidence that with proper safety, we can get the country open and tend to our medical needs. Fear must abate and common sense take over. For those not ready to venture out, that is person’s right.

  Our country’s leaders are taking the public health metrics into strong consideration, but running a country must balance the medical with the common sense economic initiatives to bring this country back. Unfortunately, the media pits these groups against each other to fuel anger and fear. For those who say, “follow the science” without appreciation for the devastating effects of the virus on our country, the science changes weekly, and we still have to eat!

  The group that is not being heard are the real doctors on the front lines of treatment. Only the academicians and public health officials (who are not actively practicing medicine) are advising the administration and that is only one impression. These doctors don’t have time to write papers.

  There is much known now about this novel virus that just wasn’t available to allow adjustments in decision making prior to 120 days ago. Treatments have had to be changed, and protocols adjusted as true evidence based information is becoming available.  

  It has cost the taxpayer over $2 trillion and now another $3 trillion was approved by the House of Representatives, but will not pass the Senate, since it has so many non-COVID pork barrel additions and bailouts of states shortfalls accumulated over years. Additional monies will have to be borrowed and will put a tremendous burden on future generations.

  Had we been notified by China and the WHO a month earlier than January, just imagine where we would be today. Obviously, the leaders of our country would have had a different game plan. And admittedly, if we had stockpiles of PPEs, ventilators, reliable tests, we could have responded faster. But the actual fast track action speed of our country to mobilize resources is unprecedented. Now we have so many unused ventilators that we are sending them all over the world.

  For all people who were too scared to go the hospital because of illness, please go!! It is the cleanest place in town. The health unintended consequence statistics I will discuss later are staggering because of delays in diagnosis preventative measures, and treatment. It really makes one ask…”Is the treatment worse than the disease”?

  The CDC announced two important revisions in their thought process. 1-The death rate in the U.S. is down to 0.4% (flu is 0.1%), 2- Surfaces are now not considered a significant source of transmission. It is, however, clear that masks, personal hygiene, and physical isolation is very valuable in reducing transmission.

2. More symptoms added to the CDC’s list

  The CDC has added more symptoms to the list that should be considered when diagnosing a patient with COVID-19. They are:

Cough, shortness of breath, fever (greater 100.4F), chills, loss of taste or smell, sore throat, muscle pain. Symptoms can appear 2-14 days after exposure (incubation period).

  I remind you that a percentage will have gastrointestinal symptoms especially children. Neurological symptoms are also not uncommon in up to 30% of symptomatic people.

  Children make up only 1.7% of COVID cases in the U.S. and are either barely symptomatic or mild in character.

  However, there is a tiny percent who develop a rash, fever, chills, toes that peel, bloodshot eyes, changes in the color of skin, trouble breathing, chest pain, confusion, and irritability. It is called PMIS—Pediatric multisystem inflammatory disease and occurs after recovery of the child, and has been documented in just 19 cases.  It is similar to Kawasaki disease, a vascular inflammatory disease causing heart disease with toxic shock syndrome.

3. When to seek immediate attention

  Patients with any symptoms should talk to a doctor, get tested, and watch for deterioration of symptoms. The following symptoms should prompt family to seek immediate care: shortness of breath getting worse, pain or pressure in the chest, new confusion, or can’t stay awake or can’t be awakened.  

4. Viral Transmission and Asymptomatic people

  April 24, the NEJM, reported on this subject especially regarding those who remain asymptomatic.

  There is a big difference how fast SARS spread and was controlled (SARS was controlled in 8 months infecting only 8000 people in limited geographic areas), whereas COVID-19 has infected 5.5 million cases spread throughout 184 countries. The main difference is the transmissibility of these 2 viruses. But distancing, masks, and hygiene can turn this virus on its nose.

  The amount of viral load equates to how much virus gets into the body and possibly whether a person is symptomatic.

5. Nursing Homes (30-40% of all cases)

  Although I have not seen any percentage of cases reported from nursing home deaths from the feds yet, according to Worldmeter, approximately 44% of deaths have come from these facilities. 

   In reviewing cases in the initial nursing home outbreak in Washington State, these patients were tested for the virus and found to have viable virus in their systems 1-6 days before becoming symptomatic. 15 of the 57 residents died. All of the residents tested positive before becoming sick.

  Nursing homes will continue to be a petri dish for any virus that is easily transmitted. Closeness of patients, communal gatherings, and their inability to perform hygienic techniques places that put a great burden on the staff creating major human to human contact. This was compounded initially by inadequate personal protective equipment. Daily screenings will be necessary, especially the staff. That means a lot of sick leave which will tax these facilities. Strict isolation for those with symptoms must be part of the strategy.

  Currently 1.3 million people reside in 25,000 skilled nursing facilities. Mass testing and symptomatic screening on a frequent basis will be the new norm for these facilities. Daily temperature checks of all personnel and visitors will be routine.

  Many people have removed their loved one from these facilities, but that is not the answer. These people also need to visit with their relatives, and rules for that must make sense.

  These dense population issues also apply to prisons, the military, schools, cruise ships, and any place where people are confined to a specific area.

6. Infection in immunocompromised patients

  Patients being treated for immune type diseases with biologic agents (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, inflammatory bowel syndromes) were found in one study that they had about the same percentage of admissions to the hospital as the general population. This study was performed at the New York Langone Medical Center. This implies that patients on biological therapies for their autoimmune diseases are no worse off than those without these diseases.

NEJM, May 1, 2020

7. Infections in homeless people in Boston

 36% of a homeless shelter (408 people av. age 51) were tested positive with the standard PCR test, and 87% were asymptomatic dispelling one more myth that these people were more prone to severe infection. JAMA, April, 27, 2020

  Homeless people refuse to go to shelter for the same reason people would not go to hospitals….they were afreaid of getting sick, so Claifornia opened the hotels to these people. WOW!

8. Semen is another source of COVID-19 even after recovery; Fecal contamination too!

  It is no surprise that COVID-19 has been found in the semen of infected individuals. Sadly, it is still present in 60% of participants even after recovery in one study. How viable the virus remains is not known. Whether this could be a source of transmission has not been studied, IF ORAL SEX IS INVOLVED, LIKELY! Also the virus persists in feces, and flushing the toilet without the lid closed spreads the virus in bathrooms, a more significant issue for public restrooms.

  It is not a great time to be single and safe. I am sure the dating sites are busy.

JAMA Network, May 7, 2020

9. Changing trends in treating severe COVID-19—explaining the mechanism of action and new treatments

The following information is provided by the COVID-19 Managent Protocol at Eastern Virginia Medical School, Dr. Paul Marik (as seen above)

  When it became obvious the use of high pressure ventilators was the wrong approach to treat these patients (they were dying in a high percentages), they began to experiment with lower pressures and higher oxygen levels without ventilators using face masks similar to CPAP. The protocol that utilized that failed in most cases was used for ARDS (Acute Respiratory Distress Syndrome), but COVID-19 was found to affect the lungs differently than ARDS. 

  Dr. Marik, mentioned above, found that this virus does directly damage the lungs, rather the virus stimulates the body to pore out inflammatory markers (cytokines) that do the damage. This massive immune response by the body had to be countered with corticosteroids, previously not recommended. The T-cell lymphoctyes were the culprit, and the steroids, if used early, could curtail the cytokine storm.

  High dose methylprednisolone is now recommended as the primary treatment, although due to the extreme circumstances, anti-viral agents are also being used.

  This treatment is now standard.

Pathophysiology of COVID-19

  Dr. Marik and others defined the disease. They defined the disease with 3 core pathologic processes that lead to multi-organ failure.  

  1. Hyper-inflammation (cytokine storm)—a disregulated immune system whose cells infiltrate and damage organs by the inflammatory markers. COVID-19 causes aberrant T-lymphocyte and macrophage activation causing the storm.

  2. Hypercoagulability (increased clotting)—activation of blood clotting factors in the lining cells of the organs causing micro-clots which block blood flow and diminish  oxygenation. The term is DIC-desseminated intravascular coagulation (thrombosis) with clots blocking the exchange of carbon dioxide and oxygen in the lungs. These same inflammatory markers stimulate these clotting factors. IV heparin is used to treat these clots. Fibrin deposits, by products of clotting factors, line the lung cell lining, blocking transfer of oxygen.

3. Severe hypoxemia—low oxygen levels—lung inflammation and microclots impair oxygen absorption and oxygenation failure.

  High dose Vitamin C (which has not been proven) is also administered IV. Low blood levels of vitamin D are known to exacerbate the cytokine storm which damages all the organs, and therefore this vitamin has been given in high doses as well.

  Oxygenation is permitted to be as low as 84% oxygen saturation, contrary to the treatment of true ARDS. However, some patients are so sick with underlying diseases that they will still necessitate intubation and mechanical ventilatory assistance and must be treated just like ARDS. Flow rates of 40-60 liters of oxygen are recommended.

Mask Oxygen

  Plasma exchange, biologics (IL-6 inhibitors- Siltuximab or Tolcilizomab), and other unproven treatment are being used in these desperate situations.  

  Below is a drawing of the SARS-Cov-2 virus, better known as COVID-19. The middle cell is the white blood cell that secretes the inflammatory cytotoxins, T-cell lymphocyte. The macrophage also gets in the act with the secretory capability.

COVID-toe (clots in small vessels causing necrosis of the skin, similar to frostbite)     

Dr. Marik and his colleagues have attained enormous success with the use of anti-inflammatory agents if started within 6 hours of a patient complaining of shortness of breath and needing more than 4 liters of nasal oxygen.

  COVID-19 does not cause ARDS*, but using a ventilator with high pressure will complicate ARDS. For those interested in what ARDS is, please read:

*ARDS is defined as acute respiratory disease syndrome caused by lung failure creating a loss of lung compliance (elasticity) in the lining of the alveoli, which normally keeps the alveolar sacs open. In ARDS, these alveolar collapses shrink the lung and block the exchange of carbon dioxide for oxygen. The cause of ARDS can be several. The elasticity is controlled by a protein called surfactant, which gets depleted in ARDS. Injuries and severe illnesses (sepsis, inhalation of harmful chemicals and smoke, severe pneumonia, burns, crush injuries) can cause this damage to happen with a collection of fluid in the lungs. With high ventilator pressures, that adds to the damage of the lung.

  According to Dr. Marik, COVID-19 patients tolerate extremely low oxygen blood levels (<86%--normal is over 90%, preferably over 94%). This appears to be high enough oxygen to maintain the organ’s functions while the body recovers from the storm.

  The prognosis is dependent on age, underlying diseases, genotype, viral load, and immunological and nutrition status.

  Autopsy results show similar lung pathology as those who died from other coronavirus epidemics (SARS, MERS). These patients died primarily a respiratory death, even though there was significant abnormalities in other organs from COVID-19.

  There is still no “silver bullet” that will stop this virus. Only prevention (vaccine) and herd immunity can accomplish that.

10. Underlying disease and high risk; understanding the mechanism --Diabetes

  Diabetics are 3X more likely to contract COVID-19. The blood sugar elevation that is the hallmark of diabetes raises the risk of vascular disease. Experts really consider this endocrine disease a neurovascular disease, because the body’s nerves and blood vessels are greatly affected by the metabolic of an elevated blood sugar.

  Diabetics are well known to be prone to infections, and it is these infections (bacterial or viral) that stress the body with a resulting rapid elevation of glucose, which creates a cascade of events that damage the tissues (ketoacidosis).

  Any major infection, including COVID-19, causes a major insult to the body when it stimulates a massive immunological response (cytokine storm in the most severe cases).

  This stress also causes the adrenal glands to produce corticosteroids to fight the virus. Unfortunately, elevation of the corticols reflexly elevates the blood sugar which causes the diabetes to be a major management issue necessitating IV insulin to combat the glucose elevation.

  Diabetics who become infected with COVID-19 must monitor their blood sugar levels with finger stick testing using the home monitors. If the patient develops more than mild disease, the physician will likely admit the patient into the hospital for management, as the course of the viral insult can create a sudden shortness of breath and need for admission to the ICU.

  --Cardiovascular disease

Strokes and heart attack are of concern since the hypercoagulation of blood occurs in moderate to severe cases, necessitating IV heparin, an anticoagulant. The pulmonary insult follows with all organ damage including the kidneys, an organ already frequently damaged by diabetes. Kidney failure risk would be elevated especially in insulin dependent diabetics. If obese, another frequent factor in these patients, carries its own set of risks to the lungs, cardiovascular system, liver, and kidneys.

  High risk patients must protect themselves even when the country opens up, and MUST manage their underlying diseases carefully.

     --Obesity alone increases risk!

  Our country is not healthy. Obesity is a epidemic. 42% of Americans (40 million people) are obese. That includes children and adults of all age. Americans do not exercise near as often as most countries, eat fatty, sugary diets, and too many calories.

  Obesity is now recognized as serious risk factor even in healthy people. Most obese people suffer from hypertension, diabetes, heart and vascular disease, all main co-morbidities that raise the risk of getting moderately or severely ill with COVID-19 3X more likely than the normal population? And according to the CDC 22.7% that are obese smoke!!

  In New York, where the epicenter occurred, at Columbia-Presbyterian/Cornell Medical Center found that people admitted to the hospital under the age of 54, half were obese (the obesity rate in NewYork is 22%).

  Obese people have respiratory problems with obstructive sleep apnea, and with a large abdomen, it is difficult to breathe with the diaphragms being forced up against the lungs. This and all the metabolic complications of obesity are the reasons even healthy obese people are at increased risk.   

  We address the opioid crisis and mental illness, but obesity kills more and even doctors have stopped lecturing patients about losing weight.

11. Are specific drugs recommended for clinical practice?

  The National institutes of Health do not recommend any specific medications outside of clinical trials or emergency use at this time. That does not mean the doctors in trenches aren’t using every possible medication to save lives.

  Remdesivir has been FDA approved for emergency use only (more details below). All others include hydroxychloroquine/Z-pack, zinc, Tamiflu, and other antiviral agent; also Lopinavir/Ritinavir, and HIV drugs, BUT, clinicians are using them with reported success, but the medical literature does not support it….at least yet.

  Trying to turn the corner on patients who are severely ill is not where some of these medications are showing success. I am amazed that studies have come out against hydroxycloroquine because it is so cardiotoxic, and yet millions of people in Africa and other countries take it to prevent malaria without cardiotoxic effects and may help prevent an exposed person from getting sick. Also hydroxychloroqine reverses some of clotting complications of COVID-19.

  Remdevisir has been approved by the FDA as a treatment for serious cases, because in a randomized controlled study* of 1000 cases, it reduced the number of sick days from 15 to 11 days, a 37% improvement, clearly showing an effect on the virus and its ability to reproduce, but we need bigger guns. The drug works by preventing replication of the virus inside human cells. This is still being studied intensely, but is no panacea.

*randomized controlled studies are the best type of research to prove value which require the subjects in the study to picked in a random group and have as many placebo subjects as the actual medication, so that there is no bias.

  Monoclonal antibodies are being used to prevent the virus from entering the cell, and reports will be published in the near future. These monoclonal antibodies are being used in cancer treatment as well.

 Reference NIH website and Dr. Anthony Fauci, Director of National Institutes of Allergy and infectious Diseases

12. Testing--still not always trustworthy!

Diagnostic tests

  Testing from Abbott Labs has been singled out by the FDA that there are a significant number of false negative tests. That means some who are infected will test negative for the first few days. This point-of-care test was touted as a great advance, giving people immediate results. The FDA suggested that negative tests be confirmed with a higher sensitivity molecular test. Also clinicians should  always correlate the clinical situation with the results of tests. If either test is positive, that is confirmatory. 

  The AMA has advised that people should not use testing to make decisions about stopping physical distancing. 

Antibody and immunity testing; mechanism of action

  There are two ways the body creates immunity—antibody response and cellular response, here is how!

  The body immediately responds to a viral infection with a non-specific increase in certain white blood cells. This is followed by an adaptive response by forming with antibodies called immunoglobulins (IgM, IgG) by B-cell lymphocytes. The body also responds with a T-cell lymphocyte proliferation which produces neutralizing antibodies.

  These cells recognize other cells infected with the virus and eliminate them, and this process is called cellular immunity. Testing for these neutralizing antibodies verify the body can kill the virus. This combination of adaptive immunity from the immunoglobulins and T- cells can potentially eliminate the virus and prevent progression of illness.   WHO website

  However, measuring neutralizing antibodies is difficult and not being performed on a widespread public basis. The antibody tests being provided only tell the person they have been infected (IgM and IgG), and not specific for COVID-19. That is why a person could have a positive test but have not been infected by COVID-19 and would be produce a false positive test. These antibodies are not specific for any particular infection.

  False negative tests can occur if there is not enough immunoglobulin elevation in the blood. This could occur in asymptomatic people, older individuals who can’t muster enough immunoglobulin response, and those immunosuppressed.

  The bottom line, it is too soon to assure people that those infected are immune to COVID-19 for future infections of COVID-19 should they occur. No immunity passports!

  Many of the Chinese manufacturer’s antibody tests have proven to be untrustworthy by the FDA. The WHO and CDC have stated that current antibody tests are still unreliable and need further study. .

  Antibody testing is still a vital function for public health epidemiologists who take data and provide information about how the virus affects different people, where the virus is spreading, and the penetrance of the virus into the special populations like first responders and healthcare providers. This will tell us what percent of the population has been infected with and without symptoms.

  It will also tell us how long people are immune, and when people’s antibodies start to diminish. It will tell us when vaccine boosters will be necessary. Herd immunity plus vaccination will defeat this silent enemy.

13. Devastating health consequences because of delay in treatment- here is a partial list:

   --39% fewer imaging studies to evaluate strokes, all missing the window of opportunity to receive tissue plasminogen (tPA) to dissolve the clot in the brain.

   --58% higher cardiac arrests outside the hospital

   --88,000 cancers delayed in diagnosis, 200+ cancer clinical trial on hold

   --900% increase in mental health hotline calls

   --Alcoholism, drug abuse, and suicides skyrocketing

   --Domestic abuse, pedophilia poisons rising

   --Poisoning of children at home

   --20% increase in severity of chronic diseases

   --Massive drop in organ transplants

   --Long term consequences of contracting the virus

        a- Worsening of pre-existing conditions

        b- Mental consequences-PTSD, depression, post-

         intensive care syndrome

        c- Anxiety, substance abuse, long term

         disability

        d- Not able to return to work, need for long term

        rehabilitation, including long term cognitive decline

    -Loss of family members, bread winners

    -Economic impact for all (1 in 4 businesses could close)

    -Loss of quality of life! Fear for the future! Repeat

     outbreaks! Destruction of our country!

   Those who chose to exploit this virus and delay reopening, know that the fear instilled in the public kept these people from seeking care when they needed it. The ultimate medical and mental costs will not be known for some time but will catastrophic.

With future infectious epidemics, people need to be assured that it is safe to go to the hospital. Emergency departments must inform the public how well the infectious patients and staff are segregated from the rest of the emergency department.

 GOOD NEWS ABOUT ANY KIND OF MASK!

Totally wrong! DO NOT TOUCH THE FRONT OF THE MASK!

The latest information from Johns Hopkins Medical Center about masks: unless a person is around a high risk population, such as in healthcare environments, or not able to keep distance between individuals, any kind of face covering or mask will prevent more than 50% of spread.

  Research has proven that people spit when they talk or sing. Without adequate ventilation (fans, outside, etc.), droplets can stay in the air for up to 8 minutes. Also flushing a public toilet causes a plume of droplets (feces contains COVID-19).

WEAR A MASK WHEN IN STORES, ETC., RESPECT OTHERS! No need to wear a mask outside unless in a crowded area.

14. Will COVID-19 return in the fall? How will flu season influence the severity?

  With the ease of transmissibility of COVID-19, experts are predicting the virus may return this fall when flu season restarts and may be around for as long 2 years until the level of immunity is sufficient to meet the viral challenge.

  Hopefully the public will still be paying great attention to personal hygiene and physical separation if there is a resurgence. But it is critical ALL PEOPLE MUST GET THE INFLUENZA VACCINE. For anti-vaccine advocates, they must realize the risks are too high to expose someone to the flu virus and COVID-19 which likely would increase the severity of both diseases and cause more deaths. The COVID-19 vaccine, once available, should be mandatory.

15. Vitamin D and COVID-19

  Recently there has been talk about the value of taking zinc, Vitamin C and D to prevent COVID-19. There is still no controlled randomized studies to prove these substances can prevent the flu or COVID-19, although many ICU physicians are giving high doses of these substances with little proof they are of value. It can be part of the supported care model.

  What is important is if a person is not consuming a balanced nutritious diet, with fruits and vegetables, nuts, and not getting any sun, there is likelihood that people could be deficient in these substances.

What does Vitamin D’s role?

  Vitamin D is necessary for calcium to be absorbed into bone. It also plays a role in cell growth, neuromuscular, and immune and reduction in inflammation. Genetic encoding uses vitamin D in the process. It is also hypothesized that it may help the immune system not over-respond to viral challenges by regulating cytokines which is the main mechanism by which COVID-19 attacks the body. It also plays a role in reducing inflammation through this mechanism!

  In some people, vitamins are not as well absorbed through the gut, but 20 minutes 3X a week in sun will allow the skin to make adequate amounts of D. For those who live in cold climates, they may develop low levels each winter. People who use large amounts of sun screen will block the sun’s ability for the skin to make vitamin D.

   People who are over 60, postmenopausal women, those with gastrointestinal disorders, and those who have a poor diet will likely have low vitamin D levels.

  Vitamin D is naturally found in many foods including some fish, vegetables, chicken, beef, and eggs.

  Some foods are fortified with vitamin D such as milk, cheese, ice cream, yogurt, orange juice, and cereals.

  600 international units (I/U) for most people per day are recommended, and those over 70 should consume 800 I/U. There is no recommendation for additional Vitamin D to prevent COVID-19. 

NIH website

16. Longer time to isolate after recovery!

  The CDC has extended the time to isolate after recovery. Recovered patients should isolate for at least 10 days, rather than 7 days. From the time of onset of symptoms, a person must wait for 10 days to leave the house. It also must be at least 3 days after all symptoms are gone and no fever (without any fever-reducing meds). This fits with the usual 14 day quarantine if exposed.

  The virus has yet to be cultured past 9 days of an infection, thus the 10 day recommendation.

  Longer periods of isolation may be needed especially if a person has high risk or immunocompromised people in their household, those living in a retirement facility, or working with high risk individuals.

  It has been proven one of the greatest chances of contracting the virus is the home.

17. Vaccine development status

  The vaccine development race is on, and to the “victor goes the spoils”. Chinese hackers are already trying to steal the U.S. research. Students have infiltrated our universities and are all part of the Chinese Communist  Party to bring down our economy.

  Researchers at Columbia Medical Center (Dr. Ian Lufkin, etal.) having developed a vaccine and initially administered it to 45 healthy participants in their clinical trial, and all 45 developed antibodies to COVID-19. The next step will be to vaccinate 1000 participants. If this is successful, the final step for approval will begin. If all goes as expected, the vaccine could be FDA approved by the end of this year.

 This vaccine genetically creates a protein similar to that which the virus produces, which is the pathway into the human cell. The body makes antibodies to this protein which kills the virus and prevents replication. 

  8 research projects have already progressed to clinical trials which must go through 3 phases of human trials before being considered by the FDA. 90% of trials fail.

  There are various types of vaccines using live viruses or attenuated ones, so that it does not infect the human cells, but stimulates neutralizing antibodies, which can kill the virus.

  Vaccines for the common cold coronaviruses only stimulate immunity for a couple of years, and if this happens with this vaccine for COVID-19 does that, boosters will be required every few years, however, after an initial shot and a booster, it is predicted to last for a few years.

  The reason that we have annual flu shots is that those viruses mutate every year, whereas novel coronaviruses (SARS, MERS, etc.) usually do not. In fact, current research validates that concept.

  3 of 8 vaccines that have reached clinical trials are Chinese. If they come in first, will they share as we are rightly attacking them for letting this virus spread over the world to 184 known countries? Reference--arsTechnica

  A recent survey found that 23% of anti-vax advocates would refuse the vaccine. That must be addressed.

  Dr. Anthony Fauci has stated that 50-70% of the country would need to be vaccinated or have had the virus to thwart the spread of the virus. Only 37% of Americans were vaccinated to the influenza in 2017-2018.

This completes the June special report on covid-19. I will update this information when appropriate. However, my next report will include the following subjects:

1. Resistent Depression

2. Pancreatic cancer

3. Health benefits of quitting smoking

4. Weight gain and depression

5. “Its all in your head”—when doctors can’t diagnose a disorder

6. Diagnosing lung disease

Thank you for reading my reports. I pray we will see rapid recovery of our country, but be safe,

 be nice, and stay healthy! Dr. Sam