Covid-19 Vaccines – Should I Get One

Covid-19 Vaccines – Should I Get One

Here we are over a year later and unfortunately, COVID is still a major topic of conversation.  It saddens me for all of us that we still must talk about and worry about this unique virus.  I know we are all sick of it (pun intended 😀 ).  I am sure we all hoped that by this point, it would be behind us, and yet here we stand.  Given that we are in the midst of another “wave” of infections, I thought it was a good time to talk about where we are with the virus and give you my opinion and recommendations on the COVID vaccines that are currently available.

Inconsistent Messaging

I will start with the current surge in cases.  I share your frustration in the ever-changing narrative of which targets we are tracking.  In the beginning we tracked the number of deaths from the virus.  Then we started to focus on hospitalizations.  Now, most sources are looking mainly at cases.  This shifting in information can be confusing, misleading and scary.  It is poor messaging like this that breeds confusion, cynicism and distrust.  I have heard it from many of you and have expressed it myself.  I have tried to stay consistent in my messaging and have therefore stuck with monitoring hospitalizations in our state to gauge not only the incidence of new cases, but the severity of those cases, as reflected by the need for inpatient care.  Georgia has a great website to track this here.  For effect I am including the graph as of today (August 18, 2021): 

You can see the biggest spike was at the beginning of the year in January 2021.  You will also note that we are rapidly heading back to that peak now.  Unfortunately, several of you have been included in this spike of hospitalizations.  I had originally hoped that many of us would be able to fly under the radar by limiting our exposure and being smart and safe when going about the business of daily living.  It has become clear that this is not going to be the case.  I think the unfortunate reality is that we are all going to be exposed to this virus and its spike protein in one way or another, whether through getting ill or getting the vaccine.  I just do not see any way around it.  As this virus continues to mutate and spread it is only a matter of time before you will be exposed to it.  My fear, similar to what many of you have expressed, is that the exposure will lead to severe illness.

Fortunately, recent data has shown that there is a way to limit the severity of illness.  There is so much controversy and fear surrounding this virus and you all know me well enough to know that a lecture about why everyone should get the vaccine, either by choice or by force, is not happening here.  I think such tactics have been highly detrimental to our ability to come together and act freely for ourselves armed with the proper information.  The messaging from our political and medical establishment on the pandemic has been poor from the very beginning.  Throw in the hyper-partisan nature of our politics these days and you have a recipe for the chaos and confusion we have been experiencing this last year and a half.

 

The Take-Away About Vaccines

All that being said, I want to be clear about our stance here at Bianco Primary Care on preventing COVID-19 infection and the use of the current vaccines.  COVID-19 is especially dangerous for those who are obese (as defined by a BMI>30), age 70 or older, have diabetes, hypertension, or other chronic cardiovascular or pulmonary disease.  If you fall into one or more of these categories, you should get a vaccination if you have not already had a true COVID illness.  This will greatly reduce your risk of severe illness, hospitalization, or death.  The numbers on this are abundantly clear at this point.  I know there are breakthrough cases with the vaccine (we have seen lots of them) but the numbers indicate that those cases are much milder than the cases in those without the vaccine.

For the rest of you who do not fall into these categories, your risk of serious illness is much lower but there is still risk.  Given that, you should consider the vaccine to protect yourself to the extent that you can if you have not already had COVID.  I know many of you are skeptical of the vaccine given how new it is and how quickly it was brought to market.  I have shared that skepticism as I do with any new therapeutic in medicine without robust data on safety and efficacy.  We all have our anecdotes about someone who had a bad side effect from the vaccine as well.  The numbers are telling a story now however, and that story is that the vaccines are preventing more serious illness and death and have shown to be safe. I have looked at the data on all three vaccines and do not see any evidence of any significant numbers of side effects, including blood clots, infertility, etc.  With any therapeutic, there will be those who have some side effects.  The question then is do the side effects outweigh the overall benefit.  In this case the current data suggests the benefits of the vaccine outweigh the risks of side effects.

In summary:

  • If you meet any of the following criteria: age greater than 70 years, have obesity, heart disease, lung disease, high blood pressure, or diabetes, and have not already had COVID, you should be vaccinated.
  • If you are considered low-risk are otherwise healthy and have not already had COVID19, we encourage you to strongly consider getting vaccinated to help mitigate your risk of severe illness.

Our desire is always to do everything we can to keep you healthy.  We strive to do that in an open and honest way, giving you the best information we have, and allowing you to make the decisions that you deem to be best for you and your family.  We hope this article helps you in your quest for optimal health and for you to be your best self!!

 A Final Note

 As noted above the best protection against COVID and any other disease is to have healthy nutrition and fitness habits.  This has been lost in the arguments over masks and vaccines and social distancing, but it remains the best thing you can do for your health in the short and long term.  If you have not already started to build better habits, then I urge you to embark immediately.  We have a wonderful resource in our office with our Nutrition and Fitness expert, Kathryn Terry. She is fantastic and takes a personal approach to find the things that fit your lifestyle and family culture that can get you on the right track.  We have even created new membership options that include sessions with Kathryn to make it as easy as possible for you to take advantage of her expertise.  I encourage you to call the office (678-254-2333) or use our contact us form to set up a complimentary “meet the nutritionist” appointment.

Now is the time to have a health plan with an affordable Primary Care Doctor who knows you and you can reach when you need them.  In-office, text, phone, email – No insurance required.

Should I Exercise with Covid?

Should I Exercise with Covid?

It is hard to believe that we have suffered through an entire year of this COVID-19 pandemic, yet here we are.  Things are improving of course as numbers are down and continue to decline.  The good news about hitting the year mark is that we now know a lot more about the virus and its impacts on health and who is most susceptible to more severe illness.

We have had several questions surrounding COVID-19 and physical activity so I thought this would be a good way to address this issue.  I would like to divide our topic today into 2 categories: 1) Fitness and exercise prior to COVID infection and 2) Exercise after having COVID infection.

Will Exercise Help Prevent COVID-19?

Let’s start with physical fitness and its effects on health, in particular as it relates to COVID-19 infection.  It turns out that the more physically fit and active you are prior to contracting COVID, the less likely you are to suffer from more severe disease or require hospitalization.  I think we could argue that this just makes sense as we know this about fitness and any disease but nevertheless, there is some data that now confirms this.  Here is one example:

“ Although the clinical course of COVID-19 illness varies among athletes, (just as it does among non-athletes), on average, physical fitness appears to mitigate the severity of COVID-19 illness. As an example, in a retrospective study of 246 patients (59±12 years, 42 percent male, 75 percent Black) diagnosed with severe acute respiratory syndrome secondary to COVID-19 illness, hospitalization was found to be inversely related to aerobic fitness [4]. Baseline fitness in peak metabolic equivalents, based on exercise stress testing results obtained within the prior four years, were significantly lower among patients who were hospitalized (6.7±2.8) compared with those not hospitalized (8±2.4) (unadjusted odds ratio [OR] 0.83; 95% CI 0.74-0.92; OR adjusted for major risk factors 0.87; 95% CI 0.76-0.99).”  Source : UpToDate.com 

The practical application here is that if you have not had COVID and are looking for things that you can do to mitigate your risk, look no further than an exercise regimen.  Things are more complicated with the pandemic and less access to gyms but that does not mean we should be sedentary. 

Spring is here with warmer temperatures and more sunshine so getting outside should be a given for all of us.  Walking or jogging daily will improve your fitness and well-being.  I will throw in that it will also increase your Vitamin D levels which have also been shown to be inversely related to COVID-19 severity. 

You should also mix in some weight training regularly which you can do at home with little to no equipment or at your local gym. If you need some guidance with that please consult a nutrition and fitness expert.

Should I Exercise with COVID-19?

Turning our attention to exercise after COVID-19 infection I will try to answer the questions of when and how much.  This advice, like that above, is also pretty intuitive.  The research we have points to being able to return to exercise after a week of recovery from symptoms. You want to give your body the time to heal before doing anything too intense or strenuous.

That being said if your symptoms are mild you can certainly get outside and go for a short walk.  Once you have given your body time to rest and recover you should ease yourself back into a routine.  You should expect that you will not be able to go back 100% right away and this is normal and natural and not a cause for concern.

“A concern among recreational and elite athletes during the COVID-19 pandemic is the impact of detraining. Several studies report that community lockdowns to prevent viral spread have had adverse effects on physical fitness. As an example, a retrospective study of Spanish students enrolled in 16 universities, and involving a total of 13,754 valid survey responses, described reduced moderate (-29.5 percent) and vigorous (-18.3 percent) physical activity during confinement and increased sedentary time (+52.7 percent) [9]. Multiple small, observational cohort studies report comparable declines in fitness among adolescents [10-13]. A small case-control study of children reported a substantial decline in the mean maximum oxygen uptake in a post-COVID-19 cohort compared with pre-pandemic controls (39.1 versus 44.7) [10]. Detraining is an important consideration for clinicians to address when providing guidance about return to play [14].”  Source: UpToDate.com 

Listen to your body and try to find that balance of pushing hard enough to produce results without pushing too hard to produce injury.  If you are having chest pain or severe shortness of breath you should stop and seek a medical evaluation.  For the majority of you, I expect you to be back to your pre-COVID workouts within a few weeks of recovery.

I hope this helps clarify any questions you may have about COVID and exercise.  As always, if you want to learn more or be evaluated for your personal and individual situation reach out to us for an appointment.

If you are looking for more specific guidance on healthy habits, nutrition or a training regimen let us know and Kathryn Terry, Bianco Primary Care’s  Director of  Nutrition and Fitness will be happy to help you achieve your health and fitness goals.

Now is the time to have a health plan with an affordable Primary Care Doctor who knows you and you can reach when you need them.  In-office, text, phone, email – No insurance required.

Am I “High Risk” For A Sever Case of COVID-19?

Am I “High Risk” For A Sever Case of COVID-19?

Those individuals that are at higher risk for worsened symptoms, complications or death are those that are age greater than 60 years, those with obesity, high inflammatory markers (CRP or ESR), heart disease, lung disease (including smokers), diabetes and high blood pressure. If you are in one of these groups then you should be extra careful.

What extra precautions should “High Risk” people take?

Be extra vigilant about washing your hands frequently when you are out in public, wear a mask if you will be indoors and unable to social distance, and avoid gatherings of more than ten people. From a long-term perspective, I must mention that those risk factors (outside of age) are usually reversible with lifestyle changes.

If you have one of the reversible conditions, let this be a wake-up call to the seriousness of not taking care of yourself properly. Do not continue to procrastinate making a change to improve your health. Now is the time!! 

If you would Like to learn more about the spread of COVID-19 and steps to avoid it, please read out article, “How Deadly is COVID-19 And How To Avoid Getting It”.

Are there medications I can take to Lessen the symptoms if I get COVID-19?

We do not have a specific treatment for COVID-19 but there are things we can do to help with symptom management and disease progression.  An option for the short term is the MMR vaccine. Yes, the vaccine for measles, mumps, and rubella could help to lessen the symptoms of COVID-19. Getting a vaccine activates two parts of our immune system.

One part of the immune response creates long-term specific immunity to the specific disease we are being vaccinated against (i.e. if we are ever exposed to Measles, our body will be prepared to fight it off with previously created antibodies).

The second immune response, however, is not specific but creates a generalized surge in our immune function that can be used to help stave off the inflammatory response to foreign invaders in our bodies.  It is this second part that stands to help fight against COVID by reducing the inflammatory response, which we have seen to be the issue in severe cases.

COVID produces a major inflammatory response in susceptible individuals, leading to severe complications and potentially death.  Here is some information on this cutting edge research: https://asm.org/Press-Releases/2020/MMR-Vaccine-Could-Protect-Against-the-Worst-Symptom. If you fall into the high-risk category, we can write you an order to get the vaccine at your pharmacy.

What About Hydroxychloroquine? 

While we do not have a specific treatment for COVID-19, there are things we can do to help with symptom management and disease progression.

For those of you in the high-risk category, I think there is compelling evidence that a combination of Hydroxychloroquine + Azithromycin + Zinc if started within 4-5 days of symptoms will lower your risk of death or debility.

We have created a protocol, so if you get sick let us know right away and we will get you tested and get you started, if appropriate.

A final word on this: this combination is not preventative and can be dangerous so please do not ask for or take these medicines unless you have confirmed COVID-19 infection and are in a high-risk category.

 

 

 

Now is the time to have an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.

How Deadly is COVID-19 And How To Avoid Getting It

How Deadly is COVID-19 And How To Avoid Getting It

The good news here is that the virus is not very deadly from an epidemiological standpoint. The overall death rate (including asymptomatic patients) is certainly less than 1%. That means if you get this virus you have greater than 99% chance of surviving!! I will take those odds😀. A word of caution: that is an average rate and those in certain “high risk” groups have higher rates. The high-risk groups include age over 60, those with obesity, diabetes, high blood pressure, heart disease, lung disease and high inflammatory markers (CRP or sed rate). In those cases, the rate is around 1.4%.   

The best news is that COVID-19 is rarely affecting our children and even more rarely do they get severe illness or death and many times less frequently than with the flu.  Recent studies have also shown that children are not spreading the virus from themselves to adults.

For most healthy individuals, if infected, you can expect 3-5 days of feeling miserable (flu-like symptoms) followed by recovery.  Certainly, those who are at high-risk could develop more severe symptoms, require hospitalization and have post-infection complications or even death.  Know where you fall in the risk continuum and take the appropriate precautions.

If you want to know if you are high risk and what extra precautions you can take, please read our article ” Am I high risk for sever case of COVID-19″

Of course the best course of action is to avoid getting infected with COVID-19. Here I address the four primary questions patients ask in that regard.

1) Do masks stop the spread?

The answer here is it all depends. If used properly and it is a quality mask, it can offer some protection for the wearer. There is a lot of discussion on this in the media and governments as well as businesses are requiring masks to be worn. A mask can help but is far from the 100% shield people have thought. For more details including studies addressing the effectiveness of masks, please read our article “Do Masks Stop The Spread of COVID-19”.

2) Can an asymptomatic person spread the virus?

While there is not yet a definitive answer from current research, it seems asymptomatic people do not spread the virus. There is evidence that a pre-symptomatic individual does probably have enough virus replication to “pass it on” but less so than someone with overt symptoms.

A pre-symptomatic individual would be someone who is infected with the virus, but 1-2 days before symptoms appear.  To be infected by such individuals it would require close and extended contact.  I know it sounds like what I said is just semantics but there is a real difference between asymptomatic (been exposed and develop antibodies but never have symptoms at all) and pre-symptomatic (the 1-2 day period before you start having symptoms).

We know that with all infections, the more virus in your body the more contagious you are. The more virus you have the more symptoms you have as well. If you do not have symptoms then that means you have a low viral load (your body is fighting the virus effectively enough to keep its population low).

Because we have no way to tell the difference between asymptomatic, pre-symptomatic and healthy individuals, the best practice is to avoid close and extended contact with others outside your home.  Wash your hands frequently and avoid touching your face or eyes.  If you are in the high-risk group, wear a mask if you are unable to social distance.

3) Does the virus live on surfaces?

Viruses do not normally live on a surface long enough to be a vector for spread and this coronavirus does not seem to be any different. While technically you may be able to find some virus on a surface in the lab for many days, it is not clinically relevant as it weakens quickly and is therefore not potent enough to cause illness.

In college, we tested this theory in the lab and I so vividly remember this experiment. Our whole class of 20 or so students put a glove on and then formed a line to each take a turn touching the doorknob to the classroom that our professor had expertly coated with germs!! We then took our gloves back to our station and ran a culture of what was on the glove. The first 20 students who touched the doorknob found germs on their gloves. However, the amount of germs on the first glove was vastly more than on the 20th glove.

So while technically the germs were on all gloves, practically only the first few gloves carried enough of them to get someone else sick.  The longer the time period between contamination of the door to the transmission to the glove, the less likely transmission and infection would occur, as the virus is unable to live long outside the body. This is why frequent hand-washing or sanitizing is so important, you never know where you are in the line—number 1 or number 20!

In short, in order to get the virus from a surface someone would have had to very recently coughed or sneezed and then touched that surface (gas pump, shopping cart, door handle, etc) and then you have to come along shortly behind them, touch the surface, and then touch your mouth or nose or eyes. This reaffirms the need to keep your hands clean and don’t touch your face while in public spaces.

4) Do gloves help or should I just wash my hands?

I do not think gloves help at all and are far inferior to a good hand washing or use of sanitizer. Gloves will pick up the virus the same as your bare hands but since you can’t wash gloves they are the perfect way to get yourself sick if you don’t change them constantly.

You are much better off just being diligent in washing your hands frequently or bringing hand sanitizer with you and using it after leaving stores or pumping gas, as examples.  If you do decide to wear gloves, remove them before touching any other surface (your car door, steering wheel, car keys, cell phone, purse) and sanitize your hands.  If you do not remove, dispose then sanitize prior to touching something else, then you have just contaminated your personal property and negated any benefit you might have received from the gloves.

 

Of course isolation is the safest way to avoid contracting the coronavirus, but that is simply not very possible in the world we live. With the information provided here, you should be able to live a fairly normal life and avoid getting Covid-19.  

 

Is it time for an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.

Do Masks Work To Stop The Spread of COVID-19?

Do Masks Work To Stop The Spread of COVID-19?

How effective masks are against COVID-19? This question seems to be a major topic these days with a lot of “experts” touting the effectiveness of masks and most major stores now requiring their use. The answer to me is “it depends”.

The “evidence” in favor of mask-wearing is not direct and has mostly been taken from computer models (which have been mostly wrong since the beginning of this pandemic). In medicine, we make treatment decisions, use new medications, approve new devices, etc. only after we have evidence in the form of the gold standard Randomized Controlled Trials (RCTs). The only one to date on masks was done in 2015 and is linked here: https://bmjopen.bmj.com/content/5/4/e006577.

In summary, this trial compared medical masks to cloth masks in healthcare workers. It was a “good study” in that it used more than 1600 subjects in a variety of healthcare settings. The conclusion, as you can see from reading the study, is that cloth masks are problematic to say the least and even medical masks were not near perfect. The study found that masks, even medical-grade masks, are not effective at blocking the virus from the wearer.

The coronavirus is less than 0.125 microns in size. For reference, 1 micron is one-millionth of a meter or 1/25,000 of an inch.  A cross-section of a single strand of human hair is 50 microns and the human eye can only discern to about 40 microns.  Masks (including N95 respirator masks) are only able to filter out 0.30 micron particles.  So, rather than being like a brick wall, most masks are more like a colander or sieve.  Some particles will get filtered, but many will pass right through.

I also want to address the trend I am seeing and that is to talk about wearing a mask to protect others. I understand this is said on TV and the internet frequently, but it simply defies logic and is not true. Masks provide protection to the wearer, hence the term PPE, which stands for Personal Protective Equipment. Dr. Shelley and I have practiced extensively in hospital settings and taken care of highly contagious patients with infections that are spread by droplets and the only people in these settings that wear PPE are the healthcare workers and the caregivers, never the patients. If a mask protected others then we would have been employing that in the hospitals but we do not and never have. Multiple studies show that droplets are not contained by masks.

In addition, most people do not wear their masks properly and leave their nose or mouth partially exposed. Also, many people are re-wearing their masks.  To control the spread of germs, the mask and gloves are meant to be a temporary barrier that are disposed of after use.  If you are wearing a mask and gloves to prevent the virus from getting into your body, then presumably that virus is located on the exterior surfaces of the mask and gloves after a single-use. 

If you remove the mask and store it in your purse or car, you have now contaminated your hands and any other surface that mask has come into contact with.  If you go on to reuse that mask, you again are touching a contaminated surface and run the risk of transmitting those germs to yourself or others.  We have seen many people leave the store, remove their mask and shove it into their purse, thus contaminating the entire contents of their purse which they will later touch while not wearing gloves. 

We have also seen people wearing gloves, leave the store and get into the car without removing their gloves.  Now the door handle, steering wheel and anything else touched with gloved hands are contaminated.

 

BOTTOMLINE: Masks provide some protection for the wearer of the mask.  If you are in the high-risk group for contracting COVID19 or for complications from COVID19, then you should wear a mask anytime you will be indoors, around more than 10 people and cannot stay 6 feet or more apart from others. 

 

Just remember, not all masks are created equal and most cloth masks are not very effective filters.  If you choose to wear a mask, do not re-use masks without sanitizing them first.  After removing your mask and BEFORE touching anything else, sanitize your hands.  For healthy, low-risk individuals keeping your distance, avoiding large crowds and frequent hand washing are all great ways to keep you safe from infection.

 

Now is the time to have a health plan with an affordable Primary Care Doctor who knows you and you can reach when you need them.  In-office, text, phone, email – No insurance required.

What are IgG antibodies? How does this Covid-19 antibody test work?

What are IgG antibodies? How does this Covid-19 antibody test work?

When our bodies see a foreign invader (coronavirus in this case), our immune system mounts an acute/immediate reaction through IgM antibodies to eradicate the problem. Once the infection is gone the IgM antibodies are no longer produced and do not linger in the blood.

The body does, however, produce memory cells in the form of IgG antibodies. These memory cells are found in your blood as soon as 7-10 days after an infection. They patrol your blood and have only one job: look for that specific infection (Covid19 in this case) in the blood and if found, facilitate a much quicker response to the known invader so that the invader is not able to gain footing and cause infection.

These IgG antibodies are specific to each infection encountered or each strain of virus, as in this case. Many viruses mutate or change frequently and therefore have different strains each new season which makes fighting them tough because our bodies do not have specific antibodies to these newer, mutated strains (think common cold which is also a coronavirus or the seasonal influenza virus).

This antibody test detects the presence of Covid19 IgG antibodies in your bloodstream.  The antibody test requires a simple blood draw.

The antibody test is a new test, is it reliable?  If I test positive, does it guarantee I will not get infected with Covid19 in the future?

  • Medical research on this virus has not explained enough about what having these antibodies means as far as immunity goes. There is already evidence that Covid19 has mutated and has different strains so having detectable antibodies does not necessarily mean you are immune to the virus. 
  • Several community based epidemiological studies have been done (more coming including one being done currently in Fulton and Dekalb counties) and have given us some good preliminary information. This data shows that up to 50 times more people have been exposed to Covid19 than are reflected in the data we have had previously. This means the death rate will hopefully be much lower and closer to the same as the flu. The bad news is that those same studies show that only 3% to 4% of us have been exposed at this point. That means if we tested our entire practice only around 15-20 of them will have antibodies. 

 

Bottom line:  Knowing you have antibodies does not necessarily mean you cannot get re-infected with the virus.  We worry that the knowledge of having antibodies will create a false sense of security. Information about this virus and it’s testing is too preliminary to make the conclusion of immunity based upon positive antibody testing.  Regardless of test results, we strongly encourage you to continue with social distancing and frequent hand-washing.

Is it time for an affordable Primary Care Doctor who knows you and you can reach when you need them? In-office, text, phone, email – No insurance required.