Covid-19 Variants

The Covid-19 pandemic continues to dominate the news, with most of the discussion revolving around the new vaccines and their distribution to those most at risk.  

The newest concern is the development of multiple variants of the Covid-19 virus.  Viruses constantly change through mutation, in which the virus’s genetic structure is randomly altered over time.  Some of these mutations may lead to alterations in the virus’s surface proteins, or antigens.  Our immune system is trained to recognize these antigens, so when the antigens change this can make vaccines, and our immune system, work less well in fighting them.  This can make the viruses more infectious and lethal.  

The three main variants currently circulating in the United States, all of which seem to spread more easily and quickly among people than does the original virus, include:

1. B.1.1.7, a variant first identified in the United Kingdom. This variant has 23 mutations, several of which affect the spike-like protein that the virus uses to attach itself to the surface of human cells. There may be an increased risk of death compared with other variants.

2. B.1.351, identified in South Africa, does not cause more severe disease that other variants.

3. P1, identified in Brazil, has 17 mutations. This variant may be less vulnerable to antibodies generated by previous Covid-19 infection or a Covid-19 vaccine.

Thus far the Moderna and Pfizer vaccines seem to be working against these new variants.  However, Moderna is already working on a booster shot designed to address the possibility that the existing vaccine is not effective enough against the new variants.

The Centers for Disease Control and other scientific bodies are working to more fully understand if the variants:

• Spread more easily from person-to person, as it seems they are doing.

• Cause milder or more severe disease.

• Are detected by currently available viral tests.

• Respond to the medicines currently being used to treat people for Covid-19.

• Change the effectiveness of Covid-19 vaccines.

What’s the good news?  Most vaccines actually cause a much stronger immune reaction than a natural infection with a virus.  And in clinical trials, Moderna found that the antibodies produced after vaccination may last longer than those naturally  produced after Covid-19 infection.

The bottom line: When you get a chance to receive a Covid-19 vaccine, take it, whether or not you have been infected with Covid-19.  But if you have been infected, you should wait 30 days after recovery before you are vaccinated. 

https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-variant/faq-20505779

https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html

What to Do Once You’ve Been Vaccinated

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As the date of your vaccination approaches, you need to be more careful and vigilant than ever.  Covid-19 is a respiratory virus carried in the air that is easily transmissible when we are around other people.  That’s why we need to practice the 3 W’s—Watch our distance, Wash our hands and Wear a mask.   And we should continue to avoid gatherings of more than 10 people even when the 3 W’s are employed.

Each of us are exposed every time we encounter another person, even if we stay entirely at home and a caregiver or family member who lives with us goes to the store, work, & etc.  Those outside contacts can lead to spread in the home, no matter how careful the “at home” persons are.  Some of my “at home” patients have still contracted Covid-19.  

The two available vaccines, Pfizer and Moderna, are equally effective and are both unlikely to cause significant side effects.  Everyone receiving vaccines must wait a minimum of 15 minutes afterwards in order to be monitored for any problems.  Immunity begins to develop within one week after your first immunization and reaches about 50% after three weeks.  Two weeks after your second shot immunity should reach 95%.

Once you have been fully vaccinated*, about two weeks after your second dose of vaccines, your life shouldn’t change very much.  At first, most other people will have not yet been vaccinated, and while the vaccines are 95% effective, 1 in 20 vaccinated persons can still contract the disease.  With nearly 25% test positivity in Oklahoma, there is still considerable risk of acquiring Covid-19, even for the fully vaccinated, so even the vaccinated need to remain careful.

However, it will be safer for you to go to the grocery or hardware store, the post office and other stores where social distancing is practiced and people are wearing masks.  Small group activities in which you know that all the participants have been vaccinated will clearly be safer.  But being in large groups and traveling will remain risky until the US population reaches herd immunity, which will require at least half of the population to be immunized and much of the rest to have recovered from the disease.

Once herd immunity is reached, it will be much safer to do such things as eat in a restaurant, ride a bus, attend religious services and attend parties, weddings and funerals.  Families will be able to gather in ways that were impossible in 2020.  But it is unknown how soon we will attain herd immunity. Until that time, I will continue practice the 3 W’s.  

*People such as health care and other frontline workers who work in high-risk-of-exposure occupations can significantly decrease their risk if immunized.  This is why these workers are among the first Americans to be offered the vaccine.

Multiple Sclerosis: What You Need to Know

Multiple sclerosis (MS) is a disease in which the immune system mounts a response against the central nervous system (CNS).  The resulting inflammation damages the myelin—the cholesterol-rich insulation that both surrounds nerves and forms the brain’s white matter-- the nerve fibers, and the cells that make myelin.  Once this damage occurs, nerve messages within the CNS are altered or stopped completely.  The damaged areas develop the multiple areas of scar tissue, or sclerosis, that give MS its name and that impair nervous system function.

A recent study funded by the National MS Society has confirmed that nearly one million people are living with MS in the United States, more than twice the original estimate from a previous study.  

Common symptoms of MS include fatigue, gait disturbance, spasticity, numbness or tingling, weakness, vision problems, dizziness and vertigo, bladder and bowel problems, cognitive changes and depression.  These nonspecific symptoms can often be confused with many other illnesses, making the diagnosis difficult.*

Criteria for the diagnosis of MS include:

1. Evidence of damage in at least two separate areas of the CNS AND

2. Evidence that the damage occurred at different points in time AND

3. That all other possible causes are ruled out.

The 2017 McDonald Criteria,  which doctors use to help to definitively diagnose MS patients, include specific guidelines for using MRI and cerebrospinal fluid to speed the diagnostic process.  Blood tests can rule out other conditions that resemble MS, including lupus, Sjogren’s, Lyme disease, syphilis, HIV, vasculitis, sarcoidosis as well as some hereditary diseases.

As CNS sclerosis progresses, one of four disease courses becomes manifest:

1. Clinically isolated syndrome (CIS)—A first episode of neurologic symptoms that must last at least 24 hours and is characteristic of MS but does not yet meet diagnostic criteria. People who experience CIS may or may not develop MS.

2. Relapsing-remitting MS (RRMS), the most common disease course, is characterized by clearly-defined attacks of new or increasing neurologic symptoms. These attacks, known variously as relapses, exacerbations and bouts, are followed by periods of partial or complete recovery (remissions). During remissions of RRMS, patient’s symptoms may disappear or some symptoms may become permanent. There is no apparent disease progression during remissions.

3. Secondary progressive MS (SPMS) follows an initial relapsing-remitting course followed by a transition to a progressive course in which neurologic steadily worsens over time.

4. Primary progressive MS (PPMS) patients experience worsening of neurologic function from the onset of symptoms without early relapses or remissions.

While the first documented case of MS was described in 1421, it was not until 1969 that the steroid compound ACTH became the first drug shown to speed recovery from MS relapses.  In 1993, Betaseron was the first drug approved by the FDA that affected the underlying MS disease process.

Today, 22 drugs are effective in modifying the disease course of MS, and almost all of them are helpful in treating CIS, RRMS and SPMS.  Patients whose MS is controlled by one of these drugs will likely continue it indefinitely.  Only one medication—Ocrevus—has been approved by the  FDA for the treatment of PPMS.

These disease-modifying therapies (DMT) primarily work by reducing inflammation and do not work as well in disease that is characterized by nerve degeneration.  Thus, DMT drugs have not been shown to be helpful in treating most progressive forms of MS.

MS patients typically are under the care of a neurologist, but many common issues can and often are managed by their family physician.  

Oklahoma patients and physicians have in the Oklahoma Medical Research Foundation a tremendous resource for helping to treat patients with MS.  Dr. Gabriel Pardo leads the Oklahoma City-based MS Center of Excellence, which focuses on providing optimal medical care while advancing the understanding of MS through participation in multiple research protocols. 

The National Multiple Sclerosis Society (NMSS) supports MS research worldwide, including that performed at OMRF.  The Society also provides direct help to people living with MS through the MS Navigator program.  MS navigators are highly skilled and compassionate professionals who connect MS patients and families to the information, resources and support they need to move their lives forward.   The program’s benefits include providing information and education about MS, connecting those living with MS to emotional and support resources including support groups, helping MS patients understand the healthcare system, and offering wellness strategies and crisis intervention.  

Thanks to decades of research into MS a critical platform of knowledge has become a springboard for progress.  For example:

• Researchers are learning how the body’s gut microbiome may influence MS severity. The microbiome is the normal combination of bacteria, yeasts, viruses and protozoa that reside in our gut and that help us to digest food.

• Early human trials are investigating how to repair myelin.

• Lifestyle factors that people can change—such as smoking, childhood obesity and vitamin D levels—have been identified that may reduce the risk of the next generation developing MS.

For more information about MS history, research, therapies, education and more, go to www.nationalmssociety.org.

*You rarely see MS  patients during a relapse because they stay at home.  In the past there was a stigma attached to MS, since it would be easy to think that MS patients instead were intoxicated by alcohol or other drugs.

What to Do While You Await a COVID-19 Test Result

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From the OKLAHOMA State Department of Health

Released December 16, 2020

What was the reason for COVID testing?

1. If you have symptoms consistent with COVID:

• Stay home and away from others while you wait for your test results.

2. If you have been exposed to someone with COVID but are not having symptoms:

• You should stay home for 14 days from date of last contact with the COVID patient, if possible. If you remain free of symptoms through day 10, your quarantine can end on day 11, but you should continue to monitor

for symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. If you are tested on day 5 after last date of exposure or later, you can end quarantine after day 7 and once you have received a negative test result. You should continue to monitor symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure.

3. If you were tested for surveillance purposes, with no known exposure to COVID, and are not having symptoms:

• If you were tested for an upcoming surgery, flight, travel, or another reason and you do not have a known exposure or symptoms, you do not have to stay home while awaiting results.

If your test is POSITIVE:

• This means you currently have COVID-19. If you have a previous positive COVID test, speak to your healthcare

provider about whether this is the same infection or a new infection. If it's more than 90 days since your last positive test, follow the instructions called "What to do if you test positive or are diagnosed with COVID-19 and

isolate yourself because reinfection with COVID can happen.

• Follow the instructions called "What to do if you test positive or are diagnosed with COVID-19."

• You should notify everyone you were in close contact with during the 2 days before your symptom onset or test date (whichever is earlier) through to the date you are notified of your test result. Close contacts include, but are not limited to: household members and people within 6ft of you for 15 minutes or more. If during that time period, you worked at, or spent time in, a high-risk setting, please notify the facility of your positive test result immediately. Examples of high-risk settings include childcare, school/college setting, healthcare, correctional facility, homeless shelter, long-term care facility, or residential care facility. Work with them to provide a list of your close contacts.

• All close contacts should follow a 14-day quarantine period from their last date of exposure, if possible. There are two alternatives to the 14-day quarantine period. If the person remains free of symptoms through day 10, their quarantine can end on day 11, but they should continue to monitor for symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. If close contacts receive a negative test result from a sampling on day 5 or later after their last date of exposure, then they can end quarantine after day 7. They should continue to monitor symptoms, practice social distancing, and wear a face covering when around others through at least 14 days after last exposure. Unless you completely stay away from your household members during the 10 days you are infectious, their quarantine period does not start until the end of your isolation {10 days after symptom onset or positive test, whichever is earlier). That means household members could be in quarantine longer than one of the quarantine options listed above.

If your test is NEGATIVE:

• This means you do not currently have COVID-19. However, you could still be exposed or become sick at any time.You should continue to take steps to protect yourself and others from COVID-19.

• If you develop symptoms of COVID-19 or your symptoms worsen, talk to your doctor or other health care

provider about getting tested again.

• If you were tested on day 5 or later from your last day of exposure so you could end quarantine early, you should stay at home until after day 7 from your last date of exposure.

Additional information can be found at Oklahoma State Department of Health COVID-19 Website

https:coronavirus.health.ok.gov/ OR cal! the Oklahoma Helpline 2-1-1 (available 24/7).

Covid-19 and the Heart

As Covid-19 continues to spread (over 200,00 new cases in the USA each day for the past two weeks) , evidence has mounted that active Covid-19 patients and survivors can experience some types of heart damage.   Heart effects are more likely among men, older persons, and people with diabetes, high blood pressure, known prior heart disease and obesity.   

A recent study of over 44,000 patients with Covid-19 showed that patients with a history of cardiovascular disease were 5 times more likely to die of the virus than patients without this history.  Frequent cardiovascular complications include heart attacks, myocarditis (acute inflammation of the heart muscle), acute heart failure (decreased ability of the heart to pump blood), failure to maintain adequate blood pressure, changes in heart rhythm, and blood clots in veins.   

New evidence suggests that some patients who are not hospitalized and who have not been diagnosed with cardiovascular complications while they were ill may seem to recover from Covid-19 and yet be left with cardiovascular damage and complications.  A recent JAMA study of mostly non-hospitalized patients revealed that 78 percent of patients who recovered from Covid-19 had abnormalities in their hearts and that 60 percent showed signs of ongoing heart inflammation.  

It’s hard to know who’s at risk or how to screen those patients who are recovering from Covid-19 for possible cardiac risks, but if these patients experience increasing or extreme shortness of breath, chest pain, swelling of the ankles, heart palpitations (irregular beats), not being able to lie flat due to shortness of breath, waking up at night short of breath, or unexplained dizziness and lightheadedness they should consult their doctor right away.

Even if there is heart damage related to Covid-19, patients with myocarditis due to other viral infections have recovered without any permanent effects.  Studies are ongoing to determine the best treatments and preventive strategies for heart disease.  Many of these patients already receive dexamethasone (a corticosteroid medication) to reduce inflammation and blood thinners to prevent blood clots from forming.  Because of these and other treatments, the mortality rates from Covid-19 infections are falling.

It has only been a year since Covid-19 was first reported.  Much has been learned and treatments have improved, but we have a long way to go to learn all of the answers.  

Check this link for more information:

https://www.heart.org/en/news/2020/09/03/what-covid-19-is-doing-to-the-heart-even-after-recovery

Simple Tips for a Healthy Holiday Season

By Janet Tiberian, MA, MPH, CHES via MDVIP Living Well Blog

Your holiday lifestyle is probably different than your usual routine. Maybe you consume more calories—a lot more if you’re like most people. Or maybe you stress over juggling social, work and family commitments. Or maybe the shopping, decorating and gift wrapping is enough to push you over the edge. Holiday stress can turn the “most wonderful” time of the year into the “least healthful.”

But you can help minimize weight gain and lower your chances of getting sick by following these tips:

PREVENT HOLIDAY WEIGHT GAIN

Americans gain between one and two pounds during the holidays. While that doesn’t sound like much, the real problem is that most people only shed half the weight they gain. If you’re doing the math—that’s a weight gain of 5 to 10 pounds over five years.

Here are some helpful hints to keep those pounds off:

• Keep your appetite under control while attending parties. Eat a light snack before arriving and drink plenty of water during an event. It'll help keep your appetite in check and portions under control.

• Be mindful of cocktail snacks. Keep track of the hors d’oeuvres and handfuls of nuts you eat. Mindless noshing equals extra calories.

• Be buffet savvy. Choosing fresh fruits and vegetables while skipping dishes with sauces, dressings, dips and marinades can help curb your fat intake.

• Be strategic about desserts. Fruit salad is nearly always the best choice if you’re watching calories. But if you want to indulge in your favorite dessert, choose a smaller portion. This will help you control calories without feeling deprived.

• Watch what you drink. Pouring a glass of club soda or sparkling water instead of an adult beverage or egg nog can help save hundreds of calories.

• Stay physically active. If holiday activities interfere with your regular exercise routine, click here to learn how to turn your holiday shopping trip into a workout.

KEEP YOUR IMMUNE SYSTEM STRONG

A number of holiday season variables can weaken your immune system, raising your risk of catching a cold or the flu. The following tips to help you strengthen your immune system:

• Drink plenty of fluids, particularly water.

• Eat plenty of vegetables and fruit. Add holiday superfoods to your holiday dinner menu.

• Get plenty of sleep, between seven and eight hours each night.

• Wash your hands regularly.

• Manage your holiday stress.

Add Health Related Items to Your Holiday Wish List

You can continue the healthy holiday spirit all year long by asking for health and wellness related gifts. Try these ideas:

• If you like to cook, ask for gadgets that can you prepare healthy homemade meals.

• If you struggle to fall asleep, ask for a sound therapy machine.

• Want to eat more plant-based foods? Ask for a membership to a fruit or vegetable of the month club.

• If you want to exercise more, ask for gift cards to fitness classes.

• Have limited strength and/or mobility? Ask for jar openers or grabbers or other tools that can help around the house.