“Follow the Science” -- The Scientific Method

Laughlin Content (3).png

During the past two years, we have heard many and sometimes seemingly-conflicting announcements regarding the Covid-19 virus.  First was news about the virus itself, then we learned of ways to help prevent the spread of  the virus and avoid infection; next came news about treatments for Covid-19, and, more recently news of Covid -19 variants, vaccines and boosters.  The information contained in these reports has not been consistent.

Many people have been confused by the varying recommendations from the Centers for Disease Control (CDC) and other experts, noting that these recommendations seem to change over time.  This confusion has understandably led to different responses to covid guidelines and often opposition to them.  It’s important, therefore, to consider how the experts in infectious disease and pandemics have developed their recommendations.

The scientific method helps these experts develop relevant and meaningful conclusions that can be the basis for guidelines and recommendations.  This is a process for experimentation that is used to explore observations and answer questions.  Using this method, a researcher develops a hypothesis—a tentative assumption—and then tests it through various means, modifying the hypothesis on the basis of tests and experiments.  The modified hypothesis is then retested, further modified, and tested again until it becomes consistent with observed phenomena and testing outcomes.  (Illustration of Scientific Method)

As each modification in a study provides evolving results that experts use to reach new conclusions, it’s easy to see how CDC guidelines change over time.  So the CDC has not been flip-flopping as new suggestions emerge, as has been reported in many media outlets.  Instead, the CDC remains open to new research and results and adjusts its guidelines accordingly.  We can expect Covid recommendations to continue to change, but each change will reflect the latest validated science.  This is how progress can be made in our struggle to control the Covid pandemic.

Covid Vaccine Boosters for Immunocompromised People

Laughlin Content (2).png

The Centers for Disease Control and Prevention (CDC) now recommends that people who are moderately to severely immunocompromised (those whose immune systems do not help to fight off diseases as well as most people) should have an additional dose of Covid-19 vaccine if they have previously received either the Pfizer or Moderna vaccines.  

Immunocompromised people don’t predictably build the same level of immunity after vaccination as non-immunocompromised people do.  By receiving a third dose of the vaccine, the immunocompromised should develop a higher level of immunity from Covid-19 infection (including from the highly contagious Delta Variant) and should be less likely become infected and to transmit the virus to household contacts.   

The booster shot should be given at least 28 days after the second dose of Pfizer or Moderna vaccines and should be the same type as initially administered.  Those who have received the Johnson and Johnson vaccine, which was approved later than the other two, need to wait for further guidance from the CDC.

Who needs the booster shot now?  The list includes people who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood.

  • Received an organ transplant and are taking medicine to suppress the immune system.

  • Received a stem cell transplant within the past two years or are taking medicine to suppress the immune system.

  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome or Wiskott-Aldrich syndrome).

  • Advanced or untreated HIV infection.

  • Active treatment with high-dose corticosteroids or other drugs that may suppress the immune system.

People should talk with their healthcare provider about their medical condition, and whether getting an additional dose now is appropriate for them.

Covid-19 Vaccine Booster Shots

Laughlin Content (2).png

The Centers for Disease Control and Prevention (CDC) has issued new guidelines for covid-19 vaccines for those adults at typical risk of infection.  Americans will be eligible to receive a Covid -19 booster starting 8 months after they received their second dose of the Pfizer or Moderna vaccine.  The goal is to begin booster shots for those who were among the first to receive Covid-19 vaccination, including healthcare providers, residents of long-term care facilities, and other older adults.    

The Covid-19 vaccines continue to work very well to prevent severe illness, hospitalization, and death, even against the widely circulating Delta variant.  Booster shots are now recommended because public health experts are starting to see reduced protection against mild and moderate disease.  The booster shots should help vaccinated people maintain protection in the coming months.

When should you get the booster shot?  Most Americans still have a high degree of protection from the worst outcomes of Covid-19, and there are no data that suggest that you benefit from having the additional dose of vaccine before your immunity levels begin to drop.  Getting a booster shot too soon may be counterproductive, since those who wait may extend their immune protection further.  Side effects from the booster vaccines, expected to be similar to those experienced with the primary course—most commonly fever, fatigue, and arm pain—may be more likely when the boosters are given early.

Contact your health professional for guidance about when you should get a booster vaccine.

Local Covid Update as of 7-15-2021

vac-01.jpg

The Delta variant of Covid-19 is responsible for a dramatic increase in Oklahoma’s cases of and hospitalizations for Covid-19.  The cause of more than half of all new Covid-19 infections in the state, this variant is 4 times more contagious than the previous strains and causes more severe disease, especially in younger patients and in pregnant women.  Nationwide, new cases have risen 109% in the past 14 days and deaths are up 17%.

            67% of fully vaccinated persons, whether they received the Pfizer, Moderna or Johnson and Johnson vaccine, are safe from infection with all known variants, leaving 33% susceptible to reinfection.  Fortunately, the fully vaccinated who develop Covid-19 infection almost always experience mild disease lasting 5-10 days and rarely end up in the hospital.

            Let’s look at the numbers for Oklahoma.

·       In the past 14 days, there has been a 53% increase in Covid-19 related hospitalizations.

·       2,688 new cases were reported in the past week, a 56.7% increase from the week of June 27-July 3.

·       11 deaths were reported in the past week.

·       The average age of cases was 40 years, much lower than during last winter’s spike, and 67% of the cases were in patients younger than 50.

·       As of July 12th, 45.7 % of Oklahomans had received at least 1 dose of the vaccine, and 39% were fully vaccinated.

·       As of July 12th, in the 12-17 year-old age group, 17.1% had received at least 1 dose of the vaccine, and 12.7% were fully vaccinated.

·       As much as 95% of new cases are occurring in unvaccinated persons.

Next, some Tulsa information:

·       Local hospitals are seeing increased numbers of emergency department visits, admissions, ICU admissions, and ventilator use involving Covid-19 patients.

·       The number of inpatients in Tulsa has increased fourfold in the past 6 weeks.

Clearly, Oklahoma has a long way to go to reach herd immunity, estimated to occur when about

72% of the population is fully vaccinated.  Until then, the Delta variant, and perhaps new ones yet to come, will continue to develop and spread.  For all our sakes, we all need to get fully vaccinated and encourage our unvaccinated friends and family to do the same.

 

Help with Weight Loss

helpweight-01.jpg

In a recent issue of The Medical Letter Vol. 63(1624), the authors review the product Plenity, a novel approach to aiding weight loss.  Plenity is the only FDA-approved weight-loss drug indicated for overweight but not obese patients, regardless of other preexisting health issues.

Plenity is an oral superabsorbent formulation of cellulose (fiber) and citric acid that forms a space-occupying gel in the stomach. It should be taken 20-30 minutes before lunch and dinner.  This gel can occupy up to 25% of the volume of an average stomach, mixing with food and providing a sense of fullness.  The gel is then digested and broken down in the colon.  

In a controlled trial, Plenity was superior to placebo in achieving weight loss.  Adverse effects reported in this trial were common, occurring in about 40% of patients, but were not severe.  As expected for a drug that remains in the GI tract, the most common side effects were diarrhea, abdominal distention, infrequent bowel movements, flatulence, abdominal pain, and constipation.  In most cases, these adverse effects were mild and resolved within 2 weeks.  No serious adverse effects have been reported.

For now, Plenity is only available via a telehealth visit on the company’s website (click here).  Later this year it will be available by mail-order pharmacy.

Does Covid-19 Infection Confer Immunity?

DrLBlog.png

The immune system can retain a memory of infection long after a person recovers from a viral illness.  Immune cells and proteins that circulate in the body can identify and kill the virus if it is encountered again.  

Long-term immunity depends upon several components:

  • Antibodies, circulating proteins in the blood, recognize viruses and destroy them.

  • Killer T cells, a type of lymphocyte, recognize and kill pathogens including viruses.

  • B cells make new antibodies when needed.

A recent study by Washington University researchers, published in the journal Nature, suggested that mild cases of Covid-19 leave lasting antibody protection and that repeated infections of Covid-19 are unlikely.  B cells multiply rapidly during infection, but, as patients recover, most B cells die off and blood antibody levels drop.  Some B cells, known as long-lived plasma cells, remain in the bone marrow, secreting antibodies, and are ready to respond against a new exposure.  These plasma cells will likely confer lasting immunity.

In a recent study at the National Institutes of Health that analyzed Covid-19 cases of varying severity, 95% of participants had 3 or more of the 5 immune-system components studied when measured for up to 8 months after infection.

Based upon these results, it appears that Covid-19 infection does confer lasting immunity in most infected individuals.  Both groups of researchers agree that it remains to be seen if vaccination also induces the immune responses needed to provide long-term immunity.  Vaccine-related studies are ongoing.