Dr. Bow Tie
COVID-19: What This Is Not
The Delta Variant continues to surge across the United States. Areas that were bad before are worse now, and areas that were doing "okay" before may not be far behind if this keeps up. Hospitals are filling again, in some places having to divert patients elsewhere and not being able to find places to divert them. This is why we had to flatten the curve a year ago, and yet here we are again. Greg Abbott vowed to fully open Texas and forbade mask mandates, and now he is having to call upon out-of-state personnel to come help in the hospitals again because they are overflowing, meaning people cannot get care for their other emergencies (heart attacks, strokes, etc.) and their needed surgeries ("elective" doesn't mean not necessary, it just means non-emergent). The only way to beat this virus and actually end this pandemic is for everyone who can to wear a mask indoors/in crowds (for now) and get vaccinated (for the long haul). As usual, there is a lot of disinformation out there, and a lot of misconceptions about what we have to do now. So it's time to play another round of... (audience joins in):
WHAT! THIS! IS! NOT!
This is long, but I divided it into sections!
Before we start. 2 things:
I'm going to say "everyone" and "all" a lot in this post when talking about people who should get vaccinated. I understand there are exceptions and people who cannot get the vaccine, but they number FAR FEWER than the number of people who claim (or are told) they cannot get the vaccine. There are real medical exceptions (with the mRNA vaccines, the only real one is a significant allergy to any of the ingredients), but those should be the only exceptions. Religious exemptions and "personal belief" exemptions should not be used because this is not a religious matter (the Pope even gave his approval) nor is it a "personal choice" as I have previously explained.
A video of a "doctor " in Indiana at a school board meeting is making the rounds among folks who are looking to stick it to the CDC or prove why vaccines aren't working/needed. He introduces himself as a "functional family medicine doctor" which is an alternative medicine discipline to which people sometimes turn, except that he overstates and misrepresents the definition of "functional medicine" and then proceeds to demonstrate a misunderstanding of every scientific point he tries to make. He gets the names of concepts wrong and outright lies about others. He claims he can effectively cure COVID-19 after treating a whopping...15 patients. Similar to Pierre Kory, whose video circulated a few months ago, he uses "studies" that are small, unsupported, and more importantly, unreproducible. The "large" studies that supposedly supported use of ivermectin turned out to have faked most of their data! Conversely, we have many studies showing that masks do work (and prevent spread of COVID-19 - see my last post). I know people are looking for an easy way out of this pandemic and disinformation about masks and vaccines (especially when stated so vehemently) can sound appealing when framed as whistleblowing, and I've openly stated my disagreement with the CDC on some of their messaging and recommendations at times. However, the scientific community can't keep secrets or form conspiracies - things leak, and there's too much oversight for that. I address some of his misconceptions below, and I'll link to a full rebuttal by the great Edward Nirenburg of Deplatform Disease.
Now, let's play!
THIS IS NOT...Discrimination or Oppression
Mask mandates are returning, and vaccine requirements are starting to appear in workplaces and fun places. Hospitals and other healthcare environments ought to be requiring vaccinations of their employees, since they are the most exposed and face the most vulnerable populations. Schools must require mask mandates for everyone inside and vaccines for all employees. We WANT in-person education for kids! But we want that education to be safe. And that applies to any business, restaurant, or other location.
However, people are already piping up with terrible takes comparing this to the Holocaust and concentration camps. Someone Tweeted, "'No vaccine no service' is starting to look alot(sic) like 'whites only'." As usual, people also claim "violation of [my] 1st Amendment rights!" Of course, these mandates are none of those things. Nor are they HIPAA violations (or "HIPPA" violations). These are nothing more than safety and mitigation measures designed to stop the spread of this virus that is still hospitalizing and killing so many people (now including children).
We need mask mandates and vaccine requirements to protect ourselves and each other. "Your freedom to swing your fist stops where my face starts."
And in the words of George Takei: "As a survivor of internment camps, I can assure you that mask mandates are not comparable in the slightest."
THIS IS NOT...Moving The Goalposts
The honor system did not work for us getting through this pandemic. The virus evolved, and as we learned about it and its evolution, the recommendations had to change (really, requirements should not have been lightened when they were). Not enough people were vaccinated and those who were not vaccinated spread it to those who were, as well as those who were not. This is not where any of us wanted to be at this time of this year. So we must do things to get ourselves out of it, and that means accepting the reality of the fourth wave and fighting it. Speaking of which...
THIS IS NOT...Vaccines Creating Superspreading Events (or Vaccine Failure)
A big story recently was Provincetown, MA, where there was a large coronavirus outbreak and all the headlines read "74% of the COVID-19 patients were vaccinated!" HOWEVER, that did not take into account 1) Provincetown is an area with a largely vaccinated population. So if you have an area where vaccinated individuals far outnumber unvaccinated, if an outbreak happens, it is certainly possible that many of the patients will be vaccinated. 2) The outbreak was most likely brought about by unvaccinated folks. Below I'll include two pictures that illustrate how much worse off the unvaccinated folks are than vaccinated.
Vaccines induce a eight-fold reduction in risk of catching COVID-19. That's huge - you cannot spread what you don't have! No one has ever said that the vaccine is 100% effective at individual protection. Breakthrough infections are expected. For complete protection, it has to be a combined effort. If more of us get vaccinated, that's far fewer that can catch a possible breakthrough infection (fewer susceptible hosts, AND FEWER VARIANTS CAN EVOLVE), which means fewer outbreaks. Again...we have to protect each other.
THIS IS NOT...A Misinterpreted Test (Double Topic!)
In case you missed it, I posted about how people ran with the idea that a revocation of of EUA for a SARS-CoV-2 RT-PCR test and, based on FDA's recommendation that labs adopt tests that can differentiate flu and COVID, claimed it meant that flu cases were counted as COVID-19. It was actually the testing company asking for EUA revocation because SARS-CoV-2 RT-PCR tests can only detect SARS-CoV-2. You need a different test (a different swab stuck up your nose) to detect influenza (which we often ordered simultaneously). So it's better to get a test that can detect both and differentiate them (one nasal swab is better than two).
Delta Variant specifics: Multiple people have asked if they are testing patients for Delta. The answer is yes and no. The test you get in the ED or clinic when you have symptoms is a standard "COVID or not?" test, which does not differentiate variants. Samples (not all tests, but several) are sent to specialized labs who can perform the genetic sequencing needed to detect the Delta variant. This is how we determine whether Delta is present in areas. However, variant does not change treatment strategy, which is why, at point of care, we just need to know "COVID or not"?
THIS IS NOT...Ignoring The Previously Infected
I have a friend who I've been trying to convince to get vaccinated. No matter how many times I answer each and every question she has (with data), she cannot bring herself to get vaccinated. She and others have one question that has continued to persist. "What about the fact that I have already had COVID-19?" We have known for a long time that post-infection immunity is variable at best, most likely lasting around 3 months, and dropping sharply after that in many people. Still people ask "well, isn't my immune system's job to remember and ramp up when I get the virus?" This is the basic idea, but how it works is a bit more complex than that.
So they did studies. They found that long-lasting plasma cells (the immune cells needed for that "remembering") were in MUCH higher numbers in vaccinated people than in previously-infected unvaccinated people. That alone clinched it - the vaccine did a better job and post-infection immunity was not lasting immunity. Still, that was not enough for some folks, so we went after real-world data.
A case-control study in Kentucky compared previously infected (in 2020, prior to delta's emergence) patients to never-infected patients and separated it out by vaccination status (non-vaccinated, partially vaccinated, and fully-vaccinated), and it was shown that non-vaccinated previously-infected people were 2.34 times more likely to get COVID-19 than vaccinated previously-infected people. TWICE AS LIKELY! Vaccination provides additional protection and not vaccinating leaves you (and your loved ones) at risk, regardless of infection status.
THIS IS NOT...Experimental or New.
THIS IS NOT...A vaccine whose effects will come back to bite you in a few years.
We've talked about this. A lot. See previous posts.
And the fear about "vaccine passports" is unfounded because we have been required to get vaccinated for diseases and show proof of that vaccination for decades. COVID-19 is no different. A year after the dosing of the initial trials, with over 4 billion people worldwide receiving at least one dose, 1.21 billion fully vaccinated. We are well past the time we would see any "long-lasting" effects and the vaccines are proven safe (see my last post for how rare some of the adverse events are). (I'll say again because so many keep asking - there is ZERO effect on fertility. Even though the guy that started that rumor is trying to gain clout by reframing his lie again). This virus is incredibly contagious, so if we're going to get past it, it has to become something everyone does.
THIS IS NOT...Child Abuse
People have tried multiple times during the last 18 months to say that masking kids is child abuse. We have seen myths that masks "make you sicker" and "increase carbon dioxide levels" and "inhibit development." None of these have turned out to be true. Two "COVID contrarian" physicians wrote an op-ed in a major newspaper citing a recent article in JAMA Pediatrics that claimed masks increased carbon dioxide levels. Except that their op-ed was written AFTER the JAMA Peds article was retracted because its methods were so deeply flawed that the conclusions could not be taken as anything but false. As I have said before, children adapt to masks well if they have good role models that wear masks, even those with speech development needs. Kids are being infected, hospitalized, and are dying in higher numbers from this virus than ever before. That is preventable if everyone masks around them and gets vaccinated.
THIS IS NOT...Underemphasizing Good Nutrition and Health
There is a myth that doctors these days don't discuss the importance of good nutrition and healthy lifestyle. We do, though perhaps not often enough, due to the nature of rapid clinic visits and how complex some of our patients get.
The main reason I have not been able to address this much in my posts is because no amount of exercise, nutritious meals, or vitamin/supplement will protect you from COVID-19. No amount of hydroxychloroquine or ivermectin will help, either, despite how vehemently people repeat those long-disproven-by-data myths (and cite trials where the data was made up). And remember, no vitamins or supplements are approved by the FDA, and HCQ and ivermectin are not approved for COVID-19 treatment - the vaccines have Emergency Use Authorization (which skips no steps in the trials, only a shorter amount of post-trial observation) and are on the verge of full FDA approval. So "waiting for full FDA approval" is flawed logic.
Numbers are climbing again - some places are facing the same challenges and dire straits they were a year ago. It will get worse if we do not act. These new waves of deaths are now PREVENTABLE. VACCINE-PREVENTABLE. So #WearAMask (indoors around others or in any crowds; see my last post), #WashYourHands, and #GetVaccinated! As always, I welcome your questions.
Several sources for the above are referenced in previous posts.
Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter K. Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021. MMWR Morb Mortal Wkly Rep. ePub: 6 August 2021.
Edward Nirenburg's rebuttal to Dan Stock's misinformation rant at the Indiana school board meeting: https://www.deplatformdisease.com/blog/addressing-dr-daniel-stock-claims