COVID 19 Update 2-26-21

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Nationwide, and here in Arizona, the number of new Covid19 cases and deaths has been declining. While still at high numbers, Arizona is now back to where we were in mid-November, with the seven-day average of cases 1,530 and the seven-day average of number of deaths at 90. Overall, Arizona is now fifth in the nation in number of deaths per capita and fifteenth in number of cases, which is an improvement from January when Arizona was number one in both categories.

It is not entirely clear why the numbers are declining. For the moment, it is too early for vaccines to be making a big difference in the general population. However, for nursing home residents, there has been a dramatic decline in the number of deaths from Covid19 and vaccines are believed to be playing a role in this improvement.

There is great worry that people will become less careful as the number of cases decline, setting us up for another bad outbreak in the next two months. As I mentioned in my message last week, even if you are vaccinated you need to wear a mask and stay socially distanced if in public. As more people get immunized and more time progresses, this recommendation will be modified, yet people must remain vigilant for now.

Also last week I talked about the variant strains of Covid19 being isolated and the concern they could make vaccines less effective or even not protective at all. It is important to realize that so far the only data we have about the resistance of variant strains is based on in vitro or test tube studies. Concentrations of the variant strains are mixed with serum from people who have been immunized and the amount of virus incapacitated or eliminated by the serum is then measured. Realize that while helpful, these in vitro studies do not always reflect what goes on in the real (or in vivo) world of the body, and it is possible that the vaccines may be more beneficial then believed. Nevertheless, both Modena and Pfizer are working on a third dose of their respective vaccines to protect against the most worrisome variants. In addition, the Johnson and Johnson vaccine has been shown to be protective against some of the variants as well.

While vaccines will ultimately be the way Covid19 is controlled, effective therapies are being sought for mild, moderate, and severe cases. Unfortunately to date, we have been unsuccessful in finding a curative treatment. A lot of publicity has been given to several proposed remedies, starting with Plaquenil/hydroxychloroquine about 11 months ago (which was demonstrated to be useless in multiple well-designed studies).

Recent randomized controlled trials have been published looking at Pepcid/Famotidine and Vitamin C and Zinc as either preventative or curative therapies. The studies have not shown any improvement using these agents compared to taking nothing at all.

Vitamin D3 continues to be talked about as possibly preventative, yet currently there is no data supporting this. Indeed, we know that low Vitamin D levels are associated with a multitude of illnesses, and that Vitamin D may enhance innate and adaptive immunity. However, some (including myself) believe those low levels are felt more to be a marker of disease, or nutritional status, rather then the cause of the illness itself.

A Brazilian study published online this week In JAMA (the Journal of the American Medical Association) looked at a single high dose (200,000 units or 5000 mcg) of oral Vitamin D3 versus placebo for hospitalized Covid19 patients. The high dose vitamin D improved the blood levels of vitamin D yet did not result in shorter hospitalizations or better outcomes.

Time will tell if Vitamin D proves effective. If you are considering using Vitamin D, do not use more then 2000 units (or 50 mcg) a day (unless you are on a higher dose for Vitamin D deficiency). Excessive vitamin D can lead to liver damage and death.

Finally, two last items: first, mammograms should not be done until four weeks after the second Covid19 vaccine since the vaccines can cause lymph node enlargement on the side of the injection. This enlargement can be mistaken for a cancer and can lead to an unnecessary biopsy. Lastly, the office will be closed next Friday March 5, 2021 for training. Phones will not be answered, yet if you need something urgently or emergently contact me directly on my cell phone.

Take care and have a wonderful week.