COVID-19 Q&A Update

You. It's great to be with everybody again. We've been getting lots of questions personally from friends, as family as well as through social media on Facebook, Instagram and YouTube. And so we want to try to address some of those questions. A lot of people are concerned, especially with a spike in cases right now. The date of today is July 18th and so there's been an uptick in new cases as well in deaths in some states this last week. And so a lot of people concerned. There's also some concerns about going back to school. So what I want to do is answer a few questions instead of, I want to go deep in those questions instead of answering 10 or 15 questions briefly. I think what I want to try to do is answer all the questions with four or five main questions, just go deeper so you all can understand some of my thinking behind what's going on. Again, I've been following this since January. I've been posting to date We've posted over 40 posts. We've done, I mean, scores of literature review posts as well on Facebook. Please share this information if you feel it's helpful. There's just so much chaos out there. It's even worse now than it was two or three weeks ago that either just finding a great source of information, sticking with it, or just pulling away and not looking at information. You have to figure out what's best for you and your family. So anyway, let's. One of the first questions actually was about sources of information. You know, how, if I could talk about how can people use data from the Worldometer. You know, I've done multiple, multiple videos on looking at the data, looking at the numbers. I'll continue to do those. You know, I would just recommend you going back to the Worldometer videos just to review those because ultimately you want to look at the data and the numbers and what's happening is a conflation of weekend trends, a conflation of the fourth of July. This past fourth of July, Friday was a federal holiday, usually three day week, two day weekends, things build up and you have a spike on Monday. Well, the spike was higher because it was a three day, not a two weekday weekend. And there was just a conflation in that spike. And so sometimes it's just better to actually look at the Worldometer, look at the United States, look at your state, look at a few key states. The top current states right now are Florida, California, Texas than your state to get an idea what's actually going on. Because numbers are flick, it's changing and my expectation Is to continue to see numbers kind of sort of go up. We never had. This is not a second wave. This is just a continuation of the first wave. People talk about a second wave. The first wave, all we did was put the lid on the pot, so to speak, and let things simmer a little more slowly. The only place that did not do that was New York. And if you look at New York, what you'll see is a huge spike. New York really didn't even implement any kind of shutdown procedures. And even then the subways were still open until their peak. And so they really didn't do a whole lot. I mean, literally, New York probably, you know, most of the cases are already spread. If you look at certain boroughs, over 50% of the population has positive antibodies. So it's very, very unlikely that New York City will see another spike. So they give you an example of an extreme on one side. Virginia, where I'm at. If you look at Virginia numbers, you'll see it's just been really steady, hasn't been a really big peak. And part of that's because Virginia has three major population centers through central Richmond, Northern Virginia and then the Tri Cities, Norfolk, Suffolk, Virginia beach area. We've been wearing masks. We did mandate mask wearing the governor. And the way they did it, they did it in a fashion that gets small businesses to enforce it, not the state, which has actually proven to be very successful. And the governor said it in a way that mandated mask wearing, but then said the state would not enforce it. The result was a small business has been enforcing it fairly well. And it's been pretty calm here in Virginia versus top down. And so you just gotta kind of see what's going on with these numbers as far as good sources of information. You know, this is research and live. There's not a single good source that I can refer you to personally. What I do is I have a. There's Dr. Soholt who's a pulmonary specialist in California and he puts out updates every day to look at his stuff. I'm looking at basically all the news outlets just to see what's what are trending. And so I'm looking at three major sources there. And then I'm probably looking at probably 20 to 30 different headlines a dates to see what's going on. I'm doing PubMed searches. And then you have people like you, you all are sending me articles and things that I'm getting look at. My wife is seeing different dashboards, different people, different questions. And that's how I'm Getting information. So I wish I could tell you I had one good source to send YouTube. I actually do not. And that's part of the problem. This is the front end of research of the first pandemic in my life and in many of our lives. And so we'll have a lot of single great databourse Resources Reviews probably in two years, which is how it happened with SARS CoV1 back in 20 to 2003. So one of the articles people ask me about, and this is I'm going to look kind of, I have a few pet peeves and this is I'm going to try to be nice about talking about this in a political way. Someone there's an article going around, you know, people with pneumonia, asymptomatic lung disease, people going to the hospital with severe lung disease. And the actual article that was published through from the nih, this is reputable CT imaging and clinical course of asymptomatic cases with COVID 19 pneumonia admission at Wuhan, China. And so this has caused a lot of fear, especially with schools opening back up, that oh my gosh, you can have serious lung disease and have no idea and be asymptomatic. That's the understanding and that's what's spreading around. The problem is, is when you actually look at the article, it does not say what the headline says. And this is one of my pet peeves where headlines do not correlate with the actual article. So if you actually get the article pulled out, which is available on our Facebook feed, it reads, 58 asymptomatic cases of COVID 19 pneumonia admitted to our hospital between January 1st and February 23rd. Okay, 1st and foremost, and this is actually in China, okay, these are people that are sick enough to be admitted to the hospital. They are not asymptomatic. What was happening was these people were going to the hospital for some other reason on admission they started their evaluation and they just incidentally found they happened to have COVID 19 pneumonia. These were not healthy, happy go lucky people. They were sick enough to be admitted during the spike in Wuhan Province, China, when these areas were totally shut down. These people were pretty sick. The key is they went to the hospital and were initially admitted not for COVID 19. So what are they being admitted for? The article does not say. And that's another one of my pet peeves is that I would love to know what these people were being admitted for, like what was their presentation, why did they go to the hospital? What was so concerning that they had to be admitted that we later found out they had COVID 19 pneumonia. And so some of the characteristics of these patients in the group. The average CRP, which is a C reactor protein, was 9. Okay. A CRP of greater than like 0.2 to 0.3 is pretty high. A CRP of 9 is you're really sick, you have cancer, you have rheumatoid arthritis, you have lupus, you're really super sick. So these people being admitted with a CRP of 9 were not healthy. They had an average D dimer of 0.76. An elevated D dimer like that can go along with pulmonary emboli, clots in your lungs, clots in your legs. Again, they were not 100% asymptomatic, and they were hospitalized for 19 days. Days. Okay? Healthy people are not hospitalized for 19 days. So I would like to know what asymptomatic means. Why would they go in the hospital? Article doesn't say that. And this is part of the issue is that these headlines are having one statement and pushing out this narrative that you can be healthy, walking around feeling great, and then go to the hospital. But that's not what the article actually said if you dig into it. And so, yeah, so that actually was a question about this article. Another question that was put to me was actually going back to school. Going back to school question. Great, great. So the American Academy of Pediatricians put a statement not several weeks ago, and we put a post actually last week about it saying they're recommending for kids to go back to full school. They made the statement. Npr then npr, they did statement. End of. Beginning of where I'm at today, Saturday. So beginning of last week, they made a clarification of that statement. The National Public Rape. NPR did a review, and they said that the AAP is retracting or stepping back their statement. That was the headline. It's another headline very concerning to a lot of people asking us questions. Oh, my gosh. What's the AAP doing? The American Academy of Pediatricians. Oh, my gosh. What's going on? Because National Public Radio was reporting they're stepping back their statement. Actually, if you look at the second statement by the aap, which is on our Facebook information feed, is that they weren't stepping it back. They were clarifying their statement because it was causing so much concern. The basic gist of what the AAP said was this. It's best for kids to be in school. Their second statement clarified that school for a lot of kids is the only place they get two meals. A lot of kids in the the inner cities, a lot of at risk groups, school is their safe place. It's where they get mentorship, it's where they actually have time to be safe. Their home is not a safe place. You know, the city of Richmond is mandating at home education for the upcoming year. Most kids in the city of Richmond that are going to public schools, they don't have Internet access. How are they going to go to school? And the Richmond's been a pretty bad experiment this past year. So the aap, what their statement was is that localities need to determine what's best for them, families, local school districts and then implement whatever. But overall the recommendation, because it's what's best for childhood development, socialization, it's best like some kids, it's their safe place, it's for full school. And that's the AP as of today that they're sticking with that statement. It's ultimately up to localities to determine with the parents and the situation what's best for kids. Whether full school, part school. That's what we're seeing going on right now across the country is every locality is determining what's best for them. And if your kids are in the public school or private school, that's what you need to do is sit down. I think Chesterfield county this past week was having a meeting and they're going to vote and figure out what they plan on doing and you need to be a part of that if your kids are in their school systems. But again, another example of someone trying to be the first to publish a article in the mainstream media and the headlines do not correlate with the actual body information. I've been seeing this a lot, a ton over the last several months, where something would come out, there'd be a headline, a flash line, and the actual headline does not correlate with the body of the data. We've been seeing evidence being pushed out quickly for publication and then later retracted through from the Lancet as well as JAM of the Journal American Association. So that's the reason why looking at lots of different sources is important. The other thing about it is that, you know, as a clinician, I have a general understanding of pathophysiology. I'm an expert in correlating patients symptoms of pathophysiology. You come with a shortness of breath and I have to figure out what underlying cause is making you short of breath. And so when I see an article, something that just doesn't quite make sense, ie, asymptomatic patients with COVID 19 pneumonia. I'm gonna wanna look at the article a little more deeply. Cause it just doesn't make sense to me. If I see an article that says, hey, half of all people with COVID 19 have no symptoms period. Well, we already know that, so I'm not gonna read that article. So that's where, unfortunately, I have advantage of interpreting this because it's what I do. So another question, this is important, the question. Can I address things like blood clots, lung damage, which the article before. Neurological damage as a result of COVID infection. Parents are really freaking out about their kids getting infected, going back to school. Even if they're asymptomatic, which these studies suggest, things can still be caused damage. Well, that's a misunderstanding of that article. They're not asymptomatic. They're asymptomatic for pneumonia. They had some other reason for being admitted to the hospital. And during the courts we call these things incidentalomas. It's kind of like you go to the hospital, you break your leg, you go get an X ray and they do an X. They do an X ray, they find a bone tumor. Whoops, where'd that come from? You know, they're called incidentalomas or incidental findings. That's what this article was basically saying someone went to the hospital and incidentally found something else. As far as the neurological issues, getting a viral infection or a bacterial infection and having a neurological consequence actually is not a novel thing. Some of you may have heard of Pandas or pans. It's where a kid gets a strep throat, mycoplasma infection, ebv, whatever. And they develop acute onset of ocd, anxiety. Sometimes infections can cause seizures. You can get a herpes brain infection and get a, get a seizure. So the idea, this is not a novel concept. This is extremely rare. How rare? Kawasaki. Okay, that is a virally induced vasculitis. You get a viral infection of some sort, we don't know what sort, and then the result is heart inflammation, aneurysms, etc. Super rare. I've actually never seen a case in my career and I've seen over 100,000 patients. So what's happening is these rare cases of things that I need to be aware of. So I don't miss them. The hospital admitting physicians and hospitalists need to be aware of. Now the general population is hearing about this. And these are super, super rare things. You know, rheumatic heart disease, you get strep throat and you get Heart disease from it. I mean, that was the most common cause of heart failure in the 1950s. Now it's pretty much unheard of. So these ideas are not novel. It's just now everybody's hearing about every single solitary case of every kid who, you know, the first case of COVID 19, a stroke, you know, so that's very rare. How rare? We're talking about like one in a million, one in 250,000 cases. I think when I last looked at several weeks ago, there were less than 20 or 30 cases in Virginia of the inflammatory syndrome of kids with COVID 19. So very, very uncommon when, you know, there's been over 3 million cases in the United States so far. We're talking about super rare, super rare things. Rare enough that the American Academy of Pediatricians says going to school for all kids is preferred across the country. But it's up to you to determine what you're going to be doing. So that's how rare these kind of things are. So some people asking questions about vaccine development that's a little too detailed for the. This kind of media. Antibodies. This is a great. Antibodies. Okay, antibodies. And I'll probably stop with this question on this, on this session. So antibodies. There's a lot of misunderstanding about what antibodies actually mean and what they actually are and how long they stay elevated. The half life of an IgG antibody is 28 days. So that means for a typical infection, if there's no reoccurrence, you theoretically could see all the antibodies go away in three to four months. Okay. With COVID 19, we know if you have a more serious infection, antibodies stay higher, longer and it's less serious, it goes away quicker. You know, if you get a polio infection, you have antibodies for that for your whole entire life, you know. So what's going on here with this? Well, the better question is what correlates with long term immunity? And it's not antibodies. Antibodies are a surrogate marker we use for B memory cells. B memory cells are the cells that you make after you make plasma cells from lymphocytes which make antibodies. When the infection goes down, there's something left. And these B memory cells have lived for years and years and years, and some live for decades. And that's where your actual immunity comes from. And that way, if you get exposed to second virus, they start reacting quickly. If there are no antibodies in your blood, the B memory cells will act quickly. If there are antibodies, they still react quickly. The actual memory comes from the B memory cells. And so what's happening is a conflation of neutralizing antibodies or spike protein antibodies with long term immunity. Long term immunity, we can't actually directly measure that. It's in B memory cells. We measure what B memory cells make, which is igg. If you have something like Epstein Barr virus, okay, which causes mono, which never ever leaves your body, you will always have IGG antibodies to that in your system 20, 30 years later because it's still there, still creating a low grade kind of smoldering effect. And you'll always have antibodies. If you are, there are other infections you get exposed to like syphilis. Okay, hopefully no one's been exposed to that. It should go away in 10, 15 years. Long time. And we actually can measure re exposure to syphilis based on a full foiled form four fold increase in antibodies from a re exposure to syphilis. So if someone, if I see someone with like an elevated antibody to syphilis and I give them penicillin to treat it and then I recheck them in a month and I see a diminution of the antibody, I know there was an acute infection, I see no change, I know it wasn't. Or if someone comes in, I think they're exposed and it goes up four times from an old lab, I know they're exposed. So, so these are surrogate markers. They don't actually correlate 100% with immunity. And that's the problem as these studies are showing antibodies going away and people are conflating that with immunity. It's not, it's just a peripheral marker we have for B memory cells activity. And my expectation would be, is if you had a little tickle of your immune system, a mild activation of your immune system, that you created a little bit of antibodies and you weren't exposed again, then they might disappear in three or four months or sooner, depending how many you made. But the B memory cells would still be there. You have to remember coronavirus is a typical infection. There's seven coronaviruses that infect humans. Four are normal head colds and three are really, really bad. You know, we expose to these things all the time and get a head cold. 15% of head colds of respiratory tract infections are coronavirus. During flu season, up to a third of people with an infection, it's actually not the flu, it's a coronavirus. So these things are all over the place all the time. Once this thing goes through the community, it will no longer be a novel coronavirus, it will be an old coronavirus. And if you get re exposed, you'll have some kind of immunity. If it mutates some, you might get another coronavirus because again these things are kind of everywhere. But it'll be a mild second infection. We assume that because we don't have experience yet. But that's how viruses actually work and that's where understanding virology human immunity, which again is my one of the field One of the things I do clinically is looking at the correlation of people's illnesses with their immune status. This is what people do in the functional integrative world all the time. So hopefully that was helpful to answer some of yalls questions. Please continue to share these videos. Please continue to watch, make comments. If you have questions, continue to post them. We will continue to post these I feel like a lot more people are getting concerned because things go forward and so I'll try to continue to help inform you, give you information that's reliable, dependable. If you have other questions. If I misspeak, I'm open to correction because this is the practice of medicine and I'm still after 20 years, I'm still practicing and I probably will be continuing to practice until I no longer actually am practicing, which will be when my career is over. That's how medicine works. So take care, be blessed, be well, have a great weekend and we'll see you soon.