COVID DELTA VARIANT

Good day and welcome to Medicine and Health with Dr. Paul Anderson. That's me, I'm Dr. Paul, and today we are going to talk about the COVID Delta variant. Got so many comments, questions, etc., about this, and I thought, well, you know, anytime you talk about COVID it's sort of a two-edged sword. You, you get usually more views and interest in things, but also everything is just so contentious around COVID. So what I decided to do, because this is a real— it is a real issue, and it's something that people have really good questions about. And I think that there's a lot of valid, you know, points to bring up and some, some data that might be Maybe not unique to the United States, but maybe a little different than what's happened elsewhere in the world. I thought, well, this, this would be a good topic because it encompasses just a whole bunch of questions. And, you know, normally I have, you know, decent outlines for these things that we're going through. Sometimes there's a lot more heavy, you know, backend research and other things that I've done. And usually I'll kind of put that together and put it into a newsletter or something. This might become a newsletter. I haven't written it yet, though, so Nothing, no promises there, but you know, this level of show notes is, is way more than you know what I normally do, with the exception of a couple of the real technical things that we've done, maybe around vaccines, stuff like that. But I do think this is a good thing to talk about because as I've listened to people's feedback, I've gotten questions, you know, both through the YouTube channel, through Facebook, through You know, every other way in the world, people, Instagram, get ahold of me. And by the way, the, the new website, dranow.com, D-R-A-N-O-W dot com, is up. And that's a great way to get ahold of me too. It's also a great way to get all the links to everything that I do. But I thought, well, we should talk about this Delta variant and we should talk about what's going on with the virus itself and, you know, where's it headed and all of that. And I think one of the things that just, you know, psychologically brings this to the forefront with people is the idea that people were feeling like, well, you know, they're, they're either removing or reducing mask mandates. There's more public gatherings going on. There's, you know, a lot more of quote unquote, you know, back to normal life going on. Whatever that means. And then all of a sudden, you know, we start hearing about this thing happening in India with this new variant, and then it's in, it's in Europe, and then it makes it to the US. And it's sort of like, you know, tearing the Band-Aid off, or, you know, or opening up a wound, because now what does this mean? Is this going to put us back to zero? Is this going to make us all sick again? You know, what's going to happen? And that coupled with the timing of, you know, whatever way you look at, you know, herd immunity, vaccination, all that stuff, but things were moving in a direction of, you know, more herd immunity. People who wanted to— people in the correct age groups who wanted to be vaccinated seemed to be vaccinated, all this business. And so people were starting to, you know, travel a little bit and do other stuff. Now, nothing about a variant of a virus, if you're in a, say, pandemic, epidemic, or pandemic situation, nothing about a variant is unexpected, number one, but also nothing about a variant really changes the rules a whole lot. actually expected. As a matter of fact, we're going to talk about there's a lot more than, say, just the Delta variant. So the first thing that we have to think about is whether or not we were thinking of it and mentally and emotionally ready for it or not. The presence of a new viral variant is simply expected. Okay. So I wanted to start out with the first, just you know, a tenet of virology, which is that, you know, many viruses will mutate. That's what viruses do. I have a friend who likes to say, you know, it's a virus being a virus. You know, this is, this is not something we would think is really crazy, right? So an example of this though, which you may have thought about, heard about, read about, or you might have experienced the other side of, Is you hear about influenza, influenza every year, there's, you know, a seasonal or, you know, epidemic influenza that hits your area. And you hear about, well, the influenza vaccine has this broad variety of efficacy, whether it works or not, and some years, you know, it's in 50, 60, 70% effective, some years it's 0 to 5% effective. Why is that? If we're, if we're immunizing against influenza, why in the world would we have this big broad variation in our immunization, you know, efficacy? And the reason is, is that influenza is the same family, but it's a different subvirus. It's a different variant every year it comes around. And so what they do is they try and, you know, forecast what direction the drift is going on with the influenza virus, and they look at other places in the world where it comes up first. They try and make a vaccine that matches that, and sometimes they're okay, sometimes they completely, you know, miss the mark. And so the reason for that is, is that the influenza, say especially influenza A, that you had this year is not gonna be the same one that you have next year because viruses mutate. So what's another reason why a virus would mutate? Well, it's survival. Viruses, of course, have a different mechanistic cycle. They're very much machine-like, and they have a very, you know, obviously a shorter span of existence than, say, a human does. So virus, like some bacteria, but viruses especially, have this ability to create mutations to make them survive better. Now there's a couple of things about virus and host that make survival better or worse. One of the things is, if you're a virus that's extremely pathogenic. and you, you know, like Ebola, okay, and you get in and your host, in this case say humans, dies rather rapidly, you're not going to spread a whole lot, and with something like Ebola that's wonderful. Any amount of Ebola is bad, but the idea is if you're that bad of a virus where everyone dies, you're going to run out of runway, you're gonna run out of room as far as the virus goes and you propagating yourself. On the other hand, if you are a virus that has this opportunity to get into people, start to fulminate, use their cellular machinery to recreate yourself, and you don't give a lot of symptoms for a little bit while your viral load builds up in your host, in this case us, then you have a lot more chance of being transmitted. Yeah. some of the older long-form videos that we've done here on the radio program, we talked a lot about that. You know, the slower you are on the front end getting into your host and creating symptoms, the more you're going to spread. We talk about this a lot with respect to SARS-CoV, the original SARS virus, and then its cousin SARS-CoV-2 or COVID-19. The reason COVID-19 spread around the world the way it did is it was not as virulent and as pathogenic as SARS-CoV-1 is, and so we noticed SARS-CoV-1 a lot faster because people got sick really quick and we isolated them, right? It was bad enough because it went to multiple cities around the world, but it didn't spread quite like SARS-CoV-2. So mutation is just a way for the virus to keep up and to keep infecting. Now what's another thing that might be a good strategy if you're a virus? Well, another strategy would be if my goal as the virus is to get into the most number of hosts possible, then I would like to have mutation as I go along that allows me entry into the host, in this case us humans. As easily as possible. Okay. So if we look at COVID, so for the sake of simplicity, SARS-CoV-2, we'll just call it COVID or COVID-19 throughout the rest of the program here. If we look at COVID that we have right now here in 2021, by the way, if you're listening, everything I say is relevant as of July 15th, 2021. If it's a week later, we might know something new and you can't blame me for what's happening in the future. But as of today, COVID has gone through some transitions. So a lot of what we think about with, we'll call it original COVID, is the COVID Alpha variant. So they use the, you know, the Greek alphabet, and they start with Alpha and go down the line. So Delta is a few letters down. So the Delta variant, as opposed to the Alpha one, has a change in the spike protein conformation, so the mutation is generally in how the spike protein forms, and what this allows is an easier entry of the Delta variant COVID virus into human cells. Okay, so if you're looking at it from the virus point of view, This is a great mutation. I have an easier chance as a virus to get into you if I enter your cells, because remember that virus have to enter the cell in order to propagate themselves. Okay, so that's very, very important. The other thing is, is that now, at least as, as of July, middle of July 2021, the Delta variant is the majority of the new cases that we're seeing here in the United States, and I would say probably North America. Now, one of the biggest areas of questions— I want to hit this topic next— was this confusion, and it's totally legitimate righteous confusion that a lot of people have, really probably everyone has to one degree or another, which is why in the world when I look at news, news reports, reports from, you know, a government agency, reports from scientific agencies. Why do I have 2 dramatically different reports about the Delta variant? This is kind of important, and it's super confusing. So I have a group of reports that say this might be the most deadly strain of COVID This may be You know, this may create not only hotspots but surges in cases and disease and death and hospitalization and everything else. So you got that kind of band of reports. And then you've got these reports that say, actually, the Delta variant appears to be less deadly overall. Those seem to be 2 very, very different types of reports and 2 very different buckets of information. So people are legitimately confused by this. Well, there's a couple of things that go into why could you have a report go in 2 totally different directions. Now, to be fair, generally these are not coming from the same, you know, news outlet or agency or whatever. Usually they pick one direction or the other. So it's not like, you know, you're, you're having a news report come from a university. And one day they're saying it's, you know, it's going to be the worst variant ever, and next day they're saying it's going to be all right. Usually there's just sort of 2 tracks these things go on. But what's the— what's one— let's go through the reasons why you get these things. Well, the first one is, I just want to get this out of the way because, you know, some people will like jump all over this and say, see, you know, every— people are lying, you know, all this stuff. Well, you know, whatever, but But it's a real thing. And that is the first phenomenon that I'm seeing is there are literally reports a lot of times from a hospital system or a government agent that are not official reports, but they are, they are conjecture. Okay. So these things are speculative reports based on almost no data, almost no information. And I watched a bunch of them where they literally say things that have no backing to them. There is no data to back the statement up, and they will say things like, it appears that the Delta variant is extremely dangerous, creates more hospitalization and, and more death. And they're talking about the United States, and that's actually, you know, as of today, middle of July, That's not the case, okay? Now, remember from other discussions we've had, if you say, it appears that, or I think, or I imagine, or I suppose, you're making a judgment call based on, you know, your available information, but you can say those things and have no relationship to any actual data. And I only bring that up first because that's actually going on, and I've watched a number of these things. Usually they're really short clips. This is another thing, just to give these people a little bit of slack. I've been interviewed by lots of people in, in my career, and especially in the last year and a half with COVID I've been interviewed a lot. And when you get these short-form things like on a news or a short video on YouTube or whatever, you can be taken out of context fairly easily. So some of this may be the way they're being portrayed to get a particular point across. So if you, if you got a 90-second spot or 2.5-minute spot on the news, and they've just got a few sentences from you, it might sound worse than what you really intended to say. So that is one thing that's going on. Well, if you are of a mind to think the world is going to end soon because of COVID and the Delta variant will make it end faster, that type of news story, even though it's based on very loose facts or no facts at all, will resonate with you and you'll be pretty sure that every, you know, the world's going to be coming to an end very soon. So that is a real phenomenon, just reports that are speculative that have no basis in any actual real fact. But what's another reason? Reports that do have basis in actual and real fact. One would be you look at data from a country that is not yours, that has different characteristics, different, you know, social political, public health, and other, you know, factors going on. And you might say, well, if we look at the experience in India with this variant, a lot of people got very, very sick. People lost eyes, they lost, you know, their life, they had all these other problems. So if we base it on that experience, the Delta variant may be, you know, just horrible, like terrible. And then if you go to the other side, because then you could say, well, people look at other countries and say, that's not happening here. So then you might go to a country that's not India, for example, and say, what's your data look like? And the data on the Delta variant is not that dark and disastrous. So what do you do with that? Well, there's a couple of things to consider as we kind of segue into the next step here, which is What is more likely here in North America, in the United States and Canada? Well, the first thing that we have to say, to be completely honest, is nobody knows. Okay. If somebody comes out and tells you the Delta variant is going to be worse and it's going to be the, you know, more people are gonna be in the hospital and dying, or if they come out and tell you the Delta variant is for sure better and blah blah blah. They don't know that because we're forecasting forward in North America, which is just getting its start with the Delta variant. And because with something like COVID, especially an infectious disease, the milieu that the infectious disease agent goes into, meaning not just the person because we're all humans around the world, but we live in very different circumstances. Not just the person, but their availability to social and health infrastructure, their availability to clean water, food, medical care, overcrowding, not overcrowding, all those things, plus a zillion other things that go into it, make our experience here different than in a place that might have different characteristics. So while there were some really horrific things that happened, for example, in India, a lot of them were due to underlying problems and other problems that had to do with not the human that the virus went into, but everything that was affecting the human the virus went into. We cannot, you know, in, in good conscience anyway, extrapolate and say US and Canada are going to have the same problems with Delta variant that India had. Because they're very, very different sets of conditions. So, a couple of things that we want to look at. The first is, if we're going to try and forecast how Delta variant might go, because now we've got plenty of it here and we'll know soon enough, but if we want to forecast, one thing that you can do is look at a geological, geopolitical, geometrical, if you will, situation that's maybe a little bit more similar to, say, the US and Canada. And one of the places to look is the United Kingdom. And the UK has a couple of things that make it nice to look at their data. One thing about their data is it's done reasonably well. Some of the data, if you look at scientists who are doing statistics, etc., they will tell you that, you know, the data collection for the United Kingdom is better than the US is doing for a number of different reasons. But be that as it may, it's good data. Like, they have some good numbers for us to look at. But the other thing is that there's a little bit more homology, it's not the same in the UK as it is in the US and Canada, but it's much more similar than say US and Canada versus India. It's, it's, it's a lot more similar. So the only way we know about North America is once we see what happens in North America, but we probably can kind of clarify things a little bit by looking at the United Kingdom data because they've had the Delta variant longer, they've got more people, they've tracked it longer. So what can we find out from that? As I say, it doesn't mean that it's exactly going to happen, but it's probably more likely to be like the UK than other parts of the world. So the first thing we want to look at, though, before we start talking about this, is to clarify. If you are looking at data and numbers that are cases, that just means somebody tested positive. Versus the actual disease process, the morbidity and mortality, meaning how sick you get and, and, or do you die of the virus itself. Because you can have all the cases in the universe, and if a very small amount of them are actually very highly pathogenic and people get sick, it's a difference between total cases and morbidity and mortality. Now, with some things like— so we talked about Ebola earlier. You've got like 100%— if you have, you know, a case of Ebola, you got 100% chance of morbidity and mortality from Ebola. If you have COVID Alpha, you know, you have a separation between cases and morbidity and mortality, and if you have COVID Delta, it appears that you have a different separation between Case and disease. So, and I say this because some of these sort of more negative reports in the US will say, well, the cases are on the rise with Delta. Well, no kidding, right? Delta is the new variant that's coming. That is going to be all, you know, maybe close to 100% of the new cases. So it seems like a big number, but it's just because that's the variant that's around. The next thing though is you could have a lot of cases and there may be very low morbidity and mortality for those lots of cases, so it's a different equation than COVID Alpha was. So if we look at the UK data, they have what is reasonably considered by statisticians and scientists around the world to be probably some of the best data as far as Number tracking and looking at Delta and all that with respect to what might translate to North America. They've got longer experience, and at least on the surface, the exposure and the people and the conditions that people live in might be a little bit more similar to the United Kingdom. The summary that you get from looking at United Kingdom data is that it is definitely more infectious. But it is less deadly than prior variants that we've experienced. So what does that mean? Well, remember going back to the idea of a viral variant, and the viral variant is the gambit for the virus to stay around and, you know, keep replicating itself. If I'm a virus and I can infect more people but not kill as many of them, I do a better job of propagating the virus into the human host, and then the thought is at one point when herd immunity is reached, then my ability to propagate my virus into the human, you know, the human host goes down. Right now we're on the upswing of all that, trying to reach herd immunity. Now, the other thing that's interesting, if we compare as close as we can apples-to-apples comparison, The case fatality rate. This is an important number because this is, if you have cases, how— what percent die. Okay, and I know, so don't write in and yell at me, I know death is not the only number that we should care about, but it's the place that we like to start. There's also, you know, non-mortal problems, the morbidity, how sick people get. Separate thing, we'll talk about that separately. But case fatality is of what percent of the 100% of cases are the people who die. So if you look at the Alpha variant, so the, the first one we're really tracking, the Alpha variant, under 50 years of age is a 10th of a percent, 0.1%, they died. Under 50 years of age with Delta is 0%. This is UK data. Over 50 years of age, and this is how the UK divides it, 50 plus or minus, Alpha variant over 50 years of age, 4.8%, so almost 5%, and Delta variant over 50 years of age, 1.1%. So just looking at the case fatality percentage, you can see that you have a pretty big difference between the Alpha variant and the new Delta variant. And yes, I want to keep saying fatalities are not the only problem that you have with a virus, but that's a great place to start. So you do have very well accepted the idea that the Delta variant gets into more people because it has this spike protein mutation allows it in your cells easier, but it doesn't kill like, say, the Alpha and earlier variants do. Now, what are some other things to consider as we go along here? They have some data that's sort of been misconstrued online from what I can see anyway, and that's fine because, you know, people can write whatever they want. But in one group, so this is not looking at everybody in the United Kingdom, but in a group they were tracking, As far as number of people, case fatality rate, and then instead of all comers, meaning vaccinated, not vaccinated, it's just, are you over or under 50 years of age? In this one, they divided out and they looked at vaccinated versus unvaccinated people. So in the group that they looked at, the vaccinated group had 50 fatalities, The unvaccinated group had 44 fatalities. Now, this is a little bit of a statistical anomaly, not because those aren't real numbers— 50 vaccinated, 44 non-vaccinated— but because the groups of people who are vaccinated and unvaccinated in this pool are different demographics. Why would that matter? Well, if you previously saw that your Delta case fatality rate under 50 was 0%, and it's 1.1% for over 50, what if everybody we looked at, you know, is under 50 in the non-vaccinated side, and then the vaccinated side, most of the people are over 50? Well, that would change things because your case fatality rates are not the same. And so one of the things that they just statistically, to be, you know, straight up and fair, say be careful with, you know, throwing these stats around, is having 50 people die is certainly unfortunate and no good in the vaccinated group, but the vaccinated group included a higher potential case fatality rate group. Unvaccinated group tended to be younger, where you tend to have less and less morbidity and mortality from the virus anyway. Now, the other thing with vaccine, and there's, of course, again, remember, this, this is all true as of July 15th, 2021. So if it's a week later, there may be new information. But with respect to vaccinations, what they know at the moment from the UK information is there is lower morbidity and mortality, so death and other problems, if a person has had both doses of one of the mRNA vaccines. And to underscore that, in a Scientific American report that I'll, I'll read into the record, so, so to speak, they basically, one of their experts said, we don't think the vaccinated people should worry at all about the Delta variant. Also, they said we don't think the Delta variant is going to cause any surges, you know, overall surges. It might be local surges, but no overall surge in cases in the U.S. Okay. Now, there's a couple of things because, you know, this is the kind of thing where people will ask for, you know, where did you, where did you get the information that you got? So I'm just going to say it here. You know, as I said, this might turn into a newsletter where I write all this out, but just so you know, the first, and this is no particular order here, scientific American newsletter dated June 29th, 2021 by Tanya Lewis on the Delta variant. That one has a lot of quotes, some of which I have pulled out here, and I'll identify if it's Scientific American. As a scientific paper in the journal Critical Care, Khatib, Li, and Zhang, July 12th, 2021, called Emerging SARS-CoV-2 Variants of Concern and Potential interventional approaches. So that one by Khatib, Lee, and Zhang, July 12, 2021, in Critical Care. I got a lot of the more scientific and treatment-oriented things from that. There was— WebMD has something they call Lung News of July 12, 2021. There's some interesting quotes in there. There are also some online lectures, the DeBreen Medical Lectures, D-B-R-E-E-N Medical Lectures, and I looked at some of those for statistical analysis. On the Delta variant. Then some interviews with Professor Martin Kulldorff, K-U-L-L-D-O-R-F-F, from Harvard University Medical School, and he was interviewed a lot all over the world, but this particular interview I looked at was from Sky News in Australia, July 8th, 2021, where they were interviewing about the potential for the Delta variant to either be maybe a better turn or a worse turn as far as the way it affects the UK and then the US, etc. And then the final one was Nick Carter of Menzies Research Center in Australia, and he had some other quotes as well that I used as background to look some of the data up. So those are the background sources. Now, these things change. As you notice, those things are Pretty close to having happened either within the last 2 weeks or even a couple of days ago, so those are fairly new, all of those things that I pulled up. But I think what would be good, because we sort of built this idea that, okay, we understand that viruses mutate, this is a virus being a virus, okay, you're going to have mutations. Number 2, the mutations usually are there to make you get into your host easier, which Delta variant does, but they're not all there to make you more deadly, because if you kill your host as a virus, you're not going to be terribly, terribly long-lived, because you're going to kill all the hosts and then they're all dead, right? So the ideal combo, if you're the virus, is more transmissible, less deadly, and that is what we appear to see with the Delta variant. That's actually good, because we would like less deadly. The problem is, People still have it. Okay. Now, when we look at this, though, what can we take away that's mostly, you know, the good news or the positive news, or at least something we can do something about and something with? So a couple of things. One thing that we are pretty confident in saying is that the Delta variant is transmitted from host to host, human to human, more easily than earlier variants, especially the Alpha variant. So that means that there is more likelihood if you're around other people that you will, through, you know, respiratory transmission, acquire the Delta variant. The other thing that appears to be true and probably happening is that the Delta variant will likely infect younger people. Now, this is partly seen in the data from the United Kingdom and partly conjecture, but it appears if you look at the data for what it is and the ease of transmission, That the Delta variant is probably going to be in a broader group of every age group. So when we say it's going to affect more younger people, remember, for the British, for the United Kingdom numbers, younger is 50 or less, older is 50 or more. They're very, you know, it's very bilateral there. There's not like all these divisions. So when they say younger people, more younger people, they mean more people under 50. Well, the silver lining of that is that people under 50 have a, you know, nearly zero case fatality rate. Now, can they get sick for other reasons? Certainly. The case fatality rate is much lower. So if you do infect a whole bunch of younger people, your collateral damage from it will likely be less than if they were people, you know, over 60, 70, or 80 years of age. The other thing that we want to keep in mind with this infamous Delta variant is that All of the current issues that we have that make the Alpha variant, let's say for example, a bad disease are still in play. So what does that mean? Well, what that really means is, is that age still plays a role in not just fatality rate, but also the morbidity part, how sick you get, how likely you are to have other problems, how likely it is is that this viral illness would maybe trigger other problems, et cetera. So age is a primary factor in the pathogenesis of this. The other thing that's a primary factor, which doesn't change from any of the Alpha variant group, is the comorbidity. So other diseases you may have also make you a better target for the Delta variant, just like it makes you a better target and you have more morbidity Now, if you have other diseases with the Alpha variant as well, so these would be things like diabetes, preexisting obesity, immune system problems. And remember from previous shows that we've done, that can be you have a prior immune disorder, an autoimmune disorder. That can mean you have immunodeficiency disorder that's acquired. It can mean you have immune imbalance or deficiencies because of drugs you're taking. That sideline or throw off your immune system. It can be any number of things that go on. Other comorbidities we would want to think about would be lung disease. So if you already have a pulmonary disease or a disease that affects your lungs, you're maybe going to have a worse problem. Other cardiovascular diseases, which would also not just include heart problems, vascular problems, if you have a vasculitis, inflammatory vessel disease, if you have a clotting disease, all these things, you're more likely to have morbidity with the COVID Delta variant, the same as with the Alpha variant. So the bottom line is these things don't really change. Okay, now what's another one that we've talked a lot about? That would be what we call coinfection. Now we've talked about before how one of the universal truths throughout COVID data and the morbidity, the intensity of disease of COVID has been in any study that has looked at it, when they look at other infections making the COVID worse, anytime you get more than one other infection, you have a potential to have coinfection to make the COVID Disease worse. Well, what if you already have infections and maybe they're kind of silent, they're not bothering you a whole lot, but then you get this virus and it starts to fulminate inside of your body and there's already another infection there? You get a double or triple effect from those things, which is why we are always talking about, you know, treating co-infections as we go along. The other things that occur are availability things. So we talked about how we're trying to look at the United Kingdom for data because it's a little bit more like North America. It's not all the same, but it's a little bit more like North America. But one of the things that we learned from everywhere, but especially, you know, like the Indian data, Is if you have lower access to healthcare, more overcrowding, and then a number of other what we would consider, you know, collateral factors to do with your life, your ability to get care, your ability to take care of yourself, how close you are to other people, etc. If you have lower amounts of access to care, lower amounts of what we call hygienic measures and factors. You're going to have more of a problem with the disease. And so now if you have a more rapidly spreading type of a variant, you're going to have more problems. Now that doesn't change from the Alpha variant. So if you have overcrowding where you live, if you don't have good access to medical care, you don't have good access to, you know, clean water and food and all that stuff, you're still going to have a problem. If you have the Alpha variant, it's still going to be a big problem. It's just that with the Delta variant, It goes into that situation maybe more rapidly, which is one of the thoughts if you listen to the statisticians, etc., behind why maybe the experience in India was much more aggressive and why some of the co-infections that developed and the other morbidity and mortality was much more aggressive. That is a big reason for that. Now, what else can we kind of take away from this? Well, there's a few other things, and I mentioned, you know, this show has more show notes than any of the other ones, and it's great. I just want to make sure that I stay, you know, stick to the data that I pulled up and, you know, all of that. But one of the other things that came out in some of the papers where they were talking about it was the expression of the disease. Okay, so traditionally with SARS-CoV-2, COVID, with the Alpha variant that we experienced in North America, it's been our primary experience. We would have a variety of disease states that would occur all the way from, you know, almost no symptoms to like a bad cold, losing your sense of taste and smell, all the way to pneumonitis, pneumonia, all sorts of other problems, clotting, you know, heart problems, brain problems, kidney problems, etc. And what they're showing or saying with respect to the UK experience is that with adults, Delta variant, you're more likely to have an experience that is akin to maybe an influenza that you may have had before, like an influenza B or a bad cold virus or something of that nature, especially if you're younger. So what they're seeing in many of those cases is an upper respiratory illness, which is kind of classic with most coronavirus. Upper respiratory illness, maybe some loss of smell or taste, maybe not. That's a little less for sure with the Delta variant, apparently. Fatigue, maybe some muscle aches, but less downstream effect into the lungs, potentially less effect into the cardiovascular system. Although I would say that, you know, certainly your doctor is going to be watching if you do acquire this, what your symptoms are doing, and you may be monitored for clotting problems because that's part of the virus under, you know, all circumstances. But I think another silver lining thing, if you look and you look at the experience in the United Kingdom, and then you look at what's reported, say, in the WebMD and the Scientific American, you know, reviews that I was looking at, even though a lot of it is speculative because they were looking forward, What they're reporting really is, at all ages, your disease process is going to probably be less endangering of your life and health than with the Alpha variant. So then that's good for us humans as the host, if more people are going to be getting this. And so one of the references, actually a number of the references, describe the Delta variant as being more like a bad cold. Now, no one likes having a bad cold either, but if you have to choose between more of an upper respiratory experience that's unpleasant, creates other problems, or an upper and lower respiratory experience that maybe also bleeds over into cardiovascular and other areas, you would pick the upper respiratory experience, and that makes a lot of sense. Now, does that mean that everyone who gets a Delta variant is going to have more of like a bad cold sort of an outcome? No. But also people that had the Alpha variant, not everybody got the, you know, the bad pneumonitis and the other things that went on. This is a very uneven expressing virus, and as a matter of fact, unlike many other viruses, it, especially the Alpha variant, the original variant that we were seeing, it expressed very differently in different groups of people. And they were still looking at this. You can go back and look at the programs I did earlier on the genomics, the genetics of COVID And even back in the beginning of COVID when we were like 3, 4, 5 months in, and they did genomic and genomic experiments with it, looking at the different genetics and looking at the phenotype, the presentation. Even early on, they were identifying 6 totally different presentations of, of the original COVID that we experienced. So it should be no surprise that then when you go down the stream, you get to a Delta-like variant that transmits easier to other people, you're going to have more people just having a bad cold-like experience, which is great, but you're also going to get other types of manifestations. And what most of the experts are saying, which makes complete logical sense, is if you're younger, obviously case fatality rate is much lower if you're under 50. If you're younger, you're going to have probably a bad cold experience, you're going to feel pretty bad, but your downstream effects are less likely. If you're over 50 and you're sicker, you have some of those other underlying problems, You're going to have a bad cold-like experience, but it might, it might trigger other things. So how would that happen? Well, in a few minutes we got left, we want to talk about this because remember, I keep going back to this idea anytime we talk about COVID that co-infections, the infections we already have with us or that we get exposed to when we're sick, are critically important to the pathogenesis of anything, but especially something like COVID. So we're going to go back to How would that work out? Let's say I don't feel sick, I don't feel like I have any infections in my body at all, great, wonderful, then I get exposed to COVID, let's say it's the Delta variant, what if, and this happens, there are many, many viruses that we're exposed to every day, we have an immune system that keeps them from being a problem, what if we get exposed to COVID And say the Delta variant starts to light up our respiratory system in the upper respiratory area, get a sore throat and stuffy nose, all stuff. What if we get that going on, but we had a dormant virus, of which your body is full of them, that likes the lungs? Well, then you, instead of just having an upper respiratory manifestation, may activate this dormant virus or maybe a dormant bacteria like a mycoplasma and other things like that, they may activate because you've become inflamed, your immune system gets turned on, there's an immune war, and things get activated, and so you may, through no fault of the Delta variant, have a big lung infection that actually is from some other infection. This is why when you're triaging people and, you know, they have certain symptoms, you are supposed to check them for other infectious things, certainly influenza and strep, strep pneumoniae, but also you're supposed to be looking for these atypical pneumonia organisms in the lungs, certain viruses, et cetera. And that's because as soon as you turn the switch on with any level of COVID let's say it's a Delta variant, now you're weakening the body. The immune system is focusing, and these either dormant, or maybe you just got exposed because we get exposed to these things all the time. Maybe you just got exposed when you first get sick with COVID Delta variant. Now, Now you have— it makes me cough. I do not have COVID or any other odd thing that I know of, but you get exposed and now you light up this other infection that's completely sometimes not even a virus, right? So then you look and you say, well, you know, why so much difference in the expression, the experience of COVID among people? That's a big thing. Yeah. If you go, as I said, in all of the research papers, uh, when they go looking for other infections, they find them 100% of the time. The sicker you are, the more infections they find. The different locations geographically in the world that they look, different infections. The one unifying thing is there's always infections in the background, and the sicker you are with quote-unquote COVID, because that's the primary insult, Usually the more infections you're dealing with that are there along for the ride. They're opportunistic in that respect, so they do need to be treated. Well, any other things from that critical care paper, that kind of hardcore science paper I talked about earlier, that might be a silver lining? In the critical care paper, they, they did have a couple of silver lining things. So they talked about the genomics and how it's different All that business, a lot of really heavy genetic science going on in that paper. But one of the things that they said was the Delta variant has a positive, big positive in the treatment realm in that it has high sensitivity to endosomal blockade agents. Now, what does that mean? What you want, if you're the virus, is to not be blocked when you go into the cell. Right. Okay, so you want the transport system to get in the cell and replicate. That's your job as a virus. The Delta variant is very weak in respect— so it's very strong in respect to it can get into people more. The spike protein mutation does that. But if you put a blocker in blocking getting in the cell, it's not as strong to get through the blockade. So what are the blockade agents? Okay. Well, blockade agents include some of the atypically used antimalarial drugs. So you hear about artesunate, artemisinin. Artesunate is a malaria drug that we use for a lot of other things. Ivermectin, hydroxychloroquine, macrolide antibiotics. So that's like azithromycin is the one they usually talk about, but there's others in the macrolides. All of those atypical malaria drugs, the macrolide drugs, there's a few others, basically put a wall up so that it's harder for the virus to get in. Turns out the Delta variant is very well blockaded by those drugs. Now, what's nice about that is that most of those drugs are available. I know, and you know, every doctor is different in the way they use these things. Every hospital has different protocols and things, but A couple of colleagues and myself, you know, shared, shared notes about treating people, you know, pre-hospital treatment or even in the hospital treatment using these different agents, and they, and they really do help. Now, if you look at it, your atypical malarials, your macrolide antibiotics, and a non-macrolide antibiotic that helps here also is like doxycycline, which is not a macrolide, but it's another kind of antibiotic. These things are well known to physicians, they're easy to use, they're easy to use along with the other treatments, and it's just really nice to know that the Delta variant is even weaker in the face of these other treatments. Also, that the antivirals that are available right now, like remdesivir, ribavirin, which is an antiviral been around a long time, gladcivir, these all work really well with the Delta variant. These are usually used if you're in the hospital, sometimes outpatient. Some of the things, the passive things like the antibody, whether they're, you know, antibodies that are from human or they're engineered, in any event, those things appear to be having some effect. And bottom line, much lower fatality rate. Well, we just about burned up all our time, and I really wanted to address this idea of the Delta variant and Do all the preventive things that we've talked about before, but if you do get the new Delta variant virus, if you're having a mild case, check in with your doctor. If you're having an aggressive case, when you check in with your doctor, do check into those other infections that may be present, because that is a huge arbiter of, you know, how sick you can become with the Delta variant. All right, well, we are out of time for today. This is Medicine Health with Dr. Paul Anderson. I'm Dr. Paul, and it's my pleasure to bring these sessions to you. Please take a look at the new website, dranow.com, dranow.com, and also check us out there. There's links to everything we do, links to the newsletters we've talked about, YouTube channel, everything else. Take a look. Thank you all. I'll see you all on the radio next week.