COVID DELTA VARIANT UPDATE Part-2

little chevron, it opens it up, it'll all be in there. Um, but I used broad resources. Now that's for 2 reasons, as I mentioned. One is there's not going to be as much published in like peer-reviewed areas with something that's pretty new. I have a little bit of that, like from the CDC and from some publications about Delta and other variants that I will list in the resources. But then the other, uh, side that I did was tried to find original interviews with people who were in the public health space. Normally those are physicians and/or public health officials or some combination thereof, and people who were on the ground looking at it. And the other part of that is, and I'll get into this right here at the top, because last time I made the proposition, which is turning out to be true, that because other countries have had Delta before, We should consider what's happened in other countries, but we should probably consider countries that are the most similar from a geopolitical, sociopolitical standpoint to North America, because it's more likely that's what's going to translate experience-wise. It's not going to be one-to-one translation, but that's what's going to translate experience-wise. So we've been looking a lot at the United Kingdom. So you'll notice in some of the references, I actually look at public health and physician Comment from the United Kingdom because they are ahead of us with Delta, and they have some good comments about safety, experience, outcomes—all of those sorts of things. So, as I said last time, you know, with Delta, I had a lot of notes. This time, you know, I have probably four times as many notes because I really, really wanted to be as close to. you know, you— the truth is elusive, but as close to the data that we have today as possible. So just for the record, it is August 12th. The last one of these we did was on July 15th, so just about a month. And here it is, August 12th. So anything from today forward might change because data and statistics are evolving. Everything I'm going to tell you is as close to accurate as I can be as of today, though. So the next thing I want to point out is there's nothing in this program that should be considered medical advice. It's a really bad idea to get your medical advice off of television or, or a podcast or anything like that. This is information. This is me answering questions, and these answers are my opinion based on the facts that I'm going to try and present. So I want to be really clear about that. I am not telling you to do or not do anything. That is between you and your healthcare team. I am trying to answer some really, really good and sometimes very hard questions that were posed to me. Now, the other thing is, as I mentioned down below, when we get to YouTube— I keep saying that because we're live streaming this right now— it'll get put up on YouTube very soon, the next few days. When it gets on YouTube, I'm gonna put all these links down. One of the links is gonna be to the last podcast, so Delta Update Part 1, and a couple of the others are gonna be to some of the immunology shorter talks about— that'll kind of flesh out some of the topics we're gonna talk about. And so just to get us back up to speed, if we wanna look at, you know, What did we talk about last time that is, uh, is still true? Okay, uh, and what we want to talk about— I can make all my props work here, there we go— uh, is that, um, uh, virus, especially this type of virus, mutate. It's their job. Okay, this is basic viral biology, if you will. Uh, the Delta variant is part of that. Now there's others, there's Lambda variant, there's all sorts of Greek letters you'll hear about. The variant that you've heard a lot about prior was Alpha, at least in North America. So it's normal for virus to mutate. So that's number one. Number two, it's their job to survive. And usually what mutations with viruses do is make them more infectious, but not always more dangerous overall. So that is important, and that's going to come up today a lot. Now, we talked about the usefulness of the UK, United Kingdom data and why we're relating to that, because they're ahead of us and they have a little more experience with this than we do. And as I mentioned, the reason that we're not keying so much off of the data from India is that the population and geopolitical sociopolitical and medical-political factors are simply not as close to North America as the UK is to North America. There's no perfect analogies, but that's why. Now, a question that I got that I think we should start with is somebody— a lot of people ask me this. I keep hearing on the news or wherever people get new information, Cases, cases, cases. The cases are going up. We're going to talk a lot about case numbers today. Does case mean sick? Good question. No, it doesn't have to. Okay, a case means that we tested you and you are positive. Okay. There are a number of people who are a positive case who do not go on to express disease with Many things, but COVID is one of them. So you're going to see a little bit later when I quote some data from the United States that there is like a bigger number— that was the total number of cases— but a smaller number who were symptomatic. So case and symptomatic are not equal. Obviously, all symptomatic people are usually one of those cases, but case is a bigger number than symptomatic. The other thing with the United Kingdom, I'm just going to repeat this from last time. This is part of the data from last time, but it still holds up. If you look at people, and they, they were doing their stats under 50 years old, over 50 years old. So if you look at people under 50 years old, the original Alpha variant had a 1/10 of 1%, so 0.1%, fatality rate. Okay, the Delta variant under 50 had a 0% effective case fatality rate. In the UK, over 50 years of age, the Alpha variant was almost 5%, 4.8%, and the Delta variant was about 1%, 1.1% case fatality rate. And that just means if you have, you know, 100 people, um, you know, you're going to have 1.1% of them You know, or as close as you can round up, who are going to be fatalities. Now, that kind of gets us up to today. Obviously, there's a lot more in that podcast from a month ago, but remember that we want to talk about this from a question-answer point of view. So the next question that I got a lot of feedback about was, and it was really good, you know, feedback and good questions, Was, I heard that there was this big outbreak in Massachusetts and— sorry, I look over here. I've got these questions written over here that people ask, so I don't make up the questions. I let people ask them. I write them down. So I heard Massachusetts had an outbreak of the Delta variant and they had a lot of vaccinated people who were positive as well as unvaccinated people. Is that true? And what does that mean? So If you look at the Massachusetts outbreak data, it started over the week of the 4th of July and then the week following. And it was this 2-week period encompassing a couple of holiday things where they had a lot of heavy crowds in, in this particular area. So there's more people, there's more proximity, there's going to be more potential for spread. And so of this outbreak in this area, they had 469 positive COVID cases. Now remember, positive just means positive test, doesn't mean that these people were sick. Okay. Now, I want to make a comment here because it goes to another question, but this is a really good place to put it in. How do we know those positive tests were Delta. Okay, for the most part, if you go and you buy a home kit and you do a swab and it's positive or negative, you don't know if it's— that's just— it's COVID-19, that's all it is. How do they know? Usually public health, like state health department, etc., will take a sampling of those cases. In this case, they took 133 of the 469 And they did a different test, which is the genetic sequencing, and that genetic sequencing showed that 90% of those cases that they sampled— so they sampled a little, about a third of them— 90% of them were Delta variant. So when they say, you know, so if you get swabbed today, you may be positive or negative for COVID depending on the type of test. But usually those aren't telling you what kind of variant. That's a secondary test that is a genetic sequencing. Now, if you look at these 469 cases and you look at, well, Massachusetts Public Health prior in the week prior, what did they have? They had zero cases. So you go from Massachusetts Public Health prior to July 3rd, that week you had zero cases, and then you go and you have the festivals, you got boom, 469 cases. All right, now to get to the question that was asked with regard to the— were they vaccinated or not? Did vaccinated people get sick or not? All that business. So on July 26th, of the 469 total cases, 74%, or 346 of these people, were vaccinated. 26%, or 123 people, were unvaccinated. So what has been put in a lot of news stories, because it's in the data here, is 3, you know, 2/3, 1/3, you know, basically, um, or 1/4, 3/4, I guess, uh, vaccinated were the larger group. So that's interesting. Now, if you look at— remember, cases doesn't equal sickness. So of 346 vaccinated people, 274 vaccinated people showed symptoms. So again, you've got a differential where there's less sick people than there are cases. Okay. Now, something that we should also look at is, in that short time period, did anyone get like sick enough to go to the hospital? They had 5 people go to the hospital, 4 of them were vaccinated, 1 person was not vaccinated. So this is a lot of the news stories, and I think where this question came from was, is a lot of stuff put out about Well, then did the vaccine really help the people or not? Why did more people with the vaccine, you know, come up sick and all of that? Um, and is there any other places where they've looked at this? Well, before we break this down and talk about, you know, vaccinated, unvaccinated, all that business, um, in, in early August, so just after this, there was another area in Colorado. And again, this is all referenced and we put this on YouTube. I'm gonna put it down in the comments so you can look it up yourself if you want. Um, But there's this area in Colorado where there were 900 cases that they checked by— 900 Delta confirmed cases, and half the people were vaccinated, half were not vaccinated. So now here's the thing that the CDC says about it, and then we'll kind of break it down a little bit more. The CDC basically says you should assume that the vaccinated people will be positive, and we'll talk about why. but will have a shorter window of carrying the virus and being positive. Now, what's another thing, and this will come up later, but when the CDC did a test on a group in Massachusetts, what they found was there was the same amount of virus in the back of the pharynx in an infected vaccinated person as in an infected unvaccinated person. I'll talk about why, but they said, yeah, there's just as much virus there. Okay. So this is leading to a lot of other things that are going on, like maybe putting back in some new controls and all sorts of other things, because obviously we have, you know, 50-some percent of the United States are vaccinated, but they can get sick still and kind of carry this, even if they're sick shorter amount of time. That changes the game as far as transmission. Vaccination doesn't mean no transmission. at this point. Now, just to discuss why would a vaccinated person even get COVID and why would they have just as much virus in the back of their throat as a non-vaccinated person, you have to look at the way the vaccine, the current vaccine works. The bottom line, and I'm going to link down below 2 short videos about T and B cell response, we don't have time for it here. The bottom line of that is, is that when you inject an immunization, you know, intramuscularly in your arm, uh, or anywhere peripherally, you're going to get and engender a T and a B cell response. And then what you're hoping for is memory T cells and then immune globulins, immune proteins, usually IgG. Well, the immune proteins that protect your ear, nose, and throat area and other mucous membranes, but in this case, ear, nose, and throat area, and your eyes is IgA, like alpha, not G, like George. IgG is what goes up mostly with your immunization, the type we have now. For instance, earlier today I was listening to an update from the CDC and they were saying, well, maybe if we develop some nasal spray type immunization, you trigger IgA response first and that would short-circuit this. But then they said the problem is that all those nasal spray things are in phase 1 development right now, so that's not really a reality for us at the moment. But that's why you can have full immunization and still have virus growing in the back of your throat. Now, CDC does say, to the best of their understanding, if you are sick— and remember, it was, you know, 3 quarters with vaccine, 1 quarter without vaccine— if you're in the 3 quarters that were sick, you're probably sick shorter amount of time. One of the troubles that the CDC was bringing up in this update this morning was They don't actually have that follow-up data to know how long were these people sick or anything, but that's what they believe right now. So the next thing really is, and this came from a follow-up question from one of these, is it says, is Delta as transmissible to everybody, meaning young and old, as I hear it is? That's one thing that's pretty uniform throughout the information from the science and the mainstream media and everybody else. Delta, one— and we talked about this a lot last time— one of the reasons— I'm giving a virus reasons like, you know, like it's thinking of this, this is how the machinery works— one of the reasons the evolution of a virus, why you would mutate, evolve, and make a variant. is so that you could get into more hosts. We people are the hosts, right? So a good mutation is if you can get into more people. What'd we see with Alpha? Alpha didn't get into children, young people quite so well, had other things. It got really hard into some people, not into others. Delta is much more egalitarian in that it, like, it will infect anybody of any age apparently. And this is based on data from Europe and And now here. So it is as transmissible as you hear. It is much higher transmissibility. You can go on the CDC website and they have these little pictures of like one, you know, Alpha variant person and how many people they infect, and one Delta person and how many people they infect. It's a lot more on the Delta side, but that's the bottom line. Now, one of the things that is something to think about, though, is whenever you have something that suddenly goes from moderately transmissible human to human to very transmissible human to human, you have a sudden increase in the numbers you're dealing with. And that's really scary, and that's what you keep hearing about on the news. more, more, more, more. It's going up, it's going crazy, all this stuff. Well, the thing that you have to remember is just because there's a big jump— remember, cases do not equal sickness. So if there's a big jump, you're going to change the statistical base for everything, which is how that works, because you've got more numbers to deal with. And you're going to pepper these numbers across the age range, especially in younger people where we didn't used to have quite so many. So you're going to have these statistics that look like, geez, we, you know, we went from almost no hospitalizations, and now we're a lot more, whatever. Those are what they're calling a numbers game, and we'll get into that. Okay. So another question that came up afterwards, because I relied so much on comparing to the United Kingdom, was, is the United Kingdom still worthwhile to look into even though we're now into Delta for a little while? Well, yes. Anytime you've got a comparator that's ahead of you a little ways, you still want to look at that. So I want to break that down with respect to United Kingdom data a little bit, just to give us a sense of transmissibility versus sickness. Okay. Now, what is coming out of the United Kingdom is it's much more transmissible, so there's more virus able to get to other people, and other people get the virus, become positive cases. But remember, Case doesn't mean sick. But what the UK is concluding is that you have faster spread with Delta, but less virulence, a less dangerous virus, and a lower case fatality rate. So if you look at it and you go sort of in a line, you've got a case, which just means you test positive. You've got a morbidity or a sick person. And then you have mortality or a fatality, someone who died. So the case fatality rate, sort of the end of that trip. Now, want to keep in mind, those are just 3 data points on a line. There's other stuff like long COVID and all sorts of other things, and we may get into those at a different time, but those are kind of important to look at. So the United Kingdom data has shown that Delta spreads faster, but it's makes people less sick and it is not as deadly. So the United Kingdom case fatality rate has had a downward trend, and it's under 0.2%. It's 0.186%, which is 90% below. So the fatality rate is 90% below the beginning of the pandemic. And again, I've got references for this in there if you want to go look. The the interviews up where we found this. So a low case fatality rate is associated with lower Delta lethality or deadliness, etc., of course, and, um, an overall increased immunity. Now, why would we get increased immunity? Because more people are getting sick. Literally, you had in Alpha, when we had those surges, you had sectors of humanity getting it and usually getting sicker and more likely to die, but there were large population groups that were missed. Now you have larger populations being infected with a less virulent virus and less deadly virus, which means the people live, uh, whether they're vaccinated or not, they live to the other side. And now they have either native immunity or native immunity plus vaccine immunity. So the UK scientists now have decided that where they're at now is they call it a manageable situation because they not only have, you know, high rates of vaccination, but they have high rates of natural immunity piggybacking on that. And the more natural immunity you can develop through any means, the better as you go along. Um, So the other thing I think that's instructive from the UK data, and, and I just— so I don't make mistakes, I am reading off some cue notes that I wrote for myself. January 2021 in the United Kingdom, their peak was 80,000 cases a day. Now remember, case doesn't mean sick, just number of cases, and 1,300 deaths a day. It's a lot of deaths. One death is too many, but that's a lot. Okay, July 2021 in the United Kingdom, because remember, they're ahead of us on the Delta curve. the peak was 60,000 cases but 78 deaths. If we go from January Alpha to July Delta, we've got 1,300 CFR deaths a day and 78 a day in July. Now, there was a really good set of interviews that were done, and I just want to go through You know, to kind of, kind of sew up a couple of questions here, and then I want to talk about pediatrics, children with Delta, because for one thing, you know, we're all concerned with children. Nobody wants children to get sick, especially not to die. And we're hearing a lot of really mixed messages around children, largely because children are getting infected now where they weren't before. So it changes the game a lot. But before we head on to children, The, the question of is Delta really more dangerous? Now I've been talking about that. If you watch a lot of news outlets and a lot of talking heads, they say it's more dangerous. But as I said, in the UK experience and now in our experience, it's, it's statistically not showing out that way. But do we have any people commenting on it, even though we don't really have a lot of hard statistics? Well, we've got people like the CDC director, the Surgeon General of the United States, and some health department folks that just want to go through this. So one of them is, although greater transmissibility of Delta is clear, scientists are less certain about whether it has higher virulence, if it's a worse virus. The evidence on the disease severity is limited and anecdotal. That means that you have people reporting, so you get one person and Their experiences. I've had 20 patients with Delta and it was a mild cold. Next person says, I had 20 patients with Delta and we had to hospitalize half of them. Well, that's 2 groups of 20. It's 2 people's legitimate experience, but it doesn't mean everything about what each person said is true. That's just not how it works. So when they say anecdotal, they mean we're just telling stories right now, and you, you have to add them up and stack them up. Uh, there is Dr., uh, Briere— I hope I'm saying his name right— critical care chief of Baton Rouge General, uh, said, you know, who said that in their experience they see, um, you know, onset of respiratory problems faster. But if you're in critical care medicine, you're seeing, you know, kind of backwards to a small sample of people who are super sick and they're going to critical care. You're not seeing everybody. And so he also said You know, this is my observation, it's anecdotal, but that's just what we're seeing. But that's with sick people. Now, another question that came up was, well, I heard reports from the White House and the CDC directors that said most hospitalized people were unvaccinated, most, most deaths were unvaccinated. And they said that, that part is true. But they also walked those comments back and said that they were relying on older data that may not have even related to Delta variant. And so the, the, I believe it was CDC director said, you know, last Thursday that they really, you know, those comments were a little bit premature. Well, Great, okay, they're all already out there. And then Ohio Health Department was interviewed, and again, I've got these references in there. But they also said that, that a lot of their proclamations about how deadly the Delta variant was were based on really old data that doesn't really translate now. Let's take a bit of a turn now and talk about children and children being infected, etc. So the first thing to think about in regard to children is, just like with adults, it's best if nobody gets sick and nobody dies and nobody has long-term consequences. But the reality is, that's just not how it's going on. Okay, any, any illness, but especially, you know, an epidemic pandemic type illness, you're going to have not only illness, but you are going to have death. So what we want to look at is, because this is now affecting children and it wasn't largely affecting a lot of kids before, we got different statistical values to consider and think about. So one of the things that we want to think about with respect to kids is related to some good questions I got from some parents. And so the first one was, uh, we keep hearing that children are being hospitalized at alarming rates. Is that true? And if so, why? So we go to January 2021. We had 0.2 children hospitalized under the age of 4. Now, under the age of 4, why would they pick that as a, as a age range for marking hospitalization? Well, there's a lot of reasons why, but the smaller that the human body is with respiratory— especially respiratory viruses and other respiratory problems— the quicker you can go into respiratory distress and failure and pass away. And so, for example, there are things that you can weather really well as, say, a 10-year-old or an adult infection-wise that can kill little tiny infants and small pediatric children because their airways are so much smaller. So it's the same infection, but the disease can get in and create respiratory distress, failure, death, etc., much more handily in a smaller person. So actually looking at, you know, children of a younger age, in this case the stats for US CDC quote is children under 4, So in January 2021, it was 0.2 children per 100,000. So that meant, you know, it would take, you know, 500,000 children to have one hospitalization. In July 17th, so into the era of Delta, we bumped up to 0.6. Okay. So you're looking at just under 200,000. So you go from 500,000 500,000, 200,000. There is a difference there. Um, but when we look at that and we say, um, okay, now if we're gonna think about it, did the United Kingdom public health people have any say around this, uh, world of children with the Delta variant? Because obviously over there they had a lot of kids get the Delta variant as well. So In the UK, this is a quote from one of the references. Again, you can have it, it's in there, put it down below in the description box when this is up on YouTube. So just be patient, people. Don't be commenting, it's not up yet. We'll get it up as quick as we can. Um, the UK public health experts basically said that they're not seeing any evidence that Delta makes kids sicker than Alpha did, for example. Yes, it makes more kids have positive cases, but is the level of illness that they're seeing worse? No, not from what they're seeing. There's a pediatric infectious disease specialist that'll be quoted, it'll be in the notes too, and she is essentially saying, you know, yes, we have more children who are sick, But we're not seeing a shift in the virulence, the danger of the virus, to a place where, uh, where it's a whole new game. Yes, it's more numbers, so it's a numbers game, but it's not a deeper level of illness with the children. Now, again, what do they mean when they say a numbers game? Well, what that means is if— especially children are a really good example of this— if you go, uh, from Alpha variant where you have, you know, a lot of adults— the older you are, more likely you were to be infected and be sick— children, lower amounts of illness. Okay, so you're looking at numbers that are filtered through a pretty low, uh, total number. Now, if you've got widespread Delta penetration into the pediatric world And, you know, technically in America, pediatric is, you know, up to 18 years old, but consider children, you know, of most any age you want to think about. Now we're going to have more kids who are sick, although not at a deeper level. We have more of a front-end number to deal with. So if you have, you know, a group of 10 children and you're looking at how many times those 10 children you know, break a bone or do some other thing, some simple statistic, you're going to get a little bit different view than if you have 1,000 children and you're looking at that. You're going to get your numbers faster, and the numbers are going to maybe be a little bit different, skewed a different way when you have 1,000 children. Well, it's that way basically with Delta, where before we're looking at minority of children, now we're looking at a larger group, if not majority of children. Then really the next thing to consider is what are US pediatricians saying about what they're seeing with COVID Delta variant in children? Again, this comes from one of the references. There's a couple that are specifically pediatric-oriented references. But I'll just go through these statements, and again, you can look them up, and, and I, I'm quoting these right out of, right out of the resources. Number 1, most children with COVID-19 have mild symptoms, and there's not enough evidence to conclude that Delta causes more severe disease than an Alpha or other variants would. So again, in general, Alpha you know, with milder symptoms for children. And there's, there's no early— this is early in the game. They're saying there's no evidence to say Delta is making kids any sicker than Alpha did. When they look at some of the specific, uh, you know, at, say, children's hospital centers and things like that where you see obviously a lot of children, what do they see with symptoms of the children. Most of these children have relatively mild symptoms such as runny noses, congestion, cough, or fever, said a particular doctor, director of pediatric emergency. Most of the kids are not very sick. Most will go home and be treated with preventive care at home. But as you might imagine, the families are scared. Well, certainly, because, you know, depending on how much news you consume or where you get your information, etc., uh, there's a couple of factors. One is just, uh, if all you hear is, oh no, Delta, and Delta's worse, and everyone's gonna die, um, and your child gets sick, you're going to be, you know, double worried at least. On one, uh, angle, you're worried because it's your child and, and nobody— we don't want our children to get sick. And number 2, they're sick with something that might be something you heard really bad things about. And so certainly there are subgroups of children who they have to be very, very careful with. I'm going to talk about that. But generally speaking, when you look at experience at children's hospitals, especially in the emergency departments, they're saying, you know, these are flu/cold type symptoms and most kids get to go home and just be treated supportively at home. That's really wonderful because you don't want your child in the hospital if at all possible, and you want them to be treated at home and get over it and be all better. Um, another quote, you know, we, we don't know if Delta is really making kids sicker or not, but because Delta's, you know, 2 or more times more transmissible, you just see more kids getting sick. So some of the reporting— and I don't believe that, you know, I, well, I believe there's, you know, sometimes people report things for particular gains or whatever. But I generally think, you know, things get reported the way they get reported, and you have to be really careful with these things. So one of the things that's, that's easy, uh, to, um, misquote or misappropriate in your reporting— it's possible— is, uh, first, you know, a case doesn't make a sick person, right? So if I have 1,000 cases but I have 500 sick people, uh, Yeah, the 1,000 cases are meaningful, but I'm really concerned about the 500 sick people. Uh, the same thing goes for if I am, you know, told as a reporter, oh man, you know, I, uh, I'm the spokesperson for Children's Hospital emergency services and we've had a fivefold increase in, uh, in COVID cases in children, then that can be, you know, kind of extrapolated out or kind of twisted to say Oh, fivefold increase in cases, that must mean it's 5 times worse of a disease. And it gets reported there's more cases and it's much worse, much more scary. And actually the two are separate. We— and we do need to keep those separate. So there is another at Texas Children's Hospital, one of the chiefs of pediatrics there. There is no firm evidence that Delta as a disease is more severe, and even though they've had a large amount of children suddenly testing positive, so about 10%, which is a huge amount over how it was before. Just to finish up that thought with the Texas Children's, they went from a 3% Case positive rate to a 10% case positive. So again, cases don't mean sick, but it's an indicator there's more people getting exposed, and in this case, more children. And let's see if there's anybody else here. Okay, so from the American Academy of Pediatrics, this is another quote. which I have reference for you for. Not all— this is a few words here. Although not all states report their pediatric hospitalization rates, the data that is available suggests that they have remained essentially steady for months. Nationally, roughly 1% of children who are infected with COVID end up hospitalized. That's of all variants, 1% end up hospitalized. And 0.01% pass away, so 1/10 of 1% pass away. Hospitalization and death rates have declined since last summer. So even according to the American Academy of Pediatrics, even though we're having this upswing in infectious ability, most kids are weathering it. They're either asymptomatic or they're weathering it at home. And they're recovering like you would from the cold or flu if you weathered that at home. Now, the next question I think is, is really good because it's germane to why, whether it's an adult or a child, would we see, you know, a lot of infections, say, in children. But a certain group of children who do get really sick and maybe need to be hospitalized and maybe even die may be part of that 1/10 of 1%. What are we seeing? Well, this is coming out in a lot of the reporting too, and this goes back to a question I was asked by a parent, and they said, you talk a lot about co-infections. So remember, that's— we talked about that with COVID in adults, where if You know, if I get COVID and I already have a lung infection, now I got 2 lung infections, I'm more likely to have lung problems than if I just start with COVID And a lot of people have silent infections just hanging around that aren't— they're not fulminating, they're not a lot of infectious material. And then you get COVID, immune system goes nuts, and you have this bloom of multiple infections. That's what a co-infection is. So coinfection is more than one infection at the same time, whether you tested for it or not. And what I usually say is, you know, if, if you don't look for an infection, you'll never find it. And so there's a short list of things you're supposed to check for with COVID patients. It has a lot of other possibilities that really should be tested for as well. But the reason a coinfection is bad is because I've already got a potentially nasty viral infection that likes my respiratory system. I don't want to have other infections in there, you know, brewing around because, A, they're going to make my airways weaker, they're going to make me more likely to clot, they're going to make all this inflammation, and I'm going to be more likely to have a bad outcome with my COVID if that is the infection. Now, what's an added problem with children, especially younger children, and, and a co-infection? What we talked about earlier, and that is respiratory distress where you have an inflammatory action in the airways. And so your airways have 2 ways of, so to speak, getting you. Okay. And one of the reasons that, you know, when you work with parents and you tell parents what to listen for their children, we worry so much about croup and croupy-sounding coughs. Is there's different reasons for that restricted airway sign of croup, and some of them are mildly inflammatory, some are major inflammatory, and some can actually kill the child. And so when you have respiratory problems and you're a big adult like me, you have more of a window for the two ways that your airways can get at you. One is constriction, and one is inflammatory fluid in. Well, if I get that, for example, I'm an asthmatic, and if I'm having an asthma attack, that's what happens. The airway starts to shrink down, I get inflammatory fluid in there, I can die from that. Okay. Well, imagine if you're not that big giant airway like me, but you're an infant or a 2-year-old or a 3 or 4-year-old. You have tiny, tiny airways, you know, I think just the how little an infant is, or even a 2-year-old. And so instead of this big, you know, trachea here and my primary bronchi and everything, uh, you've got this little tiny, tiny airway, you know, this big or smaller in an infant, and it just gets smaller as it goes down in their lungs. Well, if you inflame that, you can take away— whether it's adult or child, but in children just goes faster— and take away their ability to transfer oxygen and CO2, and that's the job of the lungs. And we get down to the alveoli at the end, those little sacs at the end. If they're full of water and they're all shrunk down, you can't get the air through. Okay, that's respiratory distress. Now, it's a little more technical than that, but that's the bottom line. So if you have a child— now, what is an upside of being a child? Most children don't have a lot of the Respiratory infections that are silent that us adults have. So that's the upside. What's the downside? There are certain respiratory infections that really get children, and if they're co-infecting, then it's a big problem. Now, the one that is getting a lot of attention right now is the RSV. RSV has its own billboards. You gotta watch, you know, for this. And you watch your kids in the fall and winter, they get respiratory illness, fever, etc. And it's called a respiratory syncytial virus. RSV is a little easier to say. And so last winter, RSV rates were pretty low because kids weren't going to school, no one was going anywhere. And, you know, whatever you think about that, there was just isolation, so there just wasn't as much virus. Well, now we have, uh, children out doing things, being kids, all that stuff. And so you have more exposure, not just the COVID Delta variant, but now also the natural stuff that goes around with children— colds, flus, RSV, all the other things that you have to watch out for. And so, for example, at, uh, uh, you know, Kansas City Children's They had a 3-time increase in RSV patients, and in Texas children, they had like 1,500 positive RSV tests, which is a lot of RSV tests. And so the, the, the normally very infective but not very dangerous COVID Delta variant for children— so again, more infective not as dangerous, becomes more dangerous when you have a co-infection, when you have this thing stacked on top of your COVID infection. And so it's not that you really, you know, are gonna be able to probably keep your children from being exposed to any of those things. But you have to be vigilant about it. And so if you have a child who gets a febrile illness and they start to have some respiratory problems, you really do need to have them seen and evaluated as quickly as you can, because respiratory problems— the smaller the human is, the faster they become a problem. And so it doesn't matter whether it's COVID Alpha or Delta or it's RSV or it's one of each. If it hits the respiratory system and they're wheezy and they're febrile, you need to get them looked at. Now, most of the time, they'll be treated with supportive measures. They may, they may use like a nebulizer. There's certain drugs that are useful for helping to open things up. There's other supportive care that you would do with other viruses. All sorts of things can be done. The point is, you don't want to let your child, especially a little you know, infant, small child, you don't want to let them sit and have wheezes or croupy coughing, you know, that kind of seal barking cough, etc. You don't want that going on without checking in with your pediatrician, whoever does your healthcare for the children, because it's something that they need to say— they get their eyes on, they listen to it, and they say, okay, it's a small, medium, or large problem. It's a small problem, we may just do supportive care at home. Medium problem, we may give you some new prescriptions, do supportive care at home. Large problem, we may put the child into the hospital until we get them stabilized. Now, the upside of this, if you're looking for silver linings, because I'm talking about children getting hospitalized, uh, almost all of the children who get hospitalized and get stabilized leave the hospital alive and weather it and are sent home to do home care. And that's what we're seeing in this data that's, that's emerging. So it's not all bad news. So just a couple of things. One is you got to remember, we have a variant that's doing its variant job, right? It's a variant. It's supposed to evolve, supposed to get more virulent. Or more transmissible, less virulent, so it infects more people but doesn't kill as many, because if you kill your host, you're gone as a virus, right? So all that being said, you know, what can we do? Well, we talked about this last time a little bit, but you want to just sort of dial back and think about environmental precautions like washing your hands. If you or any of your family members are sick, stay home. If, if you're around people, especially if they're coughing or you're in close quarters, appropriate masking. I'm not here to tell you how to do those things. Lots of stuff on the CDC about that. There's immunologic precautions that you can do, and I'm going to put some links down below to some what we consider more hygienic things, you know, like sleeping, staying hydrated, not eating a bunch of sugar— that actually doesn't help you— nutrients. I'll put links down below for that. If, if you're— it's appropriate for you to be vaccinated or not vaccinated, do whatever is appropriate there. Again, Totally different topic. Get your info from that from your healthcare providers. And then, uh, Delta variant is shown in the research— I'll put the references in— to be susceptible to uptake blockers. And that includes your antimalarial drugs. That's like artemisinin, artesunate, ivermectin, hydroxychloroquine, etc., etc., etc. The macrolide antibiotics like azithromycin, The non-macrolides like doxycycline and some other ones too. There's a lot of things that can be done, but biggest thing is, if you're sick, stay home. If you have respiratory problems, call your doctor, go to the emergency room. All right, well, we have rushed our way out of time. As I said, when this hits on, on YouTube, I will put all of that show outline with the references in it, so you'll see it down there in the Uh, in the con— in the box. Uh, please keep sending your comments. I loved all the questions, but it's time for me to get off of the radio and, uh, see you all next week. So I'm Dr. Anderson for Medicine and Health with Dr. Paul Anderson. I'll see you next week. You've been listening to Medicine and Health with your host, Dr. Paul Anderson.