Your COVID and IMMUNITY Questions Answered

Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening the often mysterious world of how doctors think and how science works. This program exists to educate and empower you, the listener. Now here's your host, Dr. Paul. Good day, everyone. Welcome to Medicine and Health. I'm Dr. Paul, and today it's, uh, your COVID questions. So I get questions across a lot of different social media outlets. And so I thought we would just jump right in and get to them. So your COVID questions answered. Now these kind of go in an order, but because they're different, obviously different questions from different people, the only theme was COVID. So there's a lot of different directions we're going to try and go here in the next hour or so. And, you know, every time I feel like, well, you know, there's probably no more podcasts left for COVID, it's like the gift that keeps on giving. And so here we go. So the first one, and I think maybe this one I just pushed up to the top because it's, it's been in the news. And if, if I was going based on, you know, things that have most recently been in the news up until about 20 minutes ago, this would have been number one. But in the last 20 minutes, FDA has put out a restriction on the Johnson Johnson vaccine because of blood clotting, which we've known for a while. You know, all of the vaccines have a potential for that. Johnson Johnson's stats apparently were high enough to get the attention of the FDA. So that would've been probably more at the top. But since that just happened a few minutes ago, we'll get into the one that's been in the news for at least a few days, if not a couple of weeks. So the drug combo called Paxlovid And if you've been watching, or maybe you've had it, or maybe you've been seeing some of the, you know, either Twitter posts or news items, et cetera, it's in my newsfeed every morning. Basically, this is a 2-part antiviral cocktail that is a drug called Paxlovid that is given for now, SARS-CoV-2, COVID, and it includes an old-school protease-inhibiting drug called ritonavir. And ritonavir has been around for quite a while. Again, it's used in the HIV cocktails. It's a protease inhibitor. So if you think about a protease inhibitor, what they do is they go and they get in the way of replication. And that's gonna become important to our story coming up here. But the other thing that it does is it blocks the most commonly used pathway for other drugs in its metabolism in the liver. Now, it's not trying to do that, I don't suppose, for the fact that 60% of all drugs go through the CYP3A4 pathway, but it's doing it because if you have other drugs and you slow that pathway down, It keeps the other drugs in your system longer. And in the case of its use in HIV, some of the other HIV drugs would be in there longer and it would extend the activity of the HIV drugs. Well, they took that drug and combined it with a more modern protease inhibitor that was developed mostly for SARS-CoV-2. And so they put these 2 things together and they call it Paxlovid. Now, what's been happening is, especially since this drug was approved and since, you know, this upswing in cases with Omicron, et cetera, people are put on Paxlovid. And the most common story is they get out about 5 days and they test negative. And then sometimes, sometime, After day 5, where they're told, well, okay, you're negative and you don't have symptoms, you probably don't need to isolate, then they have a rebound. So they're calling the Paxlovid rebound, where sometime between day, you know, reportedly 6 and 14, you go positive again. Now, Why would that happen? Well, there's a few reasons. Now, they're, they're calling it rare, but what's interesting to me is that, um, and we've seen this all along, and if you follow, you know, drug development, which many of you probably don't, but, uh, if you're like me and you follow drug development, drug research, it's very common to have a drug come out and when it's first approved, because the trials were done on X number of people, you say, well, these are rare side effects. And then somewhere down the road, the side effect profile gets revised or the drug even gets pulled off the market. And it's like, oh, well, why would they approve it in the first place when, uh, it had these other problems? Well, what happens is after you get through phase 3 trials, generally you're allowed to move the drug to market if it gets approved. And so then there's post-market analysis that is done. And if over the years after the drug is approved, you start seeing a lot of a particular side effect, then that post-market analysis will feed back to the FDA, and FDA may put a black box warning for that on there, or they may take the drug off the market. They may do any number of things. Okay. So early in the show, I mentioned the Johnson Johnson vaccines being restricted by the FDA. Why? Because of post-market reports. So the statistical anomaly that happens is your initial reports say it's super rare, and I'm just going to pick a number out of a hat here. This is not real numbers, but, you know, less than 1% or less than 0.1% have rebound positive COVID disease. after taking Paxlovid. Well, then you get out and you give Paxlovid to a number of people, thousands and thousands of people, and you find out, oh gee, well, it wasn't that low of a number, it's a higher number. So one of the things, uh, most people know about— just to use an example of a drug that had this happen— are the fluoroquinolone antibiotics. And When they first came out, I remember when they first came out, very broad spectrum, very powerful antibiotics, and we tended to use them for infections that were really out of control, hard to kill, or had a lot of broad spectrum antibacterial need. And one of the known side effects was a rare potential for Achilles tendon rupture with the fluoroquinolones. Well, then a number of years after they'd been out, there were so many reports of Achilles tendon rupture and tendinosis and things like that, that they now have a black box warning on the fluoroquinolones saying that, you know, this is a very big problem and you have to watch out for this. So my point here is that whenever you get a new drug that comes out, it doesn't matter, you know, people apply this to vaccines or non-vaccine antiviral treatments, but any drug, any drug works this way. You can only trust the side effect profile of the new drug to the degree it's been tested. Now, supposedly, you know, we're supposed to test new drugs in the IND process very well and usually go through a Phase 1 and Phase 2 and a Phase 3, and sometimes they're combined, sometimes they're fast-tracked like in COVID. But, uh, usually go through all of these layers of trial. And then you report out, okay, we had this many people, you know, have liver problems, this many people had kidney problems, this many people had constitutional symptoms, this many people had X, Y, and Z. Those statistics, if the drug gets approved, are what the initial drug rollout will say. Well, these are the side effects. Most are very rare. Don't worry about it. But we know that once we get it out to the market, we're going to have more and more people using the drug, especially a COVID drug during a COVID pandemic, and we're going to get a lot more of a spread across humanity. And it could be that in our earlier trials, let's say we used it on, you know, a middle-aged group that was generally healthy, uh, etc. You know, we had inclusion/exclusion criteria that narrowed the age range down, and then you get it out into the general public, and you've got younger people than that and older people than that using it, and you've got sicker people using it. So that's one reason why this so-called rare side effect may not be so rare. The next reason is you have to think about the way that the viral— the antiviral drug, especially these cocktails, work. So the first thing is that these work by literally blocking replication of the virus. So this is different than a lot of, say, antibiotics that you might think about. So you think, well, you know, I had strep throat, let's say, and I was given, you know, an antibiotic for the strep. Well, probably not 100%, but probably that was what was called a bactericidal antibiotic, and that would mean it actually killed the, the bacteria. When we get over to virus, most of the gambits that we use to inactivate virus activity— and you want to remember that viruses aren't really alive in the sense of the word biologically like we'd say about bacteria. Viruses are much smaller, they're much more mechanical. So as opposed to trying to kill something that's not even alive, you can inactivate it, etc. But usually what we're we're trying to do with the viral world is to stop the replication because that's really the problem with the virus. Now, of course, we don't want bacteria replicating either. But if you think about the way that the virus works, it gets to your cells, it gets inside your cells, generally hijacks your nuclear material in the cell, takes it over, and it shoots out a whole bunch of its children viruses. If we can stop replication, slow the virus down? Well, think about it this way. What if you have a, uh, very— let's say in the days of Omicron, you have a very transmissible Omicron virus. It's not very pathogenic for most people, so it doesn't make them that sick, but they get sick. And then you take this Antiviral drug cocktail. Well, the antiviral drug cocktail is generally blocking the replication of your virus. So there's a couple of things. One is the earlier you take it, probably the better. That's true of almost all antiviral drugs. But the next thing is, let's say you're taking it for the days in the beginning, you get to day 5 and you have a negative test. Why in the world a few days later or a week later would I go back to having a positive COVID test and having COVID in my system? Well, that's because what you have done effectively is suppress the amount of COVID You've suppressed the replication of the COVID and so you're very likely to test negative. But one of the things that viruses are very good at doing— certain types better than other viruses— is going a little bit dormant, so you may not test positive for them. And then, uh, when the pressure is off from whatever antiviral strategy, they come back out, come back out with a vengeance. Well, that's kind of what happens with the Paxlovid paradox or the rebound, where you think you're better, you think you're cured, and then, you know, day 5, you're great, negative, day 7 or 10 or 14, you're back to being positive again. So I just looked at the FDA update on this and it's saying, yes, this is a problem, but basically it's saying take it the way that your doctor said to take it. This is very rare. It's much less rare than it used to be. So I think my only take-home from this would be, and this, this is, this was sort of our number one question, I think, because it's been in the news a lot, is if you are on Paxlovid or you've been on Paxlovid, Definitely do retest more than just, you know, at day 5 or day 7. But also, I would do some of the other things that we're going to talk about to keep your immune system marginalizing the virus and moving out of your system on top of the Paxlovid. Paxlovid is not— antivirals are never monotherapy. Meaning even when we give antivirals for the HHV family of viruses, very common thing that we do. We generally give the drug, but then we also will support the rest of the system to, you know, kind of rise to the occasion and do what the immune system is supposed to do. We'll talk about ways and means to do that coming up. So the next one, and probably this is maybe the second most common thing in the news, I think now it'll be the Johnson Johnson thing we talked about. But the next one was, um, did Denmark really suspend its vaccination program? Well, this is very interesting because, uh, as I was preparing for this particular program here, uh, I just happened to open up my news, uh, feed. You know, you get on your, on your device there, you get all the news and news feeds you want, right? Um, So one of the things that it said, and I'd already kind of looked this up and I had looked into some reporting by some PhDs in the UK that I like to follow because they're usually a little bit ahead of where I'm at with the, with the data. Um, and they were talking about, well, Denmark did this and we'll go through the reasons why. Well, then there was like, well, it was a, a United States news outlet says, well, uh, this has been fact-checked and it's not completely True, blah blah blah. So one of the problems with you know fact checking as it were. I mean as as a concept there's nothing wrong with fact checking. It's kind of what I do on this program. But one of the problems with fact checking is you can you can say things in a number of different ways. So what I what the fact check would be reporting to you is Denmark did not suspend. Its vaccine program. Now that's not true either. So the fact check is not true, but the assertion that Denmark has completely stopped doing vaccinations is also not true. But isn't life and the truth usually somewhere in between the two extremes? Yes, that's true. And so what is really going on in Denmark? Well, and this number is going to come up as important in our in our next question. So just keep in mind, Denmark has. A greater than 80%— it's a highly vaccinated country— greater than 80% have 2 vaccines. And if you count one, you know, anywhere between 1 and 4 vaccines, it's like 90-some percent. Um, the next thing is that of this highly, highly vaccinated country, an extremely large proportion— because Europe had Omicron before North America did Extremely large proportion of this highly vaccinated country has also had Omicron. And what we know now from the research is that either just having the infection alone or having the infection on top of your vaccine creates a very heightened amount of immunity against certainly getting another one of the many Omicrons. that are out there. And so the country, based on the reporting and the, uh, and the outlets that the official scientists and policymakers have there, basically has said we are going to suspend our active vaccination program with some caveats. So this is where the fact-checkers said, well, they didn't really suspend everything, and that is true. but they suspended most of it. Okay, so Denmark did suspend most of their vaccine program, and part of it is due to their high vaccination rate. Part is due to the fact that in this high-vaccinated community, they also had a super high level of Omicron, uh, breakthrough. Okay, immune escape they call it. So the Omicron came even though you were vaccinated. So now you sort of have 2 levels of immunity developed So they are really looking at it from the point of view of acceptable infection risk, so they don't need to continue with vaccination. Now, the caveats are, number one, and any country would probably say this, we may reinstate the vaccination program in the summer if we need to. And as I say, any country would say this because Um, there you, you can't predict the future. And what if there's, you know, a resurgence or there's some other variant or whatever? Uh, you know, if you come out and you say we're never vaccinating anyone again, and then in the summer you start doing it again, you're going to look kind of stupid. Uh, so they say, well, we're reserving the right to bring it back if we have to. The next thing is, uh, they are putting a little asterisk by we're not going to do vaccination en masse anymore. they say, well, if you're over 40, uh, or, uh, if you're pregnant, or if you're not done with your vaccine series, you probably want to— we'll leave it open for you guys. Um, and then they're saying we're not recommending a 4th dose, the 4th booster, unless you have an immune compromise. So there are reasons why the country of Denmark is still doing some vaccination, but they have suspended their main en masse vaccination program because essentially what they're saying is Omicron, uh, boosted all of us who are already all vaccinated pretty much anyway. So there's really no point in us synthetically boosting because Omicron did it for us. So when you look at, uh, I've already got vaccine coverage and then I do Omicron infection on top of it, it's like a super booster, if you will. Now, you should know that there's also— and this is mostly European data— but there is also data that shows that just having, you know, Omicron on its own is pretty robust immunity also. So, and, and we've talked about in the previous uh, shows about, about COVID how with Omicron all everything changed. So used to be with Delta, you know, it was mostly unvaccinated in the hospital. Now with Omicron, it's more, you know, more vaccinated and all that. And there's a big flip that went on with Omicron. So Omicron is kind of all new news. It's all different. All right, so that covers Denmark. Now where are we at with, um, COVID infection in the United States. So if we've got, um, uh, Denmark, you know, who, who have high, high percent vaccination but also high, high percent Omicron infection, um, how many people in the U.S. have been infected? Well, if we consider that most of the estimates that it were around 60% were from the time of Delta, which is a pretty big number but not that big. And we look at what the, um, what the statisticians at a couple of big medical schools are looking at, one being University of Washington just down the road from me here, the other being Yale. Um, they are estimating between 76 and 80% of people in the United States have had a COVID infection. And now that could be low symptomatic, asymptomatic. There's a lot of people who have likely had COVID infections that thought they had a cold. But if, if you look at the modeling done by, you know, some pretty top medical schools, you're looking in the high 70s to 80%. Now when you look at— and that was sort of the third big question that came in. When you look at herd immunity, what we're now talking about is because Omicron is irrespective of vaccination status at this point, as far as its ability to infect you, it is the vaccine and Omicron have a lot of breakthrough infection with Omicron. And so because of that, as I said, Omicron becomes like a booster whether you've had a vaccine or not. It's sort of like its own vaccine. And so we're looking probably more, more than herd immunity at some sort of mosaic immunity, because what we're finding now is we have people, you know, who had prior infections who don't have a lot of don't have a lot of resistance maybe to Omicron, so they might get 2 versions of the infection even if, you know, vaccinated or not. So, but we are hitting about 80%, and, you know, the early estimates for herd immunity would be somewhere in the high 80s to the low 90% of, you know, of the world. Now that presupposes that we don't have any more aggressive variants come up, etc. And I think that, uh, that leads to the next question, which is, um, is it turning out— because now we've had Omicron for a while— is it turning out that Omicron is still less deadly but much more transmissible? And the statistics would still show that, that, you know, Omicron has immune escape, meaning it walks right through your vaccine status for the most part. It's a lot easier to get, it's a lot easier to transmit, but the disease state for most people is much lower. Now, later in the program, we're going to talk about when it's not lower, because it's not always lower. But by and large, the, the general rank and file of humans are going to do fine with an Omicron infection, and they will, you know, so it's What Denmark is essentially saying is you're gonna—we're gonna have Omicron and other variants, and we're gonna get these infections. We can't vaccinate our way out of it, so we might as well just let you know let nature immunize us, which is really what's happening in most of Europe. That's the way they're looking at it. Kind of the total opposite of the way they're looking at it in China, where there's complete lockdowns and all that. They have the zero COVID policy, which is never going to work. So there's that. Now, next question was about our old friend remdesivir, and there's a lot of controversy around remdesivir. Again, this is an antiviral. It's most commonly given in the hospital, and it is associated with things like kidney problems, liver problems, and other things of that nature. Now there's sort of 2 ways emerging in the research to look at remdesivir as far as is it an appropriate treatment for our patients with COVID One is in the hospital and the other is pre-hospital. So they're starting to look at remdesivir as a pre-hospital treatment. Essentially is a viral replication inhibiting type of a drug. That's an oversimplification, but basically. And so there was a paper that was published, uh, a few months ago, pretty— it's pretty recent for COVID time, uh, by Gottlieb et al., G-O-T-T-L-E-I-B, in New England Journal of Medicine. So if you want to look this paper up, if you have an interest in remdesivir for some reason, uh, G-O-T-T-L-E-I-B, Gottlieb, New England Journal of Medicine, December 22nd, 2021 was the publication date. And what they said was, if we took people before they got to the hospital and gave them 3 days of intravenous remdesivir, we wound up with statistically less hospitalization and less death. So that's great. Okay. Now, most of the people in the study were 50 or older and had comorbidities of either diabetes, obesity, hypertension, or some combination of those. And as we've talked about for over 2 years now, those are still the comorbidities that will sneak up and shorten your life with COVID Now, there's others that we'll talk about But those are the bad ones: diabetes, obesity, and hypertension. So when we think about it, if we have people at higher risk, which is really what the paper was looking at, wouldn't it be better to treat them before they got to the hospital? Now, there's some of us who have been talking about prehospital treatment and early treatment for a very long time. I'm one of them. And sometimes the things that we talk about using are you know, kind of popular, and sometimes they're, uh, considered, uh, unpopular by the medical community or whatever. Um, but if you're sitting there looking at, uh, people who are sick, um, and people who have potential of dying from COVID etc., uh, my experience and experience of a very large group of physicians treating patients has been if we do early treatment, we have less need to go to the hospital, we have less death. We have less post-COVID syndrome, we have less of everything. So earlier treatment is wise. Now, we already talked about Paxlovid, and, and it's going to have some limitations because either they're not using it long enough or the dosing isn't maybe dialed in right or whatever. But Paxlovid is an example of that. Another example is early use of Remdesivir. And basically what's interesting is in a, in a high-risk group of people over 50, 1, 2, or 3 of the big comorbidities for COVID, the adverse event profile was about the same between the placebo group, so they didn't get any of the drug, and the people who got the drug. And they did, in the people who got the drug, have an improvement in hospitalization and death rates. So again, remdesivir may have its best shining place in the pre-hospital environment. Now, where remdesivir is maligned a lot is in the hospital environment. But one of the problems with the hospital environment is if you're trying to, you know, treat COVID illness, by the time you get to the hospital, you got a lot of other problems going on. And if you're trying to drive uh, the bus of COVID treatment with one primary tool being remdesivir, you're going to have not only more high-risk patients, you're also going to have more comorbidity. And if you don't treat the other risk factors and comorbidities, the remdesivir can only do what it does. Also, with the higher-risk patients and older patients, You're more likely to get the other side effects because they're sicker people. Okay, whenever you do drug trials— So when you do drug trials on people and, uh, you know, you're especially doing these observational things in the hospital and you're gonna, you know, give them remdesivir or whatever, if you have a younger, healthier population, you have a lot of side effects. You get a sicker, older population with more comorbidities, you're gonna have a lot more side effects. But guess what? Those are also the people who die from COVID-related illness. So my experience with patients has been— and we're gonna get to this with patients— is, uh, I don't have a problem with them using remdesivir in the hospital. I have a problem with them not doing the rest of the work of treating the rest of the person in the hospital. Um, but there was a paper in the BMC Infectious Disease, so just BMC Infectious Disease, January 4th, 2022, so pretty recent, uh, from Gupta, G-U-P-T-A, et al. And they basically said, uh, that remdesivir is really best, has the best outcomes if you're under 60 years old and you only need low-flow oxygen. When you get beyond 60 and you have any type of cardiac or vascular disease, or you need ventilation or high-flow oxygen, you have an increase— a decreasing amount of positive effect from remdesivir. So if you think about it, a lot of people get into the hospital and they're not treating the other comorbidities the patient has. And then they're on remdesivir, the older they are, the sicker they are, the less likely it's going to work out. So again, antiviral treatment generally— and there's nothing new with COVID antiviral treatment— is better done earlier. So the earlier the better. So I would agree with Gottlieb et al. in that New England Journal piece from December 2021. that probably a remdesivir treatment early on, if you're going to use remdesivir, would be better. Let's keep people out of the hospital. Okay. So what's next here? And I numbered these to try and keep myself on, on track. Well, what are some other things you could do? Let's say you're one of the 20% of people that hasn't had COVID yet, or at least you don't know you had COVID. Something that you can take a look at, and if you want the reference for this, you can just go back to my show notes for the YouTube channel. Go to the YouTube channel where I put all the show notes and the show on March 3rd, 2022. So just a little over a month ago, March 3rd, 2022— 2 months ago now, sorry, time flies. March 3rd, 2022, there's show notes in there. It's got the paper. Basically, they looked at vitamin D levels in people, and they happened to be doing a study not about COVID but then COVID happened and they already had all the vitamin D levels on these people. And so they said, well, was there any relationship between their vitamin D levels and the severity of their COVID? Well, what they found was that At a vitamin D deficient level, you were 14 times more likely to have severe or critical COVID disease than those that had a reasonable level of vitamin D. Now, depending on what country you're in, these are reported differently. So in the paper, they reported nanograms per milliliter. So under 20 was the low deficient folks. If you're in a country that uses nanomoles per liter, that's 50. So for instance, I believe in Canada it's nanomoles per liter, which would be 50. In the U.S., nanogram per milliliter, so it'd be 20. Those are the same number, they're just different units of measurement. If you're looking at replete vitamin D status, it wasn't that high really. It was 40 nanograms per milliliter or higher. And that's 100 nanomoles per liter or higher. So vitamin D levels and status is something that you can do that's actually preventive. Now, I was on an interview about a year, year and a half ago, and we were cautioned about saying anything was preventive because, of course, it was, you know, a year, year and a half ago, and we didn't have a whole ton of data. But this is fairly compelling data. And again, you can go back to the YouTube show notes there on March 3rd, 2022, mine. It's got the reference for that in there. So vitamin D is something that you can do. Now, there's other things that you can do that I want to go through here. And these would be nutrients with respect to other vitamins, minerals, etc., that have been studied around SARS-CoV-2 or antiviral effect, etc. And so the first thing that you want to think about is with vitamin D, what we always say, it's fat soluble, so you don't want to take it at high doses forever and ever. You want to get your levels checked, etc. But short-term use of an amount to get your levels up is very safe. Now, there are some people, very rare, who short-term use might be be a problem. But generally speaking, if you're gonna go, you know, 3 months and try and get your levels up before you get a chance to get you see your doctor and get your levels checked, you're usually okay doing that. So with vitamin D, you can very easily take 10,000 international units a day. And if you do a supplement that has vitamin D and K2 together, those are usually at a particular ratio, much less vitamin K2, but they support each other. That's the one that I use, and about 10,000 a day is fine. If you're gonna do that longer than 3 months, go get your levels checked, and they can say, oh, that's fine, or you can back off now because you have enough. The next is vitamin A. Now, vitamin A is also fat soluble. Vitamin D and A aren't really vitamins, they're more hormone-like substances, but we are concerned with vitamin— fat soluble vitamins as they may build up. But again, if you haven't been taking any vitamin A and you're doing fat-soluble vitamin A, like retinyl palmitate, for example, you could take easily 15,000 to 25,000 units if you're especially in cold and flu season. And you could do that, you know, for a month. If you're pregnant, you don't want to go above 10,000 international units of vitamin A. And of course, if for anybody, you should. seek your doctor's help, especially if you're pregnant or nursing. But if you're not pregnant or nursing and you're just doing general protection for a month, you know, 15,000 to 25,000 units, and then somewhere between 5,000 and 10,000 is usually plenty to keep you there. The next thing is vitamin C. We talk about this a lot. Too much vitamin C orally can give you diarrhea, so usually we have you spread it out Remember, we've talked about this one a lot in the past, where vitamin C is best going in over time through the day. So having it and taking it with your meals is an easy way to do that. And if you do start to get loose stools, just back off on the dose. You don't need to stop, you can just back off on the dose. But most people can tolerate 500 to 1,000 milligrams with each meal, and that's usually Quite good. The B vitamins are just generally good because they help with a lot of cofactor work in your enzyme processes in your body, and there are enzymes that get involved in, uh, certainly your immune system and all of the fights that go on when you have cold and flu season going around. So the B vitamins, you can do a B complex You can do a multivitamin plus a B complex. Minerals are also very important. We hear a lot about zinc with COVID Zinc is one of the things where if you try and do it too late, like they did a study with zinc and they said, well, zinc didn't help people who were, you know, acutely ill stay out of the hospital. Well, by the time you're acutely ill, if you start taking zinc, it may not be enough, maybe too little too late. Minerals are sort of like a lot of the vitamins. You have to have enough in your system to do anything for you. So what I recommend, rather than just taking a bunch of zinc, is minerals work in balance. And zinc, for example, will, uh, will deplete copper over time. Some people have high copper, and that's great, but depleting it. Some people don't. So what I usually have recommended to patients through COVID is, you know, you, you don't really need to take a ton of zinc if you get a good multi-mineral. You can get them with and without copper. If you're going to be taking it a long time, I would, you know, either have your copper levels checked or take it with copper to balance it out. But a multi-mineral is, in my opinion, better because you can take, you know, a dose of them a day with food. Always take minerals with food because they can be a little harder on your stomach. You can take them with food and then you can back up all of the enzyme activities that the B vitamins are doing. Other things that we have used with people: N-acetylcysteine. This is an amino acid that's a precursor to glutathione. It also is helpful with a lot of respiratory things. It also happens to be used as a respiratory drug in respiratory medicine. But N-acetylcysteine, if people are taking it, it's usually, you know, 500 to 1,000 twice a day. And then one that's gotten a lot of press is quercetin, the bioflavonoid. This is actually a zinc ionophore. It does other things, but it helps zinc in the cells. When zinc's inside your cells, it helps to— in the natural antiviral processes that go on with your cells. Probiotics. Most people tolerate probiotics, so that's another thing you could add. Omega-3 oils like fish oil, etc., can be useful, etc. Now, all of these recommendations I just talked about, I want to make my normal caveat, which is, you know, I'm a doctor, but I'm not your doctor. So these are just informational things. This is not medical advice. You should only take medical advice from your healthcare team. And if you are looking at, say, nutritional or herbal medicine or other things, make sure someone in your healthcare sphere has experience with those. There's a lot of, you know, the primary care medical community is, you know, they, they know sort of the danger signs and they know the safety things around certain nutrients, but they really don't know how to guide you. into the world of, you know, taking a therapeutic dose. So make sure you have appropriate medical opinions about all of these things. Now, the next thing, the next question is in the realm of post-COVID. So we've had whole shows on post-COVID. You can go back not that far if you go back on the YouTube channel and look at post-COVID illness. Now, when I say look at the YouTube channel, that's DRA Online, Dr. A Online. And if you search, usually you'll find me there. You'll see my face on the YouTube channel. If you can't find it there, go to my website, dranow.com, and there's a hub there which has links to everything, including my YouTube channel. And the reason I talk about YouTube, because we're on all of the PodBurners, so you can listen to it as a podcast, live on CTR Radio and Facebook Live. So we're all over the place. But I put— if I'm going to put show notes or links or other things like that, I put them on the YouTube page because there's a place for it in the description box. So if you're on a device like your phone, something small, go over to the right-hand side, there'll be a little down arrow. Now be careful because if there's an ad, it'll be the first bar down there when you go to some ad. which I have nothing to do with. But right below that, there's a down arrow and it's the description box. It'll open it up, there'll be links, there'll be whatever I wrote about it. It'll all be in there. If you're on your, uh, computer, it'll be on the left side and it'll say Show More, and you click on the word Show More, which don't look like a link, but they'll open up the box, the description box. So we've done a lot of post-COVID stuff. But what I want to bring up here is post-COVID. So there's, there's some really, I would say, interesting, uh, reporting about post-COVID vaccines, post-vaccine, all this other stuff. And it's, um, it's just interesting. Okay. Now, post-COVID illness occurs in somewhere between 10 and 35% of people who have had COVID. One of the things you have to be careful with all the statistics I'm about to quote is they all are from the era of Delta and before. We don't have really good updated statistics on post-COVID for Omicron. We have a lot of anecdotal evidence, we have a lot of stories, uh, but if you have somebody saying, you know, for sure with Omicron you know, it's got more post-COVID, it's got less, whatever. We don't know that yet. We're starting to know, but we don't know that. So when I say 10 to 35% of post— of people get post-COVID, we're talking about Delta and before. And if you're hospitalized, which probably will stay the same, it's about 85% have some sort of post-COVID illness. Now, all the data though, uh, is really Older. Okay. So one of the things I tried to find good answers for, because right now there's just a lot of speculation on the news services and the internet, is does vaccination actually lower your risk for post-COVID illness? And I found some people reporting and saying definitely it's much lower, etc. I look for their references and their resources and there aren't any, uh, there. And what it turns out is it's an anecdotal observation, uh, which is fine, but they— you should say that. So if we look at people from the pre-vaccine and then the Delta prior era, the only data I could find either said there was a little bit lower risk or there was no difference. And it was 2 papers that were reported on from another paper. And so one of them was in The Lancet, the very famous journal The Lancet, from Antonelli et al., volume 22, um, issue number 1, uh, in Lancet Infectious Disease. So 2021, volume 22, issue 1, Antonelli. That was one about post-COVID and vaccine. The other was Taquet, T-A-Q-U-E-T, in Brain Behavior and Immunity, Brain Behavior and Immunity, Volume 103, July 2022. And you think, well, it's not even July 2022 yet. That's its publication date in the future. It's been out as a preprint for a while, but it's going to publication. And those 2 papers looked— and again, they looked at a lot of pre-vaccination and also a lot of pre-Omicron, and it's Somewhere between it doesn't help at all, it helps, it helps to some degree. So I think the jury is still really out on that. And again, it's not my job because I'm not your doctor, not your healthcare team, to tell you, you know, you need more vaccines or less vaccines or whatever. That's between you and your healthcare team. I'm just pointing out that I get a lot of questions about this and If we're honest about the data, especially where Omicron has changed the whole world, it's changed all of the data. We can't extrapolate from what came before Omicron to what may be going on with vaccines and COVID moving into the future. Another thing that is starting to be reported, and this one was in Science volume 375, so the journal Science volume 375, issue 6 6579, issue 6579, uh, and they're starting to talk about, um, some people having, uh, vaccine-induced post— so they never had COVID, but they have post-COVID illness after the vaccine. And that kind of makes some sense logically if you think about it. Um, if I am vaccinating you and I am inducing a piece of the COVID illness, say it's spike protein to be produced in your body, and you are one of the people who's immunologically sensitive there. Um, you may be immunologically sensitive to the degree that you have some post-COVID illness when you never had any COVID. So again, is that super common? We don't know. We don't— you know, common or not common, um, nobody knows. Uh, another thing that probably would have been high on the list of questions is, uh, the Pfizer just did a data dump of, I think, another 800 pages of vaccine-related side effects and other stuff. And I haven't had time to open it up and look at it, but that just happened last night, I think. Uh, so maybe we'll do something on that in the future. There's a lot of things in there that we, we didn't know earlier. And, and so, you know, trying to say, you know, the vaccine's all good or the vaccine's all bad and so Probably a fool's errand because nothing is all good or all bad. But also, you know, we have to remember, kind of like we talked about with Paxlovid or Remdesivir, we can only rely on the data we have at the time to make, you know, these assertions about efficacy, safety, and all that stuff. Now the last topic, and I did go through and sort of number these topics, put them in order. I did not— excuse me— I did not choose the last topic to be a downer, but depending on how you look at it, it might be. And this is deaths, death rates, etc. If you go to cdc.gov, that is our Centers for Disease Control, .gov, cdc.gov, some interesting things to look at. And one of them is something I talked about for a long time that's going to relate to the final bit of stuff I'm going to talk about, which is personal and my patients dying and things of that nature. So it is sort of a bummer. Um, don't want anyone to die, but with anything in medicine, people do die. And with COVID they do. Um, but if we look at cdc.gov and we look at deaths and comorbidity. What, what else did the person have? Almost 50% had a type of pneumonia or an influenza. Okay, that would make sense because those are immune dysregulating. You can die on your own from those things, etc. And like I've talked about, there's a lot of people with COVID that develop the atypical pneumonias, either viral or Chlamydia pneumoniae or Mycoplasma pneumoniae. And they have a very bad time if you don't get rid of those bugs as well. Almost 20% had hypertension, high blood pressure. 15% had diabetes. 10% had Alzheimer's disease. 10% had sepsis, body-wide infectious complications, which will kill you on its own very, very easily. So if we go to deaths, A large number of the deaths of people with COVID are due to COVID opening the door to something else helping to kill them. So one of my take-home points from that is, and this is where we go back to, okay, if I, if, if I'm unable to treat you to the point as an outpatient where you have to go to the hospital, you get to the hospital and now the hospital COVID team has you, there's not much your doctor is going to do from the outside because that's not how it works for them. most part with COVID in the hospital. So if they take you from scratch and say, well, you're a COVID patient, and they give you remdesivir, for example, um, and they don't give you anything else that you were taking prior, they're trying to treat your, you know, your COVID with the remdesivir, which is fine. But what if you had other problems? Okay, what if you had other infections, which again, almost half of just the ones we tested, just half did. And I went through, and if you go back again into the co-infections and COVID, I listed, you know, 3 pages of studies about other infections and COVID. This is not an unknown thing, but a lot of times people get to the hospital and it's too late by the time infectious disease specialty gets there, tests them, and finds out, oh Lord, they have COVID, but they got, you know, 2 bad bacteria and a fungal infection that we need to treat. So the risk of dying with COVID out or inside the hospital is very high with other infections, very high with other things, but infections are the top of the heap. And, uh, for the most part, these are often not tested for until it's too late. So just like I said with, you know, remdesivir or anything else, if you do it before we get to the hospital, I would prefer to test you and treat you before you need to go to the hospital, keep you out of the hospital if we can. Uh, so the other thing is, who's mostly likely to die? So as of, uh, this year, about close to 80% are over 65 years of age. And if you go and break them down into, you know, 65 to 75, 75 to 85, and all that, Then the percents are mostly weighted towards the over 70 age group. About 20% are in the 45 to 64-year-old age range. All of these are going to be higher percentage with those co-infections or higher propensity. It's about 4% under 45 years of age, but if you look and you break that down on CDC, you can go ahead and break it out. Um, 99% of those under— so it's 4% under 45. Most of the 4% are between 19 and 44 years of age, and that's more likely to be a little bit on the older side there. 0.2% is 5 to 18, so your school-age kids, 0.2% deaths, and 0.1% are babies through 4 years old. So the 18 and under is less than a fraction of 1%, right? 0.2 and 0.1%. So, you know, our focus— obviously we don't want children getting sick, we don't want any children to die. And if your child has a respiratory disease, cystic fibrosis or something, have an immune compromise, or anything else You know, your doctor should be or probably is working with you on protective strategies. Okay. Um, we are, uh, we are not managing our time very well here right at the end, uh, so I will just shorten up the part about, uh, who died in, in my patient group. Um, it tended to be people, uh, who got to the hospital, and it's a very small number, okay, of everybody we've treated outpatient in my group, tiny, tiny fraction ever have to go to the hospital. But those who do, if they go there and then they have co-infections that are not treated, those are the people that die. And then the other group are people who get too far down the road on ventilators, and you're more likely to die then. Well, I'm sorry to end it that way, uh, but this is Dr. Paul Anderson from Medicine Health. This was your questions asked about COVID as of today, uh, May 5th, 2022. I will see you all on the radio, uh, next week, or YouTube anytime. Thanks.