Dr. Martin Dubravec

January 21, 2022

This information is being provided on a periodic basis for patients and others interested in updates regarding the Coronavirus (COVID-19, Sars-CoV-2).  Facts are provided.  My comments and opinions are listed separately.  The goal of these updates has been to help the community in keeping informed of issues regarding Coronavirus from a local medical perspective.  As a clinical immunologist, I believe it is vital that information be shared with regard to this important issue.  If you would like to receive this information via Email, feel free to Email us at aasc1234@protonmail.com .   The opinions expressed in this Email are that of Dr. Dubravec.  Good doctors can disagree. Readers are encouraged to seek as much information as possible regarding COVID-19.  Information in this Email is not intended as a replacement for diagnosis or treatment by your doctor. Nothing in this Email provides medical advice or any form of diagnosis or treatment. Medical decisions should be made by the patient’s physician.  All information provided here is for general informational purposes and is not medical advice to users.

Please note that we are no longer using Facebook for posting these Emails.  We prefer an Email format for this information.  If you would like to receive this information via Email, feel free to Email us at aasc1234@protonmail.com .   

Fact:  

The FDA has approved two pills for the acute treatment of COVID-19:  Pfizer’s Paxlovid and Merck and Ridgeback Biotherapeutics’ molnupiravir.  As far as effectiveness, Paxlovid showed an 89% decrease in risk of hospitalization or death and molnupiravir showed a 30% decrease.  Paxlovid is contraindicated with a host of medications.

Sources:

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-oral-antiviral-treatment-covid-19-certain

https://www.fda.gov/media/155050/download

https://www.fda.gov/media/155054/download

Comment/Opinion:

These two new medications for COVID-19 are the newest form of treatment for the virus.  They are meant to be given within 5 days of the onset of symptoms and are to be given for “mild to moderate” COVID-19.  Paxlovid has a host of drug-drug interactions which will most likely limit its use.  The cost of this therapy for a 5 day course is expected to be about $700.  The drug interaction risk with molnupiravir is unknown, and its effectiveness is certainly not impressive at only 30%.  Availability of these drugs is also questionable as demand may be high and only limited supplies are available.  These drugs are given as a 5 day course.

When comparing these drugs to Ivermectin or hydroxychloroquine, it seems that Ivermectin and hydroxychloroquine are still favored for acute treatment, based on the combination of factors including availability, cost, safety, limited drug-drug interactions, and cost.  For example, hydroxychloroquine showed an 84% decrease in the risk of hospitalization in a randomized controlled trial when given early with zinc and Zithromax (azithromycin).

The other issue is whether or not these medications will be necessary at all in the future.  Although COVID-19 is expected to be with us indefinitely, it is becoming less and less dangerous but still present and may always pose a risk of severe illness (like any viral illness) in small, vulnerable populations (those with multiple severe medical problems).  Experts in the field of virology are predicting that COVID-19 will become simply another cause of the common cold.

Fact:

People with positive COVID-19 tests have spiked again over the past few weeks.  Death rates from COVID-19 remain low.

Source:

https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html

Comment/Opinion:

The rise in COVID-19 is most likely secondary to the Omicron variant of COVID-19.  It is very active in our area.  As described elsewhere, this is not as severe as other variants of COVID-19.  This is not to say that people are not feeling it:  the symptoms of Omicron are still significant at times, ie, like a bad flu.  The difference is that hospitalizations seem to be significantly less among our patients and other problems, such as secondary pneumonia, are not seen to any significant extent.  Patients are feeling acute flu-like symptoms earlier than the delta variant and are calling for advice and treatment sooner.  We have noted that vaccinated patients may be getting hit harder with Omicron. We will continue to see if this becomes a major trend among our patients.

Some experts are stating this may be the last major peak of COVID-19.  We will see if that’s the case.  For high risk patients and those over 40, it is still reasonable to consider early treatment with antiviral, antibiotic, and anti-blood clotting therapy.

Fact:

Great Britain has abruptly ended lockdowns, vaccine mandates and other public health measures related to the COVID-19 epidemic.  France and Denmark are also looking at easing restrictions.  Austria has voted to mandate all citizens over the age of 18 be vaccinated by February or face fines and possibly jail time.

Sources: 

https://www.theguardian.com/world/2022/jan/19/boris-johnson-announces-end-to-all-omicron-covid-restrictions-in-england

https://www.irishtimes.com/news/world/europe/denmark-eases-covid-restrictions-as-cases-hit-new-record-1.4780343

https://timesofindia.indiatimes.com/world/europe/france-to-ease-covid-19-restrictions-in-february/articleshow/89029727.cms

https://www.cnn.com/2022/01/20/europe/austria-covid-vaccine-mandate-vote-intl/index.html

Comment/Opinion:

The confusing array of new mandates and easing of up mandates across the world carries no rational explanation.  It is bizarre that Great Britain is suddenly ending its drastic restrictions on personal freedom while Austria (birthplace of Adolph Hitler) is instituting the most comprehensive forcing of vaccination among its people.  Many are concerned that, once again, other forces than science are driving this patchwork of politician action.  

One bit of science that could be playing a role in the easing up of mandates is that Omicron may be the last major source of COVID-19 illness before the virus becomes just another cold bug.  Another potential explanation for easing restrictions is that the promise of the vaccines has not been realized.  The president of the pharmaceutical company Pfizer recently admitted that the 2 shot Pfizer COVID-19 vaccine was not effective in preventing COVID-19( https://townhall.com/tipsheet/katiepavlich/2022/01/11/pfizer-ceo-our-vaccines-offer-little-protection-n2601670) .  However, he went on to state that boosters could be effective.  We were told that the Pfizer vaccine was 95% effective in treating COVID-19.  With vast numbers of people getting COVID-19 despite being vaccinated, social distancing, wearing masks, locking down, etc,, perhaps governmental leaders are beginning to second guess the measures they have long advocated.  Maybe the citizens of these countries are beginning to lose their fear of a virus that will be with us and will become even less significant over time.

Dr. Martin Dubravec

January 7, 2022

This information is being provided on a periodic basis for patients and others interested in updates regarding the Coronavirus (COVID-19, Sars-CoV-2).  Facts are provided.  My comments and opinions are listed separately.  The goal of these updates has been to help the community in keeping informed of issues regarding Coronavirus from a local medical perspective.  As a clinical immunologist, I believe it is vital that information be shared with regard to this important issue.  If you would like to receive this information via Email, feel free to Email us at aasc1234@protonmail.com.   The opinions expressed in this Email are that of Dr. Dubravec.  Good doctors can disagree. Readers are encouraged to seek as much information as possible regarding COVID-19.  Information in this Email is not intended as a replacement for diagnosis or treatment by your doctor. Nothing in this Email provides medical advice or any form of diagnosis or treatment. Medical decisions should be made by the patient’s physician.  All information provided here is for general informational purposes and is not medical advice to users.

Please note that we are no longer using Facebook for posting these Emails.  We prefer an Email format for this information.  If you would like to receive this information via Email, feel free to Email us at aasc1234@protonmail.com.   

Fact:  

We have seen a significant rise in patients with COVID-19 (symptoms consistent with COVID-19 and positive COVID-19 test). This is occurring worldwide. It is the Omicron variant is thought to be the main contributor to this rise in COVID-19.  Research indicates it is a milder form of the virus.

Source: 

https://www.americaoutloud.com/?powerpress_pinw=85948-podcast

https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html

https://www.med.hku.hk/en/news/press/20211215-omicron-sars-cov-2-infection

Comment/Opinion:  

The Omicron variant seems to be the primary cause of an increase in COVID cases. Fortunately, this seems to be a much milder form of COVID infection. Based on information thus far, many patients are reporting less than five days of symptoms. Symptoms are also milder, hospitalizations are seemingly less with this variant, and deaths are significantly reduced and in many cases not seen in communities where Omicron COVID-19 is prevalent. 

The good news is that this variant is mild and represents what could be the last stages of the COVID-19 epidemic. The Omicron variant represents what has been predicted for quite some time with regard to COVID. As time goes on, mutations in the virus would make the virus significantly less dangerous. Hopefully, this virus will become no different than that of other coronaviruses that have been in the United States for over 40 years. These coronaviruses are often the cause of a common cold. 

Fact:  

The Omicron variant is proving itself to be resistant to vaccination. COVID vaccinations do not seem to have any impact in preventing the spread of Omicron. Furthermore, patients who have had COVID-19 in the past can have breakthrough COVID infections with Omicron. 

Source: 

Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa

Comment/Opinion:  

The current vaccines for COVID-19, based on various research, do not seem to prevent the transmission or infection with Omicron. Also, new research indicates that natural immunity to COVID-19 infection may not eliminate the risk of getting the Omicron variant of COVID-19. Nonetheless, patients who have antibodies to COVID-19 may still have protection against Omicron although not complete protection against Omicron. The good news is that regardless of this, Omicron infection seems to be mild and in many patients no worse than the common cold. Omicron was first noted in South Africa and the rates of COVID infection in South Africa are beginning to go down significantly. 

As was stated in previous email updates, we have been monitoring closely to see if mutations in the COVID-19 virus may cause the virus to escape the protection of natural immunity in patients and cause infection in patients who have had COVID-19. This represents the natural evolution of viral infections. Hopefully, we will see overall continued good news with regard to COVID-19 infection. 

There have been an increasing number of experts in the media discussing the need to re-evaluate the effectiveness of COVID-19 vaccines and our national vaccine strategy. Also, experts have discussed the need not to panic with regard to this virus as it is becoming milder and milder over time. 

We continue to see some cases of patients who become significantly ill with COVID-19. However, the experience in this office is that patients with COVID-19 are having milder symptoms when they do get COVID. We are starting to see some patients who have had a good history of COVID infection in the past now develop COVID again albeit more mild.  At this time, it is still reasonable to be aggressive in early treatment of COVID-19 in high risk patients who become ill with milder versions of COVID-19.  Also, we are still seeing some cases of significant COVID-19 illness in patients.  This could be due to those patients having an earlier variant causing their illness.  It does appear that both Delta and Omicron variants, as well as a host of undetermined other variants, have spread throughout our area and can occur simultaneously in a community.

It should be noted that influenza is also prevalent in our community. Patients should keep that in mind if they do come down with an infection. It is very worthwhile to consider influenza infection in addition to COVID infection when discussing with your doctor the symptoms you are having that could be related to a respiratory-viral infection. Despite what many of the media may portray, the overall picture with regard to COVID is good in the sense that we are seeing milder and milder COVID infection which hopefully will be reflected in a significant decrease in hospitalization due to COVID-19. We will continue to monitor this situation as it unfolds. If you have any questions, please do not hesitate to contact this office. We continue to advocate for common sense measures with regard to COVID prevention, treatment, and management of side effects from the infection. 

[Posted by Lori DeVries]