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Corona virus update August 24, 2021

Corona virus update August 24, 2021.
Daniel Cosgrove, MD
Right when we start to come out of solitary confinement and take off the mask they come up with this Delta variant! We have had lots of phone calls with questions about Covid vaccines and treatments and prevention. Here’s our updated FAQ:
Should I get a booster shot?
In almost all cases, yes. I got my third Moderna shot a couple of months ago, before the CDC proclaimed it was the right thing to do. I had no reaction to the vaccine at all. Some people got a one-day flu syndrome after the second vaccine but most people have had even less on this third one. Scientists are reporting 5 to 15 times more antibodies in the blood after the third (booster) vaccine.
Do I need to stick with the same brand for a booster shot?
There is little evidence that it really matters if one switches from Pfizer to Moderna or vice versa. We have lots of Moderna vaccines. We have no Pfizer although I could have acquired some. The deep freeze issue is not an obstacle anymore. I just don’t think it matters.
What if I had the Johnson and Johnson vaccine? The “one and done”: should I get a booster?
There is no formal recommendation for a booster shot for the J&J vaccine but I recommend that you get a Moderna (or Pfizer) vaccine (not a second J+J). It may provide some additional immunity since different vaccines have slightly different targets on the spike proteins. Although doctors can’t measure antibodies remember that the vaccine provides T cell immunity as well.
Do I have to wait eight months following my second vaccine before I can receive a third one?
The official recommendation is to wait eight months, but I would not hesitate to give you another one if it’s been even 4-5 months. It may be more cost effective for government to have patients wait because the immunity may fall more after eight months. I think this is a minor issue relative to the risk of catching the Delta variant of Covid for the individual.
Is the Delta variant more contagious?
Yes the average person was spreading the original virus to two to three other people whereas with the Delta variant it appears to spread to 8 or 9 people so it’s much more contagious.
Does the Delta variant cause more or less severe illness?
There appears to be some debate about severity. It is my personal experience with patients that the Delta variant is not as severe. However, since the number of cases is surging, hospitalizations are much greater across the nation.
Should children be vaccinated?
I don’t have a strong opinion and could argue it either way. I don’t trust government and I don’t like government mandates. But realize now that over 300 million doses of vaccine have been administered, so side effects are very rare. In general (with notable exceptions) children with Covid have very mild illness and then presumably they have significant immunity. My primary concern is not the child getting sick but rather, the child being a carrier and then visiting someone vulnerable, like their grandparents. So if a child goes to school then comes home and tests positive I would be glad so that they won’t bring it to their grandparents at Christmas!
Did the government distort statistics about to describe an epidemic of the unvaccinated?
Fox News reported that the statistic of “almost everyone that was hospitalized with COVID were unvaccinated” appears to be taken from data since January 1st, and much fewer people were vaccinated at that time, so the statistic is somewhat misleading. On the other hand, as I wrote above, the Delta variant is much more contagious and lots of people are getting sick again and although most are not terribly ill many are requiring hospitalization and my understanding is that vaccination reduces rates of infection and diminishes severity of disease specifically of the Delta variant so I recommend getting vaccinated.
Does ivermectin work for prevention or treatment?
There does seem to be some evidence that ivermectin is safe and effective but these were small studies, mostly overseas, and a definite conclusion is not available. There have been several other Covid treatments that in initial small studies seemed promising and then proved really not effective, and ivermectin could easily be like that. Therefore I wouldn’t bet big that it’s worthless nor would I substitute ivermectin for a vaccine and prudent measures of prevention. If you’re already a patient here and you have your heart set on ivermectin, we won’t refuse to prescribe it but I’m not convinced it works and the CDC told doctors not to prescribe it because there’s not enough evidence it works. I do NOT think that’s a deception from big pharma or a government trick. The medication appears relatively safe, and the biggest current danger is patients believing that it’s a substitute for proper vaccination.
What should I do if I get sick?
a. If you feel mildly ill you should quarantine. It might be Covid, and it might not. Covid is contagious and potentially dangerous. Many patients hate to cancel a dinner engagement with friends. Just because you feel well enough to do what you normally do doesn’t mean that you should put others at risk. Remember they might get much more sick than you do.
b. Keep a pulse ox and check your oxygen saturation if you get flu symptoms. The pulse ox is the little finger clamp that provides a number, usually in the high 90s. I’ve seen many patients who feel ill but have totally normal numbers. They should just stay home and take fluids. However, my concern are those patients who try to “tough it out” but in fact have falling oxygen concentration. If you get sick and your pulse ox measure falls below 94% you could be in trouble, and should seek help.
c. For patients who are even moderately ill, the monoclonal antibody IV infusion treatment like Regeneron seems to be effective. I would definitely get that treatment if I were moderately ill with COVID. It’s not worth the trouble if you’re just having a mild flu syndrome but if you have other illness like diabetes or if you’re over 60 years old or feel really ill, both Desert Regional Medical Center and Eisenhower have programs to administer this monoclonal antibody infusion to patients who are sick. I personally had a close relative in Texas get sick and when I sought the monoclonal antibody therapy I discovered that Texas has a fully funded home program. They will come to one’s home and provide the infusion. The reason they do this is because they’re convinced that they can diminish hospitalizations by administering this treatment. These links have more information for those in the desert:

https://eisenhowerhealth.org/health-services/other-health-services/covid-19-infusion-center/

https://kesq.com/news/coronavirus/2021/01/19/new-monoclonal-antibody-infusion-clinic-for-covid-19-patients-at-desert-regional-medical-center/

How can I increase my immunity and prevent disease?
We recommend — even for those who are not usually vitamin takers —to take vitamin D (5000iu daily), zinc 30-50mg one pill daily, and a multi-vitamin with B every day. I still have a mask and wear it in crowded indoor places.

Can I get tested at WellMax to see if I have antibodies to COVID?
Yes, but it is not usually necessary. Nevertheless, it can be helpful for reassurance that your previous possible COVID illness or vaccination was effective in creating antibodies, in case you are considering a visit with a vulnerable person. We can draw blood at our office but this is not a quick test. Results take two to three days.
Can I get tested to demonstrate no infection to permit travel?
Yes we have the Abbott ID Now machine that gives molecular test results in 15 minutes and is accepted throughout the USA and in Canada and many other countries (but not all countries).
Can I get a test if I suspect infection or exposure?
Yes we can use the Abbott ID Now molecular 15-minute test for that. Call us first because we can go to your car if you suspect you are contagious. In most cases, even with those who probably have become infected with the COVID virus, unless you feel really sick it doesn’t make a difference for your own treatment. But it may be reasonable in certain situations to reduce exposure to others.
Bottom line:
? It’s hot outside but air-conditioned here in our office! We are in the clinic and seeing patients, including annual preventive medical evaluations. Dr Doriana and her team are seeing patients. We are here for you, whether in person, or by zoom, or a phone call.

? We have hundreds of Moderna vaccines at no charge for anyone!
Daniel Cosgrove, MD

Indian Wells, Ca 92210