January 25th, 2021 COVID-19 UPDATE
The speed at which the vaccines have been developed for COVID-19 is nothing short of
phenomenal, even miraculous. At the start of the pandemic, there was tremendous doubt
within the scientific community that any level of efficacy above 60% could be achieved given
that all previous attempts at vaccines for Ebola and coronaviruses had failed. To achieve 95% efficacy for the short term in about 8 months of starting the process is nothing short of
miraculous and kudos to all the scientists and companies and operation warp speed.
Perhaps mRNA vaccines will become the de facto standard for vaccines going forward. Certainly, a new standard has been set that will have an impact long after this pandemic has been controlled. The development of vaccines and drugs henceforth for any pandemic or epidemic will take a ton of cues from all the scientific efforts of this pandemic. In that respect, as horrible as this pandemic has been, that is its silver lining.
The other silver linings have been a 10% reduction, however temporary, in the greenhouse gases, rapid digitization of businesses and of usage of machine learning and AI in medicine. Now that the Moderna and Pfizer-Biontech messenger RNA vaccines are being deployed, the hope for herd immunity through vaccination exists. We do not yet know how long the immunity from these vaccines will last. Much depends not so much on the antibody response but on the T cell response responsible for long term memory.
The roll out has been slower than expected and the logistical issues have surfaced due to poor coordination at the National level. The great expectation this week is for a positive readout on the single dose Johnson and Johnson vaccine achieving 90% or more efficacy. That would be a game changer. Thus far the side effects of more than 62 million vaccinations have been mild and the deaths in Norway have not been linked to the vaccine.
Yet concerns remain about the safety of these vaccines and the refusal of so many individuals to get vaccinated is disconcerting but understandable. Unfortunately, this pandemic has been used as a weapon for politics instead of following the science and actually controlling the pandemic, which has not been easy. But we know a lot more about this disease now than we ever did about coronaviruses.
The other concern is that variants of Covid-19 that emerged in the UK, Brazil, South Africa are now spreading the other parts of the World including the USA. 10 states have already shown that the UK variant is here and that it may be 70% more transmissible than the original Covid-19 and that the South African variant may be more aggressive and cause more deaths.
It is not yet clear that the current vaccines will be effective against these variant viruses as they cause mutations within the spike protein, the part of the virus that binds to the ACE receptor in the nasal and respiratory mucosa. Meanwhile there has been resurgence of the virus in China, Spain, Europe, Germany and other countries. Russia and India have been hit hard as have Brazil, and South Africa. China locked down two locations recently.
Many hospitals in the US have seen a huge surge in Covid hospitalizations after Thanksgiving and Christmas holidays. Finally, we have a National mandate on masks.
Newer therapeutics are showing benefit including Covid antibodies from Lilly and Regeneron, baricitinib and Remdesevir combination (approved by the FDA), dexamethasone, with readouts on Leronlimab (a CCR5 receptor antagonist), aviptadil, Remestemcel (a stem cell product). Even Toclizumab, an IL-6 inhibitor, had a recent positive readout despite previous failures. Remdesevir alone has been controversial as has hydroxychloroquin. Data on Imervectin has not been assessed.
Within the first 5-6 days of infection, the best option may be the IV infusion of antibody to prevent the disease from getting worse. Most people fail to understand that the initial symptoms may be followed by a few days of improvement and then a rapid decline depending on the individual’s immune system response.
Many young physicians, health care workers and non-physicians have succumbed to Covid-19 despite having no other medical issues and even working out regularly. No one knows when this pandemic will end. Making sure that your Vitamin D, zinc and Vit C levels are optimized is a good thing.
ALMOST 100 MILLION CASES HAVE OCCURRED WORLDWIDE WITH 2.1 MILLION DEATHS GLOBALLY. 400,000 AMERICANS HAVE LOST THEIR LIVES TO COVID.
TO ARGUE THAT SOME DID NOT HAVE COVID AND THAT HOSPITALS ARE OVERCOUNTING CASES IS STUPID. THERE HAS BEEN OVERCOUNTING AND UNDERCOUNTING. THIS IS FAR MORE LIVES LOST THAN IN WORLD WAR II AND FAR MORE LIVES ON A DAILY BASIS THAN ON 9-11. IT IS VERY IMPORTANT THAT NO ONE TAKE THE DISEASE LIGHTLY. THIS IS NOT A HOAX.
UMANG KHETARPAL, M.D.
Dr. Umang Khetarpal finished his medical school at the young age of 22 and is trained in Otolaryngology-Head and Neck and Facial Plastic Surgery. He completed his internship and specialty residency training in Syracuse, New York. He also has extensive research experience and additional clinical experience through fellowships at Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School in Boston. He has co-authored book chapters and many publications in peer reviewed journals within the specialty. He has presented at major specialty society meetings and at academic institutions. Topics of his research included hearing loss and balance disorders, sinus problems and sleep apnea. His recent research efforts have been entirely focused on sinusitis, especially recurrent acute rhinosinusitis, allergies and in office balloon sinuplasty and in office sinus surgery. He has recently presented five papers at the International meeting of Rhinology in CHicago, June 2019. He discovered and was the first to describe a novel ear disease in families that resulted in balance and hearing problems. His most innovative research was in the cutting-edge field of genetics in Otolaryngology where he was involved in finding the genetic defects for several different diseases. In addition, he has taken time to observe the surgical techniques of some of the world’s most renowned surgeons in plastics surgery. He had been featured 3 times over the years in newspapers in the Rio Grande Valley for introducing latest treatments in thyroid cancer, sleep apnea and sinus surgery locally. His current interest is in molecular genetics of allergic rhinitis and chronic sinusitis with and without polyps and in finding better cures for these conditions. He now calls Houston his home and is starting his practice in the Woodlands.