State of The Pandemic (From My Most Trusted Source- A Front Line Covid ICU Doctor, Virologist & Epidemiologist)

Rick Loftus, MD is in the same Finding Meaning in Medicine circle with me and our mutual teacher, Kitchen Table Wisdom author and The Healer’s Art founder Rachel Naomi Remen, MD. Given his epidemiology background, his smart brain, his position on the front lines, and his huge heart, Rick is my most trusted source for current information about the pandemic, so I wanted to share with you all what he just shared with the doctors in our inner circle.

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I wasn’t going to do any more COVID science updates but I think the discovery of the B117 virus strain being present in low amounts across the US warrants a comment. This strain was a minority of viruses circulating in southern England in early December, but became the majority strain across the entire country in about a month. This has been associated with a surge in hospitalizations. While for individuals it’s not more dangerous than “regular” COVID, it will infect more people, which increases the odds of health care system collapse. Hospitals in LA, 2 hours from me, are running out of oxygen.

The new COVID variant B117 looks to be 50-70% more contagious, and seems to be easily able to infect children (there was an impression that kids were harder to infect with COVID/SARS-CoV-2, but that’s not true of the new strain, which I expect will be the dominant US strain by Feb 1. )

The variant has been found in Southern Calif, Colorado, and New York, so all of us will be affected sooner rather than later. (It’s probably in other states but those states aren’t sequencing virus so they don’t know they already have it.)

WHAT DOES THIS MEAN?: It means that we need to DOUBLE DOWN on measures to keep us safe. That starts with, 1. STAY AWAY FROM HUMANS NOT IN YOUR HOUSEHOLD as much as possible- and remember, every person that a person in your household “bubble” has contact with is also in contact with you. This means, in so many words, if you must interact with folks outside your household, try to keep it to people being as careful about avoiding COVID as you are.

Masks and Prevention

In case you have to be around others not in your household, keep in mind:

Outside is always safer than indoors; (By the way, a garage is not outdoors, and would need a fan blowing briskly through it to be as safe as outside. Those tents restaurants are putting around outdoor tables makes them indoor tables, in case that was not obvious already to you.)
If you must be indoors with those not in your household, make sure the space is well ventilated, i.e. 6 air exchanges of the space per hour; in a room, open the window at least 6 inches to bring in fresh air, and a cross breeze is helpful;
Air humidity in a sweet spot of about 40-50% is best; too dry or too wet helps the virus.
If you use a CO2 meter to judge your ventilation in a space ($100 on Amazon), the goal should be around 800 ppm or lower as your target when you ventilate it.
If you must be indoors, like a grocery, keep it as brief as possible (but remember: rule #1 is stay away from humans–if you can afford to have it delivered, do so, and tip that delivery person big.)
There is no “magic” about being 6 feet away–we had a case in South Korea that transmitted over 23 feet. But keep distance to at least 6 feet if not farther.
Related: I have lost track at how many clusters of infection happened over meals with others. If you can avoid eating around people not in your household, do so. As soon as the masks come off for eating, virus is transmitted. That’s likely to be even more true with B117. Mayo Clinic had 900 health care workers infected in lunch rooms. At the hospital, I did not eat or drink except in a private sleep room, alone, well away from patient care areas.If you must be around folks from outside your household, use at a minimum a fresh surgical mask, or cloth mask if that’s all you have, PLUS A FACESHIELD that SEALS AGAINST YOUR FOREHEAD AT THE TOP (to prevent droplets going into your eyes from above). Numerous infections of COVID have resulted from the eyes not being protected. If you don’t have a faceshield, use goggles that seal around the eyes. Regular glasses are not enough,. Again: You probably haven’t used eye protection up until now–but now is the time to start, as the B117 variant will be circulating within a month, I expect, and it’s more contagious.
If you can use an N95 or a KN95, use one of those instead of surgical or cloth masks–they work better.
N95’s and KN95’s can be re-used at least once before starting to lose protective power, and perhaps as much as 4 times at most. (Keep this in mind for workers who get one N95 for a WEEK. Ouch. Yes, that’s still happening because Trump never invoked the Defense Production Act for N95s as health care workers asked him to.) Air dry masks in a sunny dry spot for at least 4 days prior to re-use. If you have a supply of N95 or KN95 masks, use them in sequence before the first re-use, and then again in sequence until second re-use (if you haven’t gotten fresh ones by then).
Faceshields can be washed with soap and water and air-dry before reusing.

What else can I do?

I take supplements to protect myself as a front line doctor. I take Vitamin D3 2000 units daily and zinc 40mg daily, and melatonin 5mg at bedtime. All of these have suspected but not yet proven protective effects. For most folks these would be very safe, but talk to your doctor. I also take Pepcid 20mg twice daily, an antacid which is over the counter and in COVID seems to reduce risk of severe COVID, for reasons that are being studied in trials. It is cheap and has little downside/side effects, so little downside in using this way. This effect has not been seen with any other antacids and, again, talk to your doctor. The antioxidant quercitin I also take as 500mg twice daily for prevention; it’s being studied as an anti-coronavirus antiviral by a group in Montreal. It can cause low blood sugar in high doses so again, if you have diabetes and are on treatment for it, talk to your doctor.

If I were to get confirmed COVID, I would increase the quercitin to 500mg three times daily, add Vit C 2000mg daily, and add two baby aspirins daily for at least a month. Obviously, anyone diagnosed with COVID should talk to their doctor about treatment. (By the way, hydroxychloroquine, which I talked to everyone about in early March, was after study shown not to help and to maybe even harm in some cases, so do not use it. There is some hopeful data on the drug ivermectin helping COVID and it’s being studied; if I got COVID I would dose it anyway, as the downsides are minimal.

If I got COVID, I would also use a pulse oximeter at home, measuring my oxygen levels. A person whose levels fall below 94% and stay there needs to at least talk to their doctor. I advise admission for levels below 94%, but many hospitals now are getting full so may try to have people manage at home with home oxygen instead of hospitalization.

Vaccines

We are now in a neck-and-neck race between B117 and vaccination. The more people who get infected, the worse the national situation will be. I would advise more aggressive COVID avoidance habits until we get all get vaccinated–hopefully, most of us will have that by summer, hopefully sooner now that a competent administration that is not trying to lie to us or kill us will be in power.

By the way: While there has been concern that some variants will get around the current mRNA vaccines, that’s NOT true of B117. We are worried about the 510 South Africa strain getting around current vaccines and some colleagues are studying this question right now. If any new variants are vaccine-resistant, we will make Pfizer and Moderna COVID Vaccines 2.0 and it should be immediately effective. That’s the beauty of RNA vaccines. Fast.

Vaccines: They are quite safe–safer even than the shingles vaccines, which all adults 50+ are indicated for (or at least, Xers and older). Available COVID vaccines right now are Pfizer and Moderna (mRNA), although the Oxford/Astra Zeneca vaccine (DNA) may be available sooner than was initially expected. All of these are 2 dose vaccines, but protection kicks in 10 days after the first dose.

Johnson and Johnson’s vaccine (DNA) should go to FDA in a couple of weeks based on their last discussion with me 3 weeks ago. I’m not sure if they’re seeking 2-dose or 1-dose approval, but assume they’ll play it safe and ask for a 2 dose review. The Novavax vaccine (protein) is starting large studies now and is 2 dose.

The Merck vaccine I’m working on won’t go to large trials until June, sadly, due in part to dosing questions and of course to the changed situation with other vaccines now standard of care.

Please take care of yourselves. You are welcome to disseminate this to other folks if you like. Let’s hope we can all get vaccinated and not have to worry about managing a COVID infection.