Essential guide for you and your family in protecting yourself from Omicron . . .
Viruses get less virulent over time, not more virulent. We’ve demonstrated this over the last 100 years in the medical literature. And, according to the experts as of today, there is no evidence that Omicron is more severe or more infective.
Yet, Pfizer, Moderna and the other vaccine manufacture’s response is “let’s just double the vaccine dose.” They are recommending this because the “double dose” increases the antibody titer in the 309 people it was tested on.
For a vaccine that doesn’t prevent viral infection nor prevent viral transmission, just raising the antibody titer with a double dose is like saying “we should each wear two diapers so that your neighbor doesn’t get diarrhea.”
Over the last two years, clinical experience has demonstrated over and over that those who are the sickest from a COVID-19 infection are those who are obese, have elevated insulin levels and/or have significant lung disease. Reducing your weight, exercising and limiting your starch, sugar and carbohydrate intake have been the most powerful forms of prevention.
If you want prevention that works, read my article on how to prevent at treat COVID-19 here.
Over the last few months, our fearless infectious disease leader, Dr. Anthony Fauci, and the Ivory Tower of medical journals, the New England Journal of Medicine, have clearly informed us that mask wearing by the healthy is little more than symbolic ‘Virtue Signaling.’
For those Karen’s and Felicia’s who have tried to shout me down like a Tourette’s tick with ‘Social Media Science,’ in Wal-Mart, in the big box stores, at the gas station and at the burger shop, lets look closely at what the New England Journal of Medicine said on May 21, 2020.
We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to COVID-19 as face-to-face contact within 6 feet with a patient with symptomatic COVID-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching COVID-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.
So, why have we been ordered to wear are masks everywhere by mayors and governors and city officials across the country? Symbolism. Pure and simple symbolism. From that same NEJM article:
It is also clear that masks serve symbolic roles. Masks are not only tools, they also serve as a talisman [an object that acts as a charm to avert evil and bring good fortune] that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals.
The Surgeon General was widely mocked and ridiculed for suggesting in March that masks might even increase the spread of the virus. Yet, here, in the “journal of all medical journals,” the NEJM provides the same warning to mask-wearers:
What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active COVID-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early COVID-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of COVID-19 if it diverts attention from implementing more fundamental infection-control measures.
However, suddenly on June 17th, 2020, Dr. Fauci suddenly changed his tune, and contrary to all the scientific evidence and over 50 years of medical literature on the subject, said wearing a mask is “better than nothing.” Within weeks, executive orders for mask wearing were signed across the nation.
The argument should have been over. Anyone advocating for universal mask wearing by the healthy, according to all the mask wearing literature, is merely engaging in virtue signaling, not actual public health.
Cities and states across the nation have mandated mask wearing (some even advocate using bananas). I’m not telling you to break the law. I am saying that the mask mandate has done nothing to “slow the spread” as so many people have now bought into. Research demonstrates that homemade masks do little to stop the spread of viral infections. It also demonstrates that properly fitted surgical masks worn correctly decrease this risk of viral spread in a highly controlled setting at the very best by only 2-5%.
In the most recent comprehensive review of the mask wearing literature, the authors stated, “The evidence is not sufficiently strong to support widespread use of face-masks as a protective measure against COVID-19. However, there is enough evidence to support the use of face-masks for short periods of time by particularly vulnerable individuals when in transient higher risk situations.”
What is effective is washing your hands regularly with soap and water, avoiding those who are actually sick or have fevers over 101 degrees, eating a healthy diet that prevents diabetes risk and getting adequate sleep. Those at high risk for infection can and should be vigilant about avoiding exposure to those who are sick.
For the rest of us, it’s time to unmask. I, myself, struggle daily to maintain enough virtue in my bones for myself, let alone signal others about it all day long.
(Note: Author Updated this article on January 31, 2021)
I’ve been accused of writing this article because of my personal political motivation. That is not the case. I write this article because my patient’s expect me to treat them based on the actual science that exists, not the interpretative politics and non-evidence based health mandates that so many have recently cowered under, or used as a virtue signaling security blanket. A number of my patients, and potential patients, have notified me since I first published this article that I upset or angered them, because I haven’t conformed to “everyone else’s opinions.” My intent in writing this is not to anger anyone, agree with your opinion or to put forth a political agenda. Just because the media, politicians or city bureaucrats repeat something over and over doesn’t make it true. I share with you the actual science that has been recently made available so that you and I can make an educated judgement on how to act. Without an understanding of the actual evidence how are you and I to respond when there are so many voices sharing so many differing opinions? If you can’t trust your doctor to follow updated scientific evidence, then who can you trust?
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After graduation from medical residency, I served for four years as my AirForce Reserve unit’s biological/chemical weapons expert & physician. My job was to understand the risks of all the known biologic and chemical weapons that could be used on a human being, including severe viral and bacterial diseases that could pose a threat. My training was specifically focused on how to prevent and treat the effects of these illnesses in those under my care, military or otherwise.
I spent four years reading and researching where and when various types of masks, respirators and protective equipment would and should be used. Never once was a surgical or cloth mask ever found to be effective. Even N95 masks failed the rigors of these encounters.
This week our fearless Dr. Fauci says it’s “common sense” to wear two masks. So, my question to him and all of the other emperors of medicine is, what about three masks?
Even better yet, 10 masks makes even more “common sense!!” Where does this stop? (‘Cause my ears flop over at 11 masks.)
I’m thinking that 100 masks is 100% effective right?
I guess those filtered gas masks really aren’t essential then?!
One surgical mask decreases risk by 1-2% (yes, that’s the benefit of a mask that we’ve been required to wear). You’re more likely to have a 40% COVID risk reduction by throwing salt over your shoulder when you leave the house . . . (that’s the actual placebo effect).
The whole reason for mask wearing is to decrease “asymptomatic” transmission of COVID-19. That means, masks are supposed to decrease your risk of spreading or inhaling this virus when you or the person near you have no symptoms. Initially, we recommended wearing masks, because we did not know how infective the COVID-19 virus was to humans. We also knew that there was limited access to the N95 masks used in the hospital setting.
However, in the last 12 months, we’ve learned a great deal and we have a tremendous amount of data about treating this virus in the outpatient setting.
How Contagious is COVID-19?
What’s the actual risk of spreading the virus when you have no symptoms? It’s about 0.06% if you have prolonged contact (3 hours continuous face-to-face) with a person within six hours of that person having onset of symptoms (i.e. – fever, sore throat, fatigue, headache, loss of taste or smell, or runny nose). It is very rare to be infected at all with COVID-19 asymptomatically if you contact a person 6-9 hours before they have symptoms.
In fact, a recent study revealed there were no positive tests (or asymptomatic spread) among 1,174 close contacts of asymptomatic cases. So, why are we still wearing masks? Because it is politically convenient, increases fear, and increases your likelihood of getting a vaccine.
Are There Unintended Consequences of Mask Wearing?
Is wearing a mask to decrease a minimal risk by 1% more worth the risk? Increased bacterial and fungal infections that are on the rise as a consequence of chronic and continued daily mask wearing.
I’m seeing patients with increased frequency of facial rashes, fungal infections, non COVID-19 induced bacterial infections. Reports are coming from my colleagues, all over the world, that suggest bacterial pneumonias are on the rise.
Why? Because we are wearing and re-wearing of dirty masks. Untrained members of the public are wearing medical masks, repeatedly… in a non-sterile fashion… They’re becoming contaminated. They’re pulling them off of their car seat, off the rearview mirror, out of their pocket, from their countertop, and they’re reapplying a mask that should be worn fresh and sterile every single time. And, there is no way around this when 330 million people are required to wear a mask to go to Wal-Mart or Costco.
In a recent report in Emerging Infectious Diseases, the U.S. Centers for Disease Control and Prevention (CDC) suggests what experts have stated all along: There is no conclusive evidence that cloth masks protects users from coronavirus, especially since most people do not use them correctly and do not keep them clean.
The report actually says, “To our knowledge, only 1 randomized controlled trial has been conducted to examine the efficacy of cloth masks in healthcare settings, and the results do not favor use of cloth masks. More randomized controlled trials should be conducted in community settings to test the efficacy of cloth masks against respiratory infections.”
So, why, again, are we wearing these masks?
Should We Still Be Hiding In Our Homes?
Six months after the the largest variant of the five coronavirus sub-types appeared with it’s ugly little glycoprotein envelope and infective RNA fusion peptide coating, many states and countries are still in a quarantine or lock-down. Initially, because of the rapid infection rate that was seen in Italy and China, health experts recommended quarantine of the general population in order to keep hospital systems and medical providers from being overwhelmed. However, the “overwhelm” has been quite underwhelming. This begs answer to four very important questions:
Should we still be quarantined?
Should we still be wearing a mask when in public?
Should businesses still be shut down?
Should we wait for a vaccine?
This is the first time in history that large scale quarantine of the healthy across the country was ever used. The sole purpose was to control the number of severe cases requiring intensive care and ventilator use. Multiple mathematical models predicted that hundreds of thousands would die based upon statistics seen in Italy and China.
In early February, 2020, we were concerned that risk of death as high as 5.5% in our initial data from Italy and China. Limited N95 masks and protective equipment was available. In agreement with the CDC and WHO, I recommended everyone wear a mask, take drastic infection precautions and quarantine to prevent risk of transmission (Davies A, et al., Aug 2013).
Because viruses like COVID-19 and influenza are so small, a single layer cloth mask and or surgical mask has only been shown to decrease your risk of viral infection or transmission to others by 1-2%. Triple layer cloth masks with central interfacing layer give 3% – 20% reduction of infection risk based on the studies we have in the medical literature (Disaster Med Public Health Preparedness. 2013;7:413-418). At the time we learned about this virus, our understanding was that any protection was better than no protection.
Underwhelming
Yet, as this virus crossed our shores, traveled over the amber waves of grain and ascended the majestic purple mountains of majesty, the overwhelming number of patients hitting the hospital in droves isn’t what we saw. A few areas like New York and Washington State were hit hard, but not nearly as predicted. The large numbers of deaths seen in these states is because of their decision to send thousands of recovering COVID-19 patients into nursing homes, exposing those over 65 at greatest risk for death, to this virus.
The ONLY reason to quarantine an entire population was to decrease the load on hospitals and medical providers. Since the corona-virus entered the US, only 2% of those who actually get infected have required hospitalization. Our fears never came to fruition. The hospitalization load never even reached full capacity in 99% of hospital facilities across the country and many facilities began furloughing employees in April 2020. In fact, this weeks estimate by the CDC is that the fatality ratio for COVID-19 is 0.004. That means if you get the infection, you have a 0.4% chance of dying from coronavirus. Remember, influenza has a fatality ratio that fluctuates between 0.002-0.005 depending on the year (0.2%-0.5% fatality risk). In layman’s terms, your risk of death from a coronavirus infection is no greater than the flu.
The population with the greatest risk for death with any infection is that group over 65 years old. Your overall risk of getting this infection in the United States and dying, if you are over 65 years old, is 0.04% based on our current population and fatality rates. Your overall risk of getting the flu and dying, if you are over 65 years old, is between 0.03%-0.05% depending on the severity of the year.
Arizona Department of Health Services COVID-19 Dashboard – June 18,2020
As of June 18th, eight weeks from the time we began opening up businesses, elective surgeries and letting people go back to work, the death count from COVID-19 continued to fall. If social distancing and mask wearing was really effective, significant rise in infections and COVID-19 deaths should have escalated in mid-May (5-6 days after exposure). Yet, in states like Arizona COVID-19 death counts continued to fall.
Quarantine of the Healthy
In all of history, we have never seen any benefit to quarantining the healthy. In fact, quarantine of the healthy has been demonstrated to be unhealthy for a “well population” (Brooks SK, et al., Lancet, Feb 2020). Based on scientific evidences we have today, despite what our politicians say, there is no reason to quarantine those that are not ill. Seeing all this data over the last two weeks dramatically changed my perspective on this virus.
Asymptomatic Transmission
“Oh no, Dr. Nally! You can’t say that, because this virus can be transmitted when you’re not symptomatic!” Yes. I’ve heard that argument for the last three months. And it is unfounded.
The main reason for quarantine was the fear of asymptomatic transmission. Early editorial reports (these were not actually controlled studies, they were opinion reports based on a case review) showed that the virus “may” be spread prior to a person showing symptoms via respiratory secretions. Initial data in seven very small presumptive editorial case reports out of China, Singapore and Germany postulated that this could occur in 40-50% of those infected (1,2,3,4,5,6,7). Yet all of these articles were case reports of 1-10 people and the exact mechanism of transmission was observational only and is still unknown.
The CDC made its recommendations on wearing masks based on these seven presumptive editorial cases between January and May, 2020. Recent nursing home case report data from April and May looked at 76 people in two nursing homes, 50% of those with positive infections were asymptomatic for the first 5-6 days. The report implies that those with COVID-19 must have had the potential to spread the disease 3-4 days before onset of symptoms. All of our social distancing and mask wearing has been based on upon these seven very small presumptive case reports and/or medical editorials. Never in medical history has sweeping health recommendations or mandates been made on editorial reports alone.
It is very important to note a recent larger population study of 455 patients was performed looking at infected members of families and those living in close quarters over 2-4 weeks. The researchers findings were opposite that of the seven small case reports above and concluded that the likely hood of asymptomatic SARS-CoV-2 transmission was “weak.”
The assumption that viral infections can be transmitted in the asymptomatic state comes from the Ghandi study, and others, that 30-50% of asymptomatic influenza patients can spread the flu a full 3-4 days prior to showing any symptoms, and in some cases up to 7 days prior to symptom onset. We’ve assumed that is the case with COVID-19, but that isn’t what the larger study demonstrated.
Have we or do we currently quarantine the healthy or institute social distance because of asymptomatic influenza spreading risk? No.
Do we quarantine the healthy or social distance because of the highly contagious croup or whooping cough (that is still prevalent on our southern border)? No.
But, these are the same editors and journals that have been telling us for the last 50 years that eating fat makes us fat. So, we must trust them, right? Wait, didn’t the New England Journal of Medicine and the Lancet both just retract “ground breaking” articles on COVID-19 because of falsified data that was never peer reviewed?
The fear of asymptomatic spread is therefore a mute point, as it is roughly identical to the flu. And it has infectious similarities to other infectious diseases like whooping cough (pertussis) and the croup (para-influenza virus). If the only actual large study of COVID-19 demonstrates that asymptomatic droplet based spread is weak, then why have we created fear and economic collapse for a virus that is less likely to spread in the asymptomatic person than the flu, croup, or whooping cough?
Risk Factor for Disease Severity
These three maladies (hypertension, diabetes & coronary artery disease) are the three most common medical problems that I see in my clinic, and they affect 85% of the people in my practice. All three are caused and driven by hyperinsulinemia.
Hyperinsulinemia is defined as an elevated insulin production (2-30 times normal) when ingesting any form of carbohydrate or starch. It starts 15-20 years before the onset of diabetes and is the cause of hypoglycemia, elevated fasting blood sugar, pre-diabetes, metabolic syndrome, chronic kidney disease, idiopathic neuropathy, hypertension and coronary artery disease.
Elevated insulin, even small elevations, puts a load on the immune system. The higher your insulin response to starches or sugars, the more likely you are to have hypertension, diabetes and heart disease. We found that those with elevated insulin levels and those over 45 years old with stressed immune systems are the most susceptible to severe COVID-19 infection.
We know that those who do get severely ill are those over 45 with immune system compromise and/or hyperinsulinemia. A very interesting fact was published in The Lancet. The authors found that the highest rates of death occurred in those with current hypertension, diabetes and/or coronary artery disease (heart disease or atherosclerosis of the arteries).
Interestingly, Italy, Spain and Portugal have the highest incidence of metabolic syndrome (hyperinsulinemia) across all of Europe. It stands to reason that they have also been hit the hardest with a virus that is focused on this form of immune-compromise.
Corona-Virus is Quite Common
The corona-virus, traditionally, causes a simple common cold. In fact, 2% of the population are asymptomatic carriers of the six corona-virus strains that are known to infect humans. And this class of virus is responsible for 10% of respiratory infections yearly around the world (Cascella M, et al. 2020 Apr 6. In: StatPearls.).
Should We Still Be In Quarantine?
Should we still be in quarantine? The answer is therefore “no.”
What we should be focused on is limiting exposure to those with the greatest risk like those in nursing homes, care centers, populations of elderly (over 65 years old), and those with known risk for suppressed immunity. Our focus, efforts and funds should be spend keeping these populations from exposure to COVID-19.
Should we still be wearing masks in public?
As noted above, cloth masks provide only very minimal (20-40%) protection from bacteria and almost no protection (1-2.3%) from viral infections. The two studies that do exist about effectiveness of mask wearing during viral infections to prevent spread demonstrate that adherence is very difficult and that transmission of viral infections is not statistically different between those wearing masks and those not wearing masks (MacIntyre CR et al., Cowling BJ et al.). Because we now know that this virus is similar to influenza in risk for death, general healthy populations should have no need to wear masks. Wearing of a mask actually increases the likely-hood of infection by increased frequency of touching your face. It also perpetuates a climate of risk and fear. It, also, implies that if required, mask should be a covered cost of medical provision at the State and Federal levels. As you can see, even the NIH director over NIAID, Anthony Fauci, MD, the one person in the country with the most experience in pandemic infectious disease, has trouble wearing a mask in public.
Second, there are a number of other medical problems including exacerbation of headache and migraines that occurs with chronic use of both surgical and N95 masks. For those who have COPD, mask wearing can exacerbate hypercapnia (increased carbon dioxide levels causing slowed respiration, confusion and fatigue). Mask wearing can also cause chronic hypoxia (reduced oxygenation) which has been shown to increase risk of cancer growth. In cases where patients with pulmonary fibrosis or impaired lung function wear masks for prolonged periods, syncope or loss of consciousness has been documented.
Therefore, wearing a mask for prolonged periods of time when it is not medically justified is not recommended and in many cases dangerous to your health.
Despite this, and the fact that there is significant doubt as to asymptomatic transmission of this virus, mandates to wear face masks in public were decreed across Arizona today.
Should businesses be shut down?
If our ultimate goal was to “flatten the curve,” and protect hospitals from being overwhelmed, then we were successful at doing that in mid-April. Some communities rightfully extended that quarantine to the end of April. However, there has been no justifiable evidence to suggest that healthy people cannot go back to work, feed their families, pay their mortgages and provide for themselves. In fact, multiple states including Wisconsin, Kansas, & Michigan have had Federal courts overturn draconian quarantine measures enacted by over-reaching emergency gubernatorial orders.
How accurate are the tests anyway?
The accuracy and predictive values of SARS-CoV-2 tests have not been systematically evaluated, and the sensitivity of testing likely depends on the precise RT-PCR assay, the type of specimen obtained, the quality of the specimen, and duration of illness at the time of testing.
In a study of 51 hospitalized patients in China with positive SARS-CoV-2 RT-PCR test (mainly on throat swabs), 15 patients (29 percent) had a negative initial test and only were diagnosed by serial testing [Fang Y, et al., Radiology 2020]. In a similar study of 70 patients in Singapore, initial nasopharyngeal testing was negative in 8 patients (11 percent) [Lee TH, et al. Clin Inf Dis 2020]. In both studies, rare patients were repeatedly negative and only tested positive after four or more tests.
Seven additional studies (including two unpublished reports) that evaluated RT-PCR performance, the estimated rates of false-negative results were 100 percent on the day of exposure, 38 percent on day 5 (estimated as the first day of symptoms), 20 percent at day 8, and 66 percent at day 21 [Kucirka LM, et al., Ann Int Med 2020].
And even though manufacturers are pushing the new antibody testing, antibody testing with IgG and/or IgM tests are frequently falsely positive [Guo L, et al., Clin Infect Dis 2020] and have been shown to be erroneous 20-30% of the time. The accuracy and time to antibody detection vary with the particular test used. Studies evaluating the specificity of serologic tests in a broad population are lacking; in particular, the rate of cross-reactivity with other coronaviruses is a potential concern, and IgM tests are prone to false-positive results.
In the first week since symptom onset, fewer than 40 percent had detectable antibodies; by day 15, IgM and IgG were detectable in 94 and 80 percent, respectively.
In the United States, several serologic tests have been granted emergency use authorization by the FDA for use by laboratories certified to perform moderate- and high-complexity tests [FDA.gov]. The FDA highlights that serologic tests should not be used as the sole test to diagnose or exclude active SARS-CoV-2 infection. The sensitivity and specificity of many of these serologic tests are uncertain.
Should We Wait For A Vaccine?
As a preface to this section, please be aware that I am a very strong proponent of safe and effective vaccine use. Because the RNA vaccines are so new, long-term efficacy, safety and adverse reaction studies are essential before these vaccines can be recommended across the board. It takes at least 4-5 years to 1) bring a vaccine to market and 2) complete adequate safety studies.
Let’s start by looking at the effectiveness of current RNA viral vaccines. The most common RNA vaccine currently in use is the influenza vaccine, quadravalent (four flu strains) and high dose (five flu strains) versions. Over the last 20 years, the percentage of seniors getting flu shots increased sharply from 15% to 65%. It stands to reason that flu deaths among the elderly should have taken a dramatic dip due to increased flu vaccination each year.
Instead, as you can see above, influenza deaths among the elderly continued to climb. It was hard to believe, so researchers at the National Institutes of Health set out to do a study adjusting for all kinds of factors that could be masking the true benefits of the shots. But no matter how they crunched the numbers, they got the same disappointing result: flu shots had not reduced deaths among the elderly.
It’s not what health officials hoped to find. I was shocked when I read these studies. Two studies, here and here, demonstrate that yearly flu vaccine for those over age 65 does nothing to decrease influenza related death. These studies funded by the government in 2005 and 2006 were suppressed and I never heard about them. Yet the CDC still emphasizes to the elderly, “Get your flu shot.”
One reason these vaccines are ineffective is that viruses like influenza and corona-viruses are highly antigenic. That means that there are hundreds of strains and the virus is changing rapidly. Influenza has over 600 strains. Our current high dose vaccine only covers five of these strains.
SARs-CoV-2 (COVID-19) is known to have over 160 strains. “There are too many rapid mutations to neatly trace a COVID-19 family tree.” Said Peter Forster, geneticist at the University of Cambridge. “We used a mathematical network algorithm to visualize all the plausible trees simultaneously.” (Proceedings of the National Academy of Sciences, 2020). Dr. Forster’s research identifies 160 genomes within the hundreds of additional variants of the three central COVID-19 strain variants.
The other very fascinating concern found when making RNA virus vaccines is the potential to increase susceptibility to other viruses. In a Department of Defense study, looking at 6000 military personal vaccinated in the 2017-2018 season, those who got the influenza vaccine demonstrated an increases susceptibility to corona-viruses by 36%. Those who were vaccinated with the flu vaccine had additional increased susceptibility to non-influenza viruses by 15%, and increased susceptibility to human metapneumovirus by 59%.
A second influenza study demonstrated an increased risk of para-influenza virus in adults (increased by 4.6% of vaccinated adults and only 2.6% of unvaccinated adults.) Though the researchers dismissed it as calculation error, the p value reflects that the vaccine played some roll (P=0.04) in the increased susceptibility.
Herd Immunity? Maybe in 200 Years
Do the math on a vaccine that covers only four out of 600+ strains like the quadravalent influenza vaccine. For a vaccine to create “herd immunity,” currently being touted across the airwaves as the way to return to normal, it would require the average human to be vaccinated every year for 100 years, and would take 200-400 years to create any semblance of herd immunity. And, that’s after 4-5 years studying the safety of a vaccine in large populations.
Influenza and HPV, the two most widely used RNA vaccines, still have a number of post-market adverse reactions including: Guillain-Barré syndrome (GBS), convulsions, febrile convulsions, myelitis (including encephalomyelitis and transverse myelitis), facial palsy (Bell’s palsy), optic neuritis/neuropathy, brachial neuritis, syncope (shortly after vaccination), dizziness, and paresthesia (tingling of the extremities) (Package-Insert—Gardasil.pdf; Package-Insert—Fluzone High Dose.pdf). Though these adverse events occur more rarely, it is essential you and I understand the risks of these newer RNA vaccines.
Conclusion
In summary, our focus should be shifting to protecting our elderly and immune-compromised. The evidence does not support quarantine of the healthy. Evidence does not support general public mask wearing. And there is no evidence that continued business closure is beneficial.
What can you and I do?
Reduce your risk of hyperinsulinemia. Follow a carbohydrate restricted diet, exercise, control blood sugar, blood pressure, cholesterol and limit risk factors that suppress your immune system. Quit smoking, vaping, etc.
Actively engage your congressman or congresswoman. What are they are doing to assist/protect the seniors, nursing home patients, and shut-in’s in your area?
Let your governor or mayor hear your voice. What damage has quarantine has done to your livelihood and those of your family?
Get educated about your civil liberties and do not let anyone take them under the guise of an emergency.
Ensure your loved ones, especially the elderly and immune suppressed, understand the truth about their risk of infection.
Don’t be afraid to go outside and be a human being again.
I’ve taken a tremendous interest in the recent deaths caused by the corona-virus infection. The reason for my interest is high C-reactive protein (CRP), high interleukin-1 (IL-1), high interlukin-33 (IL-33) and high interleukin-6 (IL-6) levels in patients with this illness. Recent data, literally hot off the press, demonstrates that those with the greatest risk of death had the highest CRP, IL-6 and IL-33 levels.
I have a large population of metabolic syndrome, hyperinsulinemia and diabetic patients in my practice. About 85% of my practice has hyperinsulinemia. They over produce insulin between 2-30 times normal in response to any form of ingested carbohydrate (simple and complex sugars, fruit, pasta, cereal, oatmeal, etc.) High insulin causes elevated CRP, IL-6 and IL-33.
Why is this a problem?
A very interesting fact was published four days ago in The Lancet. They published a study looking at 191 patients in two hospital centers in China. The authors found that the highest rates of death occurred in those with current hypertension, diabetes, elevated cholesterol (high triglycerides and LDL) and/or coronary artery disease (heart disease or atherosclerosis of the arteries). This virus traditionally causes a simple common cold. Seeing this data in this particular viral strain dramatically changed my perspective on this virus.
These maladies (hypertension, diabetes, elevated cholesterol & coronary artery disease) are the four most common medical problems that I seen in my clinic, and they affect 85% of my practice population. All four are caused and driven by hyperinsulinemia. The higher your insulin response to starches or sugars, the more likely you are to have hypertension, diabetes, elevated cholesterol and heart disease.
Insulin Raises Cytokine Levels
This elevated insulin in response to eating any starch or sugar, hyperinsulinemia, causes a rise in molecules called cytokines. C-Reactive Protein (CRP), Interleukin-1 (IL-1), Interleukin-6 (IL-6) and Interleukin-33 (IL-33) are the cytokines that are abnormally and chronically elevated in hyperinsulinemia. These cytokines are responsible for mediating the inflammatory response to illness, injury and stress in the body. They control how your body responds with release of white blood cells, macophages, and other immune cells. These molecular hormones are ALWAYS chronically elevated in patients with hypertension (elevated blood pressure), pre-diabetes, diabetes, elevated cholesterol, coronary heart disease and obesity.
C-Reactive Protein
CRP is a reactive protein produced by the liver in response to inflammation. It is an “acute phase reactant” signaling the body’s immune system to respond to stress, inflammation or infection. The presence of insulin directly raises CRP. In my clinical experience, CRP normalizes within about three days of insulin returning to a normal level.
Interleukins (1,6, & 33)
IL-1,IL-6 & IL-33 are all cytokines. They stimulate increased body temperature, regulate fevers, modulate macrophages and stimulate other immune cells to function in various parts of the body when infection or inflammation occurs. These dual acting hormones are produced by a number of cells, but predominantly by the adipocytes (fat cells) and pneumocytes (lung cells).
IL-6 has a negative feedback on the liver’s ability to sense the presence of insulin. Elevated insulin levels over time cause increased size of fat cells. This causes abnormally high levels of IL-6 production from the adipocytes and decreases the signal of insulin on the liver – leading to insulin resistance, pre-diabetes and diabetes. Elevation of IL-6 often persists until the fat cells shrink back down to a non-obese size. IL-6 can also stimulate elevated CRP as well.
Elevated insulin on top of the presence of a viral infection in the lungs stimulates additional increase in IL-33. A normal rise in IL-33 increases fluid and cells like macrophages around the lungs causing a normal immune response. This is part of the healing process, but if IL-33 is already chronically elevated in hyperinsulinemia, then a burst of IL-33 leads to the pneumonia, hypoxia and blood clotting that commonly occurs in those with severe coronavirus infections. IL-33 has been implicated as one of the drivers in the “cytokine storm” found in severe coronavirus infection patients. The presence of IL-33 increases production of IL-6 leading to a “storm of hormones” (cytokine storm) being overproduced from the lungs and fat cells.
Risk of Death
Patients with elevated IL-1,IL-6, IL-33 and CRP were at much greater risk of mortality when exposed to COVID-19. Those that died, all of them, from this viral infection had IL-6, IL-33 and CRP levels twice as high as those who recovered from the illness. That is profound.
Temporal changes in laboratory markers from illness onset in patients hospitalized with COVID-19.
Temporal changes in lab markers from illness onset in Chinese patients hospitalized with COVID-19
What does this mean?
What does this mean to you and me? It means that those with elevated interleukin levels are more likely to experience a severe complication if exposed to this virus. That means that 85% of my practice, if not controlling hyperinsulinemia, is at higher risk of mortality. That’s what got my attention. Hopefully, it gets your attention.
But, don’t stress out. As of the writing of this post, 9-10% of the population may get sick (that is the current statistical data we have over the last three months). Relax , because 92% of people who get the virus won’t be severe enough to warrant hospitalization. And, only 0.4% of people will die from COVID-19. That’s actually lower than the current influenza numbers of 0.43% mortality. (Statistics taken from https://www.worldometers.info/coronavirus/) .
A recent paper written by Qasim Bukhari and Yusuf Jameel, both from the Massachusetts Institute of Technology, analyzed global cases of the disease caused by the virus, COVID-19. They found that 90% of the infections occurred in areas that are between 37.4 and 62.6 degrees Fahrenheit (3 to 17 degrees Celsius), and in areas with an absolute humidity of 4 to 9 grams per cubic meter (g/m3). Absolute humidity is defined by how much moisture is in the air, regardless of temperature. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3556998)
Arizona just hit temperatures of 100 degrees Fahrenheit this week, the last week in April. This means, if the research is correct, there should be a notable decline in the transmission and number of infections in hot and/or humid areas of the country like the south and south west regions.
What can you and I do?
What can be done about it? Follow a ketogenic lifestyle. Studies published in November, 2019, reveal that a ketogenic lifestyle has an enhancing effect on immunity by suppressing viral replication and barrier effect through γδ T cells in the lung.
This dietary approach is, also, the only one that I have seen clinically lowering CRP and IL-6 when using it long term. Ketosis may be the perfect prevention. Over the last 16 years of using ketogenic lifestyles, I have seen this pattern improve thousands of times. The presence of ketones immediately suppresses the production of IL-6 and improves the stimulus for CPR production at the liver. Cutting out carbohydrates lowers insulin back to a normal baseline within 3-7 days for most people. CRP returns to normal within three days of fixing your diet. And, IL-6 begins to decline immediately. In my obese patients, it can take 18-24 months for IL-6 to return back to normal.
Additional Measures
Don’t stress. The overly hyped fear mongering produced in the media in the last two weeks raises your stress level. Turn off the T.V. and stop listening to the 24 hour news cycles. Over the next couple of weeks, while the risk of viral exposure is the highest, the following precautions are essential:
Limit exposure to those who may be carrying this illness through social distancing. If you have a fever, stay home. If you are ill, wear a mask out in public.
Get good sleep (six or more hours of restful sleep)
Taiwan and Hong Kong have instituted strict quarantines and you can see their effect in the graph below.
Above all, enjoy some bacon. Seriously.
You can’t eat bacon? Have a nice rib eye. Either way, based on the data above, your ketogenic lifestyle is the very best thing you can do to avoid serious infections, including COVID-19.
I talk about this an much more here on my YouTube video:
I’ve had multiple people send me links to people and/or “supposed experts” recommending the use of quinine to prevent coronavirus or COVID-19. In my perspective, this is really bad advice and borders on malpractice.
Quinine was and still is used for the treatment of malaria. Yet, there are some significant reasons using quinine is, and should continue to be, limited. Anyone recommending liberal daily use of quinine does not have any grasp of the potential for harm and death that can arise with the use of this substance. I have seen quinine toxicity on a number of occasions in my 20 years of medical practice, and it ain’t pretty.
There is NO Evidence that Quinine Prevents COVID-19
There is absolutely no evidence that using quinine prevents infection from coronaviruses or COVID-19. Quinine differs in its mechanism of action from hydroxychloroquine, one of the drugs currently under investigation for use with COVID-19. Please, DO NOT confuse the two.
Even Small Amounts of Quinine Can be Deadly
Quinine use is the most common cause of immune-mediated drug induced thrombotic microangiopaty (DITMA), a life threatening condition caused by small-vessel platelet clots. In a systematic review of all published reports describing drugs and other substances as a suspected cause of thrombotic microangiopathy (TMA), quinine was responsible for 34 of 104 cases in which there was definite evidence for a causal association (33 percent) [1].
The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) Registry found quinine-associated TMA in 19 of 509 patients (4 percent) referred for a possible TMA over a 25-year period and found quinine as the cause of DITMA in 20 of 23 patients (87 percent) for whom a drug could be implicated as having a definite or probable causal association with the TMA [2, 3].
A 2017 report describing the 19 individuals included in this registry found the following features [3]:
All were white. This is distinctly different from Thrombotic Thrombocytopenic Purpura (TTP), in which approximately one-third are black (seven-fold higher than the reference population).
Eighteen (95 percent) were women. This is greater than the increased frequency of women (75 percent) among patients with TTP.
Eight (42 percent) had a prior history of quinine-related symptoms (nausea, vomiting, fever, chills, headache, confusion, ataxia).
Thirteen (68 percent) could recall the precise timing between quinine ingestion and symptom onset (all ≤4 hours).
Eighteen (95 percent) were caused by a quinine tablet; one was caused by quinine in tonic water of a vodka/tonic drink.
Eighteen (95 percent) had evidence of quinine-dependent antiplatelet (or antineutrophil) antibodies.
All had acute kidney injury; 17 of 18 required dialysis; three developed end-stage renal disease; and two underwent kidney transplantation.
One died from complications of central venous catheter insertion. Of the remaining 18, eight died a median of nine years following diagnosis, five from cardiovascular disease or stroke that may have been related to the TMA.
Quinine is implicated in causing neutropenia (decrease of white blood cells in the immune system). When it occurs, neutropenia is often accompanied by other organ-system findings that may include thrombocytopenia (low platelet count), microangiopathic hemolytic anemia (the most common being DITMA referenced above), rash, acute kidney injury, fever/chills, and others. The mechanism in many cases appears to be an acute, immune-mediated reaction to the drug. Evidence to support these associations was evaluated in a 2016 systematic review of published reports, which found neutropenia in 24 (17 percent) of the 142 patients who had an immune-mediated quinine reaction.
Quinine + Sugar is A Perfect Storm
The problem that many physicians find is that quinine tablets may be borrowed from a friend or family member, or the exposure may occur from a beverage like Schwepps (eg, tonic water, bitter lemon). And tonic water is loaded with sugar or high fructose corn syrup. This high carbohydrate content, in combination with quinine is a perfect storm for kidney failure.
Schwepps Tonic Water
In the United States, the only available quinine tablet (Qualaquin) requires a prescription, and the only approved indication is for malaria treatment. This restricted availability of quinine tablets may explain why we have not seen a patient with quinine-induced TMA since 2009 [3]. There are also several over-the-counter tablets and herbal remedies for leg cramps available in the United States that may contain quinine, and quinine tablets can be purchased over-the-counter in Canada and other countries. Quinine may also be added to drugs of abuse such as cocaine.
Just One Dose of Quinine Can Be A Trigger
Importantly, TMA from quinine can be triggered either by a single ingestion (eg, one quinine tablet, one quinine-containing beverage) occurring many months or years after a previous exposure, up to 10 years in our experience. This is because the drug-dependent antibodies can persist for many years, but they cannot react with target cells in the absence of the drug. Acute immune-mediated tissue damage can occur within hours of re-exposure. It is not known whether the homeopathic doses of quinine present in remedies for leg cramps in the United States can trigger TMA, but in principle, immune-mediated DITMA can occur with extremely low levels of re-exposure.
Chronic kidney disease is common following quinine-induced TMA [3].
So, please, don’t follow bad advice about using quinine from people who have no concept of what these drugs can really do.
Please see my Coronavirus Page for information and recommendations on prevention and treatment.
References:
Al-Nouri ZL, Reese JA, Terrell DR, et al. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood 2015; 125:616.
Reese JA, Bougie DW, Curtis BR, et al. Drug-induced thrombotic microangiopathy: Experience of the Oklahoma Registry and the Blood Center of Wisconsin. Am J Hematol 2015; 90:406.
Page EE, Little DJ, Vesely SK, George JN. Quinine-Induced Thrombotic Microangiopathy: A Report of 19 Patients. Am J Kidney Dis 2017; 70:686.
Should you and your family members be wearing a mask to slow the spread of coronavirus (COVID-19)? This is a hotly debated topic and one that may not soon be agreed upon by everyone. Over the last few weeks, a number of voices are saying “Yes.”
I am, also, one of those proponents of dawning a mask. And, that’s no April Fool’s joke.
Dr. Nally in the office
The head of the Chinese Center for Disease Control and Prevention, Dr. George Gao, is also one who has been very vocal about using a mask. “The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth.” Gao said in his interview in Science.
Because coronavirus is a droplet based infection, and not an aerosolized infection, wearing a face mask can more effectively prevent the droplets that carry the virus from escaping and infecting other people. However, I don’t recommend using the medical grade masks. Save those for those that must have face to face contact with COVID-19 positive patients and persons with direct exposures. For the lay person in the grocery store who must get essentials and may have brief contact, I recommend using a specially designed homemade mask.
Masks Actually Help
Recent research shows that some people infected with the COVID-19 virus who don’t have any acute symptoms can still spread the virus. This means that the person in line with you to buy toilet paper, might just be infected and not know it. Research also shows that even wearing a proper homemade mask can reduce silent transmissions of bacteria and viruses in these situations.
In fact, this has been the recent topic of discussion at the CDC, and the use of homemade masks were reviewed in great detail in yesterday’s Washington Post article here.
Homemade Masks Make a Dent in Viral Spread
Wearing a homemade mask has become the norm in Czechia. The government of Czechia mandated the wearing of masks on March 18th, 2020. Jeremy Howard of #Masks4all has collected and summarized 40 published scientific research papers that show wearing masks actually does work. One 2011 meta-analysis shows, when coupled with strict hand washing, masks have the greatest impact on reducing virus spread.
Mr. Howard states that this action of the Czechian government has flattened the curve of the pandemic in his country. You can read the article in Prague Morning.
What Kind of Mask Should I Wear?
So, what kind of mask should I wear? The what, where and how of homemade masks that I am recommending to my patients can by found in my youtube video below.
How can you avoid contaminating the mask and yourself?
The main objection of the mask naysayers is that the mask itself becomes contaminated. Carelessly using the mask and not cleaning it can become of source of viral transmission. The benefit of a homemade mask is that it is cheap, washable and re-usable.
Here are some steps to follow to ensure that you and your family remain healthy while using a homemade mask:
Wash with soap and water, or sanitize your hands well, before making any mask.
Wash and sanitize your hands before putting the mask on.
When removing the mask, do not touch the front of the mask with your hands; take it off by the ties or elastics. Then wash your hands.
Immediately after use, do not put the mask on any surface. Put the mask into the washing machine or a sink of hot soapy water and clean well. Some data shows that you can also bake fabric masks. However, the temperature must reach 180F° (82C°) for 20 minutes to cleans it.
If you have made a disposable mask out of paper towels or coffee filters, throw it out into a plastic-lined waste bin with a lid.
After discarding, or sanitizing the mask, sanitize your hands again.
Any time you are wearing a mask, do not touch the mask, your face or rub your eyes.
Wearing any mask over the next 3-4 weeks will help protect you from passing the virus on to others at greater risk. It may also decrease your risk of someone else passing the virus on to you.
This will help reduce the number of infected people from overwhelming our healthcare system, first responders, and healthcare workers.
With a great deal of fear out there about this virus, a catchy little rhyme and song often helps to remind us about prevention. It’s interesting that potential pandemics bring out songs and rhymes. Isn’t this where “Ring around the Roseys” came from?
