Pandemic Updates July 2022

Hi, it’s Dr. Jeffrey Mark. Today I’d like to talk to you about pandemic updates, including the BA fi variant and long COVID. So we’re now in mid July 2022. With many people taking their vacations., not thinking of COVID very much, just trying to enjoy and put the last two or three years behind. But unfortunately, while we’ve been going about our normal business, including vacations, the virus has continued to mutate. And with new variants being more infectious, we’ve seen an uptake in hospitalizations, and wastewater studies have shown a new variant popping up BA5, which is now taking over the BA2, the second variant from Omicron. So here’s the data as hospitalizations and you can see this is going up in the past 90 days. We see an increase in the BA fi variant. And this is the distribution that we’re seeing. VA one of course, was the original Omicron and then b two came and did have a little bit of a surge, as well as with the BAA four variants, but now we can see the BA5 clearly separating itself out from the other variants. It’s approximately 20% more infectious or more contagious. than even BA1 the original Omicron, which is more infectious Of course, than the original SARS CVO 2. But there are other consequences besides ending up in the hospital that one needs to really think about. Many people have this attitude that if you get infected most people recover which is true, but you can have multiple infections and with BA5 just because you’ve been infected before with the original Omicron or delta or even with the new BA4 variants, you can still get an infection with BA5, it’s that much different in terms of the spike protein. So the other thing to think about is if you don’t get hospitalized, you still have a risk with an entity called Long COVID. The more times you get infected with COVID and there are people that have been affected two times three times even four times there’s an increased rated chance of developing long COVID. This is an outline from the Cleveland Clinic demonstrating the various outcomes of COVID 19 infections including a silent infection, mild to moderate, or some people experience severe infections which lead to hospitalizations with a certain death rate as well. And, end organ damage, which we’ll define in a minute. Most do recover, but then there is this entity called Long COVID and depending on which studies you look at can range from 10 to 50%, usually about 10 to 16% on the most recent studies, and these are the symptoms that include continued fatigue, anxiety, depression, exercise intolerance, continued loss of smell, and brain fart and enough cognitive issues that some people have to change careers, which can be quite a significant life changing event. So what were the consequences of the end organ damage? Well if you have a severe enough reaction to COVID, meaning a cytokine storm experience where there is too much inflammation, not enough balance in your body to control the inflammation. Kind of like a fire that is supposed to be controlled that gets out of control and starts to consume a massive amount of acreage. You’re going to have pulmonary fibrosis, renal failure, congestive heart failure, and strokes. What’s the definition of Long COVID Long?  COVID has been defined by the World Health Organization. It’s referenced here as a complex multi systemic illness that follows from an acute infection of COVID-19 it may take some time for any apparent recovery there may be a component where there’s an intermediate period of time to recovery. Usually symptoms last over two months, but can resolve after three months, and it doesn’t appear to be rare for the severity of the infection. Often mild infections can lead to COVID and there is no requirement that other causes have been excluded. So these are symptoms that you can have from long COVID Which actually also overlaps with something called mast cell activation syndrome. Which we’ll discuss briefly in a few minutes. You can have continued fevers, weight loss, but you can also have weight gain as well. Various things can affect multiple organ systems, so that you can have several of these occurring all at once or just a few of them. One of the more consequential symptoms and hearing loss, tinnitus or ringing in the ears, chronic condition sinusitis, recurrent sinusitis conjunctivitis issues with the eyes and continue to inability ability to smell other things neurologically affecting people primarily through anxiety, brain fog, migraines, headaches, and difficulty sleeping which we’ll touch on another study. Looking at this area, cardiovascular people can have chest pains we do know there’s a myocarditis inflammation of the heart muscles, which can continue which is why people should not resume vigorous exercise, at least within a couple of weeks of recovery of having COVID.  But if you have long COVID Obviously, you may be limited in the amount of activities that you can do with pulmonary issues include continued coughing, wheezing dyspnea this feeling of shortness of breath is an exertion. People have had problems with urination as well with frequency pelvic pain. esophagus gastrointestinal issues include problem swallowing, or Globus sensation is a sensation where there’s a persistent lump in the throat feeling. People can have chest pain, heartburn. We’ve seen people that have never had heartburn before they’ve experienced COVID and afterwards have persistent symptoms. Also in terms of the stomach you can have dyspepsia, this feeling of bloating, discomfort after eating, nausea and vomiting as well. Issues of food intolerance can suddenly develop. People suddenly can’t eat the same foods that they didn’t before without discomfort. Diarrhea is another big issue. And changes in your bowel habits cause constipation. The liver definitely has effects as well and inflammation, which is translated by elevated liver function tests. The liver can be enlarged as well, where it was normal in the past and it can be swelling and unusual glands including the salivary glands can be moved. People can have a feeling of flushing rashes. There could be hair loss after COVID exposure and ongoing problems with long COVID That leaves some nodules and there could be various ages and the muscles and pain as well and spalling in the extremities with fluid. So what are the consequences of one COVID? In a study by dowry in a British Medical Journal and 2021 They looked at 266,586 COVID. They found that 40% of these adults had new symptoms afterwards and the persistent ones after four months. So part of the definition of COVID they were compared to age matched peers and found that the incidence of diabetes was 2.5 times greater in this group of people that have symptoms longer than four months. And sleep apnea was also 2.3 times more likely in this group, as well as new development of high blood pressure 1.2 times so you can see some of these consequences in the study. We did touch on the sleep issues but they’re also psychological issues and certainly after issues with long COVID as well, in this study in the Journal of infectious diseases. This was a Spanish multicenter study that looked at 1142 patients, seven months after they’re discharged from the hospital. About half of them had anxiety or depressive symptoms and didn’t sleep very well. So anxiety was in 16.2% of these people, or 19.7% were depressed and 34.5% had poor sleep quality. So we can see that these symptoms of long COVID are real and they have been studied. So I mentioned before that that list of symptoms that we went through, were also similar to mast cell activation syndrome. And it was a study by Dr. Larry Weinstein. This was in the International Journal of infectious diseases published in 2021. And this was a US study based on a questionnaire that was sent out to support groups for long haulers or Long COVID Long haulers who the initial descriptor of from health care providers that had developed persistent symptoms after infection of COVID-19 and they call themselves long haulers. And they found different support groups. They looked at 136 responses that were submitted that were collected from the questionnaires. mean age of 47 years, many were female 80 point 89.7%. And their symptoms lasted for at least 193 days on average. And they looked at them compared to 136 age matched controls from the general population and 80 people that had mast cell activation syndrome, looking at their symptoms before they were treated. 16.2% of these people were hospitalized 80.9% All has been confirmed by testing in terms of Long COVID and that list of symptoms that we had seen earlier seem to match up with many of the long hauler symptoms as well. So it looks like there’s a target that we can look at in terms of long COVID and that is looking at the mast cells and also the immune system. This is a diagram from the new New England Journal of Medicine describing what mast cells do. And basically they regulate the immune system by secreting many different chemicals and factors several hundred chemicals in fact, and they regulate or sound the alarm for the immune system to act. There are many activators that can activate the mast cells including allergens because mast cells release histamine and most people are familiar with, with the allergic reactions that many people have seasonal allergies, the sneezing, the runny nose, some people get rashes. All these things are because of the histamine that’s released cytokines as anything that triggers inflammation. Viruses, also fungi or mold or drugs can also cause this as people have had drug allergies, you know, and different toxins in the environment. And you can read most of the effects here but histamine does cause fatigue, malaise, weight loss, a lot of the symptoms that we described in the other charts the flushing ng edema is swelling. They can also raise blood pressure causing rapid heart rate cause lightheadedness or fainting. They can cause diarrhea reflux, and also bone pain aid, taking care of depression, insomnia and migraines. So while this sounds familiar, it’s because of the commonality of the symptoms from mast cell activation and also seen on the surveys from COVID 19 long haulers. So what can we do for treatments? We do treat the mast cell and inflammation for long COVID We also work with the immune system as well. Antihistamines which promote the inflammatory response.  Famotidine or Pepcid which are h2 blockers and also H1 blockers may help as well. Mast cell stabilizers, cromolyn or quercetin, also help to a certain degree. Low histamine diets can be attempted.  Energy or light therapy which is getting more sunlight. There is more information on another blog that I’ve given using natural sunlight in terms of boosting the natural mitochondrial melatonin that’s produced. That is a powerful antioxidant. There’s also sleep and lifestyle and you want to increase the innate immune system as well. By getting at least six hours of sleep preferably seven to eight hours of sleep, lifestyle changes that are needed in terms of limiting exercise or other things that can cause fatigue or increased activation of mast cells. Mitochondrial support, there are certain supplements and nutrients that support the Krebs cycle. People have used co Q 10 and other types of supplements as well to give the mitochondria which are the key factories making ATP and energy to be able to supply more energy but there is also a necessity to shift over the functions of the mitochondria which are normally to make energy but they can also have a repair and immune defense mode. And if they’re activated in that mode, then they are less productive in terms of making ATP and energy. So therefore, there’s this aspect of fatigue as well as the fact that your body is making more immune related cells as well. And the cytokines that go along with this response. Peptides can be used to balance the immune system, they can make the immune system smarter, increase the amount of T regulatory cells and T 4, T8 which also can help balance this immune response. And then there are also peptides that are more useful for sleep as we mentioned, the insomnia they can occur with long COVID. Anxiety as well can be helped with peptides, as well as the brain for inability to pay attention or to focus. These are all part of a regimen that has been highly personalized to treat long COVID for people that are suffering. So hopefully you can see that with this latest surge that’s not really been reported very well because most people are not in the mindset of not wanting to revisit the pandemic and revisit some of the precautions that we practiced before such as mask wearing and we want to move on. There are still concerns that we need to take care of and that is that there are those vulnerable people in the population, the elderly, immunocompromised, the pregnant people, and we want to make sure that they stay safe as possible. So we do need to continue to take precautions because even though we may not end up in the hospital, there is this risk of long COVID If we continue to get infected with COVID and you can get this multiple times and now with the BA five it’s almost a new variant kind of starting over again. And so each time you get exposed you can have up to two to three times the risk of having long COVID If you do about Long COVID we are making progress in terms of treatments and finding out the root causes but of course it’s best to avoid getting long COVID to begin with. So if you have questions on long COVID treatments, peptides, you can contact us at [email protected], find us on the web at, or call (925) 736-9828.  We’ve helped thousands of people in their journey of health and we look forward to helping you as well. So take care and stay healthy.

Jeffrey Mark, M.D.


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