Ten Questions for Dr. Edward Frederickson

Ten Questions About Covid-19

for Edward Frederickson, M.D.

Edward D. Frederickson, M.D. is a specialist in Internal Medicine and Nephrology. He grew up in Atlanta and was educated at Emory University for undergraduate and medical school. He received post-graduate education in Internal Medicine at Northwestern University, Clinical Pharmacology at the University of Chicago, and Nephrology at the University of Florida. After several years in academic medicine at The University of Florida and Emory University, he went into private practice at Piedmont Hospital where he remained for 22 years. Dr. Frederickson moved to Rabun County in 2013 and opened Highlands Internal Medicine on Main Street in Clayton. He and his wife Suzanne reside on Lake Burton and in Highlands, North Carolina. They enjoy spending time with their six sons and eight grandchildren.

Highlands Internal Medicine 156 N. Main Street Clayton, Georgia 30525 706-212-0390 GML - What do you feel is our first line of defense against the Covid-19 virus? Does mask wearing make a difference and are cloth masks effective?

Dr. Frederickson - The first line of defense against any virus that spreads by respiratory droplets is to avoid breathing in the droplets from a person who is infected with the virus. Common sense is to isolate those who have the virus, but the Covid-19 virus begins to be shed in respiratory droplets 3-5 days before the infected person starts to show symptoms of the disease. In this asymptomatic stage of viral spread, it is impossible to know who to avoid, thus the best strategy is to avoid all interchange of respiratory droplets. With normal breathing a sixfoot distance will be effective, however a cough, sneeze, shouting, and/or singing can spread the droplets/virus much farther.

A good quality face mask will markedly decrease the spread of your own respiratory droplets. Others wearing good quality face masks will keep you from breathing in their respiratory droplets. That’s where we get the saying, “My mask protects you and your mask protects me.” Well fitting cloth masks are effective, but they should be several layers thick. If you feel your own breath coming through, the cloth is too thin. Thin gators and bandanas are much too thin to be effective. Now scientists are saying we need to double mask. N95 masks are used in health care and industry to protect the wearer. If worn properly they are effective, however they frequently have an exhalation valve which makes them ineffective to protect others. Many have observed and I agree, that because we have worn masks, practiced social distancing, and observed good hand washing practices this year, cases of colds and flu have decreased. Who knows how many more Covid-19 cases we would currently have if we had not practiced these well tested and documented good community health measures?

GML - Are you confident in the vaccines that have been made available? Do you feel they are safe and do you recommend them? Are there any patients who should not receive the vaccine?

Dr. Frederickson - The vaccines currently available have been well studied and are highly effective against the current strain of Covid-19. The Pfizer and Moderna vaccines are MRNA (messenger RNA) vaccines which represent new technology. This type of vaccine has been studied for over a decade in animals, but these are the first vaccines using synthetic messenger RNA to be approved for use in humans. The vaccines contain copies of MRNA which code for the protein contained on the spike processes of the Covid-19 particles. Once injected the particles are gobbled up by macrophages and dendritic cells in our own tissues and blood stream. These cells read the MRNA and produce the exact peptides. These cells are the first steps in our immune response and are known as antigen presenting cells. They deliver the exact copies of the viral protein to our T and B lymphocytes which produce antibodies and cellular immunity. In short, the vaccines steer our immune process to protect us from the virus. The MRNA contained in the vaccine never enters the nucleus of our cells and does not in any way change our DNA. This new technology offers tremendous promise down the road toward treating auto immune diseases such as Systemic Lupus Erythematosus and Rheumatoid arthritis. These vaccines are well tolerated by most patients with only minor reactions, however patients who have had severe allergic reactions to any of the ingredients of the vaccine, specifically people who

GML - There are currently Covid-19 variants emerging. Are they deadlier? Will we see the virus change and will there be more?

Dr. Frederickson - Covid-19 is an RNA virus. It contains RNA covered by a capsule and spike-like structures which are made up of specific proteins. The RNA in each viral particle contains all of the information necessary to instruct our cells to produce the virus over and over again. This mass replication is not a perfect process and the more replication the greater the chance of a mistake or mutation. If the mutation improves the efficacy of the virus, it will quickly become dominate and a new strain is produced. We will, in fact, have more strains of the virus and a very important point is that the number of strains is completely dependent on the number of infections and replications of the parent virus. Therefore, we have a situation, a race between the advent of a more virulent strain and control of the viral spread in the population. So far, there have been three new strains identified, the UK, the South African, and the Brazilian. Evidence thus far indicates they are more contagious but not necessarily more deadly. Undoubtably more strains will follow. Hopefully we will control the virus before it becomes resistant to our vaccines.

GML - For those who believe that herd immunity is the only way that this virus will go away, what do you say about that? Isn’t the immunity to Covid-19 after exposure only temporary?

Dr. Frederickson - Herd immunity basically means that most of the population has antibodies to the virus. When this occurs, community spread of the virus is unable to sustain itself. To reach this point 75-80 percent of the population must have immunity. Herd immunity is the only way the virus will be stopped. There are two ways to get immunity, have the virus or get the vaccine. Remember from the previous question we are in a race before the virus learns to defeat our natural or vaccine induced immunity. Once the virus reaches that point, the entire process starts over again. We will need to retreat, adjust, develop, and take a new vaccine. For those who say, “We should just let the virus run its course.”, it is only necessary to do the math to realize in this country we would lose 2.5 to 3 million people. Since the exact length of time infection induced antibodies last, it is recommended to have the vaccine even if you have had the virus.

GML - Are there Corona viruses that infect humans and others that spread through animals? Has it been determined that this strain, Covid-19, came from animals?

Dr. Frederickson - Covid-19 is a mutated form of a similar virus found in pangolin, an animal native to Asia similar to an armadillo, however the exact virus from the pangolin is unable to infect humans. The precise vector for Covid-19 has not yet been elucidated but it appears to be a hybrid from the pangolin variety and the corona virus found in bats. MERS, the middle eastern epidemic, came from bats and then took home in camels before being introduced into humans. The original SARS virus went from bats to civets, a nocturnal animal native to the tropics, before infecting man.

GML - Some say that there are supplements that may have an impact on the virus if you contract it, like Vitamin D3, Zinc, Vitamin C, or Elderberry. Do you recommend any of these to your patients?

Ten Questions

Edward Frederickson, M.D.

Dr. Frederickson - Supplements will not prevent or cure Covid-19. It is very important when taking supplements to take them in appropriate doses. Supplements taken in excess may be toxic and will not provide extra protection. Vitamin D3 may have a role in our immune system. Vitamin D3 receptors are found in our lymphocytes and there is some evidence that Vitamin D3 at therapeutic levels may help recovery from respiratory viruses. The parent molecule of Vitamin D is produced in our skin from sunlight. A little-known fact is that if you live above the 35th parallel, the southern border of North Carolina, you cannot get enough sunshine to replenish your natural Vitamin D levels and a dietary supplement is important. Further studies are needed to define the exact role of this steroid supplement. Zinc is an important micronutrient in the body and is necessary for proper function of our immune systems. It also helps in our olfactory cells of taste and smell. A small study in Spain showed that patients with lower levels of Zinc were sicker and had poorer outcomes than those with higher levels of Zinc. Vitamin C is an antioxidant and anti-inflammatory. It is probably beneficial during a viral illness like Covid-19. Elderberry has not been studied in Covid-19. It has been shown to increase our body’s inflammatory response. Since it is the inflammatory response which causes injury from the virus, Elderberry should probably be stopped at the first sign of symptoms.

GML - There are some who believe that Covid-19 is the same as the flu virus and that it is blown out of proportion, what do you say to them?

Dr. Frederickson - Covid-19 has killed millions of people worldwide and close to a half-million in the United States. In the United States the death rate from influenza is usually 35,000 - 43,000 per year. There have been years when the flu was much deadlier. In 1918 the Spanish flu, which actually began in Kansas, killed 675,000 people in the U.S. It infected 28 percent of the population, killing 2.5 percent of those infected. It was also quite deadly for younger people between the ages of 20 – 40 years of age. Covid-19 is a corona virus named for its appearance as seen with an electron microscope. Its RNA is distinctly different from the influenza virus which is also an encapsulated RNA virus. The common cold is also a corona virus and with any luck we might finally be perfecting a cure for the common cold, a feat which has eluded physicians for centuries.

GML - Why do we see 90-year-old patients with underlying conditions who survive the virus and 18-year-old patients with no known underlying conditions who die?

Dr. Frederickson - I have had older patients with severe comorbidities who have survived Covid-19 and young, healthy people who have become deathly ill. The rate of hospitalization is 4 percent overall but goes up proportionally with each age group. The mortality rate has gone down as we have found better ways to care for patients both in and out of the hospital. Dexamethasone, a potent form of steroids, has been shown to be very beneficial. It decreases the body’s inflammatory response which is the mechanism by which the virus injures the cells. The lungs and other respiratory tissues account for the most damage from the illness. The disease also affects the lining of blood vessels resulting in inappropriate clotting causing deep vein thrombosis, pulmonary emboli, and decimated intravascular coagulations or DIC. We have all been astonished by the speed and severity of the illness caused by the virus.

GML - How accurate are the tests available for Covid-19? Comparing nose swabs, saliva tests, and blood tests, is one more reliable than the others?

Dr. Frederickson - The PCR test is the gold standard for testing. This test uses a swab from the nose or mouth and measures the presence of the RNA from the virus. False positives are almost impossible. A false negative is possible but is probably related to an error in sampling procedure. An antigen test is much quicker but is much less accurate. These probably have a false negative rate of 20 – 30 percent. False positive rates are probably related to reader error. Antibody tests measure the body’s immune response. They measure both IgM and IgG antibodies. As you recover from the virus you develop these antibodies and are immune from reinfection when they are present. A problem with testing is that people who are potentially infected should isolate while awaiting test results. This does not always take place. Another problem is that people who are asymptomatic do not seek testing.

GML - What impact has the pandemic had on our hospital system and health care workers?

Dr. Frederickson - The Covid-19 pandemic has been the most difficult crisis our culture has faced in my lifetime. It has killed a half million people and left permanently injured many more. Our economy has taken a large toll with increased poverty, hunger, and homelessness. Our health care system is completely overwhelmed and health care workers are exhausted both physically and emotionally. Hopefully studies will point out the deficiencies in our health care system that have left us unable to respond to the demand placed on it by Covid-19. The wealth and racial disparities have come to the forefront and our definition of essential workers has changed. My hope is that our society will improve as a result of this natural catastrophe. We certainly need to be prepared in the future and I hope we have learned that lesson.