fall 2021 • volume 13• issue 3
the unseen pandemic
SOCIAL ISOLATION US public health officials are alarmed by a growing mental health epidemic of stress, anxiety, depression, loneliness, substance abuse and suicide.
COVID-19 VACCINATION DISINFORMATION Why are we stuck at less than 60% of America fully vaccinated?
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CONTENTS PHYSICIAN HEALTH AND WELLBEING The Epidemic of Stress and Loneliness • PAGE 5 SARS-CoV-2 Vaccination Disinformation • PAGE 14 COMMUNITY NEWS Announcements & Awards • PAGE 20 In for a Penny • PAGE 24
FROM THE EDITOR | FALL 2021 Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine
SARS-CoV-2 Virus Variants: Classification, Genetics and Clinical Importance • PAGE 26
EDITORIAL
BOARD MEMBERS Robert P. Granacher Jr., MD, MBA, editor of Kentucky Doc Magazine Terry Clark, MD John Patterson, MD Tuyen Tran, MD Thomas Waid, MD Nicholas Coffey, M3 at UK College of Medicine Bowling Green Campus
STAFF Brian Lord Publisher David Bryan Blondell Independent Sales Representative Jennifer Lord Customer Relations Specialist Barry Lord Sales Representative Anastassia Zikkos Sales Representative Kim Wade Sales Representative Janet Roy Graphic Designer Aurora Automations Website & Social Media
Our country is not yet through the COVID-19 pandemic. At this time, the disease trend line has again dropped, and we await expectantly to see if we as a people have weathered the storm. Our literary journey starts on page 5, led by LMS member John Patterson, MD, MSPH, FAAFP and his article, “The Epidemic of Stress and Loneliness: We Are All in This Together.” John cites Surgeon General Murthy that a “change in culture is needed. Health professional training must emphasize the importance of self-care, stress management and resiliency training.” John then gives methods for dealing with stress and the importance of physical exercise and developing resilience. John finishes his article by listing important resources we can use to destress ourselves in this pandemic of COVID-19 induced loneliness. Our next article on page 14 is by LMS member Terry Clark, MD, FCAP. Terry provides us with a pathologist’s view of the disinformation negatively affecting increasing population stress and isolation and improving vaccination rates in his article “SARS-CoV2 Vaccination Disinformation”. He takes us behind the social media scene and opens the curtains to reveal the wizard pulling the handles of disinformation. Terry’s portrayal is both enticing and highly informative and helps to answer why the US is stuck at a 60% vaccination rate. We skip to Torie Osborne’s article on page 24. I must disclose to the readers that I am Torie’s mentor this year. However, I had no idea she had submitted this article and I had
never heard this story. I was Torie’s mentor last year when she was an M3. This year I am guiding her as an M4 to write a business plan for her practice dream after residency: return to Pikeville and establish a triple practice in Child Psychiatry, Pediatrics, and Adult Psychiatry. She hopes to match her residency at UKCOM’s triple board psychiatry program in the spring. Lastly, we have another article by Terry Clark, MD, FCAP, to be found at page 27. This is a readable hard science article titled: “SARSCoV-2 Virus Variants: Classifications, Genetics and Clinical Importance.” If you are not an infectious disease doctor or pathologist, Terry gives you all you need to know on these topics. Enjoy this eclectic fall edition of KentuckyDoc. Stay well, Bob
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PHYSICIAN HEALTH AND WELLBEING
The Epidemic of Stress and Loneliness WE’RE ALL IN THIS TOGETHER Despite widespread electronic social media, many people feel isolated.
By John A. Patterson MD, MSPH, FAAFP US public health officials are alarmed by a growing mental health epidemic of stress, anxiety, depression, loneliness, substance abuse and suicide. Britain has created a Minister of Loneliness to tackle this ‘sad reality of modern life’ and its $3.5 billion annual drain on UK employers. Vivek Murthy MD is the 21st US Surgeon General. He was also the 19th Surgeon General under president Obama. He is focused on loneliness and stress as public health priorities, saying ‘loneliness is associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes EPIDEMIC Continued on Page 7
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EPIDEMIC continued from Page 5
a day.’ In early 2020, before the COVID pandemic, he presciently published a book titled Together- The Healing Power of Human Connection in a Sometimes Lonely World. Authentic social connections
A change in culture is needed. Health professional training must emphasize the importance of self-care, stress management and resiliency training.
Despite widespread electronic social media, many people feel isolated. This was happening before the COVID pandemic and has gotten worse. Murthy says “a quarter say they do not have anyone in whom to confide about a personal problem.” Clearly, online social networks can be helpful but are not the kind of support required to combat emotional isolation and its adverse health effects. However, though in-person classes and meetings are curtailed or cancelled, technology also provides access to meaningful interpersonal support from peers and groups with which we are affiliated in ways that are meaningful and rich in purpose and values. Technology connects patients and providers, teachers and students, friends and families- as well as continuing education, culture, art, information, music, humor and endless opportunities to learn, grow, connect and serve those in need. Managing stress
Serious psychological distress and loneliness can be caused by social isolation, fear of contracting COVID-19, financial strain, job insecurity, home schooling, uncertainty about the future, political polarization and our increasing violence and ‘bad news.’ This can lead to serious mental illness, suggesting acute distress during COVID-19 may cause longer-term psychiatric disorders. Stress and resilience are major research topics at NIH, the Veterans Administration and the Department of Defense. They are creating a research network seeking non-pharmacologic approaches to chronic pain and PTSD among active duty military and veterans. They focus on traditional military camaraderie as well as individual mind-body practices such as art, movement, faith, prayer, mindfulness and meditation. Murthy says: “Stress is not evidence of weakness or a personal failure but a reality of life and we have to collectively figure out how to address it… Supportive relationships, exercise, sleep and meditation can benefit children, adults, workplaces, homes, schools, public health and medical providers and their patients…A change in culture is needed. Health professional training must emphasize the importance of self-care, stress management and resiliency training. We have enough research to justify this shift already and more is needed to weave emotional EPIDEMIC Continued on Page 8
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Headspace App: The AMA now provides members a 2 year subscription to the Headspace meditation and sleep app. Screen image source www.headspace.com
EPIDEMIC continued from Page 7
well-being into the curriculum and patient care in hospitals and clinics.” Recognizing this, the AMA now provides members a 2 year subscription to the Headspace meditation and sleep app. The Department of Homeland Security promotes mindfulness and meditation to its employees. Importance of physical exercise
Murthy explained that regular physical exercise has been shown to relieve stress and have an anti-depressant effect for many people. Exercise-related increases in endorphins play a role in this positive emotional side-benefit of exercise. Happily, the choice of physical activity can be highly personal. Choosing an activity one enjoys increases the likelihood of regular practice and long-term commitment. Yoga, gardening, aerobics and walking illustrate the widely accessible range from which one can choose to reduce stress and promote resilience. Having a buddy with whom to exercise can help keep us motivated and combat loneliness.
Emotional well being
Murthy began his tenure as Surgeon General with a ‘listening tour,’ traveling extensively to U.S. cities and small towns and was struck by a common theme. He saw people in pain everywhere—pain from medical conditions, financial uncertainty, violence, stress of daily life and work—and the pain and grief of losing family to the opioid crisis. Regardless of geography, urban or rural residence, race, age, beliefs, background or political party, there was universal recognition that stress was overwhelming Americans’ ability to cope. Among lawmakers and citizens alike, the desire for emotional well-being was the one issue people everywhere agreed upon. He ended his tour convinced that addressing stress and emotional well-being is critical to maintaining our individual health and the health of our society. Murthy passionately argues for a societal, public health perspective on stress and emotional well-being. “When we have stress and emotional discord that prevent us from EPIDEMIC Continued on Page 11
TAKE CARE OF YOUR PATIENTS BY TAKING CARE OF YOURSELF.
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Meditation can be practiced alone, with a meditation buddy or a group. Let’s help ourselves and each other manage this epidemic of stress and loneliness.
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“When we have stress and emotional discord that prevent us from coming together and talking about solutions to big problems as a country, that affects us all.” – Vivek Murthy MD, the 21st US Surgeon General | 19th Surgeon General under president Obama
EPIDEMIC continued from Page 8
can build a country that is more compassionate and that is more kind—recognizes that our emotions, when properly cultivated, are our greatest source of strength.”
Meditation can be practiced alone, with a meditation buddy or a group. Dr Patterson offers a free weekly group class as well as an 8 week intensive mindfulness based stress reduction course (MBSR). Let’s help ourselves and each other manage this epidemic of stress and loneliness. In the process, we can gain confidence prescribing lifestyle recommendations for our family, friends, colleagues, patients, communities, society and planet.
Meditation
Resources
coming together and talking about solutions to big problems as a country, that affects us all…We know from data that people who say they have a best friend at work are much more likely to stay in that job, be productive and not burn out… I believe we
Brown University School of Public Health recently created a Mindfulness Center to apply evidence-based behavioral approaches on an individual and population scale. Murthy encourages his staff to practice meditation together and is impressed with the support and rapport this creates. Just as the reasons for this epidemic are complex and multifactorial, our prevention and treatment approaches must also be varied and tailored to the educational, cultural, social, religious, financial and medical demographics of affected individuals and groups. Murthy touts the benefits of mindfulness and meditation, including practices that increase compassion, empathy and kindness, for ourselves and for others. Psychotropic medications are an essential, and sometimes life-saving, treatment option. But we will not medicate our way out of this epidemic. Health professionals and patients are also concerned about the unintended dangers of polypharmacy and an over-medicated society. These dangers are more common in the elderly, who are more likely to have multiple chronic illnesses- but people of all ages are vulnerable to the medication burdens of cost, side effects, drug interactions and the sense of dependency on pills.
• Together: The healing power of human connection in a sometimes lonely world, Vivek Murthy MD, Harper Wave, New York, NY, 2020 • National Institutes of Health webinar, The Public Health Consequences of Stress in America, NIH Director Francis Collins MD interviews US Surgeon Vivek Murthy MD Sept 7, 2017, https://www.nccih.nih.gov/news/events/a-nationunder-pressure-the-public-health-consequences-of-stress-inamerica • Stress in America- 2017 Snapshot: Coping with Change, American Psychological Association, 10th edition, https:// www.apa.org/news/press/releases/stress/2016/coping-withchange.pdf • American Medical Association member Headspace benefit, https://www.ama-assn.org/practice-management/physicianhealth/how-headspace-helps-physicians-medical-studentstame-stress • Brown Center for Mindfulness, https://www.brown.edu/ public-health/mindfulness/home • US Department of Homeland Security, https://www.dhs. gov/employee-resources/mindfulness • 12 Mindfulness audio sessions Dr Patterson has created at Mind Body Studio https://www.mindbodystudio. org/?page_id=1594
LMS 2022 LMS Officer Slate will be closed to further nominations at the LMS Virtual Meeting on October 12, 2021 and virtual election November 1–5, 2021.
President-Elect Lee Dossett, M.D.
Vice President-Elect Hope Cottrill, M.D.
Secretary Treasurer Tina Fawns, M.D.
PROTECT YOURSELF AND YOUR FAMILY THIS FLU SEASON!
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SARS-CoV-2
Vaccination
Disinformation WHY ARE WE STUCK AT LESS THAN 60% OF AMERICA FULLY VACCINATED?
By Terry Clark, MD, FCAP In June 2021 infections by the delta variant of the SARS-CoV-2 virus exploded in the U.S., taxing medical facilities to the breaking point just as it had in Europe in April and May. With its contagion 2-5 fold that of the original alpha variant, a fourth surge began and by September 3rd the new case rate and hospitalizations were greater than the peak last winter. Deaths, however, have been lower and Sept 3rd were about 1500 per day nationally; less than the 3,400 deaths per day in mid January 2021. Somewhere between 95-99% of deaths are reported to be occurring in unvaccinated individuals. In a sane world the need for vaccinating as many people as possible would be undeniable. So why are we stuck at less than 60% of America fully vaccinated? Surveys of the unvaccinated have shown many different issues in the minds of the reticent. The following are the most common, with factual defense attached.
I just haven’t gotten around to it, doesn’t seem urgent to me — and I’m young and healthy and won’t have much problem if I get it. It’s no worse than the flu. This is common among those under 50. The vast majority of Covid-19 deaths were in >70 year-olds, justifying the lack of concern in younger individuals for their personal safety. This was the attitude pushed early in the epidemic by President Trump. It has been reported that in traditional media between Jan 1 and May 26, 2020 that he or his surrogates with reference to him, down-played the pandemic in 517,000 articles (47% of 1.1 million total articles identified as Covid disinformation, 23% specifically claiming “Hoax”)1. Even this number was dwarfed by the millions of people reached through each of his Tweets. The great majority of Republicans, including Dr. Rand Paul, as well as the right wing media, labeled the alarm raised by authorities and Democrats as a hoax. Even with improvements in treatment
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over the last 12 months, mortality with alpha variant was about 1.5% of known infections. Early surges saw mortality rates of 4-6% as hospital capacities were exceeded. It is too early to determine the eventual mortality rate for the delta variant; but it is definitely more deadly for younger people, including children, than the alpha variant was. Mortality from usual influenza strains is much lower; only about 0.1% of cases. The development of the vaccines was rushed and safety was probably compromised. Plus, the effectiveness really wasn’t as high as claimed. And they don’t have full approval.
Immunity from natural infection is superior to vaccine induced neutralizing antibodies so we should vaccinate only the vulnerable elderly and younger with comorbidity. Once most of the “invulnerable” have recovered from natural infection we will have “herd immunity” without the economic ruin of social distancing and other restrictions on commerce. This “quarantine” of the elderly with a laissez faire approach for the younger population and businesses/schools was taken by Sweden early in the pandemic, but before vaccines were available they reversed course due to the number of infections and deaths seen with no evidence of “herd immunity” having been reached. Most epidemiologists feel at least 80-90% vaccine/post-infection antibody immunity is needed to control infection and hospitalization rates. In
The Trump Administration did pressure the manufacturers to release their Phase 3 trial data prior to the November presidential election. Democrats probably added to public distrust with their the absence of vaccines or effective prophylactic drugs, they found accusations of political pressuring and distrust of the process as the elderly could not be adequately protected. Unexpectedly, it was well. However, the necessary phases of vaccine development were also found that morbidity in the recovered patients was significant. all carried out, but without the customary bureaucratic slow pace. The economy was still affected due to fear of the disease. The The usual independent advisory committees evaluated the data question of relative strength of antibody from the manufacturers. Their experts (with only response between the natural infection a few dissenting individuals) felt the results, as versus the vaccines is complicated far as efficacy and safety, were statistically reliable and consensus hasn’t been reached. and met criteria for clearance under Emergency Decreasing neutralizing antibody activity Use Authorization (EUA). Given that the is seen as time goes by in either case. number of U.S. deaths was nearing 500,000, it Patients who have recovered from alpha is a theme currently was judged that the vaccine benefit definitely pushed by Russian, Chinese variant Covid-19 disease can suffer from exceeded risk on a population basis; and in a second infection, usually more than 3 and North Korean groups most opinions, also on an individual basis when months from recovery and from a slightly impersonating Americans looking at the accelerating rate of new infections different strain of virus. It may be mild on social media. and deaths predicted. The engineering of vaccine or severe. Some studies show up to 30% bulk production before waiting for regulatory of individuals with the alpha variant approval of the Phase 3 study results was a major
Safety concern
time saving factor, probably moving delivery time forward by at least a year. Federal funds for development also meant corporate boards of directors didn’t hesitate on equipment and staffing budgets. Safety concern is a theme currently pushed by Russian, Chinese and North Korean groups impersonating Americans on social media. Numerous activists in the anti-vax community (many selling supplements and vitamin/mineral programs claiming to prevent or lessen COVID-19 disease severity) also promote this view. There are a few sincere, credible critics who question the amount of time given to detect rare adverse events or common but subtle side effects that might manifest months or years after vaccination. Those are hypothetical situations that have rarely (never?) been seen in vaccines. Most of those critics do support the risk/benefit decision to proceed with EUA status after the dramatic fall of cases following vaccine rollout in January 2021.
infection or with vaccination (in elderly or immunocompromised) may not form neutralizing antibodies. U.S. delta experience is yet limited and may show a different pattern. Cell mediated immunity is difficult to measure and few studies are published comparing vaccines with natural infection cell mediated immunity, particularly as time passes. The adverse events (complications) caused by the vaccines are much more frequent and serious than admitted by the vaccine companies or the government health agencies. It has been “reported” that at least 7,000 people in the U.S. have died due to the vaccines. This is a statistic quoted by many of the disinformation sources and accepted by many people as fact. It was even brought up in one DISINFORMATION Continued on Page 16
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95-99
%
OF COVID-19 DEATHS ARE REPORTED TO BE OCCURRING IN UNVACCINATED INDIVIDUALS
DISINFORMATION continued from Page 15
of the Kentucky House of Representatives Committee meetings on Sept 7. A Representative asked a couple of times why the FDA had not retracted approval of a vaccine that violated a claimed FDA threshold of 25 deaths. The Committee was pushed to require the statistic in any educational material or public service announcements (PSA) put out by the Department of Health. The source for this 7,000 number is the Vaccine Adverse Event Reporting System (VAERS) managed by the FDA and CDC. Depending when the VAERS database was queried the death number may be from 4-7000. The presence of an event in the system does not indicate it was caused by vaccination. Individuals receiving a vaccine can register with VAERS and report any symptoms or problems they feel may be related to their vaccination. Vaccine manufacturers are required to record any deaths or significant events that come to their attention under EUA rules. I am currently a participant in the J&J Phase 3 trial and file a status report twice per week. Health care providers, health departments, hospitals, in-home nursing also enter deaths or any events they may be aware of into VAERS. CDC does review the reports for significant patterns and investigates deaths to the best of their ability. On the CDC website, adverse events section; it reports no mRNA vaccine caused deaths were identified. CDC did attribute 3 U.S. deaths as of April 2021 to the Thrombosis and Thrombocytopenia Syndrome (TTS) following Johnson and Johnson ( J&J) vaccine inoculation. Twentynine TTS patients were identified after pausing vaccinations when about 8 million doses had been administered.
The Astra-Zeneca (AZ) vaccine is almost identical in components to J&J. Used in the United Kingdom and a few other countries, TTS deaths have been reported. I have not seen an estimate of the frequency of its occurrence with AZ vaccine. Vaccine related TTS occurs within a 6-16 day window following vaccination. An antibody to Platelet Factor 4 is felt to be the cause. There are occasional media stories about vaccinated patients who died dramatically in a short time after their vaccination. Some with thrombocytopenia and hemorrhage, some with thrombosis. Very few received the J&J vaccination. Whether these might be related to vaccine is speculative. They could also be due acquired Thrombosis and Thrombocytopenic Purpura (TTP) disease or an occult underlying sepsis. The above paragraphs detail some of the more reasonable concerns of patients, but with “facts” distorted or presented to them without context. There are also many more bizarre conspiracy theories that are promoted on social media. Following are a several. None have a factual basis. » The mRNA vaccines bind to your DNA and change it permanently and so can make women sterile or give their babies birth defects or stillborns. Or it may cause your cells to make virus S protein forever which causes deterioration of your chromosome telomeres and death from early aging. » The virus was engineered through China by global elites to make themselves richer since they own pharmaceutical, testing, and vaccine company stocks. DISINFORMATION Continued on Page 18
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Disinformation Dozen: Twelve individuals responsible for spreading 65% of Covid-19 vaccine disinformation on the internet. Some maintain their own websites that sell "preventative supplements."
DISINFORMATION continued from Page 16
» There is genetic sequencing that shows the virus was a Chinese » » » » » » »
bioweapon that escaped from a Wuhan laboratory. Reishi mushrooms can solve aging and cure Covid. Schweppes tonic water will prevent and treat Covid. If businesses mandate vaccination OSHA has ruled that they will be liable if any adverse events occur. The Red Cross has warned blood centers to stop plasma donations from vaccinated persons. Dr. Fauci emails show he wrote at least one prescription for Hydroxychloroquine. The Moderna vaccine development was helped by Bill Gates and includes a microchip to control people. The main stream media and government health authorities are conspiring with the Junk Food Industry to deny the natural preventives and treatments for Covid that the bloggers peddle.
So who is promoting all the social media disinformation? The onslaught comes from too many persons and organizations to list in detail but I will describe two. On Aug 10, 2021 the AP reported that Facebook removed the Russian related advertising company Fazze, with 65 Facebook accounts and 243 Instagram accounts from its platforms. The company attempted to send messages to dozens of social media “influencer accounts” offering them “whatever their fee was” to discourage Astra-Zeneca and Pfizer vaccine use and to feature their negative ads and You Tube videos. Very few influencers took them up and they were reported to Facebook quickly. Earlier, Fazze had attempted the same in India, France, Germany and Britain (Reported on msn.com and theguardian.com). In late March 2021 Imran Ahmed of the Center for Countering Digital Hate (CCDH, counterhate.com) released a news article entitled The Disinformation Dozen.2 It was featured in an interview
on the NPR Website May 14th. It lists the top 12 persons identified as spreading Covid-19 vaccine disinformation on the internet. They were identified from a sample of 812,000 posts on Facebook, Instagram and Twitter from the period Feb 1–March 16, 2021. The twelve were responsible for 65% of the content within the 812,000 posts/shares in their sample. Most of the individuals are associated with the anti-vax community and some maintain their own organization websites that either sell Covid “preventative or treatment supplements” and/or solicit donations to support their cause. Most have several accounts from which they post. Following the article and a Congressional hearing in which the article was referenced and Mark Zuckerberg testified, almost all of them were supposedly banned from Facebook. As of May 14, however, Ahmed found that 10 of the 12 were still on Facebook and all were on at least one platform. The Center estimates that 95% of anti-vax disinformation is not caught by Facebook’s policing algorithm. Go the the CCDH website for the complete list and details of the twelve. Below is the #1. Many of the others follow a similar profile. Joseph Mercola, D.O., ranked as the most prolific social media spreader of anti-vax disinformation: Dr. Mercola lives in Cape Coral, FL according to an article on the New York Times website, 7/24/2021. At least 3 separate fact checkers have credited him as a leading source of vaccine disinformation. He has been an activist in the anti-vaccine community for at least ten years and sells “natural cures”. He has run several different internet websites through the years and his current site is simply “Mercola”. He is reported to run 17 Facebook pages as well as additional Instagram and Twitter accounts. He is reported to have 1.7 million followers on Facebook in English and 1 million followers in Spanish. He employs several people to promote his views online and has been responsible for over 600 disinformation articles on Facebook. He has published 2
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CDC:
For further information regarding almost any Covid-19 issue go to www.cdc.gov.
previous anti-vaccine books and 8 “natural health” books. The FDC warned him at least 3 times prior to Covid that his product claims were illegally representing their abilities to cure, treat or alleviate medical conditions. He has been warned again since Covid emerged. He has pushed hydrogen peroxide nasal nebulizer and vitamin D for Covid treatment; and at one point tanning beds for cancer treatment. The Fed Trade Commission (FTC) forced him to refund 2.6 million dollars to purchasers of his beds. Regarding Covid, he has claimed there is proof that Covid is a bioweapon from China, Pfizer vaccine is no more than 39% effective, masks are ineffective, the mRNA vaccines alter genetics and make your body a permanent viral protein factory. He has claimed there were no more deaths in the U.S. in 2020 April–Dec 31, than in the same 2019 period; and therefore the Covid epidemic is a hoax. He has pushed his claims on the Tucker Carlson and Laura Ingraham shows as well as at rallies and anti-vax “seminars”. After being banned from Facebook spring 2021, he has removed all of his previous posts and will remove all current posts within 48 hours. The only product on his website that appears to be for sale today is his recently released 2021 Covid-19 exposé book. Go to his biography on Wikipedia for more detail. Another area of disinformation/controversy involves use of the drugs Ivermectin and Hydroxychloroquine in the treatment or prophylaxis of SARS-CoV-2 infection. This is complicated and deserves a more detailed discussion. These are endorsed by some sincere physicians but also by many others who are simply Trump MAGA supporters or generic antivaxers seeking a vaccine substitute. The FDA does not approve either of them for Covid-19 therapy currently. There is some antiviral activity in the laboratory for both and an early published Chinese Hydroxychloroquine study concluded that there was significant improvement of clinical condition in hospitalized
patients. For several months it was standard therapy in China as well as France and Italy. Ivermectin was looked at in an early observational study with similar findings and promoted by a group that included some respected pulmonologists and infectious disease physicians. It is currently approved for COVID-19 treatment in some countries. See References3,4 For further information regarding almost any Covid-19 issue go to the CDC website: cdc.gov.5 It has the most current information on most issues. References • Evanega S., Cornell Alliance for Science, Oct 1, 2020 online at allianceforscience.cornell.edu • Ahmed I., Center for Countering Digital Hate, “The Disinformation Dozen” published March 2021online at counterhate.com/Covid/Disinformation Dozen • Lawrie, T., “Ivermectin Reduces the Risk of Death from Covid19: Rapid Review and Meta Analysis in Support of The Front Line Critical Care Alliance”, published online May 8, 2021, researchgate.net/publication/348230894 (also can be found at covid19criticalcare.com, FLCCA website) • Sinha N., Baylayla G., “Hydroxychloroquine and COVID-19”, Postgrad Med J, April, 2020;(96) 550-555 • cdc.gov/vaccines/adverse About the Author Dr. Clark has practiced Pathology in Kentucky since 1980. He attended residency at the Univ of Kentucky and Surgical Pathology Fellowship at the Univ of North Carolina, Chapel Hill. He was on faculty at the Univ of Kentucky from 1986-1989 and entered private practice in Lexington in September 1989. He was on staff at Baptist Health Lexington as well as numerous smaller hospitals within Kentucky. He retired from active practice in 2020. He has been a member of the Lexington Medical Society since 1990.
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COMMUNITY NEWS A N N O U N C E M E N T S , AWA R D S , E V E N T S & M O R E
Lexington Clinic Joins Anthem Blue Cross and Blue Shield Medicare Advantage Network: Lexington Clinic’s 180 + providers will collaborate with Anthem to improve the health and wellness of its Medicare patients Lexington, KY (September 10, 2021) – As part of its commitment to deliver the highest quality patient experience, Lexington Clinic has joined Anthem Blue Cross and Blue Shield’s Medicare Advantage network. This collaboration will make it easier for Anthem’s members to receive care from Lexington Clinic’s network of providers. “Through this effort, Lexington Clinic aims to offer new patients in Central Kentucky personalized and innovative healthcare services with the goal of supporting better outcomes,” said Eric Riley, Chief Administrative Officer (CAO) Lexington Clinic. Founded in 1920, Lexington Clinic is the largest independent multi-specialty group in Kentucky with more than 180 providers in 30+ specialties, across 25 locations throughout Central Kentucky. By using modern data analytics, best practice protocols, experience and compassion, Lexington Clinic aims to provide the highest quality of care to the communities it serves and is committed to perfecting the patient experience. “We look forward to working closely with Lexington Clinic’s providers to give our members in Central Kentucky access to the care they need, when and where they need it,” said Jess Hall, Market Leader in
Kentucky for Anthem’s Medicare business. “The addition of Lexington Clinic to our Medicare Advantage network furthers our efforts to improve our members’ health and wellbeing as well as create a better healthcare experience for them.” Anthem currently offers a number of Medicare Advantage plans that meet the needs of individuals eligible for Medicare in every county that Lexington Clinic has a location. Dr. Fred Odago Joins CHI Saint Joseph Medical Group in Lexington: After a decade of scientific research, Dr. Odago joins local neurology team LEXINGTON, Ky. (Sept. 8, 2021) – Fred Odago, MD, has joined CHI Saint Joseph Medical Group in Lexington as a neurologist. Growing up, Dr. Odago says he was subliminally influenced into the medical field by his uncle, who was the family’s first physician. Dr. Odago eventually became a medical Fred Odago, MD researcher; however, 10 years later, he entered medical school. The change of heart came after he realized he would have more of an impact as a physician in a clinical setting, rather than as a basic scientist within a lab. “I was a nontraditional student when I went to medical school,” said Dr. Odago. “I’d done a lot of research, and at that point realized I was ready to go into clinical
practice. In medicine, I’m able to see the impact of medical research on patients directly. I’m still research-minded and was drawn to neurology due to the active research that is still ongoing to address neurological conditions such as ALS and because, historically, doctors are often trying to find answers that aren’t always clear.” Dr. Odago received his medical degree from the University of Kentucky after working in research positions for a decade at several institutions including his alma mater. Prior to employment or attending medical school, Dr. Odago was one of 30 international students from Kenya selected to attend Berea College in central Kentucky. Professionally, Dr. Odago is excited to be involved in medical scenarios that emphasize the essence of research such as investigating the cure for Alzheimer’s disease, or finding ways to end debilitating migraines. “I think there is a misconception that neurology is a field with a big question mark - that we don’t have a lot of solutions for our patients’ conditions,” said Dr. Odago. “While we may not yet have curative therapy for some of these neurological diseases, we are finding new ways every day to improve the quality of life of these patients as well as increase their life expectancy. Over the last decade we have also seen rapid progress in finding new effective treatments for neurological conditions such as multiple sclerosis and migraine. Additionally, we are starting to discover ways of identifying patients who are at risk of certain neurologic conditions and potentially alter the disease course.”
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SHARE YOUR STORY WITH THE COMMUNITY. E M A I L B R I A N @ R O C K P O I N T P U B L I S H I N G . C O M T O H AV E Y O U R N E W S P U B L I S H E D.
Professionally, Dr. Odago has received various professional accolades including “Resident of the Month” from the Department of Neurology at UK, and has participated in more than 15 publications, abstracts and presentations throughout his career. Within his practice, Dr. Odago aims to be an advocate for all his patients. “I want to make sure we are addressing neurological issues, providing good care, but also focusing on making sure patients receive the right treatment and resources,” said Dr. Odago. Dr. Odago is excited to remain in Lexington, where he met his wife, Krista. Together, with their three children, the Odagos enjoy camping and spending time outside. In his spare time, Dr. Odago runs at least 25 miles a week and enjoys reading. Dr. Odago is accepting new patients and will practice at CHI Saint Joseph Medical Group – Neurology, 1021 Majestic Drive, Suite 200, in Lexington. To make an appointment with Dr. Odago, visit www. chisaintjosephhealth.org or call 859.296.1922. Saint Joseph Hospital Foundation Yes, Mamm! Yes, Cerv! 5K Goes Virtual: Virtual race to celebrate local survivors during Breast Cancer Awareness Month LEXINGTON, Ky. (Sept. 27, 2021) – To ensure the safety of all, the Saint Joseph Hospital Foundation Yes, Mamm! Yes, Cerv! 5K race is now going virtual. Participants can now race in place to compete on Saturday, Oct. 16.
This is the sixth anniversary of the race, which took a break in 2020 due to the COVID-19 pandemic. The Yes, Mamm! Yes, Cerv! Virtual 5K, presented by RJ Corman Railroad Group, is open to runners of all ages. Proceeds from the virtual race support free mammography and cervical cancer screenings, diagnostic testing, and program support to underinsured and uninsured patients across Kentucky. Every dollar raised will support Yes, Mamm! Yes, Cerv! programs statewide. Registration for the Yes, Mamm! Yes, Cerv! Virtual 5K will remain open until midnight Friday, Oct. 15. To register online, visit https://runsignup.com/Race/ KY/Lexington/YesMamm5KatRJCorman. Packet pickup for the virtual 5K will be held on Thursday, October 14 from 5:30-8:00 p.m. at 1451 Harrodsburg Road, Building D, in Lexington. If you cannot attend packet pickup, your race materials will be mailed to you. Dr. Phyo Phyo Ye Kyaw Joins CHI Saint Joseph Medical Group in Lexington LEXINGTON, Ky. (Sept. 24, 2021) – Phyo Phyo Ye Kyaw, MD, has joined CHI Saint Joseph Medical Group – Pulmonology in Lexington. As a first-generation physician, Dr. Kyaw practices with the belief that helping patients breathe easier is a privilege – a vital service as our communities experience the second year of the global COVID-19 pandemic.
Dr. Kyaw received her education in Burma from the University of Medicine 2, Myanmar, and completed her postgraduate trainings at Texas Tech University and Southern Illinois University. During her residency and fellowship, Dr. Kyaw completed rotations within internal medicine, pulmonary consults, level 1 trauma, cardiac Phyo Phyo Ye Kyaw, MD intensive care unit (ICU), and neuro ICU among numerous others. “As a pulmonologist, I need to help my patients understand their lung diseases, but I also need to help them make informed decisions on how to seek the appropriate treatment,” said Dr. Kyaw. “Whenever I meet a patient, I try to know not only their diseases but also who they are as a person.”
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In for a
Penny By Torie Osborne, UK COM 4th year medical student I am defined by the people who made me. I am my Mother’s determination and my Father’s inquisitiveness. I am my Nanny’s empathy and Paw’s selflessness. I am a proud daughter of Eastern Kentucky and its beautiful quilt of mountains, fried chicken, and fiddle music. Throughout my life, I’ve often taken pride in the title of “student” and now, with the transition to “doctor,” I question whether I’m worthy of the title. There was a time when I questioned my worth concerning any title. In 2017, before medical school started, I was racing away to Florida in an attempt to find out who I was on my own. It was during this time that I discovered my knack at finding pennies, or rather it may have discovered me. I prayed that God would send me pennies, one a day for an entire week, to show me that I was on the right path. I easily found a penny the first three days, but when day four came and went without a penny, I became discouraged. Days five and six passed me by and I became further disillusioned. On Day seven however, I found four pennies scattered about a vacant parking spot.
Since that day, finding pennies has become my touchstone. I followed my path of pennies right into the University of Kentucky’s College of Medicine and they haven’t led me astray yet. Abraham Lincoln’s copper face has guided me through exams, patient encounters, and tricky attending physicians. Now, they begin to guide me through another set of big decisions. If you had asked me five years ago where I would end up practicing medicine, I would have told you I didn’t know. I have skillfully avoided the question, “Are you coming back home?” on many occasions. A blessing in disguise, COVID-19 interrupted my regularly scheduled medical school programming and I found myself scouring First Aid in-between home cooked meals and much needed family time. As I sat in my childhood room, I looked around and realized that there is nowhere that I would rather be. I wanted to be home. On a hot summer’s day, I found myself, and the rest of my extended family, surrounding a tree at my Father’s childhood home. This was the first time I had been there. It was tucked away in a holler. A winding gravel road wound around until eventually coming to a stop
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at the top of a hill. My family had made tha hill trip to help lay my Father’s aunt to rest. She had passed away on Christmas Day and her final wish was to have her ashes scattered around the pecan tree that she loved as a growing girl. We I prayed that God would waded through the informal send me pennies, one a ceremony. At its end, my Father asked me to join him day for an entire week, to show me that I was on in the overgrown raspberry patch where a rock wall was the right path. barely visible in the foliage and the shade. “Your Paw made this by hand,” he said. He plucked a rock from the crumpling wall and explained that he wanted to put the rock into our landscaping at home, beside the one he picked from his grandmother’s chimney when she passed away. We began to make our way back over and down the hill, carefully side-stepping holes and poison ivy. I looked down at my feet to better navigate the challenging hillside when I found my compass. A worn, faded, and dirty penny. I couldn’t believe it. My great-uncle Jack began telling me that my Paw would place pennies in the trees and try to shoot them out with his .22 rifle. Somehow, I had found a token of
time. A penny that was lost to my grandfather many years ago, possibly when I was his age and my father was wearing diapers. As tears filled my eyes, I tried to read the date. “1940 something”. With my lucky penny clasped in my hand, I hopped into my Dad’s truck. The penny had followed me to the place where my family began. It had withstood 50 years of weather and the changing of the seasons to prove that I was where I was always meant to be, never to be doubted again. All my questions about my identity were answered that day on that hill. I may not be deserving of the new title of “doctor” yet, but I now know who I want to help. I want to help my family. I want to help my friends. I want to help the people who made me. As long as I keep them in mind and squeeze my penny in my hand, I will live up to the title. I have to live up to it. I want to do it all for them. They have given me everything and they deserve the world. About the Author Torie Osborne is a 4th year medical student at the University of Kentucky. Torie was born in the mountains of Virgie, KY. She hopes to return home to practice as a Pediatrician and Child Psychiatrist.
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SARS-CoV-2 Virus Variants:
Classification, Genetics and Clinical Importance By Terry Clark, MD, FCAP In the beginning of 2020 the world learned there was a “Novel Corona Virus” in China, which over 8 weeks became pandemic and the media added additional labels. Some of these were: Covid-19 virus, China Virus, Wuhan Virus, KungFu Virus. Eventually the scientific community settled on SARS-CoV-2. Early on the U.S. was infected with 2 strains, only slightly genetically different; one in New York City (directly from Europe) and the other on the West Coast (directly from China). By fall 2020 global viral proliferation had given rise to large clusters of mutated virus that had higher contagion ability and slightly higher morbidity/ mortality. The earliest of these became known as the UK and South African variants. They were labelled B.1.1.7. and B.1.351 in the most popular system used by the scientific community. The media and even the CDC and WHO largely used the UK and South African monikers. Soon a Brazilian variant also joined the discussion. Having multiple systems for naming the virus has been confusing for everyone—the public, media, government agencies, and even the scientists studying the viruses. Some history of the nomenclature follows. In traditional viral taxonomy, SARS-CoV-2 is a member of the Coronavirus subfamily, a single stranded RNA virus subfamily that primarily infects mammals and birds. Genus and “species” of virus are designated mostly by the species they infect or the disease they cause. Corona virus genomes are 26-32,000 nucleotide bases in length, with 9-12 genes. Mutations are very common during replication. Hundreds of mutant virus occur and are secreted in the mucus and breath from every patient infected, whether they are symptomatic or not. The vast majority of these are defective. Rarely, they can be more virulent.
As the Covid-19 outbreak progressed, numerous mutant clones rapidly evolved; only a few clinically important. A new system was needed to label the important ones. The popular method of labeling them by the country in which they first blossom into public notice is not necessarily accurate as to origin and has nothing do with their pathogenic properties. The most populated countries have multiple variants arising. The Global Initiative on Sharing Avian Influenza Data (GISAID) monitors the mutant influenza strains that emerge globally every year. They help the manufacturers to modify flu vaccines to be effective. When the Covid-19 pandemic hit they undertook to create a database of all of the laboratories doing genomic sequencing of the SARS-CoV-2 isolates. Several different systems of identifying the variants have been used, but most prevalent in the literature is the alphabet-numeric system is called “Pango” (ie; B.1.1.7). There is a computer program (Pangolin, there are already 3 generations) used by participants in the GISAID data base. This identification algorithm, proposed around April 2020, attempts to trace the virus mutants along their evolutionary lines since the early spread. The first letter A is assigned to those mutants arising directly from the original China strain, B to those from the first Italian isolates. Subsequent extensions (ie: B.1.1) indicate the succeeding mutant variant from the immediate ancestor B.1 line. The UK virus designation B.1.1.7 indicates the 7th variant that was identified arising from the B.1.1 mutation lineage and the S. African strain B.1.351 is the 351st variant arising from the B.1 ancestor. There is so much mutational activity that even this system has problems. Within a year of expanded genome sequencing surveillance VARIANTS Continued on Page 28
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VARIANTS continued from Page 27
of this system had become too cumbersome for public discussion. In consensus, around Feb 2021; WHO, CDC and other research groups implemented a more useful labeling of current significant SARS-CoV-2 strains. Letters of the Greek alphabet have been assigned to the most significant variants. The Alpha variant was originally “UK”, the Beta was “South Africa”, Gamma was “Brazil”, Delta had no previous country of origin name but arose in Peru in Aug 2020 and is now the predominant virus in the world. There are currently at least 3 mutational spin-offs from the Delta SARSCoV-2 stain (B.1.672.1) designated as subgroups AY, AY2,AY3. They have no mutations that make them more or less dangerous than the original Delta strain. Mu is the latest added variant which was first noticed in Colombia and Ecuador in Jan 2021, but has minimally spread out of S. America and is decreasing as Delta is replacing it. Epsilon, Kappa, and Iota variants are also named but are of very little interest. Of note — there is no C, F, J, ,Q or V in the Greek alphabet. Non-English “fraternity” favorites you might recognize are Psi, Phi,Theta, Chi and Omega; which will probably be used in the not to distant future. To help prioritize the importance of the variants the U.S. SARS-CoV-2 InterAgency Group (SIG) assigns each to one of 3 categories based on their genetic and clinical risk profiles.
» Variants of Interest (VOI): These variants carry some
mutations that are thought to enable enhanced contagion or mortality; or ability to avoid immune response to infection, or avoid recognition in PCR testing or may be resistant to current vaccines, monoclonal antibodies, or chemotherapeutic agents. However, they are currently a minor percentage of cases in most countries (especially the U.S.). They have not shown “significant” increases in severe disease or mortality in vaccinated patients. SIG designated VOI are Eta, Iota, and Kappa and all seem unlikely to be a danger. WHO keeps its own list and has recently listed two additional as VOI: Lambda and Mu. U.S. SIG has not included them, since U.S. cases are <1%. » Variants of Concern (VOC): These variants meet criteria of VOI, and have shown rapid spread within many populations and usually there is some but not extensive evidence of increased severe infection/mortality in unvaccinated individuals. Some evidence for resistance to vaccines is present at least in elderly or immunocompromised individuals. Delta, Alpha, Beta, Gamma are in this category. » Variants of High Consequence (VOHC): These variants would be genetically, as VOI and VOC, worrisome; and would have shown definite ability to evade current vaccine protection against severe disease or mortality, or not be detected by PCR testing, or resistant to multiple chemotherapeutic agents or resistant to most monoclonal antibody preparations. There are no variants currently placed in this category. *See cdc.gov/science/surveilence for exact wording of all category criteria VARIANTS Continued on Page 30
Do you have uninsured patients in need of FREE breast and/or cervical screening?
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All I Need to Know is Where I Need to Go! Call 1-844-249-0708! The Kentucky Women’s Cancer Screening Program (KWCSP) offers FREE breast and cervical cancer screenings. The program provides Mammograms and Pap tests and follow-up services, education and outreach to low income, eligible women. Once in the program, if a woman has an abnormal screening, the KWCSP covers the cost of most diagnostic tests. If a pre-cancer or cancer is found, the program connects her to treatment through Medicaid’s Breast and Cervical Cancer Treatment Program (BCCTP). The KWCSP provides services through Kentucky’s local health departments, community health clinics and other healthcare providers. A woman does not have to reside in the same county in which she receives services. Healthcare providers, please refer eligible women to a participating KWCSP clinic/provider. For a participating clinic/provider listing call KWCSP, 1-844-249-0708.
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VARIANTS continued from Page 28
Below are profiles of the variants with WHO or SIG assigned categories as of Sept 3. » Eta: (B.1.525) First seen UK and Nigeria, Dec 2020.
»
»
»
»
»
Genotype suggests potential monoclonal antibody resistance, convalescent plasma antibodies resistance, and vaccination induced antibody resistance. Variant spread is limited and genetic potential does not seem realized. Iota: (B.1.526) First seen US, NewYork, Nov 2020. Manifests monoclonal antibody resistance (bamblanivimab/esesevimab combination products only ). This is not the more widely used brand REGN-COV2 from the Regeneron Corp. Convalescent plasma antibodies, and vaccination induced antibodies show reduced neutralization in lab tests. Clinical vaccine resistance is unproven. Variant is limited in prevalence globally. Kappa (B.1.617.1) First seen India, Dec 2020. Genetics suggest potential for reduced neutralization by monoclonal antibody and convalescent plasma antibodies, but evidence for clinical resistance is unproven. Variant is limited in prevalence globally and decreasing. VOI without WHO designation: (pango B.1.617.3) First seen India Oct 2020. Shows 7 mutations felt to increase resistance to vaccines but no definite evidence in clinical studies. Genetics also suggest there may be resistance to monoclonal antibody drugs. Very low prevalence globally. Lambda: (B.1.1.1.37) First seen Peru, Aug 2020. Was dominant virus in South America. Only 0.1% US (about 2,000 cases) and falling everywhere as Delta spreads. Genetically 7 mutations are present, particularly 3 in the S receptor gene with one being an unusual large deletion mutation. Vaccination induced antibodies show moderate reduced neutralization in lab tests. Clinical vaccine resistance is unproven but suggested since it arose in a highly vaccinated city (Chinese Sinovac product).1 No clinical evidence of resistance in mRNA based vaccines. It does have a mutation that some PCR testing platforms may miss, but not the vast majority of platforms. Mu: (B.1.621 and B.1.621.1) First seen in Colombia, Jan 2021. As with all mutants followed under the SIG criteria, this shows many mutations worrisome for more contagion or resistance to vaccines. Mu has reached maximum prevalence in Colombia at 39% of cases. There is still low prevalence globally, US 0.2%. Only one lab study seems to have been reported; out of Italy, with convalescent plasma from Pfizer
vaccinated patients which showed only mildly decreased neutralization of the Mu variant compared to the early Italian lineage B.1 virus in cell culture.2 » Alpha: (B1.1.7 and sublineages “Q”) First seen in United Kingdom, mid 2020. 13 spike protein mutations. Definite increased contagion compared to B.1 lineage, about 1.5 times more. Cases in UK first surge were felt to show increased severity of disease as well. No monoclonal antibody resistance has been seen. Minimal to no impact on vaccination efficacy has been seen. » Beta (B1.351 and sublineages B.1.351.2 and 351.3) First seen S. Africa, mid 2020. 10 spike protein mutations are present. Definite increased contagion is present, similar to Alpha. No impact of vaccination efficacy. Significant resistance to monoclonal bamlanivimab/etesevimab combination preparation has been reported. » Delta: (B.1.1617.2, and sublineages AY1-3) First seen
India, late 2020. The variant shows 15 different S protein mutations. The most of any variant. It was responsible for the largest surge in India cases and deaths. Transmissibility is estimated at 2-5 times that of the Alpha (UK) strain. No evidence for resistance to monoclonal antibody therapy has been seen. Some lab studies have shown moderate decreased neutralization of the virus compared to the Alpha virus by convalescent plasma from patients of Pfizer, Moderna, and J&J vaccinations. Some labs have seen only mild or no decrease. Recent clinical studies have found some evidence of more breakthrough cases and moderate disease but rare deaths in frontline healthcare workers and in patients at long term care facilities3,4. At issue is whether the increased breakthrough infections in the vaccinated are really due to the Delta virus’ intrinsic pathogenicity or due to waning vaccine induced antibody levels over time. Delta only exploded globally in July. The studied populations (ie. Long term care patients, healthcare workers, Israelis) were the first groups to receive vaccines in Dec 2020 and Jan 2021. Studies of vaccine induced antibody levels show definite declines at 6-8 months, most dramatic in the elderly. This is an argument for a third inoculation, at least for high risk individuals in the coming months. » Gamma (B.1.1.28.1, alias P.1) First seen in Brazil and Japan, Oct 2020. The virus has many sublineages as well. It has 11 S protein mutations. In lab, there is moderate resistance to convalescent and vaccine induced antibody neutralization. There has been no evidence of reduced vaccine efficacy clinically. Significant resistance to monoclonal bamlanivimab/ etesevimab combination preparation has been reported.
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Variants with WHO or SIG assigned categories as of Sept 3. Eta
Dec. 2020 UK
Alpha
Mid-2020 UK
Iota
Nov. 2020 New York
Gamma
Kappa
Oct. 2020
Dec. 2020
Japan
India
Mu
Delta
Jan. 2021
Late-2020
Colombia
Lambda
Aug. 2020 Peru
India
Gamma
Oct. 2020 Brazil
Beta
Mid-2020 S. Africa
In conclusion, more variants will arise every month around the world. One hopeful observation from the genetic studies of the variants is that increased mutations in transmissibility capabilities seems to diminish the number of mutations in genes that promote severe disease. The more deadly variants are at a competitive disadvantage with the highly contagious variants like Delta during viral surges. It seems that variants are unlikely to be both highly transmissible and highly lethal. References
• Kimura I, et al. “SARS-CoV-2 Lambda Variant Exhibits Higher Infectivity and Immune Resistance”. bioRxiv Preprint Server for Biology. 28 July 2021 https: //doi. org/10.1101/2021.06.28.2159673 • Messali K, “ A cluster of the new SARS-CoV-2 B.1.621lineage in Italy and sensitivity of the viral isolate to the Pfizer
vaccine”. Journal of Medical Virology 9/8/2021 doi:10.1002/ jmv/2021.09.08.27247 • Fowlkes A, et al. “Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations”, December 2020–August 2021. MMWR Morb Mortal Wkly Rep 2021;70:1167-1169. DOI: http::// dx.doi.org/10.15585/mmwr.mm703e4. • Nanduri S, et al. “Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — National Healthcare Safety Network, March 1–August 1, 2021”. MMWR Morb Mortal Wkly Rep 2021;70:1163-1166. DOI: http::// dx.doi.org/10.15585/mmwr.mm703e3
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