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Update on COVID-19 Vaccines, Boosters, and Masks
Dr. George Munoz provides an update on COVID-19 vaccines, boosters, and the efficacy of masks.
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Learn more about George Munoz, MD
George Munoz, MD
George Muñoz, MD, is a board-certified rheumatologist and internist, fellowship trained in rheumatology/immunology at Harvard Medical School affiliates the Brigham and Women’s Hospital and the Beth Israel Hospital in Boston. He completed a second fellowship in integrative medicine at the University of Arizona Center for Integrative Medicine founded by Andrew Weil, MD, and was the first recipient of the Jones/Lovell Rheumatology Scholar Award for 2006-2008. He is a national speaker, lecturer, published author, and co-editor. He serves as chief of integrative medicine and integrative rheumatology for the American Arthritis and Rheumatology Associates (AARA), the largest rheumatology super-group in the US. He is a futurist and innovator, “specializing in the patient journey and experience” as a cornerstone and guiding principal for healthcare stakeholders to emulate and innovate.Learn more about George Munoz, MD
Transcription:
Bill Klaproth (Host): Welcome to Oasis Rheumatainment, a podcast with Dr. George Munoz, Chief Medical Officer, and Founder of both the Arthritis and Osteoporosis Research Institute, the Arthritis and Rheumatology Association Care Center and the Oasis Institute, a fully integrative multidisciplinary clinic in Aventura, Florida. I'm Bill Klaproth.
And on this episode, Dr. Munoz gives us an update on COVID-19 vaccines, boosters, and masks. Dr. Munoz, it's always great to talk with you. Thank you so much for your time. We appreciate it. And we're looking forward to your update on COVID 19. So, can you give us your overview of where we are at in the US primarily with COVID-19 since you last updated us?
George Munoz, MD (Guest): Hello, Bill. And absolutely. So, this is a very broad topic. And today, as of August 18th, 2021, since we last updated approximately six weeks ago, we seem to be at new cases at about 130,000 each day that are almost double last summer's peak levels. As far as hospitalizations, we've reached the highest levels since the winter. Parts of the south, including here in south Florida have actually shattered case records of Delta variants, overwhelming resources for intensive care units. Locally, I can tell you here in Southeast Florida, we are at about 98 to 103% of capacity for ICU beds. In spite of all that, vaccination rates are still lagging. Only about half of Americans are fully vaccinated.
And since the Delta surge began, daily vaccinations have really not kept up with the number of new cases of COVID. So, approximately 700,000 doses a day are being dispensed at this time. So, the bottom line is, that the US has recorded about 36.7 million Corona cases. And unfortunately we've had at this point, approximately 621,000 deaths since the pandemic began. While most people do recover from mild to moderate COVID in a few weeks, we're also experiencing at this point, a new perplexing set of symptoms that is being called long COVID that can include brain fog, fatigue, muscle pain, just to name a few of the symptoms that can last anywhere from weeks to months after the actual infection has ended.
So the update is, is that we now have long COVID as part of the medical model, that physicians and multi-specialty is internal medicine, family practitioners and specialists are seeing, and it looks like, we've got somewhere between 10 to 30% of adults who catch the virus may experience long COVID symptoms. So, that's where we're at right now as a high level overview of where we stand and we have some specifics to discuss.
Host: Yeah. We're not in a good spot right now. And when you tell us those statistics, that really emphasizes how we're not doing very good with this and some parts of the country are really struggling with this. And another thing that we in America are struggling with is, mask usage. Some are okay with it and understand the value of a mask. Some are refusing to wear masks because they feel it interferes with their freedoms. What is your medical opinion on mask use at this time during this Delta surge?
George Munoz, MD (Guest): So, I think the important thing that you just emphasized Bill is what's my medical opinion because that's really what should be focused on, in my humble opinion, both as a physician, as a healthcare provider, as an observer of what's happening, both locally and in our country. All politics aside, it's clear that a few things are quite evident.
Number one, we are in a surge again with the Delta variant. The uptick in cases, hospitalizations, ICU beds requirement, and deaths really tell us that we need to be smart and being smart means using masks. The masks are effective, nothing is a hundred percent. The masks do mitigate, reduce the risk and significantly alter, the infectivity rate even of this Delta in comparison to not using masks and being aerosolized contaminated with droplets that are usually airborne. And so it really is very, very smart to continue to use masks in closed settings, indoors, in gatherings, for which there should be very few. But in terms of scenarios like school openings, and other events that are happening, the mask really becomes an essential part of prevention.
Host: Right. It's a science has proven that masks do help control the spread of COVID-19. And as you said, follow the science, which I agree with. So, there was a recent study out of Israel and the New England Journal of Medicine on the effectiveness of vaccines with the Delta versus the Lambda variants. Can you give us a briefing on those findings?
Dr. Munoz: Sure Bill and the reason this study is even out here is because of the current Delta surge, which is global. And this study came out in the New England Journal, as you said in July 21st of this year. And really it was a study looking at a specific time period between January and late April of 2021.
And it was among health workers, approximately just shy of 1500 health workers in Israel for which 39 infections were detected, based on screening for high risk contacts post-exposure and then doing contact tracing. And what was interesting was that in Israel, everyone's been vaccinated, primarily with the Pfizer vaccine.
The point of this study was to get a handle on what are the percentages of breakthrough infections in a fully vaccinated real-world population, so that we can have an extrapolation for the rest of the world what might be expected as to how the vaccines are operating, their effectiveness and whether they lose effect over time.
Those are really questions that are being asked at this time. And based on the results of this study 2.6% of the infections in fully vaccinated individuals were detected meaning that 97.4% of vaccinated people did not get infected. The vaccines work very well. They work over 95% of the time.
At the time of the study, 85% of the COVID variants were Alpha at that time. Delta was not yet, in place. So, we know what it looks like for the Alpha variant. Now we are in a different time zone. Now we've got Delta primarily in North America and in a lot of places in the world, but not exclusively.
So, what they used was a rapid antigen and the PCR testing. What they found was they didn't have needs for ventilation and there were no deaths in those breakthrough infections. At that time, the feeling was the vaccines work. Breakthroughs can happen at a very small percentage. And that was pre-Delta.
Host: I think what you said there is very important and the fact that over 90% of the people that are currently hospitalized are people that are not vaccinated. That just proves again, that vaccines work.
Dr. Munoz: Absolutely.
Host: That That really illustrates that point, but a lot of people don't want to get vaccines for many reasons. One of them is side effects. So, can you comment on vaccine side effects, such as myocarditis? I know there have been reports of this, especially in younger people. So, who gets this and, and what is the prognosis?
Dr. Munoz: That's another great question. And these questions and topics seem to develop a life of their own Bill, both in the media and social media word to word and community. So, it's important that we address them. And it's important that people get clear answers as to what's statistics look like. So that informed decision-making can be made by individuals and with their physician. So, in terms of myocarditis, I can tell you that it looks like this is primarily a side effect of young males in very small percentages. The prognosis, thank goodness is quite good. This seems to be in general, a self-limiting event, meaning that it rarely has long-term consequences. Now, what is myocarditis? Myocarditis is inflammation of the heart muscle. We typically see myocarditis not related to vaccines, but rather to viral infections such as Coxsackie virus, but that's not the only virus that can cause myocarditis. Typically myocarditis when it's caused by a wild type virus could be mild or it can be severe and lead to permanent problems with the heart muscle.
But this is not what is typically being seen with the vaccine related myocarditis. The vaccine related myocarditis seems to be again, primarily males, short-term symptoms, very small percentages and with a very good long-term prognosis.
Host: Well, that's good to hear and it's good to get the real facts on that. So, we're talking about boosters now in the United States. So, on the topic of boosters, where do we stand on this right now?
Dr. Munoz: The topic of boosters is a very fluid situation, Bill. It seems to be changing weekly, if not daily. And part of this is science. And part of this is, in my opinion, related to political pressure of the said government empowered to try and get ahead of what appears to be a global surge specifically with Delta. Where we stand right now is, is that the FDA, is currently pending an actual final approval for the vaccines, the Pfizer and the Moderna vaccines and J and J in the United States.
So, we have to remember that these vaccines have been deployed under emergency authorization use, not the usual FDA approval process that is typical for drugs to be approved and then used, in the United States populace. We're still pending the approval. The approval we think is imminent, talking weeks, two to four weeks.
And that both the Pfizer Biontech and the Moderna and J and J vaccines are all pending. Booster FDA approvals are being considered and were just approved for a relatively narrow swath of more vulnerable individuals that accounts for about 3% of the US population. Not for the general public as the vaccines are still felt to be highly effective as we can see in real world situations. So, that narrow swath is about 3% of people who include individuals with immunosuppressive medications, who are on transplant medications, are on chronic corticosteroids, have cancer or auto-immune diseases that predispose their immune system.
Host: So, those are the people that should get the booster?
Dr. Munoz: Absolutely. And then the other people that we need to consider is that people over 65, people with multiple comorbidities, heart disease, diabetics, obesity, chronic asthma. This might also be another group of people who have these multiple comorbidities and at an increased risk that depending on their general health would be considered to be added to the vulnerable group that I mentioned previously.
That includes cancer patients initially, but now has widened to include the immunosuppressed individuals who are on specific medications, the transplant rejection regimens, such as CellCept, Prograf, tacrolimus, steroids, more than 10 milligrams. And in rheumatology, medications such as Rituxan, CellCept, and other advanced biologic medications. It is a bit complicated. It requires medical opinion and people should ask their physicians and their specialty care physicians who manage either their transplant medications or the rheumatologist or hematologist oncologist when it's a cancer patient. Or in the case of other co-morbidities, individuals should speak to their cardiologist or pulmonary specialists that are relevant to their daily care.
Host: Right. And let's talk about COVID-19 blood antibody testing. Should we be monitoring this? Should we rely on these results to determine if a booster is needed? Would that help when we're talking about boosters?
Dr. Munoz: That's another great question, Bill. I'm so glad you asked that because I must hear this question four or five times a day, both from patients and even physicians. There's a lot of confusion about what the antibody blood tests tell us and what they don't. I can summarize this by saying that following blood antibody levels to determine if somebody needs a booster, is flawed. The science to determine if someone who has been fully vaccinated, meaning they've received two doses of either Pfizer or Moderna, or one dose of J and J, two weeks after the second shot or three to four weeks after their J and J, that individual is considered fully vaccinated. Doing blood tests, antibody tests to measure spike proteins, COVID antibodies does not reflect whether someone is actually protected or fully immunized or not. The reason is, is that more than antibody levels are involved in protecting us via the immune system, which is very complex and which includes other types of cells in the immune system, such as T cells to protect us from viruses, including COVID.
This is not determined, measured, or evaluated by the simple blood antibody COVID test. Therefore making conclusions based on the COVID antibody test, whether it's positive or negative, gives us flawed data as to determining whether someone is protected or not from previous vaccination and should not be used in a sequential monitoring fashion.
Host: All right. Well, that makes sense. And then for someone who has been infected with COVID-19, what are the recommendations for vaccination?
Dr. Munoz: For those individuals Bill that have had COVID, we recommend that the vaccination can be given three months after the wild type infection has occurred. So 90 days is enough time to do that.
Host: So, for someone infected with COVID-19, the guidelines are wait three months and then get vaccinated.
Dr. Munoz: Correct.
Host: Okay. And how about COVID-19 vaccines during pregnancy? Yes. No, I know there's a lot of questions about that as well.
Dr. Munoz: Short answer. Yes. But again, shared informed decision making, but the American Obstetrics and Gynecology Society has given the thumbs up for pregnant individuals to go ahead and get vaccinated.
Host: Good news. And then what about supplements? We're still in the middle of this with the Delta surge. This is still very important. What supplements do you recommend to combat COVID-19?
Dr. Munoz: So I recommend zinc, vitamin D, in adequate amounts to keep one's level between 50 and 70 nanograms per ML in the blood. So, that could be five to 10,000 units a day, depending on your body size or requirement. I recommend vitamin C, one to two grams of sustained release daily NAC and reservatrol. All of these have antiviral benefits effects on both innate and adaptive immunity and are recommended to be taken at this time.
Host: So, these supplements will help bolster your immune system against COVID_19?
Dr. Munoz: Absolutely.
Host: Got it. So, when it comes to what we're dealing with right now, which is the Delta variant, and it is surging across the United States, what's the bottom line on this Dr. Munoz?
Dr. Munoz: The bottom line is wear our masks, get vaccinated. Consult your physician. Be smart. Don't go too super congested closed in areas. Do things outside. Continue to exercise, continue to eat right. Take your supplements and let's follow the science and the guidelines as they happen.
Host: Follow the science and the guidelines as they happen. Always good advice. And thank you for your knowledge and information, Dr. Munoz. It's always very helpful. Thank you again.
Dr. Munoz: Thank you so much Bill.
Host: And this is the Oasis Rheumatology podcast featuring Dr. George Munoz. For more information, just call 305-682-8471. Or you can visit the Oasisinstitute.com. Thanks for listening.
Bill Klaproth (Host): Welcome to Oasis Rheumatainment, a podcast with Dr. George Munoz, Chief Medical Officer, and Founder of both the Arthritis and Osteoporosis Research Institute, the Arthritis and Rheumatology Association Care Center and the Oasis Institute, a fully integrative multidisciplinary clinic in Aventura, Florida. I'm Bill Klaproth.
And on this episode, Dr. Munoz gives us an update on COVID-19 vaccines, boosters, and masks. Dr. Munoz, it's always great to talk with you. Thank you so much for your time. We appreciate it. And we're looking forward to your update on COVID 19. So, can you give us your overview of where we are at in the US primarily with COVID-19 since you last updated us?
George Munoz, MD (Guest): Hello, Bill. And absolutely. So, this is a very broad topic. And today, as of August 18th, 2021, since we last updated approximately six weeks ago, we seem to be at new cases at about 130,000 each day that are almost double last summer's peak levels. As far as hospitalizations, we've reached the highest levels since the winter. Parts of the south, including here in south Florida have actually shattered case records of Delta variants, overwhelming resources for intensive care units. Locally, I can tell you here in Southeast Florida, we are at about 98 to 103% of capacity for ICU beds. In spite of all that, vaccination rates are still lagging. Only about half of Americans are fully vaccinated.
And since the Delta surge began, daily vaccinations have really not kept up with the number of new cases of COVID. So, approximately 700,000 doses a day are being dispensed at this time. So, the bottom line is, that the US has recorded about 36.7 million Corona cases. And unfortunately we've had at this point, approximately 621,000 deaths since the pandemic began. While most people do recover from mild to moderate COVID in a few weeks, we're also experiencing at this point, a new perplexing set of symptoms that is being called long COVID that can include brain fog, fatigue, muscle pain, just to name a few of the symptoms that can last anywhere from weeks to months after the actual infection has ended.
So the update is, is that we now have long COVID as part of the medical model, that physicians and multi-specialty is internal medicine, family practitioners and specialists are seeing, and it looks like, we've got somewhere between 10 to 30% of adults who catch the virus may experience long COVID symptoms. So, that's where we're at right now as a high level overview of where we stand and we have some specifics to discuss.
Host: Yeah. We're not in a good spot right now. And when you tell us those statistics, that really emphasizes how we're not doing very good with this and some parts of the country are really struggling with this. And another thing that we in America are struggling with is, mask usage. Some are okay with it and understand the value of a mask. Some are refusing to wear masks because they feel it interferes with their freedoms. What is your medical opinion on mask use at this time during this Delta surge?
George Munoz, MD (Guest): So, I think the important thing that you just emphasized Bill is what's my medical opinion because that's really what should be focused on, in my humble opinion, both as a physician, as a healthcare provider, as an observer of what's happening, both locally and in our country. All politics aside, it's clear that a few things are quite evident.
Number one, we are in a surge again with the Delta variant. The uptick in cases, hospitalizations, ICU beds requirement, and deaths really tell us that we need to be smart and being smart means using masks. The masks are effective, nothing is a hundred percent. The masks do mitigate, reduce the risk and significantly alter, the infectivity rate even of this Delta in comparison to not using masks and being aerosolized contaminated with droplets that are usually airborne. And so it really is very, very smart to continue to use masks in closed settings, indoors, in gatherings, for which there should be very few. But in terms of scenarios like school openings, and other events that are happening, the mask really becomes an essential part of prevention.
Host: Right. It's a science has proven that masks do help control the spread of COVID-19. And as you said, follow the science, which I agree with. So, there was a recent study out of Israel and the New England Journal of Medicine on the effectiveness of vaccines with the Delta versus the Lambda variants. Can you give us a briefing on those findings?
Dr. Munoz: Sure Bill and the reason this study is even out here is because of the current Delta surge, which is global. And this study came out in the New England Journal, as you said in July 21st of this year. And really it was a study looking at a specific time period between January and late April of 2021.
And it was among health workers, approximately just shy of 1500 health workers in Israel for which 39 infections were detected, based on screening for high risk contacts post-exposure and then doing contact tracing. And what was interesting was that in Israel, everyone's been vaccinated, primarily with the Pfizer vaccine.
The point of this study was to get a handle on what are the percentages of breakthrough infections in a fully vaccinated real-world population, so that we can have an extrapolation for the rest of the world what might be expected as to how the vaccines are operating, their effectiveness and whether they lose effect over time.
Those are really questions that are being asked at this time. And based on the results of this study 2.6% of the infections in fully vaccinated individuals were detected meaning that 97.4% of vaccinated people did not get infected. The vaccines work very well. They work over 95% of the time.
At the time of the study, 85% of the COVID variants were Alpha at that time. Delta was not yet, in place. So, we know what it looks like for the Alpha variant. Now we are in a different time zone. Now we've got Delta primarily in North America and in a lot of places in the world, but not exclusively.
So, what they used was a rapid antigen and the PCR testing. What they found was they didn't have needs for ventilation and there were no deaths in those breakthrough infections. At that time, the feeling was the vaccines work. Breakthroughs can happen at a very small percentage. And that was pre-Delta.
Host: I think what you said there is very important and the fact that over 90% of the people that are currently hospitalized are people that are not vaccinated. That just proves again, that vaccines work.
Dr. Munoz: Absolutely.
Host: That That really illustrates that point, but a lot of people don't want to get vaccines for many reasons. One of them is side effects. So, can you comment on vaccine side effects, such as myocarditis? I know there have been reports of this, especially in younger people. So, who gets this and, and what is the prognosis?
Dr. Munoz: That's another great question. And these questions and topics seem to develop a life of their own Bill, both in the media and social media word to word and community. So, it's important that we address them. And it's important that people get clear answers as to what's statistics look like. So that informed decision-making can be made by individuals and with their physician. So, in terms of myocarditis, I can tell you that it looks like this is primarily a side effect of young males in very small percentages. The prognosis, thank goodness is quite good. This seems to be in general, a self-limiting event, meaning that it rarely has long-term consequences. Now, what is myocarditis? Myocarditis is inflammation of the heart muscle. We typically see myocarditis not related to vaccines, but rather to viral infections such as Coxsackie virus, but that's not the only virus that can cause myocarditis. Typically myocarditis when it's caused by a wild type virus could be mild or it can be severe and lead to permanent problems with the heart muscle.
But this is not what is typically being seen with the vaccine related myocarditis. The vaccine related myocarditis seems to be again, primarily males, short-term symptoms, very small percentages and with a very good long-term prognosis.
Host: Well, that's good to hear and it's good to get the real facts on that. So, we're talking about boosters now in the United States. So, on the topic of boosters, where do we stand on this right now?
Dr. Munoz: The topic of boosters is a very fluid situation, Bill. It seems to be changing weekly, if not daily. And part of this is science. And part of this is, in my opinion, related to political pressure of the said government empowered to try and get ahead of what appears to be a global surge specifically with Delta. Where we stand right now is, is that the FDA, is currently pending an actual final approval for the vaccines, the Pfizer and the Moderna vaccines and J and J in the United States.
So, we have to remember that these vaccines have been deployed under emergency authorization use, not the usual FDA approval process that is typical for drugs to be approved and then used, in the United States populace. We're still pending the approval. The approval we think is imminent, talking weeks, two to four weeks.
And that both the Pfizer Biontech and the Moderna and J and J vaccines are all pending. Booster FDA approvals are being considered and were just approved for a relatively narrow swath of more vulnerable individuals that accounts for about 3% of the US population. Not for the general public as the vaccines are still felt to be highly effective as we can see in real world situations. So, that narrow swath is about 3% of people who include individuals with immunosuppressive medications, who are on transplant medications, are on chronic corticosteroids, have cancer or auto-immune diseases that predispose their immune system.
Host: So, those are the people that should get the booster?
Dr. Munoz: Absolutely. And then the other people that we need to consider is that people over 65, people with multiple comorbidities, heart disease, diabetics, obesity, chronic asthma. This might also be another group of people who have these multiple comorbidities and at an increased risk that depending on their general health would be considered to be added to the vulnerable group that I mentioned previously.
That includes cancer patients initially, but now has widened to include the immunosuppressed individuals who are on specific medications, the transplant rejection regimens, such as CellCept, Prograf, tacrolimus, steroids, more than 10 milligrams. And in rheumatology, medications such as Rituxan, CellCept, and other advanced biologic medications. It is a bit complicated. It requires medical opinion and people should ask their physicians and their specialty care physicians who manage either their transplant medications or the rheumatologist or hematologist oncologist when it's a cancer patient. Or in the case of other co-morbidities, individuals should speak to their cardiologist or pulmonary specialists that are relevant to their daily care.
Host: Right. And let's talk about COVID-19 blood antibody testing. Should we be monitoring this? Should we rely on these results to determine if a booster is needed? Would that help when we're talking about boosters?
Dr. Munoz: That's another great question, Bill. I'm so glad you asked that because I must hear this question four or five times a day, both from patients and even physicians. There's a lot of confusion about what the antibody blood tests tell us and what they don't. I can summarize this by saying that following blood antibody levels to determine if somebody needs a booster, is flawed. The science to determine if someone who has been fully vaccinated, meaning they've received two doses of either Pfizer or Moderna, or one dose of J and J, two weeks after the second shot or three to four weeks after their J and J, that individual is considered fully vaccinated. Doing blood tests, antibody tests to measure spike proteins, COVID antibodies does not reflect whether someone is actually protected or fully immunized or not. The reason is, is that more than antibody levels are involved in protecting us via the immune system, which is very complex and which includes other types of cells in the immune system, such as T cells to protect us from viruses, including COVID.
This is not determined, measured, or evaluated by the simple blood antibody COVID test. Therefore making conclusions based on the COVID antibody test, whether it's positive or negative, gives us flawed data as to determining whether someone is protected or not from previous vaccination and should not be used in a sequential monitoring fashion.
Host: All right. Well, that makes sense. And then for someone who has been infected with COVID-19, what are the recommendations for vaccination?
Dr. Munoz: For those individuals Bill that have had COVID, we recommend that the vaccination can be given three months after the wild type infection has occurred. So 90 days is enough time to do that.
Host: So, for someone infected with COVID-19, the guidelines are wait three months and then get vaccinated.
Dr. Munoz: Correct.
Host: Okay. And how about COVID-19 vaccines during pregnancy? Yes. No, I know there's a lot of questions about that as well.
Dr. Munoz: Short answer. Yes. But again, shared informed decision making, but the American Obstetrics and Gynecology Society has given the thumbs up for pregnant individuals to go ahead and get vaccinated.
Host: Good news. And then what about supplements? We're still in the middle of this with the Delta surge. This is still very important. What supplements do you recommend to combat COVID-19?
Dr. Munoz: So I recommend zinc, vitamin D, in adequate amounts to keep one's level between 50 and 70 nanograms per ML in the blood. So, that could be five to 10,000 units a day, depending on your body size or requirement. I recommend vitamin C, one to two grams of sustained release daily NAC and reservatrol. All of these have antiviral benefits effects on both innate and adaptive immunity and are recommended to be taken at this time.
Host: So, these supplements will help bolster your immune system against COVID_19?
Dr. Munoz: Absolutely.
Host: Got it. So, when it comes to what we're dealing with right now, which is the Delta variant, and it is surging across the United States, what's the bottom line on this Dr. Munoz?
Dr. Munoz: The bottom line is wear our masks, get vaccinated. Consult your physician. Be smart. Don't go too super congested closed in areas. Do things outside. Continue to exercise, continue to eat right. Take your supplements and let's follow the science and the guidelines as they happen.
Host: Follow the science and the guidelines as they happen. Always good advice. And thank you for your knowledge and information, Dr. Munoz. It's always very helpful. Thank you again.
Dr. Munoz: Thank you so much Bill.
Host: And this is the Oasis Rheumatology podcast featuring Dr. George Munoz. For more information, just call 305-682-8471. Or you can visit the Oasisinstitute.com. Thanks for listening.