Monday, January 11, 2021

A Broader Conversation About Vaccines - Part #3

2019 Novel Coronavirus (CoVID-19): Part XIX
2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:

January 7, 2021 update Part 19 (Vaccines - Part #3)
Paul Herscu ND, MPH
Herscu Laboratory 

 

Hello and good day to you and yours. 

 

This COVID-19 Update #19 is the companion piece to COVID-19 updates #17 & #18, and forthcoming updates #20 and #21 all of which focus on vaccines. I focus here on the role organizational and educational institutions have to change the course of this pandemic as related to vaccines.

 

The next update will focus on vaccine reactions. Lastly, I will write about what you, your loved ones and patients/clients can do to help prevent side effects from the vaccine if taken and to mitigate side effects that may arise. 

 

POTENTIAL FAILURE and CONTINUED NEED FOR A PLAN B

We know that the conventional medicine community has more money than integrative or naturopathic doctor communities do, and therefore more influence. Which means, if looking at only that medical model, there will be more and more vaccines for both prevention and treatment. The vaccines for SARS-CoV-2 are only the most current ones we are hearing, reading and thinking about. And because of all the controversy, anxiety, depression, and just bad time we have all had, this vaccine has garnered more controversy than others. 

 

I have spent the last year describing workable simple options, numerous options really, and also the direction we were going, and that, if unchanged, we would end up with this this vaccine option as Plan A and only Plan A. I will not repeat myself here. The last two updates, this one, and the next two focus on the vaccine issue itself. We are stuck in the pro/con vaccine false dichotomy which has become even more entrenched. A very complex discussion is minimized to soundbites which does a great disservice to all. In these treacherous waters, many individuals and organizations decide to sit out the debate, put their heads down and remain ambiguous. I think this, too, misses the opportunity to help science move forward to help more people. This update is aimed at organizations, trying to give more support to positions they might be able to take today, as a way to build a solid middle, a way to break through the rhetoric, to get to a closer approximation of what really happens. 

 

Let me start with an illustration of a problem from the past, to illustrate why vaccine makers and government officials would do well to engage with naturopathic and integrative physicians soon and more closely.

In 1998, FDA approved a Lyme Disease vaccine LYMErix, with protein antigens from Borrelia burgdorferi. The vaccine rollout failed miserably. It was unclear if the vaccine protected you and how long protection would last. Additionally, you would have had to take multiple doses. Some patients felt they became chronically ill post-vaccine. No one wanted to take the vaccine and it was discontinued. A complete rollout failure.

I believe the COVID-19 vaccine rollout may also fail. It has to do with what was tested, as I mentioned in the previous update. Most of us think of vaccines as a one and done effort or a series and then done. For example, when many of us received the polio vaccine, we had one series and were done. What was measured was how likely are were to become sick and/or how likely are we were to pass the bug to someone else. That is NOT what tested in the initial COVID vaccine trials. The main endpoint tested was how many people became SEVERELY SICK with the virus in the vaccinated group versus the placebo group. But they only measured SICKNESS if you were symptomatic. In other words, they did not test everyone to see if they were getting sick, potentially transmitting the virus, but who may have developed only mild symptoms or those who remained asymptomatic entirely.

Wednesday, January 6, 2021

A Broader Conversation About Vaccines - Part #2

 

2019 Novel Coronavirus (CoVID-19): Part XVIII
2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:

January 2, 2021 update Part 18 (Vaccines - Part #2)
Paul Herscu ND, MPH
Herscu Laboratory

 

A Broader Conversation About Vaccines

 

This Covid Update #18 is a companion piece to #17, and forthcoming updates #19, #20, and #21. The topic of vaccination is a difficult one, with a great deal of information and misinformation circulating. There is tremendous emotion, anxiety, fear and anger surrounding the topic of vaccines. The opinions here, are for your consideration. Make up your personal choice in consultation with your health care provider. But to help inform your choice, it is useful to have information. In this post, I briefly touch on some of the science for those interested in understanding vaccines in a broader context, and in learning about the different vaccine forms and how they relate to COVID-1 vaccines.

 

In the next update, I focus on the role organizational and educational institutions have in changing the course of this pandemic. What is the big ask we want from those in the position to effect change and how to shift the discussion and the focus of our efforts so they lead to better outcomes.

 

Update #20 will discuss the framework to understand vaccine reactions.

 

Lastly, I will take up the important topic of what you and your loved ones and your patients/clients might do to potentially prevent or mitigate side-effects from the vaccine if taken. I have broken this large topic up, as there is a lot to share from several angles!

 

This piece is about vaccines and how to think/talk about the topic in general, from the conceptual model, away from the operational specifics.

 

I am writing to those that actually believe we are in trouble here. (I had an interesting moment where Amy and I were presenting a talk for a professional organization last month and a physician there said something like, is this whole thing real? I have not seen anyone with this disease yet. I said, yes, very real. What I did not say was that right before our presentation, I had a patient who was waiting for a room in the hospital because the whole hospital was full, the ICU was full, the ED was full, and the hospital was setting up makeshift oxygen tents in peoples’ cars, just to keep them alive until someone either got better or died and there was room in the hospital.) So, I am writing for you. Dealing with the reality and tragedy upon us. 

 

At this point, for many, the discussion hovers at the for or against vaccinations point. Vaccinations are good or vaccinations are bad. My goal is to permanently change this discourse so that it fits a bit closer to reality and offers you, your family, and your patients a clearer way to think about vaccines. This discussion is the same one I have given in 1990, in 2000, in 2010, and now here, again in 2020. I hope, at some point this discussion can become more mainstream to move the actual conversation to where it belongs, mirroring reality, predicting outcomes, lessening harm. 

 

Let’s get started.

Wednesday, December 30, 2020

Get the First Series of Shots! (Conversation About Vaccines - Part #1)


2019 Novel Coronavirus (CoVID-19): Part XVII
2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:

December 29, 2020 update Part 17  (Vaccines - Part #1)
Paul Herscu ND, MPH
Herscu Laboratory

Get the First Series of Shots! 

I receive numerous emails and telephone calls daily, from colleagues, family members, other physicians, policymakers and schools, from across the globe, asking me what my personal position is around the topic of COVID-19 and SARSCoV-2 vaccinations. With this update, I intend to answer these questions in broad and specific ways. I would like to describe the variables to consider, so we all have a fuller, nuanced understanding to contextualize this point of view. At the end, I hope you will see why and how I believe that vaccine in this very instance, at this specific time is important for everyone to have. In the future, I hope we develop better solutions, since this one is imperfect at best, but for the first cycle for the first year, a vaccine is the best way forward. I will keep this short, and mostly touch on a few of the most important variables. Please consider reading this post in its entirety.

Amy says I lost a decade of my life this year. As this virus began early this year, most of you know the tireless work we embarked upon, and then when the virus came into full swing, we wound up working with, well, countless patients with this virus. The work is nonstop. Initially, most of the work was trying to change the course of where we were going. But that was not to be. Here, I want to describe how that intersects with the current question of vaccinating for SARS-CoV-2, why we worked so broadly and tirelessly then to create a different path forward.

Often, people want a quick answer. And when I give them the quick answer, they seem disappointed, or confused, or are left feeling surprised and unsure. One very important group is integrative medicine providers (NDs, DCs, acupuncturists, DOs, and integrative MDs etc.) Many are looking for their role at this time in regard to the topic of vaccination. Please consider this discussion in the most general way. What I mean is that the issues mentioned here are universal to every epidemic/pandemic. Please don't simply apply this understanding to the current pandemic, but consider these basic tenets that ring true regardless of epidemic or pandemic illness. In other words, learn these issues once, and you will be able to apply this at any other time in the future. This framework is universal with regard to understanding epidemics and pandemics. 

That said, the topic of vaccinations in general has been polarized in our society, and in the midst of this pandemic, that polarization is evident and growing. Within this polarized landscape we are finding up to 50% of adults considering not seeking the vaccine, a public health disaster by any definition.

Wednesday, October 28, 2020

Air purification from September, 2020 –April, 2021: Germs and Smoke

Germs and Smoke

October 28, 2020 update Part 16

Paul Herscu ND, MPH

Herscu Laboratory

Air purification from September, 2020 –April, 2021: Germs and Smoke

 

This is a follow-up to the post on this topic from September, but an urgent one for two reasons. First, there are fires raging in the west of the United States leading to smoke entering homes irritating the respiratory tract of many people. And as importantly we are in the midst of a second wave of viral activity which has not come close yet to peaking. I am not focusing here on mounting virus activity or on changing morbidity/mortality rates, but suffice to say, the second wave has arrived, on schedule, as we predicted earlier this year.

 

The overall topic of this post is mitigation. Sometimes we find ourselves in situations where the water we drink, the food we eat, or the air we take in is less than optimal and if possible we need to mitigate or modify our exposures so the possibly harmful impacts are minimized. I would like to focus on air quality today and how both smoke and viruses impact air quality.

 

Over the past many decades, I have been impressed by public health infrastructure and work accomplished in the USA and abroad developing processes that help many people and communities, those with means and those without. It is impressive to examine the ability for governments to intersect with NGOs and stakeholders in an ever-evolving partnership to offer health and safety quickly and efficiently. 

 

And there are areas where we could do better and occasionally there are quick, easy, inexpensive do-it-yourself solutions for a challenging issue.

 

I describe here one such idea, born from current need: an economical, home-made, Box Fan - Air Filter System.

Tuesday, September 22, 2020

Fire and Smoke

Fire and Smoke

September 21, 2020 update Part 15

Paul Herscu ND, MPH

Herscu Laboratory

 

I have, over the past many decades, been incredibly impressed by the public health infrastructure and work accomplished in the USA and abroad. In general, developing processes that help the many, those with means and those without means equally. And in general, it is impressive to examine the ability for governments to intersect with NGOs and stakeholders in an ever-evolving partnership to offer health and safety quickly and efficiently. 

 

That said there are at times gaps in this process. And often those gaps fall in what for lack of a better term I might fit within the ‘here is a quick and easy and inexpensive do-it-yourself solution’ for whatever the issue at hand might be. 

 

I bring this up as I received an email from a patient in California describing how bad the smoke is from the fires burning all around her city. And even though she does not go outside, it is in the apartment, and is irritating her eyes, nose and throat. She has tried several solutions in her space but the problem persists. And also, since she lives in a garden apartment, it costs too much to develop a central air solution for the owner, and even if he would want to, everyone who can do that work is already too busy and would be placed on a waiting list. But the problem exists right now. What to do? 

 

I would like to describe a very simple solution that almost everyone could do and afford. I think there may be a few public health authorities that might mention this but in fact this has not been generalized and most people do not know this. So, if you do know someone in that area pass this along. 

Thursday, September 3, 2020

2019 Novel Coronavirus (CoVID-19): Part XIV

 

2019 Novel Coronavirus (CoVID-19): Part XIV 

2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:

 

September 3, 2020 update Part 14

Paul Herscu ND, MPH

Herscu Laboratory


This is the fourteenth piece of writing on the current epidemic. Please read Part 1Part 2Part 3Part 4Part 5Part 6 Part 7Part 8Part 9 Part 10Part 11, Part 12, and Part 13 for context and also, please read my other writing on this site for a larger context on the overall topic of public health and epidemics.


One element at a time: Induction, or where should they focus

 

Back during the SARS epidemic, and then the Ebolavirus epidemic, I spoke a great deal on the topic of public health modeling. Specifically, and you can hear this on tapes of the day, I mentioned that, medically speaking, we are in the new era of germs. Every few months or years there will be a new germ discovered that is lethal to human or animals or crops. And that basically, as a species, we need to develop a better way to think about germs. Instead of thinking of germs as deadly and how they need to be eradicated, a better way may be to learn to adapt towards them and encourage the bug to adapt to become less virulent. But the bottom line is that we will discover more germs, the science is there for that capacity. And if we are not thinking of it in the right way, we are going to go insane worrying about all the germs constantly surrounding us. Enough said here for now.

 

One of the main points I made is that everyone, every single person, from about middle school onward, is able to greatly understand the underlying issues if you can present them with the science of epidemiology, of public health. More or less, everyone arrives at the same position then, and can make informed decisions. The problem is that these basic public health concepts are not taught to most of us. Many of you have attended lectures where I have presented the basics in a few hours talk. What I want to do here, now, is review that material, one important piece at a time. Yes, they apply to this particular epidemic, but if you understand the basic concept it will help you into the future and with any potential epidemic. Let’s start.

Tuesday, September 1, 2020

2019 Novel Coronavirus (CoVID-19): Part XIII

2019 Novel Coronavirus (CoVID-19): Part XIII 

2019 Novel Coronavirus (2019-nCoV (first named); COVID-2019 (later named disease); SARS-CoV-2 (final name of the virus causing COVID-2019), COVID-2019 Pandemic:


September 1, 2020 update Part 13

Paul Herscu ND, MPH

Herscu Laboratory


This is the thirteenth piece of writing on the current epidemic. Please read Part 1Part 2Part 3Part 4Part 5Part 6 Part 7Part 8Part 9 Part 10Part 11, and Part 12 for context and also, please read my other writing on this site for a larger context on the overall topic of public health and epidemics.


 Eight months!

 

It has been, as one might count for the USA, roughly 8 months since SARS-CoV-2 virus causing COVID-19 has struck the world, and as I mentioned in the first of these blogs in January, February, and March, that it was probably earlier, but that is another story for another time! I wanted to catch us up to where we are, within the context of the past, as a way to help us gauge where we are going. As usual, I think understanding the underlying issues should make us be less lost when hearing or reading the bombarding news. I have conducted dozens of interviews, webinars, conferences on this topic, but since it has been a while writing here, please indulge me going into each of these matters, in brief. It should help! I will delve into them in the next updates, which will be posted soon. 

 

The Virus 

There are many things one could say. The main points I want to highlight are:

1.     The first point I made when this began is that we have to think of this virus as different than other viruses we have experienced. This is not one that is going to come and go by itself, rather, it is the ‘birth’ of a new virus that is going to be with us, with ups and downs, but be with our species for the time being. And the point I made is that for many of us, except for those dealing with AIDS) we have not really experienced this concept of a new disease as an epidemic. We really have not. 

2.     As discussed early on, while the virus mutates, like all viruses, the part that is most lethal to humans seems, unfortunately to date, resistant to change. 

3.     With these two points in mind, I urged us to consider that this is not something that we can wait out and it will not just go away but rather, we need to be proactive. There are essentially a few essential levers to pull here, as described earlier: 

a.     Vaccinations to make people either not catch the virus or not have it be so problematic (This is being worked on intensively)

b.    Develop nondrug therapies to make people either not catch the virus or not have severe symptomatology.

c.     Change the virus to make it less problematic (To my knowledge this is not being worked on. If it is, the likely place would be at military facilities)

d.     Wait until it evolves or we evolve, a coevolution so that it is less problematic to us (This does not seem practical)

e.     Develop drug therapies that can treat the unwell person (This is being worked on intensively)

f.      Develop nondrug therapies that can treat the unwell person

 

The main point here is that it is an unavoidable problem we have to come to decisions on how to address. This really has not changed. I know this had gotten politicized, early on, and it seems as though people are digging their heels in, as to how they would think about this virus. But the reality on the ground is still the same. I will come back to B and F above below. Onward.