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WE TREAT LONG COVID

Our top priority is making sure our patients, our staff, and our community remain safe, especially during extraordinary times.

As with any communicable disease, our clinic has strong infection control policies. Our staff has been screening and triaging over the phone for potential acute infectious diseases prior to coming into the clinic. Our healthcare providers are exercising judgment with further recommendations.

We will continue to recommend all patients bring their own masks as our supply for the staff is limited. Please wear your mask during the duration of your office visit. Additionally, we will continue additional triage questions at check in and may perform spot temperature checks before continuing with scheduled in-office appointments. We have also been temperature screening our office staff, clinic team, and all healthcare providers along with episodic COVID-19 surveillance screening to ensure that we may continue to safely and appropriately care for our patients.

We understand that high risk patients, including the elderly, smokers, chronic lung disease, heart disease, autoimmune disease, diabetics, and cancer patients may feel uncomfortable coming into the clinic for routine follow up visits at this time. Although we prefer to care for you in the office, we can schedule a TELE-MEDICINE visit with your healthcare provider to further evaluate you over the phone and review any diagnostic testing results and proceed with treatment plans. We will bill your insurance based on the level of care.

Testing for Coronavirus (COVID-19) is not currently conducted at our clinic. If you have new onset of fever, cough, and/or shortness of breath and/or meet other Center for Disease Control) CDC criteria for testing, we recommend obtaining readily available COVID-19 testing or initial evaluation with your primary care doctor or local urgent care. You may also call your local state health department or Arizona Poison Control for further triage and recommendations. If you have severe respiratory symptoms, you should call 911 and proceed to your local emergency department.

For more up-to date information on COVID-19 and criteria for testing, please visit your local state health department website or CDC.gov website.

Thank you for your understanding!

Dr. Stephen N. Finberg, FCCP

Friends and Family COVID-19 Update August 24, 2022

Dr. Stephen N. Finberg, FCCP

You have probably noticed that our country has put COVID-19 behind us, few are wearing masks at the airports, planes, markets and celebrations are in full swing! "Part of the new normal." COVID reinfections are here to stay.

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians; American College of Allergy and Immunology; Society of Critical Care Medicine; Mayo Clinic; National Jewish Health, John Hopkins and other scientific articles and other colleagues.

Stephen N. Finberg D.O. FCCP

Pulmonary/Sleep

Allergy/Immunology

Desert Center for Allergy and Chest Diseases

IN THIS UPDATE

  • COVID 19-WHERE ARE WE AND WHERE ARE WE GOING-COMMENTARY
  • THE VACCINE-HESITANT MOMENT-PHYSICIANS ARE KEY
  • LONG COVID (PASC-POST-ACUTE SEQUELA OF SARS-CoV-2)
  • REBOUND WITH PAXLOVID

COVID-19 data from John Hopkins University

(since the last time I emailed you)

Vaccinations: Fully Vaccinated, 223 Million or 67.3% have received two doses.

Apr. 27, 2022 Apr. 24, 2022
DAILY CASES Approx. 54,447 77,091 +
TOTAL US CASES 81,100,599 + 95,734,084 +
DAILY DEATHS Approx. 305 369
TOTAL US DEATHS 991,940 + 1,067,549

COVID 19 COMMENTARY

WHERE ARE WE AND WHERE ARE WE GOING

BA.5 is now the dominant US variant accounting for more than 80 % of our countries Covid cases and BA.4 makes up 17 % (per CDC). Europe and South Africa offer a preview of what comes next. By the end of June, new weekly cases were up 32 % in Southwest Asia, 33 % in Europe, and 47 % in Africa. As of June 19, BA.5. accounted for 43 % and BA.4 12 % worldwide. These variants pose the biggest threat to immune protection. They are about three times less sensitive to neutralizing antibodies than previous variants. Cases are up, hospitalizations are up, but deaths have not increased as dramatically.

Multiple studies underscore the importance of booster vaccinations against emerging variants including BA. 4/5. Booster vaccination provided sufficient neutralizing -antibodies titers. (NEJM 386;26, June 30, 2022) It is recent infections or boosters that have reduced the death rate.

‘Part of the new normal’: COVID reinfections are here to stay. In 2022, we are recording reinfections and break through infections. U.K. researchers have found that the risk of reinfection was eight times higher during the Omicron wave than in last year’s Delta wave. There is now some evidence that multiple reinfections may lead to long COVID. COVID reinfection may have a silver lining- one that may help tame the pandemic. COVID variants may evade antibody immunity but have to deal with the other half of the immune system T cells. When antibodies fail to stop the virus from getting into our cells, there is a robust T cell response in the cell for at least 15 months. These T cells may be partially responsible for the mild infection following fully boosted Patients. A bivalent vaccine targeting the original Corona Virus and the new BA.4/5 variants hopefully will be available in the near future. Staying up to date with the vaccinations and boosters has decreased the transmissibility and has limited hospitalizations and deaths from COVID 19.

THE VACCINE-HESITANT MOMENT

PHYSICIANS ARE KEY

In 2019, WHO named vaccine hesitancy as one of the top 10 threats to global health. Vaccine hesitancy has been defined as an attitude or a state of indecision and uncertainty that precedes a decision to become (or not become) vaccinated. The period of hesitancy and indecision is a time of vulnerability, as well as opportunity. Volatility around vaccine hesitancy, often coincide with new information, new policies, or newly reported vaccine risk is often powered by digital media platforms.

Timing is everything regarding both the personal moment and the historical moment when it comes to making a decision about vaccination. The uncertainty and constantly evolving nature of the Covid 19 pandemic and response measures, the rapid introduction of new vaccines, emerging variants, and the volatility of the surrounding politics and polarization have all contributed to the public questioning and the trends in vaccine hesitancy.(1-3) vaccine hesitancy can be triggered by anxiety about the administration of the vaccines, including fear of needles, or by concern about possible side effects, vaccine ingredients which preserve or adjutants that boost the effectiveness of the vaccines.

"The Internet represents a greater potential for the public to make an informed decisions about vaccination "(4)" Many people search online for health information, and the information found impacts patient decision-making; it is therefore essential to understand what is shared online… The anti- vaccination movement has taken advantage of this milieu to disseminate its messages " (5) The role of social media in fueling the spread of vaccine hesitancy and its increasingly documented health consequences cannot be overstated; vaccine hesitancy has escalated over the past decade to new levels in the context of the Covid 19 pandemic.

Keeping vaccine conversations open and ongoing will be important in order to identify and address emerging concepts early. The Welcome Global Monitor noted in higher income countries 90 % of respondents trusted doctors or nurses more than others.(6)

A recent article in the NEJM (7) discusses physician spreading misinformation on social media. With the growing allegiance to crowd endorsed "facts" poses a serious challenge for the institutions and structures developed to protect the public. The structures include comprehensive medical education, licensure and board certification. The object is to help ensure that physicians are practicing evidenced-based medicine supported by the latest peer reviewed research, with a goal of protecting patient well-being and safety. The Federation of state medical boards has noted that board certified physician's provide outstanding care and guidance; providing misinformation about a lethal disease is unethical, unprofessional and dangerous.

With over 1 million Americans dead from Covid –some of them clearly preventable–continuing at a rate of more than 200,000 per year, vaccine acceptance can increase, but healthcare providers need to offer support and encouragement and listen to what matters from the patient's perspective. Physicians don't always have the right answers, but some answers are clearly wrong.

1. E clinical medicine 2021; 40:101113.

2. S Afr Med J 2021; 111:702–3.

3. Nature 2020; 582::230–3

4. Arch Dis Child 2002; 87: 22–5

5. Vaccine 2012; 30:3778–89

6. Welcome global monitor 2018

7. NEJM 387; 1

LONG COVID

(PASC: POST-ACUTE SEQUELA OF SARS-CoV-2)

PASC (Long COVID) is marked by persistent COVID symptoms 30 days or more after a person tests positive for COVID. PASC also can emerge with new COVID-related symptoms weeks or months of the initial infection have gone away. The American College of Cardiology has estimated 10-30 % of people who have had COVID may experience PASC. PASC strikes about two to three times more women than men, and people who are over the age of 50 are more vulnerable. A study in March 3, 2022, Cell found that several factors at the time of the initial COVID diagnosis causing PASC were diabetes and reactivation of Epstein- Barr virus. Asthma and obesity also may play a role. The severity of COVID and hospitalization were 9 times more likely to get PACS.

PASC symptoms more often reported were fatigue, shortness of breath, problems with taste and smell, cough, headache, brain fog, anxiety, depression and chest pain. Even patients who never had symptoms with their COVID infection may develop PASC.

In the September 2021 issue of Annals of Internal Medicine, researchers followed 410 patients after they were diagnosed with COVID and found 39 % had lingering symptoms seven to nine months later. A study in the March 22, 2022 Nature that people with mild PASC suffered tissue damage and shrinkage in brain areas related to smell, decision making and memory. A study published on March 15, 2022 by Radiology looked at 100 patients with PASC and found 58 % had lung abnormalities, most often consistent with inflammation or scarring.

Observational finding in my practice have seen significant Pulmonary manifestations, cough, dyspnea and chest discomfort many months after a mild case of COVID and I have seen patients with multiple infections with COVID having symptoms of long COVID.

People who are vaccinated can develop PASC, however fully vaccinated people seem to have a 50% lower average risk of developing PACS than unvaccinated people. Fully vaccinated people also tend to have less serious PASC.

Adam Schwartz
Adam L. Schwartz, MMS, PA-C

There are two FDA EUA outpatient oral anti-viral Covid 19 treatments available for patients greater than 65 and high-risk individuals. The studies for use of these 5-day oral antiviral treatments demonstrated reduction in severity of disease, hospitalizations and death up to 89% for these groups of individuals if treatment is initiated within 5 days of symptom onset. The leading oral medication is Paxlovid and although still considered a rare phenomenon, there has been increased reporting of “Covid 19 rebound” after completing the 5-day course of Paxlovid. This often can happen within 2-10 days after completing the 5-day course of treatment which may include recurrent upper respiratory symptoms, headaches, fatigue and fogginess. Repeat COVID 19 testing sometimes can be negative and then turn positive. The Paxlovid studies for EUA use did report 1-2% rebound symptoms could develop.

The Covid 19 rebound phenomenon typically has not resulted in severe disease requiring hospitalization. Researchers are continuing to investigate this phenomenon and there have been many theories of why this may be happening. Most recently, researchers have found that symptom relapse was not caused by the development of resistance to the drug or impaired immunity against the virus. Rather, a Covid 19 rebound may be a result of insufficient exposure to the drug or not enough of the drug was getting to infected cells to stop all viral replication suggesting this may be due to the drug being metabolized more quickly in some individuals or that the drug needs to be delivered over a longer treatment duration.

Although a recent report of Dr. Fauci contracting COVID 19 with mild symptoms improving after a 5-day course of Paxlovid and subsequently having rebound symptoms days later initiated a second 5-day course of Paxlovid, the CDC does not recommend a prolonged or repeat course of the anti-viral therapy. CDC currently recommends providers advise their patients with Covid 19 rebound symptoms to re-isolate for at least 5 days along with additional precautions such as masking and can end their re-isolation if fever has dissipated for 24 hours and symptoms are improving. Patients should also consider wearing a mask for a total of 10 days after rebound symptoms started. Further research on this rebound phenomenon is on-going.

Adam Schwartz PA-C

Desert Center for Allergy and Chest Diseases

If you have not seen this PSA, please view it and pass it forward and/or post to a social media site that you use.

Youtube Facebook Instagram

Dr. Stephen N. Finberg, FCCP

Friends and Family COVID-19 Update January 27, 2022

Dr. Stephen N. Finberg, FCCP

My apologies, it has come to my attention that although I have been sending updates for about two years, the email address that I have been using under trainpop@aol.com may be going to your spam or junk mail.

I will be using Stephenfinberg@desertcenter.org to send future updates.

I have resent my previous update from Jan. 27 using Stephenfinberg@desertcenter.org to avoid spam problems.

I always welcome your comments.

I felt compelled to send another COVID UPDATE because I am getting so many calls from Friends and Family as they are either exposed or have the OMICRON variant of Covid-19. I am either caring for or consulting with Patients from Massachusetts to California.

Last year, some people knew of others that had COVID, but this year practically everyone knows of someone who has been infected.

In the present environment, if you have a sudden onset of nasal congestion and fatigue- cold or allergies- get tested, you have Omicron.

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians, American College of Allergy and Immunology, Society of Critical Care Medicine, Mayo Clinic, National Jewish Health, other scientific articles and other colleagues.

Mask Up - N95 or KN95 are the most effective.

Be well. Stay safe,

Stephen N. Finberg D.O. FCCP

IN THIS UPDATE

  • COVID FATIGUE – WE ALL HAVE IT
  • A DOSE OF REALITY
  • BOOSTER HESITANCY
  • LOOKING AHEAD

COVID-19 data from John Hopkins University

(since the last time I emailed you)

Vaccinations: 240.4 Million or 64% have received two doses.

Dec. 15, 2021 Jan. 24, 2022
DAILY CASES Approx. 116,892 1,029,906 +
TOTAL US CASES 50,200,000 72,200,000
DAILY DEATHS Approx. 1,739 2,181
TOTAL DEATHS 800,000 + 891,000 +

COVID FATIGUE - WE ALL HAVE IT

It has been nearly two years and mostly everyone has had enough. There is still over 30% of the US population that has no intention of getting vaccinated and even a number of those who have been hospitalized in the past don’t think they need it. There is no cure for COVID-19, but with time there will be enough monoclonal antibodies and oral meds to prevent more hospitalizations and deaths even in those at highest risk for infection. Therefore it is in our and our family’s best interest to do everything we can to prevent the transmission of the disease to not only our loved ones but inadvertently to others. Full vaccination with the BOOSTER is still our best therapy with documented minimal hospitalizations and deaths.

A DOSE OF REALITY

A healthy child or adult contracting COVID-19 with OMICRON is likely to have a mild case and return to work or school in 5-10 days. Some of these people will have moderate disease and require an Emergency room visit and possible hospitalization. The ones with booster vaccination are significantly less like to require hospitalization or death.

Here is the reality check. I have been in contact with the Mayo Clinic, Honor Health and Abrazo. They all have the same problems that the country has: less Physicians, Nurses and ancillary workers available. They do not have an ample supply of the new monoclonal antibody (sotrovimab) against Omicron and they have a limited supply of the new oral medications (Paxiovid and Ritonavir). Some of my Patients have waited over 6 hours at these facilities and were turned away without a COVID test. There are simply not enough tests at these hospitals and they are for the Patients who are admitted. In other words, you may not receive the optimal treatment as it may not be available. It turns out the state decides how much medication is given to each facility.

I am seeing more LONG COVID in unvaccinated or not fully boosted Patients. They first have mild disease and then it doesn’t clear up. We do not have enough data on the long-term effects of the disease, but over the last two years, I am caring for more long Covid Patients with more chronic respiratory symptoms. Get your booster!

BOOSTER HESITANCY

Study after study has documented the efficacy of a booster dose as being protective against hospitalization or death. The CDC guidelines recommend a booster 5 months after the second Moderna vaccination (Pfizer or Moderna) or 2 months after the J&J. If you have COVID-19, you can get a booster shot as soon as the time limit has been reached and your isolation is over.

There is no down side to getting the booster!

A DOSE OF REALITY

A healthy child or adult contracting COVID-19 with OMICRON is likely to have a mild case and return to work or school in 5-10 days. Some of these people will have moderate disease and require an Emergency room visit and possible hospitalization. The ones with booster vaccination are significantly less like to require hospitalization or death.

Here is the reality check. I have been in contact with the Mayo Clinic, Honor Health and Abrazo. They all have the same problems that the country has: less Physicians, Nurses and ancillary workers available. They do not have an ample supply of the new monoclonal antibody (sotrovimab) against Omicron and they have a limited supply of the new oral medications (Paxiovid and Ritonavir). Some of my Patients have waited over 6 hours at these facilities and were turned away without a COVID test. There are simply not enough tests at these hospitals and they are for the Patients who are admitted. In other words, you may not receive the optimal treatment as it may not be available. It turns out the state decides how much medication is given to each facility.

I am seeing more LONG COVID in unvaccinated or not fully boosted Patients. They first have mild disease and then it doesn’t clear up. We do not have enough data on the long-term effects of the disease, but over the last two years, I am caring for more long Covid Patients with more chronic respiratory symptoms. Get your booster!

LOOKING AHEAD

In one of my past Covid Updates, DELTA VARIANT FOLLOWED BY THE NEXT ONE (July 6, 2021), I noted that in a Pandemic the more replications the greater the risk of variants and hence Omicron or BA.1.

Omicron BA.2 has now been identified in Denmark, India and Britain and there are at least three cases identified in the US. Although this appears to be more difficult to identify on a PCR test, more data is needed to determine the severity. The BA.2 has also been called the “Stealth Omicron” because it has genetic traits that make it more difficult to identify on a PCR test.

Vaccinate, America

If you have not seen this PSA, please view it and pass it forward and/or post to a social media site that you use.

S Finberg

Friends and Family COVID-19 Update December 15, 2021

Dr. Stephen N. Finberg, FCCP

THE PANDEMIC IS ALMOST OVER

GET READY FOR THE COVID ENDEMIC-COMMENTARY

Everyone is tired of the Pandemic and especially the politics and government regulations associated with it. Sometimes we forget that this was a global infection and once enough people on our planet either get immunized or get infected, (or die off) the Pandemic will be over. With the increase in world-wide vaccination of all people, my feeling is that will be relatively soon.

That being said, that will leave an ENDEMIC infection (like the flu). People will then have a choice to Mask Up, Isolate, or get a Vaccination. They will be able to choose to infect their families, fellow citizens or protect others. We will continue to have many variants as the COVID-19 will continue to be prevalent throughout the world and continue to mutate. Of course, we will have better vaccines and medications to treat the infections, but it will take its toll on the higher risk people throughout the world. It will also continue to have a tremendous effect on health care workers, who are under a great deal of stress treating so many very sick patients.

I grew up in an age, where if you were sick, mom took us to the family doctor with respect and confidence. If we were given antibiotics or other medications, we trusted our family physician. I honestly have no idea how that changed in March 2020.

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians; American College of Allergy and Immunology, Society of Critical Care Medicine, Mayo Clinic, National Jewish Health, other scientific articles and other colleagues.

Your many positive comments are greatly appreciated. There are no shortage of relevant topics. Thank you for passing it on to others.

Be well. Stay safe,

Stephen N. Finberg D.O. FCCP

IN THIS UPDATE

  • C DELTA VARIANT FOLLOWED BY THE NEXT ONE (July 6, 2021) HERE IS THE NEXT ONE-OMICRON B.1.1.529
  • CASE STUDY-LUNG BIOPSY OF LONG COVID – Phillip Menashe, MD
  • CHILDREN AND COVID VACCINES – Adam Schwartz PA-C
  • ASTHMA RISK FACTOR FOR SEVERE COVID OR NOT? Sanjay Patel, D.O.

COVID-19 data from John Hopkins University

(since the last time I emailed you)

Vaccinations: 240.4 Million or 64% have received two doses.

Sept. 22, 2021 Dec. 1, 2021 Dec. 15, 2021
DAILY CASES Approx. 129,771 109,000 116,892
TOTAL US CASES 42,420,384 48,692,483 50,200,000
DAILY DEATH Approx. 2,363 1,555 1,739
TOTAL DEATHS 678,584 782,100 800,000+

DELTA VARIANT FOLLOWED BY THE NEXT ONE (July 6, 2021)

HERE IS THE NEXT ONE- OMICRON B.1.1.529

Omicron was discovered in Africa on November 22, 2021 and the WHO has labeled Omicron a “variant of concern”, This has a unique constellation of more than 30 mutations to the spike protein, the component of the virus that binds to cells. This is significantly more than those of the delta variant. Many of these mutations are linked to increased antibody resistance, which may affect how the virus behaves with regard to vaccines, treatments and transmissibility, health officials have said.

A DOSE OF REALITY

Omicron contains around 50 mutations in total. The receptor binding domain, the part of the virus that first makes contact with cells, has 10 mutations, far greater than just two for the delta Covid variant, which spread rapidly earlier this year to become the dominant strain worldwide. It is already in over 20 countries and although not reported in the US (as of my writing on 12/1/21), it is here. (12/15/21- It is in 35 states)

Here is the reality check. I have been in contact with the Mayo Clinic, Honor Health and Abrazo. They all have the same problems that the country has: less Physicians, Nurses and ancillary workers available. They do not have an ample supply of the new monoclonal antibody (sotrovimab) against Omicron and they have a limited supply of the new oral medications (Paxiovid and Ritonavir). Some of my Patients have waited over 6 hours at these facilities and were turned away without a COVID test. There are simply not enough tests at these hospitals and they are for the Patients who are admitted. In other words, you may not receive the optimal treatment as it may not be available. It turns out the state decides how much medication is given to each facility.

A COMMON THREAD

Last week, just days before scientists discovered the Omicron variant, South Africa’s government asked Johnson & Johnson and Pfizer not to make some planned deliveries of their Covid-19 vaccines. The country already had more doses in storage than it could use — about 16 million, in a country of 60 million people — and officials were worried that further supplies would spoil before they could be used.

Why ? The main answer should be familiar to Americans: vaccine skepticism. There is a fair amount of apathy and hesitancy. The sources of the skepticism are different in the U.S. and in Africa. In much of Africa, they are related to decades of exploitation and poverty. In the U.S., the biggest cause is political polarization.

But both forms of skepticism stem from distrust — of experts, institutions and government leaders. And that distrust has become a major reason that the world is struggling to defeat Covid. The more people that remain unvaccinated, the more the Covid virus spreads and the more people die. Less vaccination also increases the chances that dangerous variants will emerge like possibly Omicron

After scientists in South Africa announced the discovery of Omicron, some commentators in the U.S. jumped to the conclusion that unequal vaccine distribution between rich and poor countries was the cause. But that’s not quite right, as the stories of Africa’s unused vaccines make clear. In the next few weeks, we will know more about Omicron and its effect on fully vaccinated, high risk and unvaccinated patients. I do think one thing is certain, a number of studies have come out that confirm a fully vaccinated (3 shots mRNA or 2 shorts J&J) are going to have a better outcome – protect against hospitalizations and death.

Menashe

Dr. Phillip I. Menashe, FCCP

Although most patients surviving Covid-19 infection and pneumonia rapidly recover, a small subset have persistent dyspnea, cough and abnormal chest imaging with hypoxemia. This group has been shown to have persistent organizing pneumonia when histopathology from lung biopsy is examined. Although there are numerous reports showing a clinical response to subsequent corticosteroid therapy there are no well-designed studies that confirm benefit.

Early into the pandemic I performed biopsy in just such a patient and confirmed organizing pneumonia. I did treat this patient with oral prednisone and over the next six months symptoms and reticular and nodular pulmonary opacities on thoracic imaging gradually resolved. My overall impression was that while there may have been some early benefit from steroids, ultimately time proved to be the best “therapy”. Since that time, I have generally taken a very conservative approach if the patient demonstrates continued improvement and resolution even if protracted. On a few occasions I have noted new or developing infiltrates associated with new or changing symptoms. In those cases, I have perused additional testing such as CTA to rule out venous thromboembolism and invasive evaluation with bronchoscopy to diagnose superimposed bacterial or fungal pneumonias in patients at risk. To date I have seen at least one patient who may be going on to persistent or progressive fibrosis and this of course presents a more challenging diagnostic and therapeutic clinical conundrum. In cases where subsequent histopathologic evaluation of lung tissue is desirable, the preferred approach has yet to be determined. In addition to flexible bronchoscopy with transbronchial bronchoscopy, newer approaches with Robotic-Assisted bronchoscopy which I have recently been doing at HH Shea may allow more accurate localization and sampling of abnormal lung tissue resulting from prior infection.

As the pandemic continues to evolve so does our understanding of post-infectious lung disease. Many of these patients are quite debilitated and benefit from physical therapy, nutritional support, healthy and active lifestyle and a positive outlook that odds favor that with time they will regain full function

Dr. Phillip Menashe is the only Pulmonary Physician performing Robotic-Assisted Bronchoscopy At Honor Health.

Adam Schwartz

Adam L. Schwartz, MMS, PA-C

Excerpts from American Academy of Pediatrics, CDC, WHO, and other reputable sources of studie.

COVID-19 is not a benign disease in children. It has had a significant impact on children’s health as outlined below:

  • Nearly 6.3 million children have been infected with COVID-19 since the pandemic’s onset.
  • More than 22,400 children have been hospitalized.
  • At least 605 children aged 18 and younger have died. 
  • Patients with SARS-CoV-2 infection had 16-18 times higher risk for myocarditis compared with patients without SARS-CoV-2

Risk of myocarditis, pericarditis and anaphylaxis in individuals following SARS-CoV-2 (COVID-19) infection was 6-34 times higher compared to those who received mRNA vaccine.

Recent studies show that around 2% of children experience Post-Acute Sequelae of COVID-19 and symptoms that persist beyond 56 days.

Compared with 2019, the proportion of mental health related visits to the emergency room for children aged 5–11 and 12–17 years increased approximately 24% and 31%, respectively.

Between April 1, 2020, through June 30, 2021, over 140,000 children in the US experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minorities, compared to Non-Hispanic White children. 

Therefore, The AAP (American Academy of Pediatrics) recommends COVID-19 vaccination for all children and adolescents 5 years of age and older who do not have contraindications using a COVID-19 vaccine authorized for use for their age.

Children with prior infection or disease with SARS-CoV-2 should receive COVID-19 vaccination, according to CDC guidelines.

COVID-19 vaccination is a safer way to help build protection.

Children ages 5 years and older and adults who are eligible should get vaccinated regardless of whether they already had COVID-19. Evidence is emerging that people get better protection by being fully vaccinated compared with previously having a COVID-19 infection. Studies have shown that unvaccinated people who already had COVID-19 are more than two times as likely than fully vaccinated people to get COVID-19 again.

Given the importance of routine vaccination and the need for rapid uptake of COVID-19 vaccines, the AAP supports coadministration of routine childhood and adolescent immunizations with COVID-19 vaccinations.

COVID-19 vaccines have undergone and will continue to undergo the most intensive safety monitoring in U.S. history

The benefits of COVID-19 vaccination outweigh the known and potential risks.

Adam L. Schwartz, MMS, PA-C

Board Certified Physician Assistant

Dr Patel

Dr. Sanjay 'Jay' B. Patel

Asthma and COVID-19: How do we prevent severe disease?

As of late November, the CDC continues to warn that “People with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized from COVID-19” [i]. The American Academy of Allergy, Asthma, and Immunology (AAAAI) published a review on their website that references several studies; one study suggested that non-allergic asthma is indeed a risk-factor for severe COVID [ii].

Asthma is a heterogeneous disease and is an “umbrella” diagnosis. That is, defining an individual's “flavor” of asthma (phenotype) is necessary to provide prognosis and individualized treatment options rather than the outdated practice of applying a “one-fits-all” approach. This principle is more important than ever right now during the COVID-19 epidemic and can help guide the best approach based on that individual’s phenotype/endotype. Phenotyping requires ample historical information regarding a patient’s comorbidities and asthma triggers, appropriate bloodwork, and accurate allergy skin testing performed by a board-certified allergist.

I agree with the CDC’s general recommendations for moderate/severe asthmatics to get vaccinated and practice safe infectious control measures (full list on of recommendations can be seen on link provided). Having a printed asthma-action plan can also be a crucial tool for the individual; this is particularly important for schoolchildren as many have returned to the classroom and face obvious exposure risks. Performing routine and accurate spirometry and pulmonary-function tests help classify a person’s asthma severity, and as mentioned previously phenotyping patients may help specifically risk-stratify severe COVID risk which is optimally performed by an allergy specialist.

Sanjay “Jay” Patel, D.O.
Board Certified-Allergy/Immunology (Peds/Adult)

Vaccinate, America

If you have not seen this PSA, please view it and pass it forward and/or post to a social media site that you use.

September 22, 2021

PSA VACCINATE, AMERICA VACCINE HESITANCY – IMMUNOLOGICAL APPROACH

(Meet our Allergy/Immunology Physician “ Sanjay”)

IVERMECTIN- CHEAP and EFFECTIVE- NO PROOF

Theresa Pinder PA-C

LONG COVID IN PEDS FLU and PNEUMONIA VACCINES

I very much appreciate the positive feedback on the Public Service Announcement and it is being gradually circulated. We are trying to get it circulated on a National level.

We present VACCINATE, AMERICA

I only ask you to forward it to at least ten people and/or post to a social media site that you use.

(FACEBOOK, TWITTER OR OTHERS)

Please do your part.

Here’s the YouTube link: Youtube

Here’s the Facebook Link: Facebook

Here’s the Instagram Link: Instagram

Stephen N. Finberg DO FCCP

Pulmonary/ Critical Care

Allergy/Immunology

7/6/2021 9/22/2021
DAILY CASES Approx. 3,697 129,771
TOTAL US CASES 33,570,000 42,420,384
DAILY CASES Approx. 33 2,363
TOTAL DEATHS 605,526 782,100

Total Vaccinations (at least one shot) 181 Million or 70%!! 169,592,873 Million or 51.1% have received two doses.

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians; American College of Allergy and Immunology; Society of Critical Care Medicine; Mayo Clinic; National Jewish Health, other scientific articles and other colleagues.

VACCINE HESITANCY – IMMUNOLOGICAL APPROACH

Dr. Sanjay "Jay" Patel

Allergy/Immunology (Peds/Adult)

Many of us in the Allergy/Immunology field have focused our efforts to vaccinate America not only on encouraging patients to get vaccinated, but also by seeking to understand the risks factors involved in allergic reactions to the COVID vaccines currently on the market. Although new research and studies continue to be published., an article from the Journal of Allergy and Clinical Immunology (JACI) in Practice (Banerji et al…) does justice in summarizing the evidence to date of COVID vaccine allergy risks and recommendations for vaccinating based on this data.

In brief, here are some key points taken from the article:

  1. Excipients (ex PEG, Polysorbate) in the vaccines are the likely culprit antigens triggering Type I reactions (immediate hypersensitivity)
  2. Because Type I Hypersensitivity to excipients is extremely rare, the overall risk for any individual, in general, is also rare. See rates below.
  3. There are 3 tiers when risk stratifying an individual to determine whether any precautions should be taken when obtaining the vaccine.

Low Risk:
  • No history of anaphylaxis or severe systemic reaction.

  • Obtain vaccine as usual.

Moderate Risk:
  • History of anaphylaxis of any cause, or systemic reaction to a food, drug, or flying insect.

  • Obtain vaccine as usual but should stay for 30 minutes after vaccine instead of 15 minutes.

High Risk:
  • History of severe immediate systemic reaction specifically to PEG, Polysorbate, or to a vaccine containing those excipients.

  • Needs further risk stratification including possibly allergy skin testing to the excipients to further clarify risk.

Here are the estimated reporting rates for anaphylaxis for each vaccine in the US :

  • Pfizer-BioNTech: 11.1 cases per million doses
  • Moderna: 2.5 cases per million doses
  • J&J: Not officially reported
  • Vaccines in general: 1.31 in 1 million doses
  • Motor vehicle accidents are responsible for the deaths about 90 people every day

We now have excipient skin testing available to further risk stratify those patients who fall into a higher risk category that can be performed before administration of a COVID vaccine. Again, this testing applies to a rare subset of patients and more importantly familiarizing ourselves with and implicating the guidance above should help encourage majority of these patients to get vaccinated!

IVERMECTIN- CHEAP and EFFECTIVE ? - NO PROOF

Theresa Pinder, PA-C

Desert Center for Allergy and Chest Diseases

Multiple credible agencies such as the Center for Disease Control (CDC), Food and Drug Administration (FDA), National Institute of Health (NIH), World Health Organization (WHO), American Medical Association (AMA), European Medicines Agency, Infectious Disease Society of America (IDSA), American Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP), and local infectious disease clinicians and hospitals have issued statements against the use of ivermectin for COVID-19 infections due to insufficient evidence. Even the manufacturer of ivermectin, Merck, has warned that its analysis of ivermectin identified “no scientific basis for a potential therapeutic effect against Covid-19 from pre-clinical studies”, “no meaningful evidence for clinical activity or clinical efficacy in patients with Covid-19 disease” and “a concerning lack of safety data” in most studies.

How is ivermectin gaining popularity? One explanation is it’s an inexpensive and readily available drug especially in countries with less access to vaccines. Other therapies such as Dexamethasone, Gilead’s remdesivir and various monoclonal antibody treatments have been granted emergency approval for the treatment of certain hospitalized Covid-19 patients, are less available and more expensive.

The pro-ivermectin push is very strong in South Africa, where coronavirus infection rates are among the worst in the continent combined with poor vaccination coverage for the country’s most vulnerable. Some doctors have been prescribing ivermectin to Covid-19 patients, claiming anecdotally that it alleviates virus symptoms, despite the South African Health Products Regulatory Authority (SAHPRA) warning against its use.

The Philippines’ Food and Drug Administration has faced similar pressure, as the country faces surging Covid-19 cases and a dwindling supply of vaccines. Widespread support for ivermectin in Latin America was largely based on findings in a now-retracted preprint by health analytics company Surgisphere, after its Covid-19 data was found to be largely unreliable. Following the scandal, Peru reversed its inclusion of ivermectin in national coronavirus treatment guidelines, but several other countries in the region continue to recommend it.

Despite the cost and availability, there is little literature supporting ivermectin as a Covid-19 therapy and much more evidence advising against its use. Over the past 6-12 months, several studies have been published showing no benefit or worsening after ivermectin use. Some studies show benefits and resolution of symptoms, reduction in inflammatory markers, shorter time to viral clearance, and lower mortality. However there are concerns with all studies including small sample sizes, various dosing regimens of ivermectin, various concomitant medications including nonapproved options like hydroxychloroquine and azithromycin, and poor study design. Early in vitro studies against the virus showed potential benefit of ivermectin via inhibition of processes used by the virus to enter cells. However the dose as needed to achieve the drug levels necessary to replicate those results in humans would require up to 100 times the typical doses used in ivermectin’s FDA approved use which could lead to toxic and/or fatal consequences. More research on ivermectin is needed to determine its antiviral potential and safety profile with certainty. Until then, people desperate to protect themselves will continue to self-medicate with dangerous quantities of the drug.

Honor Health and Abrazo have both advised not using Ivermectin.

Guideline References

COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Ivermectin. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/. Accessed August 24, 2021.

Why You Should Not Use Ivermectin to Treat or Prevent COVID-19. Available at

https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or- prevent-covid-19. Updated March 5, 2021. Accessed August 24, 2021.

IDSA Guidelines on the Treatment and Management of Patients with COVID-19. Infectious Disease Society of America. Available at https://www.idsociety.org/practice-guideline/covid-19- guideline-treatment-and-management/. Accessed August 24, 2021.

LONG COVID IN PEDS

Like many of you, I have had my concerns relating to vaccination of the Pediatric population due to the lack of long-term data and the fact that the pediatric population was not getting very sick with COVID and had a fast recovery. Things have changed – DELTA-. Children are now getting very sick with COVID and are being hospitalized. A recent study from the Pediatric Emergency Research Network ( PERN) global research consortium, assessed more than 10,500 children who were screened for SARS-CoV -2 when they presented to the ED at 1 of 41 study sites in 10 countries.

This study provides the first good epidemiological data on persistent symptoms among SARS-CoV-2 infected children, regardless of severity.

Children aged 10-17 years were more likely to experience persistent symptoms than children younger than 1 year.

Hospitalized children were more than twice as likely to experience persistent symptoms as nonhospitalized children.

Given the known acute cardiac and neurological effects in any infected child, getting children vaccinated when it is available to them, and taking precautions to prevent unvaccinated children getting COVID is the best way to reduce the risk of severe disease or persistent symptoms.

The recent data that the neutralizing antibodies are decreasing following the vaccination with mRNA Vaccines and the rise in cases and persistent symptoms in children has made me rethink my hesitancy for my own grandchildren receiving the vaccine. LONG COVID is devastating to children and the decrease in Antibodies makes me less concerned of any long-term side effect from the Vaccine.

FLU and PNEUMONIA VACCINES

Please don’t forget about the FLU and PNEUMONIA vaccines. With the surge in Delta and hospitalizations, we really need to prevent the Flu and Pneumonia this year.

Remember Prevnar and then Pneumonvax in 9-12 months.

Adults ages 65+ are at ~2x greater risk for pneumococcal disease compared to healthy adults 50 to 64 years of age.

Pneumococcal disease risks also include:

  • Pneumococcal Pneumonia:

    1 of every 4 patients with pneumococcal pneumonia will develop pneumococcal bacteremia.

  • Pneumococcal Bacteremia:

    Pneumococcal Bacteremia: Can be associated with pneumococcal pneumonia. More than 12,000 cases of pneumococcal bacteremia without pneumonia occur annually.

  • Pneumococcal Meningitis:

    Pneumococci cause over 50% of bacterial meningitis cases in the United States

The CDC recommends a routine vaccination for all appropriate adults ages 65+.

Everyone eligible please get your COVID Vaccine.

Be well

Stay safe,

Stephen

Stephen N. Finberg D.O., FCCP

July 6, 2021

Your appreciation and sediments are very much valued.

My last COVID update was April 5, 2021 and on numerous occasions I started to write the next chapter, but before I could finish the data would change and I was starting over. I hope everyone somewhat remembers my updates from last year noting this is NOVEL virus and a Pandemic.

Being a NOVEL virus means that we are still learning about the virus and how it affects the population of our planet and we are learning about the side effects following infections.

This is a Pandemic and the only way to eradicate this Virus is to treat the entire planet. Giving vaccinations to all the people in America will not contain COVID-19 unless the population of the Earth is included.

DON’T BE TOO LATE. VACCINATE - AMERICA !

I feel strongly that Americans will either get the VACCINE or the VIRUS- it is only a matter of time.

WHY HERD IMMUNITY IS SLIPPING AWAY- A GENERATION OF COVID-19

DELTA VARIANT FOLLOWED BY THE NEXT ONE

MIXING TWO DIFFERENT VACCINES

CHILDREN AND SCHOOL

Stephen N. Finberg D.O. FCCP

Pulmonary/ Critical Care

COVID-19 John Hopkins University

4/5/2021 7/6/2021 8/14/2021
DAILY CASES Approx. 64,001 3,697 141,397
TOTAL US CASES 30,424,000 33,570,000 36,623,835
DAILY CASES Approx. 944 33 691
TOTAL DEATHS 553,000 + 605,526 + 621,199

167.7 M 51%

Total Vaccinations (at least one shot) 172 Million or 67 %!! 156 Million or 47 % have received two doses.

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians; American College of Allergy and Immunology; Society of Critical Care Medicine; Mayo Clinic; National Jewish Health, other scientific articles and other colleagues.

WHY HERD IMMUNITY IS SLIPPING AWAY- A GENERATION OF COVID-19.

The present data demonstrates that less than 70% of the American population has had one Covid -19 vaccination. This is not enough to reach Herd immunity in the US. The present situation is not likely to improve because of Vaccine Hesitancy. We are starting to see the first studies on the duration of immunity.

With no Herd immunity on the horizon either in America or the World, we will continue to have mutations/variants. The variants will continue and our Vaccine will most likely need to be reformulated and we may need a booster shot to continue immunity. With the total Covid numbers declining and continued Vaccine hesitancy, I think it is less likely American’s will get a booster and hence COVID-19 will likely be here for at least a generation.

The variants are directly related to multiplication of the Virus. If we Vaccinate the World, then we will effectively wipe out this Virus.

DELTA VARIANT FOLLOWED BY THE NEXT ONE

The coronavirus is becoming more transmissible. Ever since the virus emerged in China, it has been gaining mutations that help it spread more easily among humans. The Alpha variant

( B.1.1.7 ), first detected in the United Kingdom last year, is 50 percent more transmissible than the original version, and now the Delta variant ( B 1.617.2), first detected in India, is at least 40 percent more transmissible than Alpha.

Efficacy of vaccines. The vaccine rate was 95% but with variance including delta variant is down to 65%. That means a number of patients will have an infection with Covid even though they were vaccinated.

The United Kingdom recorded the most coronavirus cases in 1 day since mid-February driven by the highly transmissible and potentially more resistant delta variant.. The initial research demonstrated that delta variant may be a threat to people with only one vaccine dose.

Editorial in the New England Journal of Medicine July 1, 2021.

It was noted that neutralizing antibody titers were higher in patients who had COVID-19 and vaccination for Covid then in patients who never had COVID-19 and were vaccinated. It's noted even a single dose of vaccine gave an increased humoral response in patients with a history of COVID-19.

There was initial efficacy of SARS- CoV-2 vaccine booster against variants. It appeared a booster given 6–8 months following the primary vaccination had elevated titers following the booster.

TEL AVIV—About half of adults infected in an outbreak of the Delta variant of Covid-19 in Israel were fully inoculated with the Pfizer Inc. vaccine, prompting the government to reimpose an indoor mask requirement and other measures to contain the highly transmissible strain. Preliminary findings by Israeli health officials suggest about 90% of new infections were likely caused by the Delta variant, according to Ran Balicer, who leads an expert advisory panel on Covid-19 for the government. Children under 16, most of whom haven’t been vaccinated, accounted for about half of those infected, he said.

The Delta variant, which first emerged in India in late 2020 and is also known as B.1.617.2, has now been detected in more than 70 countries. In the U.S., it appears to be the dominant strain. Delta has gotten so much attention because it has the most troubling collection of traits yet: It is markedly more transmissible than Alpha, can sicken a large proportion of people who have had only one dose of a vaccine (though not those who have had two), and may even cause more severe disease.

Experts agree that vaccines are the best way to stop Delta. Data from the U.K. suggest that one dose of the Pfizer vaccine offers only 34 percent protection against the variant, while two doses provide 88 percent. Large swaths of the U.S., however, are still struggling to get people to take any doses at all.

It should be noted that there is still a very low rate of patient's being hospitalized or dying from COVID-19 when they have been fully vaccinated.

MIXING TWO DIFFERENT VACCINES

Mixing 2 different vaccine doses may actually strengthen COVID-19 immunity. There have been reports of patients receiving different doses of vaccine study by a group of researchers in Spain found that vaccinating patients with both the Pfizer–bioNTech and Oxford–AstraZeneca vaccines developed a strong immune response against SARS- CoV-2. It is intriguing to note that the body's immune system may actually develop a stronger immune response with a mix and match approach to vaccines than if you simply get 2 doses of the same vaccine.

Being able to use different vaccines for the first and second doses, and potentially for booster doses is important , because it allows for greater flexibility in vaccine schedules, particularly if there are shortages of one type of vaccine. While there is not as much reason to be concerned about mixing vaccines, the same is not true for the millions of Americans who are only getting one shot of vaccines and need to be administered two doses to be complete. It may result in an under-vaccinated population making it is difficult to achieve Herd immunity.

CHILDREN AND SCHOOL

The Pfizer vaccine appears to be safe and effective in 12-year-old and up and the FDA has now approved its vaccine to allow eligibility for children ages 12-15. (5/10/2021) Since the likelihood of severe outcomes or death associated with COVID-19 infections is very low for children, I personally feel we should consider vaccinating younger children after the EUA is lifted and the manufacturing moves for authorization from the FDA. Although children are unlikely to have serious infection, there is the potential for infecting their family members, including grandparents and immunosuppressed relatives as well as reinfecting their parents, even if they have been vaccinated.

JAMA April 2021. Nearly 12% of our children with COVID-19 were hospitalized in 2020 and nearly a third of those had severe disease that required mechanical ventilation or admission to the ICU. A team of Israeli researchers led by Prof. Nadav Davidovitch of Ben-Gurion University, has said that one dose of the Pfizer COVID-19 vaccine provides 100% protection to youth ages 12-15 within three weeks, raising the question of whether the second dose is necessary.

Injecting a single dose could be considered for young teenagers in Israel “both because the second dose adds relatively little, if any, immunogenicity and we know that for some young people there can be complications like myocarditis,”

At this time I feel that before I would recommend vaccinating children younger than 12, I would like to see the EUA ( emergency use authorization) lifted and the vaccine approved by the CDC and FDA.

DON’T BE TOO LATE, VACCINATE- AMERICA !

50.9 % of Arizonians have received one dose.

Be well.

Stay safe,

Stephen N. Finberg D.O. FCCP

COVID-19 John Hopkins University 12/17/2020 1/24/2021
DAILY CASES Approx. 252,400 180,000
TOTAL US CASES 17,200,000 25,188,728
DAILY DEATHS Approx. 3,406 3,060
TOTAL DEATHS 310,935 419,696

In this update on the state of the COVID-19 in the US, I have gathered the latest information from the American College of Chest Physicians, American College of Allergy and Immunology, Society of Critical Care Medicine, Mayo Clinic, National Jewish Health, other scientific articles and other colleagues.

VACCINATION HESITANCY

There are a significant number of people that are hesitant to receive the vaccination for COVID-19. There are many reasons for this and there are plenty of qualified opinions against the vaccine. How does one sort this out? Where do I receive my information?

First let me say, I received both vaccinations and am doing fine. I did have a little bit of sore arm and was tired 48 hours after my second dose. Having any reaction following the dose is a good thing as it reflects that your immune system is working, however no reaction does not mean your individual immune system is not working. Before I received my vaccination, I reviewed the data as published in multiple sources. I did not make my decision based on the media or any news channels.

ANTI-VACCINE = HERD IMMUNITY

There are a number of organizations against vaccines and wearing masks. They point out that there is no real proof the vaccine will work, no need for masks as there are a number of treatments for COVID-19. There is disinformation that Hydroxychloroquine is effective in preventing COVID-19 as noted in Africa.

We need 70-80 % of our population to receive the vaccination to reach herd immunity, meaning enough of our population is not likely to get sick from the disease. Everyone is aware that there are now variants of COVID-19 evolving all over the world. All viruses have variants, which are expected and still are responsive to vaccines.

The United States represents 4% of the world population and we have over 25,000,000 cases and over 400,000 deaths or 25% of the cases and deaths. If we allow natural herd immunity, then with a population over 350,000,000, we may have near 4,500,000 deaths! One of the problems besides 4.5 million deaths is the time it will take to reach herd immunity and the real possibility that the virus will have the time to mutate and hence we are back to square one and need to establish herd immunity again.

Hydroxychloroquine (HCQ) was initially touted as a cure, but then multiple ‘double-blind’ studies disproved the effectiveness of HCQ. One of the well-known facts leading to disinformation is the fact that the median age of the US population is 37.7 years and the median age in Africa is only 18.9. In other word HCQ or not, that young African population will have less cases that are sick or get tested. (I refer you to my update of 8/16/20- see below)

8/16/2020 UPDATE HYDROXYCHLOROQUINE (HCQ) - follow the science This drug has continued to be in the news and our Patients are confused trying to figure out if they have had contact with a COVID positive person, should they start prophylaxis with HCQ. A randomized, double -blind, placebo-controlled trial after high-risk or moderate-risk exposure did not prevent illness with COVID-19.

This is from the NEJM, August 6, 2020. ( New England Journal of Medicine- this is the most prestigious Medical Journal in the world. Every article that is published is peer reviewed extensively. It was done in a way to certify results and avoid any bias.)

WHEN DO I GET MY SECOND SHOT?

Presently, there are two mRNA vaccines available. The second dose of the Pfizer vaccine should be three weeks from the first vaccination. This is based on the data that gives about a 95 % efficacy as the result of both vaccines given 3 weeks apart.

The Moderna vaccine should be given 28 days following the first per the data from the study. Increasing the days between doses may decrease the overall efficacy.

Presently the US has vaccinated 5 per 100 people.

Israel leads with 38 per 100 people. (mainly because they have a socialized system of healthcare)

IF I GET MY VACCINATION, CAN I GET COVID-19?

Yes, you may still contract COVID-19, but would be mild or asymptomatic. You also may carry the virus and give the disease to someone else.

IF I HAVE HAD COVID, DO I NEED THE VACCINATION?

Having COVID-19 might offer some natural protection or immunity from reinfection with the virus that causes COVID-19, but it's not clear how long this protection lasts. Because reinfection is possible and COVID-19 can cause severe medical complications, it's recommended that people who have already had COVID-19 get a COVID-19 vaccine. If you’ve had COVID-19, wait until 90 days after your diagnosis to get a COVID-19 vaccine.

RISKS VS. BENEFITS

The risks of not getting your vaccination could be devastating. I am presently caring for Patients with COVID in the office, hospital as well as post- COVID patients. This is a very aggressive disease. There is probably nothing worse than not be able to catch your breath. Many of my patients are having post-COVID symptoms long after they were diagnosed with COVID. This includes, shortness of breath, cough, muscle weakness, fatigue, brain fog, clotting (deep vein thrombosis and pulmonary emboli) arrhythmias, sleep difficulties, anxiety, depression and loss of taste and smell.

DAYLIGHT MAY BE NEAR- ISRAEL

TEL AVIV—Early data from Israel suggests Covid-19 infection rates began to decrease among a group of vaccine recipients two weeks after they received the first shot of Pfizer Inc. and BioNTech SE ’s vaccine, offering important insights to other countries as they roll out their own campaigns.

The small country—whose roughly nine million population is about the size of New York City’s—has vaccinated nearly a fourth of its population in just under a month, the first country to hit that mark as it fights an upsurge in new infections.

Israel’s largest health-care provider, Clalit Health Services, compared test positivity rates among 200,000 people over 60 who received the vaccine with 200,000 that didn’t. Until day 14, there was little difference between the two groups. But after that, the data showed a 33% fall in infection rates among those who had already been vaccinated compared with those who hadn’t.

The US has vaccinated 5 per 100 people; Israel 38 per 100 people. Part of the reason is thought to be due to its socialized medical system with everyone covered.

I personally recommend signing up for the vaccine as soon as it is available to you. We need to reach herd immunity as soon as possible to avoid more variants, protect our population and return to normalcy.

MASK UP AMERICA, GET YOUR VACCINATION, social distance and wash your hands

Be well.

Stay safe,

Stephen N. Finberg D.O. FCCP & Desert Center Staff

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