Consulo Indicium - 12/29/21

Information for your Consideration…

A Part Of Build Back Better – The Biden-proposed legislative initiative – Build Back Better, H.R. 5376 – included the Child Tax Credit which was intend to lift half of all children in the USA out of poverty. This is an important component of the overall legislative effort. Putting aside all of the other elements of the proposal, the Child Tax Credit is a very worthy piece of legislation that we should not allow to die for lack of one vote. It is important to note that a child born in a household among the bottom 20% of the USA household income distribution only has a 7.5% chance of reaching the top 20% in today’s environment. In fact, the social mobility of the American populace is one of the lowest in the developed world. I raise the issue because my family was in fact a part of the lowest segment in American society back in the 1950s when we lost the farm to drought, grasshoppers and in the third consecutive year of bad luck – a hailstorm. Despite that situation, we were able to raise ourselves up and move on. The same elements are not in play in American society today. We really need to address the issue of whether or not we want to be the land of opportunity or as Ronald Reagan said, “…that shining light on the hill…” We are not on course to accomplish that objective! It’s time to put aside partisan politics and move this piece of legislation forward – for the good of the country…

Viral Data Points – Amidst the misinformation that is commonly disbursed on the “F-Channels” (Facebook, Fox & Friends, etc.), there are any number of studies that are now coming out with solid information on the Covid-19 viral pandemic. Here are a few snippets of real data done by real scientists to throw into your conversations:

  • Two Israeli studies have now estimated the risk of myocarditis after an mRNA vaccination at 4/100,000 for males and 0.23 – 0.46/100,000 for females (October, NEJM). That means rare!!
  • Kaiser Permanente reported a much lower rate of 5.8/1,000,000 after the second dose of the mRNA vaccine (October, JAMA Internal Medicine).
  • Young males in their teens and 20s are at highest risk of the myocarditis side effect.
  • Anaphylaxis occurs at 0.025 – 0.047/10,000 vaccine doses (US Centers for Disease Control and Prevention) although a study in Massachusetts saw rates as high as 2.47/10,000 (March, JAMA)
  • Even if individuals had anaphylaxis on the first shot, if the second shot was given in smaller increments, the individuals were able to be vaccinated (June, Science News Online).
  • The rare thrombosis with thrombocytopenia syndrome (TTS) primarily occurs with women younger than 50 who received either the Johnson & Johnson vaccine or a similar vaccine distributed by AstraZeneca (April, Science News Online) with about 5+/1,000,000 cases per million doses.
  • Coronavirus spreads mainly through fine aerosol particles that “hang in the air” for hours, especially in indoor, poorly ventilated settings. In fact, 85% of the COVID-19 RNA detected in an infected patient’s breath was found in fine aerosol particles 5 micrometers or smaller according to reports in Clinical Infectious Diseases (August 6, 2021). The aerosol spread occurs with coughing, sneezing, talking, singing, shouting and even, quiet breathing.
  • Masking MAKES A DIFFERENCE along with social distancing. So, please do it!!
  • BUT, it’s equally clear that VACCINATION IS THE DEFINITIVE TOOL FOR CONTROLLING THE SPREAD OF COVID-19 so to reach herd immunity, the health care community needs to encourage as many people as possible to get the vaccine!!!
  • The use of mRNA vaccines is on the cusp of some very exciting diminution of diseases that have become endemic in the human diaspora such as Zika, HIV, influenza, cytomegalovirus – so, keep your eye on the literature for even more viral dispositions in the coming year(s).

Distilled Advice – The Omicron Rush – There is obviously a lot of information flying around the country on various media related to the Omicron surge. Rather than jump into the mix, I thought there were a few pertinent points to consider as you make decisions on how you, your family, along close friends and associates should manage. Consider these points:

  • For the period of December 4 through December 18, the Omicron virus went from 0.7% of COVID cases (12/4) to 12.6% of cases (12/11) to 72.3% of cases (12/18) which means that by Christmas, the “new” variant probably represented >95% of cases…the reports have not come through as of this writing.
  • The CDC issued a statement that the symptoms of flu, COVID and other respiratory illnesses are often quite similar and that testing is needed to confirm a diagnosis. Furthermore, while we are seeing a surge in Omicron variant COVID cases, we are concurrently seeing a rise in the incidence of the usual winter flu according to the Centers for Disease Control and Prevention (CDC). A careful review of symptoms; however, show that they are slightly different:
    • For COVID-19, the top five reported symptoms are a runny nose, a headache, fatigue, sneezing and a sore throat – with some individuals also presenting with chills and shaking, shortness of breath and loss of taste or smell. Still others also present with onset of diarrhea.
    • For the common cold symptoms usually include a sore throat, a runny nose, coughing, sneezing and head and body aches.
    • The differences are often subtle yet consistent in presentation.

COVID-19 Vaccine On The Horizon? – On December 21st, it was announced that the Walter Reed Army Institute of Research is expected to release information soon on their efforts to develop a vaccine effective against COVID-19 and all its variants. The work is the result of over two years of intensive work by the Institute’s scientists. The only difficulty is that the research is still at the bench state where the vaccine is being tested in the lab against clinical human trial samples. In essence, the "neutralization assays" determine if the antibodies produced from the vaccine are able to inhibit the growth of the virus. Regardless, this is good news.

Follow The Pandemic – If you are so inclined you can actually follow all of the data points on the evolving pandemic by checking in on Regular updates are provided on the status of the pandemic worldwide. It’s one of those sites for us nerds…

On A More Mellow Note – I picked up the December, 2021 issue of American Family Physician last week (the journal for the American Academy of Family Physicians) which provides “generalist” type information for those of us who serve as Family Physicians. On page 598, I came across an article that not only turned my head but also made me realize that – in fact – “the times they are a changin’”. The article? “Cannabis Essentials: Tools for Clinical Practice”. Now, to put this in perspective, you need to appreciate that in 1973 when I was admitted to medical school at the University of North Dakota, using, holding, accessing cannabis products (ranging from “weed” to “brownies”) was a felony that could send you to prison. Furthermore, a felony conviction precluded one from consideration for entry to medical school. As a pre-med student, I assiduously avoided (“sort of”) parties or events where this type of activity was at play because I really wanted to go to medical school (or, at least my mother thought I should go…). So, what’s the lesson? The times do change but sometimes you have to wait 48 years to see the results…

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