Dennis Bassetti & Associates, MD, PA

01/15/2022

The Omicron variant picked the perfect time to appear and will lead to widespread natural immunity. (If only it would have been the first variant to come out of Wuhan...)

[Citations listed at the end of the article.}

The U.S., indeed, the world, has been suffering through different strains of the Coronavirus, beginning with the Wuhan strain December 31st, 2019, then alpha, beta, gamma, delta and now the omicron strain (1). In the U.S., up to the 10th of January, a total of over 62 million cases and over 840 thousand deaths have occurred (2). Omicron is so contagious that in one day there were over 1.35 million new cases in the U.S. (3). Though I hate the thought of people getting sick, considering the proportion of our population who are resistant to taking any vaccine, I think this might be a good thing. Let me explain.

We know that the delta strain is more than twice as contagious as the alpha strain, which is twice as contagious as the initial Wuhan strain (4). The delta strain causes a more serious infection and has a much higher hospitalization rate and death rate than previous variants (5,6,8). Unfortunately, the increase in mortality and serious illness predominantly hit the unvaccinated. Unvaccinated are 10 to 14 times more likely to be hospitalized and in the 65+ age group are 15 times more likely to die (7). The reasons people refuse vaccines are beyond this paper but can be read in the following references (9,10).

What we all know is that the majority of deaths occur in the unvaccinated and, in spite of this, the unvaccinated are unlikely to change their minds and receive vaccination. So, what are we to do? Omicron has propitiously come along and may well save the day for the majority of us. Here’s why:

Omicron is highly contagious -- two to three times more contagious than the delta variant (11). It is less susceptible to the effects of vaccination, and breakthrough infections are very common (12). It is less severe than delta and other variants (13). Deaths have been reduced by around 80% and ICU admissions have been reduced by similar numbers. Hospital stays have been reduced by 50% (13). It also has a very fast doubling time of between two to three days. This means that if one person gets Omicron, within two months this may have spread to an additional 1,000,000 million individuals (20).

This virus, as in all viruses, needs an animal host to survive. If you have ten people on an isolated island in the middle of the Pacific, once the virus spreads to all inhabitants of that island, the virus dies off and the survivors have natural immunity. If there is a neighboring island with inhabitants with no natural immunity, and if they are visited by someone with the virus, they will get the disease; whereas if the immune folks are visited by someone with the virus there may be an occasional breakthrough infection but it will be less severe and less likely to spread.

This brings me to the herd immunity question. I last reported that we need somewhere between 80% and 90% to have adequate herd immunity. Immunity can occur with vaccination or as a result of a natural infection. Waiting for a natural infection to cause immunity is extremely risky and dangerous, considering we have lost 840,000 people, due to earlier variants of this virus. However, if you have a group of individuals who are refusing vaccination, then by default this group will need to rely on natural immunity for us to reach herd immunity levels. There is a risk to this approach, but if this group of individuals is willing to accept it, then so be it.

Currently about 74% of our population has been vaccinated (15). This equates to around 250 million folks vaccinated. Another 42 million have had the virus and survived (16). Totaling these two numbers yields around 292 million either vaccinated or with some natural immunity, which is around 88% of our total population of around 330 million. A few days ago, our country administered over 895 thousand doses of vaccine (17). [Go to reference 17 to see our historical administration rate.]

I tried to attach two graphs from South Africa because I like the data format, but FB will not allow them to be posted. The point I would have liked to make with them is that Omicron appears to be rapidly tapering off in South Africa (as it is or shortly will be in the U.S.) and, comparatively, it has had a dramatically lower death rate, which is also quickly tapering off.

Extrapolating data from South Africa, in conjunction with all of the above information, leads me to believe that we are rapidly hitting the herd immunity point and that coronavirus cases will dramatically decline. I think that within 30 days or so, a lot of restrictions to movement and other restrictions will be able to be cut back so that we can get back to enjoying life. Hospital admissions, as well as deaths, will also most likely dramatically diminish. Eventually, we may get to an annual Coronavirus death rate similar to the flu of around 50,000 individuals, with the avilability of an annual Coronavirus vaccine injection.

Speaking of vaccines, Pfizer is coming up with an anti-Omicron vaccine by March, and this should also help. This vaccine will also provide us cross-coverage against some other variants (18).

Coronaviruses are here to stay. For about 60 years at least 4 Coronaviruses have been circulating in the U.S., causing common cold symptoms (21). All viruses mutate from varous parts of the world the Coronaviruses have mutated and caused Sars-COV-1, Sars-Cov-2 and MERS. For examle the Wuhan strain has mutated over 12,700 times! (19). Five of these mutations are called “variants of concern,” due to having increased virulence, contagiousness, or both.

It is only a question of time until the next mutation. However, the world has learned from our current pandemic a list of best practices that we should be able to implement a lot more quickly next time.

Take care and stay safe.

1. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/
2. https://www.google.com/search?q=us+covid+cases&rlz=1C1CHBF_enUS899US899&oq=us+covid&aqs=chrome.0.0i131i433i512l4j69i60l3j69i65.1879j0j7&sourceid=chrome&ie=UTF-8
3. https://www.reuters.com/business/healthcare-pharmaceuticals/us-reports-least-11-mln-covid-cases-day-shattering-global-record-2022-01-11/
4. https://www.yalemedicine.org/news/5-things-to-know-delta-variant-covid
5. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html #:~:text=%E2%80%A2%20Some%20data%20suggest%20the,the%20original%20virus%20strains.
6.https://www.cmaj.ca/content/cmaj/early/2021/10/04/cmaj.211248.full.pdf
7.https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/421-010-CasesInNotFullyVaccinated.pdf
8. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00685-X/fulltext
9. https://www.forbes.com/sites/roberthart/2021/09/05/by-the-numbers-whos-refusing-covid-vaccinations-and-why/?sh=548e5f5552ea
10. https://www.vox.com/2021/6/2/22463223/covid-19-vaccine-hesitancy-reasons-why
11. https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1
12. https://coronavirus.health.ny.gov/covid-19-breakthrough-data
13. https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-50-severity-omicron/
14. https://www.sciencedirect.com/science/article/pii/S120197122101256X
15. https://ourworldindata.org/covid-vaccinations
16. https://www.worldometers.info/coronavirus/country/us/
17. https://ourworldindata.org/grapher/daily-covid-19-vaccination-doses?country=~USA
18. https://www.cnbc.com/2022/01/10/covid-vaccine-pfizer-ceo-says-omicron-vaccine-will-be-ready-in-march.html
19. https://srhd.org/news/2021/coronavirus-mutations-and-variants-what-does-it-mean
20. https://www.forbes.com/sites/kimberleespeakman/2021/12/21/omicron-variant-has-doubling-time-of-about-2-to-3-days-fauci-says/?sh=356645004fbd
21.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2595130/pdf/yjbm00155-0028.pdf

04/22/2021

We have the COVID-19 vaccine now. If interested please call to schedule your injection.

04/13/2021

Bassetti Medical Research Inc. is seeking Volunteers for research studies for:

• MAC
• Bronchiectasis
• Active COVID-19 Infection
• Idiopathic Pulmonary Fibrosis or Interstitial Lung Disease

• Free study related medical visits and tests.
• Study participants will be paid for their time.

Call for details: 863-314-8971
Ask for Whitney or Caitlin

Please share this post with your fiends.

03/10/2021

Two interesting topics: Vaccine Breakthrough and First Dose Vaccine Effectiveness

Vaccine Breakthrough is a term used when a person who has been vaccinated against a specific infectious disease comes down with that disease 2 weeks, or more, after being fully vaccinated (fully vaccinated means completing both vaccine doses of a 2-dose vaccine, or the one and only dose of a one-dose vaccine).

Obviously, it takes a while to buildup one’s immunity after vaccination therefore someone getting the viral infection within the first two weeks of being vaccinated wouldn’t be categorized under this definition.

I have been curious as to the incidence of Vaccine Breakthrough and ran across some recent data from the state of Wisconsin, as of March 3rd, and more recently, Oregon that address this issue. I think we can extrapolate this data for use across the entire data from our country and can use it to estimate rates state to state.

As of March 3rd, in Wisconsin, 14 people have been documented to have a new COVID-19 infection after being fully vaccinated. Around the same date some 1.6 million doses had been given and 556,000 people were fully vaccinated.

Using the latter as the denominator, the incidence of a vaccinated patient getting the infection is about 1 in 50,000 patients. This implies profound vaccine effectiveness and bodes well for our collective herd immunity, that I previously projected we will hit by the end of May.

As in the Stanford-Santa Clara study there were a large number of asymptomatic individuals who had the infection that were undetected. It’s very likely that a fair number of individuals may have had asymptomatic Vaccine Breakthrough, and the above low numbers would be much higher.

These 14 patients were mostly healthcare workers who were tested routinely and mostly weren’t having symptoms. This also suggests that though a tiny fraction of vaccinated patients got the disease, their vaccination status protected them from suffering anything more than a minor illness.

February 12th Oregon reported 4 Vaccine Breakthrough cases out of 152,361 fully vaccinated patients. This works out to about 1 in 38,000 patients getting the virus after vaccination. While this is a bit less than what was found in Wisconsin it is still stupendous. These data are new so the final risk rate of getting the disease after vaccination remains to be determined, but still are very encouraging.

If the entire 330 million or so members of the US population were to have been vaccinated prior to this virus hitting US shore a year ago January, assuming for now no issue regarding resistant Coronavirus strains, this means that there would have been a total of around 8,600 cases of COVID-19 with minimal, if any deaths, as opposed to 29.2 million cases with 526,000 deaths.

While this is good news it doesn’t answer the question whether or not vaccination will prevent or limit the spread of disease in cases of breakthrough, but my guess is that it will be shown to diminish both the duration and degree of viral shedding.

Efficacy of the first dose of the Pfizer vaccine

I’ve been interested in the protective effects of a single dose of the Pfizer and Moderna vaccines. Regarding the Pfizer vaccine, immunity gradually increased over the first two weeks and lasted the duration of the study.

Attached is an interesting graph showing the placebo group in blue and the vaccine group in red. Each circle or square indicates the time a specific patient became infected with the COVID-19 virus.

Both lines begin congruent with each other for the first ten days, more or less, indicating the same susceptibility to the virus prior to the development of immunity. They then noticeably diverge after that, becoming easily apparent after around two weeks, indicating the profound effects the vaccine provided the test subjects.

Each arm of study had around 25,000 participants so the study met statistical significance.

Please go the New England Journal of Medicine website article listed below and look at the smaller graphical insert inside the larger one. You’ll notice that there is a miniscule divergence between the graph as early as 3 days. To me this suggests the onset of a tiny amount of immunity beginning at that time.

Take care and stay safe . . .



https://www.nejm.org/doi/full/10.1056/NEJMoa2034577


https://minnesota.cbslocal.com/2021/03/03/mdh-tracking-14-covid-vaccine-breakthrough-cases-all-had-mild-or-no-symptoms/
https://github.com/owid/covid-19-data/blob/master/public/data/vaccinations/us_state_vaccinations.csv

02/27/2021

A Bold Prediction: by mid-August we will be in excellent shape.

As of this morning, in the United States we have had over 28,400,000 known cases of COVID-19 infections and 508,314 COVID-19-related deaths. So far, 70,500,000 vaccine doses have been administered in the United States, according to Bloomberg (please see reference below).

The two vaccines that have accounted for these doses, from Pfizer and Moderna, each require two doses to be fully effective; so it’s impossible at this point to determine the proportion of these 70+ million people who are fully vaccinated, and presumably protected, versus those who have had only one dose and who are partially protected.

Also, Johnson and Johnson’s single dose vaccine was approved today by an FDA advisory committee and is expected to receive FDA emergency use authorization quickly, increasing our vaccine supplies tremendously.

Last week, an average of 1,450,000 vaccine doses per day were administered across the US, and more sites are coming online every day. There is a vaccine finder website listed at the end of this post that will allow you to search by zip code for locations giving out vaccine. Please remember this is a new site and there may be some glitches.

The numbers in the first three paragraphs above are extremely encouraging. Even one dose of a two-dose regimen will provide some defense against the disease, though it will take a few weeks for one’s immunity to ramp up after the first shot.

You may remember from the Stanford/Santa Clara study that I reported on early last year that at that time there were 50-85 undiagnosed, and presumably asymptomatic infections for every person who tested positive in the community (infection to case ratio). For the purpose of speculation and rough calculation let’s assume that, due to increased testing, this number has dramatically gone down to perhaps 2 – 3 unknowns per 1 known case diagnosed. (Compared with the Santa Clara study my numbers are extremely conservative, which should give my hypothesis more validity.)

Using the numbers from the first sentence and a very conservative infection to case ratio of 2:1, a total of 57,844,120 people have been infected with the virus (including deaths, also mentioned above) and 70,500,000 have been vaccinated for a total of 128,344,120 individuals who are now at least somewhat protected from the virus.

Currently, our population is around 328,000,000 and for adequate protection we will need 80% (please see my previous post last year regarding herd immunity and its calculations) either vaccinated or previously infected for herd immunity, meaning we will need 262,400,000 individuals vaccinated or infected. 262 million minus 128 million currently protected (partially or completely depending upon vaccination status) means around 134 million patients will need to be vaccinated (or survive the innate infection).

This is extremely encouraging. Assuming we continue vaccinating close to 1.5 million people per day, we should, dare I say, easily hit the 134 million target by the end of May. By mid-summer, we will be in great shape. There will still be infections and deaths, though deaths should continue to decline, as we obtain more medications in our armamentarium to prevent progression of mild disease to more serious forms.

In a recent, ongoing clinical study, monoclonal antibodies have been shown to provide protection from disease progression; and an independent monitoring committee evaluating the monoclonal antibodies' effectiveness advised the manufacturer to stop enrolling patients into their placebo arm. (This is in one of the links below.) When this happens during a drug study, this is a tremendously good sign.

Many other drugs are currently being worked on to prevent progression, and there may be crossover benefits of these drugs against other diseases yet to appear on the horizon. At my research site we are initiating an outpatient study that is part of the National Institute of Allergy and Infectious Diseases Warp Speed program, evaluating several different drugs to prevent progression of the disease process. We are also involved in another Warp Speed study in inpatients, involving sicker patients using an inhaled medication to see how it works to prevent disease progression.

Though we will be a lot safer this summer, for many people masks are probably here to stay, as they are in Asian countries. In addition, though there is a recent increased influenza vaccination rate, masks appear to have cut back on influenza infections, and probably even the common cold has been attenuated these past six months or so.

I, for one, will probably dump my mask early this summer, unless a patient requests that I wear one. However, it is nice not having a cold or the flu, so perhaps I may give in and wear a mask next flu season.

Take care and stay safe,

https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1

https://www.reuters.com/article/us-health-coronavirus-regeneron/regeneron-to-stop-giving-placebo-in-covid-19-drug-trial-after-clear-efficacy-idUSKBN2AP1J8

https://vaccinefinder.org/

Vaccine Finder is a free, online service where users can search for locations that offer vaccinations.

02/03/2021

Fluvoxamine, and antidepressant, shows promise in COVID-19.

Fluvoxamine, an antidepressant with the trade name Luvox is used in patients with OCD and is also widely used off-label in bulimia, major depression, panic disorder, social anxiety, and PTSD. It has been known to decrease the production of cytokines and was postulated to be of benefit in treating/preventing the cytokine storm and preventing progression of coronavirus infections.

The receptor attached by fluvoxamine is called the Sigma-1 receptor and it migrates to the cell membrane dragging with it another receptor that the SARS-CoV-2 virus can attach to. (See image elsewhere.) Fascinating concept. The virus attaches to this receptor instead of the normal ACE receptor, and it is degraded by the cell, preventing entry to the cell to take over the cellular machinery that duplicates the virus.

In one study using the drug, a double-blind, randomized study of 152 patients, 109 of whom finished the study, the results showed a significant reduction in progression of COVID-19 disease. 80 patients received fluvoxamine 100 mg three times a day for 15 days and 72 patients received a placebo three times a day for the same amount of time.

0 of the 80 patients who took fluvoxamine deteriorated and 5 of the 72 patients in the placebo group deteriorated. In the fluvoxamine there was one serious and 11 other adverse events while in the placebo group there were 6 serious adverse events and 12 other adverse events.

While suggestive that this medication might be effective it was a small study, and the patients were monitored for a short time. Also, it’s possible this cohort of patients might have had a relatively mild form of the disease.

A second study which was a “real-world experience” study recently published showed that 65 persons who opted to receive fluvoxamine 50mg twice daily had no hospitalizations and no residual symptoms at 14 days, while in the placebo group of 48 patients, 12.5% (6/48) required hospitalization and 60% (29/48) had residual symptoms at 14 days. Two of the placebo-treated patients required ICU care and one died.

What is very interesting is the lack of residual effects from the virus in the group of patients who took this medication. None of the treatment group had persistent symptoms at day 14. In the placebo group 29 out of 48 had persistent symptoms such as anxiety, difficulty concentrating, insomnia, myalgia and headache. No serious adverse events occurred with fluvoxamine. No adverse events led to early discontinuation.

This last study suggests there may be a benefit utilizing this drug either early in the course of the disease and at least in mild cases, to prevent disease progression and to prevent post-viral symptoms.

A lot of people suffer with persistent symptoms long after the acute illness subsides. If this medication were to be proved beneficial in this regard it would be very helpful to our society to get back to normal sooner.

Thus far there is no evidence that this drug will work in patients with more severe disease, but this bears scrutiny as it is possible. The last study above was not double-blinded, and patients were allowed to choose between taking the drug when offered or refusing, reducing the reliability of the study. Nonetheless the results are intriguing, and it might make sense adding this
medication to the FLCCC protocol I’m following.

The drug is not without side effects though most are minor. Some of these side effects might mimic symptoms of the actual disease. The doses in the second study were lower than in the first which might lead to less side effects.

A treatment course of this medication, according to Goodrx.com, of 15 days duration costs around $25 at Walgreens, and is similarly priced elsewhere.

A note about the term “off-label” use of a drug. Drugs need to be extensively tested to obtain FDA approval, and due the expense involved drug companies usually submit trials for only one or a few indications. Physicians frequently use drugs for usages not approved by the FDA. It doesn’t mean that this is wrong, bad or illegal; it is a fact of life in the physician’s realm over the past century or more.

For example, just about any medication currently being used for the coronavirus infection is being used off-label, aside from substances being used under the FDA “Emergency Use Authorization”, due to the newness of this disease and lack of formal FDA approval.

Regarding “real world experience” this is a study that is less precise using a medication that might work. Due to unreliability of these types of studies the FDA doesn’t rely on them to make important decisions. However, physicians in the “real world” read them and use them in decision making.

Hope you all can stay safe.




Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/33180097/

Prospective cohort of fluvoxamine for early treatment of COVID-19
Open Forum Infectious Diseases, ofab050,
https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab050/6124100

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751758/

01/27/2021

Vaccine Update

Encouraging news regarding vaccine development, and other news. (See various links below.)

As we all know this is the first time the world has experienced a pandemic such as the one we’re experiencing. The only way we can get past it is with 80%, or so, of our population having either natural immunity, or immunity through vaccination. Obviously, the natural immunity route is dangerous due to the fact that some 500,000 individuals have already died from it. (We are slowly getting better in treating it but it still a risky disease that costs patients, families, and society dearly.)

The US currently has around 331 million individuals so I estimate we will need to have some 264 million with immunity to substantially stop the pandemic. Some vaccines require two doses and others one dose so we will need between 260 million and 500+ million doses to get a handle on this issue. Not only will we need the vaccine we also need to get it distributed and administered to our citizens, which is no small a feat.

Patients need to read instructions about the vaccine and its potential side effects, the staff needs to document this as well as other data specific to each patient, and a little vaccine card needs to be kept. Vaccines need to be safely stored (some at -80 degrees) and accounted for, and vaccine transfers must also be documented. Afterwards, patients need to be monitored for some 30 minutes to screen for side effects. All of this takes time.

So far Moderna has supplied the US some 30 million doses that when administered will protect around 15 million individuals. They state they will provide an additional 100 million doses by the end of March and another 100 million doses by the end of June 2021. This totals 200 million doses which will be good for 100 million individuals.

Pfizer/BioNTech is expected to be able to provide an additional 200 million doses by the end of May, which will cover 100 million people. The combination of these two vaccines will cover 200 million individuals by the end of June, but it will take time to trickle down to the people who administer the vaccines. The Pfizer vials actually contain an additional dose above and beyond what was on the initial FDA-approved packaging. The vials were initially labelled having 5 doses but actually have 6, assuming one has the proper syringe to extract the extra dose. Anyway, it’s a big gift in a small package.

So far, “the U.S. has distributed more than 44 million doses of vaccines and has administered about 23.5 million doses, according to the CDC.” A good start but only about 10% of what we need.

Johnson & Johnson is developing a single-dose vaccine soon to be reviewed and hopefully approved by the FDA. However, factory production has fallen behind schedule. They were due to have 100 million doses by the end of June, but the expected date of delivery may be a month or two later.

We lost one vaccine maker, Merck. Unfortunately, their vaccine produced suboptimal levels of immunity, so they’ve stopped development of it. Instead, they will concentrate on the development of drugs involved in the treatment of the disease.

President Biden has a plan to inoculate 1.5 million people every day for the next 100 days. So far we've averaged around 1.1 million vaccinations a day so we're headed in the right direction. His is a very ambitious plan and I certainly hope it works because this would quickly take us a long way toward recovery and normalcy. Actually, it should be doable, assuming vaccine supplies, because this only equates to 30,000 people being vaccinated per state per day.

On a side note, yesterday a Polk County paramedic was arrested for diverting vaccine based on instructions he states he received from his fire captain, plus for falsifying documents. (See the link below.) Apparently, the Captain wished to do some favors for his friends and family and instructed the paramedic in his charge to divert the vaccine away from first responders. It was only a question of time when something is sought after and is in scarce supply.

https://www.healthcarefinancenews.com/news/healthcare-finance-news-latest-updates-covid-19-vaccine-distribution
https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-supply-us-100-million-additional-doses
https://www.nytimes.com/2021/01/13/health/covid-vaccine-johnson-johnson.html
https://www.tampabay.com/news/crime/2021/01/26/polk-county-paramedic-arrested-in-vaccine-theft-sheriff-says/
https://www.cnbc.com/2021/01/25/president-joe-biden-targets-1point5-million-covid-vaccinations-a-day-up-from-1-million.html

Last week, President Joe Biden dismissed the idea that the goal of 100 million vaccinations in 100 days might be too low of a threshold.

01/23/2021

Front Line COVID-19 Critical Care Alliance Recommendations
FLCCC

Dear Friends:

I hope you are continuing to do well going into the New Year. This coronavirus event is a first for all of us and we are all on a learning curve. Every healthcare provider, politician, first responder, and the wider public are all trying to do our best to get a handle on this situation. Coronaviruses tend to mutate so it is likely we will experience another epidemic in the future, if not multiple ones. What we have learned and will learn will hopefully make the next outbreak much more tolerable.

I have never seen the world research community rise to the occasion such as they have during this crisis. Thousands of research papers have been published so far and tens of thousands more are on the way. Around 100 different companies are working or have worked on vaccines in a tremendously short amount of time. Heartwarming. Anyway, once this issue is passed it will take a few years to clean up all the data and come up with a coherent narrative regarding the entire spectrum of questions that need to be answered.

Tonight, I thought I would include a protocol that I’ve implemented in my practice from a handout from the organization listed at the top of this article. Here is the FLCCC group’s brief bio:

The Front Line Covid-19 Critical Care Alliance was created by highly published critical care specialists from major academic medical centers with collectively over 1,000 medical publications. Based on the rapidly emerging research into COVID-19, the early clinical experience in China reflected by the Shanghai expert commission, and their decades-long clinical and research experiences in severe infectious diseases around the country, the 5 experts developed the MATH+ Hospital Treatment Protocol for Covid-19. It is intended for use early in the hospitalization of patients presenting with states of respiratory distress requiring supplemental oxygen. In October 2020, after reviewing numerous new studies from around the world on the antiparasitic drug ivermectin’s use in prophylaxis and all stages of treatment for COVID-19, the team created the I-MASK+ protocol for prevention and early outpatient treatment. These 5 physicians have since been joined by an increasing number of hospitalist and ICU physicians who recognize the sound physiologic rationale, the emerging published research in support of the components, and the data demonstrating good clinical outcomes in hospitals and communities that have adopted the treatment regimen.

The treatment regimen I use is slightly different from theirs insofar as I use a more rapid-acting form of Vitamin D in patients whose Vitamin D status is unknown. I also don’t normally use Melatonin but in some cases use a higher dose.

Vaccine rollout is plugging along, and many people are becoming frustrated. Remember that this is new for all of us including our state and local departments of health and they are doing the best they can. They’re overworked and understaffed but are doing a good job.

Regarding the risks of the vaccine, they are exceedingly small. Each person needs to balance in his or her mind the risks vs the benefits of anything he/she does, including deciding about the vaccine. I’ve seen so much misery and heartache firsthand due to the coronavirus that the vaccine benefits to me and my family easily outweigh any small risks involved with this vaccine. However, everyone has free will and can decide what course is in their best interest.

Anyway, look the following protocol over and post any questions below. I’ll try to get to them when I can. Take care and have a good evening.