Delta Variant, Breakthrough Infections & What You Need to Consider

As a primary care physician treating older adults fifty years of age and older, I am starting to be involved in the treatment of “breakthrough” COVID-19 cases in vaccinated adults. At the end of June 2021, just prior to the July 4th holiday, we were told to enjoy the summer if we were vaccinated. Many in my patient population took this to mean book flight and cruise reservations and begin travelling. Others started meeting friends to shop again, exercise together in gyms or eat lunch socially indoors.  Experts at the CDC felt it was safe to take off our masks indoors.  Then came the Delta variant – a far more transmissible virus. 

I first read about breakthrough cases in a peer reviewed medical journal discussing the widespread outbreak of COVID-19 in Israeli citizens vaccinated with the Pfizer Vaccine. The message was clear, if vaccinated, you can still get the viral infection with the Delta variant, but you won’t require hospitalization and you have a minimal chance of dying. 

With that news many of my patients continued resuming their lives and normalizing to pre-pandemic routines without masking or distancing in public areas.  Three weeks ago, our local hospital had no breakthrough cases. Two weeks ago, there were five. All the breakthrough cases in individuals 65- years of age, or older, or with symptoms, are invited to receive the monoclonal antibody treatment which shortens the course of the illness and the severity.   Treatment should be within 10 days of first developing symptoms. The cases are so numerous this week that there is a wait of days to get treated.

In discussing the breakthrough cases with my ill patients, they all feel miserable.  They are exhausted, coughing, some febrile with high fevers and severe joint and muscle aches. Some have lost their sense of taste and smell. They say the monoclonal antibodies help, but a week later most of my patients are too weak and tired to do much beyond their necessary activities of daily living. They call daily asking how much longer this will last.  My answer is, “I just do not know.”

I also do not know If their viral load was high enough to transmit the disease to the unvaccinated, the immunosuppressed vulnerable vaccinated patients or even other vaccinated individuals.  The experts are not sure either. Will these vaccinated breakthrough patients become “long haulers” with chronic symptoms stretching to months post infection?  We don’t know – it’s too soon to tell. 

I am also getting calls from patients who were out socially unmasked with close friends and relatives and have now received a phone call that their friends have the COVID-19 infection, and they were exposed.  These patients need to be tested for the disease a few days after exposure but, with the closure of all the state-run testing sites locally, you are limited to going to your pharmacy or some walk-in clinics for COVID testing. Take my advice, get the nasal PCR test sent to the lab which takes longer than the quick test but produces fewer incorrect results.

What I do know is this is a disease well worth avoiding.  Get vaccinated if you haven’t already done so.  Wear a good N95 or KN95 mask if you must go out in public to an indoor facility, and you have no idea who is vaccinated, and who isn’t, and who might be spreading the disease prior to developing clear cut symptoms.  Yes, this is retreating and taking a step backwards into a bunker mentality.  If you don’t believe me, just ask my COVID-19 breakthrough patients. They will tell you this is more than just a “bad flu.”

Deep Breathing to Lower Blood Pressure

A new breathing device called Resperate is being marketed to slow your breathing rate, stimulate your parasympathetic nervous system and ultimately lower your blood pressure. The device sells for $330 and has been discussed in numerous health letters the last few weeks including the Harvard Health Newsletter.

The sympathetic nervous system controls involuntary functions such as breathing, digestion, heart rate. The parasympathetic division of it can slow your heart rate, dilate blood vessels and ultimately lower your blood pressure. The Resperate device uses sensors on your chest connected to a belt device to create a slow melody for you to listen to and breathe to. You synchronize your breathing to the melody slowing your breathing with prolonged exhalations. The slow breathing stimulates your parasympathetic nervous system slowing your heart rate, dilating blood vessels and lowering your blood pressure.

The device is used four times per week for 10-15 minutes sessions and should lower your diastolic and systolic blood pressure over a few weeks. How much and for how long does the effect work is currently unknown.

Medicare does not yet cover the cost of the device but some private insurers do.  After reading about slow breathing lowering blood pressure I looked for information on breathing techniques to lower your blood pressure without requiring a breathing machine. A website viitalheartandbrain.com offered several options:

Thirty Second Method: Sit in a quiet place and relax. Set a timer for thirty seconds and begin. Take six slow deep breaths through your nose and exhale slowly through your mouth during the 30 second period. Repeat the process as often as you can. This method studied with 20,000 Japanese adults lowered BP.

Equal Breath Length Method: Begin by sitting or lying down in a quiet area and close your eyes. Inhale through your nose counting to 4. Pause and feel the air in your lungs. Exhale thorough your mouth to the count of four. Feel the emptiness of your lungs. Repeat as often as you can

4-7-8 Breathing Technique: Sit in a quiet place. Place the tip of your tongue behind your teeth. Inhale through your nose slowly counting to four. Hold this breath for a count of seven. Exhale through your mouth to a count of eight making a gentle whooshing sound. Repeat four times per session

Diaphragmatic Breathing: Lie flat on your back. Place a pillow under your neck and bend your knees up. Place one hand on your chest and one under your rib cage (diaphragm). Inhale slowly through your nose and watch the hand placed under your rib cage rise while the hand on your chest remains still. Exhale through your pursed lips while watching the hand under your rib cage descend and the hand on your chest remaining still. Repeat the process several times.

Give these relaxation techniques and slow breathing techniques an opportunity to relieve your stress and lower your BP and heart rate. In a previous post I discussed tea both green and regular tea lowering blood pressure. Try a cup after the breathing exercises for further relaxation. If tea isn’t your drink, then consider unsalted tomato juice, beet juice, prune juice, pomegranate juice or skim milk. These drinks all had a similar blood pressure lowering effect.

The COVID-19 Pandemic Continues Due to Citizen Dysfunction

Last night on the national news coverage of the Sars 2 Coronavirus Pandemic a major story dealt with the large number of children infected with the Delta variant of the virus and the severity of their illness. These children are too young to receive the vaccine.

At best, Pfizer and Moderna hope to have approval to start vaccinating young children by the end of September. These children are dependent on their parents, teachers and counselors keeping them masked, keeping them distanced and keeping them safe. This story dealt with an outbreak in Missouri and Mississippi with 10 youngsters currently on life support systems.

It is a dilemma for parents, especially working parents, about what activities to allow their children to engage in. With previous COVID-19 surges and outbreaks, experts have discussed how mild the illness is in children and how infrequently long-term and life-threatening complications occur. They stress the need for children this age to socialize and go to school and camp but that was prior to the Delta variant and other mutations and variants becoming the dominant source of infection in the USA. It is hard to tell whether the news coverage is sensationalized to promote viewership or is the Delta variant a threat to young unvaccinated children different and more severe than it was 90 days ago?

It’s time for our federal government to take a hard line with health care workers and health care facilities. All employees without a valid health reason for being vaccinated must be vaccinated or face termination. This would include hospitals, outpatient facilities, senior centers, childcare centers, etc. If the result is the facility is understaffed resulting in delays in elective profitable procedures, then so be it until the pandemic is controlled!

Commercial air traffic from regions of the country and world with low vaccination rates and vaccine hesitancy battling large outbreaks of COVID-19 should be halted until their outbreaks are under control. Vaccine passports should be encouraged – not legislated against. When an individual’s actions and decisions threaten others around them by increasing the likelihood of spread of a disease, and its accompanying economic devastation, then the issue is not about loss of freedom. It is about public health and the governments’ sworn duty to protect its citizens.

It’s time to end this Pandemic and the way to achieve that is through mandatory vaccination.

Aerobic Training Helps Blood Pressure Medications Do Their Job

We are always looking for ways to stay healthy with less medicine.  Miguel Ramirez-Jiminez, PhD of the  University of Castilla-La Mancha, Toledo, Spain presented a paper to the American College of Sports Medicine recently week and addressed this topic.

His group looked at 36 obese and overweight adults who normally did less than 120-minutes of physical activity per week. Ages ranged from 53 – 65 years with 22% postmenopausal women. They had all been taking blood pressure medications for at least eight years and all met the criteria for having the metabolic syndrome which includes hypertension, elevated blood glucose, elevated triglycerides and a large waist.

The group was randomly divided into a placebo group whose medication was stopped or a trial group who continued their antihypertensive medications for the next three days. All participants then underwent 24-hour ambulatory blood pressure monitoring. All the participants were then entered into a four-month cycling program three times a week. 

After completing the four months of cycling training the placebo group again did not receive their medications for three days while the trial group did.  Twenty-four-hour ambulatory blood pressure was then checked in both groups.

The group exercising plus taking their medications saw an average drop in blood pressure of 3-5 mm Hg in addition to the 5mm Hg noted just from the medication’s pre-exercise training. When the exercise program stopped, the extra drop in blood pressure additionally dropped. There is a phenomenon known as “post exercise hypotension” that can reduce your blood pressure for up to 24 hours after training. This is the reason experts advise 3-5 exercise sessions per week.  

The study also revealed that if you exercise aggressively, and hope to permanently stop your blood pressure medications, your pressure usually rises above acceptable levels.  Exercise is not a substitute for prescribed blood pressure medicines. The article can be found at www.medscape.com  

Eggs Are Safe & Delicious

A few years ago, while visiting my pug’s veterinarian to try and find a way to get the dog to eat while undergoing radiation therapy, he suggested, “Why don’t you scramble him some eggs? It’s a great protein source and doesn’t contribute to cardiovascular disease in canines.” I have to admit I was a bit jealous since I was avoiding eggs, using egg whites and Egg Beaters instead. Two recent studies suggest eggs are safe for humans too.,

The American Journal of Medicine, in the January 2021 edition, published a research paper by C. Krittanwong, MD and associates which looked at 23 prospective studies covering a median of 12.8 years and 1,415,839 patients. There were 157,324 cardiovascular events during the study period. “Compared with the consumption of no egg or 1 egg per day, higher consumption was not associated with significantly increased risk of cardiovascular disease events. Higher egg consumption (>1 egg per day) was associated with a significantly decreased risk of coronary artery disease compared to no egg or one egg per day.

A study with similar results was published in the March 2020 edition of the British Medical Journal in a study involving 14,806 patients over 32 years. “Moderate egg consumption is not associated with increased cardiovascular risk overall.”

The message is clear, eggs are a fine source of protein in moderation.