Omicron the new COVID Variant & the Pandemic

Last week my office staff and I met to discuss loosening some of our COVID-19 precautions due to the low positivity rate in the area and the vaccination status of the local population. We all enjoyed the return to normal this Thanksgiving inviting family to celebrate with us for the first time in two years. My children, their spouses and kids all flew home for a joyful few days. Then came news of a new variant out of South Africa, Omicron.

It is too soon for scientists to know very much other than structurally there are multiple mutations on the P-spike. It is felt that this makes the virus more transmissible than previous versions including the Delta strain.

We don’t yet know if the Omicron variant will produce more severe illness. It is too soon to know the incubation period and most significant period of disease transmission. We do not know if the COVID-19 vaccines will work against Omicron or if it will dodge our immune response. Nor do we know if it will bypass the immune response of those previously infected? I expect it will take at least three weeks to get some of the answers but probably three months to have a better idea.

The travel restrictions imposed by world leaders are too little and probably too late. Banning foreign nationals from entering your country while permitting citizens to return assumes the virus recognizes national flags and only infects foreign nationals. This decision is an outrage. Returning citizens need to be tested frequently while being quarantined for about 14-days. That is the type of travel restriction required. It is highly probable the new strain is already in the USA.

We need mass testing to start again so we can identify infection quickly and we need the lab capability to identify the infecting viral strain. In the meantime, while we learn about what we are dealing with, we need to once again wear masks, keep our social distance and avoid crowded indoor venues.

My practice will continue to screen patients over the phone and at the door. We will limit entry into our office and require masks to be worn. We will stagger patient visit times so that patients coming and going are not in close proximity. If necessary, we will return to telehealth visits only.

On the bright side, we are much more prepared for a new surge than before. More individuals are vaccinated and boosted. The COVID treatment pills work via a mechanism that is independent from the genetic mutations on the P-spike protein. Vaccine manufacturers have already begun preparing a vaccine against the Omicron strain that will take three months to reach the market. It is disheartening to face this crisis again, but we will, and hope the knowledge we need to acquire is learned quickly.

Clostridia Difficile Colitis Treatment Pills on the Horizon

Antibiotic related colitis powered by post antibiotic clostridium difficile bacteria infection has become epidemic. Patients suffer from abdominal cramps, fever, recurrent loose and bloody stools. Dehydration and even bowel perforation have occurred. Treatment involves using a non-absorbable antibiotic called vancomycin . If that failed, fidaxomicin has been used in recent years – since its development and approval.

Despite the use of these drugs, patients have been having more frequent recurrences which sometimes require additional treatment. When these treatments fail to stop recurrences, researchers have gone to fecal transplants – tried via collected stool enemas. The idea that an individual suffering from fevers, severe recurrent abdominal pain and diarrhea, sometimes grossly bloody would consent to an enema of collected stool points out just how miserable this entity makes the poor suffering individuals.

At a virtual meeting of the American College of Gastroenterology 2021, Jessica Allegreti, MD, MPH, a gastroenterologist at the Brigham and Women’s Hospital in Boston Massachusetts reported on the most recent successful trial of a freeze-dried human stool pill. The pill contains a powder of freeze-dried human stools from pre-selected donors. The study selected patients who had suffered through several bouts of C Difficile colitis and were now symptom free. The group had either been treated for their last recurrence with vancomycin or fidaxomicin.

After a period of days for the antibiotics to wash out of their system, they were either assigned to receive the CP101 pill or a placebo. Normally these patients would be told to resume their lives and receive no treatment unless they developed symptoms of a C Difficile recurrence. The pill was more successful than the placebo in preventing recurrences at the 24-week mark.

Interestingly, when the stool of all the disease victims was looked at for normal bacteria that is supposed to be present in our bowels, they had a paucity of bacterial types expected. One week after taking the freeze-dried pill the numbers and diversity of healthy bacteria had increased due to the CP101 contents.

The pill is made by Finch Therapeutics and now moves into Phase 3 studies prior to being ready to be presented for marketing. Competing firm Vedanta Biosciences is doing similar studies with its whole stool VE303 pill while Seres Therapeutics works with SER-109 which is an accumulation of highly purified Firmicutes spores.

Having an oral pill to replenish our natural micro biome after an unfortunate antibiotic related colitis infection with C Difficile will be a major advance in its treatment. Hopefully it will reduce the recurrences of this miserable disease.

Vitamin D & Autoimmune Disease

Karen Costenbader, MD, of the Brigham and Women’s Hospital in Boston reported at a plenary session of the American College of Rheumatology that adults taking 2000 IU of Vitamin D and one gram of omega 3 fatty acids daily were less likely to develop autoimmune disease than adults taking a placebo. Costenbader’s research group reviewed data from the Vitamin D and Omega 3 Vital trial which included 2,000 men ages 50 and older and women 55 and older.

In her work, Dr. Costenbader looked at almost 17,000 participants who had blood tests for Vitamin D levels and Omega 3 fatty acids. The study groups were followed for over a five-year period. Those supplemented with Vitamin D and Omega 3 fatty acids reduced the incidence of autoimmune disease by 25- 30%.

Vitamin D supplements and Omega 3 Fatty Acid supplements are readily available, inexpensive and non- toxic when taken in appropriate dosages. Their use should be encouraged.

Prediabetes & Exercise

Prediabetes is a condition that identifies individuals who have an increased risk of becoming Type II diabetics. It is diagnosed with either a fasting blood glucose measurement of 100-125 or an elevated Hemoglobin A1C level. The Hemoglobin A1C level provides a look at the average blood sugar level over the previous 8-12 weeks and is fairly independent of the previous few meals.

Gone are the days of the physician saying to his patient, “your blood sugar was elevated at 120” and the patient responding, “Well it was my birthday this week and I had some cake and alcoholic drinks causing the elevation.” The hemoglobin A1C removes that reason.

When physicians diagnose patients with “prediabetes” we try and educate the patient and family encouraging dietary education on a healthy eating lifestyle, weight reduction if they are overweight and regular exercise. Fortunately, in the senior citizen age group, newly diagnosed prediabetics usually don’t end up developing full blown diabetes if they watch their weight and get active.

A recent study published in BMC Endocrine Disorders found that aerobic exercise was best at controlling Hemoglobin A1C levels but resistance training was not far behind. Those individuals who engaged in both aerobic training plus resistance training showed better weight control and fasting blood glucose levels than the control groups or aerobic training alone. When evaluating the data both aerobic training and resistance training helped. The message to me for my patients is, if you are a prediabetic, start exercising doing what you enjoy doing. Make it fun, not work. Couple that with a dietary education from a trained dietitian or diabetes peer educator and you will do well.

Zinc For Colds This Season?

Two weeks ago, my wife was doing her weekly childcare activity of love watching our two toddler grandchildren while our adult kids were on a business trip. The 3.5-year-old had brought home a viral respiratory infection the week before, gave it to his one-year-old brother and both kids were now in the tail stages of recovering from annoying but not serious illnesses.

In today’s world, coming home from school with a sore throat, runny nose and malaise means tea and honey, warm soup and a COVID-19 test. Both kids were negative but several days later my wife, then I, had similar symptoms. My wife’s symptoms settled in her sinuses and 10 days later her doctor put her on antibiotics and nasal spray. I was fortunately much less symptomatic but still have some nasal congestion and dry cough. We have a commercial preparation of a zinc product to prevent and reduce the symptoms of these infections but did not get around to taking them. In the past the literature wanted us to take these lozenges every two hours and I was not going to set an alarm at night to wake up to suck on a zinc tablet.

Jennifer-Hunter, PhD, from the Western Sydney University and associates studied the questions about zinc products’ effect on preventing and abating the common cold and published their findings in the online version of the BMJ Open on November 1, 2021. They looked at 28 randomized controlled studies with 5,456 patients. Their results showed that oral or intranasal zinc did prevent about 5 infections of those exposed per 100 persons when compared to a placebo. They found that if you challenged healthy individuals with a human rhinovirus inoculation the sublingual zinc did not prevent a clinical cold. Those who continued the zinc tended to have resolution of symptoms two days earlier than those who took placebo. For those who took the zinc prep there were more episodes of nausea and mouth and nose irritation.

I appreciate the science and think I will pass on the zinc for now and stick with avoidance of sick individuals plus chicken soup, tea and honey when I catch the virus anyway.