COVID-19 Update 9/9: Vitamin D, Vaccines, Flu Shots, and More

Dr. Steven Bishop returned to Facebook Live to provide an update on all things COVID-19. He discussed the importance of Vitamin D, various vaccine developments, the upcoming flu season, and more. Watch the video below and read on for the full recap. 

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Vitamin D and COVID-19

I want to talk to you guys about a study that came out in JAMA related to vitamin D. It's an observational association study, so it doesn't give us any definite causal information about vitamin D and COVID, but we've been talking about vitamin D in general and, in particular, in relation to wellness and your risk for COVID for some weeks and months now.

And what they have found in this study is that there was an association between people who had deficiency of vitamin D and their risk factors for getting coronavirus. Essentially, people who were low in vitamin D had higher risk for getting COVID. And I think that makes a lot of sense for a whole lot of reasons.

It jives very well with all the other data coming out from CDC, NIH, and other researchers, showing that people, in general, who have metabolic diseases like prediabetes, diabetes, obesity, all these things, are more at risk for having coronavirus and for doing poorly with coronavirus.

So why does this make sense for vitamin D? People with these metabolic diseases are also very likely to have vitamin D deficiencies for a number of reasons. It does stand to reason that people who have vitamin D deficiency, probably not only are they at risk for COVID, they probably also have these other metabolic issues going on at the same time. All of it sort of paints the same kind of picture as what we're saying.

The bottom line here is that if your vitamin D is low, take that as a warning sign that you either need to get some more sunlight, or you need to take a supplement, or you need to work on your metabolic health like we've been talking about these last few weeks in order to reduce your risk for COVID.

The best way to improve your vitamin D levels? Eat those nutrient dense foods. Get 20 minutes of sunlight every day. If you can't get your vitamin D levels up naturally, take a supplement. That is fine.

This study does not tell us that taking a vitamin D supplement is going to keep you from getting sick with COVID. Okay. I just want to make that distinction clear. It does tell us that people who have low vitamin D at baseline seem to be at higher risk for getting COVID.

That's what that says, but it doesn't mean necessarily that if you take a vitamin D pill, that all is well and you don't have to worry about COVID.

What it means is that if you have low vitamin D, take that as a warning sign, work on increasing that level of your natural means — diet, exercise, exposure to sunlight. Take a supplement, if you still can't get the level up, because it probably is helpful, but taking a vitamin D supplement is not a substitute for doing all of the other healthy lifestyle things that you need to do to get your vitamin D level up naturally.

Your Questions, Answered. 

• If you get a chance, could you discuss this article? Particularly the part about effects on the heart. 
  
  She linked to an article about this concept of long COVID. So what this issue is, is just the new term that people are coming up with related to people who seem to have COVID symptoms for a very long time — weeks, if not months. This is not unique to COVID. This happens with many viruses. This sort of post-viral syndrome can linger for many things. Influenza does this. There are other viruses that do this too, but it's actually not all that uncommon to have post-viral fatigue, a post-viral cough.
  
  These post-viral symptoms can linger on. And especially in people who are really sick with the virus, if they were in the ICU on ventilators, anything like that, people can have lingering and prolonged recovery from any kind of severe illness for a very long time.
  
  I'm not surprised to see that people are having weeks and months of symptoms related to COVID, especially after they'd been very sick with it. And some people are having heart issues related to it, heart failure and things like that. And again, this happens with many types of viruses. It's not unique to coronavirus. There's a lot of attention being paid to it because we're just sort of discovering the frequency of these issues because now people have recovered and been in their sort of recovery phase for up to six months at this point, or longer.
  
   I'm not shocked that that people are having prolonged recoveries, but that being said, it is disturbing. We'll find out more over time, but it's kind of something I would expect to see in any severe illness as time goes on and we have more and more sort of recovered and semi-recovered patients.
  
  
• Thoughts on 6 potential treatments for COVID-19 identified? 
  
  This is an interesting article. And so what goes through and details briefly is that there are some folks using artificial intelligence and computer algorithms to essentially search a library of compounds that are already in use and figure out which of them may potentially be helpful for treating coronavirus.
  
  And I think this is a very smart way to approach drug development and and what's referred to as drug repositioning. This is the whole idea behind hydroxychloroquine or zinc, or in these other things that are being investigated or have been investigated... is let's find a drug that's already in existence.
  
  Let's use artificial intelligence to kind of compare the molecular status of that drug with the molecules of the virus and see if there's a potential match there where one may impact the other. And so what these computer algorithms are showing us is potential therapies.
  
  So it gives researchers and scientists something to go off of and say, of the millions of compounds that we're aware of, we can't obviously test them all. There's just not enough time. There's not enough resources to do that. So let's use an AI or an algorithm to tell us which ones might be useful for targeting and doing clinical trials.
  
  These six potential ones showed up, let's go ahead and do some small scale studies on them. Let's see if there's any promise, behind these drugs in terms of whether they work for COVID. And if so, then great, then we keep doing tests on them further and further until, if the tests come back positive and the small scale trials come back positive and keep doing larger and larger studies, and that's how you get to eventually true randomized control trials. And you figure out whether the drugs actually work or not. So very astute use of the technology there, which I think is great.
  
  
• What do you know about the illness that person came down with in phase 3 vaccine trial they stopped?
  
  What has happened in one of the trials, and we don't even know whether it was in the treatment arm that got the vaccine or the placebo arm, or which arm of the vaccine trial, it was, someone came down with a significant illness and that happens, you know, as, as a matter of course, just in life, right?
  
  So whenever these trials are halted by the safety monitoring boards, it doesn't mean that the vaccine, or whatever the compound is, has caused the problem. It means they don't know. They got an alert that somebody who was involved in a trial got sick and that information doesn't go to the researchers. It goes to a safety monitoring board, someone who's not directly part of the study. And this is so that the blinding of the trial doesn't get undone. You don't want to report this out to people who are actually doing this study because it can mess up the bias prevention mechanisms that are built into the study.
  
  So the illness gets reported out to a data safety monitoring board, which is sort of a separate committee of statisticians and researchers who are overseeing the trial, but aren't directly involved in doing the administration of the trial. That's the way it's supposed to work. So the safety monitoring board gets this notice, Oh, someone who's in the trial got sick. They then go and look separately and say, okay, did this person get the vaccine? Or did they get placebo? If so, what dose, what happened? What's actually going on here?
  Maybe the person has a completely unrelated illness that has nothing to do with the vaccine or anything else. Maybe they had a car accident. There's no way to know. And so they hold the trial whenever this happens until they can figure out what's going on.
  
  I'm sure they will sort this out in the next few days. We will find out one way or another, whether this person was in the placebo group, the trial group, or something else was going on there. So time will tell, we just don't know quite yet what's going on with that. It doesn't necessarily mean anything nefarious or bad is happening with the vaccine trial. It just means someone got sick of the tens of thousands of people who were in the trial. Someone got sick, it could be completely unrelated to the vaccine altogether.
  
  
• Have you seen the latest articles being written about how it is unsafe to continually use the infrared thermometer’s on people’s foreheads, especially their use on children?
  
  Yeah. I've seen these reports on Facebook. And pretty much, let me just categorically say that that is totally fake news.
  
  There is no issue, no safety concerns around infrared front thermometers. There's sort of some hoaxy stuff going on that it's zapping people's pineal glands and this and that.
  
  Here's the bottom line. The infrared thermometers don't emit anything. They don't emit radiation. They absorb and detect radiation that's emitting off of your skin. The only thing that they might emit is if they happen to have a laser light associated with them and all that is a light. Like anything like a pin, like it's not anything nefarious there. But that actually has nothing to do with the measurement of the temperature. The light is just a guide. It doesn't penetrate the skin beyond surface level, anything like that, the gun, the little thermometer gun doesn't emit anything. It is a absorber of information. When you put it up to your forehead, that little light is a guide, if it's got one.
  
  That's not actually measuring anything. What's measuring is the device itself. It's absorbing the heat, the infrared signature that your own skin is giving off. So there's nothing nefarious being emitted from the thermometers. Even if something was being emitted, like a light, it's not penetrating more than skin deep. And it's certainly not getting to the pineal gland, which is way back in the middle of your head. So there's nothing concerning about the infrared thermometers for kids, adults, or anybody else. They are perfectly safe to use.
   
• Do you know how many places in Virginia are doing this (sewage testing)? I read that UVA and Va Tech are doing it.
  
  Some places may choose to do this as a surveillance mechanism. I think it's probably overkill and probably not extremely high yield or helpful, but in some very large urban centers, like Northern Virginia, it may be helpful in terms of monitoring disease activity. But it's not something that I think every city and town needs to be doing on a large scale basis. It is definitely something interesting to do, but certainly not something that I would say that every place needs to do. I think that the testing of people and looking for symptomatic people is probably more than sufficient.
  
  
• When does flu season start in our area? How much hospital capacity does seasonal flu typically occupy? I know there is concern that the combination of flu and Covid could stress hospital resources.
  
  This is always a concern. Flu season starts soon, probably the next couple of weeks, more than likely. And that's pretty typical. We'll start seeing an uptick and the first instances probably by early October at the latest. In terms of hospital capacity, yes, that is a concern. But truthfully that's a concern every year. Hospital capacity gets nearly maximized every year with just regular flu.
  
  I'm hopeful that we will have a lighter flu season, like they had in the Southern hemisphere because so many people are wearing the masks, socially distancing, washing their hands, and paying so much more attention to hygiene this year. The Southern hemisphere seems to have had a light flu season. I hope we are just as fortunate and have something similar.
  
  Hospital capacity is always a flexible metric. Hospitals are 90 to 95% full most of the time, all year round. And that's certainly true in flu season and in flu seasons in years past, in my hospital work that I had done prior to 2020 and since the time I was a resident, hospitals are always full or at capacity throughout flu season.
  
  I's pretty much a routine, par for the course thing that goes on every year. I expect we'll have the same this year. I don't know that it's going to be any worse or better or any different related to COVID. Perhaps it will be worse. Perhaps not. Time will tell. That being said, hospital capacity can be surged in certain ways, just like we did in March and April when we had to close things down in case of surges.
  
  And I think if surges do happen, you'll see a return to some of these practices where we're limiting elective procedures and other things to make extra hospital rooms available for people. But I'm hopeful that that won't happen. We ended up not needing most of the surge capacity we created in the spring, except in a few isolated areas in the country. And most of the field hospitals that were created went completely unused for the most part, except in places like New York City, which is extremely densely populated.
  
  So I suspect we won't have that problem most other places. When I say expect, I mean that in the terms of expect and hope that that won't be the case. 
  
  
• When should 50+ folks schedule their flu shots?
  
  Anytime now is a good time. Anytime from mid-September through mid-October really is the time to do it. It takes a few weeks for the protectivity of the flu vaccine to really kick in, for the antibodies to develop, and all that. So I would go ahead and schedule that in the next few days so that you get it done between now and mid-October at the latest so that you are fully protected by the time flu season really comes into full swing here.
  
  And if you're in that 65 and up crowd, I would definitely get the high-dose flu vaccine, so you can maximize your chance of getting the antibodies.
  
  Let me just reiterate: the flu vaccine is an extremely safe vaccine. The effectiveness is not a hundred percent. That is definitely true. It varies from year to year. However, in general, for most people, it's a very safe vaccine. It has minimal side effects.
  
  Please get a flu vaccine this year, please, please, please, everyone get a flu vaccine. Even people who have egg allergies, there are flu vaccines that you can take. One of them is called flu block. There is a flu vaccine for you.
  
  The vast majority of people, even folks I know who don't normally get the flu vaccine, please do do this. It's a simple thing that you can do to protect yourself and other people. Even if the vaccine is not perfectly protective, it does reduce the transmission of the flu virus. And for this year, especially while we're trying to deal with COVID, please do yourself, your loved ones, and your doctors and nurses in the community a favor... get the flu shot this year to reduce the flu transmission.
  
  It's a simple thing. Please, please do do it. And if you're concerned about that, or have other questions, please talk with your doctor or your nurse. Let them answer your questions.
  
  For the flu vaccine, all the injectable vaccines, just know that you cannot get the flu from the flu vaccine. It's all inactivated virus or viral particles. They're not live viruses. None of the injectable vaccines that are live viruses, so you can't get the flu from the flu shot. 
  
  
• When will PartnerMD have the flu shots available?
  Hopefully in the next couple of weeks. We had some shipment delays at some of our practices due to shipping problems related to the hurricanes that came through recently, but we're hoping to have them in the next week or two. You should hear something from your local practice manager shortly, if you haven't already. If you have questions, go ahead and reach out to your doc and your nurse, and they should have more information about your local office.
  
  
• I thought kids had very low rates of infection and transmission, but I heard today that over half a million kids in the U.S. have already had it?
  
  I have to go back and review those stats. There may be a half million kids that have had it. So that is still a low rate of infection, right? Compared to how many millions upon millions of children that we do have in the country. And we've had over 6 million people with COVID who have actively gotten sick with it. Even if it's sick a half a million out of the 6 million, that's still not very many.
  
  Let me see if I can quickly get to COVID cases by age while we're talking. So the transmission piece, what they, what they mean by that. And what they are saying is that we have not had very many cases where we have been able to sort of convincingly show that children had transmitted it either within their households or to other people like say teachers, etc.
  
  This goes along with... it seems that people who are minimally or modestly symptomatic or not symptomatic at all are less likely to transmit it in general. And this goes back to something we were talking about last week where the PCR tests may in fact be picking up many people who were not infectious, because the tests run on something called a cycle count and the tests are turning positive. The longer it takes the test to turn positive in terms of cycle numbers, the less viral load there is. So the test might be reporting back positive, even if it was taking 30 or 35 cycles for it to find the virus.
  
  And what they found in some studies that were done recently was that if the test, the PCR test, took more than about 25 or so cycles to locate the virus in the sample, the odds of that person being actively infectious were pretty minimal. So I think that's probably what they're referring to with that. 
  
• As a physician, what do you think the biggest public health risks remaining for the pandemic? Is it your sense that we have already suffered the brunt of the pandemic, or is there no way to know this?
  
  I am hopeful that we have already gone through the quote "worst" of it. That being said, there's no way to know, right? We don't know how long the immunity will last. We know that there are still many people that are very much at risk. I think that people need to continue to be on their guard, even though many restrictions have relaxed in the subsequent weeks and months.
  
  And I still stand by what I've been saying. I think for the low risk and the younger, we need to normalize things as much as possible, but we do need to continue to protect the elderly and the vulnerable as much as we can. I agree with what Medicare is doing and what HHS is doing, where they have updated guidelines just this week for the frequency with which nursing home patients and staff need to be tested.
  
  I think this is a smart strategy. I think we need to continue to be hyper-vigilant about COVID in the nursing homes and the long-term care facilities. I think that's absolutely critical so that we don't continue to have elderly people suffer unnecessarily or disproportionately, so that we can keep tamping that down as much as we can while we do search for an effective treatment and an effective vaccine.
  
  I think if we let our guard down with the elderly and the vulnerable, I think you will see a major resurgence of illness in that population that has borne the brunt of the deaths. But I do think that in terms of the younger population and the healthy, I'm hopeful that we have seen the worst of it at this point. And indeed I do think they never were at significant risk, but we didn't know that right at the beginning. We just didn't know the infection fatality rate, and the case fatality rate continue to prove out to be very, very low, far less than 1%, and generally, probably less than half a percent, in the young and the healthy. And so I think for them, the risk never was high and continues to be very low.
  
  For people, as you climb in the fifties and sixties and beyond, and especially if you've got any kind of underlying condition, like we talked last week, especially any kind of metabolic issue, excess weight, pre-diabetes, diabetes...you need to continue to be vigilant, continue to be cautious in what you're doing day to day and who you're interacting with, staying away from sick people, doing the distancing, to a large degree. I think that continues to be wise.
  
  And I think if people in those high risk categories don't continue to be cautious about what they're doing or start to let their guard down too much, I think we will see a resurgence. But I think for the lower risk people, I'm hoping that the worst of it, so to speak is, is over with. But time will tell. And I think we are eventually going to have to have a vaccine for this. I just hope we're able to find a safe and effective one. 
  
  
• Thoughts on why some colleges are able to control spread better than others?
  I'm not sure that any colleges are really controlling the spread better than others. I think probably what we're seeing is a reflection of some colleges doing more extensive testing than others. Finding more cases, per se, and again, I think this gets back to the thing we were talking about last week. Whether identifying all of these cases in the young and healthy is truly critical, especially with this issue of the PCR tests, perhaps identifying a lot of people who are not likely to be transmitting the virus and especially if people are asymptomatic.
  
  I think JMU has an identified a thousand cases of late. I'm not sure that it's truly critical that they identified all those thousand people. Because again, we don't treat other viruses this way. So it's sort of, we're still in this strategy of identifying every potential person who has been exposed to the virus that we possibly can. And I'm not sure that that's the most prudent use of resources, especially in the young and healthy.
  
  I think it's better to isolate the sick when they do get sick, so they don't transmit it and to identify the ill quickly and provide them with supportive care, but in the young and healthy, I'm just not sure that it's super necessary to identify every single case, every single time. So I think what you're seeing in the colleges is more a reflection of differential testing strategies, rather than certain colleges being better or worse about spreading the virus in general.
  
  I think most young people are not doing a great job of the social distancing, the mask wearing, etc. They're young people. They're going to college. They're mingling. They're doing what young people do. I think, regardless of what government officials are telling them, and regardless of whether they were in college or out of college, the young folks have been doing the same stuff since the start of the pandemic. And I don't think their behavior is likely to change. I think that more or less, you're seeing the differences in how aggressive certain universities are or are aren't being with testing, rather than whether they're being good or not about controlling the spread of the illness or the virus. So Andy says, is infection in colleges and universities mainly a matter of luck.
  
• Is infection in colleges and universities mainly a matter of luck? Should we expect those with few infections to have more over time as their luck runs out? (Assuming campus testing is reasonable.)
  
  Yeah, I think it is pretty much a matter of time. I think most of the colleges, if they have somewhat rigorous testing, I think they're going to find more cases over time, especially as the weather cools and more and more people spend more time indoors, you will see outbreaks. It's going to happen.
  
  Now, the question again becomes, same thing. Is it important that we identify every single person, asymptomatic or not, with the virus. I think maybe not. I think it's definitely critical that we identify the ill and isolate them, because those people are likely to be transmitting. I think that for the asymptomatic, who the data seems to be indicating may not be really transmitting the virus too much or as much as we thought, it may not be so critical to identify all those people.
  So I think we're going to need to keep being flexible with how we interact with this virus. I think it's fine to be cautious, but I think we have to balance that out with some judicious use of the new data that's coming out and say, okay, maybe you don't need to identify all of these people. And let's just test the sick. 
  
  I think time's going to tell a little bit, a little bit with that as we go on. So yeah, I think it is just a matter of timing. And I think mostly what we're seeing is differences in testing strategy rather than differences in school policies, because even school policies that are very strict, and you're seeing students suspended and kicked out of school for violating these policies, it's not keeping the kids from doing what college students do, which is get together and spend time with other people.
  
  
• So, data suggests that asymptomatic infected students don’t pose a risk to older college faculty and staff?
  
  No, no, no. I think that hasn't changed. So symptomatically infected people, I think same thing, no change in that we definitely need to identify all the symptomatically infected people. I'm talking about whether it's important or not to identify all the asymptomatic people. There are people who have very minimal symptoms,. But yeah, symptomatic people, we absolutely have got to keep testing all those people aggressively.
  
  But what happens when you have one symptomatic person is it starts this concentric ring of testing contacts and all the contacts of those people. And it may not be as critical as we thought to find every single positive person who's asymptomatic, right? And that's in line with what the CDC has been slowly updating their recommendations for, where they have made some changes of, okay, if you're a primary contact, but you're asymptomatic, we may not need to test you.
  
  Not all States are following that currently, and that's fine. But I think that is consistent with what the CDC is saying.
  
  So I think that the answer is to your question, there's no definitive answer to your question, but I think there probably is less risk from asymptomatic people than we thought based on this new data coming out, that the asymptomatic probably are not really transmitting the virus too much.
  
  But I think we're sort of still in this gray area where the data is evolving. So I think it's likely that they're not a risk for transmission based on what we're seeing from this data that's coming out, but you can't say that definitively just yet, which is why I think for the older faculty or high-risk staff and faculty, if they're concerned about their risk, they still need to be given the option to work virtually.
  
  
• Any further advances in possible monoclonal antibody therapy?
  
  I have not seen any new studies on this lately. I'm suspecting that the studies are still in progress and they just have not reported out the data yet. But no, unfortunately I have not seen anything new in that regard just yet.
  
• Are there any indications of other new or weirdo viruses coming out of the blue. This one's quite enough, but curious?
  
  Oh yeah, absolutely. There's always new viruses coming out. And that we're finding all the time. The World Health Organization, the CDC, other health organizations monitor the development of zoonosis, so viruses that show up in animals and in people all the time. There are always new viruses cropping up. Flu viruses in particular are heavily monitored, especially animal flu viruses, because they can so easily crossover into humans.
  
  So, yeah, I expect that we will continue to have new viruses like this on a regular basis.
  Nothing is gonna stop that process from going on as it has been going on for decades. And it's probably going to continue to escalate, because of how connected to the global economy is at this point. It's pretty much inevitable.
  
  
• How do you feel about the vaccines that may be coming in October and November?
  I don't really think any vaccines are coming in October or November to be quite honest. I don't think they're going to be ready for prime time by then. I think that would be way too rushed. I just don't foresee it happening.
  
  I could be wrong, but given that some, at least one of the major trials that's going on is halted as of today to check on some safety stuff, things just take some time and I don't think they should be rushed. And I think they're just not going to be ready by October, November. We'd be happy to be proven wrong on that, but I just don't think they're going to be ready in time. And I don't think we're going to have enough safety data yet to really implement that on a wide scale.