Hello, and welcome to my channel Medicine with Dr. Moran. I'm Dr. Keith Moran. It appears that we're
now entering the endemic phase of Covid-19 due to both the vaccines and therapeutics which we have
to protect people. There will be new variants but hopefully these will easily be able to be managed.
We've known for a long time that this virus was going to be endemic eventually. We have to learn
to live with this virus. I'm sure you've heard that. Policies of Zero Covid and herd immunity
as most people think about it are not going to be possible with the current medical approaches.
This video is about what people need to focus on now as many countries in
the western world are opening up. I'm talking about things like optimizing your immune system,
getting your health problems under the best control possible, risk management, beginning
to live again to improve your mental health, and developing a plan for what to do if you were to
get Covid or get re-infected. There are chapters for your convenience in the description below.
The first and most important thing is to optimize your health so you do your best to stay healthy if
you are and to get healthy if you're not. This is probably the biggest single most mistake in
this pandemic in general. Any doctor will tell you that the better health you're in the more likely
you're going to fight any disease successfully. There should have been huge campaigns to improve
people's health at the very beginning of this pandemic. I told my patients of the importance
of staying active, eating well, sleeping well, as the pandemic started. These pandemics don't
suddenly go away. There is time to improve your health ,reverse comorbidities that you might have,
or at least manage them better. We're two years into this particular pandemic. Next it's important
to improve your mental health. Most people have been living literally on hold waiting for this
to be all over. We need to understand that we're now in a much better situation with vaccines and
therapeutics that hopefully further waves of the virus will not lead to any restrictions.
If you're concerned about getting back to your pre-Covid activities you should consult
your doctor to assess your actual personal risk and find out what treatments and care you have
access to if you do get sick. Having a plan will help you feel much better. I know firsthand that
some people are still living with a heightened amount of fear which is not healthy itself.
If you know of someone who's having a hard time adjusting to things right now and who may find
this video helpful please share it. Many people of course significantly overestimate their risk or
even underestimate their risk. You need to do your best to get any health problems under control.
This means going to your regular medical appointments whether they're in person
or by telephone or even video. Doctors of course take precautions like I do to keep
their patients safe when we're providing medical care. Cancer screening for example is important.
It's always better to find out that something's wrong sooner than later. Since the fall of 2020
we've seen cancers I've had a number in my practice that were not diagnosed when they
should have been and they grew much worse because of the fact that things were locked down and
appointments were pushed back. People have missed appointments either with their regular physician
or going to the emergency department when they need urgent care because they're afraid afraid
of getting Covid. It's important not to miss those opportunities to seek medical help if you need it.
I made a video on the best ways to improve your immune system so you've got better chances of
beating whatever comes your way in life. If you do get Covid and you're at high risk there are
numerous treatments which I'll talk about towards the end of the video which can be given to prevent
severe disease and hospitalization. I would also recommend making arrangements for care at home if
you do get sick. At home sick care could include having some extra food if you can't shop for a
while, arranging with friends or family to check in on you, or knowing of an organization that can
help you out in such situations. Having a plan will ease your mind. Now there will be more Covid
variants unfortunately and one of the things that we can do is waste water testing. This will help
us diagnose a new wave much faster because it shows up in the waste wastewater first.
That's quicker than people presenting with symptoms and would allow us to assess the virus to
see if it's a new variant or not if a new variant was to arise that could causes more serious
illness that would be a concern and that obviously would have to be dealt with. Now the ideal
situation of course would be if a new variant would cause less severe disease even than Omicron
and even higher risk people would not end up in the hospital just like a common cold coronavirus.
Our knowledge of viruses is limited to the last 60 years or so but it's possible that
the four common coronaviruses may have caused more serious disease many centuries ago before
we had good records and ultimately mutated to the viruses that we have now and for the vast majority
of people if you get one of those common cold coronaviruses you simply get cold like symptoms.
This of course is the biological evolution of viruses because they don't want to die
out. They're looking for new people to inhabit so they must evolve in order to transmit and do that.
The problem is we don't really know what period of time it takes these viruses to mutate to a less
serious form and it's a question I've been asked a lot over the last couple of years.
Now fortunately the Omicron variant is less serious in terms of the disease that it causes
but unfortunately it's so much more transmissible that many countries
have seen just as much hospitalization and death as Delta for example even though it's
a less serious virus when you get it. So what do we do now? In many countries there have been
lockdowns in order to protect hospitals and healthcare workers from becoming overwhelmed.
We have not seen more hospitals being built, more nurses, respiratory technicians,
and other health workers being trained either. This has caused significant strain on health care
and burnout of course with some health care workers leaving the profession altogether
and many being very disillusioned. There have been significant shortages of health care workers
in different countries and unfortunately many have been fired for refusing to get the vaccine.
There are about 40,000 care workers fired in the UK many of which I'm sure had natural immunity
why because through their job they came into contact with covid-19 and I've said on many of
my videos that natural immunity has been shown to be as protective as vaccinations but most
countries don't have a policy to deal with natural immunity. So what can you and your family and
friends do now that this is endemic? Well it's important to address people's comorbidities and
general health as I've mentioned. This would have saved many lives protecting the people at risk.
One of the many harms of lockdowns are the fact that most people tend to eat more because they're
stuck at home. Staying at home leads to things like depression, anxiety, drug use, alcohol abuse,
physical abuse of others and so on. As I've said before we're all going to get exposed
to this virus at some point and many of us are going to get infected and re-infected. If your
general health changes you can be more seriously ill when you're reinfected with Covid. The hope
was that we would have a better vaccine that would stop transmission and provide good immunity in the
nose and mouth so people who got exposed would not get sick and would not give it to others. If your
general health changes you can be more seriously ill if you get reinfected with Covid-19 that's
something to remember. The hope was that we would have a better vaccine that would stop transmission
to others and provide good immunity locally in the nose and the mouth so that people would not get
sick and would not transmit to other people. It's important to remember that the vaccines are good.
They are dissociating the number of cases from the number of hospitalizations and deaths and
they're protecting the people that are most at risk of this. It's still important to protect
yourself and your family so that when you do get exposed you're more likely to be asymptomatic
or have mild symptoms. I've always thought about people during this pandemic as either having some
immunity versus being non-immune as opposed to what most people are saying in the media
you're either vaccinated or you're not vaccinated. Now people that have a degree of immunity through
either natural infection or vaccination are best able to fight off a Covid infection.
We're continuing to study what the benefits of vaccination is as well as natural immunity and
this will obviously be a moving target and so questions surrounding this in your specific case
because there's many groups now is best discussed with your doctor. If you've never been vaccinated
and your doctor recommends vaccination it's important to space the first two shots out
eight weeks for safety. There's actually less Myocarditis risk for the MRNA vaccines especially
if you're a younger male and there's also more effectiveness to the vaccinations if you spread
them out eight weeks. Now this would be assuming that you're not immunocompromised or there's a lot
of virus in the community in which case sticking to the three or four weeks interval depending
on whether it's Pfizer or Moderna respectively would then make sense. Now the CDC finally in the
last couple of weeks have actually advised this. I've been talking about this for over a year the
benefits of delaying the second dose and I've made a number of videos on that. This points out the
fact there's a lot of nuance to this pandemic and the one size fits all with respect to different
aspects just doesn't work. Frankly a one size fits all doesn't work for most things in medicine.
Now when in doubt speak with your doctor. Your protection of course is going to vary depending
upon when your last exposure was whether it was an exposure to a vaccine or the virus because
antibodies do wane but we know that protection against serious disease is much more robust.
We've seen with omicron given its relative immune evasion that there is some benefit in people over
the age of 50 according to CDC U.S. data from a third vaccination to prevent severe disease.
This is shown on the slide. Now a strategy to include protective immunity after recovery
from covid does need to be included. We of course have many groups of people now that I
just spoke about some of my patients have had anywhere from one to even four vaccinations
others have had no vaccination but previously been infected some have what we call hybrid immunity.
Which means they've had vaccination plus infection or infection plus vaccination and there are people
out there who are still unvaccinated and have never had the infection meaning they're completely
non-immune. Now the last group of course is the group that's most at risk of a bad outcome from
the virus. So to make a long story short there's a lot of nuance on what to do with each of these
groups and your doctor should be able to provide some help in navigating this going forward.
As some of you I'm sure know the antibody boost now with the fourth vaccination only bumps your
antibody levels up five to ten times which is much less than you see with the third dose. So it may
be that they're ongoing vaccinations that we will need to use completely different vaccines like
whole inactivated Viron vaccine which is taking the virus and inactivating it and using that in
the vaccine. It allows people to make antibodies against other parts of the virus not just to
the spike protein to improve immunity. There's obviously the concern that there will be less and
less benefit with the same vaccine given over and over again. This may not come to fruition but that
is the concern that has been brought up. If the community prevalence is low asymptomatic testing
will obviously stop which is what we're starting to see travel testing will stop and ultimately
if you're sick you'll just stay home for five days and you won't test to come back to work.
Physicians in Canada recently have appropriately pointed out that travel testing positivity rates
are the same as the general population and a few have called for travel testing to be discontinued.
That's something that's going to go away as we shift to the endemic phase. Wastewater
surveillance can and will be very helpful as this tends to go up before an increase in cases and it
will allow us to look for new variants as well. It's important that doctors and the public have
better data about this virus in general that's something I've mentioned in the channel many times
data transparency and getting the data quickly. Holding back on data of course erodes trust and it
makes it difficult for doctors to advise patients on what to do if you or a family member does get
sick and they're at risk. We do have a number of treatments and here's the treatment slide.
These include monoclonal antibodies, convalescent plasma, drugs like Paxolavid, inhaled steroids,
Remdesvir, Fluvoxamine. I have a separate video about this particular type of treatment in the
outpatient sphere. The link is in the description. Now the pandemic has also brought up the issue of
indoor ventilation. Proper indoor ventilation and HEPA filtration has the ability to filter
a number of respiratory viruses to make the indoor environment safer for all people.
Upgrading systems where possible makes a lot of sense when it's time to do that and I think
you're going to see this over the next few years both in homes as well as buildings and I think
as we're going to become endemic they're going to be people who are going to want to mask when
they're in indoor settings and I think we have to be respectful of their wishes. It's their choice
their freedom to do that. Remember that younger people can be immunocompromised too and so if you
see someone who's younger and they have a mask on in an indoor situation please be respectful.
I hope this video has been helpful for you today. I appreciate you joining me on
Medicine with Dr. Moran. I'm Dr. Keith Moran and remember get healthy and stay healthy.