COVID-19 PERSISTS
GERALD ENTE MD

By now, we all know that Merck's new brown pill, an antiviral agent named molnupiravir, has received FDA approval. Merck partnered with Ridgeback Biotherapeutics to produce this oral treatment, replacing currently only iv treatments, not the preventive vaccine, requires taking 2 pills several times daily for 5 days and costs about half of what the iv treatments cost. many other pharmaceutical companies are working on such treatments. This drug may be taken at home.  This drug cuts the risk of hospitalization and death by 50%. This drug may be a game changer.

Multiple studies have shown that Covid-19 causes an unusual complication in as many as 1 out of 3 patients who recover from this disease. Long Covid symptoms continue for 3 to 6 months post infection. (I am working with 2 patients who have had their symptoms for at least 8 months). Symptoms include shortness of breath, cough,  joint and muscle pain, abdominal distress, diarrhea, brain fog,  memory loss, sleep disturbances, fatigue, anxiety and depression.  Much research is being done everywhere on this condition and yet we do not know why this happens. Research on data from 81 million patients does show that 1 in 3 patients continued to have at least 1 of these symptoms persist after 3 months. This complication was higher in people who had more severe disease and were more slightly common in women. It has occurred in mild and even asymptomatic cases, and no difference was found between whites and non-whites. A study from the UK on 1.24 million patients showed that the odds of developing long covid about 5% after full vaccination. Israel has  reported several cases. I could find no good data on the chances of long Covid happening after breakthrough Covid infections. Kids can get this also. On 9/13 CDC defined long Covid, long-haul Covid, chronic Covid, post Covid as “health problems that last 4 or more weeks after first getting infected with the coronavirus”. People affected with this may be eligible for rights under the American Disability Act of 1990 (a great article in FORBES magazine 9/13/21).

For some reason I cannot explain. In the USA we are paying no attention to Natural Immunity. We are not accepting proof of natural immunity, which means that you have developed immunity naturally after surviving Covid-19 and can prove it with laboratory results. An Israeli study shows that natural protection from the infection gives a stronger response than full mRNA vaccine. Plus adding a single Pfizer shot (a booster) gives super immunity. So there is the question of whether those survivors actually need the 2 shots. There is an argument with conflicting data on both sides as to which immunity is stronger: natural or vaccine induced. Virologists know that severe viral infection is associated with a strong antibody response while less severe infection is associated with a T-cell response. Before we had a Chicken Pox vaccine, we used to have Chicken Pox in order to get over this disease. Yet in the USA schools, colleges, municipalities as well as the Federal Government do not accept proof of natural immunity.

• We know there is a clear connection between disease and brain pathology. Also there is preliminary evidence that even mild Covid disease can have long term brain dysfunction and possibly neurologic deficits.
• Delirium is common after hospitalization for severe disease.
• Flu shots may be given at the same time as Covid shots or boosters.
• Monoclonal antibodies reduce Covid hospitalizations and death by nearly 80%.
• De Blasio offered a $100 incentive for taking vaccine. 
• No increase in miscarriage risk after Covid vaccine.
• Pregnant women pass high levels of antibodies to their fetuses. CDC says Covid vaccine is safe for women who are pregnant, breastfeeding or trying to conceive.
• Microbes in your gut affect your immune reaction to this virus… there is a potential for future prevention or treatment.
• Complications of nasal swabbing reported on 1.6 million people in Sweden were 8 in total: 4 broken swabs and 4 minor bleedings.
• Private insurance carriers are considering financial changes in the future for Covid related claims.
• Even if no one else is wearing a mask, a mask still can help protect you.
• Covid Delta patients have 2 times greater risk of hospitalization than with Alpha variant patients
• Over 11 million children’s routine vaccinations were missed so far during the pandemic mostly because people stayed away from medical facilities or clinics were closed.
• Unvaccinated teens were hospitalized 10 times more than vaccinated teens.
• Studies show that Covid-19 is highly transmissible 2 days before and 3 days after symptom onset. (This means before you know you are sick. Also remember lots of Covid cases have no symptoms.)
• Inhaling Hydrogen Peroxide directly or by nebulizers not only will not prevent or treat Covid but it may injure your lungs permanently.
• Remdesivir reduces risk for hospitalization in high-risk patients.
• Ivermectin is a large animal (horses and cattle) drug used for treating parasites. it was not made for human consumption… doses are based on animal weight in tons not pounds. Agricultural states are running out of this because it is being used falsely to prevent and treat Covid in humans, who then frequently have overdosing reactions serious enough to require hospitalization (taking up beds in ICUs and regular wards).
• Alaska, Montana, and Idaho are rationing entry to hospitals because of lack of beds. Doctors must decide who lives and who dies. • Masks do not cause carbon dioxide poisoning. The Doctor in Oregon who flouted this had his medical license revoked. • Newly discovered health benefit of this vaccine is a positive mental health effect, while the pandemic, itself, is causing anxiety, depression and other negative mental health effects.
• Delayed (2-12 days) local skin reactions (COVID ARM) which occur most often from Moderna vaccine is a delayed skin hypersensitivity and is not reason to discontinue the series.
• Moderna is now beginning phase 1and 2 studies on a mRNA seasonal Flu vaccine.
• Researchers are using mRNA technology to work on a new vaccine for multiple sclerosis.
• Covid-19 is killing rural Americans at twice the rate of urban Americans.
• California announced the first state mandate requiring all school children from elementary school through high school, both public and private, to get the shots once the vaccine gets full approval by the FDA for each age group.

In response to the 8/28 mandate that all persons working in NYC schools must be vaccinated on 10/4 it was reported that 96-97% of teachers have taken at least 1 shot. 

• A preprint of a Canadian study on the cardiac side effects of the vaccine leaked and hit the press. It contained a mathematical error showing a high rate of myocarditis; it spread like California wildfires via the anti-vaxxer movement; the retraction, of course, was hardly seen; lots of good scientific educational damage was done.  Myocarditis remains a rare side effect. Still Scandinavia suggesting that Moderna vaccine not be used for young people (10/6)
• It is 1 thing to argue, even emotionally against mandates. I believe the following physical actions are not okay: Anti-vaccine villagers in Guatemala held nurse hostage and destroyed 50 doses of vaccine. Hundreds of US commercial flyers have become violent injuring working airline flight attendants while in the air because of the mask mandate. In Amador County, California a fourth-grade student’s father punched and seriously hurt a teacher over the mask mandate.
• Both mRNA vaccines are effective against Delta variants, but Moderna has maintained its full efficacy by 9/23 while Pfizer has dropped from 91 to 77%. The Pfizer vaccine elicits a “relatively slower” antibody response than Moderna. Both are still excellent.
• Unlike the flu which seemed mild last winter, common colds persisted. Remember that having a common cold makes you more resistant to catching Covid infection.
• Moderna is working to develop a single combined shot booster for the Flu and Covid for the future using the mRNA technology.
• Shingles Vaccine has been shown to lower risk for Covid disease diagnosis by 16 % and chances of hospitalization by 32 %. (This has its basis in the fact that there is an innate immune booster response from 1 virus protecting against another.)
• A 3D printed microneedle vaccine patch that outperforms shots is being developed by scientists at Stanford University and the U of North Carolina.
• 5 countries report zero cases of Covid: Turkmenistan, 3 isolated island countries in the Pacific and of course North Korea.
• Recent studies have shown that cloth masks are not as effective as disposable paper surgical masks. N95 is considered the most effective.

The US appears to be having fewer new cases of Covid although the daily death rate still sits at around 1800. Dr. Fauci warns against complacency. Winter with its cold weather might easily bring another surge of new cases. Unvaccinated people are 11 times more likely to die Covid-19 than vaccinated people. A super study shows the Covid 
vaccines have prevented nearly 140,000 US deaths through May 2021. About 570,000 people had died of Covid in the US by that time instead of the 709,000 predicted deaths in this study. New York State was found by those researchers to have the greatest reduction in deaths, 12 less per 10,000 people in the state (with a population of 19.45 million, that figures to be 233,400 lives saved in NYS). This study highlights in numbers the crucial role that vaccines play. Covid
vaccines work. The benefit overweighs the risk. They cut the risk of transmitting Delta. Usually we produce herd immunity against a virus at a rate of 70-75%. With Delta, experts are saying we shall need 90%.  vaccination rate. Because of the unprecedented politicization of medical knowledge, the continued disinformation attacks, the speed of viral mutations and the mounting anti-science aggression, we all must try extra hard to do all we can to see that our families, friends, and neighbors get vaccinated.

Stay safe and be well.

Gerald Ente, MD
Honorary Association Police Surgeon

  DOWNSLOPE OF COVID-19
by GERALD ENTE, MD

6/21/2021 

     As we enter the downslope of the Covid-19 pandemic, I think it is important to write an update, a review, a piece with my opinions about this pandemic.  By 6/15/21, 20% of the world's population had received at least 1 dose of the vaccine; 53% of Americans have received 1 shot while 44% are fully vaccinated.  The G7 meeting concluded with a pledge of 1 billion doses to be given to poorer countries; President Biden pledged 500 million doses of the Pfizer vaccine to poorer countries.  According to the NYTimes, we are paying about $7 per dose. By that date, over 600,000 Americans have died from this virus. Blacks account for about 15% of these deaths; Hispanics account for about 19%; Asians about 4% and Whites about 61% according to Johns Hopkins University.  Although these percentages are not far off from the racial distribution of the US, the deaths in the Blacks and Hispanics, however, occur in younger age groups. Global death toll is about 3.8 million with about 177 million cases reported.

     Let us go to CDC, the Centers for Disease Control, which is our nation’s leading health protection agency.  Its’ mission is to save lives and protect our people from threats to their health and safety.  CDC has always been considered top-notch, always looked-up-to by the US as well as the world, always revered by Public Health officials, American peoples and worldwide agencies.  Wherever in the world a medical threat arose, there was CDC.  In its hey-day, CDC, for example, was intimately involved with the eradication of Smallpox worldwide, lowering the devastating death rate that Malaria produced in Africa and the recurring epidemics of Measles worldwide.  To me, it seems that the downfall began in the late 1970's during the Swine Flu epidemic when a bunch of soldiers at Fort Dix in New Jersey died unexpectedly.  The Swine Flu epidemic then swept through the country.   Efforts with the vaccine program met with failure.  President Jimmy Carter fired the CDC director.  From that time on this Directorship became a political appointment chosen by the President rather than a career civil servant public health official chosen from within by their peers.  After that, the White House meddled with affairs of CDC, instructing CDC in what to do and what not to do. This was magnified with the entrance of Covid-19 where CDC hit bottom in my opinion. This has necessitated a major rebuilding of the agency as well as its reputation.  This shall take time.

     COVAX program is an initiative that aims to distribute the Covid-19 Vaccines equitably throughout the world to needy nations. It is co-led by the WHO [World Health Organization], CEPI [Coalition for Epidemic Preparedness Innovations] and GAVI [the Vaccine Alliance, formerly the Global Alliance for Vaccine and Immunization]. They plan to deliver free Covid vaccines to 20% of the population of the poorest nations of the world.  Global herd immunity cannot be reached until the percentage of about 70-75% positives is reached worldwide. Their plan is to deliver 2 billion vaccine doses to the 92 poor countries by the end of 2021.  Thus far, 50 nations are part of the giving group.  (According to google, there are 195 countries in the world.)  Actually, thus far, about 1.5 billion vaccine doses have been given globally with nearly 65% administered to the 20 richest countries. This is not equitable. Several countries have not signed up with COVAX. Cuba plans to use their own vaccines. Tanzania has refused vaccines after a political leader had said that prayer has driven the virus away. Haiti has refused to accept the Astra-Zeneca vaccine and so remains the only country in the Western hemisphere to have ZERO vaccinations. As of 6/21/21, COVAX has distributed 88 million doses to more than 131 countries. Their problem has been supply of the vaccines. The richer nations have bought up most of the available supply.  The Serum Institute of India, which manufactures the Astra Zeneca vaccine and was to be the primary supplier for COVAX, has had to use its resources to assist its own nation as their numbers have skyrocketed. In the middle of May, the USA promised to donate 80 million doses. On June 10 President Biden pledged to buy and donate, 500 million doses of Pfizer vax.  Astra-Zeneca has planned to give 60 million doses (not yet authorized for emergency in US). Pfizer and BioNTech have pledged 1 billion doses in each of 2021 and 2022.  COVAX has stated that they expect to deliver at least 2 billion doses by the end of 2021.  MasterCard has just pledged to give GAVI a donation of $25 million. It is my opinion that COVAX will not meet their goal, I am sorry to say.

     Novavax, the fifth private company which has received major federal vaccine support, announced that its 2-dose vaccine is safe and 90% effective in adults.  The vaccine is named NVX-CoV2373. Their original study included 30,000 people over 18 years old across 119 sites in the US and Mexico.  They had announced that a study in the UK using 15,000 people was 96% effective while a study in South Africa using 3000 people, was only 86% effective due to the resistance of the local variant. Their vaccine is simple to transport and store, requiring regular refrigeration only. They plan to request emergency use authorization from the FDA in September when they have pledged a 1.1billion dose vaccine donation to COVAX.  Their plan is to use their vaccine for booster shots if/or when boosters become necessary. Novavax is a protein based vaccine, meaning that the proteins studded throughout the virus are used to enter the human cells and teach the cells to copy this protein, thus affording immunity.

     A special possible side-effect problem had arisen with the Pfizer and Moderna (the 2 mRNA) vaccines. There is a statistical potential linkage to 2 heart problems worthy of discussion.  A small number of young people, 226 thus far in the USA, have developed an inflammation of the heart muscle (myocarditis) or an inflammation of the membrane sac surrounding the heart (pericarditis), which usually has been mild. This has occurred mostly in males, mostly in athletes, mostly between the ages of 16 to 24 and mostly after the 2nd shot. Statistics from Israel show that this rare possible side effect, if it really is a side effect, has a risk factor of 0.001% (62 out of 5 million people). Israel data did, however, include 2 deaths in their study although the typical cases were mild and required only 2-6 days of rest and supportive care in hospital.  Experts state that the risk of myocarditis is far greater (a thousand-fold) from the disease than from the vaccine. Many viruses cause myocarditis.  Also, several other vaccines are known to cause myocarditis.  In addition, the hospitalization rate for teens is rising at a deeply concerning rate not only in the USA but internationally, possibly due to increased transmission of the variants, possibly to the extra-curricular activities like sports, or possibly due to the life-style of adolescents and young adults.  This is a "thorny issue.”  We need to weigh out the risk-benefit ratio...the generally mild nature of Covid in healthy youths, the greater risk of these heart problems from the disease than from the vaccine, the need for the speedy herd immunity to prevent the resistant and serious variants, the 2 deaths. Our experts have not yet reached a decision..."thorny" indeed.  The UK ministers have advised against the mass vaccination of 12–15-year-olds. CDC is expected to reach a decision about this in the near future.  

     The World Health Organization (WHO) on May31 decided to change the naming of the variants for simplification and so that there would be no stigma given to the nation of origin of the variant (like the Brazilian variant).  They changed from an alphanumeric system to the Greek alphabet They began with 10 variants only: 4 in Variants Of Concern (VOC) which means that the WHO and CDC consider these to increase transmissibility, increase virulence and interfere with public health diagnosis, therapy or vaccines (this means that these are a significant threat to the non-vaccinated); 6 in Variants Of Interest (VOI), which means that they can form clusters and appear in multiple nations (probably covered by our vaccines).

Variants Of Concern include:

•            Alpha=  B.1.1.7 originally found in the UK/Kent...listed on 12/18/20

•            Beta= B.1.351 originally found in South Africa... has at least 3 other names...listed on 12/18/20

•            Gamma=  P.1 originally found in Brazil...listed on 1/11/21

•             Delta=  B.1.617.2 originally found in India...listed on 5/11/21 

Variants Of Interest include:

•            Epsilon= B.1.427-B.1.429 first found in USA-California...listed on 3/5/21

•            Zeta= P.2 first found in Brazil...listed on 3/17/21

•            Eta= B.1.528 first found in multiple nations...listed on 3/17/21

•            Theta= P.3 first found in Philippines....listed on 3/24/21

•            Iota= B.1.526 first found in USA--NYC...listed on 3/24/21

•            Kappa= B.1.617.1first found in India...listed on 4/4/21

•            Lambda = C.37 first found in Peru...listed on 6/14/21

Other viruses will be given Greek alphabet names as they become of concern or interesting.  Presently in the USA, Delta variant is responsible for about 10% of our cases (it increased from 6% to 10% in 1 week) but there is fear that this may become our predominant strain shortly.  This is where the race of mass vaccinations is important.  Delta is 50% more contagious, is more virulent and now is considered a virus of concern by CDC, which means that it is possibly resistant.  A study in the UK showed that the Pfizer vaccine was 88% effective, and the Astra-Zeneca vax was 60% effective against Delta (significant), which has been found in 80 countries. The Delta variant is now the most prevalent in Moscow, where we are told that their case numbers have tripled in the past 2 weeks.  All 4 vaccines used in the US are somewhat effective to the variants at present.  Alpha is highly transmissible, affects the younger group, and requires more oxygen, but there is a question about how lethal it is. Alpha is now the most common in the US. Gamma is the second most common. Beta was found to break through full Pfizer vaccinated Israelis. In other studies, the Pfizer vax was found to be only 33% effective after 1 shot while increasing its effectiveness to 90% after 2 doses against most variants.  In Florida, it has been shown that Hispanics are hit the hardest by the variants. As India is near drowning with Delta, a new 'double mutation' has been found. It is a combination of the Beta, the Gamma and the Epsilon variants.   Remember, viruses mutate rapidly so these aberrations can and do happen. These combinations can become catastrophic. The importance of speed for an effective vaccination rate locally, nationally, and globally cannot be overstated.  Early speed is the best tool for fighting a pandemic.

     Studies in Finland show that the vaccine has an indirect effect of protecting non-vaccinated household members of the vaccinated person.  They studied healthcare workers who received the vaccine at the beginning of the epidemic and found that both mRNA vaccines caused an immune response in their family members living in the same household.  An Israeli study also showed cross-protection from the vaccine that they were using - the Pfizer vaccine.  They showed that for every 20-point increase in adult vaccination rates in a community, the risk of kids testing positive (getting sick) drops in half. They also show that people getting only 1 shot and then getting sick with this virus have smaller viral loads, which means that they are less transmissible.  This cross-protection provides proof that vaccinated people provide protection to the unvaccinated people in their community.  This is important for the consideration of herd immunity. This type of study is being done in many European countries.

•            Covid-19 was the third leading cause of death in the USA in 2020.

•            The US administered its 300 millionth vaccine shot on 6/5/21.

•            Vaccine goal in the USA is for 70% of adults to receive at least 1 shot by 7/4/21.

•            The Pfizer vaccine no longer needs special deep freezing.

•            Women report more side effects from vaccines than men.

•            Dogs now have been trained to "sniff out" the diagnosis of Covid with 96% accuracy.

•            Delay of the 2nd Pfizer shot by 3 months compared to 3 weeks allots a greater immunologic responses. Remember, Canada did this attempting to  vaccinate more people faster without this knowledge and they turned out to be lucky.

•            Repeated studies show that people who never wear masks are twice as likely to get infected as those who always wear masks...interestingly wearing masks also protects against the Flu.

•            Businesses and hospital systems are mandating vaccines for their employees...a hospital in Houston, Texas fired 178 of their employees who refused vaccines...those employees sued the hospital...A Federal judge ruled against the employees.

•            Re-infection is milder than primary infection.

•            Breast milk does not spread this infection...Covid vaccines produce full immune responses and are safe for pregnant and lactating women. In spite of this just 16% of American pregnant women have received vaccines according to CDC on 6/15/21.  A US study of both mRNA vaccines showed that women receiving the vaccine during their 3rd trimester produced a strong immune response and were likely to transfer antibodies to their babies. This disease increases the risk to pregnant women for preterm delivery to 60% as well as for pre-eclampsia to 76%...non-brainer to me.           

•            COVID NAILS are a new sign that a person has recovered from this infection...2 separate findings...a reddish half-moon pattern appearing above the normal half-moon at the base of each nail...or a horizontal line or depression above the normal white half-moon at the base of the nail occurring weeks to months after the infection.  These are proof positive of having recovered from Covid-19. The normal white half-moon is called lanula.

•            Most people admitted to hospital after the vaccine [within 1-2 weeks] were actually infected before they received the vaccine + before immunity could develop...CDC finds that less than 1% of fully vaccinated people become infected.

•            Yale researchers have shown that the rhinovirus, the most common cause of our colds, protects against Covid-19 as well as the Flu.

•            Study from Miami showed that sperm are not affected by the vaccines.

•            US government plans to invest $3.2 billion to develop anti-Covid-19 oral preventive pills

•            China has 2 inactivated virus vaccines in use throughout the world (Sinopharm +Sinovac). Chinese CDC says that they "don't have a high protection rate".

•            Re-infection rate was less than 1% after recovery from severe infection in studies before variants became more common.

•            No close contacts have been reported to become positive in 2/3rds of laboratory confirmed cases as of 5/17/21.

•            People with high levels of ACE-2 (a biomarker of cardiovascular disease) in their blood are more likely to get severe infection.

•            Polls show that people trust their personal doctors more than other scientific or governmental sources.

•            Repeated studies show the vaccines are safe for people with chronic inflammatory conditions, immunosuppressive conditions and therapies but they may not mount a good immunologic response.  So, it is worth it to get a follow up blood test after 3 weeks.

•            Ventilation outside with only a gentle breeze is over 100 times more effective for disbursing the virus as in an office and over 1000 times better than in most homes.  Studies show that only 1 case in a 1000 is linked to outside transmission. These viral droplets are dissipated in the air and deactivated by normal ultraviolet radiation, heat and humidity. Therefore, masks are not routinely needed outside as long a physical distancing of 3 feet is maintained.

•            3 in10 healthcare professionals say that they are considering leaving their fields due to the stress of the pandemic. During the first 1 year of the pandemic more than 3,600 US healthcare workers have died. 96% of physicians in USA are fully vaccinated.

•            A study done in Spain, in an attempt to assess the risk at mass gatherings, was done using about 1000 people at a 5 hour indoor concert under strict safety measures wearing N95 masks and other full preventive measures.  It showed no participants got sick.  Similar studies are being done in other European countries.

•            There is a possible link with these vaccines and tinnitus, which is constant sound in the ear. About 1 in 2,500 adults getting the vaccine have reported this.

•            Covid-19 disease with fever and oxygen therapy may be responsible for the loss of gray matter in the brain according to a study from the Georgia Institute of Technology.

•            Children with autism and ADHD are capable of wearing masks according to the JAMA.

•            Mixing of the vaccines is now acceptable.  Spanish studies show that Astra-Zeneca following Pfizer is safe and effective. (this was taboo).

•            'Black Fungus", an invasive, normally rare skin fungus infection is appearing more commonly now in India after recovery from the virus in people whose immune systems were damaged and were treated with steroids. Remember it is a small world today.

•            Black women have a higher death rate here than renin other racial groups.

          There are many more topics I would like to discuss but time and space prevent this now. Some of these are: passports, hesitancy, airborne transmission, emergency use vs. full use, future pandemic, blood clot issue, treatments, medical vs. political issues, origin, split states and nations, boosters, payments for vaccine and long haul.  Perhaps at a future date these will be attended to.

      Hippocrates, the father of medicine, once said “The greatest medicine of all is teaching people not to use it.”

Preparedness, prevention, vaccination, hand washing, masking, social distancing when needed, these are what we can do, what we must do and, I hope what we shall do.  Remember, when you get a vaccine, you help yourself as well as your communities.

Stay well and be safe.

From Lou Hollander keystonecop1@verizon.net

This is the update from Errol from the SBA regarding Emblem/GHI.  I’m pleased to say that 64 new doctors have been already accepted since the Emblem Panel has been reopened. The PBA and DEA MLC liaisons, Mr. Nicholson and Mr. Russo, were involved in having Emblem health reopen its panels as well.  This is a group effort now between all three police unions.   A special thanks to all three men for their efforts in helping us retirees.  
Negotiations are still going on and I will post all info that I receive as I receive it.
Bill McMahon

Bill,
This is from an email from Emblem Health outlining instructions to nominate a provider for participation in the Emblem Health network.
We also requested and received a roster of GHI CBP Participating Providers and geo-search matching Florida plan participants to providers within 10 miles of their zip code. We found fault in this analysis as it used a provider list that was not updated nor verified.  We therefore requested a complete audit of providers -in fact status verifying their "active" participation in the GHI CBP networks and acceptance of new patients.
We believe if we verify what we currently have and work with members to aggressively add providers we can have a vibrant network of providers in Florida, North Carolina and South Carolina amongst other regions.
FYI
Errol
 
Gentlemen,
I have the following information regarding adding providers to the Florida, North Carolina, South Carolina Emblem Health in network  medical panels.
We are pleased to announce that the process for GHI non-Medicare retirees nominating doctors with the intention of being added as CBP participating providers, has been restored as of today.
 
1.            EmblemHealth’s Customer Service, Provider Network and Grievance & Appeals advocates (representatives) have been informed that the network is in fact, open for provider nominations; letters will no longer state the network is closed.
 
2.            Members who wish to nominate their provider may contact EmblemHealth via telephone or email. If an Emblem advocate receives a call from a CNY PPO (GHI) Retiree member requesting information on how to nominate their provider for participation, advocates will:
               Confirm the member is an active CNY PPO Retiree plan member
              
Obtain the following information:
              
             Provider’s full name
             Practice name
             Contact person
             Address
             Telephone #
             Specialty
             Email the information to cityofnyretireesprovidernomination@emblemhealth.com
             If a member sends the request via a secure email from the portal, the correspondence advocate will:
             Review the request to ensure all the necessary information has been provided, see above
             If so, will forward the request to cityofnyretireesprovidernomination@emblemhealth.com
             If the request has incomplete provider information, a reply will be emailed to the member requesting the additional  information
            
Advocates will not send a letter to a CNY Retiree member indicating that their network is closed. If an Out of Network Provider calls requesting to join the CBP network, they will be directed to the EmblemHealth website, Provider Resources > Join Our Network page to access the Provider Credentialing Form: 
https://www.emblemhealth.com/providers/resources/join-our-network
 
3.            Below are the updates implemented on our City of NY micro-site page www.emblemhealth.com/city:
              
On the member CBP page we posted
Nominate Your Providers!

Did you know that the EmblemHealth CBP Network is open to new providers? If you are a City of New York retiree who does not have Medicare, you can ask us to invite your doctor into our network. The process is simple—just send us an email to cityofnyretireesprovidernomination@emblemhealth.com and include the following information so we can reach out:
•             Full name of the provider you’re nominating
•             Practice name
•             Contact person
•             Address
•             Telephone #
•             Specialty

We can’t guarantee that they will join the network, but we will reach out to them on your behalf and offer them an invitation.

2. On the provider Join Our Networks page, we edited the copy to reflect this specific situation
Joining EmblemHealth HIP and GHI
To join the GHI PPO or EmblemHealth EPO/PPO National Network, please make sure you have reviewed the “Credentialing EmblemHealth Applicants” section above.
Our network in Florida is closed except for our CBP network* (non-Medicare City of New York retirees), primary care physicians, cardiologists, orthopedic surgeons and any provider that is joining a group that is already participating with EmblemHealth. The network outside of New York, New Jersey, Connecticut and Florida is currently closed unless the provider is joining a participating group. To join the GHI PPO or EmblemHealth EPO/PPO National Network, please make sure you have reviewed the “Credentialing EmblemHealth Applicants” section above.

*IMPORTANT NOTE: Our CBP Network, which primarily serves City of New York non-Medicare retirees, remains open to new providers. Members can nominate their provider for entry, and providers can submit applications for their practice(s.

With much thanks to our Association's Honorary Police Surgeon Gerald Ente MD

VERY GOOD ADVICE FROM A GOOD DOCTOR FRIEND OF MINE!
By: Arnaldo Liechtenstein, Physician

2) Alert for family members: constantly offer fluids to people over 60. At the same time, observe them.
 
If you realize that they are rejecting liquids and, from one day to the next, they are irritable, breathless or display a lack of attention, these are almost certainly recurrent symptoms of dehydration.
 
Inspired to drink more water now???  Your friends and family need to know for themselves and help you to be healthier and happier.

 COVID-19 UPDATE
by Gerald Ente, MD

 Johnson & Johnson Vaccine

     As the USA death toll passed 500,000 [worldwide 2.5million], this was a perfect time for the FDA to give emergency use authorization to the new vaccine by Johnson & Johnson [ChAdOx1 nov-19{AZD1222}]. An addition to our present 2 working vaccines, both of which require 2 doses and complicated freezing, this vaccine is a single dose and can be kept in a standard refrigerator for a 6-month period.

     This is good news. It gives a major boost to our national vaccine shortage.  According to a major Public Health expert, we need to give 3 million doses of vaccine daily to get ahead of the rapidly spreading virus.  As of today, we are at 1.8 million, but our supply is short. To assist with speedy increased manufacture, Merck & Co. has joined with its competitor J&J to expand speedy production.

     The new vaccine may be given to any person over 18 years of age. The side effect profile is similar to the others. A major advantage is that it may be kept in a standard refrigerator for up to 6 months. It becomes effective after 28 days. It has been used in the UK for many months.  Its efficacy rate averages about 65% overall, 72% in the USA, to prevent disease. BUT IT IS 100% EFFECTIVE TO PREVENT DEATH, COMPLICATIONS OR HOSPITALIZATION.

     Vaccines have 2 effects. One is to prevent the disease and the other is to prevent the serious effects of a disease, such as death, hospitalization or complications like lung, heart, kidney, etc. disease. From my point of view, this new J&J vaccine meets the main purpose of this vaccine, which is to prevent serious damage. 50% of people who contact the disease are asymptomatic anyway.

     Remember that the Pfizer and Moderna vaccines are both mRNA types. This one from J&J is different. It is an adenovirus-replication-deficient type of vaccine. The adenovirus is extremely common causing lots of upper respiratory infections (colds), so that most of us already have immunity to it. Replication is the act of copying or reproducing something. So, here, they are letting the COVID-19 virus ride along with the adenovirus to which we are already immune. It is tricking our immune systems. This is the fourth adenovirus -based vaccine. These are now being used in 70 countries throughout the world. Although this is the first adenovirus-based vaccine approved in the USA, it has been successfully used against the Ebola virus and has been approved in Europe.

     J&J vaccine, called a vector type of vaccine, uses a common human adenovirus as its vector, namely adenovirus 26 [Ad26], similar to the Sputnik vaccine used in Russia. Remember last time we mentioned that the Astra-Zeneca vaccine, which probably will be available in the USA available next month, uses a chimpanzee adenovirus. Researchers try to use a virus which is common to a community so that there is immunity to the virus they choose as a vector [carrier]. Most often this vector is the adenovirus. Next, the researchers render the Adenovirus 26 replication-deficient, meaning that they make it so that it cannot reproduce in the vaccine recipient, by removing the 2 genes necessary for reproduction. Then they replace those with the gene, the SARS-CoV-2 spike protein, which they plan to use. Now, to be successful, the vaccine needs its virus to be able to copy itself in large volumes. To do this, J&J chose embryonic cell lines from human embryonic retinal cells. The Catholic church made a statement about this recently.

     Once the vaccine enters the muscle cells in the arm of the recipient, the infected muscle cells, and the immune system cells, both produce spike protein by activation of the immune system by the [impotent] adenovirus. Unlike the 2 other mRNA vaccine, this adenovirus vaccines uses a DNA pathway because when the DNA-based adenovirus vector enters our cells, it immediately proceeds to the cell nucleus where it serves as a blueprint to produce the mRNA of the SARS-CoV-2 which is then released into the cytoplasm of the cell.  Finally, this guides the production of the coronavirus spike protein, which ultimately causes our immune system to create immunity. So now you see why you may get a red, tender, and swollen and you may get tired and perhaps have a fever...lots going on here...maybe too much information, but this is how the new vaccine works. This process cannot cause any genetic changes.

 OTHER VACCINE NEWS

•           In general, vaccines prevent 2-3 million deaths per year...vaccines saved 37 million lives from 10 diseases from 2000 to 2019.
•           In February, Black and Hispanic Medicare recipients were less accepting of COVID-19 vaccine because of trust issues.
•           In March, White Republicans were found to be largest group of anti-vaxxers.[possibly related to the fact that ex-President Trump and wife secretly were vaccinated in December 2020.]
•           About 1/3 in the USA are anti-vaxxers.
•           President Biden says we shall have enough vaccines by the end of May for every adult American.
•           Second vaccine shot may have more side effects because recipient now has some immunity.
•           New Pfizer vaccines may be kept in a standard freezer rather than ultra-low-degree [-95] freezer for 2 weeks.
•           Pfizer and Moderna vaccines now are more effective against known variants than earlier vaccines.
•           None of the authorized COVID-19 vaccines can cause COVID-19 illness. They are not live vaccines.
•           After receiving full doses of these vaccines, you will not test positive for a COVID-19 viral test. [you develop immunity not disease].
•           After receiving full doses of these vaccines, you should still follow all original precautions-masks, distancing, washing, etc.                                          
•           After receiving full doses of these vaccines, it is recommended that you follow all quarantine regulations.
•           Even after having the disease, you still DO NEED to take the vaccine because you can't be sure of the quality of your immunity...vaccine yields a stronger protection than disease.

•           Smokers [and ex-smokers] are on the priority list because smoking damages lungs causing them to end up in hospital with COVID-19.
•           COVID-19 vaccines may lower transmission of disease.
•           Even if you are 1 of the 50% of recipients who experience no side-effects you are still about 94% protected.
•           After only 1 shot of Pfizer vaccine, you will have 92.6% efficacy; after 1 of Moderna you will have 92.1%; BUT it will not persist...the job of the 2nd shot is to act as a booster and prolong the efficacy...there is data that you can put off 2nd shot about 50 days but no good data after that.
•           'COVID zero' will not happen. Experts agree that COVID-19 will probably become endemic. [will remain prevalent in an area.
•           Herd immunity will have a 70-80% positivity rate.         
•           WHO states that a person can be reinfected with a COVID variant after having successfully recovered from COVID illness.

OTHER COVID-19 UPDATES

       After a year of good data showing that wearing masks is an effective tool, it is not surprising that masks do reduce the number of COVID hospitalizations. There is also excellent data that masks and social distancing are associated with a large reduction in influenza cases and influenza prescriptions [my personal observation] during the flu season. What is surprising to me is that a Walmart security guard can end up in the hospital after being beaten up over a mask dispute or that a Tulane police officer was SHOT DEAD after a mask dispute at a high school basketball game. Wearing a mask is a medical protective issue, not a political issue.   Presently, CDC showed wearing of 2 masks stops about 80% viral size particles [1 cloth over 1 surgical mask]. Dr. Fauci has said that masks will probably still be necessary in 2022.

•           Risk of death is 3.5 higher from COVID-19 than from Influenza.
•           Men are 20% more likely to die from COVID-19 than women. There is a fundamental genetic and cellular difference.
•           Texas, Mississippi, Montana, Iowa, and N. Dakota have lifted their mask requirements despite rising numbers.
•           Mortality incidence overall in household contacts is about 10%.
•           Comorbidities' of this pandemic are partner violence, child violence, divorce and suicide.
•           Schizophrenia adults with COVID have a higher mortality.
•           Dry cleaning kills COVID on clothing. The heat in the process, not the chemicals is effective.
•           Loss of smell and taste occurs in 86% of mild cases in 1 study.  i do not agree with this.

     Not only is COVID-19 a new disease, but after 1 year, the world experts are still learning about it. COVID-19 keeps mutating, keeps changing the rules, keeps causing illness, devastation and death. We keep enlarging our armamentarium in our fight with vaccines, new vaccines, and medications.

 We must continue with our basic tools, including masks, hand washing and social distancing. Even Dolly Parton sings "Everybody should get the vaccine." Any vaccine you get will do a great job for you and everyone else. 

Stay safe and stay well,

Doc Ente

There are 2 ways to gain immunity to the new Coronavirus, SARS-CoV-2, the virus which causes the disease Covid-19.  You can “catch” it [and either have no symptoms or be sick]  or you can be immunized with the vaccine. Here, we shall talk about the vaccine.

ABOUT DNA and RNA
 The disease Covid-19 is caused by an RNA virus. Let’s define DNA and RNA.  DNA is present and the main constituent in chromosomes as a double helix [a twisted ladder].  It is the carrier of genetic material.  Most viruses are DNA.
 RNA, also present in all living cells, is a shorter single helix and acts mainly as a messenger from DNA in controlling the manufacture of proteins. Particularly in this virus the RNA carries the genetic material. 
 Almost all previous vaccines have been DNA type.  This one is different. HIV and RSV in infants are examples of other RNA viruses. We have not previously made a successful large scale RNA vaccine.

ABOUT VACCINES 
 A vaccine is a compound made specially to stimulate production of antibodies which produce immunity to the specific disease without becoming sick from that disease.  Vaccines against Covid-19, in conjunction with the basic anti-Covid-19 measures, are the best way to end this pandemic.

 Although there are about 11 vaccines in the hopper, only 2 are available in the USA at present. The Pfizer and the Moderna vaccines both have been granted emergency use authorization by our FDA. Both are mRNA [messenger RNA] vaccines. A third vaccine by Astra-Zeneca is being used in Europe, but has not yet been approved for use in the USA. The EU has contracted a total of 6 vaccines.
 These vaccines do not contain live virus.  You cannot get Covid-19 or any other disease from these vaccines. This is not possible. There is no tracking chip in the vaccines.

ABOUT PFIZER VACCINE
 The Pfizer vaccine, made with their German partner BioNTech, which may be given to anyone over 16 years, requires 2 doses given 21 days apart. It has a 40-50% efficacy rate starting after 8 days and a 95% efficacy staring 7 days after the second shot. The downside of this vaccine is that it must be kept at -95F in transit as well as in storage.  This requires special freezing equipment.
 In the key double-blinded study of 44,000, only 94 individuals became sick and of those 90% were in the placebo [no active ingredients] group.  this study will not be complete until 164 positive cases are included in the results.
 Pfizer-BioNTech vaccine uses RNA genetic molecule to cause our own cells to make a protein called a spike or S protein.  Then our immune system encounters this protein and produces antibodies and immune cells that can recognize the protein quickly and then deliver a swift attack against the virus when it is met.

ABOUT MODERNA VACCINE 
 Moderna’s vaccine, a.k.a. mRNA-1273, is given to people older than18 years, and it also shows a 90-95% efficacy after the 2 dose regimen, given 28 days apart.
IT IS VITAL TO CONTINUE WITH THE 2ND DOSE OF THE SAME VACCINE AT THE PROPER TIME INTERVAL because they work differently.
 In the key study of over 30,000 participants, mean age 51.4 years, including many predisposing medical conditions, more than 96% completed the 2 doses, symptomatic Covid-19 was confirmed in the placed group and only 11 in the active group, showing an efficacy of 94.1%.  Keep in mind, these data are only short term. We need to see how long this level of efficacy persists.
 Both the Pfizer and Moderna vaccine send a message to our cells to produce a harmless piece of the S protein [remember the spike on the outside of the virus] which our immune system recognizes as foreign and creates antibodies, building an immune response. These both are mRNA vaccines.
 The mRNA in these vaccines is synthetic, made from chemicals to look like normal RNA but modified slightly to increase its stability. No viral component is used to make this vaccine. The mRNA is delivered in a small sphere of inert fatty material, which is then suspended in saline solution and injected into the muscle of the arm.

ABOUT ASTRA-ZENECA VACCINE 
 The European Union has approved the use of Oxford University/Astra-Zeneca Vaccine in Europe for people over 18 years of age. This also is a 2 -dose vaccine to be given 4-12 weeks apart. The
beauty of this is that needs to be kept at 35.6F to 46.4F, which is the same as regular refrigerator and may be kept refrigerated for 6 months. This is a viral vector vaccine. It retools a chimpanzee adenovirus, which was chosen hoping that people would not be immune to it or that could cause a reaction in itself.  They make a weakened version of this virus and insert some genetic material from the virus that causes Covid-19, into it.  Once inside, the plan is for our cells make a protein unique to the COVID-19 virus, make copies of it and fool our body to make an immune response [giant macrophages, B and T-lymphocytes] which will remember how to fight that virus in the future if we become infected.

ABOUT SIDE EFFECTS 
 Side effects are effects which may possibly happen but are not the sought aftereffects. These Covid-19 vaccines cause the routine mild side effects seen with most vaccines.
•   Pain, redness, soreness at injection site
•   Low grade fever
•   Fatigue 
•   Headache, nausea or vomiting
•   Chills
•   Rash
•   Muscle or joint pain
After receiving the vaccine, it is recommended that you are to be observed for 10-15 minutes to ensure that there is no immediate severe allergic reaction, like anaphylaxis, which will be immediately treated. The minor side effects listed above typically occur within the first 2 or 3 days and last for 1-2 days. These effects indicate that the inflammatory process is occurring. They actually indicate that the vaccine is working.  The immune response involves some degree of inflammation and these short-term side effects are merely the signs of inflammation. so actually, they are not bad.  They are expected.  Most studies show 5-15% chance of these side effects.  Oftentimes these effects are worse after the second muscular injection.
 The safety of the vaccines has been rigorously studied.  Although “Warp Speed” had increased the speed of research, development and manufacture, the safety trials went through routine FDA phase 1, phase 2 and phase 3 trials, where tens of thousands of people, teens and elders, healthy and frail, were included. Possible long term side effects have yet to be studied because the rush to stop the pandemic has not permitted long term study yet.

ABOUT WHO SHOULD GET VACCINE                     
     Everyone older than 18 years old.
     Elderly people and those with underlying medical condition may get the vaccine.
 People who have recovered from the disease.

ABOUT WHO SHOULD NOT GET VACCINE
 Anyone who has had previous severe allergic reaction to this vaccine.
 Anyone who has had previous severe allergic reaction to any ingredient in this vaccine.
 Anyone who is pregnant, or breast feeding, should discuss this with her physician.
 Children under 18 years of age.
 Anyone who has an acute illness.
 Anyone exposed to COVID-19 should wait out the quarantine period.

ABOUT HERD IMMUNITY
 Dr Anthony Fauci estimates that 80-85% of Americans need to be vaccinated for us to reach herd immunity. Most other experts have said that 70-75%, which is similar to most other diseases, should suffice.

CONCLUSION

 Multiple layers or protection, like layers of slices of cheese, are needed to stop the spread of Covid-19 and finally end this pandemic.  No individual layer is perfect, including the vaccine. Each layer has holes in it.  When the holes are aligned, disease occurs. [you can see why this is called “the swiss cheese model”.]  Now, if when we combine several layers - masks, social distancing, hand-washing, testing, tracing, outdoor small groups, indoor ventilation, education, and vaccines - we can significantly reduce the overall risk of infection and bring an end to this pandemic.  One out of every 1.000 Americans alive at the beginning of 2020 has died of Covid-19 by the year’s end.  Experts tell us that all these things will be required to produce the desired result, not just any one modality. But, remember that there is no positive effect of the vaccine if you do not take it.  We can do it. We must do it.

  by Gerald Ente, MD  Retirees Association Honorary Police Surgeon