New mRNA Vaccines - A Huge Breakthrough

COVID Vaccine explained and the incredible medical breakthroughs

 

In the past 100 years life span in the Western world has more than doubled, from under 40 to about 80. Vaccines have been so effective at improving health and saving and extending lives that most people in the U.S. have no idea what it’s like to watch a child die a painful death from a tetanus infection or to witness a loved one experience brutal paralysis and death from polio. Providing and supporting vaccinations is a key tool in today’s public health toolbox.

 

There are very few effective antiviral medicines (as opposed to anti-bacterial medications, that is antibiotics). The vast majority of viral infections can only be treated by prevention with vaccinations.

 

There is a lot of conflicting information about the current COVID vaccine. Unfortunately most of this is spread through social media and word of mouth, without appropriate review or scientific background.

 

Many are hesitant; mostly due to this misinformation. The new mRNA technology is a game changer both in efficacy, but more importantly in safety.

 

To really understand what is going on, it is necessary to explain how viruses work, how the body defends itself, and how vaccines work.

 

1.    Natural Defenses

 

The way one’s body defends itself against foreign invaders, such as bacteria and viruses is truly incredible. We are constantly exposed to all types of bacteria and viruses. The body has two major defense systems; antibodies and killer T-cells.

 

The antibody system is truly amazing. When a foreign invader comes into our body, there are special defenders that recognize it as foreign, and start the process of developing antibodies specific to that invader. This takes about a week or two; and during that time the virus or bacteria can wreak its havoc. The fascinationg thing is that we have the ability to make millions or billions of different antibodies, specific to each invader. How this happens is not well understood.

 

The antibodies attach to the invader (in the case of COVID we produce antibodies to the so-called spike protein). Once attached, the antibody protein changes its shape and attracts a white blood cell, a special army of cells that “eat” invaders and debris, and so destroys the virus. (The actual process is that the cell surrounds the marked virus, places it in a vacuole and applies enzymes that digest it).

 

Aside from our incredible ability to make antibodies against virtually anything, the system also has the ability NOT to make antibodies against our own body. This is because each of our cells have special markers that tell our defenders that these belong there. Occasionally this fails, and we do make auto-antibodies, such as in diseases like Rheumatoid arthritis and lupus.

 

The killer T-cell system is similar to the antibody system, in that our body has the ability to make special killer cells that specifically recognize the invader. Again this takes 1-2 weeks.

 

Once we have fought off the invader, by either system, our body remembers by keeping a few cells that specialize in that specific antibody; if the invader comes back it can ramp up antibodies in 24 hours or less.

 

2.    How our body functions

 

It is important in this context to understand how our body works, specifically how it makes proteins. Our genetic code is DNA. This can be thought of as a complete set of building plans used to operate. In a construction sense, this would contain all different plans, such as plumbing, electric, etc.

 

If our cell wants to make something, it produces a copy of that specific blueprint. We call this messenger RNA or mRNA. It sends the mRNA to the factory, also known as the ribosome. The factory then makes the protein. For example, to make insulin, the cell makes an insulin mRNA, sends it to the ribosomes, and insulin is released.

 

Most mRNA is destroyed after one use, some can be reused, but these blueprints usually only last a few minutes, or in some cases up to a week or two. It is quite unstable.

 

This process is simple, the complicated part is the co-ordination of when certain proteins need to be made and released, or production needs to stop. However this is not important in a viral infection.

 

3.    How a Virus works

 

The COVID virus is quite simple. It is a big piece of mRNA surrounded by a capsule. It injects the mRNA into the cell, and the mRNA makes its way to the factory (ribosomes). Then it makes ALL the parts needed to make a virus, including copies of the mRNA, and the coating. The viral mRNA can survive from several hours to a day; enough time to make several thousand virus particles. However this process is quite error prone, and it seems that only about 10-100 of these new viral products are actually functional. The rest are so full of errors they don’t work.

 

After about 10,000 virus particles are made, the cell bursts and release the infectious virus, and the process continues. This only takes a few hours, so within 24 hours your body has made hundreds of thousands or millions of infectious viral particles from the approximately 1000 initial virus particles you inhaled.

 

4.    Vaccines

 

Currently, because viruses use our own bodies “factories” to make new viruses, they have little or no unique metabolic processes. Bacteria, like strep, are physiologically different and reproduce on their own, and have different enough metabolic processes that we can produce antibiotics that are safe for us but can kill them.

 

The development of vaccines was a huge advance, and mRNA vaccines are a game changer. The theory of vaccination is to induce our body to create the antibodies needed to kill the virus. Then the body will have a memory, and can defend against COVID within 24 hours, not 1-2 weeks.

 

The first vaccines were live viruses that were mutated, intentionally or not, to be less infectious. The first was cowpox, a live virus which made us produce antibodies against smallpox. The early polio vaccines were live viruses, and could rarely actually cause paralysis. Current polio vaccines are not live viruses.

 

Until mRNA vaccines, the vaccinations contained specific protein parts, or dead virus, usually attached to an adjuvant, like aluminum, to help induce an immune response. Development of the appropriate combination of protein and adjuvant could take years; and often the first tries were unsuccessful.

 

5.    mRNA Technology and vaccines

 

As noted, the mRNA is very unstable and quickly destroyed. Over the past 25 years, researchers had been searching for ways to stabilize the mRNA and then have methods to deliver it to the cellular factories without it being destroyed. The thought was that we could treat diseases where people are missing specific proteins and use the mRNA to have the body make it. Vaccines were the other possibility.

 

So how does the current mRNA vaccine work? Researchers quickly were able to map the entire COVID virus RNA “blueprint”. Then they looked at patients who had recovered from COVID and found they all had antibodies against a part of the virus called the “spike protein”. Quickly they determined which part of the mRNA made (or coded for) the spike protein and were able to put it in a special capsule to deliver it to our cellular factories to make the spike protein, and only the spike protein. Within 2 months of the pandemic starting they had this perfected.

 

Compared to previous vaccines (which are generally safe) these vaccines are incredibly safe and reliable. First, there are no adjuvants, no live or killed virus, and no extra substances. The protein produced is the spike protein – the same exact one that your body would be full of if you got the infection. The antibodies produced are the exact same ones you would make if you got infected.

 

The mRNA lasts less than two weeks, and is localized in the muscle where it is injected.

 

You might hear about side effects, such as blood clots and myocarditis. In actuality these are likely related to the antibodies, and they occur far more frequently with actual infection. The incidence of serious side effects is less than one in a million, less than most current vaccines for other diseases, and less than most common oral medications (including Tylenol!).

 

The COVID virus has the ability to infect and damage your lungs, nasal passages, kidneys, heart and brain and many other tissues. About 60% of recovered have some long term effects, often very subtle.

 

All the vaccines in current use were based on the original version of COVID. As the virus has mutated, the current vaccines are less effective, but still highly protective against serious disease. It appears that higher antibody levels protect better against the newer mutations.

 

The levels of antibodies do drop slightly after about 6 months. We do not know if this will affect risk to infection, but since the vaccine is so safe it may be worthwhile getting a booster. Similarly, if you had COVID infection, scientists have found that antibody levels are much lower than after the vaccine, so it is a good idea to get at least one vaccination. As long as the infection is cleared up the shot will be effective – and can be given as early as 10 days to 2 weeks after infection. The vaccine has also been shown to decrease symptoms in long haulers.

 

Some groups have latched on the fact that the vaccines have not obtained full FDA approval. To get full approval, FDA investigators need to personally inspect all manufacturing facilities in extreme detail (which they have started for emergency approval), as well as do complete reviews of all data. This is a procedure that is organized to take a minimum of 6-10 months so any side effects and changes in doses can be carefully evaluated. The process also is there to ensure future production maintains the protocols and safety measures that are being used. There are numerous cancer drugs that have similar emergency approval.

 

mRNA technology is a game changer in safety and efficacy. It uses a copy of real viral mRNA and makes us produce the exact same antibodies as if we were infected. The risks of infection

are so much higher this should be a no-brainer.

Why Refusing the New COVID RNA Vaccine Makes NO Sense

 

Why Concerns about The New RNA vaccines make no sense

 I have heard from some patients that they have decided not to get the COVID vaccine. They give many reasons. These include concern that the vaccine is too new, and we do not know about side effects. Also about possible long term complications. One patient was worried about putting something into his body.

There are those who don’t believe the disease exists. If seeing sick people with COVID-19, and interviews with deniers on their death bed “I thought it wasn’t real!”, as well as an excess of 520,000 deaths over average in 2020 in the United States does not convince them, I think I have some swamp land to sell. Those naïve people can stop reading and go back to their homes.

 Anti-vaxxers have many reasons not to get vaccines, few or none of which have any scientific basis. Some believe that the adjuvants added to may vaccines (often organic aluminum) can cause damage. Again there is no proof of this, but it is understandable. The belief that vaccines can cause autism has been disproven many times over. But let’s not talk about older vaccines.

 First you need to undertand how a virus infection works. A virus is simply genetic material surrounded by a fatty membrane (also called a lipid coat). When a virus infects you, its lipid membrane combines with your individual cell mabrane and the genetic material (RNA or DNA) gets injected into your cell. Then your cell uses the RNA to create new proteins and more RNA which become new viral particles. And it keeps doing this until it explodes releasing all the infectious particles.

To help the virus enter the cell the lipid coat has proteins, or spikes, on its surface, that guide it to the cells it wants to infect.

 You get sick because your body gets overwhelmed by the virus particles that your own body made, and there is widespread destruction of tissue (with COVID the lungs) as cells explode releasing virus.

 Our bodies have an amazing way of defending itself against infection. It has a “random” method of producing antibodies which are programmed to match the spikes on the virus. These antibodies attach to the virus and then attract killer white blood cells to destroy the virus. Unfortunately it can take 2-6 weeks for our bodies to adapt and produce sufficient permanent antibodies to make us immune. The body can program some immediate antibodies as well, that can clear up the initial infection; this can  take 2-12 days. In some people the virus can overwhelm this initial defense.

 These “permanent” antibodies are also called neutralizing antibodies. Are these really permanent? We really don’t know, but based on every other virus these should last many years. (Flu virus changes totally every year so previous year’s vaccine may not work).

 The best way for medicine to prevent infection would be to induce production of these neutralizing antibodies before we get infected. Before MRNA vaccines scientists would try to make the virus pass through chicken egg cells so it would change and not be as dangerous, but still could produce an immune response. Or inject us with the spike protein attached to an adjuvant, like aluminum, to induce a larger response.

 Imagine if there was a COVID type virus that caused your cells to make only spike protein and not new viruses. And didn’t kill the cell. The new mRNA vaccines are such a breakthrough!

 The Pfizer and Moderna vaccines are almost like viruses themselves – but not infections. Scientists have created a lipid coated “virus” that only contains genetic material to induce your cells to produce spike proteins. These proteins are released alone so the cell does not explode. Then the body, in about 2 weeks, makes neutralizing antibodies. The vaccine does not contain any adjuvants or other artificial ingredients.

 So we have a choice – get infected with the virus – with the possibility of dying, or becoming a long-hauler with chronic heart or brain issues. Or if you recover then you have neutralizing antibodies that protect you against future infections. Of course the alternative is to “catch” a viral infection that only produces the spike proteins and makes your body make the exact same neutralizing antibodies you would get if you had the real infection. That, naturally, is the new mRNA vaccine.

 This new vaccine technology, first developed in 2008, is a game changer in vaccines. No longer do we have to try and inactivate the potentially deadly virus; we can create our own virus like particle that only contains enough genetic material to cause antibodies to be made.

 To me the choice seems quite easy. Get a potentially fatal or disabling disease and if you survive make some neutralizing antibodies. Or take a vaccine which is essentially a modifies virus, which does not make you sick but makes you produce the exact same antibodies (actually in larger amounts).

 Can anyone tell me why someone would refuse the vaccine? Do they prefer to get the disease? Or are they just being stubborn, knowing they are wrong, but obstinately refusing to admit it.

 

 

 

 

 

 

COVID-19

COVID-19 Masks and Spread

It is now clear that this deadly virus is spread mostly by aerosol transmission. That means places like bars and restaurants are the most dangerous especially because you sit there without a mask for a prolonged period of time. Due to their indoor location and minimal air circulation it has been shown that even someone several tables away can infect you.

If you are in a high risk group you must avoid these exposures until we have found a vaccine or good treatment. I think, based on the ongoing studies, that we will have something by December and can hope that things will go back to normal by early 2021.

Even if you are not in a high risk group, about 1/200 to 1/400 healthy young adults can die of the disease. If we are not prudent then, in a city of 500,000 young adults (that is a small city in the US), if 1/2 the people get the disease, 2-3 thousand young adults can die!

Wearing masks and social distancing works. I have been driving cross country in an RV to get back to Las Vegas and avoiding contact. But in Florida it looked like no one was wearing a mask anywhere. We are now in Kansas and everyone was wearing one; in Colorado it is a state mandate like Nevada. That is the way to stop the spread.

You know, heroes come in many forms. Most people consider the military heroes who protect us from terrorists and risk their lives. But you can be a hero by wearing a mask to protect your fellow Americans. Refusing to wear one is a cowardly act, not an act of freedom. Not protecting your fellow Americans places you in the same category as those terrorists and murderers our President feels he needs to keep out of this country.

The no mask attitude of this country has resulted in an explosion and now schools are in limbo for the fall - for no good reason.

In a recent study (Nature 2020 Jun 8) A multinational team of social scientists modeled data on the effects of large-scale anticontagion policies in six countries. The team estimates that these measures already have prevented 285 million cases in China, 38 million in South Korea, 49 million in Italy, 54 million in Iran, 45 million in France, and 60 million in the U.S. — a total of 530 million cases prevented or delayed, thus far. If COVID-19–related mortality is 0.5% (a conservative estimate), such measures have prevented 2.65 million deaths. We need to continue this!

In another study, JAMA Intern Med 2020 Jul 1, researchers have found that there have been an excess of 120,000 deaths between March 1 and May 20 of this year; likely all due to COVID.

Wear a mask!!

The New Coronavirus - not a time for panic!

The New Coronavirus - my take

Family member have been calling me concerned about the COVID-19 virus and what will happen. I think the press has "enjoyed" the publicity and people are genuinely frightened. I have been asked questions such as "should I start stocking up on food and water", or "should I travel by plane?" etc

First, there is of course, reason to be concerned about this contagious infection. But it will not cause the chaos people are fearing.

About The Virus

Like two other recent Corona Virus infections (SARS and MERS), this virus seems to affect lung cells more than those in the throat and nose (like a cold). It can lead to lung failure and death BUT the death rate (from a recent study of 72,000 patients in China) is only 2.3%. And the majority of deaths occurred in the elderly, immunosuppressed and chronically ill. In patients over 80 the rate was 15% and 70-79 was 8%.

Think about it - if I told you there was a contagious virus that killed 1% of its victims and was even more deadly in elderly and ill (5-15%) I am sure you would be concerned. Would you get vaccinated for it if possible - I would think yes. Especially if you knew there were over 45 million worldwide cases last year. Well why didn't you get the flu vaccine, because those are influenza statistics?And unlike COVID-19 influenza has the ability to mutate and become immune to vaccines. In 1918 this virus had a 20% fatality rate. Much scarier!

It seems inevitable that COVID will reach the USA. And we will take gargantuan measures to prevent transmission (as we would if we did not have a flu vaccine!). This may disrupt schools, sporting events, gatherings and transportation. It may overwhelm our medical facilities. There is no reason to think it will affect our food sources, shipping, police, fire etc - remember only a small percentage get seriously ill. But the CDC and government will stop large gatherings and movement from affected areas to help prevent spread.

So a little about the disease itself. Probably about 2-5% of infected individuals will have no symptoms at all. Are they contagious - maybe; we do not know yet. The incubation is 2-14 days, and more severe cases have fever, cough and shortness of breath, which can lead to respiratory failure in a small percentage. Once you have had COVID infection you are probably immune; certainly in the short term. Again we do not know how long antibodies last.

How is it spread? Certainly by respiratory droplets in the air; like the cold virus, measles, chicken pox etc. Wearing a mask probably helps prevent a sick person from spreading the disease as all the droplets from coughs get caught. But unless you wear a medical respirator designed to filter the air, masks do not appear to prevent you from catching it. It does not seem as infectious as some respiratory illnesses (like chicken pox and measles); it is thought you need to be in relatively close contact (6-10 feet). Of course this is so new that these are only based on current observations.

How about air travel? All airplanes have fine HEPA filters that remove viruses from the air. So again it is close contact that is the issue. If you have an air vent above you on a flight turn it on to form a cone of fresh air around you. The air coming out of that is filtered and sterile.

Can you get it from a surface or through the skin? Currently we do not believe if can penetrate intact skin. And probably does not survive long on dry surfaces. But this is still unknown.

Another question is how long a person is contagious after being sick. With MERS and SARS this could be 2 weeks. With another recent virus, ZIKA, intact particles could be found months after infection. Another question. 

Finally, when can we expect treatment? Several studies of an antiviral drug developed for SARS are now underway and we should have results in a month; and then can come to market if successful as soon as May. With new DNA and genetic technology there are already 2 vaccines in preliminary testing that could become available as soon as this summer.

What about travel? Check the CDC site; the most recent advisory:

• CDC has issued the following travel guidance related to COVID-19:

• China — Level 3, Avoid Nonessential Travel — updated February 22;

• South Korea — Level 3, Avoid Nonessential Travel — updated February 24;

• Japan — Level 2, Practice Enhanced Precautions — updated February 22;

• Iran — Level 2, Practice Enhanced Precautions — issued February 23;

• Italy — Level 2, Practice Enhanced Precautions — issued February 23;

• Hong Kong — Level 1, Practice Usual Precautions — issued February 19.

• CDC also recommends that all travelers reconsider cruise ship voyages into or within Asia at this time.

In summary - it is not time for panic. The death rate is quite low and might even be lower in the US and Canada with our most advanced medical care. Vaccines and anti-virals will be developed; probably before the end of the year. It will come to the US and will create disruptions, but not Armageddon!

Curing Diabetes?

There are many Gurus who claim that their retreat, diet, etc can "cure" diabetes. In non-insulin dependent diabetes (type 2) the physical issue is not enough insulin (as opposed to none). In this type of diabetes, making the lower amount of insulin work will "cure" it without medication.

Essentially the way to do this is to eat less and exercise more and lose weight if possible. Retreats that force you to do that will work.

Recently some researchers (http://dx.doi.org/10.1136/bcr-2017-221854) tried a diet where patients were asked to fast (until dinner) three times a week, and generally eat a low carbohydrate diet. All the patients were able to stop their insulin and 67% stopped all diabetes medicine. And they felt great. They all lost weight.

This is not going to be a universal cure, but shows how proper diet can help diabetes!

Children and Food Additives

The American Academy of Pediatrics has recently posted some recommendations on food additives and their effects:

Here are some of the additives with the most evidence for concern:

• Bisphenols: Used in plastic containers and the lining of metal cans, bisphenols (such as BPA) can disrupt endocrine function, potentially reducing fertility and changing the timing of puberty. Research also suggests effects on neurodevelopmental outcomes and childhood obesity.

• Phthalates: Found in plastic food wrap as well as in plastic tubes used during food manufacturing, phthalates have been tied to endocrine disruption (including testicular toxicity), cardiotoxic effects, and oxidative stress.

• Nitrates and nitrites: Added directly to foods (usually processed meats) as a preservative or to enhance color, these compounds have been linked to cancer and thyroid dysfunction.

To help reduce exposure, the AAP recommends that clinicians advise families to eat more fresh or frozen (rather than canned) fruits and vegetables, and to avoid processed meats. In addition, plastic shouldn't be put in microwaves or dishwashers, as heat can cause chemicals to leak into food.

More information is available here

You Are What You Eat

I have always been a proponent of eating unprocessed food, fresh fruits and vegetables, and a generally healthy diet. Recently there have been a slew of studies which support this.

Processed Foods

In JAMA Intern Med. 2019;179(4):490-498, a study in France of over 45,000 people showed a 14% increase in death for every 10% increase in ultraprocessed foods.

Fiber and Grains

In Lancet Volume 393, ISSUE 10170, P434-445, and in Lancet January 10 two articles confirmed the health benefits of "good" carbohydrates, high in fiber, and whole grains. Diets rich in these foods resulted in up to 30% lower risk for heart disease, colon cancer, and type 2 diabetes.

Sweetened Drinks - Home is where it starts

Our family never had sweetened soda in our home - probably started by my Eastern European parents who couldn't comprehend spending money on drinks when water was free. To try and stop children from drinking these in excess there have been movements to tax the drinks, make large cups illegal, and remove them from schools. But is a recent study, J Pediatr 2018 Jul 18, researchers found that the one most important factor in adolescents drinking sugary soda was availability in the home. That's where it needs to start!