Here we are - we just made it past the winter solstice. Now, every day going forward, the daylight will be a little longer and the sun will get a little more intense. The vaccine is here, we are approaching the final mile. You may be frustrated and exhausted, but we can see the finish line. And once we reach it, life will start to move towards a better existence. We can shake hands, hug, slap each other on the back...the release of oxytocin!  When you embrace, hold hands, kiss, hug, oxytocin is released, and it makes you feel good. Oxytocin is an important player in social behavior. It is so important that it has been referred to as the 'love hormone' and 'cuddle chemical.' For the past 10 months, you may be suffering from PODS - "Pandemic Associ-ated Oxytocin Deficiency Syndrome". I just coined this acronym. No wonder we feel so down. And added to this, there is less sunlight. Have you ever noticed that on a sunny day your mood is so much better? Sunlight causes the release of serotonin, a feel-good neurotransmitter.

Things may never be the same as they were, particularly if you lost someone close to you or if your business was affected in some way, but hold on, with the new year is hope and relief. And as the Queen of England said in her annual Christmas speech this year, and as the Eagles sing, You Are Not Alone.

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The Numbers:

USA: Case numbers, hospitalizations, and deaths are continuing to increase, these graphs show the sobering statistics. And although case fatality rates continue to fall, we are dangerously close to a surge that could overwhelm our health system.

Maryland: The Rt is 1.03 as of December 25. We want it to be <1.0, this would imply we have some control of the situation - but we do not. People are traveling and getting together when they should not. The virus is invisible until we contract it and because we cannot see it, we do not believe it can infect us. This is known as Normalcy Bias (NB). In other words, in the face of danger, the brain says relax, it will be okay. And yes, it will be okay, until it is not. Do not fall prey to NB, be smart, follow the rules. These graphs (be sure to adjust the state) show that tests, cases and hospitalizations are all up.

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You know the rules, they have not changed:

• Mask when out of your safe bubble.
• Distance > 6 feet.
• Keep air moving if more than one person in a car.
• If you have well visitors at home (<10) crack the windows, keep your distance.
• Think about getting a device that cleans the air -- I like this device I have it in my exam rooms and at my home.
• Wash or sanitize your hands often.
• Avoid gatherings; if necessary, keep to <10 people.
• No hugging, kissing, or shaking hands.
• Eat well, daily exercise, get your rest.
• Yes, to vitamin D-3, at least 2000 units per day.
• Other supplements may be: Zinc 30 mg per day, Vitamin C 250 mg twice per day, Quercetin 250 once a day.

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The Science of COVID: 

• Two vaccines are approved (Pfizer and Moderna) and have become available. Both are greater than 90% effective. More vaccines are just down the road. In Maryland, so far >18,000 people have been immunized. Stay tuned for how to get it. I will be sending this out as soon as I get any updates - I have not received any details yet.

• The monoclonal antibody against the spike protein from two pharmaceutical companies (Lilly and Regeneron) has emergency utilization approval (EUA) and is available in Maryland. This high concentration of antibodies is directed at spike protein that the virus uses to attach to receptors on vulnerable cells. If used early, it stops mild to moderate infections in high-risk patients. It is an intravenous infusion administered over 15 minutes. It should be a game-changer for reducing hospitalizations and the progression of the infection. We just need to figure out a way to seamlessly test high-risk people and give it as soon as we know they are positive. I have been able to arrange this for a patient once last week, but it was complicated and time-consuming, I have written to the Governor's office about this!

• Remember remdesivir, hydroxychloroquine, lopinavir, and interferon-beta? Sadly, no better than placebo so says a randomized study recently published in The New England Journal of Medicine.

• You may remember in April I told you about ivermectin, a drug used for parasitic infections for over 40 years. It shuts down the virus in culture and seems to be effective if taken early or prophylactically. I am actively researching it. More to come on this. For now, just know, it is not sexy, it's cheap and it is off-patent so big pharma is not interested.

On a musical note:

You Are Not Alone by the Eagles (see above)

On a lighter note:

As a reminder, I am no longer sending out daily updates and instead, I am updating you periodically as things change. Just like yesterday, face masks, social distancing, hand washing and/or sanitizer whenever you need to leave your safe zone. Stay home if you display any symptoms.

Reach out. Stay connected. Stay home. Save lives. The power of one. Be well.

Feel free to forward this on: spread the word, not the virus.

HAO

24/7

Harry Oken, M.D.

Adjunct Professor of Medicine

University of Maryland, School of Medicine

Office 410-910-7500

Fax   410-910-2310 

Cell   443-324-0823