COVID Update Spring/Summer 2023
Last week on May 5th, the World Health Organization announced the end of the global emergency for COVID-19. However, this does not mean that COVID is over. Due to rapid transmission, spread, and mutations of the virus, COVID is now an endemic disease. “Endemic” is defined as a disease that is constantly present and occurring in a community. This means COVID is not going to go away. The initial emergency of identifying the virus, treating cases, developing treatments and vaccines is over but the World Health Organization, CDC and FDA continue to all work together so that we can try to stay ahead of the new variants on the horizon. COVID response systems in place in the USA are also being maintained. We may feel like we are “done” with COVID, but unfortunately, COVID is not done with us…
Approximately 1,000 people per week are still dying of COVID in the United States. The Omicron variant XBB.1.5 that has been the main variant for the last 6 to 9 months is still causing the majority of cases (67%), but there are two new variants that are starting to displace it. Variant XBB.1.16 is up to 12.5% of cases in the US, and the mutations in this version have given the virus increased transmissibility and more infectious capability. Up and coming variants XBB.1.9.1 and 1.9.2 are at 9% and 4% respectively, with the viral mutations for these also conferring more of a transmission advantage, meaning that the virus is more easily able to spread from person to person. The CDC continues to track this data weekly- see this link for more information: https://covid.cdc.gov/covid-data-tracker/#variant-summary
Because of the now endemic nature of COVID, the CDC has simplified vaccine recommendations.
This CDC link has more information: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html
The CDC and Advisory Committee on Immunization Practices (AICP) will be meeting in mid-June to review current and emerging variants and determine what the next composition of the COVID vaccine should be to provide the best protection. They are anticipating that a new vaccine will be available by the autumn. This type of decision process is similar to what is done for the yearly flu vaccine. Of note, I do not recommend getting both the COVID vaccine and the flu vaccine at the same time- I recommend separating these vaccines by several weeks.
In the meantime, with summer travel starting soon and these new variants having increased transmissibility, I highly recommend wearing a mask anytime you’re in a crowded indoor public space, including on public transportation and airplanes. An N95 mask (without a vent) is still the best protection for yourself and those around you. And as always, please be considerate of those who have chosen to wear a mask!
I’m writing this on a brilliant fall day- Asheville trees are magnificent in their fall colors and there’s just the right amount of chill in the air. It’s hard to believe that Earth is in crisis on a day like today. But just one week ago, I got a call from a family member in San Francisco- the “bomb cyclone” storm, along with a rare weather phenomenon called an “atmospheric river”, had resulted in the strongest storm in that area in 26 years. Heavy rainfall, flooding and landslides, especially in areas that had been burned in the wildfires, resulted in floods, road damage, evacuations, power outages and loss of life… weather sequelae that are becoming commonplace.
Today marks the beginning of the UN Climate Change Conference 2021 in Glasgow. Known as COP26, which stands for “Conference of the Parties”- this is the 26th meeting on climate change, and will run for two weeks. In 1997, during COP3 in Kyoto, the Kyoto Accord was drafted but it wasn’t until 2015 that all 197 COP participant countries agreed to the Paris Accords. The Paris Agreement included making significant changes to greenhouse gas emissions, decreasing carbon footprint and furthering green energy initiatives as a global endeavor, with larger more prosperous countries banding together to help underdeveloped countries financially and technologically to meet the global climate crisis.
The USA has been warmly welcomed back (no pun intended) to the 2021 Climate Conference and is continuing to take a leadership role in COP26 after the last administration’s abandonment of climate action and the Paris Agreement. Ironically, the countries the least implicated in the causes of climate change are the ones being the most affected, with island nation countries literally at risk of losing their entire civilizations and populations with sea level rise. This year’s Conference is vitally important to decrease temperature rise and limit the worst effects of climate change on the Earth, and world leaders seem to recognize the urgency of the situation.
To see the UN Climate Change Conference real-time is a powerful experience as leaders, diplomats and change-makers share insights, technology developments and initiatives from around the world. Here are ways to hear the meetings as they happen, or to replay later:
https://unfccc-cop26.streamworld.de/program
See information, sessions and more at the main website:
https://unfccc.int/conference/glasgow-climate-change-conference-october-november-2021
Moving to a more plant-based diet may be one of the most important things we can do to limit greenhouse gas emissions- one study showed that vegan diets can reduce our carbon footprint by 73%!
Here’s a wonderful butternut squash soup perfect for our colder nights- I like to add some carrot and even apple to give it more “fall flavor”… https://www.loveandlemons.com/butternut-squash-soup/ .
If you would like a personalized integrative wellness plan that includes personalized nutritional information, telemedicine consultations as well as office appointments are available for new and established patients- call the office at 828-333-3339 for more information.
There has been a lot of confusion about the two most available COVID-19 mRNA vaccines that are manufactured by Pfizer and Moderna. Here are answers to some of the most frequent questions I’ve gotten in clinic:
Vaccines work by stimulating your immune system to recognize disease-causing organisms like viruses. By recognizing and killing the organisms early, your immune system can help you avoid getting sick or can decrease the severity of symptoms and illness if you do get sick.
Vaccines were pioneered by Edward Jenner, a British physician, in 1796. Dr. Jenner used cowpox virus, a weak variant of the smallpox virus, to immunize people against the smallpox virus. People who were injected with the cowpox vaccine were immune to smallpox.
Modern vaccines such as the flu vaccine are similar to Jenner’s cowpox immunization. Attenuated viruses (viruses that are altered so they cannot infect you) or inactivated viruses (killed viruses) are injected to teach your immune system to identify and attack viruses before they can make you sick.
To understand mRNA, we must first understand DNA. Put simply, DNA is our genetic code. It is a long complicated set of genes that code for everything in our bodies including proteins that our cells may need. When our cells need a protein, they read a section of DNA and produce a small message to give to our cellular machinery. That message is read by the cellular machinery and the protein is produced. The message created by reading DNA is called messenger RNA or mRNA. mRNA does not change, alter or affect the DNA at all.
Using mRNA for prevention and treatment of disease is not new; in fact, it has been researched over the past thirty years in the field of cancer treatment. The primary difficulty with mRNA is that it is very fragile; this is why the current mRNA vaccines in use have to be frozen. Once thawed, the vaccine must be used rapidly before the mRNA in the vaccine breaks down or degrades. Prior to now, this fragility has limited mRNA’s use in immunizations and cancer treatment. Only in the past two years have scientists have been able to stabilize the mRNA enough to make it clinically useful.
When COVID-19 hit, pharmaceutical companies that have been researching mRNA for cancer treatment switched their research to developing mRNA vaccines for COVID-19. That is why the vaccines were able to be so quickly developed, studied and approved for emergency use. Full authorization for the vaccines was given by the FDA in August of 2021.
The mRNA vaccine contains a small snippet of mRNA that codes for the COVID-19 “spike protein”. The spike protein is the protein on the surface of the COVID-19 virus that allows the virus to attach to and infect your cells. On its own, separate from the rest of the COVID-19 virus particle, the “spike protein” is not infectious. When the mRNA is injected into your arm, your cellular machinery reads the mRNA and produces the protein that it encodes. Your body then produces an immune reaction to the spike protein and learns to block the virus from infecting your cells.
It is important to understand that mRNA vaccines are focused- they have our bodies produce just one protein for our immune system to learn and defend against. Other types of vaccines, like the flu vaccine or varicella (chickenpox) contain multiple components for our immune system to mount a defense against. The current mRNA vaccines produce just one protein for our immune system to learn and attack. The likelihood of unusual reactions is lower with such a tailored type of vaccine.
The Pfizer and Moderna mRNA vaccines showed an effectiveness of approximately 95%. That means that the mRNA vaccines prevented 95% of people from becoming infected with COVID-19. The success rate is spectacular. These vaccines also show high protection against the Delta variant of COVID.
In the Moderna trial 30,000 people were enrolled and in the Pfizer trial 43,000 people were enrolled. For perspective, these clinical trials were very large.
Most people have mild reactions of arm soreness, fatigue, muscles aches, and occasionally low grade fever. This can last up to 48-72 hours.
There were very few significant adverse reactions to the vaccines. In the Pfizer trial four people developed a neurological condition called Bell’s palsy, a limited partial facial weakness that usually resolves spontaneously over several months. Severe allergic reactions have been extremely rare, approximately three to five episodes per million doses.
Short and long term effects of the vaccine are being rigorously tracked, monitored and studied by the CDC and other organizations. Over 22 million (and counting!) vaccinated people in the U.S. are voluntarily participating in an easy-to-use smartphone based vaccine monitoring program called V-SAFE through the CDC. You can participate as well- information will be given to you at your vaccination appointment. You can find more information about V-SAFE here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html
Yes! The vaccine immunity does not happen immediately. Studies showed that it took approximately 2 weeks after the first Pfizer and Modena vaccine for antibody effectiveness to reach 50%. After the second shot, it took an additional 2 weeks after to reach 95% efficacy.
We know that it is possible to have COVID-19 without symptoms, but still be able to spread the virus to others. The vaccine cannot prevent all cases of COVID- about 10% of all vaccinated people may get COVID. It is also possible for immunized people to have asymptomatic COVID-19 infection and be able to spread it to others, but if an immunized person does get COVID, the risk of death or ICU admission is greatly reduced. It is very important to continue to follow all COVID-19 precautions, including continuing to wear a mask in public, maintaining 6 ft. distance from others, and washing your hands frequently even if you have been vaccinated.
Current recommendations for vaccinated individuals who are immunocompromised or on immune modulating medications is to receive a booster shot at least 28 days after their second Moderna or Pfizer vaccine. See https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html for more details on how immunosuppression may affect vaccine response.
Overall, the mRNA vaccines show excellent effectiveness against COVID-19 with few known adverse reactions. In contrast, COVID-19 itself can cause severe illness and death, especially in the 65+ population and in people between the ages of 35-65. The Delta variant of COVID is more infectious than the initial “alpha” COVID virus and more virus is made in the body with Delta. We are also just beginning to understand “Long-COVID”, where patients who have had COVID-19 infection, including mild disease, continue to have longer-lasting symptoms and medical issues including heart, lung and neurologic symptoms. Getting vaccinated against COVID-19 greatly decreases the possibility of these types of outcomes. I encourage you to highly consider this information when deciding whether to get the COVID-19 vaccine.
For more vaccine information go to https://covid19.ncdhhs.gov/vaccines/find-your-spot-take-your-shot or https://www.buncombecounty.org/covid-19/default.aspx for Buncombe County.
If you would like information on integrative approaches for COVID-19 prevention or how integrative medicine can help with Long-COVID symptoms, please contact the office at 828-333-3339.
We had a couple of storms blow through recently…I was struck by how the trees were able to withstand all the wind, with their branches whipping back and forth. As we move into Phase I and some carefully structured easing of the Stay at Home order in WNC, I thought about those “tree qualities” we’ve all had to cultivate over this time. Strength. Flexibility. Endurance. Normally I’d be thinking about those qualities as I take a tae kwon do class, or go to the YMCA. But with the time at home and social distancing, as human beings, these are exactly the kinds of qualities that we are internally cultivating as well. And thank goodness for that!
Strength, flexibility and endurance are key pieces for our physical, mental, spiritual and emotional resilience during this time. One common definition of resilience is the ability to “bounce back” after a stressful event or challenge has happened. But a newer definition takes resilience to a higher level. Resilience can be thought of as the capacity to prepare for, recover from and adapt in the face of stress, challenge or adversity. I like the word “capacity” in that definition, because it means that resilience is not an “all or none” thing- it fluctuates like energy in a battery. In these times of challenges, we build our mental, spiritual and emotional resilience capacity and have more to draw on when we need it, just like we exercise our bodies and become stronger physically.
I encourage you to continue to create simple daily ways to recharge mentally, spiritually and emotionally. There are a variety of free resources at the University of Arizona Center for Integrative Medicine, where I did my fellowship- check out the variety at https://integrativemedicine.arizona.edu.
Mental and spiritual practices can be extremely helpful, and they have the extra benefit of improving our immune system function and quieting our body’s stress response. If you can, go outside or open a window. Spend 5-10 minutes or more focusing on the sound of the birds, or the feel of the sun on your face. Or focus your attention on your heart, and imagine that your breath is moving in and out of your heart or chest area. These types of meditative, centering exercises help calm and rebalance our nervous system.
Other free options include:
Kaiser Permanente free meditation audioguides-
https://m.kp.org/health-wellness/podcasts/emotional-wellness
HeartMath Global Coherence app and Inner Balance app – www.heartmath.org-– can download these from the app store for free. Both have audioguides, and the Global Coherence App has two audio guides specific for coronavirus. Contact me if you would like information on how to obtain and use a HeartMath sensor for these apps.
Other smart phone apps: Breathe2Relax, Insight Timer-Guided Meditations app, Calm app
Strength, flexibility, endurance, resilience: even just a few minutes taken to support ourselves mentally and emotionally can make a big difference. See what you think!
If you would like a personalized integrative wellness plan during this time, telemedicine consultations are available. In-office visits are slated to restart in June- call the office at 828-333-3339 for more information.
Do you have a computer or any technological gadget that starts with the letter i? Could you ever visualize treating that expensive piece of equipment less than gently? Imagine what would happen if you smacked your computer lid closed every time you used it, or dropped your iPad or smartphone from 4 feet in the air onto the kitchen counter multiple times a day. How effective would your technology be if you forgot to plug it in at night?
Our bodies are incredibly complex, beautiful technological wonders. How we “fuel” our bodies makes a huge difference in performance. Thinking about “food as medicine” is a great idea right now during this time of COVID-19. Studies are showing immune system support and antiviral benefits of a variety of nutrients, which we can get from what we eat. Three of these nutrients, vitamin C, quercetin and zinc, are particularly beneficial right now.
I recommend incorporating a variety of vegetables/ fruits in your diet daily- 5-7 servings/day is optimal. Although that sounds like a lot, remember that a serving size is ½ cup. It is also important to get a variety of colors of vegetables in your meals- these contain compounds, like quercetin, that decrease inflammation in the body and improve immune system balance and function.
Quercetin is high in onions, apples, tomatoes, berries, parsley, and celery and may prevent COVID-19 virus from binding to human respiratory cells. The vitamin C in fruits and veggies improves immune system function and even lowers the ability of the COVID-19 virus to create inflammation in the body.
Zinc is an important trace mineral for our bodies and also has antiviral properties. Good food sources of zinc include beans, nuts, whole grains, red meat and poultry. Past studies on zinc’s effects on SARS-CoV, a “cousin” to COVID-19 showed interesting viral blocking effects. Based on that research, it has been suggested that zinc may inhibit COVID-19 virus’ ability to enter into human cells and replicate itself.
Here’s a delicious ratatouille recipe that uses a variety of vegetables to make a delicious and flavorful stew- https://healthiersteps.com/recipe/easy-ratatouille-recipe/
Adding beans to this recipe is an easy way to add protein and zinc for even more health benefits!
If you would like a personalized integrative wellness or nutrient plan during this time, telemedicine consultations are available now for new and established patients- call the office at 828-333-3339 for more information. In-office visits are anticipated to restart in late May.
In the Korean language, it turns out there are numerous ways to say “crisis”, and one of the “crisis” words means “bifurcation or diverging point.”…one path that splits into two. Any time there are two ways to possibly go, there is the power of choice. Even though a lot of things are out of our control, it is important to pay attention to the things we can control and the choices we can make, as a way to maintain our personal resilience.
Since our “homestay” began, I’ve been out walking daily, usually with my husband, and always paying close attention to the “6-foot away rule” if we pass anyone on our path in the woods. We’ve done these walks B.C. (before COVID), without much other “foot traffic”; in fact, it was rare to see another person. But now? Lots of people are getting out in the fresh air and choosing to make this time a healthier time by walking.
Exercise has a number of health benefits that are especially important now. Exercise helps us to “stay in the moment” and to decrease anxiety. It supports proper immune system function by enhancing immune system competency and regulation. Studies continue to show that regular physical activity and frequent structured exercise reduces incidence of viral and bacterial infections in addition to decreasing other chronic diseases such as cancer, inflammatory disorders, type 2 diabetes and heart disease. Regular exercise for all ages, but especially in older adults, increases both numbers and effectiveness of a variety of immune cells in our bodies: T cells, natural killer cells and neutrophils.
Currently the WNC data shows that all the work each of us are doing to stay home, and social distance when we do need to go out is working! As we continue to “flatten the curve” of coronavirus, and as our weather in WNC transitions to summer, take heart and know that by choosing to do some daily exercise, you are choosing to support your health in a variety of ways.
If you would like a personalized integrative wellness plan during this time, telemedicine consultations are available- call the office at 828-333-3339 for more information.
“Mind-body medicine is one of the most underutilized tools in health care today, and can make a huge difference in a patient’s experience and ability to heal,” says Danna Park, MD.
Dr. Park should know. A graduate of the Residential Fellowship in Integrative Medicine at the University of Arizona Center for Integrative Medicine, she is as well- rounded a physician as one could hope to find. She specializes in integrative medicine, internal medicine, and pediatrics, and is board-certified in all three specialties, having earned her integrative medicine certification through the American Board of Integrative Medicine (ABOIM).
As the director of Mountain Integrative Medicine, PLLC, in Asheville, NC, Dr. Park provides integrative medicine consultations for adults and children with a variety of conditions, including cancer, heart disease, diabetes, chronic pain, and ADD/ADHD. She also works with people who are well and simply want to optimize their health.
In her practice, Dr. Park utilizes a number of mind-body modalities for patients and families, including guided imagery, HeartMath®, and clinical hypnosis. These tools can be very powerful when incorporated into medical care, she says, such as when a patient is undergoing cancer treatments, or when preparing for or recovering from surgery. “In addition to decreasing the PTSD-type symptoms that can accompany cancer diagnosis and treatment,” she explains, “these modalities also have demonstrable benefits in decreasing pain medication use and complications after surgery.”
But mind-body techniques are also powerful preventative medicine, Dr. Park points out. Because they affect the interface between the cardiac, nervous, immune, and endocrine systems, these techniques can decrease inflammation, improve cortical and executive function in the brain, and improve overall well-being. Some of the beneficial outcomes reported are improved quality of life, decreased symptoms, and improved blood sugar control in patients with chronic illness like asthma and diabetes.
Mind-body medicine tools can also be highly useful for providers’ self-care, Dr. Park says. With a career-long interest in the relationship between healthcare provider well-being and better patient care and outcomes, she frequently gives presentations and workshops for healthcare provider groups and organizations on practitioner resilience and self-care.
“Having practical easy-to-use tools to improve resilience and decrease the physiological effects of stress is so important for us as providers,” Dr. Park says. “Techniques that are heart-based are particularly beneficial because they work so quickly. We don’t have to wait until our next day off or for vacation next month – we can decrease the physiological and psychological effects of stress right away. And studies show that these kinds of interventions improve patient care as well, which is a win-win for everyone.”
If you would like information about healthcare provider resilience workshops or well-being initiatives for your practice or organization, contact Dr. Park at mountainintegrative@outlook.com or 828-333-3339.
HeartMath is a registered trademark of Quantum Intech, Inc.
First published AAPS 11/2019
The experience of buying supplements in a health food store can be daunting! Multiple companies sell similar or identical vitamins, herbs and other supplements, and choosing one can seem like a Herculean task if you don’t come armed with some specific information. When I prescribe or recommend supplements, I give patients very detailed information on exactly what to buy, often including a few specific brand names that provide the quality and dose I recommend but are more flexible in price.
Labeling requirements for companies that make vitamins, herbs and supplements are regulated by the U.S. government, in the form of the Dietary Supplements and Health Education (DSHEA) Act of 1994, and overseen by the FDA. Companies are not allowed to make explicit claims about how the contents in the bottle may play a role in preventing or treating a medical condition. They can, however, put information on a bottle about the function of a product in the body (ie: “helps maintain healthy intestinal flora”) or how it may affect the structure of the body (“assists in lubricating joints”). These are called “structure/function claims”. The Federal Drug Administration is responsible for stepping in and enforcing the DSHEA rules if a company strays from the requirements.
Despite these rules, what is advertised on the front of the label may not necessarily be the whole truth for what is truly in the bottle. I was reminded of this the other day when looking at a calcium supplement bottle brought in by a patient. The front of the label advertised this as a calcium/magnesium supplement; the Supplement Facts label on the back told a different story! Included in the product were turmeric, ginger, horsetail, spirulina and willow bark. While these unexpected additions may be fine for some people, they could potentially increase the possibility of bleeding risk in other patients on certain medications. Of note, there was no warning on the bottle for consumers about potential herb/drug/supplement interaction risks.
While the DSHEA rule protects our very important freedom to obtain herbs, vitamins and supplements “over the counter” and without a doctor’s prescription, it also heightens the responsibility of the consumer to make sure what they decide to buy/take is both safe and appropriate for their individual medical condition(s) and needs. Just because something is “natural” does not mean it is safe or won’t interact with medications. In my practice, I check for both supplement/herb/vitamin and drug interactions as well as have detailed knowledge and information about potential interactions with medical conditions. Always “play it safe” and check with your healthcare professional and/or pharmacist before starting any type of supplements.
Danna Park, MD