Episode 2 - COVID questions

In this episode Comrade Uncle Doctor AJ Layon answers listener questions about COVID, long COVID, risky behavior, "natural" immunity, and much more.

The questions answered in this episode are:
1) If you are fully vaxed and still get Covid, should you get treatment? Or just ride it out?
2) What is the immunity difference between getting a booster and getting actual omicron Covid? 
3) Thoughts about Long Covid and brain fog. Causes, remedies, supplements, and treatments?
4) Does he (doctor Layon) go out to restaurants, stores, and bars unmasked? Or is he still wearing a mask? 

To help with labor struggles, go here:
https://www.change.org/p/we-support-nurses-who-are-calling-for-a-union-voice-for-safe-quality-care-at-uw-health
and here:
https://dsa-la.org/tacos-for-teachers/

Paxlovid for long covid study: https://clinicaltrials.gov/ct2/show/NCT05576662

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Video available on YouTube

Transcript

0:09

all right so uh welcome back Dr layoon um it's a comrade uh Uncle uh intensivist uh all-around good guy thank you that could be our that could be the title of a of the Cod podcast yeah right Uncle yeah that's kind of what I was thinking I like it that's what I'm talking about all right so I got some questions for you um are you ready sure no all right um uh listener JM asks if you are fully vaxed and still get covered should you get treatment or just write it up well if you're fully vaxed and you get covered uh the odds are all things being equal you're gonna have a relatively mild case of the disorder you still have to worry about long covet so frankly in my in my opinion I don't know that there's a best practice on this but in my opinion I would say you you get treated with the five-day course of tax limit which is the antiviral medication which really does work quite well um so I would I would definitely would do it I I would really take little chance with the up with the possibility of getting long covered that's that's you know between two and three out of every ten people who get covert doesn't have to be severe develop long covert I would not mess with that yeah I have on coveted it is uh it's not fun I would pass on it given the choice yeah um what symptoms do you have boy man you name it it's kind of over time it has changed or rather not changed but some of them have diminished more than others uh especially with boosters um but uh you know to start with uh of course uh shortness of breath uh brain fog insomnia kind of some mood stuff uh um uh you know for how long will they say has that been going on uh that's since I got it uh basically I mean you know and then there was a dramatic decrease by how long is that uh since 2019 since January uh yeah really January of 2019 yeah two years later yeah two years three years later three years later three years later wow yeah I'm a long hauler is it improved or is it the same uh it improved it improved dramatically the first um the first vaccine that I got it improved dramatically um and and that was like you know a lot of uh so other stuff loss of smell um uh post uh exercise malaise you know so after I I you know stand even stand a lot or or work out I get like kind of like muscle joint pain you know kind of like if you had you know run a marathon or something you know it worked out really really hard um and then you know but just kind of out of all proportion with the amount of felt like the amount of yeah yeah uh exertion so um and then uh the first time the first one uh vaccine it got like a lot better I gained a lot of my smell and taste back uh um kind of the a lot of the mood stuff went away uh you know it's still still you know sort of there but like wait you know dramatic decrease um uh uh in insomnia didn't really get any better um the uh most of the smell stuff uh still stayed lingered on and then each successive one um was pretty minor um uh like sort of a decrease in symptoms um man I teach successive one you say you mean yeah right yeah the second the second course uh or I'm sorry the second so you know I did the the um what do you call it uh the moderna so the two main full doses uh and then boosters after that I think uh like three or four or something like that boosters very very little especially with the boosters very little um until the bivalent Omicron uh booster and there I noticed a kind of I mean by then I was starting to pay more attention too so maybe there's that some of that you know where I'm like really like monitoring uh stuff uh as opposed to just kind of stumbling around not realizing um what's going on uh but uh but the bivalent vaccine surprising uh you know booster whatever um surprisingly seemed to change a lot I mean like almost all of my smells backed it uh uh you know I went from kind of the only upside I would say pretty much the only upside uh would be that I couldn't smell cigarettes for a really long time um it was it was great I mean truthfully like if I had a switch that was awesome and then right then I got the Omicron booster the bivalent omo crowd booster and and uh you know for the two strains um and and that one and that came back so well it's interesting I I don't I mean I'm not 100 sure how to explain that uh except with as I mentioned earlier the one study that's now been released that shows the virus and I'm so I'm assuming active virus but I could be wrong on that everywhere in all organs and so possibly being boosted and reboosted and reboosted has made it possible to somehow clear some of that I don't know maybe or maybe it's just you know it could be look look I mean here's the other thing right maybe it's just time yes exactly exactly I mean you know I hate to attribute one you know it's like one of those things you never really I mean your mind can create the association of being like Oh I got my thing and then I got you know but I was I was doing breathing exercises uh you know stuff like that so um yeah yeah well it what's cool I mean it's clear that that there's not a lot that's clear that's what's clear there's not a lot that's clear about about long coverage it's being studied actively it's a it's a problem yeah um yeah it's a problem and lots of people again as I mentioned earlier you know people say where are where is everybody you know uh well a million people are dead and 20 to 30 percent that's 20 to 30 million I think there was 100 million people who have gotten over 20 to 30 million of those people yeah are have uncovered yeah and it's like that's where they are yeah that's what mismanagement to this disease has done and I blame that fully completely and utterly on Trump and his minions mismanaged it no no worst it no cannot help would have been to stumble through and make mistakes they purposefully downplayed this he purposefully did this this was this is this was worse than that but what about I mean you know now like so so my kind of you know okay like I look at the Trump policies and then I look at um you know uh the sort of by the current Biden policy and while I do see um a difference in the sort of messaging the the lack of a PR campaign the sort of uh basically peeling back and maybe maybe that's totally justified to peel back uh restrictions to the point where we're at um you know I see I see and changing the a critical one for me is the changing of the the model now granted I know that um the reporting from the CDC you know the reporting that we're getting back from hospitals is is different now but uh but they also changed the model to this community-based spread model and and that is uh kind of chronically under reports because it just sort of it Wings it um and the way that they choose to interpret the data kind of downplays the severity so we have a ton of cases going on most of those going unreported no effort on the part of the government to even estimate that their calculations are all based on what limited data they're still receiving which is ever decreasing as free testing closes as you know so my my kind of view of this is yes there's a hundred percent a huge I mean a big chunk of the Fall definitely lies with Trump absolutely set the tone uh but then now I look at the Biden Administration and I don't see them doing anything in terms of material uh you know anything terribly different I see them making po I mean they aren't even really telling people about the booster right well yeah no I I mean I I some of your critique I think is legitimate I I there is look I mean I mean by the administration is a conservative Democratic I mean it is they do however recognize the Primacy of science when it comes to medicine and disease that's for sure you know there are things I've disagreed with them on like for example I think the the making masking uh optional I think was a mistake I think that's that's what I think now okay I mean don't misunderstand me the CDC there's an incredibly smart people there no I do not hold myself out to be this expert is there about this but but just knowing what I know and seeing the cases and seeing what happens I think that the the limitation of masking making masking optional I think is a mistake and I think I think I can't prove it I think it was basically done for political reasons right not because the The Binding people are corrupt but because they were getting slack after Flack after slack right and I think that's going to end up hurting us yeah I have probably I have seen and heard now may not be enough but I have seen and heard advertisements media for the bivalent vaccine to go get it and stuff but you're right about what you're what I think you're really really right about is is this thing is not behind us I if I'm not mistaken uh Biden did say at one point um I forget what they said it's over or when we cost a Rubicon or it's behind I forget the phraseology but the implication was it was I think and again I don't mean to I don't want to I didn't come prepared having reviewed his material yeah I know I remember hearing this you know and and I think to that effect at the very time I yeah and I don't at all mean to put him in the same category as As Trump ever but I do think it could be more aggressively I think it could be way more aggressively attacked uh in the pub in media you know with campaigns and I think masking it just has to be done it just has to be done you know okay you don't want to keep your kids at home I mean you can't I mean there's a million reasons to not do that again but but the masking stuff for example I just think is it is one who is not perfect doesn't solve every problem but it's the right thing to do so so there are differences but it's not it's it's not what one would hope and and then the question is is so then what would one hope right we talked earlier about the Chinese model which you know at least initially worked it it didn't work to solve the problem it worked to buy them time but the time I think wasn't used the way it should have been but again you know any any government any country any public health people any Physicians we can all make mistakes but I think that was a mistake I think one of the things that was done right here certainly once Biden got in was immunize the world immunize everybody in the country just do it I think it's the right thing to do I think think of the wrong things there are several wrong things one of the wrong things was that it's a pandemic not an epidemic in the U.S it's a pandemic we should have been much more aggressive about making basically all this vaccine free a global initiative yes every country yes exactly exactly this will come back to invite us in the bottoms uh again and and again I I it's it's the system we have is performing exactly the way it was set up to perform right it's not what you and I would want right but it is performing the way it would the way there are tons of really smart people who know what to do and how to do it and I don't think they can do it but anyway so so I would say uh what was the question actually I forgot what was your question yeah yeah if you're yes exactly should you should you go in for treatment should you get treatment if you catch uh coven um even with if you're fully vacced well to go in for it yeah it would you would have you would call and you'd get a a five-day course they asked um uh should you get treatment that's it so should you go in or not and should you get treatment maybe I should ask you that so that I would say the tax limit yes I would take it five-day course relatively safe good drug should you go get monoclonal antibody I wouldn't waste my time really Omicron is it's it evades those it doesn't they don't work they don't work but the tax limit I would do it I would do it I would all right all right excellent all right so uh next question um we have from Dr what is the immunity difference between getting a booster and getting actual Omicron yeah that's the that's the question of natural immunity versus right quote artificial inquiry there's no such thing there's no difference right there is no difference you just don't know if you've gotten the disease whether you how how how protective how much protective immunity you've got you do know once you've been immunized that you that you will so even if I I'm like I've been lucky so far lucky I've been careful I've not had uh I've not had the disease but had I had had I gotten infected I would have still gone after I was over the the infection I would have still gone to get immunized and boosted continuously because immunity of any kind I mean it's all this it's all natural I mean for God's sake I mean right your immune system work and doing what it's supposed to do right it does Wane after a while and remember there's two components to that at least there's the humeral component and there's a cellular component what's normally measured as a humeral component which does weigh in relatively rapidly it's the but you know but there are there are cells that remember right uh and they and they will reboost they will remake antibody if you see the same antigen again but the cellular mediated immunity that those guys hang around and those that's probably better and more important for viral infection but infection infected or not I would get and I would get immunized and boost it and keep getting boosted because the the the immunity appears with this disease to weigh in relatively rapidly tends to wear off relatively rapidly and the uh and the Omicron booster I mean it is a bivalent uh vaccine so it it is for more than one strain just like when you get the flu shot it's for whatever three to five I think something like that whatever you think right yeah right you get you get uh vaccinated against more than just the one strain that you got so you will get more especially with the booster I mean it also seems to be more effective but even beyond that the booster is is because this latest one is bivalent we'll give you for sure at least more protection against those two strains nothing else the well the so the beauty of the MRNA um vaccine is that it can be rapidly altered and the virus itself I mean so that there's a there is when you study virology one of the things you learn is that DNA viruses uh smallpox uh are different than RNA viruses and that the former DNA viruses don't alter as much when they when they uh grow and and in a body and get transmitted They Don't Really alter very much RNA viruses are much more prone to uh to modification as they as they um as they as they infect other hosts and grow and multiply and so forth and so there's been multiple alterations in the in the covet virus not all of them have been a problem some of them make the virus just die right some of them make it more infectious but less lethal homicide right um the one that everybody's afraid of is the one that makes it more infectious and morally right which we haven't seen yet right that's the fear so so the beauty of the MRNA vaccine is that it can be altered relatively rapidly to changing conditions in the virus that is that is the predominant virus um and that's the beauty that's why one keeps one gets boosted again and again and again with this particular disease and our and our immunity seems to wane relatively quick quicker than we would like yeah yeah I mean our immunity for lots of things doesn't wait but for this it does why I I I don't I don't I don't know yeah right who knows or maybe somebody knows but I don't yeah right um um okay all right so uh I think that's pretty clear the immunity difference between the booster and getting the actual Omicron covet the booster is better uh get it um all right so uh next we have from s m thoughts about long covet and brain fog causes remedies supplements and treatments so kind of what we were talking kind of what we were talking about yeah I mean so we've kind of touched on it it appears that the virus invades all organs all organ systems and sits there it's not clear that that part from the from the postmortem study that it just has just been reported that's pretty clear uh um it's there is to the best of my knowledge one study ongoing looking at Pax livid to treat that I don't know if it's ongoing I don't know what's going to happen supplements I mean look I if you decide you want to take Vitamin C or zinc or I don't know whatever I I it's probably not going to hurt you probably probably probably but supplements there were people who were earlier insisting on hydroxychloroquine and Ivermectin and stuff like that I mean I I mean I wouldn't do that I don't think the supplements will help honestly I do know that that there is a group that has argued for high dose vitamin C and so forth I know some of those guys they're smart guys they're good guys I think they're wrong I think that data has shown their own I don't think it will matter but you know but if you want to take you know 500 milligrams of Vitamin C every day because you think it makes it better and a little bit of zinc it's probably not going to hurt you it's I don't think it's going to clear anything I don't think it's going to help right right um let's see what else what uh remedies supplement stream so is there so the treatment the only real treatment that we're looking at right now um seems to be and you should I should say you should talk to your doctor talk to your doctor keep talking to your doctor uh uh you know send them a message on my chart or whatever things will change and we'll try to do updates but uh you know it's possible that something between now and maybe even when you listen to this will will change so keep an eye on it and keep asking keep in contact with your doctor maintain an open Avenue of communication um but uh yeah so um I can tell you what what what worked what worked what maybe worked for me um aside from getting boosted which you should do uh and maybe the help maybe the time of course but uh I saw there was one study another preliminary um and and because it's so low uh cost uh I think that it's worth at least trying uh and what what people were looking at was um well they're basically doing Square breathing you know so like deep breathing breathing exercises uh maybe seem to kind of help or or possibly could help with the overall long coveted symptoms uh I don't know um it's it was just a preliminary study I think they're still going through it they're still doing it's long it's on those longer term things but if you wanted to try um but it sort it seemed to sort of help at least with um uh some of the uh uh you know shortness of breath stuff if nothing else just because I think that doing breathing exercises in general is probably good for you um there's especially if you have you know so I've had asthma All My Life um you know having activity uh you know getting up and walking around and and also you know of course anything else I mean this is sort of like stuff that isn't going to hurt you and you could definitely try um Square breathing uh in for the count of four hold for the count of four out for the counter flow for um hold for the count of four and then repeat that for two minutes uh and then you have to do that twice a day basically according to this study that is super preliminary and not a lot of you know good data for but uh yeah that's that's actually interesting so a couple of points one is what you call Square breathing is what we call or not we guys what people who I have worked with call combat breathing and it's meant to overcome the sympathetic discharge that you have with uh basically Panic so in through your nose to the count of three or four hold three or four out through your mouth through the count of three or four hold three or four and what that does is that triggers the vagus nerve so it slows your heart rate down a little bit and when you're jittery and nervous a combat situation right which is not quite what you're talking about uh it actually it actually does help if you're having a panic attack it actually does help uh that's point one point so I'm not making light of it at all I'm not but point two that I was going to say is is in the ICU once when we've got patients who are who have uh respiratory failure uh um for a number of different reasons one of the things we do when they're when they're able to come off of their mechanical ventilator either invasive or non-invasive ventilation is we use breathing exercises to try and make their lungs I would say strong it's stronger it's not the physiologic term but that's kind of what we're doing to help keep things open and open them up better and it really does work so so I can't think of a good reason not to do what you're saying at all I cannot think of the good reasons there are some you know sort of big the big treatments initially were um where the monoclonal antibodies right those really don't work at all anymore for the viruses that we're now seeing that basically the variant the four new variants of Omicron uh paxilabid does work and that still works and so that's a that's a treatment if you get it rapidly after you're diagnosed it really does help shorten the course and limit the risk of getting sicker but the immunization is the thing that will really help it's safe it's it is you know there of course there are side effects I mean it is a drug there are but you know whether the side effect you're looking at is myocarditis in young people the risk of not being vaccinated and getting the virus the risk of myocarditis is manifestly and manifoldably higher than it is with the risk with the with the immunization I mean everything the risks are there are risks but they're quite low compared to getting the virus itself so that's the thing to do as you said as we've said to get it and to stay boosted appropriately um if you if you really do get sick and you end up in you know in my ICU or anybody's ICU there's not a whole heck of a lot we can do there is the antiviral REM desevere which isn't great it does help a little bit uh and then and then there's the utilization of this very potent steroid called dexamethasone which which you know you would you usually give after the virus is essentially gone or it appears to be gone to blunt the body's immune response that's called cytokine storm which can actually is when the body itself attacks let me sorry when the immune system it's our own immune system attacks our body and it blunts that and there are some good data that that's helpful there's really not a bunch of them there's not much else you can do there are people who've argued using higher dose steroids no evidence I'm aware of but that helps using zinc and high dose vitamin C no data is it going to hurt probably not is it going to help No so at least when patients I'm caring for I try and get rid of all the stuff that's just extraneous that isn't going to do anything probably won't hurt but it's just going to Cloud the picture and try and stay as much as possible with evidence-based uh uh medications as much as possible you know if somebody's begged me to give them vitamin C would I say no of course I wouldn't say no somebody begged me to give Ivermectin that'd be a little bit different issue in fact I have had that happen really and I was screamed and cursed oh man I called names you wouldn't believe because I wouldn't do it but but you know it's okay it's like people you know I don't expect the families or the people I care for to be at their best but I'm supposed to be at my best so they can do all they want and I try and maintain some kind of equanimity and deal with it because they're they're sick and they're scared and as you said earlier they've been they've had the will pulled over their eyes by some fairly unscrupulous characters in our country right right right oh so so long story short there's doesn't seem to be a lot you can do we sort of are kind of figuring it out uh maybe sort of a little bit it seems to be in uh cadavers that were autopsied right afterwards so this is this is 40 there's a 40 Cadet 40 people who died with Slash of covid uh I'd have to re-look at the study again but what was important about the study is that in every organ system they looked at brain lung liver kidney name it there was virus and that their thinking that is part of the explanation for long covet it's not just it gets in your lung and messes things up gets in your blood vessels and causes Strokes it is everywhere and that may be the reason why we're seeing long covet and that's the rationale for the paxilivid study that's ongoing right now right right oh man well I hope to see some good stuff out of that so uh keep uh keep on I'll put in the show notes um I'll put in links to the study uh to that one and to whatever anything else uh useful or relevant to this stuff um okay so um let's see here uh next uh how about this um and we actually talked about this a little bit uh TM asks uh does uh should you go out to restaurants stores and bars unmasked or should you still wear a mask so it's all options based upon how much risk you're willing to take so when I go to like the market and stuff like that when I go to the hospital right in the hospital I'm masked every day everywhere full stop when I'm in my little office writing notes I take the mask off um if but but you know my friends and I my comrades and I my wife and I have gone to restaurants all right and you know you say we we you know we we first say well is it shall we go some risk okay can we sit outside if we can we sit outside better if you can't sit outside I mean I'm in Florida so I can sit outside but you're not you're not and you can't you know you say can you see this sort of away from other people if it's possible that what wake staff will do that and then we just take off the mask when we're eating and put it back when we're done eating there's still risk involved there's no question about it but and but so the question is is how do you how do you navigate and adjudicate the risk and how much risk are you want to take excuse me it's as simple as that if I was going to go to uh a bar you know which which I must say but I haven't been to in a good while but but if I had a friend who came to visit and I was going to take that person to a to a bar to to sort of uh there's a really cool bar here in Gainesville called cry babies which I've been told I don't know is a really cool bar so I need to I need to go there and if I was going to take a friend to that bar you know we would not wear a mask in the bar I mean it would be absurd you yes there is some risk I mean there's risk on the other hand I would uh any friend that anyone that I know that I would do that with was is completely up-to-date and their immunization so am I and so you say well so this is probably relatively low if I but if so but if if I'm not immunized I thought you know I wouldn't I wouldn't do it but but again it's it is the amount of risk and and you would not do it if you were if you were unable to if you were unable to get vaccinated uh or whatever then you would not do it I wouldn't do it yeah I wonder but but again it's because so so it's the on the one hand to be clear it's the risk that you're willing to take for yourself that part's true but the problem is that problem is it's not just you or me who's at risk if we don't mask right it's everybody we're around and if we're around a parent or a uncle or a grandfather or whatever whatever who's like old and frail and sick you can put them at grave risk if you get around somebody who's immune compromised for another reason your age but an uncomfortable you know in other words youngish you put them at risk around little kids you put them at risk so you know the way I try to argue this with patients who don't want to be immunized and family members who don't want the memories this just happened a couple days ago again a couple days ago again a couple of days ago again is you know I said look if this was if this was um smallpox right what would you think right because it's not just you you're putting a risk it's everybody around you because the are not the the infectivity right the r Big R zero are not the number of cases that come from one that are that are engendered from one person who's infected and depending on the the infectivity of the viral agent it can be from 1 to 10 to 20 right and in measles and in smallpox is quite High uh Omicron is quite High I I I'm purposely not giving the number because I did not look that up before I came on I said I can't quite remember but it's high so you're putting at risk not just yourself which you know that's your call you can do that but you're putting at risk everybody around you and then finally you're putting at risk the health care workers that you come to and you say fix me and you know I mean we're happy to do that and that's that is what we do but you know if you get us sick and overwhelm the system much like is happening with pediatric hospitals and respiratory Sensational virus there'll be no place for people to go and then what are you going to do so I would ask people to sort of make the calculation do what they think they want to do but think about the others around you directly around you and and people like me and then my colleagues who are the people who are going to care for you if you get sick you really have to be careful about this I I know it's it I'm I may be asking people to do more than than most of us are willing to do but I don't know what else you can say about that you know it's it's one of those things yeah yeah I mean you can't just stay in your house for the rest of your life because you're afraid of this I mean so you there is some calculated risk all I would ask is it use what exists get immunized wear a mask wash your hands when you can do it distance if you're sick and if you can do it try not to go out you know but then everything else is a calculated risk and our I mean our health system should be better our national Safety Net should be better so that there are ways to do this and it's an it's an embarrassment an international embarrassment that we're so backward but you know this is this is we have a massive military a trillion dollars a year for National Security State more than that but we don't have the money for health care or child care or or or or or so this is something we have to change and it'll probably be out well after I'm dead but maybe not after you did so maybe you can do it foreign I hope so we we uh I definitely agree we need we need Universal Health Care truly universal healthcare it is it is and really we need a global something we need to stop like you said stop treating it like it can only happen in one country or you can only vaccinate people in one country and we're not all into we are all interconnected covet does not respect borders it does not uh and it doesn't respect class either if you can't afford to get vaccinated you know you can't I mean sorry not vaccinated geez if you can't afford to get uh you know good insurance or take time off from work or whatever you know anyway so yeah so so wear a mask uh and and calculate your risk and uh and make sure that you take care of the people around you and uh and when you're making that calculation please put healthcare workers into the uh on the scales as well um because you know I like my uncle I want him to be around don't overwhelm them thank you thank you there's lots of good people I work with who are on the edge they are especially some of the nurses they are just on the edge they've just they've had enough um you know it's a I mean and they say the same thing that I said when they that when they hear that hero nonsense they roll their eyes we're not Heroes they say we're doing the job we know how to do give us the resources we need to do it that includes everything from personal protective equipment you will remember that our nurses were using garbage bags for PPE because we outsourced everything this starts under Reagan and continues under uh Clinton and continues to this day all those maybe going to start to be reversed because it's cheaper for manufacturers to use low low cost call it slave labor if you will compared to the American workers who should be making this stuff and should be unionized and should be paid at proper wage I think we can do with a few less billionaires and a few more middle class types foreign