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CoronaVirus Covid-19
Influenza and CoronaVirus: A Thoughtful Response

Influenza and CoronaVirus: A Thoughtful Response

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How should you respond to the spread of the Coronavirus?  Renamed COVID-19.  What is the most rational and sane response?  Should we close off all the borders?  Should we cancel all conferences and outdoor events?  Should we cancel the Olympics?  What is the real prevalence and mortality rate?  The answer: this is a time for vigilance, preparation, with calmness.

This is your grand sweep of time overview.  This series will be updated as this is a fast moving story.

CoronaVirus Requires Organized Incident Command

Great leaders exhibit calmness and reassurance while at the same time exhibiting  the qualities of a effective incident commander.  That is how massive wild land fires are fought.  An incident commander is identified and the command structure is assembled. Plans are coordinated and executed purposefully with determination.

So the problem with the Coronavirus is the fear of the unknown.  In the end this will portend far greater economic, commercial and societal consequences than epidemiologic or medical outcomes.  We have already seen a precipitous fall in the stock market, amounting to $5 trillion ($5,000,000,000,000) in paper losses.  It will rebound, but will fall again.

We should heed the words of Franklin Delano Roosevelt.  The only thing we have to fear is fear itself.  You will not die.  You simply need to take modest precautions.

Disease Outbreaks — Four Horseman of the Apocalypse

We are always faced with the Malthusian Four Horsemen of the Apocalypse.  War, famine, pestilence and disease.  They will never fully disappear.

Throughout all of human history we have witnessed great epidemiologic challenges and disasters.  Leprosy, tuberculosis, the plague (the Black Death), smallpox, the pandemic flu of 1918, AIDS, SARS, swine flu, MERS, Ebola virus and now Coronavirus.  It will never end.

There were numerous recurrences of the plague through out the middle ages.  The worst in 1348 where an estimated 40% of population throughout Europe succumbed.  That must have seemed like the end of the world.  It was centuries before the germ theory of contagious disease.  No one knew the source.  So there were religious incantations.  There were whole groups who were shunned or dispossessed.  And then it stopped.

Half of Paris’s population of 100,000 people died. In Italy, the population of Florence was reduced from 110,000–120,000 inhabitants in 1338 down to 50,000 in 1351. At least 60% of the population of Hamburg and Bremen perished,[81] and a similar percentage of Londoners may have died from the disease as well.[67] In London approximately 62,000 people died between 1346 and 1353.[19]  — Wikipedia

1918 spanish Influenza pandemic

During the Spanish flu Pandemic of 1918, it is estimated that nearly 1/3 of the world’s population contracted the flu.  More than 500,000,000 people.  It followed the end of WWI, with mass troop movements.  With massive shifts in human populations.  The flu actually lasted 2 years.  There was a ping-pong effect between America and Europe.  The stories are legion of physicians working around the clock, tending to patients without antibiotics or antivirals as we have today.  That also was a draconian period of time.

But we survived.

Annual Influenza Review

Each year I compose a blog detailing the ineffectiveness of the influenza vaccine, because the flu mutates each year.  The vaccine is always based on last year’s virus.  It is always a guess.  Effectiveness varies between 10-60%.  But a more detailed look at vaccine effectiveness shows a distinct stratification according to age.  Where the effectiveness of the vaccine is even dramatically less in older and frail individuals.  That is why we are now giving triple or quadruple strength vaccines to older individuals.

And currently the number of fatalities from the flu, even this year, far exceeds the Coronavirus.  But the flu has become displaced as the topic du jour.

CoronaVirus in Perspective

Even last week a more detailed look at the viral spread in China is quite revealing.  At least 80% of all cases originated in one province.  From Wuhan.  Virtually no fatal cases in Shanghai or Beijing.  High density populations where you expect higher incident and mortality rates.  You never hear about this.  And with draconian infection control the rate of spread is beginning to diminish.CoronaVirus StatisticsIt’s interesting a whistleblowers complaint about known Coronavirus patients disembarking from a ship in Vallejo may have been the source of the recent death.  But what about all of the unprotected team members who were sent home?  As far as we know none of these have succumbed.

In the end all viral and bacterial infections are a host response.  If you are healthy and vigorous, your chances of contracting any illness are diminished.  Those that are older and frail are more subject to pneumonia and perishing.

I am not reassured by the current administration’s haphazard and amateurish approach.  This appears to be a Keystone Cops approach. There are some stars.  Dr. Anthony Fauci is highly respected at the CDC.

Treatment Modalities

So here are my annual recommendations.

These were formulated for the flu but may pertain to the Coronavirus.   Influenza vaccines are ineffective.  Anti-virals such as Tamiflu and Relenza have immediate value if taken within the first 48 hours.

My recommendations each year are effective.  [Although the usual FDA disclaimers for advocating treatment therapies are acknowledged.]

At the first sign of the flu or any viral syndrome:

  • 50,000 units of vitamin D daily for 5 days.
  • Astragalus 1000 mg daily for 5 days.
  • Thymic protein A (ProBoost) 1-2 packets 3 times daily for 5 days.

The effectiveness of vitamin D against viral syndromes is well demonstrated.  Similarly should there be any doubt of high dose vitamin effectiveness, the only known cure for severe life-threatening measles is – vitamin A.

Wash your hands.  As Ignaz Semmelweis demonstrated in the mid 19th century, washing the hands prevents dissemination of disease.  He was able to decrease the rate of postpartum death  (Puerperal Sepsis)  from 40% to 1% simply by washing hands (in carbolic acid).

Stay calm. Get plenty of rest and sleep.  Don’t panic.

Let me know your own observations.

 

Philip Lee Miller, MD

Carmel CA

March 3, 2020

2018-2019 Flu Vaccine, Prevention and Treatment

2018-2019 Flu Vaccine, Prevention and Treatment

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This is my seasonal flu post.  One that I update each year.  Here are current recommendations and controversies regarding influenza vaccinations, prevention and treatment.  I am going to give you a slightly expanded version this year related to last year’s flu vaccine post.  In short, I have never been a proponent of flu vaccinations.  I am middle of road on vaccinations.  You really want polio, measles and mumps and tetanus every 10 years.  For high risk exposures you want Hepatitis B vaccination. But we are over vaccinating our children and even pets.

Influenza is a seasonal epidemic viral syndrome that usually starts in December and lasts until approximately February or March.  In the past, I would begin to see large number of acutely ill patients pouring into my Urgent Care clinics in October and November. I eventually termed this the “pre-flu” syndrome.  Something approximating the flu but not the full-blown symptom complex.  The true flu is manifest as fever, shaking chills, severe achiness (myalgias), and malaise.  You feel really sick.  This is more than a common cold.

Now the problem with flu vaccination recommendations is dependent on who makes the recommendation and for what population.  I am going to make a recommendation for you specifically.  This is in contradistinction to a public health official who epidemiologically makes decisions for large populations.   They are concerned about “herd immunity.”  Higher rates of immunized people decreases the spread.  At least that is the theory.

There is no universal flu vaccine

The challenge has always been how to formulate this year’s flu vaccination.  There is no universal flu vaccination.  That is the basic dilemma.  Influenza A is the more virulent strain mainly affecting adults.  Influenza B affects mainly children.  Influenza mutates by “antigenic drift” from year to year.  It can even mutate during incubation. In most years, there is a “minor antigenic drift.”  In some years there is a “major antigenic drift,” in which case far more people fall ill because they have not never been exposed to the current strain.   And thus it is more virulent. A pandemic.

Flu Strains

Epidemiologists classify influenza with two attributes.  H attribute (hemaglutinin).  And N attribute (neuraminidase).  H1N1 and H3N2 are targeted this year.  So the recommended quadravalent (4 strains) flu vaccine being manufactured this year targets:

  • A/Michigan/H1N1
  • A/Singapore/H3N2
  • B/Colorado 2017 B/Victoria 87
  • B/Phuket 2013 B/Yamagata 88

Because we do not know the precise strain that will prevails this 2018-2019 season, it becomes our best educated guess.  What is the most likely strain based on recent world wide observations.  The selection process may begin in February of the current year.  This gives enough lead time for sufficient vaccination stocks to be replenished each year.  This takes time.  It is all the guess.  Again, the primary dilemma is – there is no universal flu vaccine.  That is the holy grail.  Research scientists are busy trying to develop this.

Vaccine Effectiveness Rates

CDC Seasonal Flu Vaccine effectiveness
Seasonal Influenza Vaccine Effectiveness, 2004-2018

Last year it was said that the flu vaccine was only 10% effective.  In retrospect, the CDC published an average for all age groups of 40%.  Here are the reported rates of effectiveness for the last 14 years [link is no longer available].  A more detailed breakdown by age for 2016-2017 shows even more variability.  All these statistics are somewhat irrelevant.  What is more relevant is the flu vaccination most often less than 40% effective.  So the recommendation is based on, “well, it’s better than nothing.”  I can’t think of hardly any other medication in use today were the rationale is, “well, it’s better than nothing.”  Surely there must be a stronger argument and rationale to the widespread public campaign to “get your flu shot now.”

Recalling my days in Urgent Care once again in the early 1990s, it was common knowledge that “there is no medical treatment for the flu.”  So you must get a flu vaccination.  This always puzzled me because there was indeed a medication that treated the flu.  Symmetrel (Amatidine).  This was discovered by happen stance when so many Parkinson’s patients who were treated with Symmetrel for “the shakes” had a much lower incidence of the flu.  I began using Symmetrel with rewarding success.

Anti-Virals now available

Today, we have a developing stable of anti-influenza virals.  That is Tamiflu, Relenza, Rapivab and the newest Xofluza (Baloxavir).  So you have a choice.  You can have the flu vaccine in various forms.  You can defer any vaccination and be treated with any of a number of antiviral drugs.  Or there is a natural routine that I have developed over the years.  Empirically quite effective.

My recommendation for a natural approach

Miller Anti-Viral Regimen ™

  • Vitamin D 50,000 daily x 5 days
  • Astragalus 1000 mg daily x 5 days
  • Thymic Protein A (TPA) 1-2 packets 3 times daily x 5 days

So what do I recommend?  I have been a proponent of aggressive doses of vitamin D which is known to prevent seasonal flu syndromes.  At the first sign of any viral illness or especially the flu, start taking vitamin D 50,000 units for 5 days.  Yes that is high dose.  Astragalus 1000 mg daily for 5 days and a proprietary product called Thymic Protein A (ProBoost).  One packet 2-3 times daily for 5 days.  This is a highly effective routine.  And most effective when started in the first 48 hours.  Sometimes this routine is so effective that after one or day, you may feel totally resolved and stop the routine.  2 to 3 days later, the virus is even stronger.  So a 5 day routine is highly recommended.

Now let me know your thoughts and experiences.

Philip Lee Miller, MD
Carmel, CA 93923
Nov 2018

Flu Vaccine 10% Effective

Flu Vaccine 10% Effective

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getting your flu vaccineFlu vaccine may only be 10% effective this year?  That means 90% ineffective.  Tell me more.

I am asked frequently by my patients, “do you suggest or advocate the flu vaccine.”   My simple answer is no.  I do not recommend flu vaccines.   I am middle of road on vaccines.  Some vaccines are essential.  No argument.  Tetanus boosters, MMR for measles, mumps and rubella, polio vaccine.  In my day we all had smallpox vaccination.   That is now history.

 

Sabin oral poio vaccine

I can vividly remember lining up at my high school for the first series of oral polio vaccinations.  It was a new era.  Based on the original Jonas Salk vaccine and later refined as the Sabin Vaccine.   It was the Sabin vaccine that we all eagerly took on sugar cubes.  [many years later Larry Sabin, his son, was one medical school graduating class behind me]

Now the problem with the flu vaccination is quite different.  Every year the current strain mutates or originates in a different vector or region.   It is subject to antigenic drfit.  There is minor antigenic drift and major antigenic drift.

Vaccine Effectiveness by Varies by Year

flu vaccine effectiveness over timeMajor manufacturers of the vaccine only have 6-8 months lead times.  The current stock is always based on last year’s strain.   With the assumption that there are only minor changes.  The minor antigenic drift.  But it is never identical.  In the best of years, the vaccination is 40-60% effective.   Or contrariwise, 40-60% ineffective.

This year, CDC experts are admitting it will only be 10% effective.  90% ineffective or not worth the bother.

So I am greatly puzzled why all hospitals and large institutions mandate the flu vaccination.  “It’s better than nothing.”  10% effective is not “better than nothing.”   It gives rise to a false sense of security.  Staff and patients are protected.  No they are not.  This is where public safety and good epidemiological policy making collides with individual choice.

Here is a news story from 2004.   We have not seen significant change since then.

 

WASHINGTON – The influenza vaccine that many Americans clamored for this year was not very good at protecting people against influenza, colds and similar viruses, a preliminary report published Thursday shows.

The study is the first attempt to show whether the vaccine that many sought after a flu scare this autumn and winter actually worked.

The study of hospital workers in Colorado, a state that was hit early and hard by influenza, showed the vaccine had “no or low effectiveness against influenza-like illness,” the U.S. Centers for Disease Control and Prevention said in its report.

Reporting this year:

What’s more, this year’s flu shot may not be up to the task. It is the same formulation that was used during Australia’s most recent flu season — which typically sets a pattern for what the U.S. will face — and it was only 10 percent effective there.

…  But Sabeti says even though the effectiveness of this year’s vaccine is particularly low, it’s still worthwhile to get a flu shot.

“Even 10 percent effective is better than nothing, and a lot of it has to do with herd immunity — the more people are protected from it, the more other people will also be protected,” she said. “In fact, in a year where it’s low effectiveness, it’s even more important that everybody get it so we can get as much resistance and we don’t allow the virus to thrive and grow and keep changing.”   — CBS news

Searching for the Holy Grail — the Universal Vaccine

Researchers are avidly seeking the “universal vaccine.”  That is the Holy Grail.  An admission that the current crop of vaccines has been admittedly inadequate.

Recent efforts have focused on the development of a new generation of influenza vaccines that could provide broad spectrum, “universal” protection against a wider range of influenza variants including strains with pandemic potential. DNA vaccines possess a number of characteristics that make them particularly well suited for a universal influenza vaccine [3–6]. In the event of a pandemic threat, DNA vaccines offer an important advantage of accelerated vaccine development and production since the DNA vaccine sequences can be obtained directly from the clinical isolate and rapidly constructed and propagated using well-established molecular techniques without the need for cell culture or eggs. DNA vaccines induce both antibody and T cell responses, and both arms of immunity contribute to cross-protection against different influenza variants [7, 8].  — PLOS One

Anti-Viral Medications and Treatment

As recently as 1990’s the common wisdom offered was, “there is no treatment for the flu.”  That was not true.  And it always puzzled me.  It was quite well known even then that Symmetrel (Amantidine) used for Parkinson’s Disease was effective against the flu.   From empirical observations it was noted that Parkinson’s patients treated with Symmetrel were far less likely to suffer the seasonal influenza.   I began treating patients in walk-in clinics appropriately.

Today we have a new series of anti-viral flu treatments.  The most effective is oseltamivir (Tamiflu).   A second choice is zanamivir (Relenza).  These need to be started in the first 48 hours for maximal effectiveness.

The authoratative and erudite source The Medical Letter concludes:

A neuraminidase inhibitor, either oseltamivir (Tamiflu) or zanamivir (Relenza), remains the drug of choice for treatment of patients with influenza who are at high risk for complications of the disease, and for anyone hospitalized with presumed influenza. Oseltamivir is preferred for treatment of pregnant women. Otherwise healthy persons who are not in a high-risk group generally do not require antiviral prophylaxis or treatment for influenza

A most interesting conundrum.  If anti-viral prophylaxis is not indicated for healthy individuals then why is the flu vaccine indicated for everyone?   And the debate continues.  While there is policy decision-making consensus on flu vaccination, the debate as to the appropriateness of anti-virals continues.   I argue here that anti-viral treatment is far more effective per case than vaccination.

Dr. Miller’s Novel Approach

Which finally leads me to a more novel and less toxic approach that has been effective across a wide variety of viral and flu syndromes:

  1. High dose Vitamin D — 50,000 units daily for 5 days (yes, that is high dose)
  2. Astragalus 1000 mg daily for 5 days.  A most potent Chinese herb known for its potent immune boosting properties
  3. Thymic Protein A — 1-2 packets three times daily for 5 days.   Activates anti-viral t-cell and b-cell immune activity.

thymic protein A -- immune booster

Philip Lee Miller, MD

Jan 09 2018

Carmel, CA

 

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