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Ep. 143 - LiveWell Talk On...Busting Common COVID-19 Myths (Dr. Evan Diehl)

episode 143

Ep. 143 - LiveWell Talk On...Busting Common COVID-19 Myths

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Evan Diehlvice president medical director, UnityPoint Clinic Cedar Rapids

Dr. Arnold:
This is LiveWell, Talk On…Busting Common COVID-19 Myths. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health - St. Luke's Hospital, Cedar Rapids, Iowa. You cannot turn on your TV or look at your phone without seeing some sort of headlines about the pandemic and COVID-19. Whether it's new variants, whether it's mask or not mask, vaccine hesitancy and even to the point of COVID 19 denial, that it is really real which is mind boggling. But in any case, we thought it'd be nice to have a podcast where we looked at some of these myths we, and analyze them to see because there may be an element of truth. It may be all a mass hysteria. And to join me today as Vice President, Medical Director of UnityPoint Clinics -Cedar Rapids, Dr. Evan Diehl. We're going to break down some of the common myths and take a look at why these things are developed and why they're persistent. Dr. Diehl, welcome back to the podcast. I think you've been on before.

Dr. Diehl:
No, it's the first time, Dr. Arnold.

Dr. Arnold:
Really?

Dr. Diehl:
Yeah. First time the invite. I appreciate it. It's first time, on.

Dr. Arnold:
You listen on a regular basis, correct?

Dr. Diehl:
Absolutely longtime listener first time being on the show.

Dr. Arnold:
Longtime listener, first time guest.

Dr. Diehl:
Thanks for having me,

Dr. Arnold:
Evan, as you and I have talked before (and I've talked to other people) you know, this pandemic arrived in a campaign year presidential campaign, and during campaigns, everything is politicized. That is historically what happens. But the politicization, the polarization, the black and white of an issue that's incredibly gray has been persistent to the disadvantage, I think of the scientific community on some level, as far as building trust. And I think Americans in general are readily independent when they need to be, and that's why they're Americans, but it certainly has complicated issues. So I kind of want to go through kind of some of the common things that we hear and just where we are at, and maybe what was the, or how did this start? And the first one that I wanted to ask you about was airborne versus non airborne transmission, as well as asymptomatic transmission. You know, I can remember I was just reviewing some stuff for this podcast that when the WHL said, it's not person to person transmission, and now we know that it's to be patently false. Not that they were misleading people, I just think don't think they knew. So is COVID-19 airborne?

Dr. Arnold:
Yeah. I, I think there's, there's evidence that, you know, scientifically that it, that it can be - that it is. I think the question we don't know is like, is that a regular part of how people are getting it. You know? And so I always remember, like when they closed down the playgrounds and talked about disinfecting surfaces and things like that, and I always just found that shocking to think, like, I don't, I don't think we're getting the virus from, you know, touching some plastic from somewhere else. I think most of us in the medical community are aware, how influenza spreads, like we get the idea of droplet spread of sneezing and, and that most of the evidence suggests that people are getting it from close contacts, you know, people breathing and coughing and sneezing by them. So there's going to be these like, you know, scientific studies that talk about transmission and ways that it's transmitted. But I think the bigger question is how is it most commonly spread? How do we stop the biggest chunk of that? And I, I do think that comes back to the common sense there of some masking, of covering your cough, cover your cough and your mouth when you're sneezing and washing your hands. And I think that's the biggest part of it.

Dr. Arnold:
I think you're right. I mean, I think whether or not it's airborne... First of all, measles is known to be airborne with a very high R.O rate, meaning for every case of measles, (it may be close to) 10 other cases start and that's how airborne measles is. But do you know, they've never cultured if that's the right term, because we don't really think a culture when we talk about viruses, but have they, they've never cultured measles out of the air. It's done by looking at well, how does it present and how does it transmit. And I think if you look at a couple of things that to me, I think it's pretty definitive that it probably is airborne. That is the USS Roosevelt and other cruise ships - they had people that had no contact with each other, didn't touch the same things were not in that, but they shared the same air for a period of time.

Dr. Arnold:
And we had transmission and particularly in the U S Roosevelt, they could buy duty assignments and logs. They know where people were, you know, so they could say, okay, this person never came in contact with these people and they got it. And the other is we know that outside events are pretty safe. It's indoor events without ventilation being dangerous and indoor events with poor ventilation are dangerous. So, I mean, I think, I really think it's put to rest, but there's still a lot of controversies. There are still people who don't believe it's airborne, but you're absolutely right, it started the fomite or the touching surfaces. That was huge. Everybody's wiping down everything in, it's probably not transmitted that way.

Dr. Arnold:
Right. I mean, I know I'm not a, this is one of those do what we say, not what we do, sort of things that not none of us are perfect with masking. And I think I try to as much possible in close contact with people to put on a mask. But you always know there's people that have different levels of caution than you. And I've wondered when I'm outside walking my dog, you know, in the middle of Iowa not close to people that I presume that as being safe and you walk by someone briefly on the sidewalk who has an N 95 on, and you realize like, oh my goodness, like maybe they think, I don't believe in masks. Like they're, they're so far in that other spectrum. So it's just interesting, you know, the wide degree of how serious people take that.

Dr. Arnold:
I think you can't deny the, the elephant and the donkey in the room and make a political pun that it kinda depends where you're falling as far as what you believe in. And I, I wholeheartedly believe particularly with the vaccine passports that if it was reversed people that are for it would be against it and the people that are against it would be for it. And there's on certain level, there's just no doubt in my mind, that that be true. I remember learning this when we went to Italy that the term passport actually comes from the play that you had to pass to get through the ports to enter these walled cities. So you had to, in some way, prove that you didn't, weren't active with the plague. So that's kind of interesting that when we, when we think about that. It always surprises me the asymptomatic transmission. And I want to hear your pickup, you know, people say, well, respiratory viruses don't transmit asymptomatically, but there's a lot of viruses that transmit asymptomatically, you shed the virus before you're infected.

Dr. Diehl:
Yeah, that's actually true. And think of how frequently, you know, we all get a little cough or cold or sniffles that, you know, just have for a day, it could be allergies. And we just don't know. And I think that comes back to a lot of these recommendations that, like, if there's any question we don't know, like it's just, let's set a low bar for, you know, trying to avoid populated places and wear a mask. And, you know, there's plenty of times I woke up with something that I usually would call allergies that, you know, the last two years has put a great deal of you know, put a little bit more stress on that. Like, oh my goodness, maybe this is COVID. So, so we don't know. I think it happens a lot before the last two years with other viruses in cold season. And you know, what is that level of having symptoms? Is it just a little scratchy throat or are we talking about a full blown fever?

Dr. Arnold:
Well, and here's another thing. I mean, you'll appreciate this as a physician, we're all day long asking patients, when did the symptoms start? What made him better? What made him worse? We're taking a history because the history is 99% of medicine getting the narrative from the patient. And then 1% is confirming that narrative on physical exam. Right? And how have you ever been a patient as a physician and you're a patient and they start asking you those questions. You realize what a horrible historian you are. They're like, when did you start kind of like I don't know, you know, and you know, the nurse asks you and you say, well, it started a week ago. And then you sit there for a while and you'd go, oh boy, it did happen at that wedding, so it was about two weeks ago, I guess. Doctor comes in and now it's two weeks, you know, and that happens all the time. It's happened to every clinician. But you realize patients are, just not just patients, people are not reliable historians.

Dr. Diehl:
It's really hard, and we don't know the difference between completely asymptomatic, just really mild symptoms. You know, I knew someone that just had a headache and didn't feel that good for day And, and ended up testing positive for COVID. So was that COVID, was it asymptomatic? Was it something else we just won't know.

Dr. Arnold:
In a related, as far as symptoms and contact, you know, we can do a whole other podcast about just the stress in society prior to the pandemic. I mean, I think it's safe to say this now. I wouldn't have said it back then, but I did feel it, that there was kind of a sort of enthusiasm to cancel meetings and change your schedule because it was so stressful prior to the pandemic. It kind of was a stress relief, and that's probably hard to explain, but I felt that not just in our industry, not just in medicine, but just in everyone's industry, that it was the early on that first week or so it was like, just, although it was scary, it was also kind of break from just the mundane and the stress of what we do every day. It's really made me rethink that well. Okay. Is it, was it important to have these meetings on regular basis when we went without them and the world didn't end. And so I've tried to look at my life a little bit as far as what brings value to things. And, I think that the pandemic has made me look at it. It's kind of an unrelated topic, but not...

Dr. Diehl:
Imagine the number of books that will be written about these few years. I mean, there's so many societal things to study and, that first one you mentioned is like, yeah, we all kind of came together that late winter and spring. And there was a lot of you know just "us" and "we" thinking about, you know, even the country, the world, as humanity as a whole, we were gonna get together and fight this thing. And even the support that we got for as healthcare workers, I mean, that was amazing. And for most people it's still going on, but I think what we're just seeing now is just a lot of real burnout and people are just really, really tired and still talking about it. And so some of that, some of that grace that we gave each other has worn off a little bit.

Dr. Arnold:
Well, we, we talked yesterday on that podcast, that weekly update, and I've come to this observation. I want to get your opinion on this. This is kind of off topic, but it is. So the communities that were vaccinated at a low rate had this spike at Delta, almost overwhelmed sending us patients from Missouri, from St. Louis, because they had no critical care beds. I mean, absolutely five alarm "Def con five" crisis. Right. But it lasted for a brief period of time. And now it's kind of come back to these communities. Like what's, COVID? They're back to normal where here in Cedar rapids in Lynn county, we have like a 65% and climbing vaccination rate our own employees that's 4,000 or so, I think we're in an, almost the nineties percent, you know? And so I think with the communities that have a high vaccination rate, that Delta moves through slower. So you end up rather than being overwhelmed with 120 really sick people in the hospital. One time when you're just about ready at your breaking point, and then it drops that it's actually harder to do this sort of prolonged plateau of 25 plus or minus two for weeks on end, because it's hard to continue to adrenalize the situation over a sustained period of time. Now I'm not, this is just my observation. I'm not saying that the vaccine, but I'm still recommending the vaccine. That's, that's good because less people die. But it, I think, I think you're right. I think when we look back at this, you're gonna, we're gonna learn some things about ourselves and as well as learning some things about just stress and dealing.

Dr. Diehl:
Yeah. I think, you know, things could have been worse that first wave, and there were some people that were screaming like, you know, Hey, let's just get this over. We'll all get it, you will all get immune to it. And the initial attempts were about like flattening that curve, right. Flatten the curve so that we don't run out of ventilators. So we don't run out of hospital beds. And for the most part, we were successful with that through a lot of the country. You're right that, you know, we might have a, more of a slow burn ongoing, but I guess the, the, the benefit of that hopefully would be that fewer people should die. You know, we should be able to maintain our supplies. I mean, think about back last year, we didn't literally didn't have surgical masks for awhile, and we're very much in a different place, I think because of our efforts to conserve those things and supply chain efforts. So there's benefits there, you know, we've gotten more comfortable with caring for some of these patients, you know, when we show up to work each day as - I'm a hospitalist - at St. Luke's and you know, I think it's a little bit more everyday practice now that we have a few patients with COVID, we kind of know what the standard care is. So, you know, you lose a little bit of that fear, a little bit of excitement, and I think that's, that's mostly a good thing in medicine. We don't want to be dealing with an unknown and be unprepared, but you're right. It does seem like, you know, we're going to have a bit of a slow burn for a while still.

Dr. Arnold:
Yeah. you actually, right. I'm not saying it's a good or bad. I'm just saying that I think that's why some of the, that's why it's so hard at times to have that slow plateau or persistent plateaus (what I'm calling it) because you endup with pandemic fatigue and I've got a couple of interviews national public radio and local television saying that you don't call it burnout. Okay. Cause burnout is that the things that you've always done no longer provide emotional value to you and you're burned out. Right? This is totally different. I mean, this isn't burnout, this is pandemic fatigue. You know, I've even heard people call it empathy, fatigue. I don't know if I like that term, because it kind of has a slight negative connotation. Like you no longer have the ability to be empathetic, which there is probably such thing as empathy fatigue, but I don't really like to use that term. But it is, he said right before the podcast, it's gonna be interesting to look back and say and learn from everything because it's so hard to study something when you're part of the study because you have observational bias and I can't, for a lot of reasons.,I can't wait until we get through this, but it's gonna be interesting to look back on this. The fact of this, the mask, you know, you mentioned it, at the end of the day they don't hurt.

Dr. Diehl:
I think that's the biggest thing, especially when we're talking about public policy, like, you know, yeah. There's not a research behind like a community you know, recommendation for everyone to wear a mask in a restaurant or not. But if at the end of the day they don't hurt. You know, I think that's what a lot of the thought comes from that. Like if I don't know for sure if I'm going to spread it and there's a chance that we're going to mask might help reduce it. It's something that I should be able to do. I think, as a member of a, of a community as a citizen to help protect others. I do think we get spent a little bit too much time on the thought that the masks are helping us. I mean, there, there likely is some benefit there, but really I think of wearing a mask is about not spreading my potential viral load to others. There might be settings even with cloth masks or things like that, where they could be less efficacious, but I think if there's a chance to help and they're not causing me harm, it's a, it's a minor annoyance at times. It's a reasonable thing to do until we're really past the worst of this.

Dr. Arnold:
Well, you, you know, I've been very vocal a bit. I get frustrated because masks are, they should be put on correctly, not touch from one once, you know, have anything beyond that. I think it loses the, the, the value, the benefit, but it doesn't ever become a negative. I don't think it really, you know, I mean, I still think of people will say, well, there's no evidence that masks work. And it's kind of the analogy of, there's no evidence that a study placebo, controlled, blinded that jumping out of an airplane with, without a parachute, which group does better. Right. Because why would you study that? Because it's obvious do you need, (a parachute)...

Dr. Diehl:
Well, indeed this would be much more controversial if it was a expensive, dangerous invasive therapy, you know, something like that where it could potentially do harm. And I, I really don't see any reason to think that wearing a mask could, cause harm to the mask wearer

Dr. Arnold:
Although wearing a mask by yourself, driving a car is still a little weird to me.

Dr. Diehl:
I will give you that, I've had some, yeah, some strange looks at.

Dr. Arnold:
Back to the mask and just in general, you know, I've been kind of, I've been disappointed in the United States that we haven't done a better job of answering some of these fundamental questions. Some of them, you and I are talking about right now, antibody testing, effective public health measures. You know, I mean, we're the United States. We should be conducting these studies. We're getting the studies out of Thailand and Hong Kong. Not that the study is inferior. It's just I'm a little disappointed that our public health apparatus hasn't made a bigger, better effort to study some of these things transparently.

Dr. Diehl:
Yeah. I mean, it's the, it's just been such a moving target. And you've said this before, you know, like science is about the pursuit of knowledge. Right. And I think recommendations keep changing as we get more information and with the mask guidance initially all the way back there was, we were, we were concerned that we weren't going to have masks in the hospital and I mean that, and that was a big part of that recommendation of saying that, no, you don't need to wear one out in the community because we need them in the hospital. Well, once that barrier went away, then you know, then they, I think could get a little bit more generous with, with those guidelines. But now people might look back on that and say like, see, you, you, you changed your tune here. First he told us not to wear it. Now you're telling us to wear one. I think that's one reason why you know, people started to lose a little trust

Dr. Arnold:
Ivermectin, this, this has come up and I've told you that I don't treat river blindness. So I remapped it and it is not a drug that I would think of. And in preparation of this podcast, you and I had a conversation last week talking about what, what we're going to talk about and some of the questions that we need to answer, you know, I mentioned to you like Colchicine, which is an old drug has been tried just about on every disease. I've even seen the cold see, might help COVID, you know which it's a gout medication has as inhibit, inhibits the movement of white blood cells. So it reduces inflammation, which is, it's an, it's a novel mechanism. And so I think that's why, but there's also the Statins. I just saw an article come by today, statins have an influence on - it was a non-cardiac illness, you know? I mean, so it's never ending where they're trying to find new indications for an older drug. Right. And do you know where, where did this ivermectin come from? Why would I even think, I mean, am I a bad doctor if you walked in my office with a viral illness? And I said, I'm going to give you something for river blindness?

Dr. Diehl:
I think it would be a bit of a bad doctor, but where did this come from? I think you, and I know that like, these studies are going on all the time for, for lots of things. Right. And I don't think there's ever been this level of public scrutiny on primary literature, you know, before. So like, as soon as a new study comes out with a new medicine, they're trying, I mean, this was a new disease. People were going to, they're going to throw the kitchen sink at it and try to find something new and that's the right thing to do, right? Like a scientists and physicians like to try and fight a new disease. We need to try and find a new cure. So that's the right thing to do. We all were initially on board with some evidence that hydroxychloroquine, or Plaquenil was effective, you know, back in that initial spring, we started to use it for a short while they were recommendations to do so - that quickly became apparent that we were causing more harm than good, you know, as patients were developing issues with cardiac arrhythmias, et cetera. And so we changed practice as more evidence became apparent and recommendations came out. I'll tell you this, like, I'm a practicing physician in the mindset that the vast majority of what I do with patients should be, should be pretty well recommended by our national bodies. You know, the for internal medicine or family practice or hospital medicine. And right now it's very clear that they're not recommending the use of, of ivermectin based off that congregate analysis of all these studies. I think that for myself as a practicing physician I do not see it as part of my regular duty to be going through primary literature all the time and trying what's new you know, or finding the new hottest thing. I think it is appropriate the way our healthcare system set up to let the process work and let peer review studies be peer reviewed, go to the journals and then have consensus recommendations by those, by those bodies. And we, haven't got there with, with specifically with ivermectin, you know, we're being recommended that it is not appropriate, that it's causing more harm than good. And perhaps it's more of a controversial thing because it is available over the counter, you know, and that you know, that patients are able to get it in other places, you know, they're not able to get some of these other prescription meds that have been experimental therapies. One that we seem to have stuck to in the hospital for hospitalized patients is knowing that a steroid dexamethasone has shown some benefit. But again, we're talking about pretty limited benefit about like reducing the time and severity of symptoms. It's not a cure. And so the biggest thing I'd take away with the controversy ivermectin is that we've still lost some of that patient physician provider trust. Like we, everything we do is, is based around that. And you have to understand as a patient that like your provider wants you to get better. If there's something there that we could use to make you get better, we do anything to, to get that to you, safely, but you mentioned it before at first do no harm. We have to wait until we have evidence. And we know that we're not going to give you something that's going to cause harm. And no one's withholding any medicines from patients, you know, because of government conspiracies or anything like that. We are following the scientific recommendations and guidelines and want to get you the best treatment as soon as possible. That's, that's my biggest takeaway from it.

Dr. Arnold:
I, I think well at this point, I think if the boards of medicine and the media would have just said, yeah, if you and your doctor want to try ivermectin, that's you and your doctor's decision, you know, and there's no evidence, it's tremendous amount of noise, but I keep right under the glass near my desk, that evidence, studies refuted overtime, randomized controlled trials. 32% of them are refuted over time - non-randomized controlled trials, 83%. And I keep that on my desk just to remind me that, you know, what I'm doing today may really not be a benefit, but it sure as hell, better not be of harm. You know, I think that's the way you go into these conversations with patients that, what, what is the benefit, but what, what let's make sure it doesn't harm you. Plaquenil is a safe drug when it's used appropriately. And if you're not using all the time then you need to be careful that, but then also you run into an issue and we did this with Plaquenil back then we looked at downstairs in the pharmacy looked at our chronic Plaquenil prescriptions. And we set three months aside Plaquenil for those patients, right? Because we were afraid that we could have a run on the pharmacy, and then these people that need it for their lupus that need it for the rheumatoid arthritis, it wouldn't be there. So that was, a decision that we made. So sometimes if something might be of a benefit, but if you're taken away from another patient that it's proven to be a benefit, proven to modify their disease, then that causes harm too,

Dr. Diehl:
I get concerned specifically with ivermectin talk that the more we talk about it, do we, you know, increase this controversy? That amongst medical professionals, I, I don't really think is there, I don't think it's controversial right now amongst, you know, physicians and providers that the evidence is not there, but it doesn't help and it could cause harm. So to me, it's not,

Dr. Arnold:
Yeah. I know you'd have a lot of interaction with the outpatient doctors, more so than me just in your position. But I would confidently say our medical staff is not walking around looking for ivermectin, you know, because it's the, data's a lot of noise and it's the Miami trial, beta blockers and heart attacks that took 18 years before the Miami trial was completed. And it became standard practice because it kept being retested. That truth kept being re-looked at, because we don't want to harm people. And it's really hard just to throw something out there that can potentially harm.

Dr. Diehl:
So I've encouraged people to like, let's move on. We're going to keep looking at the data and studying drugs, you know, in therapies as we can. But I don't think this is a controversial topic on that standpoint. And you know, don't get medicines from, from animal pharmaceutical companies. I think that's a pretty clear-cut recommendation

Dr. Arnold:
Unless you're an animal.

Dr. Diehl:
Unless you're an animal. Think about those animals. yes.

Dr. Arnold:
More to come on that as far as I think that hopefully that will be cleared up someday and definitively answered, but it may not be, you know, it may be one of those things. While we're talking about treatments that kind of came out of nowhere, Vitamin D comes up a lot, and I'm going to tell you a story that I think is really important. So, I mean, vitamin D is just not with the pandemic. I mean, it's been, it's, it's comes up all the time. And so there's a guy named Doc Carney. He was he was African-American doctor in a practice in Brooklyn, Iowa. And he was my patient. When I was in Grinnell, we became very good friends and watched a lot Iowa basketball together with them. And, and I would see some of his patients and they say, oh, I just need to get a Carney cocktail and I'll feel better. And I was like, what the hell? So one time we're watching a game. I go, Hey doc, my patients, they always say, they need a Carney cocktail. What, what is that? And what he would do is he said, look, this is a true story. He said, look, patients get relative vitamin D depleted. And that's their cabin fever. It's not cabin fever. It's a vitamin, it's a sunshine vitamin deficiency that will go away once the sun comes out. But what he would do is he would give them B12 and a steroid injection, you know, in middle of February, they would feel great. He says, and then about the time that that steroid wears off, they got their vitamin D levels up. And, and, and the sunshine came out and the Carney cocktail worked. And I was like, you know, that's crazy. But then over the years, 25 years later, I'm like, yeah, that does kind of make sense. You know? I mean, so he's kind of ahead of his time saying, there's this cyclic phenomenon with vitamin D that if you test patients at the right time, they are going to be low. And they might not feel it. Sometimes. I think some of this kind of achy and stiff feelings that people have like in February and they attribute it to, you know, it's spring fever, cabin fever. I need to get outside. I think it's relative vitamin D deficiency. And then they get it replaced and they feel better. And so, so I'm not so sure that, you know, this vitamin D is more of a innocent bystander in a way or coincidental. Yeah.

Dr. Diehl:
I'll date myself a little bit. I've only been out of practice for, out of residency for her seven or eight years. But when I was in residency vitamin D I think became really, really invoke to check it for inpatients, a lot for inpatients. And specifically in the nephrology community, it seemed like every time I worked the nephrologist, you know, we'd admit someone for sepsis or pneumonia or anything, and they'd say, well, what's your vitamin D level. And so it became very clear that sick patients had really low rates. A lot of them had low levels of vitamin D. I don't think what we know though is that if you artificially boost that up, does it change their outcome? And I think there has been some evidence in septic patients in the ICU. And that's where the idea for treating COVID with vitamin D came from because a lot of them meet criteria for sepsis. But again, yeah, like, could you check all these patients a lot of them are going to have low vitamin D levels, but there's a, we wonder, like what's a normal vitamin D level. It's not really well established depending on where you live, your race, your skin color, things like that. And then are we going to change outcomes by artificially boosting that level up? And to me that's unclear you know, it's generally a benign treatment, but it is a fat-soluble bite, but vitamin theory, we could overdose someone in vitamin D and cause a problem. I don't think that happens very often, but that's probably one reason why it's just, it's kind of added on for some people's therapy, especially if they're severely ill in the hospital. Cause, cause again, we don't have a cure for, for COVID-19 right now. And so it's thought that if something might help a little bit and not harmful that, that's why, but I think that comes back from, from a lot of the work around sepsis. You know, it's not overly impressive that it's helpful and you know, it's going to take more time to, to know if it really has an effect.

Dr. Arnold:
Yeah. And I, I think, you know, you, you take a patient that's been in a nursing home a couple of years. How many, how often are they out in the sun and you check it and they have a low vitamin D level. I mean, I, when I take care of these patients, I do give them kind of what I call a metabolic resuscitation, you know, a full, late thymine because these things can be depleted. They're water-soluble they'll be peed out, but you're absolutely right. You could get in trouble with the vitamin fat-soluble vitamins, A, D, E, and K. And I think one of the issues that I always worry about is patients over-taking vitamin D, which probably won't get him in a lot of trouble, particularly. But if that's along with vitamin A, that can be really toxic, but it can cause liver failure, you can die.

Dr. Diehl:
Yeah. Yeah. And again, most of the time supplementing someone that has a low level with, you know, a normal supplement dose is not going to overdose them, especially in a controlled setting, but is it going to change their outcome? I think that we don't really know,

Dr. Arnold:
You know, speaking of over time, when I was a senior resident in the early nineties, my grand rounds was on mineralocorticoids and sepsis. Okay. And at that time it was recommended, you know, thought it would benefit and that has fricking gone back and forth over the years that, you know, I think if, I think as doctors, you eventually become invoke, if you just keep doing the same thing you did 20 years ago, you know, like, wow, he's really cutting edge. Nah, he's actually been doing that for 20 years. So I mean, that's not even a controversy, that's settled it over time. And, and that just, that just reassures us that, you know, science is the search for the truth, not finding the truth. But I'd like to wrap up talking about the vaccines and really get into, I really want to talk about some of the unusual things that people mentioned infertility, it alters my DNA. I think the rare thrombotic events with the J and J vaccine, I think the myocarditis, pericarditis in young people is real. It's not a contraindication for that, but it, there is an association and it's small, but, but I think it's real, particularly young male adolescents with a mild carditis pericarditis. So what, what's your thoughts on that? There's some of these things that are said

Dr. Diehl:
I'd want to start with, you know, the, the vaccine adverse information reporting system, the VAER system. And I think that's where a lot of this came from, and, and we've tried to clarify it even had specific questions, but again, that, that system is there to capture everything. So, you know, if you get anything, you know, the next day, if you stub your toe the day after getting a vaccine VAERS would want to know about it, you know, that you, you had some physical ailments right after getting the vaccine, they want to capture everything to make sure we're being as sensitive as possible and casting a wide net. So that is why, you know, deaths infections, all these sorts of things do get cataloged and by the VAER system after getting the COVID vaccine. But to this date, there's been, none of those things have been shown to have any real cause and effect or statistical significance. And so again, we're, we're catching a lot of people die every day in this country, you know, for all these reasons, all those will be cataloged and the VAER system, if they had got the COVID vaccine, you know, shortly before.

Dr. Arnold:
If they volunteered for it, bears is that, you know, the VAER stands for vaccine adverse event reporting system. But if it was important, right, and I'm going to be completely honest with listeners and with you, I didn't even know VAERS existed until the pandemic, because I just ordered the vaccine that people needed. You know, I mean, I support vaccines. Vaccines are, are in a lot of ways have just, if you think about it, vaccines have saved more people than vaccines in a bar of soap are probably the two things have saved more people in the history of mankind than anything else that we do, By bar soap, I mean, good hygiene, you know, drinking contaminated water, et cetera, but I didn't even know fairs existed. And

Dr. Diehl:
And so, so now we have this heightened you know, just societal awareness of that system and a lot of people reading it and reading the logs. And so, you know, to find all these adverse reported events, but reality, you know, none of them have been really linked as a cause or a cause and effect from the COVID vaccine. So I think that's the biggest part of it. You know, anytime you do something to millions of people, you know, a point, if there's a 0.0 001 chance that you could get a rash, or you could have a thrombotic event, something like that, that's an incredibly small chance. But if yes, if you do it to millions of people, you'll see a handful of those cases. And I think that's that is okay to admit that there are those risks, very, very small risk, but we know that the risk of not getting vaccinated I think are much higher. So, I mean, that's just comes back to the pros and cons of the safety profile of vaccine. And it also speaks to how, you know, how safe does this vaccine have to be to be authorized, very safe, you know, cause you're going to do it to millions of people. And so we have to feel extremely confident that it's not going to cause a significant side effect, you know, cause a 1% chance if you got a thrombotic event in 1% of people that had the vaccine, that'd be an incredibly high number of side effects, you know, and it probably wouldn't be safe enough to give to the public. So, you know, I'm incredibly confident.

Dr. Arnold:
I think we're approaching 7 billion doses, you know, and you know, so even if you have, you know, a million adverse reactions that still a small percentage, right.

Dr. Arnold:
Incredibly, incredibly small. So I think that's important to know you know, for the public it comes back to that trust too, that their physician and providers, they want what's best for them. And that we, that we feel really confident in the safety of these, these vaccines. And so that's, that's, I think the biggest thing to take away from it, the, the really, you know, far out there controversies or conspiracy theories, you know, I don't know how to speak to that, to that level of mistrust. That's something you know, a larger societal issue of people would believe that there's microchips going on or things like that. You know, I think that's kind of outside the realm of, of what we think of as, as medicine or typical medical care. There's something there's something funky going on there if that's what people are believing. But I think there's an extreme amount of evidence out there walking around with all of us that have been vaccinated, the millions and millions or billions of doses given and knowing that the vast majority of us are, are doing just fine.

Dr. Arnold:
And yeah, another thing that I think on the vaccines, particularly messenger RNA, is that it doesn't get into our DNA. Right? I think that's a lack of understanding of the cellular mechanics of messenger, RNA transfer, RNA, etcetera. But you know that technology, I remember reading about that in college, 1990.

Dr. Diehl:
It's really exciting. I mean it is.

Dr. Arnold:
And it's been around for a while. So to say that messenger RNA technology is not safe. I don't know. You can say that you, you, you could see it's maybe it's not effective in this case, but it may be, and I've said this to you and I've said it to another pocket. This may end up the vaccines may end up being a therapeutic and not necessarily vaccine, you know, and you could, we could someday have messenger RNA technology that a type one diabetic could have the beta isolate cells make insulin and they have to get a shot twice a year with messenger RNA to tell those cells to make insulin and cure diabetes. I mean, so the horizon messenger, RNA technologies just amazing.

Dr. Diehl:
Yeah. And this, this pandemic, you know, this sped up process to now get billions of those doses out. And people like might be, you know, a, just a landmark study in the safety and efficacy of MRN a, you know, the fact that we've done it so much and the safety profile has been really, really remarkable. That's potentially really exciting for the future.

Dr. Arnold:
I think one issue that, that I think, I don't know if you could change it, but you know, people work at the FDA and the CDC and then they go get a lucrative job with big pharma. Then it calls into question what was their stewardship and a consumer protection mentality. You have big pharma. They come with a vaccine. The government says, okay, well, since it's hard to prove true, true, and related to some of these side effects, right or not related, we're not, we're going to make you immune from lawsuits related to the vaccine. Cause we have to have vaccines. Like I said, bar soap and vaccines have saved more lives than anything. Well then people look at that retrospectively and they say, okay, well, it's clear that they're in bed with big pharma and that's why they won't let me have vitamin D or Azithromycin or hydroxychloroquine because they want, you know...

Dr. Diehl:
And that's just a result of, we have a, we do have a huge problem with big pharma in this country. You know, the fact that we advertise for prescription medications and things like that. I mean on one hand is kind of ridiculous. And so it is kind of speaking on both sides of our mouth. And I think there is a big issue with the way pharmaceuticals are set up in this country. The money there, the costs to our patients is, is unbelievable and not sustainable. But we also, in this light, you know, from a vaccine are very much dependent on them getting this vaccine up. And it's been a life- saver for many.

Dr. Arnold:
I think also you can go back, you can use that also to, to address some of these controversies that unfortunately in, in medicine, big pharma profits motivate the company because they're a company, right. They're not you know, and, but you also can look at some of these other things about causing people infertile and microchips, you know, where's the money in that, you know, they don't do anything for money, so you can't have it both ways. You can't criticize them for making a profit and then accuse him of doing something that would prevent them from making data, making a profit.

Dr. Diehl:
Yep. That's a, that's a really good point. And, and, you know, the infertility thing is you know, it, it's understandable people at this stage in our life are just really, really cautious. And they're, you know, anyone who's struggled with that is extremely distressed about making sure they're taking care of their body the right way. And I think you've talked about before, you know, it's about empathy. You know, a lot of those people are just trying to do what's best for them. It's been really well established right now, you know, it doesn't cause infertility. And the other thing that is becoming more and more apparent is how many more patients that are pregnant are having bad outcomes with COVID. And it just speaks back to it's it's even more important that those patients get vaccinated because we have otherwise healthy, you know, young women, potential mothers and such and babies that you know, that many have died from. So it's just...

Dr. Arnold:
And you probably know this, I approve all monoclonal antibody orders just because of the shortage. So there's good stewardship there. So every single case I review. Right. And I can tell you now, again, this sample size here, small, less than 40, but all the pregnant women that we've given monoclonal antibodies to, they did not become hospitalized with COVID. So, and I'm glad to see our local obstetricians, I love to see their names on these orders, because I do think it is preventing hospitalization. It's just human nature that, you know, you treat pregnant patients different because you have two patients. Right. And we were, we all, all had moms and we, you know, we, so we look at them differently and we do give them a little bit, so I don't see it as controversial on that some agencies and some employers have said, you know, we're going to defer the vaccine during pregnancy. I don't think that's, that's not sending a signal that they don't believe in vaccines. I don't think that's true at all. I think what it's saying is, you know, Dustin you're, like you said, 83% of non-randomized controlled trials go away over time. It's a pregnant mom. I just don't want to, I don't want to put them through this. Let's wait 90 days. I think that's completely fine.

Dr. Diehl:
Right. Give them a pause, give them, you know, give them some grace to think it through. I think it's very reasonable thing, but it's, it's just become very apparent how at risk that population is too. And I'm really excited to hear, especially locally of our obstetricians how supportive they've been. And I think that the last couple, you know, the last month or two, it seems like they've even accelerated in that process and it or patients are aware. So yeah, really,

Dr. Arnold:
Two of them prior to this podcast orders came in. Well, Evan, thanks for coming and joining me. And I think we'll have you back and maybe we'll talk about we'll see if there's some more data comes out about the Merck pill. I think it's really exciting. I mentioned that yesterday in the podcast. So I think I'd like to have you come back and maybe we can talk about that as well as the Cleveland clinic study on natural immunity, at least coming out saying, you know, maybe you should booster and give a third dose to other people. Not people who've had it because you know, once again, good or bad, the United States has an overwhelming lead, very efficient healthcare system. Our rates of vaccinations exceed other countries by a lot particularly developing countries. And, and I think it's reasonable to look at these studies from a standpoint of stewardship that should, should this group of people get the vaccine. You know, a second dose or third dose, or should we get to these people that they have no healthcare infrastructure. I think that's a good conversation to have. So once again, this is Dr. Evan Diehl, Vice President Medical Director for UnityPoint clinic, Cedar rapids. That's kind of like being principal of a homeschool. Isn't it?

Dr. Diehl:
Something like that. No comment, no comment.

Dr. Arnold:
All right. Thank you for listening to COVID-19 update for the latest on COVID-19 vaccine information, more visit union point.org. Thank you for listening live well. Talk on if you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on apple podcast, Spotify, Pandora, or wherever you get your podcast. Until next time, be well.