COVID-19 Vaccines: The Light At The End Of The Tunnel

By Dr. Ernst von Schwarz, Cardiologist, Medical Researcher drvonschwarz.com

Finally, we as healthcare providers will have an option to help end the COVID-19 pandemic. New vaccines will hopefully create herd immunity and eradicate this deadly disease. Over the last several weeks news reports have focused on 2 vaccines, one of which was co-developed by the German company BioNTech and the US pharmaceutical giant Pfizer. The second vaccine was developed by Moderna, a relatively small biotech company, in collaboration with the National Institutes of Health. The Pfizer vaccine showed a 90% effectiveness in preventing mild and severe forms of COVID-19 in individuals who were vaccinated. A total of more than 44,000 volunteers were part of this study which resulted in a total of 170 COVID positive cases in which 162 of those were in the placebo controlled group and only 8 in the vaccinated volunteer group. At the same time the company Moderna reported a 94.5% effectiveness in their vaccine product which prompted Pfizer to reissue a statement a day later, showing a 95% effectiveness rate. Obviously, both vaccines seem to be highly effective when given to these volunteers.

Pfizer receives COVID-19 vaccine emergency use authorization approval by the FDA. Pfizer and Moderna have applied for emergency use authorizations for their COVID-19 vaccines by the US Food and Drug Administration (FDA), with Pfizer becoming the first to gain approval. The first doses are now being distributed and ii is estimated that wide spread distribution will be available in spring 2021. Pfizer stated that by the end of 2020, 15 million doses will be manufactured and half of those are planned to go to the United States. Both the Pfizer and Moderna vaccines, reuire two dose applications as subcutaneous injections; for the Pfizer vaccine 3 weeks apart from each other, for the Moderna vaccine 4 weeks apart. The vaccines must be stored in ice. For the Pfizer product it is actually required to be stored in a freezer at -95 degrees which can be kept for 5 days. The Moderna product can be kept in the refrigerator at -4 degrees for up to 30 days. Side effects for both products as far as we know at this point are very mild; fatigue occurred in 3.7% and headaches were reported. No serious side effects were reported by either product.

A novel vaccination technique developed in record time The amazing thing to know about these vaccines is first the speed, meaning how quickly those vaccines were developed by these companies. Secondly, the use of a completely novel technique of using a synthetic version of the coronavirus genetic material in the form of MRNA (messenger ribonucleic amino acids) which induces in the recipient the production of “spike” or surface proteins of the coronavirus which then in turn will result in an immune response including T-helper cells, killers cells and the production of antibodies which then in combination will attack if the individual is exposed to the real virus.

This new technique has never been used for any vaccine development and does not require the real virus material to be injected into the individuals but instead a synthetic version of its genetic material is used. Through this method a much higher immune response is expected with a higher effectiveness and efficacy when the individual is exposed to the coronavirus.

Under usual circumstances it takes several years to develop a vaccine, from the initial development in the laboratory to cell testing, animal testing, then safety testing in a small number of individuals followed by large number of individuals and then a clinical trial. However, in the current situation of the COVID-19 pandemic it was crucial to act quickly. The biotechnology and pharmaceutical companies put major effort into this worldwide task to speed up their processes and did an amazing job to come to this point within less than 9 months. We now have a vaccine available.

The next steps after the vaccine’s FDA emergency use approval are placing priorities for use, and everybody agreed that the first use should be for those considered at highest risk for contracting the virus. These groups include frontline workers such as healthcare workers (nurses, physicians, in intensive care units and emergency rooms), residents in senior citizen establishments, the elderly, and also those with underlying severe pulmonary and heart conditions. This distribution and subsequent vaccination began December 14, 2020 and twide spread distribution, requiring millions of doses to be manufactured, should be available by early spring of 2021.

Of interest, the vaccine will be free for all consumers since the US government bought a large majority of the doses and will cover the costs. Of course there are still some unanswered questions such as the real world effectiveness outside of the frame of clinical studies, potential unforeseen and even long-term side effects, and whether or not someone who contracted the virus after vaccination still might be able to spread it to others or not. At the same time there are many other companies working on vaccine development and currently there are more than 80 clinical studies ongoing to assess the safety and effectiveness of different vaccine products.

As we hear in the media, there are several conspiracy theories circulating against the vaccine which play on the understandable fear of many consumers of getting vaccinnated with a completely new drug agent which has not been around for a long time, such as influenza or smallpox vaccines.. As healthcare providers however, we eagerly await getting our hands on the vaccines, especially in view of the current surge of COVID-19 infections, with more than 3000,000 deaths so far in the United States alone, and more than 10 million infections with further increases to be expected during the winter months, especially because of weakened immune systems, concomitant respiratory infections, and the flu season.

Until the vaccine or many of them are widely available, usable, and hopefully eradicate COVID-19 disease we still encourage the public to continue measures such as wearing masks, keeping social distance of 6 feet, avoiding gatherings, frequent hand washing, and following the CDC guidelines with regard to isolation of people infected with COVID-19 and quarantine for people exposed to infected individuals.

Preparing Children’s Return To School

Dr. Ernst von Schwarz advises on how parents should prepare their children for returning to school after the Covid-19 shutdowns. How should schools plan to safeguard student’s safety?

Dr. von Schwarz discusses back to school safety on Good Morning Arizona

1) Have a word with your children repeatedly regarding the risk not only to themselves about contracting this deadly disease but also the possibility of transmitting Covid – 19 to other family members such as elder grandparents and other high-risk individuals

2) School children should wear masks at all times whenever possible. Exceptions for children under 5 years old must be considered but arrangements should be made as best as possible.

3) For children attending school in person, consider adding hand sanitizer or other forms of disinfectant in their lunchbox or coat pocket.

4) Children should be reminded to practice social distancing and to avoid physical contact on the playground or in classrooms as best as possible.

5) Upon arriving home from school, children should be conditioned to take a shower, change their clothes, and wash hands before convening with other family members.

Should schools be re-opening?

  • If the “R factor” is below 1, in essence once the transfection rate is declining, schools could be re-opening.
  1. What should schools do?
  • Temperature checks
  • Self administered COVID testing
  • Class sizes should be cut in half.
  • Hallways should be one-way systems.
  • Breaks should be staggered. – Teachers should wear masks – Students should be told to dress warmly because windows and doors should be kept open for air circulation
  • Make wearing masks mandatory
  1. What should parents do?
  • have a dialogue with their children
  • Encourage social distancing
  • Encourage wearing masks
  1. What should school kids do?
  • Avoid gathering
  • No hugs or kissing
  • Use hand sanitizers repeatedly
  • Wear masks
  • Shower and change clothes after school

If anyone develops a fever or other symptoms, stay home!

Good Morning Arizona” asked Dr. von Schwarz about school safety after the Covid-19 shutdowns in this live interview:

The COVID-19 Second Wave Is Already Here Says Dr. von Schwarz

Don’t go back to normal – adopt and observe a “new normal”.

By Prof. Dr. Ernst von Schwarz

It appears that the expected second wave of COVID-19 infections has already arrived.

On June 11 Florida reported the highest number of new cases since the beginning of the pandemic, averaging an additional 128 hospital admissions per day. The day before, Texas recorded 2,504 new cases. This represents the highest number of reported cases in one day. Also on June 10, California recorded 3090 newly infected COVID-19 patients. Altogether more than 20 states have now reported a second spike in coronavirus cases.

As healthcare providers we must distinguish between:
(a) new COVID-19 diagnoses, and
(b) new COVID-19 related hospital admissions.
(c) new COVID-19 related deaths.

It appears that there are more diagnosed cases for COVID-19 right now. This is because:

  1. More testing is being provided for the public.
  2. The reopening of the country and the reopening of businesses with the subsequent reduction of social distancing and gatherings likely is resulting in a higher transmission rate.

There are multiple reasons for the higher rate of hospital admissions but they include:

  1. More testing is being provided for nursing home residents and positive cases are often directly transferred to the hospitals.
  2. The currently increased transmission rate from asymptomatic individuals due to the lack of social distancing affects the elderly and more vulnerable patients who end up with symptoms in the hospitals.

As a physician in California dealing with more than 100 patients every day in hospitals I am not seeing as many healthy patients who contracted COVID-19 in dire physical conditions as had been reported initially in Italy and in New York months earlier.

On the other hand, we see more chronically ill patients who are now diagnosed with COVID-19 and end up in critical condition with respiratory failure. These patients require intubation and ventilator therapy in the Intensive Care Units.

In particular the elderly (above 75 years of age) and those with underlying chronic lung conditions such as chronic obstructive pulmonary disease (COPD) and those with chronic heart or vascular illnesses such as congestive heart failure appear to be at highest risk for compromised respiratory conditions and subsequent death. Even though we have also seen a reduction in the number healthcare providers dying in California compared to New York or Italy, we currently do see more COVID-19 related death cases in those high-risk populations.

As a result of the recent mass gatherings with many people who are not adhering to social distancing recommendations we likely will see more transmissions from healthy people who remain completely asymptomatic. The R-value, which represents the reproduction value of the virus, has creeped up above 1.

The R-value is a virtual number, which means that if it is 1.5, 100 people transmit the virus to 150 others. The goal is to reduce the R-Value value below 1 so that less people will be infected and the virus would disappear in the future. At the current time, however, the R-value in many states has increased above 1, so more infected cases are expected within the next weeks.

Obviously, the virus is not going away and we may have to deal with coronavirus infections for a prolonged period of time.

Public heath experts are developing models which show the real numbers while frontline health care providers are now dealing with more COVID patients. The numbers we are now seeing might be also related to gatherings during the Memorial Day weekend, and recent mass gatherings might increase those numbers further.

As a healthcare provider I have the following suggestions:
 

  1. Continue to stay within your own community “bubbles”, which means to stay within your close family members or groups. Remind each member of each particular bubble to get COVID-19 testing, ideally on a regular basis and possibly repeatedly over time, so that anyone who tests positive should either be separated within the bubbles or asked to stay out and to avoid close contact with the elderly and those with underlying pulmonary and cardiac diseases.
  2. Continue to avoid exposure to large crowds. The soccer stadiums in Italy represented a Petri dish for the transmission of the virus and the attendance of mass events should be strongly discouraged at the current time.
  3. Evaluate the daily news with a critical eye. Several statements that have been made were retracted just days later. As an example, the hype about a registry demonstrating a very high death rate of patients receiving Hydroxychloroquine for COVID-19 published in the Lancet medical journal within the last month was retracted by the authors since they were unable to verify their own data. Still, in my opinion, Hydroxychloroquine remains controversial and should not be used at this time as a treatment or prevention for COVID-19 until further validated data are available.
  4. Continue adhering to precautionary measures such as using personal protection devices, masks, gloves and eye shields as well as frequent hand washing with soap and the use of hand sanitizers.
  5. Continue healthy habits of exercising at a distance to others, i. e. at least six feet away from others in a gym or an outside environment, observe healthy food habits by eating a balanced diet and avoid toxic substances.
  6. Adopt a “new normal” to protect yourself and your loved ones, rather than returning to the behaviors of the pre-pandemic era.
     
    Almost everybody has contact with those at highest risk, whether it’s a family member, parent, grandparent or even younger people with immunosuppression. It is our duty to protect those most vulnerable ones even though the younger and healthier ones might not develop symptoms or illness from the infection.
     
    We all welcome the opening of businesses, restaurants and gyms for the sake of the economy and our psychological and social well-being, but we should not underestimate the constant risk, which might stay with us for a prolonged period of time, at least until appropriate vaccination will be available.

Together we can fight the virus by staying healthy and safe and to some degree by keeping social distancing measures in place.

This article is part of the Ask Dr. von Schwarz series of health and medical articles, expert comments and medical news updates.

Treatment For Heart Attack Shown by Cardiologist Dr. Ernst von Schwarz

Los Angeles cardiologist Dr. Ernst von Schwarz treats a heart attack patient, showing how he clears a blockage in this one minute video edit shot in the operating room.

Also: New Implantable Device To Treat Chronic Heart Failure

Protests Spur Stress-Related Conditions, May Contribute To Covid-19 Second Wave

Stressors such as the ongoing nationwide demonstrations weaken the immune system while the lack of social distancing opens the door to more person-to-person virus transmission, says Dr. Ernst von Schwarz.

“As a result, many of the elderly are even more fearful of venturing outside, especially those living in the cities,” says Dr. von Schwarz. “I have received several phone calls from patients living in the Grove / Fairfax / Mid-Wilshire and Beverly Hills areas in Los Angeles. The patients are complaining about chest pain, anxiety, and they fear to go to even the nearest hospital, especially as the massive protests have turned violent with break-ins, arson, and looting. The stress on the elderly population can be devastating to their cardiovascular and immune systems.”

“Even though most people are protesting peacefully, as a doctor on call I am seeing the consequences in the hospital emergency rooms because of bodily injuries.”

“The increased risk of a potential second wave of Coronavirus infections as a result of lack of social distancing is exacerbated by these large-scale protests. The COVID-19 outbreak in Italy started during a Champions League soccer game with a majority of young soccer fans in the stadium, the outbreak in Germany started in a beer tent, so do we really think that hundreds of people gathering in protests in close proximity will be immune?”

“As a physician I recommend that everyone continue to observe the same guidelines of social distancing and using masks during this difficult phase.”

Dr. Ernst von Schwarz Warns Against Hydroxychloroquine For Covid-19 On CBS News

Los Angeles cardiologist and researcher Dr. Ernst von Schwarz appears on CBS 8 News San Diego to warn of the risks in prescribing hydroxychloroquine / hydrochloroquine for treatment or prevention of COVID-19 infections. Link:

https://www.cbs8.com/video/news/local/morning-extra/discussing-hydroxychloroquine-with-southern-california-doctor/509-d833f59b-201c-485a-b1c0-7b982d0ef2ba

drvonschwarz.com

No Evidence That Hydrochloroquine Prevents Or Cures COVID-19 says Cardiologist Dr. Ernst von Schwarz

Doctors who prescribe hydrochloroquine / hydroxychloroquine as a prevention for COVID-19 act irresponsibly, says Los Angeles cardiologist Dr. Ernst von Schwarz.

“Hydrochloroquine is a well known drug used for malaria as well as for certain inflammatory connective tissue diseases such as lupus or rheumatoid arthritis. Hydrochloroquine toxicity for the heart has been reported as early as in 1987. Several case reports in the scientific literature show rare but sometimes life-threatening conditions such as heart failure and arrhythmia, in some cases leading to permanent heart damage due to thickening of the heart walls, congestive heart failure even occurring rapidly, and different kinds of heart irregularities. Some of those patients needed a heart transplant, while others died.”


“There is no evidence that hydrochloroquine prevents a bad outcome after someone has contracted COVID-19 and does not seem to prevent the infection.”


“Doctors should be cautious to prescribe hydrochloroquine / hydroxychloroquine for COVID-19 patients without proper evaluation of the heart. Patients receiving the drug need to undergo frequent cardiac testing, even in the long run.”

Website: drvonschwarz.com

Heart Disease In Young Women Is Often Misdiagnosed Says Renowned Cardiologist Dr. Ernst von Schwarz

Los Angeles – Dr. Ernst von Schwarz says that women often experience unique warning signs of heart disease that can be mistaken for other health issues or disregarded by their doctors. “This is especially dangerous in younger women who may not realize that they are at risk. Women of all ages should familiarize themselves with symptoms that are unique to females so they may become better advocates for their own healthcare when seeking medical advice.”


Dr. von Schwarz appeared in this interview on ABC 7 News in Los Angeles with his patient Tara to show how heart disease in women is often misunderstood or misdiagnosed. “This is largely because women often experience symptoms that differ from those typically reported by male patients,” says Dr. von Schwarz.


A Surprising Diagnosis
Tara, now 41, first learned that she had heart disease at 29 after going misdiagnosed for several years, even though she was experiencing chest pains and arrhythmia. Tara was advised by doctors that she was just “too stressed” or was “drinking too much coffee.” Eventually she found herself in a hospital emergency room, in shock from an adverse reaction to a pain medication she had used for the first time. In the emergency room, Tara’s heart function was found to be “extremely low” and Dr. von Schwarz was called in to assess her condition. Tara ultimately underwent several procedures including having a pacemaker implanted and a later surgery to repair a damaged heart valve.


About a year after her heart valve surgery Tara learned that she was pregnant. She was advised by her primary care physicians that her pregnancy would present a serious risk to her health, Tara was determined to have at least one child with her husband. When her doctors were reluctant to care for her during her pregnancy she turned to Dr. von Schwarz who saw her through to term. Tara beat the odds, ultimately giving birth to healthy twin boys who are now 9 years old.
Dr. von Schwarz practices in Los Angeles, Culver City and Murrieta / Temecula, CA. Visit http://www.drvonschwarz.com

This story is part of the Ask Dr. von Schwarz series of news stories, expert comments and health & medical updates.

The Future Of Medicine After COVID-19

Los Angeles cardiologist and researcher Dr. Ernst von Schwarz appears on Fox News to explain how COVID-19 is changing the ways that physicians and their patients interact. From the expanded use of telemedicine to the adoption of enhanced safety measures in the medical office, things will never be the same.

“Telemedicine is useful and follow – up visits for patients that do not require a full physical examination are now handled via phone, Skype, FaceTime, Zoom or other video media. This trend will definitely continue,” says Dr. von Schwarz.

“We have used telemedicine for many years (initially for the Texas prison system where inmate patients were evaluated via tele media). In some cases, home health nurses are now on-site with the patients to talk with the patient and the doctor. In some cases we can provide an electronic stethoscope so the doctor can remotely listen to the patient’s heart and lungs. In other cases, doctors can provide a high resolution camera to the patient’s home that can be zoomed in to view the patient’s eyes very closely or to examine other body parts that require attention.”

“Finally, many insurance companies have agreed to reimburse telemedicine visits. This allows patients easier access to their doctors without the trouble of traveling to the office clinics and without spending time in waiting rooms. Patients welcome these conveniences and we currently are conducting approximately 40% of our daily patient encounters via tele media. This definitely will continue and will likely increase in the future.”

Visit http://www.drvonschwarz.com Dr. Ernst von Schwarz practices in Los Angeles and Temecula / Murrieta, CA.

Staying In Shape During The Covid-19 Lockdown

Sheltering in place, lack of exercise and weight gain

The lockdown caused by the COVID-19 pandemic forced most of us to either stay home or definitely reduce our outdoors and out-of-the-house activities. Gyms, public pools, golf courses, tennis courts, soccer fields are closed. All of these sport activities are at least in part still on hold. Even the daily 1-2 hour walk that many were used to perform as part of a moderate exercise regimen are on hold right now due to restrictions but also fear.
The American Medical Association’s recommendation of moderate exercise for a minimum of 30 minutes per day for 5 days per week (minimum of 150 minutes per week) for all of us has hardly been feasible to follow within the last two months. As a result, many of our patients did report weight gain and less physical activity.

At this point, I have the following 5 suggestions:

  1. Try to use 30 minutes per day to do home exercises, whether it is walking around the house, stretching, going up and downstairs or even arm exercises by repeatedly lifting up your water bottle 30 times per arm until your heart rate goes up and you feel a bit short of breath.
  2. When the gyms etc re open, do not overdo it! You might create a muscle breakdown (even in young and healthy people) which in turn can lead to kidney failure among other health problems.
  3. Stretch, ease into a progressive exercise regimen, and be well hydrated in order to avoid injuries and damage.
  4. Eat a healthy balanced diet, avoid overeating, ideally what we a call a Mediterranean type diet.
  5. Track your activities in a log book including the activities and time spent as a referral to measure further progress.

Important to know: you want to challenge your heart and blood vessels a little bit by doing exercises that make you either sweat or get your heart rate up or develop a bit short of breath to keep your blood vessels elastic, train your hearts capacity, and to loose these extra lockdown pounds!