COVID-19: What are the odds of my survival?

COVID-related questions that I wish I knew their answers!

What do we need to know to healthily navigate through our COVID-infested world?

On May 7, my puzzling question was “what are the chances that COVID-19 might have been around for a while in one form or the other but has gone rogue during the past spring?” 

 
Did COVID Spare me? Today I would like to delve into a few other puzzling questions. Let me begin with a more personal and  perplexing question of mine, that is “what are the chances that I might have been exposed to, but spared from, COVID?”

Am I spared because I am O-positive? I will be thrilled to think that all along I might have been resistant to COVID-19. My blood type is O-positive, and some believe that the O-type and COVID don’t mix well together! For confirmation of this association I guess we have to wait for the worldwide results of available data to show us if there is a more accurate statistical association between the two parameters. I would have been ecstatic to think that COVID spares most O-types because “O” looks like zero and COVID gets nothing from grazing on a zero!

What else can I think of to dodge COVID? I don’t take any medication for any chronic ailment on a routine basis, and I consider myself an avid practitioner of health and hygiene. Conquest of longevity has been my lifelong passion, and I believe that I’ve mastered the art of balancing physical, mental, and spiritual aspects of my life. I don’t believe that I have any COVID comorbidities, other than my gender and driver license’s age! To the latter all I can say is “would you rather take me for what I am, or would you rather take my driver’s license age for what I should look like!”

What are the chances that I might have gotten it asymptomatically? Throughout the fall of 2019 and winter of 2020, I used to navigate through so many COVID pits. I worked out, daily, at my athletic club; I frequently travelled for short and long distances using multi-passenger cars, trains, and planes; I dined at so many restaurants; and I hopped in and out of so many congested elevators; … and so on! Did I get COVID? No, or at least, not that I know of! What are the chances that I might have acquired COVID asymptomatically and brushed it off as a few days of low energy? I must confess that I don’t like to give this idea much credit! To begin with, I have a hard time understanding the meaning of an “asymptomatic disease”. What does it mean when we say someone has contracted COVID asymptomatically? Does it mean something like being kicked in the balls without having any pain? If so, then one must either have iron balls or he’s been kicked too softly! If one has iron-balls he is immune to even the stallion’s kick… and if he is kicked softly, then he’s not kicked! Most immunologists believe that unless our sentinel bodily defense cells encounter an intruding foe, such as COVID, our bodies will not mount an immune response against them. Given the sophistication of our innate or non-specific immune system, it is unlikely that an intruder like COVID may sneak into our bodies unnoticed. We would expect some sort of innate responses such as mild fever, minor respiratory irritations, or a day or two of low energy levels…wouldn’t we? Would it be arrogant if I say that my sentinel cells are so awesome that they quietly knockdown intruding foes without sounding any alarms inside me? I understand that there are some unfortunate individuals with certain immune deficiencies who cannot mount any type of immune responses against the invading pathogens. But do I have any such conditions? The answer is: no! Do I have memory of any flu-like ailment throughout the past year? No, I don’t! Did I recall any ailment that has made me bedridden within the past several years? Again: no! Have I gotten annual flu shots within the past six years as a 65-year-plus elderly-person? Only once, and it just happened during an annual check-up a few years ago. The nurse who was working with my internist asked if I wanted to have a flu shot, as she couldn’t see one recorded in my file. I just couldn’t say no to her, and instead I said: “why not!” Do I consider myself an anti-vaxxer? Of course, not! I must confess that I used to be an anti-vaxxer during my childhood as I couldn’t tolerate being poked by the needles back then! You may want to ask if I have a history of allergies to eggs or certain drugs that might have instilled the fear of injectables in me? My answer is “no”!  Do I believe in the annual influenza vaccination for myself? Not really… or at least not for the time-being! I must add that I really don’t want you to take my words the wrong way, because had I been a frail septuagenarian with respiratory comorbidities, I would have definitely opted for annual flu vaccinations! Incidentally, until a little while ago I didn’t know that septuagenarian is the mouthful term for someone in his or her seventies! I just wanted to brag that I have recently learned a mouthful term! 

Revisiting Influenza Virus: Well, let us get back to our thoughts of the influenza. The fundamental issue that we often neglect to consider is the extent of resemblance of the vaccines that we have received in the prior years to the one that we are about to receive for the current year. If similarities outweigh dissimilarities, then would it be necessary for healthy individuals who are adamant against receiving injectable biological products to lavishly receive yearly vaccinations? The answer is “most likely NOT”… unless we are convinced that the harmful components, the virulence factors, or the so-called antigens of the flu, namely, neuraminidase (N) and hemagglutinin (H) molecules have assumed significant mutations or structural changes to warrant training our immune system against their new structures. One common misconception is that the flu vaccine can safeguard us in an all-or-none fashion against the very same strains of viruses for at least a year. This is not so, as in the case of flu, booster vaccinations are mainly aimed at decreasing the severity and morbidity of the subsequent exposures. 

What do everyone need to know about influenza vaccine? How do the pharmaceutical companies figure out what is the most workable flu vaccine for the next flu season? By looking back at the prevalent forms of the influenza strains during the past flu season(s) in the US, or during the current season in the Southern hemisphere, and then producing vaccines against them. Do I need a booster vaccination if the strains used for making current vaccines haven’t changed much from the prior years? Most likely I don’t! Then who needs annual vaccinations? Those who have weak immune systems or suffer from chronic respiratory ailments. Ideally, we should measure serum IgG (antibody) levels against the virulence factors of the flu virus to predict our resistance against the most likely flu bugs of the upcoming years. But this is an expensive and time-consuming endeavor that no one is willing to undertake. So, what do we do? To be on the safe side, we take any flu shot that is freely offered to us. How many people say no to free hot dogs on the 4th of July? Not that many! How many people pass on a free flu vaccine? Again, not that many! What do doctors do for the people when it comes to the flu vaccination? They make the rules of engagement easy…if you are over 65 with risk factors such as obesity, diabetes, or weak immune status, then they recommend that you should take it. Of course, we live in the land of the free, and you can always say, “no thanks… or I need no vaccines”!

I love to believe that my physical fitness, and health and hygiene principles have so far safe-guarded me against the COVID! A few other unanswered questions of mine are these: “To what extent has my overall health and hygienic precautions spared me from airborne germs?” If I haven’t had any noticeable respiratory ailment within the past decade, and if I believe that my general health is just fine, would it be reasonable for me to lower my guard against all sorts of respiratory ailments? I was waiting for you to ask me if I will get a flu shot this year! Well, I couldn’t wait any longer; let me answer it for you! Yes, I will! Do you like to know why!? Because I’ve been in partial or complete seclusion for almost 6 months now. During this period, I had no or low exposure to respiratory bugs. I just feel that it does not hurt to challenge my immune system with a booster dose of the flu vaccine. But there is another reason! I understand that there are so many bugs out there, including the COVID-19, that may initially give me some sort of flu-like symptoms. Vaccination helps me to kick the influenza to the back of the list of several flu-like ailments, if I encounter any in the future. Of course, as it stands now, if I get any flu-like symptoms my utmost worry would be COVID-19! Why: simply because we yet don’t know much about the behavior of this rascal! 

Well, as it turned out, a few days after I wrote the above, one morning during the senior hours I headed to Costco to get a flu shot (see the picture below).

Dr. E is getting his flu shot!

How can I be sure that I have immunity to Covid-19? Another puzzling question of mine since the beginning of COVID’s lockdown has been “what are the chances that I might have contracted a mild COVID infection and have developed immunity to it!” All along I have believed that a positive IgG antibody serology would have solved my puzzle. But amidst COVID’s pandemic, I have been dragging my feet for the right time to get tested. Until a Saturday evening in late May when I cut my left hand with a utility knife while cutting some cardboard. The cut was a deep three quarters of an inch one in my left thenar webspace. This is the area of the skin between my left thumb and the index finger. I was lucky that the blade did not injure any vital tissues. However, the depth of the wound would have required stitches plus a booster tetanus shot, as my last shot was over 7 years old. The decision of going to a nearby urgent care facility instead of the emergency departments of the nearby hospitals was made almost instantaneously. I was convinced that I will receive a much faster service, and as result of spending less time I might minimize my exposure to the COVID virus as well. After I checked in, it occurred to me to ask them if they can perform a COVID serology test on me. To my astonishment they said “of course”! In short, 1.5 hours after entering the clinic I was out with five stitches on my hand, and a tetanus booster shot that will safeguard me for the next 10 years. Most importantly, I gave a venous blood sample for COVID serology, and I was directed to check the results online within 5 days! 

The Art of the Deal!
Five Stitches + Tetanus Shot + COVID Serology!

Five days later I checked the results. It was negative for IgG and/or IgM against the COVID! Did I get happy? Absolutely not! Actually, I was utterly saddened! What were the chances that my results were due to lab errors? What were the chances that the technician who tested my blood, just decided to give me a clean serology bill by error? What were the chances that the technician who had to measure and record my test results might have had a bad day and they’d decided to check my results off as “negative” without even bothering to look at them? What were the chances that the laboratory test kit that was used to evaluate my results might have been defective? What were the chances that the diagnostic kit that was used on my serum might have had fundamental flaws that were concealed from the public to expedite premature introduction of it into the hot COVID serology market? How am I going to be sure about all these? Most likely, I never will! I suppose doing another serology test may always be a viable alternative! But am I willing to go out of my way to do it? Of course, not! 

I did it my way and I will most likely do it again! How about looking at it through a more positive and upbeat outlook? What could I have done differently in all those COVID pits during the last fall and winter that would have given me a positive COVID IgG serology or would have helped me to lightly brush off COVID? I can’t think of any! Believe it or not, had there not been any COVID restrictions I would have most likely lived my life the way I used to live it before! What I might have done a little differently would have been adding an extra bit of cautiousness! 

Truth lies somewhere in the middle! There are two opposing groups of us; those who express extreme panic and fear of COVID and those who believe in the contrary and express overconfidence and folly. The unfortunate outcome of having these two opposing camps is their megaphonic exploitation of the mass and social media that mars one’s unbiased vision of the real world. You may ask, what is my stance on this, I tell you for me the truth lies somewhere in between the two! I am not a hardcore follower of facemask use as I despise rebreathing my own expired breath. However, I will follow the health etiquette as much as I keep silent in movie theaters. 

The American Horror Story: Fear of Becoming Old! In our country we have the fear of old age. The mouthful term for this is “gerontophobia”. We work relentlessly to optimize our financial security and physical health during our old age. This forces many of us, and in particular our younger generations who cannot afford to purchase health insurance, to continue going to work despite burning fevers and communicable ailments. 

We should not blame those who fear COVID in settings like this!

It is easy for me to sit in my suburban back porch, about 50 to 60 yards away from my closest neighbors, and blame Chicago, New York, Atlanta, Houston, and Los Angeles for their failures to contain COVID. In my neck of the woods, using public transportation does not feel like a cool idea. Almost all the cars on our streets have only one passenger: the driver! We do not have any high-rise buildings in my city. I am not forced to share elevators when going into and out of my apartment. Guess who are the people who are much luckier than even me? They are the people that live in rural America. These people may have no clue about the viciousness of COVID-19. They may not know much about the other communicable respiratory ailments that we have to struggle with every fall and winter. Had I been a country-folk I might have not heard much about COVID in my area. For this reason, no one could have blamed me for not knowing much about the viciousness of this disease. More importantly, had COVID not compromised my ability to make a living in my rural world, I might have even brushed it off loudly and proudly as a hoax!

We have no COVID in our neck of the woods!
It’s all a hoax!

To be continued…

Dr. E

By

Also known as "Dr. Testbuster", Dr. Eftekar (Dr. E) is the founder, head coach and lead lecturer of the medical board training programs at Northwestern Medical Review. A unique attribute of Dr. E is his well-rounded academic background that, in addition to the science of medicine, extends over several other disciplines such as physiology of aging and longevity, philosophy of science and medicine, and integrated kinesiology.

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