"As the 'S. Family,' what we consider your best practices are: 1-availability of both Dr. Davis and Dr. Zeller...provides piece of mind--especially in emergency situations; 2-your staff remembers us!  Dinah S. and family

"Dr. Zeller, I may be the slowest, but I also may be the most grateful for the 'Walk with the Doc' program.  That program not only introduced me to the park but also gave me incentive to lose the weight that has been creeping up for years.  In addition, it shows me that my doctors are serious about helping their patients while providing the opportunity to meet in a relaxed atmosphere.  That will translate into making office visits less stressful."    Eileen B.


Kolvita Family Medical Group 

"All of my friends are in AWE at the attention I receive from Dr. Davis, as well as how personalized her practice is with me.  No one in my "circle" has anything like it from their Practitioner or Health Group.  I told Dr. Davis during the year, which was very traumatic for me physically, that I shudder to think that I might have decided not to sign up with Kolvita.  My experience would have been entirely different if I didn't have the weekly visits while in Rehab, the ability to text and be a 'nuisance' when something bothered me or when I had questions, and the unwavering advocacy of my care.  As I face a new year with new challenges I take the most comfort from my relationship with MY DOCTOR."   Lorraine F.

Call Us:  9496008990

"People are always astounded by the fact that I can just text, call and speak to my doctor 24/7.  I love Kolvita!  AND I can usually get same day appointments if necessary.  I don't have to sit in the waiting room for an hour (the usual wait time is 5 minutes or less) and Dr. Zeller spends as much time as I need in the examining room.  I never feel rushed or hurried.  At my age, I want a doctor that knows my health history, and can respond to my needs.  Need a prescription refill? I just text it, and 'boom' it is at the pharmacy in minutes.  I am spoiled now.  Thank you Dr. Z!"     Rhea T.

COVID-19 UPDATES (5/3/21)



Hello Kolvita Family,


Due to the ever-improving numbers here in Orange County--as well as the state of California as a whole, we are going to adjust and shorten our weekly emails.  In fact, on Friday, 4/30, California had the lowest levels of reported positive Covid-19 cases in the entire country!  Now, if things were to change and we feel it is important to look again at all the numbers more closely, we will return to our previous email format.

COVID NEWS:


- NEJM reports that we are now >6 months out from the phase three trials of the Moderna vaccine from last Fall.  This report shows that individuals in this trial that have been retested for antibodies at 180+ days past the second vaccine still have full SARS-CoV-2 neutralizing activity against the virus.  Scientists are still trying to determine how long the "immunity" will last--but this is a good sign at this point.
- CDC announced last week the change in guidance for mask use outdoors.  The new recommendation is that anyone fully vaccinated can safely participate in small-to-medium social gatherings outdoors without a mask.  This does not include large gatherings like sporting events or concerts.  The CDC still recommends that ALL individuals wear masks when indoors.
- Medscape reports that the CEO of Pfizer is confident they will have an oral medication to treat Covid approved and available by the end of the year.  This medicine would be similar to Tamiflu--it will not prevent the viral illness, but it would make it less severe and could keep those individuals out of the hospital.


VACCINE UPDATES:


- Covid-19 vaccines are now fairly readily available all throughout Orange County.  One can still go onto the many vaccine finder websites available (ie- www.vaccinespotter.org), contact their insurance carrier, or use the Othena App.  Anyone that is >16 years old is qualified to receive the vaccine.
- Reuters London reports that in England, the Covid-19 vaccines not only prevented serious illness from the virus in >90% of people vaccinated, but it also cut household case spreading in HALF!  The testing endpoint was to prove the vaccine prevented serious illness...the decrease in transmission is a bonus!

- 30.4M vaccines have been given in California (as of 5/2/21), 2.54M vaccines have been given in Orange County (as of 5/2/21)

COVID NUMBERS


Orange County (as of 5/2/21)


- 495 new cases in the past week (531 last week)
- 36 deaths in the past week (37 last week)
- 111 hospitalizations (113 last week)  
- 24 ICU patients (25 last week)
- 3-day change in hospitalizations: -10.6%

State Tier Status per County      + cases per 100k   /     + rate %
    
Orange Co (ORANGE)                      2.6 (ORANGE)       1.4% (YELLOW)
Los Angeles Co (ORANGE)               1.9 (ORANGE)       0.9% (YELLOW)
Riverside Co (ORANGE)                   3.9 (ORANGE)       2.1% (ORANGE)
San Diego Co (ORANGE)                  6.2 (RED)               2.3% (ORANGE)
San Bernardino Co (ORANGE)          3.4 (RED)              2.0% (ORANGE)


Southern California Regional ICU Availability is at 33% (33.3% last week)


If you have any new questions or concerns regarding Covid, testing for Covid, the vaccines, etc.--please send your doctor an email.  Kolvita is always ready to serve you and answer any questions you have!

Stay safe and stay healthy everyone,


Dr. Davis, Dr. Zeller and the Kolvita Staff




COVID VACCINE FREQUENTLY ASKED QUESTIONS (from Medscape Infectious Disease)


- Is the vaccine safe? What side effects can I expect?
Yes, the vaccine is safe. Short-term side effects are common and may include soreness in the arm, fatigue, headache, and muscle aches, and pain within 2-3 days of getting the vaccine.  Some rare allergic reactions (increased heart rate, lowered blood pressure, swollen lips, hives) have occurred in people with a history of allergic reactions. The reactions were detected during the monitoring period after administration and treated successfully. Sites that give the vaccine should be equipped to treat this type of rare reaction. If a severe allergic reaction occurs after the first shot, a second shot is not recommended.  If you have a known allergy to a component of the vaccine, you should not take the vaccine. For instance, polyethylene glycol (PEG) is in the vaccine. This is a compound found in some foods, beverages, toothpastes, shampoos, and medications, and some people have a known allergy to it.  One thing to guide you would be---expect some side effects.  Dr. Davis and Dr. Zeller both just received their second doses of the Moderna vaccine.  Dr. Davis had one night of a fever, chills and headache but was better the next day.  Dr. Zeller felt fine right after but about 24 hours after the vaccine had a significant headache, chills and fatigue but felt better on day 3.  It will vary, but be prepared that you will most likely have some sort of side effects--especially after dose #2.


- What should I do if I experience side effects?

Most side effects are short-lived and relieved with acetaminophen or ibuprofen. If a patient experiences a severe side effect after getting vaccinated, they and/or their vaccine provider should send a report to the national Vaccine Adverse Event Reporting System (VAERS), which tracks and monitors adverse effects.


- Are there any long-term effects from the vaccine?
Monitoring of long-term safety data is still ongoing. Typically, vaccines only have short-term side effects. We do know that COVID-19 can have long-term effects — fatigue, shortness of breath, prolonged cough, joint pain, difficulty with concentration, depression, and more — so the disease is worth preventing by receiving the vaccine.


Is the vaccine effective?
All of the recently authorized COVID-19 vaccines are effective. The Pfizer/BioNTech vaccine trial had 43,000 participants and 95% efficacy, and the Moderna vaccine trial had 30,000 participants and 94.1% efficacy. The Johnson & Johnson vaccine had >50,000 participants on three different continents.  Vaccine effectiveness was comparable across subgroups by age, gender, race, ethnicity, and underlying conditions.  Effectiveness in the 75-95% range for a vaccine is exceptional. We don't have many vaccines with this kind of efficacy, so it is worth getting the shot.


- How were these vaccines made so quickly? I don't trust them.
The SARS-CoV-2 genome was sequenced by early January 2020. This allowed characterization of the spike protein, the immunogenic protein on the coronavirus that allows for cell entry. Because of novel mRNA technology, the coronavirus did not have to be grown in eggs or cell culture to develop the vaccine. Also, the partnership with the federal government has allowed companies to develop the vaccine faster than they normally would. The committee that reviews the efficacy and safety data for the FDA (the Vaccines and Related Biological Products Advisory Committee) is served by respected experts from around the country, and they recommended authorization of these vaccines.


- Will this new technology alter my genes?
NO...This mRNA technology has been studied for decades. The mRNA sends a genetic message to cells to make spike protein, the protein that coronavirus uses to enter cells. The mRNA is very unstable and has to be encapsulated in lipids to make it to the cell and deliver the message. Once it is in the cell, the mRNA is rapidly destroyed by enzymes, so it does not stay around. When the cell makes spike protein, the body produces antibody to it.  The mRNA technology is safe, but vaccines with other technologies are being developed. Two vaccines that are currently undergoing phase 3 trials use virus that cannot replicate as a vector to carry the message to the cells. These are the Oxford/AstraZeneca and the Johnson & Johnson vaccines. The Novavax vaccine uses another technology that has previously been used in vaccines — a recombinant spike protein along with an adjuvant to stimulate the immune system.


- What about the new variants I have heard about?
Viruses typically have mutations over time, and this virus is not an exception. There have been three significant variants documented recently — one in the United Kingdom, one in Brazil, and the other in South Africa. Though each of these has a number of mutations, the vaccine was designed to neutralize the entire spike protein, so the vaccine will probably still be effective. Studies are being done to specifically evaluate the efficacy of the vaccines against these variants.

- What if I had Covid already, should I get the vaccine?  If so, when?
There are varying opinions on this topic, as the research is currently being done to see how much immunity and for how long will a person previously infected have protection.  The current guidelines set forth by the director of the CDC is that anyone that was previously infected by the virus should wait at least 90 days before getting the vaccine, and that those with underlying high risk conditions should be the ones to highly consider getting it at that time.  All others could potentially wait 6-12 months for the vaccine.  Those previously infected, at this time, will only need one booster vaccine.



Covid-19 + FAQs:


1.  I tested positive - now what?


We have been in discussion with our hospital/pulmonary colleagues and here are some of the recommendations we have for patients that have tested positive for COVID19, but are doing well (ie--they don't need to go to the ER or be hospitalized):
Supplements:

Vitamin C 1,000mg twice a day
Zinc 220mg daily (most over the counter formulations are 50mg so you can take 4 (or 4.5 if they are "breakable")
Melatonin 10mg at bedtime
Coenzyme Q10 (100 or 200mg) daily
A daily multivitamin
Vitamin D3  2,000-5,000IU daily
Pepcid (famotidine) 20mg twice daily (if you already take a prescription famotidine 40mg that is sufficient as well).


Prescriptions:
Based on your symptoms and your medical risk factors, your doctor will determine if additional medications are indicated.


2.  Now that I am positive - how long do I need to quarantine?


CDC guidelines recommend a 10-day isolation from the time of diagnosis or from the first day of symptoms. Assuming your symptoms are improving and you are fever-free without taking fever reducers for a minimum of 24 hours . . . after that 10th day you can leave quarantine.


3. Who do I need to notify that I tested positive and who should I recommend be tested?


Since the highest contagious period is thought to start 2 days before symptoms, we recommend you track back who you may have come into contact with in that time frame. A "true exposure" is spending 15 minutes or more in a 24 hour period where you were in a confined space with a person while not wearing a mask . . . so, most likely it would be family members in the same household and possibly any other family/friends/coworkers you may have been in close proximity to for that time frame.  Anyone that meets these criteria are technically supposed to quarantine. That quarantine is now down to 7 days (as long as by that 7th day they have no symptoms and they get a negative Covid test taken on day #5 or later.  It would be 10 days if they have no symptoms and choose to not get tested.


4. Where can I go to get tested?


Most local urgent cares are now offering the rapid tests. Although, due to the huge demand for testing, they may require a reservation first and it might not be that same day.  Some of the hospital affiliated offices, as well as the pharmacies, may bill your insurance---if not the rapid tests are cash-based tests. At Kolvita, we do have limited rapid office tests, for our patients on a case-by-case basis, and we also offer the nasal PCR swab that gets sent to the lab and results are available in ~2-3 days.