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El Condado de Garfield sigue con el plan de vacunas de COVID que están basado de los hospitales

Jane Dinsmoor, center left, and Bill Dinsmoor receive their first round of the Pfizer-BioNTech COVID-19 Vaccine from Nurses Erica Purcell, left, and Tiffany Poss, right, during the first day of the drive through vaccinations for those 70 and older in the Benedict Music Tent parking lot in Aspen on Thursday, Jan. 14, 2021. The vaccinations are for those with an appointment only. (Kelsey Brunner/The Aspen Times)

La Salud Pública del Condado de Garfield no tiene planes inmediatamente a funcionar una clínica fuera del sitio y detenerse para la comunidad de las vacunas de COVID-19 como la clínica que está funcionando ahora en el condado de Pitkin.

En vez de esto, la continua dependerá de los dos hospitales del condado, Valley View en Glenwood Springs y Grand River en Rifle, a distribuir las vacunas a las rondas primeras de residentes elegibilidades solo dentro de un hospital.

Esto puede cambiar como la vacuna será más disponible por las agencias federales y del estado, la especialista de Salud Pública del Condado de Garfield Carrie Godes dijo el miércoles.

“Nuestra enfoque a vacuna la comunidad evolucionara como más proveedores pueden distribuir la vacuna, las vacunas llegan y más grupos agregaran a las categorías elegibilidades,” ella dijo.

Godes dijo que ella habla frecuentemente con oficiales de comunicación en salud pública en los condados de Pitkin y Eagle, y un punto de discusión es los métodos diferentes de distribución de la vacuna, lo que funciona bien y lo que no.

Las personas elegibilidades a recibir una vacuna en el condado de Garfield — que para ahora incluye residentes que tienen setenta años o más, trabajadores de la atención médica en frente y los socorristas — tienen que coordinar con uno de los dos hospitales para recibir una vacuna en sitio.

Mientras tanto, el condado de Pitkin la semana pasada abrió una clínica grande y detenerse al aire libre en el Todo de Benedict Music estacionamiento en Aspen, trabaja juntos con el hospital de Aspen Valley.

Este esfuerzo se guió por el equipo de la gerencia de incidentes del condado, con ayuda de AVH, Autoridad de transporte de Roaring Fork, ek Asociados de Música en Aspen y muchos voluntarios, según un artículo del lunes en el Aspen Times.

El condado de Garfield tiene un plan de preparación de emergencias para pandémicas que incluir los escenarios de clínicas más grande, y detenerse, y todavía practicó una prueba de funcionamiento de este procedimiento dos años pasados, Godes dijo.

Sin embargo, basado en las aumentas limitades de la vacuna de COVID el condado ha recibido inicialmente y los tiempos muy fríos la vacuna requiere antes de la distribución, “todos nuestros planes fueron tirado por la ventana,” la Directora de Salud Pública en el Condado de Garfield Yvonne Long avisó los comisarios del condado el lunes.

“Así que continuamos haciendo lo que hacemos mejor,” ella dijo — esto es el plan de distribución dentro del hospital.

Godes aumentó en una entrevista seguimiento del correo electrónico, “Cada condado tiene un plan diferente y está recibiendo cantidades diferentes de la vacuna en tiempos diferentes.”

Ella también habló de la disparidad aparente en la cantidad de la vacuna que está llegando al condado de Garfield en comparación de Pitkin y otros condados de los complejos turísticos de las montañas, aunque el condado de Garfield tiene una población más grande.

“Los departamentos de salud locales no son parte del reparto del estado o decisiones de distribución,” ella dijo. “Estos son hicieron en todo por el nivel del estado en el cual no sabemos qué son los parámetros.”

El condado de Garfield recibió 1,000 dosis de la vacuna de COVID-19 este semana, lo cual fue más de la cantidad el condado fue avisado por primera vez que recibiría, ella dijo.

“Hasta ahora, pudimos vacunar eficientemente personas en 1A (trabajadores de salud y los socorristas) y categorías aplicables del 1B (70+),” Godes dijo. “Nuestra única restricción hasta ahora es el número limitado de vacunas.”

La residente de Glenwood Springs Ann Faulk dijo en una conferencia de Zoom antes de los comisarios del condado de Garfield el lunes, e instó al condado a considerar una clínica de vacunar afuera de los hospitales.

“Yo debo recomendar que mires a una locación fuera del hospital, donde podemos tener un proceso más eficiente en vez de personas entran el hospital y suben el segundo piso a obtener su vacuna,” Faulk dijo.

Ella también pidió que los hospitales hicieran una forma del internet para personas que se inscribieron a una vacuna y hacer una cita.

“Por el uso de esta forma del internet, siento como el condado podría prepararse mejor para la distribución de vacunas entrantes, y determinar la necesidad basado en la cantidad de personas que son registrados,” ella dijo.

Valley View y Grand River han estado preguntando a las personas a llamar para una cita o estar en la lista de espera. Sin embargo, los hospitales han tenido limitar el tamaño de la lista de espera y cerrar a veces, dependiente en la disponibilidad de vacuna.

Otro aspecto detrás de la cantidad de vacuna distribuyeron a los condados es de una tendencia en nuevos casos del coronavirus y el ritmo de extendido en la comunidad. El condado de Pitkin ha visto un aumento grande en casos nuevos en semanas recientes, mientras los números del condado de Garfield han bajado.

“Durante las semanas recientes, casos de COVID-19 han permanecido estable, (y) algún aumento potencial en números desde vacaciones han pasado,” la Salud Pública del Condado de Garfield dijo en una declaración el martes.

Todavía, hay días con números grandes de los casos se reportaron, incluyendo 55 casos en cada día tan recientemente de enero 14, la declaración dijo.

“Este es un disminución del medio de diciembre, pero el departamento de salud continúa siendo cauteloso, especialmente porque hay ratos grandes de casos en condados cercos.”

Mientras el condado de Garfield continúa operando debajo de restricciones de nivel Naranja basado en los números de COVID-19 de la rueda del estado, el condado de Pitkin y Aspen se movieron al nivel de rojo y más estricto esta semana.

jstroud@postindependent.com

 

Garfield County stays the course with hospital-based COVID vaccines

Jane Dinsmoor, center left, and Bill Dinsmoor receive their first round of the Pfizer-BioNTech COVID-19 Vaccine from Nurses Erica Purcell, left, and Tiffany Poss, right, during the first day of the drive through vaccinations for those 70 and older in the Benedict Music Tent parking lot in Aspen on Thursday, Jan. 14, 2021. The vaccinations are for those with an appointment only. (Kelsey Brunner/The Aspen Times)

Garfield County Public Health does not have immediate plans to run an off-site community drive-through COVID-19 vaccination clinic like the one now operating in Pitkin County.

Instead, it continues to rely on the county’s two hospitals, Valley View in Glenwood Springs and Grand River in Rifle, to administer vaccines to the first rounds of eligible residents within the hospital setting only.

That could change as the vaccine is made more readily available by federal and state agencies, Garfield County Public Health Specialist Carrie Godes said Wednesday.

“Our approach to vaccinating the community will evolve as more providers are able to administer the vaccine, more vaccine arrives and more groups are added to the eligible categories,” she said.

Godes said she speaks regularly with public health communications officers in both Pitkin and Eagle counties, and one of the discussion points is the different methods of vaccine distribution, what works well and what doesn’t.

Those eligible to receive a vaccine in Garfield County — which for now includes residents age 70 and older, and frontline healthcare workers and first responders — must arrange with one of the two hospitals to have a vaccination on site.

Meanwhile, Pitkin County last week opened a large-scale outdoor drive-up vaccination clinic at the Benedict Music Tent parking lot in Aspen, working in conjunction with Aspen Valley Hospital.

That effort was led by the county’s incident management team, with help from AVH, the Roaring Fork Transportation Authority, the Music Associates of Aspen and many volunteers, according to a Monday Aspen Times article.

Garfield County does have an emergency preparedness plan for pandemics that include larger, drive-in clinic scenarios, and even practiced a test run of that procedure two years ago, Godes said.

However, based on the limited amount of COVID vaccine the county has initially received and the super-cold temperatures the vaccine must be kept at before administering, “all of our plans got thrown out the window,” Garfield Public Health Director Yvonne Long advised county commissioners on Monday.

“So, we continue to do what we know how to do best,” she said — that being the in-hospital administration approach.

Added Godes in a follow-up email interview, “Each county has a different approach and is receiving different amounts of vaccine at different times.”

She also spoke to an apparent disparity in the amount of vaccine coming to Garfield County versus Pitkin and other mountain resorts counties, even though Garfield County has a larger population.

“Local public health departments are not part of the state allocation or distribution decisions,” she said. “Those are made entirely at the state level and we are not clear what those parameters are.”

Garfield County did receive 1,000 doses of the COVID-19 vaccine this week, which was more than the county was first advised it had been allocated, she said.

“So far, we have been able to efficiently vaccinate those in the 1A (health workers and first responders) and applicable 1B (70+) categories,” Godes said. “Our only constraint at this point is the limited number of vaccines.”

Glenwood Springs resident Ann Faulk spoke via Zoom conference before the Garfield County commissioners on Monday, and urged the county to consider an off-site vaccination clinic.

“I would recommend that you look for a location outside of the hospital, where we can have a more efficient process instead of people going into the hospital and up to the second floor to get their shot,” Faulk said.

She also requested that the hospitals set up an online form for people to sign up to receive a vaccine and schedule an appointment.

“By using an online form, I feel like the county would be better able to prepare for the rollout of the incoming vaccines, and determine the need based on those who are registered,” she said.

Valley View and Grand River have both been asking people to call for an appointment or to get on the waitlist. However, the hospitals have had to limit the size of the waitlist and close it at times, depending on vaccine availability.

Another factor driving the amount of vaccine distributed to counties has to do with the trend in new coronavirus cases and the rate of community spread. Pitkin County has seen a major surge in new cases in recent weeks, while Garfield County’s numbers have been going down.

“Over the past few weeks, COVID-19 cses have remained stable, (and) any potential upswing in numbers from the holidays has passed,” Garfield Public Health said in a Tuesday press release.

Still, there are days with large numbers of cases being reported, including 55 cases in one day as recently as Jan. 14, the release stated.

“This is a decrease from mid-December, but the health department remains cautious, especially in light of case rates in neighboring counties.”

While Garfield County continues to operate under Orange level restrictions based on the state’s COVID-19 metrics dial, Pitkin County and Aspen moved to the stricter Red level this week.

jstroud@postindependent.com

UPDATE: Latest Garfield County COVID-19 Statistics and Risk Level

AS OF THURSDAY, JAN. 21

Cumulative cases: 4,680

New cases reported since Wednesday: 0

Deaths since outbreak began: 35 confirmed

Current Score: Level Red-Severe Risk

Current Restrictions: Level Orange-High Risk, with county policy variances

Recent 14-day case totals: Jan. 7-20 – 424; Dec. 24-Jan. 6 – 517; Dec. 9-23 – 891

Two-week daily case average: 30

Single-day high: 101 on 12/10/20

Two-week incidence rate: 718 per 100,000 people (Red-Severe Risk)

Test positivity rate: 7.2% (Yellow-Concern)

Days in last 2 weeks of declining/stable hospitalizations: 11 (Yellow-Concern/closer to 14 the better)

Community spread: 43% (Orange-High Risk)

Days before seeking testing: 3.2 (Red-Severe Risk)

Test turn-around time: 2.3 days (Yellow-Concern)

Percent of cases interviewed within 24 hours: 61% (Red – Severe Risk)

Source: Garfield County Public Health

HOSPITAL STATS

Valley View Hospital, 1/21/2021

Specimens collected through Valley View — 18,817 (+160 since 1/19)

Positive results — 1,577 (+15 since 1/19)

Pending results — 45

Hospitalizations since outbreak began — 208 (+3 since 1/19)

Patients discharged (incl. transfers and deceased) — 183 (1 since 1/19)

Grand River Hospital, 1/21/2021

Specimens collected through Grand River Health — 6,290 (+50 since 1/19)

Positive results — 1,037 (+7 since 1/19)

Pending results — 62

Hospitalizations since outbreak began — 40 (1 new since 1/19)

Patients discharged — 27

Patients transferred — 12

Source: Hospital statistics released twice weekly on Tuesday and Thursday

ACTIVE OUTBREAKS IN GARFIELD COUNTY

Rifle State Correctional Center: Date determined, 12/31 (updated 1/20); 3 residents and 2 staff positive, one staff probable.

Mesa Vista Assisted Living, Battlement Mesa: Date determined, 12/21 (updated 1/20); 3 residents and 8 staff positive cases.

Colorado State Veterans Nursing Home, Rifle: Date determined, 11/3 (updated 1/20); 15 confirmed resident deaths, 41 confirmed resident cases and 1 probable; 49 confirmed staff cases and 3 probable.

Grace Healthcare and Rehabilitation Center, Glenwood Springs: Date determined, 1/16 (updated 1/20); 2 residents positive and 1 probable.

Renew Roaring Fork, Glenwood Springs: Date determined, 11/25 (updated 1/20); 2 residents and 2 staff confirmed positive.

Mountain Valley Developmental Services, Pitkin House, Glenwood Springs: Date determined, 11/30 (updated 1/20); 2 residents confirmed positive and 1 probable among staff.

New Castle City Market: Date determined, 11/22 (updated 1/20); 5 confirmed and 7 probable staff positive.

Recently resolved/closed cases: E. Dene Moore Care Center, Rifle; New Creation Preschool, New Castle; Heritage Park Care Center, Carbondale; Carbondale City Market; Garfield County Community Corrections

Source: Colorado Department of Public Health & Environment Covid-19 outbreak data page

 

Limited supply slows rollout of COVID vaccination in Garfield County

Garfield County’s healthcare network easily has the capacity to administer twice as many COVID-19 vaccinations than it has given so far, Garfield County Public Health Director Yvonne Long said Monday.

The problem, she said, is that the county has only received about half the doses requested from the state of Colorado, which in turn relies on vaccine distribution at the federal level.

“That continues to be a struggle and a challenge for all of us, at the state and federal level, which then comes down to the local level,” Long said during a vaccine update to county commissioners Monday morning.

Long addressed concerns expressed by many residents of the county that the vaccine rollout locally has been slow.

Many of those now eligible to receive the vaccine, including people age 70 and older, have been put on long wait lists or not even wait-listed at all until more vaccines are available.

“We just have way more people who want the vaccine than there is vaccine available,” she said. “Right now, it’s just sort of a game of persistence and patience.”

Hospitals also don’t want to run a wait list out more than a couple of weeks without a better idea of the state distribution schedule, she said.

Through last Friday, and since the Moderna and Pfizer vaccines were first made available in mid-December, Garfield County has received 3,715 doses.

However, because the viles often contain an extra dose, the county’s two hospitals, Valley View in Glenwood Springs and Grand River in Rifle, have been able to administer 4,092 doses, Long said.

“We’re not willing to waste or not use any vaccines in this county,” she said.

The challenge continues to be on the supply side, with only between 200 and 600 doses typically available per week, Long said, including 400 doses this week.

“That’s nothing to be able to start any sort of mass vaccination program … and doesn’t go very far when we have to consider second doses right now.”

During one recent week, she said the county had requested 8,000 doses, and was fully prepared to administer that many, Long said. It received 300 that particular week, she said.

Of the vaccines administered in Garfield County to date, about 2,000 have gone to frontline health-care workers and first responders, and about 1,860 have gone to the 70-plus age group — both part of the 1A priority group, Long said.

For the 70-plus group, that represents about 30% to 40% of the county’s population in that age range, not including residents in long-term care facilities, Long said.

All but three long-term care facilities have had their residents fully vaccinated at this point through separate contracts with Walgreens and CVS, she said. Vaccines for nursing and other group home settings are handled directly through the state, Long explained.

Not ready for expansion

Nationally, the vaccine has been opened up to other frontline critical workers falling in the 1B group, such as teachers and other school workers, as well as extending the age to 65 and older. However, Colorado is not yet able to accommodate those groups, Long clarified.

That led to some confusion last week, when those age 65-70 in Garfield County began inquiring about receiving the vaccine.

Valley View Hospital and Grand River Health are continuing to follow the state priorities of vaccinating people 70 and older before any expansion to those 65 and older.

“People that are 70-plus in age will need to make appointments with local hospitals to receive the vaccine,” Garfield County Public Health said in a statement issued last Wednesday. “Appointments are only being made as the vaccine is available.”

The state’s goal is to vaccinate 70% of Colorado’s 70-plus population by Feb 28.

In Garfield County, more than 200 second doses have already been administered in the county, she said. Both the Moderna and Pfizer vaccines require a second dose.

Valley View Hospital reported in a Friday Facebook post that it had received just 100 new doses for this week.

“This is extremely disappointing, as we know that every vaccine is a possible life saved,” it said in the post. “The supply of vaccine that we receive is unfortunately outside of our control.”

Until further notice, Valley View is not able to reopen its wait list due to the limited supply, it said.

Community concerns

County commissioners heard from one member of the public, Ann Faulk of Glenwood Springs, who suggested the county set up an electronic alert system to let people know when appointments are being taken and for which priority groups.

She also suggested that, in addition to the two hospital vaccine sites, the county also consider setting up some community vaccination clinics once the vaccine is more readily available to avoid backlogs.

Long said the state is working to launch a statewide notification system. In the meantime, she encouraged eligible residents to continue calling the nearest hospital — Valley View at 970-384-7632, or Grand River at 970-625-1100 — to see when appointments are being scheduled.

Public Health workers have also been available to assist people with the online scheduling, she said. But she encouraged the public to also lend a helping hand if they know of anyone who may be having troubles with computer or internet access.

Long also advised those who have received the vaccine or are in the process to receive a second dose to not let their guard down when it comes to public health precautions, including wearing masks.

Just because someone is vaccinated against COVID-19 doesn’t mean they couldn’t potentially be a carrier of the virus, putting unvaccinated contacts at risk, Long said.

Also, anyone who has had COVID-19 or tested positive but was asymptomatic should still get vaccinated, she said.

Long said the weekly vaccine numbers for Garfield County, which are reported each Friday, will be added to the county COVID-19 data webpage.

jstroud@postindependent.com

El departamento de salud pública del condado de Garfield ofrece gratis pruebas de COVID-19 por la comunidad para Parachute, Rifle y New Castle

Una camioneta móvil de Curative para pruebas de COVID-19 visitará partes del Condado de Garfield Oeste empezaba este lunes, enero 11, según una versión de noticias.

Las pruebas son gratis y las personas no necesitan una nota de un doctor, identificación o seguro. Este servicio semanal estará disponible por la exigencia de comunidades, la versión declaró.

“Las pruebas empezaban en enero 2021 y van a continuar en cada sitio entre de marzo siempre y cuando numeros de participación están allí,” Christine Singleton, el coordinador de pruebas de Curative para Salud Pública del Condado de Garfield, dijo en la versión. “No tuvimos mucho tiempo para contactar personas sobre la vuelta de la camioneta móvil, pero ahora hay una oferta semanal en estas comunidades.”

Las pruebas del principio de diciembre tuvieron 88 participantes en Parachute, 125 en Rifle y 185 en New Castle, la versión dijo. Las pruebas durante la primera semana de enero tuvieron ocho participantes en Parachute, 33 en Rifle y 62 en New Castle.

“Números de COVID continuarán siendo altos, pues pienso que la falta de participación fue una problema de personas que no sabían el sitio de pruebas fue disponible,” Singleton dijo en la versión. “Sabemos que puede ser muy difícil para algunas de nuestras residentes de Parachute y Battlement Mesa viajar a otros pueblos para servicios. Esperamos que las personas aprendan sobre los sitios de pruebas y usarlos como necesitan porque es una situación de usarlo o perderlo.”

Elk Creek Escuela Primaria

• 9 a.m.-3 p.m. los domingo

• 804 W Main St., New Castle

https://curative.com/sites/17935/walkup#9/39.573/-107.5417

Bea Underwood Escuela Primaria

• 9 a.m. – 11 a.m. los lunes

• 0741 Tamarisk Trail, Parachute

https://curative.com/sites/17936/walkup#9/39.441/-108.0382

El Recinto Ferial del Condado de Garfield

• 12:30 p.m. – 4:30 p.m. los lunes

• 1001 Railroad Ave., Rifle

https://curative.com/sites/17938/walkup#9/39.5401/-107.7851

Curative ofrece una prueba de un hisopo de líquido oral — un método alternativo a hisopos de nasofaríngeo o el cerebro para pruebas de COVID-19 con la más alta sensibilidad de clínico, la versión dijo. Es una prueba dirigida, observada y auto-recogida, que minimiza el contacto en persona y el riesgo de transmisión para todas los visitantes del sitio y profesionales de pruebas.

Los resultados son regresados a paciencias dentro de 48 horas tras la recepción al laboratorio.

La Pública Salud del Condado de Garfield anima a alguien que tiene síntomas a obtener una prueba inmediatamente y aislarse por lo menos 10 días del comienzo hasta no tener fiebre por 24 horas (sin la ayuda de medicación) y los síntomas han mejorado.

Alguien que ha tenido exposición a otra persona con COVID-19 debe obtener una prueba 5-7 días después del exposición y cuarentena, la versión dijo.

Aunque puede recibir una prueba sin una cita, una inscripción en línea es altamente animado. Los sitios móviles de pruebas se ofrecerán entre de marzo.

Valley View, Grand River suspend COVID-19 vaccine wait lists as demand heightens

Carbondale & Rural Fire Protection District Operations Chief Mike Wagner receives his COVID-19 vaccination at Valley View Hospital recently.
Courtesy CRFPD

Valley View Hospital in Glenwood Springs said Tuesday it is suspending its wait list for the COVID-19 vaccine due to intense demand and a limited supply of the vaccine coming to Garfield County.

Valley View advised in a Tuesday afternoon press release that those who are already on the wait list to receive the vaccine will be contacted when additional doses are available and to schedule an appointment.

Phone messages left after 2 p.m. Tuesday will not be responded to. Anyone who left a message earlier in the day should receive a callback, Valley View spokeswoman Stacey Gavrell said in the release.

“Valley View apologizes for this change,” she said in the release. “The number of vaccines received has been very limited, and Valley View Hospital cannot schedule without additional supplies.

“As Valley View receives more information about vaccine supplies, we will continue to improve our process,” Gavrell said, referring to the hospital website (vvh.org) and its Facebook page for updated information.

Grand River Health in Rifle is in the same holding pattern.

“We are giving out all of our remaining vaccines this week to 230 seniors,” Grand River spokeswoman Annick Pruett said. “We are hoping to hear soon about our vaccine allocations moving forward and are working with our partners at Valley View and Garfield County Public Health to obtain more vaccines to serve our community.”

Garfield County as a whole, as well as neighboring Pitkin County and many other counties across the state, have been dealing with limited vaccine supply after the state last week expanded the first round of vaccines to those age 70 and older.

As of Sunday, the county had received 2,215 doses of the vaccine, including 2,000 doses of the Moderna vaccine and 215 of the Pfizer vaccine, said Carrie Godes, public health specialist for Garfield County.

“Vaccine shipments to counties are still not predictable, and in most cases lower than the numbers needed or ordered, but they are coming,” she said Tuesday.

Currently, the vaccine is only being administered at the county’s two hospitals, Valley View in Glenwood and Grand River Health in Rifle.

“As more vaccine becomes available, more medical providers will be able to become vaccine distribution sites,” Godes said. “Garfield County is still working through the 1A (high-risk health care workers) and those limited 1B categories (moderate-risk health care workers, first responders and people 70 and older) and anticipates those will take several more weeks.”

Godes reiterated that additional appointment times will become available as more vaccine is received.

“However, the process is going to take some time,” she said. “We will need everyone’s patience and cooperation as the hospitals try to vaccinate everyone in the priority groups. It will take several weeks to vaccinate everyone in the 70-plus category.”

jstroud@postindependent.com

Doctor’s Tip: New recommendations for Vitamin B12 supplementation

Editor’s note: This column was corrected Tuesday, Dec. 29.

Vitamins are substances that the body can’t make that are necessary in trace amounts for normal metabolic functioning. Vitamin B12 is made by bacteria in dirt, and as humans were evolving over millions of years they ate plenty of dirt. In modern times though, with treated water and pre-washed produce, most of us don’t eat much dirt.

Animals get some dirt in what they eat, and B12 is stored in their flesh. So most people who eat animal products (fish included) get enough B12, with the following exceptions: 1) people over age 50, because they don’t absorb B12 as well; 2) people with the rare autoimmune disease pernicious anemia, that destroys intrinsic factor which is needed for B12 absorption; 3) people who have had obesity surgery that affects the part of the intestine where B12 is absorbed; 4) people with diseases that affect intestinal health, such as celiac disease and Crohn’s disease; 5) people who take the diabetes drug metformin; 6) people on long-term drugs that prevent the stomach from making acid, such as Nexium, Prilosec, Pepcid, and Zantac.

B12 is involved in the function of every cell in the human body. In particular, it is necessary for brain, nervous system, and red blood cell health. Low B12 levels can result in the following problems: 1) anemia, associated with abnormally large red blood cells; 2) fatigue; 3) numbness and tingling in hands and feet and poor balance—both of which can be irreversible; 4) poor memory, depression, psychosis, and dementia; 5) elevated homocysteine, which is a risk factor for cardiovascular disease.

In the absence of eating dirt, vegans (no animal products) and vegetarians (small amounts of animal products) tend to become B12 deficient, and MUST take a supplement. It is possible to get enough B12 “naturally” through products such as nutritional yeast, which is usually—depending on the brand—fortified with B12. But it’s so important not to become deficient that experts such as Dr. Greger (nutritionfacts.org, “How Not to Die”) recommend supplements instead.

B12 levels can be measured through a blood test, the most accurate test being methylmalonic acid. However, B12 tests can be falsely negative, and there have been cases of symptomatic B12 deficiency in people with normal B12 blood tests. Dr. Greger does not recommend checking B12 levels as long as people follow his guidelines, except in pregnant and breast-feeding women, people with unexplained neurologic symptoms, and people with abnormally large red blood cells.

There are 2 types of B12 supplements, and Dr. Greger recommends cyanocobalamin, which can be found at any pharmacy and most grocery stores. He recommends getting tablets and chewing them, because absorption is markedly improved with interaction of the B12 supplement with your saliva and mouth microbiome. Taking B12 simultaneously with other vitamins as in multivitamins can interfere with it, so Dr. Greger recommends taking it separately. Dr. Greger’s latest B12 recommendations are somewhat complicated and in some cases confusing, but you can’t go wrong if you go with the following:

  • vegan children ages 6 months to 3 years: 5 micrograms (mcg) a day
  • vegan children ages 4 to 10 years: 25 mcg. a day
  • vegan children above 10 years: 50 mcg. a day
  • non-vegan and vegan pregnant and lactating women: 50 mcg. a day (adequate B12 levels in the mother is necessary for adequate brain development in the fetus and infant).
  • vegetarians, vegans, and meat eaters age 50 and above: 50 mcg. a day
  • vegetarians and vegans, and meat eaters 65 and older 1000 mcg. a day.

People on metformin or stomach acid-blockers should take 50 mcg. People with celiac disease, Crohn’s disease, or history of obesity surgery should take sublingual B12 preparations or consider injections. B12 injections are not recommended otherwise, because of the inconvenience, the extra cost, and the fact that high blood levels associated with injection aren’t “natural” and in one person out of 10 can cause acne.

Greg Feinsinger, M.D., is a retired family physician with a special interest in heart disease and diabetes prevention and reversal, ideally though lifestyle changes. He’s available for free, one-hour consultations — call 379-5718.

PHOTOS: Grand River healthcare workers receive COVID vaccine

A handful of Covid 19 vaccines wait to be distributed to healthcare workers at Grand River Health.
Chelsea Self / Post Independent
Emergency room physician and chief of staff Dr. Skiwot receives his first dose of the Covid 19 vaccine at Grand River Health.
Chelsea Self / Post Independent
Repertory therapist Daniel Ray receives his Covid 19 vaccine at Grand River Health.
Chelsea Self / Post Independent
Speech Language Pathologist Edie Jansen receives her Covid 19 vaccine at Grand River Health.
Chelsea Self / Post Independent
Grand River Health Infection Preventionist Tina Moon administers a Covid 19 vaccine to a healthcare provider.
Chelsea Self / Post Independent

Doctor’s Tip: Vitamin D and fybromyalgia

Fibromyalgia affects 3% to 10% of Americans, and is most prevalent in women age 20 to 50. Symptoms include aching and stiffness, often involving the whole body, but primarily the neck, shoulders, low back and hips. Other symptoms include fatigue, sleep disorders, numbness, headaches and irritable bowel symptoms.

Fibromyalgia is closely related to chronic fatigue syndrome, although in the former musculoskeletal symptoms predominate and lassitude in the latter. The cause of chronic fibromyalgia is unknown, but abnormal perception of painful stimuli, sleep disorders, depression and viral infections have been suggested. If a patient presents with symptoms of fibromyalgia, it’s important to rule out conditions such as rheumatoid arthritis, lupus, polymyositis, polymyalgia rheumatica, low thyroid and sleep apnea.

The only findings on exam that suggest fibromyalgia are pain with pressure over certain trigger points on the body, such as the trapezius muscles in the shoulders, the inner knees and the outside of the elbows. There are no lab tests that are positive in fibromyalgia. This illness is therefore frustrating for both physicians and patients, and it’s easy for both providers and patients to start thinking the disease psychological. However, there is good science that supports this being a physical and not a mental illness.

Also frustrating is the lack of effective treatment. Opioids and anti-inflammatories such as ibuprofen and naproxen don’t help. Corticosteroids such as cortisone don’t help. Acupuncture doesn’t help. Certain antidepressants help some patients somewhat, as do anti-seizure medications such as gabapentin. Exercise programs, cognitive behavioral therapy, and mindful meditation can offer some relief.

According to a recent blog on Dr. Greger’s website nutritionfacts.org, there is something that has been shown recently to help symptoms of fibromyalgia: 2,400 units of vitamin D3 a day. Over the years, there have been many uncontrolled studies looking at treating fibromyalgia with low doses of vitamin D, and results have been mixed. However, in 2014 a well-controlled study using 2,400 units a day showed clear reduction in pain scores, and especially given that this treatment is inexpensive and free of side effects, it is definitely worth trying.

Why would large daily doses of vitamin D3 help the symptoms of fibromyalgia? The answer isn’t known, but we do know this about vitamin D: According to Dr. Joel Fuhrman, author of several books including “Eat to Live,” it regulates several genes and cellular processes. Almost all cells, organs and tissues in our body have vitamin D receptors, including our nervous system and muscles. Vitamin D helps build strong bones and enhances the immune system. It fights inflammation, including inflammatory diseases such as asthma, ulcerative colitis and Crohn’s disease.

Greg Feinsinger, M.D., is a retired family physician with a special interest in heart disease and diabetes prevention and reversal, ideally though lifestyle changes. He’s available for free, one-hour consultations — call 379-5718.

Garfield County frontline medical workers administered first round of COVID-19 vaccinations

Grand River Health’s Dr. Bonnie Walsh being administered the COVID-19 vaccine in Rifle Thursday. Ray Erku / Post Independent

Among colleagues and fellow practitioners on perhaps one of the most historical days in Garfield County, Grand River Health’s Dr. Alan-Michael Vargas was administered a COVID-19 vaccine developed by Pfizer.

“It feels like a flu shot,” he said. “It’s really no different.”

Vargas said he was chosen to first receive the vaccine because he’s essentially spent the entire year helping patients fight the virus while on the front lines of Grand River’s respiratory clinic.

“It came down to us and our fellow man, our community, our loved ones and our families,” he said. “This is me giving back, this is us going ahead and turning around and saying, ‘This is huge, this is going to be a turning point.’”

On Wednesday, frontline medical workers at Valley View Health in Glenwood Springs were also administered the vaccine — the first, in fact, for all of Garfield County, according to a news release from Valley View.

“This is a historic moment,” Valley View Chief Medical Officer Dr. David Brooks stated in a Wednesday news release. “Today, we begin to turn the tide of the pandemic in our community. By starting with our community’s front-line healthcare workers, we protect those who are at high risk and the patients for whom they care.”

“I’m grateful to the entire team at Valley View who have worked for months to prepare for this moment,” he added.

The next day, after receiving hundreds of vaccinations, a spate of Grand River frontline medical workers were also administered the initial vaccination.

Grand River Health’s Dr. Alan-Michael Vargas being administered the COVID-19 vaccine Thursday in Rifle. Ray Erku / Post Independent

Just after being injected with the drug, family medicine specialist Dr. Bonnie S. Walsh said she could barely feel any pain and that “it’s awesome.”

“(I’ve) been super excited to get this pandemic over,” she said. “It’s been very trying, with a lot of new things, a lot of new protocols, a lot of sick people… I’m very hopeful that this really is going to help our community.”

Once the vaccine is administered to frontline medical workers in Garfield County, it will then make its way to the local geriatric population, first responders and those with preexisting conditions and, finally, the general public. That last wave of vaccines will likely happen in late spring or early summer, according to health care professionals.

Walsh was asked what she looks forward to when the pandemic ends.

“The beach, vacation, family, hugs,” she said. ‘All of these things.”

According to Dr. Dustin Cole, a Grand River lab, pharmaceutical and radiological administrator who’s helped coordinate the response to COVID-19, the vaccine might be new but is based on tried and tested technology over three decades old.

Cole said physicians began studying the mRNA technology back in the late 1980s in an effort to combat influenza, zika virus and Cytomegalovirus.

“I think our biggest challenge is, there’s so much misinformation and disinformation on vaccines out there,” he said. “As providers, as a doctor and as a system, if we do it right, we give our patients all the facts and empower them to make the right decisions for themselves.”

In other words, the advent of the virus has acted as a catalyst for progress.

“It’s the perfect marriage of the evolution of that technology, the pandemic, the need for a quick vaccine and then the funding and the resources to make that happen,” Cole said. “So, it’s that marriage that probably moved us 10 years down the road in less than a year.”

How the vaccine actually works is simple, Cole said. What researchers have been able to do is take a small sliver of barcode from one of those weird little spikes you see sticking outside of the virus sphere, aka those little red balls you’ve seen in CDC graphics and elsewhere this year. That barcode is the mRNA.

The mRNA is then wrapped in fats, salts and sugars and injected back into the body to trigger an effective immune response. “So what we’re doing is hijacking the machinery of our body,” Cole said. “Instead of injecting a protein, we’re making a protein from inside the body — a very tiny protein that then goes outside the cell. The minute it goes outside the cell, the body says, ‘Whoah, that’s foreign, we’re going to attack it.’”

After the first vaccination, however, the efficacy rate of the vaccine doesn’t reach the desired level. Instead, it’s after the second go around that efficacy reaches 95%. But even a higher vaccination rate — measles is at 97% — doesn’t mean the disease will fully disappear.

 

Grand River Health’s Dr. Alan-Michael Vargas after being administered the COVID-19 vaccine Thursday in Rifle. Ray Erku / Post Independent

“The reason why we did not eradicate measles is because, honestly, there’s people that don’t do vaccines,” Vargas said.

Speaking to minority groups — demographics in which have been disproportionately more affected by the virus and are more skeptical in taking the vaccine due to a number of reasons — Vargas said that the drug has already been successfully tested using different ethnicities, ages, genders, nationalities and backgrounds.

In spite of this, Vargas said confidence in the vaccine among minority men and women is roughly 50% and lower. He said everyone, even those who are skeptical, should take the studies well into consideration.

“It actually makes it a little more real,” Vargas said of the research.

Still, as more and more people are vaccinated, Vargas stressed that social distancing and mask wearing will continue to be important tools in combating the virus.

Asked what he plans to do once the full positive effects of the COVID-19 vaccination unfold throughout the course of 2021, Vargas said he plans to finally visit his in-laws.

He also looked back on his toughest point in 2020.

“Honestly, my kids are really fighting me to go outside, to go to parks, to go to places,” he said, tears building in his eyes. “And to have to tell them why we can’t go, that bothers me. They’re really thinking about the world as ‘this is what it is.’”

“To think of a future that all of sudden I have to teach them that this isn’t the norm, that’s the hardest part.”

Nevertheless, he expects a celebration.

“That’s going to be the big thing, summer 2021,” he said. “When people feel like they can come out and see their families, that’s what matters.”

rerku@postindependent.com