COVID-19 Vaccine Availability around the Bell County / Central Texas Region

Bell County Texas Health Department: County Wide Vaccine Availabilty

  • Since Bell County is providing widespread availability Adventhealth Central Texas hospital is No longer offering the Vaccine, they are providing the second dose of the vaccine if they administered your first dose.

  • State of Texas COVID-19 Vaccine Availability: type in zip code on map | Google Maps can search for covid-19 vaccines in any ZIP CODE.

  • VA Administration Central Texas COVID-19 Vaccine Available at Temple Texas location.

  • The Carl R. Darnall Army Medical Center/Fort Hood announced it is moving its COVID-19 vaccination clinic to Abrams Gym and starting Feb 8. The gym is located in building 23001, on 62nd Street. Hours are from 8 a.m. to 4 p.m. Monday through Friday (closed on weekends and federal holidays) Beneficiaries looking to get vaccinated are asked to bring a valid DoD ID card and are encouraged to complete necessary paperwork beforehand to minimize wait times. That can be found on the DARNALL hospital website.

Double Masking and Chinese KN95 Masks

From Washington Post newspaper. Direct link blow.

DOUBLE MASKING: some public health experts to recommend doubling up face coverings or donning medical-grade masks.Officials initially discouraged most people from buying medical masks such as N95s and KN95s, to try to protect the supply for health-care workers. If you’re going to buy KN95s, choose a type that has received emergency use authorization from the Food and Drug Administration, said Anne Miller, executive director of Project N95, a nonprofit organization that helps health-care and other essential workers access protective gear. The FDA keeps a list of approved products, which the agency refers to as “respirator models manufactured in China.”

The Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health also maintains a website focused on counterfeit N95s for reference.

Whatever face covering you choose, it should be snug and without gaps. Here is a link on masks from NYTIMES and a very nice 3D graphic demonstrating how the viral “particle” aerolization lingers in the air, drifting beyond the 6’ perimeter where larger droplets tend to fall. 3D GRAPHIC SIMULATION. See the September 2020 post below for more helpful links specifically on masks, and which ones to avoid.

Currently, it is felt that placing a cloth mask over a blue paper mask with metal prongs to shape over the nose provides filtration approaching that of an N95, if placed correctly. See the video at the link for the correct way to put on 2 masks.

Washington Post Link To Original Article Feb 2, 2021
Washington Post
Video On The “Variant” Covid-19 Strains, Feb. 2, 2021

"What To Do If You Test Positive To COVID-19"

see discussion and You Tube link below: updated August 29, 2021

I am frequently asked what to do if tested positive for COVID19. Professor Roger Seheult MD, is an SDA physician that produced the you tube video below that addresses important topics such as who is a candidate for early antibody infusion in the Emergency Department, the utility of purchasing a pulse oximeter to know if supplemental oxygen ( hospitalization) is needed.

He then reviews the Lifestyle/Integrative medicine recommendations for which there is supportive evidence. He closes with recommendations on ventilation/air filtration to prevent the spread in the home of the viral aerosol which can linger in the air and frequently are the unsuspected source of covid-19 infection. (I have posted numerous links to articles dating back to June 2020 explaining the under appreciated source of corona virus infection by the aerosolization of the virus which lingers in less well ventilated rooms such as a small bathroom and is an additional source of infection. This is in addition to the “six foot droplets” which people are generally more familiar with. The video above mentions higher grade filters for your central air intakes. and correctly mention the higher grade filters, MERV14 . (A personal note. In my home we installed MERV11 filters which severely limited air flow through our 2 1/2 ton air conditioner unit and we had to drop back to MERV8 grade air unit filters, and instead bought several free standing HEPA filters . Not everyone might have this same issue.) As an additional note: In the early days of this pandemic , much stress and anxiety was produced by the fear of getting covid-19 infection by touching objects, food packages from the supermarket. These are called fomites and we now know are a very minor source of infection, except for shaking hands , touching other individuals, in close proximity. Good hand hygiene is always good advice but I advise putting more focus on the more infectious viral aerosol..

The You Tube speaker, Dr. Seheult, was a contributor to the Adventist World Radio (AWR360) series and is Assistant Professor at Loma Linda University and is quadruple board certified. I endorse the recommendations provided. There are links provided on the You Tube site under the video with useful information such as which pulse oximeters are recommended.

View youtube video below for additional tips on what to do if you test positive


Supplements

I have written down and expanded somewhat the discussion on supplements mentioned in the You Tube video above. These have been shown to have positive effects on our immune system defenses and may provide additional protection against the COVID-19 virus, but less so against an actual covid19 infection. The following supplements below are those for which evidenced-based medicine provides some support ; conclusions drawn are from known activity against older viruses that have been better studied such as the influenza virus which may not necessarily translate to the SARS CoV-2 virus. These supplements are in addition to the known lifestyle medicine benefits provided by a healthful diet, physical activity , adequate sleep and stress reduction discussed in the “make the transition now” section of this website. Supplements are not a substitute for a healthful diet because no supplements contain all the benefits of minimally processed actual foods. In addition , there is more information on the You Tube video TIPS TO OPTIMIZE YOUR IMMUNE SYSTEM IF YOU TEST POSITIVE TO COVID-19 from Dr Seheult at https://www.youtube.com/watch?v=vN30emwcNS4 . Please feel free to share this information. Keeping this in mind, let’s begin.

Zinc. is a component of many enzymes and transcription factors in cells all over the body, playing a role in immune function via antibody and white blood cell production. Zinc supplementation has been suggested to increase polymorphonuclear cells’ ability to fight infection, while there is evidence that zinc deficiency increases pro-inflammatory cytokines and decreases the production of antibodies. Angiotensin-converting enzyme-2 is a zinc metalloprotease that is important for cellular entry of coronavirus. Randomized controlled trials have shown that zinc supplementation reduces the incidence rate of acute respiratory infections by 35% - BUT does not shorten the severity / duration of established COVID19 infections. Recommended dose is 25 mg up to a maximum of 40 mg a day of elemental zinc, again for prevention only. My recommendation would be to continue this through spring 2022 , which would correspond to the end of the flu season, and then discontinue daily use.

Vitamin C. Vitamin C or Ascorbic Acid is a cofactor for many enzymes and acts as an antioxidant, limiting inflammation and tissue damage associated with immune responses. Studies evaluating the effectiveness of vitamin C have shown it to significantly reduce the incidence of respiratory tract infections. Studies (in vitro and in vivo ) in avians (birds) have shown that ascorbic acid could be protective against coronavirus. Common sense dosing is between 1000 and 2000 mg a day.

There is additional evidence that the immunomodulatory effects of Vitamin C are augmented by the flavonoid Quercetin and that Vitamin C / Quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral / immunomodulatory properties. Common sense dosing is 250 mg twice a day . These positive effects are most clear for prevention BUT does not shorten the severity / duration of established COVID19 infections. My recommendation would be to continue this through spring 2022 , which would correspond to the end of the flu season, and then discontinue daily use.

Quercetin: Antiviral Significance and Possible COVID-19 Integrative Considerations

Vitamin D. Several studies have demonstrated independent association between low serum concentrations of Vitamin D and acute viral respiratory tract infections including both influenza and the H1N1 viral pandemic in 2009. The immunomodulatory effect of 25-hydroxyvitamin D supports induction of antimicrobial peptides in response to both viral and bacterial stimuli. Patients who were Vitamin D deficient and those not receiving weekly bolus doses experienced the most benefit : prevention of acute respiratory tract infection. Among those already infected, influenza symptoms were fewer and recovery earlier with vitamin D of at least 1000 IU daily especially those starting with low vitamin D levels.

Vitamin D doses between 3000 to 5000 units daily with the goal of raising blood levels to between 40 to 50 nmol/L . Daily dosing is more effective than weekly high-dose bolus dosing; the D2 form appears more beneficial. Magnesium 250-400mg daily increases absorption of vitamin D. My recommendation would be to continue this through spring 2022 , which would correspond to the end of the flu season, and then lower high dose vitamin D down to 1000mg until reviewed by your personal care provider.

NAC. The rationale for the use of N‐acetylcysteine: NAC is a precursor of the antioxidant glutathione, promoting its antioxidant, anti-inflammatory and immune-modulating characteristics. A significant elevation in blood serum glutathione reductase (GR), resulting from oxidative stress imbalance, was detected in COVID‐19 patients. NAC replenishes “reduced glutathione” thereby lowering oxidative stress inside neutrophils which reduces production of pro-inflammatory cytokines implicated in the destructive “cytokine storm” inflammatory reaction. NAC has been shown to diminish replication of the influenza and respiratory syncytial viruses and appears to bind “main protease” of SARS-CoV2 potentially inhibiting its protease activity needed for viral replication. The dose often quoted is 600mg twice a day with a wide safety margin. Keep in mind , many of the studies were involving the influenza virus through winter flu season. My recommendation would be to continue this through spring 2022 , which would correspond to the end of the flu season, and then discontinue daily use. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649937/pdf/tcrm-16-1047.pdf

Melatonin: has been studied not only for its effect to promote sleep but also for its antioxidant effects , which is an important part of promoting a healthy immune system. This makes getting adequate restorative sleep, with the bodys’ natural production of melatonin critically important.Melatonin is especially secreted during “slow wave” sleep before midnight, and when growth hormone secretion also takes place, which is associated with longevity. Melatonin also appears to have immunomodulatory effect against CD147 which is a glycoprotein implicated in the destructive “cytokine storm” inflammatory reaction. (https://link.springer.com/article/10.1007/s11033-020-05830-8 ). Common sense dosing would be a 3 mg tablet, 1 hour before sleep , or 1 mg sublingually, which is more quickly absorbed and bypasses hepatic “first pass” metabolism, limiting clearance by the liver. My recommendation would be to continue this through spring 2022 , which would correspond to the end of the flu season, and then discontinue daily use. Ideally however, since melatonin is hormone produced by the brain we should be obtaining melatonin from adequate restorative 7+ hours of sleep nightly, lessening our need for continuous use.

Texas Stats and COVID19 TESTING

Texas Department of State Health Services COVID-19 Dashboard : select Bell county from dropdown

The Texas Tribune : coronavirus in Texas

Bell County Texas COVID-19 Dashboard : scroll through 8 pages

Johns Hopkins University : COVID-19 TEXAS Overview

CDC COVID Data Tracker: Maps, charts, and data provided by the CDC (select dropdown for Bell County,Texas)

CDC : Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020

Texas COVID-19 Test Collection Sites

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And More Evidence oN the Risk of Infection from Aerosolization of the COVID-19 Virus (continuation of June 2020 post below-see the june post for specific recommendations on how to lessen your exposure to the aerosol form of the virus )

CDC: Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission Updated Oct. 5, 2020

Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission may 27 2020

Droplets and Aerosols in the Transmission of SARS-CoV-2 april 15 2020

The coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? april 3 2020

COVID-19 Is Transmitted Through Aerosols. We Have Enough Evidence, Now It Is Time to Act: TIME Magazine August 25 2020

Yet more data support COVID-19 aerosol transmission : august 31 2020

Scientific Brief: SARS-CoV-2 and Potential Airborne Transmission : CDC October 2020 Update

It Is Time to Address Airborne Transmission of Coronavirus Disease :  November 1 2020

September 20 , 2020

How to Select, Wear, and Clean Your Mask | CDC

Summary of Current Recommendations : more information at cdc.gov

  • Wear masks with two or more layers to stop the spread of COVID-19

  • Wear the mask over your nose and mouth and secure it under your chin

  • Masks should be worn by people two years and older

  • Masks should NOT be worn by children younger than two, people who have trouble breathing, or people who cannot remove the mask without assistance

  • Do NOT wear masks intended for healthcare workers, for example, N95 respirators

  • CDC does not recommend the use of gaiters or face shields. Evaluation of these face covers is on-going but effectiveness is unknown at this time.

Your Most Pressing Questions About Masks | CR

Consumer Reports Chief Scientist “Here’s what you really need to know” at consumer reports.org

This page answers a lot of those questions we all have -regarding bandanas , masks with valves , and is it okay NOT to cover your nose ?

and more on Aerosolization of viral particles

Aerosolization continues to be an under recognized or poorly understood secondary source of infection. Reminder that the virus has been shown to linger in the air of small , poorly ventilated rooms such as a private restroom at a workplace , and my more recent concern , a lavatory on an airplane which I liken to “a phone booth in the sky “, very noisy but is it ventilated adequately to clear the air in-between two users back-to-back ? I have reservations and would not remove my mask in an airplane lavatory , for now.

The CDC now has recognized on September 18, 2020 that aerosols are perhaps the most important route of COVID19 transmission :

-This was reported on CNN September 20, 2020 based on CDC September 18, 2020 revisions to their website which can be viewed here: How COVID-19 spreads | CDC -Airborne Transmission of SARS-CoV-2 : JAMA July 13, 2020 Generation and Behavior of Airborne Particles (Aerosols) by Baron et al. : CDC pdf

June COVID-19 Update

Introduction to risk of infection from breathing in fine particles of the virus. This is called “ Aerosolization “ and is an important source of infection in small , not well ventilated rooms.

We have reached the awful milestone of over 100,000 deaths in the United States from COVID-19. It has become apparent that there is a mode of transmission in addition to the “6 foot droplets” that hasn’t been accounted for. There is a growing body of evidence pointing towards aerosol transmission of microscopic viral particles that can float in the air for hours. Infection is a function of concentration of viral particles and length of time exposed; it seems 10 minutes of breathing in a higher concentration of viral particles in a poorly ventilated small room, such as a small restroom or office, or an elevator is enough to become infected.

If an individual uses a small office or restroom a few minutes before you, and had their mask off for 10 minutes or more, that could be enough time to leave an invisible cloud of microscopic aerosolized viral particles anywhere from 20 minutes to 2 hours in a small, poorly ventilated room.

Therefore I am recommending leaving masks on when entering such a space, even if the room is not occupied. Why? If an individual uses a small office or restroom a few minutes before you, and had their mask off for 10 minutes or more, that could be enough time to leave an invisible cloud of microscopic aerosolized viral particles anywhere from 20 minutes to 2 hours in a small, poorly ventilated room. If you then enter and remove your mask, thinking you are alone, your risk of infection escalates. To compound the problem, aerosolized particles float with the air current, effected by gravity more slowly than the droplets with the “6 foot distance” we have heard so much about. These aerosolized particles, floating in the air you breathe in, can easily float around loose fitting masks or bandanas. However even a poorly fitting mask is better than no mask as lowering the viral load you breathe in will lessen the chance of infection, or at least the severity of the infection. So when entering an empty small room or restroom, instead of letting your guard down and removing your mask, that is the time to tighten the mask, open doors and ventilate small rooms, to lower the concentration of that invisible cloud of aerosolized viral particles. These recommendations are in addition to those already given. Does it seem extreme? As of this writing there are 106,195 reasons to say no, it’s not. Stay safe.

Stephen Ralph MD ABIM DipABLM BCEM (emeritus)
Killeen Texas


  1. The Risks-Know Them-Avoid Them : Erin Bromage

  2. SARS-CoV-2 in Aerosols:
    Richard T. Ellison III, MD reviewing Liu Y et al. Nature 2020 Apr 27 Analysis of air samples from two Wuhan hospitals identified SAR-CoV-2 RNA in submicrometer aerosol samples.

  3. The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission |PNAS

  4. We cannot keep ignoring the possibility of airborne transmission. Here’s how to address it: The Washington Post

  5. Coronavirus Is Aerosolized Through Talking, Exhalation:
    Medscape 

  6. Reducing transmission of SARS-CoV-2:
    Kimberly A. Prather, Science May 27, 2020 

COVID-19 Walk With A Doc March 2020

  • Learn to use VA Video Connect through the VA mobile app store or by contacting your VA care team, before any urgent problems arise. For non-VA patients, there are numerous telemedicine services with online MDs

  • Wash your hands often with soap and water for at least 20 seconds. An easy way to mark the time is to hum the “Happy Birthday” song from beginning to end twice while scrubbing.

  • Use an alcohol-based hand sanitizer that contains at least 60% alcohol

  • Avoid touching eyes, nose and mouth with unwashed hands.

  • Avoid close contact with people who are sick

  • Stay home when you are sick or becoming sick

  • Cover your cough or sneeze with a tissue (not your hands) and throw the tissue in lined trash can

  • Clean and disinfect frequently touched objects and surfaces, especially work surfaces daily. Start getting in the habit of washing hands often and “not touching your hands nose or mouth with unwashed hands”, at least outside your home. Although not in pdf, I would add wipe down your grocery packages after your home with a disinfectant wipe; many hands touched that package before you

  • Getting a flu shot is recommended

  • Changing the focus from “keeping them from infecting us” over to “keeping us from infecting each other” Among new messages that should be delivered are:

  • Build up a reserve of nonperishable food and extra prescription medications, incase homebound.

  • Consider care of sick family members (parents)

  • Cross-training work personnel so one person’s absence won’t derail an organization’s ability to function.

SYMPTOMS INCLUDE FEVER, COUGH, AND SHORTNESS OF BREATH, PREDOMINATELY LOWER RESPIRATORY

A differentiation from influenza “flu” are prominent chest symptoms of shortness of breath but cough nonproductive, and a low oxygen saturation and bilateral interstitial infiltrates on chest x-ray signifying an “interstitial pneumonia”. This picture can be blurred and become more critical in patients with COPD/emphysema and in asthmatics. These individuals and the frail, immunocompromised, or with significant congestive heart failure should avoid large gatherings and crowded waiting rooms. Supermarket shop during quieter early morning hours and clean those cart handles; consider shopping online with curbside pickup might be appropriate. A family member may need assistance with ordering, but that can be done from anywhere. Anticipate closures/ disruption of schools/daycare etc.