Updates on the Novel Coronavirus (aka COVID-19): What You Need to Know

Information about the spread and about the safety concerns of the novel coronavirus (aka "SARS-Cov-2"), and the disease it causes, COVID-19, is evolving on an daily basis. It is also clear that politics has played a major role in the information that has been distributed and the recommendations made. So I wanted to try to bring you unbiased, non-political information about the of the virus in our community and in general. I will include details on this topic from previous newsletters, as they remains important - new information will be in BOLD.

I know this has been a very stressful time for many of us. One major reason for this stress seems to be our loss in trust for the institutions we have so long relied upon in the past: many of us now have doubts about our government, our leaders, our news media, and our scientists. I feel that new sense of uncertainty myself... however, I did want to address one rumor that has been circulating about COVID-19 in recent past that I strongly object to: the rumor that physicians have exaggerated the diagnosis of coronavirus cases for financial reasons. I can tell you that this is categorically wrong: physicians get paid for services based on the complexity and length of a medical visit, not based on the associated diagnosis. So, we will NOT improve our bottom line if we add more COVID-19 diagnoses to an outpatient visit or a hospitalization. And I resent that this rumor has put physicians in this category of people that can't be trusted.

For my part, I can assure you that I will never lie to you or to anyone about medical facts. I will always be your advocate and - hopefully - someone you can trust... regardless of whether we share the same political opinions. And I am grateful for the trust you put in me every day in return.

Thank you!

General Information:

Pandemics are not new to our civilization and each pandemic is unique. What makes SARS-Cov-2 different and more challenging is the high degree of infectiousness as well as transmission from people who have no symptoms at all or only mild symptoms.
Looking at the experience of New York between March and June, 2020, researchers found the mortality rate to be 1.4% overall. However, for adults between 65 and 74, the mortality rate was 4.9% and those over 75 had a mortality rate of 14.2%.
As treatments have been improving, the mortality associated with COVID-19 has been steadily decreasing over the last few months. An article from the Journal of Hospital Medicine found a death rate of 25.6% from COVID-19 in New York in March. In August, the death rate had declined to 7.6%. The improved outcomes were attributed to a better understanding of when a patient requires intubation, better positioning, and more effective medication use. Of course, a decreased rate of hospitalized patients played a significant part as well. Finally, a lower viral exposure due to social distancing and mask wearing was also found to lead to a decreased incidence of death.
COVID-19 has had negative health impacts on many people who don't contract the virus: 40% of U.S. adults surveyed in late June reported at least one or behavioral health problem associated with the pandemic. In general, young adults, Hispanic and Black people, as well as essential workers and unpaid caregivers had the highest rates of issues.
Anxiety is rising during the pandemic: 62% of respondents in a recent poll reported increased anxiety.
The newest studies (published in the journal Science) suggest that the antibodies developed by people who have recovered from COVID-19 actually last for at least 5 months. This is runs contrary to an earlier finding suggesting that antibody levels last for 3 months or less. The data remains inconsistent, however. A different study published in JAMA looked at antibody levels in health care providers in Nashville. In the latter study, antibody levels from recovering illnesses declined over 2 months and were no longer detectable in 58% of people at that time. Regardless of the length of antibodies in our system, please realize that it is common for antibody levels to various infections to decrease with time. This does not mean that people are no longer immune, as other cells in the body also confer immunity. Also, such antibody levels can often increase again quickly, when we are re-exposed to the virus at a later date.
There is more recent data out suggesting that this coming flu season will be relatively mild: early studies in the U.S. and previous studies in countries in the southern hemisphere suggest that the social distancing measures and masks have meant that flu transmission has gone down in addition to SARS-Cov-2 transmission. We do, however, still urge EVERYONE to get a flu shot.

Transmission:

The incubation period can be 14 days (or more), though most people develop symptoms within 5-10 days.
Transmission occurs predominantly via respiratory droplets. Transmission is more likely the longer you are close to an infected person, the closer you are, and the worse the air ventilation is. Transmission via touch (touching a surface with the virus on it and then touching your nose, eyes, and mouth) is quite unusual. The virus can also be spread through the air beyond a 6 feet distance, especially in poorly ventilated spaces. Although it seems likely that COVID-19 can be transmitted via both droplets and aerosols, preliminary research suggest that droplet spread is much, much more common.
Household contacts of COVID-19 patients have a risk of 53% of becoming infected themselves. (MMWR)
Humans can transmit the Novel Coronavirus to dogs and cats but these animals don't get particularly ill. More importantly, these animals don't seem to be able to give the virus back to us!
There is some concern that minks can transmit the SARS-Cov-2 virus to humans. Mutations acquired when the virus jumps from one species to the next can also make a possible future vaccine less effective. As a consequence, Denmark, for one, has announced that it would kill its entire population of farmed minks. Until the U.S. does the same, please stay away from any wild minks!
People are most infections the day prior to developing symptoms and then infectivity declines about one week after onset of symptoms.
A study published in the journal Virology in October unfortunately showed that SARS-Cov-2 can stay alive and infectious on surfaces much longer than we thought: at room temperature, it can live up to 28 days! In comparison, the influenza virus can stay alive on surfaces for 17 days. Glass surfaces (such as smart phone covers!) are particularly likely to carry the virus, so please clean your smart phone surfaces frequently!
We need to all recognize that face masks are extremely important and effective in protecting the wearer as well as the people around them
Please, folks, wear the face masks properly! I see so many people walking about wearing face masks with their noses not covered. This doesn't protect anyone!
On October 19, the CDC issued a "strong recommendation" that all passengers and employees on airplanes, trains, buses, taxis, subways, and ride-share vehicles wear a face mask. In addition, people in airports or trains stations are also asked to wear facial coverings.
There are rumors that wearing of masks is associated with lower oxygen saturations in the blood, a fact that can be critical in vulnerable populations. However, a study published in JAMA studied 25 senior citizens in Canada, all of whom were given a three-layer mask. Then their oxygen was check at rest and with activity. Luckily, there was no clear drop of oxygen saturations associated with the wearing of masks.
More of us are traveling by airplane again these days. An interesting article from JAMA looked at the risk of flying and getting infected with SARS-Cov-2:
The risk of getting COVID-19 during air travel is lower than from an office building, classroom, or supermarket.
The low infectivity has to do with the relatively low airflow between rows.
Half of the airflow in a plane is from fresh air from outside - the other half is recycled through HEPA filters similar to the ones used in an operating room.
Current estimates suggest that only 42 people have gotten COVID-19 from being in an airplane.
A study just conducted in Germany looking at the safety of indoor concert venues was promising: in this study, participant volunteers for a concert were all tested for SARS-COv-2 prior to the event and had their temperatures checked. Then they were seated at the concert in different configurations and with different ventilation techniques. Airflow was assessed with fog machines; fluorescent hand sanitizer was used, and location trackers were attached to the volunteers. Also, people were also studied as they stood in line for the restrooms or at the concession stands. The upshot: going to an indoor concert can be safe, if appropriate hygiene protocols, limited capacity, and appropriate ventilation measures are maintained.

Symptoms and Risk Factors:

People with COVID-19 usually develop achy muscles and a fever, as well as shortness of breath. A small number are also nauseated and have diarrhea. Loss of taste and smell is common. Severe cases usually involve a pneumonia that may lead to hospitalization and the use of a ventilator to allow the lungs to adequately transfer oxygen into the blood.
About half the patients with COVID-19 have neurologic symptoms.
Pediatric cases of COVID-19 are increasing, with 61,000 new cases documented in children in the last week of October.
Most children who get infected do not exhibit any symptoms. However, a small percentage who end up in the hospital have symptoms of "vasculitis," which is an inflammation of the blood vessels. This syndrome, called "pediatric multisystem inflammatory syndrome (MIS-C)" is still rare, but can be very serious.
Death rates from COVID-19 have dropped from 25% to about 7.6% since onset of the pandemic. Nonetheless, COVID-19 is about 10-times more deadly than influenza - and much more infectious.
An increasing number of COVID-19 patients seem to have long-standing sequelae of their infection:
persistent lung disease is common, with people experiencing cough and shortness of breath 12 weeks after hospitalization.
One preliminary study coming out of the U.K. noted that women between the ages of 50 and 60 were most likely to develop prolonged COVID-19 symptoms. Other people more affected included older patients, women in general, as well as those experiencing five or more symptoms from the disease.
Certain underlying conditions make you more prone to get sick with COVID-19. These include emphysema, diabetes, and heart disease. Also, obese people as well as smokers and people with kidney damage are also at higher risk.
The CDC announced in mid October that people who are overweight (but not obese) have an increased risk of severe illness with COVID-19. This means that 75% of the U.S. population is at heightened risk as 75% of the U.S. population is overweight or obese.
Adults with vitamin D deficiency are at greater risk for severe COVID-19 disease and death.
In the United States, Black people and Hispanic people are three times as likely to become infected with COVID-19 compared to Caucasians. Moreover, Black and Hispanic people are twice as likely to die of the disease compared to White people.
A new study showed that pregnant women with COVID-19 were more likely to give birth prematurely (13% compared to 10% prior to the pandemic). Pregnant women were also more likely to end up in the ICU and needing to be put on a ventilator compared with non-pregnant infected women.

Incidence/ Prevalence:

To the best of our knowledge, only about 5 people world-wide have become re-infected with SARS-Cov-2, a tiny number given the prevalence of the disease. This is great news!
COVID-19 illnesses and infections have been increasing in recent weeks, suggesting that the long-dreaded fall spike of cases is beginning. Yesterday, the number of new cases in the U.S. surged to 120,276. Indeed, in three of the last seven days, the number of new cases has been at least 100,000. The good news is that the number of deaths from COVID-19 has not increased nearly to the same extent. Unfortunately, the number of hospitalizations has shot up also. So: more people are getting ill; more people are needing to go to the hospital and hospitals are getting filled up. But, the number of people who die from the disease is not increasing....silver lining? This increased need for hospitalization has turned into a significant issue in parts of rural America, where hospitals tend to be further away and smaller in size.
At this time, over 49.1 million people in the world have contracted the novel coronavirus. 1.24 million people have died worldwide (compared to 1.14 million two weeks ago). The United States has the highest number of cases. The U.S. also has the highest number of deaths (at 236,000) in the world (223,000 two weeks ago).
In the United States, more than 9.76 million people have now contracted SARS-Cov-2 (8.49 two weeks ago). The current rise in nation-wide cases is driven by the rapid transmission in Midwestern states.
In late October, more than 41,000 people were hospitalized in the U.S. with COVID-19, an increase of 40% within the last month. At least 14 states had more people hospitalized with the virus during one day in the last week than on any other day previously...fasten your seat belts: winter is coming...
In the last week, the people in the U.S. diagnosed with coronavirus increased by 18% and the people who died of the disease increased by 3%.
In the U.S., 6% of adults hospitalized with COVID-19 are in the health care field; Almost 30% of these hospitalized health care personnel were admitted to the intensive care unit.
California is reporting that it now has more than 962,000 people infected with SARS-Cov-2 (compared to 897,000 two weeks ago).
As of October 22, 2020, there have been 11,710 people in San Mateo County who have tested positive with the SARS-CoV-2 virus (compared to 10,961 people two weeks ago). 162 people in San Mateo County have died from the disease (compared to 157 people two weeks ago).
A bit of good news: even as coronavirus disease is spiking throughout most of the country, the incidence of COVID-19 infection and deaths has been flat or decreasing in San Mateo.
At this time, children account for 11% of the SARS-Cov-2 infections in the U.S., an increase of 14% over the past 2 weeks.
Some more bad news: a recent study published in JAMA looked at the per capital death rate in the United States and compared it to 18 other countries with populations larger than 5 million people and a per capital GDP of more than $25,000 per year. This "all-cause" mortality takes into consideration those fatalities that may have been related to the coronavirus, but were never confirmed. Overall deaths in the U.S. in 2020 are more than 85% higher than in places such as Germany and Israel. Even if we look at the deaths clearly due to COVID-19, the number of people dying of the disease since May 10 is about 50% higher than every other country in the study. Possible reasons for this excess mortality is assumed to be weak public health infrastructure and a decentralized, inconsistent US response to the pandemic. Also, the U.S. population has more associated underlying disease (such as diabetes and obesity) compared to many other countries.

Testing

Another rapid COVID-19 test has been approved by the FDA. This one is called "CareStart" and functions much like a home pregnancy test. I only hope that small physician's offices like mine will have access to such testing in the near future....other rapid tests have been on back-order and not available to small private practices.
Also, another saliva test ("SalivaDirect") has been approved by the FDA and will be distributed to laboratories - hopefully soon!

Treatment

On October 22, the FDA approved remdesivir as a treatment for COVID-19 and therefore took it out of the "experimental/ emergency use" category. It is the only medication COVID-19 treatment in the United States. Unfortunately, recent reports on the efficacy of remdesivir have been mixed.
A new trial found that the combination of remdesivir with baricitinib improved the time to hospital discharge from 8 days to 7. Also, this regimen increased the survival of patients with COVID-19.
Low doses of the steroid "dexamethasone," given intravenously, have been found to reduce death rates by 33% in people with COVID-19 who are on a ventilator.
Vaccine development is ongoing.
Dr. Fauci was "cautiously optiministic" this week that we will have a safe and effective vaccine for the novel coronavirus by November or December.
The U.S. Administration has announced that a COVID-19 vaccine, once available, will be free for all Medicare beneficiaries as well as those with private health insurance.
There are currently 35 vaccines in phase 1 trials, 14 vaccines in phase 2 trials, and 11 vaccines in phase 3 trials. 6 vaccines have been approved for limited use.
Both Pfizer and BioNTech have entered phase 3 trials. The mRNA technology for vaccine development is new and could usher in a new era of faster and safer vaccine development in general.
Johnson & Johnson has launched phase 3 trials for it's vaccine. This vaccine candidate is good because it requires only one administration dose and does not have to be kept frozen.
J&J reported on October 23 that their vaccine trials would resume after having concluded that prior adverse events noted with the vaccine were unlikely to be a result of the vaccine administration.
AstraZenica reported also on October 23 that they would resume their vaccine trials. The trial had been halted after two volunteers developed neurological events. Subsequent analysis could not link the events to the vaccine administration, however.
Antibody therapy:
Eli Lilly has developed an experimental treatment involving SARS-Cov-2 antibodies.
On 10/13/2020, Eli Lilly had to pause their clinical trials due to "a safety concern."
The U.S. government on October 28 promised Eli Lilly as much as $1.19 billion to secure almost one million doses of its antibody treatment. However, this announcement came one day after Eli Lilly announced that it's drug had not been found to be helpful for patients in the hospital already - though it may be helpful in an earlier stage of the disease.
Regeneron's "REGN-COV2 antibody cocktail" was found to lower viral loads and the need for additional medical care in outpatients (i.e. not those who were in the hospital already).
However, on November 1, an independent data monitoring committee recommended that Regeneron stop enrolling COVID-19 patients that were very ill (requiring high doses of oxygen or use of a ventilator) due to "an unfavorable risk/ benefit profile" in these groups.
A recent study published in the British Medical Journal found that plasma from convalescent patients (i.e. those who had COVID-19 in the past) was NOT effective in treating active coronavirus patients.
The New England Journal of Medicine reported an intravenous antibody therapy derived from convalescent plasma (known as "LY-CoV555") led to improved symptoms and fewer hospitalization for outpatients (phase 2 trial). This antibody is not yet available outside of a clinical trial, at this time.
Another new and interesting therapy comes in the form of a preventative nasal spray: in a trial involving ferrets (!!), researchers have inoculated ferrets with a daily nasal spray that blocks the absorption of the SARS-Cov-2 virus. This data is based only on a small number of animals tested and needs to be studied further. However, if this strategy proves effective in humans, then a daily nose spray of such a medication could function like a vaccine and keep us safe from COVID-19. Interesting...

Mills-Peninsula Hospital:

Peninsula Hospital continues not to be full and is managing its share of COVID-19 cases as well as could be hoped for. Plenty of beds are still available in case more people fall ill and all the treatment modalities we discussed above are available here.
People hospitalized at Peninsula Hospital for reasons other than COVID-19 may now have one visitor per day during visiting hours (10 am to 5 pm daily). Visitors will be screened for symptoms and asked to provide their name and phone number for contact tracing purposes. Also, visitors must wear specific face masks provided by Sutter.

Our Community and Beyond:

The State of California has come out with a new color-coded system to guide reopening of different parts of the state: this system has 4 tiers: certain criteria such as each region's number of positive COVID-19 tests, hospitalizations, and Intensive Care Unit admissions will dictate what tier is appropriate for each region. Also, each region needs to be in a certain tier for at least 21 days and have improved their COVID-19 metrics for this time period prior to being able to "advance" to a higher/ better tier. The lower the tier, the more likely the region can open services.
On October 27, San Mateo County moved into a less-restrictive orange coronavirus tier. Contra Costa, Marin, and Santa Cruz counties moved to the orange tier also. As a consequence:
many indoor businesses will be able to increase their maximum capacity from 25% to 50% (or 200 people - whichever is fewer).
gyms and fitness centers, as well as hotels, will be able to reopen indoor pools. Gyms can increase their capacity from 10% to 25%.
On October 19, Gov. Newsom announced his plans to launch a scientific working group to examine the safety of any coronavirus vaccines that receive federal approval.
California is also preparing to launch a massive vaccination campaign, according to plans released last week. The details of the plan, which presumably include information on where the vaccine will be distributed and stored as well as what populations will be prioritized, have not been released. Given the size of California's population, such a vaccination campaign is a huge undertaking and requires careful planning.
On October 19 Governor Newsom announced that the majority of Californians (those not at high risk of infection or complications) may have to wait until the second half of 2021 to be vaccinated for COVID-19.
On September 23, San Mateo announced a plan to significantly increase testing opportunities. The county's strategy involves a three-pronged approach:
Scheduled testing at the San Mateo County Event Center. Testing here will occur Tuesdays through Saturdays from 8 am to 3 pm - all without a cost to the patients. Appointments are required and can be made at "projectbaseline.com/COVID19"
Mobile testing in under-served communities.
Targeted neighborhood testing.

Our Office: What We Are Doing to Keep You Safe:

All patients seen in person will be screened for COVID-19 exposure and symptoms prior to coming into the building.
We disinfect all exam rooms and medical equipment as well as all door handles after EVERY patient visit, regardless of the medical issues involved.
We are also using tele-health options that allow you to have video as well as audio interactions with us as part of a "remote office visit." Tele-health is one change associated with the COVID-19 crisis that is likely to remain long after this pandemic is over. However, video visits can never replace in-person visits in our ability to make diagnoses and to really get to know our patients.
For those patients seen in the office, we ask that friends and family members stay in the car (or elsewhere outside the office) during the visit. Of course we do welcome caregivers into the office with the patient if they are needed for improved safety or communication. Other office guidelines will be based on recommendations of the American Medical Association and local public health ordinances. We have installed Plexiglas screens in the front office. We will do everything possible to make sure you feel safe to come back to our office.
All of us in the office are healthy and doing well.
All patients coming into the office will be required to wear masks.
As in previous years, our office will be offering both quadrivalent flu shots as well as the flu vaccine for "seniors." We have finally received more "regular" flu shots (i.e. NOT those for seniors). So if you are under 65 and have not yet received your flu shot, call our office and come on in! Unfortunately, we have run out of our flu shots for seniors, for now. We are on the wait-list to get more, but are not sure when that will be. We'll let you know as soon as we know. Until then, we encourage our senior patients to get their flu shots from a pharmacy.

We will try to keep you updated as the epidemic evolves. Feel free to call or email with questions or concerns.

About Dr. Sujansky's Life in These Times

On a more personal note, my family and I continue to do well.

My extended family has now been hit by COVID-19 also: my 45-year-old cousin, who lives in Germany, is just today leaving the hospital after a one week hospitalization due to pneumonia from the novel coronavirus. Previous to this illness, he had been fit and had no significant underlying diseases. Luckily, he seems to be out of the woods now.

Halloween was low-key at the Sujansky residence this year. No trick-or-treaters came and we were in bed early. I have attached a picture of my costume on the thumb-nail...for those of you who are paying attention: yes, the black jacket/ blanket was the gift I received from my son for Mother's Day not too long ago. How versatile such a piece of clothing is! Who would have thought?!

It has just started raining and that is the unofficial start of autumn for me. Stay warm and dry, everyone...though I have no problem if you go outside to get some fresh air. Just take a shower and drink a warm drink when you come back in.

Updates on the Novel Coronavirus (aka COVID-19): What You Need to Know

For my part, I can assure you that I will never lie to you or to anyone about medical facts. I will always be your advocate and - hopefully - someone you can trust... regardless of whether we share the same political opinions. And I am grateful for the trust you put in me every day in return.

Thank you!

General Information:

Pandemics are not new to our civilization and each pandemic is unique. What makes SARS-Cov-2 different and more challenging is the high degree of infectiousness as well as transmission from people who have no symptoms at all or only mild symptoms.

Looking at the experience of New York between March and June, 2020, researchers found the mortality rate to be 1.4% overall. However, for adults between 65 and 74, the mortality rate was 4.9% and those over 75 had a mortality rate of 14.2%.

Anxiety is rising during the pandemic: 62% of respondents in a recent poll reported increased anxiety.

Transmission:

The incubation period can be 14 days (or more), though most people develop symptoms within 5-10 days.

Household contacts of COVID-19 patients have a risk of 53% of becoming infected themselves. (MMWR)

Humans can transmit the Novel Coronavirus to dogs and cats but these animals don't get particularly ill. More importantly, these animals don't seem to be able to give the virus back to us!

People are most infections the day prior to developing symptoms and then infectivity declines about one week after onset of symptoms.

We need to all recognize that face masks are extremely important and effective in protecting the wearer as well as the people around them

Please, folks, wear the face masks properly! I see so many people walking about wearing face masks with their noses not covered. This doesn't protect anyone!

On October 19, the CDC issued a "strong recommendation" that all passengers and employees on airplanes, trains, buses, taxis, subways, and ride-share vehicles wear a face mask. In addition, people in airports or trains stations are also asked to wear facial coverings.

More of us are traveling by airplane again these days. An interesting article from JAMA looked at the risk of flying and getting infected with SARS-Cov-2:

The risk of getting COVID-19 during air travel is lower than from an office building, classroom, or supermarket.

The low infectivity has to do with the relatively low airflow between rows.

Half of the airflow in a plane is from fresh air from outside - the other half is recycled through HEPA filters similar to the ones used in an operating room.

Current estimates suggest that only 42 people have gotten COVID-19 from being in an airplane.

Symptoms and Risk Factors:

About half the patients with COVID-19 have neurologic symptoms.

Pediatric cases of COVID-19 are increasing, with 61,000 new cases documented in children in the last week of October.

Death rates from COVID-19 have dropped from 25% to about 7.6% since onset of the pandemic. Nonetheless, COVID-19 is about 10-times more deadly than influenza - and much more infectious.

An increasing number of COVID-19 patients seem to have long-standing sequelae of their infection:

persistent lung disease is common, with people experiencing cough and shortness of breath 12 weeks after hospitalization.

One preliminary study coming out of the U.K. noted that women between the ages of 50 and 60 were most likely to develop prolonged COVID-19 symptoms. Other people more affected included older patients, women in general, as well as those experiencing five or more symptoms from the disease.

Certain underlying conditions make you more prone to get sick with COVID-19. These include emphysema, diabetes, and heart disease. Also, obese people as well as smokers and people with kidney damage are also at higher risk.

The CDC announced in mid October that people who are overweight (but not obese) have an increased risk of severe illness with COVID-19. This means that 75% of the U.S. population is at heightened risk as 75% of the U.S. population is overweight or obese.

Adults with vitamin D deficiency are at greater risk for severe COVID-19 disease and death.

In the United States, Black people and Hispanic people are three times as likely to become infected with COVID-19 compared to Caucasians. Moreover, Black and Hispanic people are twice as likely to die of the disease compared to White people.

A new study showed that pregnant women with COVID-19 were more likely to give birth prematurely (13% compared to 10% prior to the pandemic). Pregnant women were also more likely to end up in the ICU and needing to be put on a ventilator compared with non-pregnant infected women.

Incidence/ Prevalence:

To the best of our knowledge, only about 5 people world-wide have become re-infected with SARS-Cov-2, a tiny number given the prevalence of the disease. This is great news!

In the United States, more than 9.76 million people have now contracted SARS-Cov-2 (8.49 two weeks ago). The current rise in nation-wide cases is driven by the rapid transmission in Midwestern states.

In the last week, the people in the U.S. diagnosed with coronavirus increased by 18% and the people who died of the disease increased by 3%.

In the U.S., 6% of adults hospitalized with COVID-19 are in the health care field; Almost 30% of these hospitalized health care personnel were admitted to the intensive care unit.

California is reporting that it now has more than 962,000 people infected with SARS-Cov-2 (compared to 897,000 two weeks ago).

As of October 22, 2020, there have been 11,710 people in San Mateo County who have tested positive with the SARS-CoV-2 virus (compared to 10,961 people two weeks ago). 162 people in San Mateo County have died from the disease (compared to 157 people two weeks ago).

A bit of good news: even as coronavirus disease is spiking throughout most of the country, the incidence of COVID-19 infection and deaths has been flat or decreasing in San Mateo.

At this time, children account for 11% of the SARS-Cov-2 infections in the U.S., an increase of 14% over the past 2 weeks.

Testing

Also, another saliva test ("SalivaDirect") has been approved by the FDA and will be distributed to laboratories - hopefully soon!

Treatment

On October 22, the FDA approved remdesivir as a treatment for COVID-19 and therefore took it out of the "experimental/ emergency use" category. It is the only medication COVID-19 treatment in the United States. Unfortunately, recent reports on the efficacy of remdesivir have been mixed.

A new trial found that the combination of remdesivir with baricitinib improved the time to hospital discharge from 8 days to 7. Also, this regimen increased the survival of patients with COVID-19.

Low doses of the steroid "dexamethasone," given intravenously, have been found to reduce death rates by 33% in people with COVID-19 who are on a ventilator.

Vaccine development is ongoing.

Dr. Fauci was "cautiously optiministic" this week that we will have a safe and effective vaccine for the novel coronavirus by November or December.

The U.S. Administration has announced that a COVID-19 vaccine, once available, will be free for all Medicare beneficiaries as well as those with private health insurance.

There are currently 35 vaccines in phase 1 trials, 14 vaccines in phase 2 trials, and 11 vaccines in phase 3 trials. 6 vaccines have been approved for limited use.

Both Pfizer and BioNTech have entered phase 3 trials. The mRNA technology for vaccine development is new and could usher in a new era of faster and safer vaccine development in general.

Johnson & Johnson has launched phase 3 trials for it's vaccine. This vaccine candidate is good because it requires only one administration dose and does not have to be kept frozen.

J&J reported on October 23 that their vaccine trials would resume after having concluded that prior adverse events noted with the vaccine were unlikely to be a result of the vaccine administration.

AstraZenica reported also on October 23 that they would resume their vaccine trials. The trial had been halted after two volunteers developed neurological events. Subsequent analysis could not link the events to the vaccine administration, however.

Antibody therapy:

Eli Lilly has developed an experimental treatment involving SARS-Cov-2 antibodies.

On 10/13/2020, Eli Lilly had to pause their clinical trials due to "a safety concern."

Regeneron's "REGN-COV2 antibody cocktail" was found to lower viral loads and the need for additional medical care in outpatients (i.e. not those who were in the hospital already).

However, on November 1, an independent data monitoring committee recommended that Regeneron stop enrolling COVID-19 patients that were very ill (requiring high doses of oxygen or use of a ventilator) due to "an unfavorable risk/ benefit profile" in these groups.

A recent study published in the British Medical Journal found that plasma from convalescent patients (i.e. those who had COVID-19 in the past) was NOT effective in treating active coronavirus patients.

The New England Journal of Medicine reported an intravenous antibody therapy derived from convalescent plasma (known as "LY-CoV555") led to improved symptoms and fewer hospitalization for outpatients (phase 2 trial). This antibody is not yet available outside of a clinical trial, at this time.

Mills-Peninsula Hospital:

Peninsula Hospital continues not to be full and is managing its share of COVID-19 cases as well as could be hoped for. Plenty of beds are still available in case more people fall ill and all the treatment modalities we discussed above are available here.

Our Community and Beyond:

On October 27, San Mateo County moved into a less-restrictive orange coronavirus tier. Contra Costa, Marin, and Santa Cruz counties moved to the orange tier also. As a consequence:

many indoor businesses will be able to increase their maximum capacity from 25% to 50% (or 200 people - whichever is fewer).

gyms and fitness centers, as well as hotels, will be able to reopen indoor pools. Gyms can increase their capacity from 10% to 25%.

On October 19, Gov. Newsom announced his plans to launch a scientific working group to examine the safety of any coronavirus vaccines that receive federal approval.

On October 19 Governor Newsom announced that the majority of Californians (those not at high risk of infection or complications) may have to wait until the second half of 2021 to be vaccinated for COVID-19.

On September 23, San Mateo announced a plan to significantly increase testing opportunities. The county's strategy involves a three-pronged approach:

Scheduled testing at the San Mateo County Event Center. Testing here will occur Tuesdays through Saturdays from 8 am to 3 pm - all without a cost to the patients. Appointments are required and can be made at "projectbaseline.com/COVID19"

Mobile testing in under-served communities.

Targeted neighborhood testing.

Our Office: What We Are Doing to Keep You Safe:

All patients seen in person will be screened for COVID-19 exposure and symptoms prior to coming into the building.

We disinfect all exam rooms and medical equipment as well as all door handles after EVERY patient visit, regardless of the medical issues involved.

All of us in the office are healthy and doing well.

All patients coming into the office will be required to wear masks.

We will try to keep you updated as the epidemic evolves. Feel free to call or email with questions or concerns.

**Household contacts of COVID-19 patients have a risk of 53% of becoming infected themselves. (MMWR)**