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 constantly evolving. I will include some details on this topic from previous newsletters, as they remain important - new information will be in BOLD.
General Information:
The U.S. has now surpassed 700,000 deaths attributable to the coronavirus. The death count is higher than the count attributed to the 1917/18 flu pandemic, which killed about 675,000 people.
At this time, almost 64% of the U.S. population has received at least one dose of the coronavirus vaccine. Nonetheless, the summer surge in infections continues strong and the average number of people dying of COVID-19 per day has climbed 40% in the last two weeks alone. Over 1,900 people are dying of COVID-19 daily at this time, the highest number since March, 2021.
Most people older than 65 are vaccinated against SARS-Cov-2. As a consequence, the average age of Californians who died of the disease has dropped steadily in the last 9 months, as the disease is targeting a younger (unvaccinated) population now.
Since mid-June, about 100,000 people have died of COVID-19. Of those, only 2,900 had been vaccinated against the disease.
On September 23, the CDC's Advisory Committee on Immunization Practices voted to approve booster vaccinations for people who had received their second Pfizer/ BioNTech vaccine at least 6 months previously. This recommendation was only for people aged 65 or older, those in long-term care facilities, as well as those younger with underlying immune compromise. In addition, the CDC approved the booster for people in high-risk professions, such as teachers and workers.
The CDC plans to review the recommendations for those who have received a J&J or Moderna vaccine soon.
The European Medicines Agency (EMA) has largely followed suit in recommending booster shots for anyone with a severely weakened immune system, as well as for people older than 18 who are at least 6 months out from their last vaccine
The Biden administration plans on lifting travel restrictions for fully vaccinated travelers from Europe, China, Iran, South Africa, Brazil, and India starting November.
Studies have shown that side effects to the third Pfizer booster shots have been similar to those reported with the second shot.
New COVID-19 variants
SARS-COv-2 variants:
(Alpha Strain)
Scientists estimate that this variant spread about 1.55 times faster than the previous variant.
Beta Strain
This strain is also more contagious than the original virus and it is more resistant to some of the antibody treatments we use on other strains.
Gamma Strain
Epsilon Strain
Delta Strain
This variant is significantly more contagious than prior versions of the virus.
Lambda strain: a new variant has just emerged, originally in Peru.
Mu variant:
This variant was first detected in Columbia.
The WHO recently designated this strain as a "variant of interest" due to it possibly being more resistant to the human immune response.
Transmission:
A recent article in JAMA Internal Medicine showed that people with COVID-19 were most contagious 2 days before onset of symptoms to 3 days after onset of symptoms.
I know you have all heard me for years (literally!) now about the importance of masks. But there are still people doubting masks' ability to help stem the transmission of this virus. Well, we finally have some prospective data that should (hopefully) lay the issue to rest: in a recent study done in Bangladesh, some villagers were instructed to wear masks and some were not. Significantly more people in the villages without masks became sick with COVID-19 than in those where mask-wearing was encouraged. This study has not yet been published in a journal, but the data is pretty compelling.
Symptoms and Risk Factors:
Although COVID-19 is associated with a wide array of symptoms, 96% of infected people have either fever, cough, or shortness of breath.
The lingering effects of COVID-19 infection ("long-haul COVID") continues to be investigated. Prominent symptoms include brain fog, kidney damage, and lung problems. Long-haul COVID-19 is seen in 45% of people who were sick enough to require hospitalization for COVID-19.
Incidence/ Prevalence:
As mentioned above, at this time, COVID-19 has killed more Americans as the 1918/1919 Spanish flu pandemic.
The U.S. leads the world in COVID-19 cases and deaths, making up 19% of world-wide cases and 14% of deaths.
As of October 4, 2021, in the U.S.
43,605,623 people have contracted COVID-19
700,176 people have died
The above numbers represent 72,455 new cases and 1,504 additional deaths in the prior 24 hours.
64.9% of people have received at least one dose of vaccine and 56% of people have been fully vaccinated.
Currently, in the United States, the COVID-19 incidence and death rates are highly variable. In southern states like Florida and Mississippi, hospitals are filled to capacity and patients are waiting in the emergency department for days waiting for beds. In Alabama, currently all ICU beds are occupied. In Texas, 169 hospitals that ICU that are more than 95% full. At the same time, states like California (with a high vaccination rate!) are doing extremely well. The new "hot spot" of infection is Alaska, where hospitals and ICU's are full and doctors are put into the impossible position to decide who will get an available ICU bed who will not...
Treatment
A head-to-head study of the Moderna, Pfizer/ BioNTech, and J&J vaccines done in the U.S. found that the Moderna vaccines seems to be slightly more effective than Pfizer in preventing hospitalization. J&J came in third, but still offered 71% protection, though not enough people in the study had received the J&J vaccine to form clear conclusions (MMWR).
A recent study confirmed initial reports that the Pfizer/ BioNTech and Moderna vaccines can cause myocarditis, an inflammation of the heart muscle. Nonetheless, this risk is still extremely low (5.8 cases per million) and the complication occurred almost exclusively in men around the age of 25 (JAMA Internal Medicine). Also, all cases improved/ resolved on their own.
Federal health officials are entreating pregnant and breast-feeding women to get vaccinated against the coronavirus. COVID-19 poses a significant risk to the fetus. Also, protective antibodies to the virus could be transferred in breast milk and help protect the newborn baby. Finally, "infants born to mothers who received the Pfizer/ BioNTech or Moderna vaccines had a high levels of protective antibodies." (American Journal of Obstetrics and Gynecology). As of September 27, more than 125,000 of laboratory-confirmed cases of COVID-19 have been found in pregnant patients, with 22,000 hospitalizations and 161 deaths.
Pfizer/ BioNTech:
A Study in the New England Journal of Medicine looked at the effect of giving a third booster shot to people aged 60 and older in Israel. The study showed that the booster reduced the likelihood of infection 11-fold and the rate of severe infection by almost 20-fold.
A study in The Lancet again showed high effectiveness of the Pfizer/ BioNTech vaccine in protecting against hospitalizations for 6 months after completion of the two-dose series.
On September 20, Pfizer announced that vaccination of a lower dose of the vaccine (one third the amount given to adults and teens) was both safe and elicited a robust immune response in kids as young as 5 to 11 years old. Pfizer will present the information to the FDA in short order and they hope to get approval of the vaccine in kids older than 5 by early November.
Pfizer is also beginning trials on a flu vaccine, that is mRNA-based.
Moderna:
According to an article in the New England Journal of Medicine, the Moderna vaccine continues to be effective in preventing COVID-19 and severe disease at more than 5 months after administration. It is therefore not clear that recipients of the Moderna vaccine need a booster anytime soon!
Johnson & Johnson:
Recent studies show that a booster to the J&J vaccine prevented 94% of moderate to severe COVID-19 cases in the U.S. Also, the two-dose vaccine was 100% effective against severe disease. This information has now been submitted to the FDA on October 5 for review.
The European Union's drug regulator have identified the rare side effect of blood clots in the legs due to the J&J vaccine.
The Oxford/ AstraZenica vaccine:
This vaccine has NOT been approved for use in the United States yet.
Novavax:
This vaccine is produced by a company based in Maryland.
Other treatments:
Remdesivir, the primary medication used earlier in the pandemic to treat hospitalized patients with COVID-19, has gotten some bad news: in a European trial, remdesivir was NOT found to be helpful in treating COVID-19 patients. At the same time, a study in Clinical Infectious Diseases DID find that remdesivir did help, reducing mortality from 19.1% to 15.4%....I guess the jury is still out on this medication!
Luckily, Merck has developed the first pill that seems to be effective in preventing severe disease from COVID-19. The medication is called "molnupavir" and likely will be effective for different variants of the virus, as it does NOT target the spike protein. This medication seems to decrease the risk of hospitalization from the virus by 50%! Now the FDA has to review the data and hopefully will approve the medication before the end of the year. However, please don't rely on getting this medication anytime super-quickly, as there are likely to be supply issues at the beginning!
Pfizer has announced that they are in mid-to-late trials on an oral medication to PREVENT COVID-19 altogether.
Our Community and Beyond:
The California Department of Public Health mandated on September 28 that all senior care facilities and in-home care workers be fully vaccinated for COVID-19.
Gov Newsom has also mandated that all students aged 12 or older, as well as all school employees, be fully vaccinated (unless they have a medical exemption). COVID-19 vaccination requirements would join the already-present requirements of measles, mumps, and rubella for kids to attend school in California. Implementation of these requirements would likely take place in 2022.
In the greater Bay Area, vaccination rates are higher than in the rest of California (except for one county)! and about 80% of Californians eligible for the vaccine have received at least one dose, while 65.4% of eligible Californians are fully vaccinated.
San Mateo County is offering drive-through venues for people needing a COVID-19 booster shot (or the original series). Boosters are only available to people older than 18 and who have received 2 doses of the Pfizer vaccine. You can make an appointment through the state's website "Myturn." Also, there are dates at the Events Center (1346 Saratoga Drive in San Mateo) on:
October 7 (9 am to 4 pm)
October 8 (9am to 4 pm)
October 12 (120m to 7 pm)
Non-Covid Medical News
Teenagers use of electronic cigarettes has fallen significantly in the last two years. In 2019, 27.5% of middle schoolers and high schoolers admitted to vaping; in 2020, that number was at 19.6%. And in 2021, we're looking at 11.3! Let's hope the trend continues after the pandemic abates...
We all know that being overweight and sedentary will increase one's risk of dying. The good news is that if such people start exercising - even if they don't lose any weight!- they can reduce their increase mortality by 30%!!
None of our public health experts has a crystal ball for predicting the future..., but the experts are still worried about the upcoming flu season: they are concerned that last year's very, very light season means that we are more susceptible to this year's bugs, as we have not built up the same amount of resistance. And with people socializing so much more than last year, the influenza virus is much more likely to spread. Indeed, the American Heart Association, the American Lung Association, and the American Diabetes Association are urging all to get their flu shots this year. So, as I've said before, come in and get a flu shot!
About Dr. Sujansky's Life in These Times
Can you believe it's fall again? I just decorated our house for Halloween and it seems that I just took down last year's decorations so recently...
We visited our younger son in Boston recently for parents' weekend. We were relieved to see that he was happy and seemed to be thriving. One of the highlights of the trip was the football game: mind you, I am not a football fan! But this game (Boston College against Missouri) was very close and exciting. Missouri actually tied the game in the last second of play and so they had to go into overtime. Luckily, at the end of the game, Boston College won. The best part of that was seeing all of these enthusiastic college students rush the field afterwards. It was mayhem!
Then, to re-create the fun of the football game, my husband and I accepted an invitation sent out by the college for a Boston College football watch party, which was held last weekend at a bar in San Francisco. We were hoping to meet some other parents of BC students and enjoy a good game. Well, we were the oldest patrons at the bar by about 20 years, as most of those who attended the watch party were recent college alums! Yes, we felt a tad out of place...but it was still fun, though a bit different than what we had expected....
