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 Biden administration has mandated that companies with more than 100 employees will be required to have their employees vaccinated or undergo regular testing by January 4. In addition, companies may require unvaccinated employees to pick up the tab for their COVID-19 testing.
On November 6, however, a panel of three judges suspended this vaccine requirement for private companies, wanting to review the legality of the ruling further prior to coming to a final decision.
The American Medical Association filed an amicus brief on November 11 supporting the Biden administrations vaccine mandate for larger companies. The AMA argued that COVID-19 threatens public health and the mandate would be in the public interest.
Also, by January 4, all nursing homes and other health care facilities that receive Medicare and Medicaid funding will be required to have all of their employees vaccinated for SARS-Cov-2.
The Pentagon started requiring universal coronavirus vaccination in all troops two months ago. At this time, almost all troops have received their shots.
A study published in MMWR found that people with previous COVID-19 infections were much more poorly protected from hospitalizations for the disease than people who had been vaccinated against the virus.
On November 2, the CDC officially recommended use of the Pfizer/ BioNTech vaccine for kids aged 5 to 11. The recommendation came after a unanimous panel decision by the CDC. This decision was made after "under one of the most intensive safety-monitoring efforts ever." The hope is that having children vaccinated in time for the holidays will allow for safer family gatherings and help minimize COVID-19 cases in January.
Vaccinations will be available in many pediatrician's offices as well as pharmacies and through the counties.
The CDC estimates that for every million doses given to children aged five to 11 will prevent about 58,000 cases and 226 hospitalizations in that age group.
Immunizing these young children is expected to prevent about 600,000 new cases from November, 2021 to March 2022.
Almost 10% of kids aged 5- to 11 have already received their first vaccine.
As of November 11, California officials are urging all adults (not just those older than 65 or with underlying medical conditions) to receive a booster shot for COVID-19. This recommendation comes in the wake of increasing case rates and hospitalizations in much of the state. It is hoped that the additional booster shots now will help prevent a COVID-19 surge during this holiday season.
The FDA is planning on authorizing boosters of the Pfizer/ BioNTech for adults nationwide in the coming days....and therefore would follow California's lead in this respect.
The WHO warns that there by be a shortage of syringes to administer the COVID-19 vaccines in 2022...I do wonder at the world sometimes: we, as a world community, have been able to develop an extremely effective vaccine against a deadly vaccine and we can't figure out that we need more syringes?!
The Biden administration is planning on investing billions of dollars to expand U.S. manufacturing for the coronavirus vaccines and supply poorer nations with vaccines as well.
On November 8, the U.S. has re-opened its borders for foreign travelers who have been vaccinated against COVID-19 and have had a negative COVID-19 test in the preceding 3 days. Unvaccinated Americans need only take a COVID-19 test within 24 hours or travel.
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.
A recent article in Lancet Infectious Disease unfortunately found that vaccinated people could still spread the delta variant. So it is NOT appropriate to decline vaccination just because you feel protected by the vaccinated people around you!
A review of eight studies published in the British Medical Journal shows that face masks reduces the risk of getting COVID-19 by over 50%. Physical distancing cuts the risk by 25%.
Symptoms and Risk Factors:
And yet another study (JAMA Network Open) shows that about 50% of people with COVID-19 have symptoms that last at least 6 months after the initial acute disease.
An article in JAMA Otolaryngology highlights the loss of smell associated with SARS-Cov-2 infection: between 700,000 and 1.6 million people in the U.S. lost their sense of smell for at least 6 months due to the infection.
The CDC has now included mental health conditions such as depression and schizophrenia to the list of conditions that increase the likelihood of a patient requiring hospitalization for COVID-19. Other such conditions include cancer, diabetes, and obesity. The inclusion of mental health conditions to the list of high-risk conditions is based on a study published in JAMA Psychiatry.
Incidence/ Prevalence:
A fourth wave of COVID-19 infections has started to grip some European countries, including Germanyand the Netherlands. Almost all of the patients hospitalized with the virus had not been vaccinated.
Unfortunately, California is no longer doing as well with its COVID-19 cases either, as deaths and new cases are increasing throughout the state. Large urban areas (like the greater Sacramento area, Riverside and Orange counties), that have lower vaccination rates than in the Bay Area, are seeing increases of 20% in hospitalizations. Luckily, hospitalizations in the Bay Area are at their lowest points in four months.
Other "cold weather" states in the U.S. are likewise seeing an increase in coronavirus cases, while Florida's COVID-19 cases are finally dropping.
Testing
On October 25, the federal administration announced more measures to increase availability of rapid at-home COVID-19 tests and reduce their costs with a $70 million NIH investment. Also, the FDA plans to streamline its regulatory pathways for at-home tests approval to make the process faster and easier.
The Australian company Ellume has needed to recall its at-home coronavirus tests due to an excess of false positive results.
Treatment
Vaccines:
Another recent study (JAMA) shows that vaccinated people are about 8-times less likely to be in the hospital for COVID-19. If a vaccinated person is hospitalized due to the coronavirus, their likelihood of dying is one third of the unvaccinated hospitalized patient.
A new study done by the Center for Disease Control and Prevention indicates that vaccines are better at protecting against the coronavirus compared to prior COVID-19 infection itself: unvaccinated people who had had COVID-19 in the past were five-times more likely to get COVID-19 again compared to people who had received the vaccine.
A recent study confirmed initial reports that the Pfizer/ BioNTech and Moderna vaccines can cause myocarditis, an inflammation of the heart muscle. In a study in Israel, 2.6 million people were surveyed after receiving the Pfizer/ BioNTech vaccine: 54 cases of myocarditis were reported. Of these cases, 41 were mild. The medial age of was 27 and 94% were male.
Pfizer/ BioNTech:
Data from the CDC and published in the Morbidity and Mortality Weekly Report showed that the Pfizer/ BioNTech vaccine was 93% effective in preventing hospitalizations in kids aged 12 to 18. Those who were hospitalized tended to have at least one underlying health condition such as diabetes, asthma, or lung diseases. Indeed, of the kids studied who were hospitalized for COVID-19, 97% were unvaccinated. 16% of patients were sick enough to require life support.
A recent study done in Israel (and published in Lancet) looked at the effectiveness of booster shots for the Pfizer/ BioNTech vaccine: after the booster, the vaccines were 93% effective in preventing hospital admissions and 81% in preventing death.
Pfizer/ BioNTech is seeking FDA authorization for booster shots for all adults. The FDA is expected to grant this request - possibly even before Thanksgiving. Studies have shown that booster shots can protect against infection with any symptoms by 95%.
Moderna:
A recent trial done by Moderna show that its vaccine was able to produce a strong immune response in kids aged six to 11.
The FDA has yet to approve use of the Moderna vaccine for adolescents aged 12 to 17.
Moderna has submitted a request to the FDA to authorize its booster shot for all adults in the U.S. Please note that in California, Moderna is already able to provide booster shots to all adults.
Johnson & Johnson:
A study involving 9,000 real-life people assessed the effectiveness of the J&J vaccine and found it 73.6% effective. (JAMA Network Open)
J&J is calling for a shorter timeline for booster shots: they suggest that anyone who received a J&J shots should get a booster two months later. A company study showed that two doses of the J&J vaccine, given 2 months apart, increase the effectiveness of the vaccine from 70% to 94%. the FDA has yet to weigh in on this recommendation.
Covaxin: the COVID-19 vaccine "covaxin" made in India has received emergency use authorization by the WHO. The vaccine is administered in two doses and has an efficacy rate of 78% against the disease
Other treatments:
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. This medication seems to decrease the risk of hospitalization from the virus by 50%!
Pfizer has announced that their new pill to treat COVID-19 is highly effective in preventing severe disease among high-risk people who started the medication soon after developing symptoms. Indeed, the pill seems to cut the likelihood of hospitalization by 89% when given within three days of developing symptoms. The FDA will now review the data in the coming weeks and, if found to be safe, the medication could become available within a few weeks...though supply could be limited at first. It would be dispensed at pharmacies and taken at home.
Regeneron says that their monoclonal antibody infusion reduces hospitalization by 82% and continued to provide protection for eight months.
Remember ivermectin? This is the anti-fungal medication that was rumored to help treat and prevent COVID-19 just a few months ago. Well, the authors of the study that purported to show the efficacy of the medication have now retracted their paper and admitted that it was based on faulty data.
OK, this one is interesting: if you are on an SSRI antidepressant and you get infected with SARS-Cov-2, you are 8% lower risk of dying of the disease! (JAMA Network Open).
Our Community and Beyond:
The counties of San Mateo (as well as San Francisco, Santa Clara, and most other Bay Area counties) plan to lift the indoor mask mandate for most public spaces if the following criteria are met:
COVID-19 transmissions are in the moderate (yellow) tier for at least three weeks.
80% of the jurisdiction's population is fully vaccinated.
COVID-19 hospitalizations are low and stable.
Unfortunately, as of November 3, there are no Bay Area counties in the moderate tier that can revoke their indoor mask mandate. The recent increase of COVID-19 cases is thought to be related to more indoor private gatherings such as dinners and parties, rather than transmissions in public places.
Many Bay Area counties have been bouncing in and out of orange and red tiers for weeks. This is likely due to the new way that the color-tier system is now being reported: last year, the color-tiered system had a two week lag time. Now, the numbers are being updated every evening. Therefore, a small shift in COVID-19 cases can shift a county into a new tier more easily.
Sonoma and Solano counties hare now in the red (high) tier.
San Mateo County is partnering with the San Mateo Office of Education to implement vaccination drives in four local elementary schools. These sites would be in Redwood City, Pacifica, San Mateo-Foster City, and in the Jefferson Elementary School district.
Santa Clara County Pulbic Health is having a contest for middle and high school students to create videos encouraging COVID-19 vaccination with cash prizes. I, personally, think this is a fantastic idea!
Non-COVID-19 News
OK, this fact is sort-of COVID-19 related: burnout for health care providers has sky-rocketed with the COVID-19 pandemic. A recent meeting of the U.S. News and World Report detailed the toll this burnout has had on the U.S. health care system as well the future threats that lack of appropriate medical and nursing professionals encompasses.
Virtual Reality is coming to modern medicine: The FDA has recently cleared a virtual reality system to treat chronic low back pain. The device is called Ease VRx (AppliedVR), requires a doctor's prescription, and is used at home. Employing techniques of cognitive behavioral therapy and other behavioral techniques, the device facilitates deep relaxation, attention-shifting, as well as other behavioral methods to mitigate the perception of pain. The device consists of a headset and controller as well as a "breathing amplifier" for deep breathing exercises. It is not yet clear to me how well the device works, what it costs, and whether it will be covered by insurance...
And finally, in time for Thanksgiving, the medical benefits of gratitude: researchers from the University of California, Davis, and the University of Miami have done studies looking at the health benefits of gratitude. In one such study, participants were asked to write a few sentences each week with a focus on certain topics: the first group wrote on things that had happened that week for which they were grateful. The second group wrote about the irritants and annoyances of the week. Finally, the third group wrote about events of any flavor that had impacted them that week. After 10 weeks, the gratitude group reported being more optimistic and felt better about their lives. They also exercised more and had fewer doctor's visits....so this is one way to minimize seeing me!
About Dr. Sujansky's Life in These Times
Well, the Holidays are officially upon us! I know one of my goals (again) will be to try to enjoy the sounds and smells of the season and I look forward to blocking out the noise and spending some quite time with friends and family. I will be flying out to the Washington, D.C. area for Thanksgiving, where I will be meeting up with my parents, siblings, and sons for a major day of feasting and family togetherness. I hope you all have wonderful plans also and I look forward to hearing about everything!
