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:
At this time, COVID-19 has killed 800,000 Americans. Of these deaths, 75% are in people older than 65. In fact, one in every 100 older Americans has succumbed to COVID-19, a scary scary number!
The CDC now has stated that the Moderna vaccine or the Pfizer/ BioNTech vaccines are preferred over the other vaccines on the market. This recommendation is based on the increased risk of rare blood clots with the J&J vaccine. Most of the people who developed blood clots are women under the age of 50. The risk of blood clots is about four in one million. The J&J vaccine will continue to be available to anyone who wants it, however.
The CDC is now strongly encouraging a third booster shot for all people older than 16. This third booster will be needed to better protect from the rampant spread of the Omicron variant.
The Administration plans on delivering a half-billion free rapid COVID-19 tests to Americans' homes next month. Health officials will set up a website from which such tests can be ordered. Also, the administration is deploying 1,000 troops with medical skills to hospitals that are struggling with the latest surge of new COVID-19 infected patients, especially in Michigan, Indiana, Wisconsin, Arizona, New Hampshire, and Vermont.
Omicron:
A report from December 20 found that the Omicron variant was now the most dominant version of the coronavirus in the U.S., making up 73% of new infections in the prior week. These numbers represent a six-fold increase in Omicron's share of infections in only one week.
The Omicron variant is spreading quickly in the United States and could peak as soon as January, according to modeling from the CDC. Researchers at the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine estimate that the U.S. may see about 140 million new infections from January 1 to March 1, 2022.
Luckily, the new wave of COVID-19 infections due to Omicron may be short: South Africa, where the variant was first reported in late November, is already seeing a sharp decline in COVID-19 cases there now.
The new variant seems to be twice as contagious as the Delta variant and 4-times more contagious than the original strain.
Growing evidence on the Omicron variant confirms initial concerns that this variant can infect people who had previously been sick with COVID-19 or people who have been vaccinated. Getting a third booster shot seems to mitigate this infection risk.
Though we are seeing a lot of breakthrough COVID-19 cases, most of them seem to be more mild.
South Africa, which was at the forefront of infections with the Omicron variant, has NOT seen a big rise in hospitalizations due to the infection, suggesting that the disease caused by this variant may be more mild. Similar findings were reported by three different teams of scientists in the U.K. and South Africa.
Unfortunately, different studies out of the U.K., where Omicron has been raging for longer than in the U.S., do NOT suggest that the infection with this variant is less severe: the number of symptoms and hospitalizations there is rising along with the new Omicron infections.
A British study published in Nature found that heart inflammation and irregular heartbeats are more likely to occur from COVD-19 infection than from the vaccine.
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.
Symptoms and Risk Factors:
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.
Initial concerns about inflammation of the heart ("myocarditis") in athletes and young adults after COVID-19 infections were recently downgraded: a study showed that the risk of heart injury is extremely low. A study looked at over 3000 college athletes diagnosed with the coronavirus and found that 0.7% had hear injury. During subsequent surveillance, only one athlete had any heart issues, and even this was not thought to be related to COVID-19.
Incidence/ Prevalence:
A fourth wave of COVID-19 infections has started to grip some European countries, including Germany and the Netherlands. Almost all of the patients hospitalized with the virus had not been vaccinated. As a corollary observation, those countries with low vaccination rates (largely in eastern Europe) are seeing a spike in their death rates from the virus, while western European countries, with higher vaccination rates, are seeing increased rates without increased deaths.
Treatment
Vaccines:
It's been one year since the U.S. has started it's vaccination campaign. 200 million people have been fully vaccinated.
An analysis of the Pfizer/ BioNTech and Moderna vaccines published in the Annals of Internal Medicine found their efficacy was only 69% against any infection and 86% against COVID-19 related death. This effectiveness was lower than what had previously been reported.
A Danish study (published in the British Medical Journal) looked at the incidence of heart inflammation due to one of the mRNA vaccines: the incidence for the Pfizer/ BioNTech vaccine was 1.4 per 100,000 people. For Moderna, that number was slightly higher at 4.2/ 100,000. Nonetheless, the risk was quite low, iven in younger age groups.
Pfizer/ BioNTech:
A study done in Israel and published in the New England Journal of Medicine in December looked at the effectiveness of getting a third booster shot in people aged 50 and older: those who had gotten a third booster had a 90% reduced death rated due to the coronavirus compared to those who had only received two doses. A separate study, also published in the New England Journal of Medicine on December 8 used government data to look at death rates in those who had received a third booster shot vs only two shots and found very similar results.
Pfizer's COVID-19 vaccine for kids aged 2 to 5 needs to go back to the drawing board: on 12/17/21, Pfizer reported that the lower dosed vaccine for kids in this age group did not produce a sufficient immune response. They are now looking at adding a third dose to the regimen to see if this remedies the situation. If it does, then they will seek authorization for the vaccine for young kids in the first half of 2022.
Moderna:
The FDA has yet to approve use of the Moderna vaccine for adolescents aged 12 to 17.
Johnson & Johnson:
A second booster shot is now recommended for everyone who has received only one dose of the J&J vaccine and is to be given 2 months after the original vaccination.
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
Pharmaceutical companies Medicago and GlaxoSmithKline announced on 12/7/21 that they have produced a plant-based coronavirus vaccine. A global late-stage trial found an overall efficacy of 71%. Moreover, it was 75.3% effective in preventing the Delta variant.
The Novavax vaccine, which is produced by a company based in Maryland, has been approved by the European Union. This vaccine does not rely on a mRNA-based immunity, but is made up of viral proteins, much like our current flu shots. A recent article in the New England Journal of Medicine found the vaccine to be 90% effective against symptomatic infection and 100% effective against moderate and severe disease. It is unclear how well Novavax works against the Omicron variant. This vaccine is not yet approved for use in the United States.
Human trials are beginning in Canada on two Canadian-made vaccines that are made in an inhaled formulation that targets the upper airways and lungs. Both of these inhaled vaccines would act as boosters to people who have received injected vaccines previously.
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. Unfortunately, MERCK recently announced that the medication was only 30% effective in preventing hospitalization from COVID-19, not 50% as was initially thought. At this time, the medication has NOT yet been approved in the U.S. Some concerns are based on how the medication works: it mimics one of the building blocks of the viral RNA and tricks the coronavirus to use the molnupavir molecule when the virus is replicating itself. This could hypothetically lead to mutations in human DNA also. So we will need to wait evaluation of this risk before the medication can be available to us.
Pfizer has announced that their new pill "Paxlovid" to treat COVID-19 is likely to work against the Omicron variant. The most recent trials found that the pill could reduce the risk of hospitalization and death by 88% when given to unvaccinated people at high risk of severe COVID-19 and when given within 5 days of onset of symptoms. Pfizer laboratory studies also suggest that the new medication will be effective against the Omicron variant. On December 22, federal regulators approved the pill for use in the U.S. Treatment is authorized for people who test positive for the virus AND are vulnerable to becoming severely ill due to the disease, based on risk factors such as age, diabetes, or compromised immune systems. Supply will be quite limited initially. Nonetheless, Pfizer plans on making enough pills available in the next week to treat 65,000 Americans. More treatments should be available in January.
Unfortunately, some of the antibody cocktails that hospitals have been providing intravenously in their emergency departments to treat COVID-19 largely don't seem to work against the Omicron variant. Only one of these infusions, "sotrovimab," seems to be effective.
Our Community and Beyond:
California is also beginning to see a significant increase in COVID-19 cases, mirroring a trend seen in other parts of the country. In the last week alone, the number of all new cases has doubled and the number of Omicron cases in California has quadrupled.
On December 15, the California Department of Public Health started to require universal masking in all indoor public settings. About half of Californians live in counties without mask requirements.
Governor Newsom has ordered all state health care workers to receive their booster shot by February 1, 2022. Also, the state plans on testing children for the virus prior to returning to school from their winter break.
With the Omicron variant spreading in the Bay Area, residents of Santa Clara and San Mateo counties are flocking to get the booster shots: In Palo Alto, Mountain View, and Los Altos, 41% of eligible residents have received the booster shot.
Stanford University has suspended in-person classes for the first two weeks after winter break due to the Omicron outbreak. Also, all Stanford students will be required to receive a booster shot no later than January 31.
Major Broadway shows in New York (including "Hamilton" and "Aladdin") have been cancelled until after Christmas in an attempt to stem the rising tide of COVID-19 infections due to Omicron.
Non-COVID-19 News
The Department of Health and Human Services is rolling out a new phone number for people who are suicidal or are having a mental health crisis: the new number is "988" (just like "911" is for other emergencies) and will be rolled out in July - SO DON'T START USING IT YET! Until July, people should continue to call the current National Suicide Prevention Lifeline at 1-800-273-TALK. In addition to voice calls, the number will handle texts and chats and put people in touch with a trained counselor.
The U.S. population growth dropped to its lowest rate ever during the first year of the pandemic. This is likely due to lower pregnancy rates, death associated to COVID-19, and decreased immigration. The growth rate in 2020 was even smaller than during the influenza pandemic of 2017/18 and during World War I or II.
About Dr. Sujansky's Life in These Times
Well, both of my sons came home last weekend and it is so great to see them! We will go skiing in Tahoe next week, so I will have them as a captive audience to ski together, eat well, play games, and watch movies.
I hope each of you will enjoy the Holiday spirit for the rest of December and I truly wish you a happy and health 2022!
