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. So I wanted to try to bring you unbiased information about the of the virus in our community and in general. I will include some details on this topic from previous newsletters, as they remains important - new information will be in BOLD.
Some of you have noted that my newsletters are not upbeat enough. I will try to make this one more so.
At this time, more Americans have received at least one dose of the COVID-19 vaccine than have tested positive for the coronavirus! That's more than 26.5 million Americans!
Coronavirus cases have been trending down for weeks and are now at half of what they were in early January. Deaths have been declining as well
California is now administering 150,000 doses of coronavirus vaccine daily, a level that is over 3 times as high as the vaccination rates in early January.
As of Sunday, 84,783 people in San Mateo County have received at least their first dose of vaccine. This number includes about one third of the population that is 65 and older.
On February 11, President Biden announced that his administration had purchased another 200 million doses of vaccine from Pfizer/ BioNTech and Moderna. This would provide sufficient vaccines for every adult in the U.S. by the end of July.
Dr. Anthony Fauci, the nation's top infectious disease expert, announced this week that he predicted that by April, 2021 anyone in any adult age group and health category could start to get vaccinated.
Americans are now more accepting of the coronavirus vaccines: from September to December, the percentage of Americans who said they were very likely to accept the vaccine rose from 39% to 49%. In people older than 65, the percentage rose to 66%.
Overall, the number of new coronavirus cases and hospitalizations is dropping rapidly. We have more immunity in the community. And the number of people dying of the disease is also dropping....yes, yes, yes: we still have problems; the rest of the newsletter is devoted to those problems. But for now, let's take a deep (socially distant) breath, as this is the best data and the best news we've had in a long while.
General Information:
A recent investigation done by the World Health Organization in Wuhan, China, refuted past theories that SARS-Cov-2 originated in a lab. Instead, they thought it most likely that it came from a natural reservoir. Investigations are now centering on countries in Southeast Asia that supplied animals to Wuhan market from which the pandemic seems to have taken off. The journal Nature Communications reported similar coronaviruses circulating in bats in Thailand. In addition, antibodies to the viruses were found both in bats and in pangolins.
Vaccine Distribution:
California has enlisted the help of and Kaiser Permanente to help organize the vaccine distribution process in our state. Although Kaiser would be concentrating its efforts mainly on its members, the effort would encompass people not covered by a . The hope is that Blue Shield will help provide more equity in the vaccine distribution process. Blue Shield's approach is expected to include a wide range of vaccine locations, including pharmacies, community health centers, and temporary pop-up locations.
Starting today, February 12, the clinic at San Francisco Airport (which is located at the Long Term Parking Lot) will provide vaccine doses for people 65 years of age and older.
Also, starting next week, the federal government will start shipping vaccines directly to 150 community health centers across the nation, bypassing the state governments. The goal of this initiative is to increase access of vulnerable and under-served groups to the vaccines.
Dr. Anthony Fauci, the chief medical advisor to the Biden administration, recently said that states could expect a 16% increase in vaccine allotment "very soon." Pfizer/ BioNTech as well as Moderna had originally been contracted for 200 million doses each. Each company now has agreed to provide an additional 100 million doses. Additional vaccines from Johnson and Johnson as well as other manufacturers are expected to be available soon also.
You can go to the following website to put your name on a waiting list to get the coronavirus vaccine San Mateo. Once you are eligible and a site is available, you will be contacted. I have heard from a number of patients that this process is quite easy and quick!
https://www.smchealth.org/covid-19-vaccination
Health officials have created a "COVID-19 Hotline" that is open seven days a week who can advise people on eligibility issues etc.: 1-833-422-4255.
Sutter Health has started allowing patients older than 64 to sign up for the COVID-19 vaccine via their "myhealthonline" site. To sign up for this site, you can go to www.sutterhealth.org to register or call 844-987-6115.
Please let me know if you get a COVID-19 vaccine, so I can add it to your medical chart.
Stanford is also vaccinating people who are older than 65. This can be done via the Stanford "healthonline" website or by calling them.
Starting February 11, some RiteAid and CVS drugstores will start accepting appointments for their Covid-19 vaccines at 100 of its California stores, including locations in Sunnyvale, Sonoma, and San Francisco. Walgreens is also offering the vaccine in parts of the Bay Area. Only people aged 65 and older are eligible.
People 65 and older can book an appointment at CVS by calling 800-746-7287 or at CVS.com. the stores offering the vaccines will shift, thereby allowing more people to access the vaccines locally.
The World Health Organization now recommends that people dealing with COVID-19 outside of the hospital use a pulse oximeter (that little gadget that goes on your finger and reads how much oxygen is in your blood) to help gauge disease progression. These are readily available and cost about $20.
The World Health Organization now has come in line with the CDC and recommends giving the new COVID-19 vaccines to pregnant women. This is good news, as pregnant women have a higher risk of dying, going into early labor, and developing blood clots if they are infected with the coronavirus.
Dr. Anthony Fauci recently stated that he hopes that children will start receiving the new COVID-19 vaccines within the next few months. He estimates that kids could be receiving the vaccine more regularly by late spring and early summer. Yeah!!
New COVID-19 variants:
We have all heard about this highly contagious coronavirus variants that are popping up all over the world. And we also know that some of the vaccines seem to be less effective in preventing infection with the South African variant. However, that is only half the story: two of the five vaccines (J&J and Novavax) included studies in South Africa. None of the people who were vaccinated died of COVID-19. At this time, 75,000 people were vaccinated by any of the five vaccines and reported on in the medical trials. Of these 75,000 people, not as single person has died of COVID-19 and only very few were hospitalized. As a comparison: in an average 75,000 unvaccinated American adults, about 150 will die of COVID-19. Hundreds more have ended up in the hospital. Also consider that in a typical flu season, 5 to 15 out of 75,000 adults will die of influenza and hundreds will end up in the hospital. So the new COVID-19 vaccines look pretty good on all these measures!
Previously, if you were infected with the novel coronavirus, you were very unlikely to get re-infected. However, now scientists believe that if your initial infection was mild (or you mounted a weak immune response) then re-infection is more likely. Also, it is possible to get re-infected by one of the new coronavirus variants.
Various vaccine manufacturers are now looking into producing specialized booster vaccines to specifically target the new coronavirus variants. The FDA has stated that reviews of such updated vaccines and boosters will receive a "quick turnaround" and not require the same large trials as were needed in the initial vaccine production.
SARS-COv-2 variants:
B.1.1.7
This variant was first seen in the United Kingdom, but has since spread across the globe.
Scientists estimate that this variant spread about 1.55 times faster than the previous variant.
This variant is spreading rapidly in the U.S., doubling about once every 10 days.
The B.1.1.7 variant has been found in the Bay Area. It is predicted to become the predominant strain within the next weeks to month.
Currently, this strain seems to be prevented by the vaccines currently in development, including the Moderna, Pfizer, and Astra-Zenica vaccines.
Antibody treatments including bamlanivimab and etesevimab seem to continue to work on this coronavirus variant.
Unfortunately, some of the viruses in this strain recently acquired another mutation (called E484K) that appears to make the virus more resistant to vaccines. This mutation was previously found in the South African variant.
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
It has acquired more mutations in the spike protein part of the cell. As a consequence, the mRNA vaccines (Pfizer and Moderna) may well be less effective against this strain. However, it is far from clear if the vaccines actually are significantly less potent against this strain and the hope is they vaccines will still keep you from getting seriously ill.
Antibody treatments including bamlanivimab and etesevimab and convalescent plasma seem to be less effective in neutralizing this coronavirus variant.
The Bay Area has identified two residents with the South African strain (one in Santa Clara, the other in Alameda County).Another new highly-contagious variant has originated in Brazil.
California strain
Also known as CAL.20C
This strain is largely circulating in Southern California.
It is unclear how well current vaccines protect against this strain.
There is no signs to suggest, as yet, that this new variant is more lethal (or even more contagious) than other strains.
Transmission:
A January article in the Annals of Internal Medicine suggested that at least one third of SARS-Cov-2 infections are asymptomatic. If you don't have any symptoms and test positive for the virus, you have only a 25% chance of developing symptoms down the road...though you are still contagious!
The CDC came out with a new recommendation on 2/11/2021, with which I have a few problems: those people who have completed their second COVID-19 vaccination do not need to quarantine if they are exposed to a person who has COVID-19. However, here are the caveats:
People need to have completed their second vaccine at least 2 weeks previous.
No more than 3 months can have passed since their last dose of vaccine.
Vaccinated people have not developed any COVID-19 symptoms since their exposure.
I have problems with this recommendation for the following reasons:
We are still not clear if the vaccines prevent infections with the virus or just symptoms...this is why we are still asked to wear a mask even after being vaccinated.
The CDC recommendations give you two and a half months of the "get-out-of-jail-card" of not quarantining after a known exposure...that doesn't even seem worth it!
What about the new coronavirus variants and the uncertainty about our vaccines protecting us from them? Couldn't a newly vaccinated person be expose to a person infected with the new variant and get infected themselves.
The above is just what I'm thinking and not official doctrine - sorry!
Indeed, it is estimated that about half of infections occur through contact with people who are infected by the virus but have no symptoms.
A recent study (published in Science) used cell phone data to show that the biggest spreaders of SARS-Cov-2 are people between the ages of 20 and 49. Children actually account for very little spread.
There is a new travel ban on non-U.S. citizens entering the country from countries with more contagious variants: the United Kingdom, South Africa, and Brazil. Also, 26 other European countries are effected, as these allow travel over open borders and may therefore also have increased incidence of these more contagious strains.
The CDC has issued a new requirement for people flying into the U.S. from abroad: effective January 26, all travelers boarding flights from abroad must now have evidence of a negative COVID-19 test within 3 days of travel. The CDC also recommends that passengers get re-tested 3 to 5 days after arriving in the U.S.
Face masks are extremely important and effective in protecting the wearer as well as the people around them
The CDC is now mandating face masks to be worn in all public transportation, including planes, trains, busses, and subways.
Another recent study looked at the effect of states implementing mask mandates: within about 3 weeks, hospitalizations rates in these states began to drop significantly.
Cloth masks worn over medical procedure masks are particularly effective and can block out 95% of viral particles. Wearing only one mask will block about 40%. Also, masks with a snub fit work better. You can improve the fit of your mask by knotting the ear loops and tucking the in the sides close to the face to prevent air from leaking out around the edges.
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. About 45% of infected people have all three of these symptoms.
Many people (14%) who are hospitalized with COVID-19 and are seriously ill will subsequently develop diabetes. At this time it is not clear if this is related to people with risk factors for diabetes (like being overweight) also being at higher risk for COVID-19. Alternatively, it could be the virus itself that damages the insulin-producing pancreas and makes people develop diabetes. Or, finally, it could be related to the medications (including steroids) with which people with severe COVID-19 are often treated.
An increasing number of COVID-19 patients seem to have long-standing sequelae of their infection: three quarters of people previously hospitalized with COVID-19 have at least one ongoing symptom 6 months later (The Lancet). Such symptoms usually included muscle weakness or fatigue, sleeping issues, and anxiety/ depression.
Incidence/ Prevalence:
Some statistics:
San Mateo:
number of cases: 37,437 (34.957 two weeks ago)
number of deaths: 447 (356 two weeks ago)
number of people in the hospital: 86 (149 two weeks ago).
California:
number of cases: 3.46 Million (3.26 Million two weeks ago)
number of deaths: 45,976 (39,211 two weeks ago)
U.S.:
number of cases: 27.4 Million (25.8 Million two weeks ago)
number of deaths: 475,000 (433,000 two weeks ago)
World:
number of cases 107 Million (101 Million 2 weeks ago)
number of deaths: 2.36 Million (2.19 Million 2 weeks ago)
Testing
On February 1, the White House announced that it was purchasing 8.5 million rapid coronavirus test made by the company Ellume for the American population. These tests could provide results within 15 minutes and would not require a physician's prescription. By ordering such a large number of tests, Ellume could quickly scale up its test production and also create manufacturing facilities for the tests in the United States.
The Biden administration plans on signing contracts with six diagnostic companies in the coming weeks to allow for Americans to have easy access to COVID-19 testing kits at home.
Treatment
Remdesivir is the only medication approved for COVID-19 treatment in the United States.
Lots of other medications are being tested aggressively in the treatment against SARS-Cov-2. Indeed, over 200 possible treatments are in clinical trials. One such drug is called Aplidin. A study published in the journal Science showed that this drug drastically prevented replication of the virus and may indeed be 30-times as effective as remdesivir. However, we are still in the early part of trials, so nothing conclusive can be said as yet.
Another medication, tocilizumab, has been shown this week to decrease deaths in people with severe COVID-19 by 14%. The medications also significantly reduced the likelihood that a patient would require a ventilator. The results are preliminary, however, and not yet published.
Vaccines:
People who had been infected with COVID-19 previously and then received only one dose of the COVID-19 vaccine developed antibody levels that were ten times higher than people who had not been infected previously. This is clearly good news. However, these people also had more achiness, fever, and headaches. Scientists are considering recommending just one vaccine dose for those people previously infected with SARS-Cov-2. But that is not the official recommendation as yet, so for now, everyone needs both doses of the Pfizer/ Moderna vaccines.
For now, the CDC is recommending that people who have previously been infected with SARS-Cov-2 be fully vaccinated regardless.
There has been some news in recent past on people who have received the Pfizer or Moderna vaccine subsequently developing a blood clotting disorder known as "immune thrombocytopenia." There have been 37 such cases to date, making the incidence of the this about "one in a million." A causal relationship has not been established. Also, immune thrombocytopenia seems to occur to occur randomly in the U.S. population at approximately the same rate. Further studies are ongoing.
Scientists are still waiting to learn if people who have been vaccinated can still spread virus to others...though early data on this topic is promising. So you still need to wear a mask, even if you have been vaccinated!
It is not uncommon to have irritation at the site of their vaccine injection, reactions that can be quite large. These are not worrisome (just uncomfortable) and should NOT (according to the CDC) prevent you from getting your second vaccine dose. Just use the opposite arm for the second vaccine dose, if possible.
Pfizer/ BioNTech:
Good news: initially, the number of severe allergic reactions to the vaccine were on the order of 11/ million, based on studies done in December. Now, including the data from January, it looks like the likelihood of an allergic reaction to t he Pfizer vaccine is closer to 5/ million.
A new study (in bioRxiv) suggests that the Pfizer vaccine can neutralize the B.1.1.7 (British) variant of the virus as well as the one from South Africa. However, the efficacy for the South African variant is "only slightly reduced."
Moderna:
Moderna announced that their vaccine did protect against the two virus strains first found in Great Britain and South Africa, though the response to the South African variant was not as strong as against other variants. Now Moderna is looking at developing special booster shots to the South African variant, should that become needed in the future.
Studies show that severe allergic reactions to the Moderna vaccine are quite rare, on the order of 3 in a million.
Moderna has applied for permission to fill it's vaccine vials with about 50% more vaccine product This could expedite distribution, as it would address the production bottleneck associated with the final part of the manufacturing process.
Johnson & Johnson:
The advantage of the J & J vaccine is that it requires only one shot of vaccine. Also, the vaccine can stay stable in a refrigerator for months.
This vaccine is also different from the Pfizer and Moderna vaccines as it does not employ mRNA technology; instead, it uses an adenovirus vector system, which has been used in vaccine development for a long time.
On January 29, J&J announced that its vaccine was 85% effective in preventing severe disease. I realize that the Pfizer and Moderna vaccines reported 95% efficacy, but the comparison is not quite fair, as those vaccines were tested before some of the newer virus variants were circulating widely and therefore didn't include these in their data. Overall, this vaccine did greatly protect against severe COVID-19, though some people still became moderately ill. It also completely protection against developing COVID-19 that was bad enough to require hospitalization or even kill you.
Efficacy of the vaccine against the new South African variant (B.1.351) dropped to 57% in preventing disease...though it still protected more significantly from severe disease and death. Allergic reactions to the vaccine were minimal.
On 2/4/2021, J&J asked the FDA for an emergency use authorization for its coronavirus vaccine. The FDA will review the data and meet on 2/26/2021 to decide on authorization.
The Oxford/ AstraZenica vaccine:
The most recent studies show that about 2% of vaccine trial participants developed symptomatic COVID-19 infection after receiving the vaccine. This puts the efficacy rate at 67% after the second dose.
Interestingly, the efficacy of the vaccine rose to to over 80% if the second vaccine dose was delayed and given 12 weeks after the first one.
The World Health Organization has recommended that the two doses of the vaccine be spaced 8 to 12 weeks apart.
In addition, studies show that this vaccine actually prevents virus transmission and actual infection - not just symptoms! Protection seems to last for at least three months on just one dose.
Last week, South Africa stopped giving out this vaccine as a new trial showed that it did not protect against mild to moderate COVID-19 infections of the South African virus variant.
The AstraZenica/ Oxford vaccine was found to be just effective in preventing the highly contagious B.1.1.7 (U.K. variant) as in preventing the "older" virus models.
This vaccine does not yet have emergency use authorization in the U. S.
Novavax:
This vaccine is protein-based (not RNA-based like the Moderna and Pfizer vaccines).
One advantage of this type of vaccine is that it can be manufactured on a large scale quickly.
On January 28, 2021, a Novavax news release reported trial results indicating that their vaccine was effective in preventing symptomatic infections world-wide. However, the vaccine was much less effective when tested in South Africa in preventing any symptoms.
More definitive results of the vaccine trials are expected in the spring with possible government EU authorization as early as April.
This vaccine can be stored and shipped at regular refrigerator temperatures.
The Russian vaccine known as "Sputnik V" was reported in the medical journal Lancet to have a 92% efficacy in preventing symptomatic disease.
This vaccine needs to be given in two doses, 3 weeks apart.
This vaccine can be stored in normal freezers.
The pharmaceutical company Glaxo-SmithKline announced last week that it would work with the German vaccine company CureVac to target the many new viral variants in just one vaccine. The cost of this enterprise will be about $181 million.
Antibody therapy:
COVID-19 patients who receive convalescent plasma containing high numbers of antibodies did better than those receiving plasma with low levels of antibodies...makes sense.
A recent trial gave the antibody treatment bamlanivimab to staff and residents of nursing homes in England. These people had not contracted the virus yet. Those people that were treated with the intravenous prophylactic medication were 80% less likely to later develop COVID-19.
Similar to above, it seems that the antibody cocktail (casirivimab- imdevimab) produced by Regeneron can also help prevent infections and disease in people when given PRIOR to them getting sick.
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. ICU and acute care beds are still available and the surge capacity beds have not been activated yet. All the treatment modalities we discussed above are available here.
Our Community and Beyond:
The Bay Area has still received only a small fraction of the vaccines needed to vaccinate residents aged 65 and older. At the current pace, it will take several more weeks for all older adults who want a vaccine to get one.
Over 68,000 San Mateo County residents have received at least their first dose of vaccine, which represents about 10% of the residents over the age of 15
At this time, vaccines are available to health care workers, long-term care residents, and people older than 64.
The San Mateo County Events Center now is being used for vaccination, rather than testing. There are still multiple free testing sites in the county. Schedules are available at
https://www.smcgov.org/testing
Levi Stadium in Santa Clara opened this as a mass vaccination site this week for Santa Clara County residents
I am repeating the information from above here:
You can go to the following website to put your name on a waiting list to get the coronavirus vaccine San Mateo. Once you are eligible and a site is available, you will be contacted. I have heard from a number of patients that this process is quite easy and quick!
https://www.smchealth.org/covid-19-vaccination
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."
All of us in the office are healthy and doing well.
Both Dr. Daniher and myself have gotten both of our COVID-19 vaccines. Our two staff are in the middle of their vaccination process themselves.
In addition to the "regular" Covid-19 testing that we have had all along (nasal swab, PCR-based test with approx. 24-48 hour turn around) our office also has two other COVID-19 testing options available:
A saliva based PCR-test that can be done in a patient's home. It is then sent via Fed-Ex to a lab and usually gives results in 36 hours. This test is usually covered by insurances and is 100% sensitive and 100% specific. It is accepted as evidence of immunity for most travel (not including travel to Hawaii, which does not accept this test).
A rapid 10-minute test that is based on a nasal swab and performed in our office. This test is 85% sensitive and 100% specific. This test is perfect for people without symptoms or prolonged exposure to a COVID-10 patient who "just want to make sure" they are ok. This test is not covered by insurance and costs patients $30/ test.
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.
I know we should all be grateful for rain (and snow in Tahoe!) but it does seem to put a damper on our mood, doesn't it? So perhaps we all should be extra-good in our self-care efforts right now. I, for one, have been taking more long baths and watched more Netflix in recent weeks. Getting fresh air and some exercise is also part of the package: I don't necessarily enjoy running in the rain, but I know I feel a lot better after I've done it...sort of like the man who kept hitting his head against a wall: when asked why he was doing that, he said it felt so good once the pain was over. :)
My son Markus drove up to Tahoe last weekend to go skiing with some friends: he got up before 5 am, drove for four hours, skied all day, then drove back for four hours before collapsing in bed with fatigue. I am so glad he did this, but you could not pay me enough to do this myself.
Valentine's Day is coming up. I have fashioned a crossword puzzle for my husband (see "https://crosswordlabs.com" for one of many free websites to do this...). As my husband never reads my newsletters, I feel ok in letting you know what I am up to!
We are also planning to go back up to Kirkwood for the President's Day weekend. Nice to have a change of wallpaper sometimes...
I hope all of you have a good Valentine's Day and know that I, for one, appreciate you and am so glad to know you!
