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.
Earlier this week, the death toll for COVID-19 patients exceeded 500,000 Americans. Sadly, this milestone comes only one month after we have passed a death toll of 400,000. 500,000 deaths is more than all the people who died in WWI, WWII, and the Vietnam War combined. However, it is lower than the death toll for the Civil Wary and also lower than the death toll associated with the Spanish of 1918/1919.
On the other hand, over 50 million coronavirus vaccines have been given in the United States already!
Coronavirus cases have dropped below 100,000 for the first time since early November. Hospital admission have plummeted 72% in the last month and older Americans in particular have benefitted there. COVID-19 cases in nursing homes have dropped 80% between late December and early February.
But even now more than 2000 people die of COVID-19 daily. I mention this not to depress you, but to encourage you not to become complacent and to continue to wear masks and be careful with social gatherings, for now. Many experts fear that there will be a fourth wave of illness starting in late March/ early April that could be attributed to Americans letting their guard (and their mask!) down and starting to ignore the social distancing guidelines, thinking we are out of the woods.
As of February 15, about 17.1% of the population of San Mateo older than 15 had received at least one dose of vaccine.
Currently, the national goal is to have 50% of the U.S. adult population vaccinated by April. By June, everyone who wants a vaccine should be able to get one. Let it be so!
On February 22, the county will start vaccinating teachers, childcare workers, farmworkers and first responders.
It is hoped that the advent of warmer weather combined with a increased vaccination numbers will lead to a further drop in COVID-19 cases....but for now the wild card seems to be the various new coronavirus mutations, so mask wearing and social distancing continue to be important.
General Information:
Recent studies have shown that pulse oximeters (the little devices you put on your finger to measure oxygen in the blood) may have variable accuracy and may miss low oxygen saturation in African Americans, in particular.
Recent news out of Scotland has seen a rapid drop of COVID-19 hospital admissions. The rate of admission after just one dose of the COVID-19 vaccine (AstraZenica or Pfizer-BioNTech) was reduced by 85% to 95%. The United Kingdom has delayed administration of the second dose of the COVID-19 vaccines for up to 3 months in an effort to vaccinate more people. It is unclear how long the imparted by a single vaccine dose lasts.
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.
Vaccine Administration:
Check out www.vaccinefinder.org. This website, while not 100% updated in California (yet!!), is easy to use and seems quite helpful in finding places that offer the vaccine in real time.
The United States has made great strides in vaccine administration and now is in the top five countries worldwide in effective vaccination.
In Santa Clara and San Mateo counties, about 54% of people aged 75 and up have received at least one vaccine dose.
Unfortunately, the winter storms affecting much of the country have delayed arrival of the vaccines in the Bay Area. Thankfully, the vaccine doses will just be late and we will just need to administer twice as many vaccines for a few weeks to catch up.
San Mateo County is opening up more and more times for vaccine administration at the SFO Long Term Parking and the San Mateo Events Center. Check out availability and make an appointment at
http://www.smchealth.org/covid-19-vaccinations
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 Kaiser. The hope is that Blue Shield will help provide more equity in the vaccine distribution process.
Blue Shield hopes to vaccinate 3 million Californians every week, starting March 1. Eventually, they plan on vaccinating 4 million people in California every week.
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.
Some CVS and Rite Aid stores have started booking vaccine appointments at various locations throughout the county.
Rite Aid is only accepting appointments through its online portal.
You can make an appointment at CVS through their website (CVS.com) or by calling (800) 746-7287.
As of February 22, San Mateo County will start vaccinating teachers as well as child care providers, first responders, and food and agricultural workers.
Gov. Newsom has announced that the state will be setting aside 10% of it's vaccine supply for teachers and other school staff starting in March.
As of March 15, 2021, California will start vaccinating people under 65 who are at the very highest risk of dying of the disease. The people eligible for the vaccine include people with
active cancer with a compromised immune system
chronic kidney disease stage 4 and 5
oxygen-dependent COPD
Down's syndrome
a solid organ transplant
pregnancy
sickle cell disease
heart failure, coronary artery disease, or cardiomyopathy (hypertension alone is not enough of a risk factor)
severe obesity and a BMI of above 40
type 2 diabetes which is poorly controlled (and has a hemoglobin A1C of above 7.5)
a high risk of developing severe life-threatening disease from SARS-Cov-2 infection
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.
New COVID-19 variants
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.
Pfizer/ BioNTech and Moderna are beginning to test their vaccines against the various new coronavirus variants. They are also looking into the utility into adding a booster shot. A phase 1 trial with 144 participants in the U.S. has started already.
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.
Currently, this strain seems to be prevented by the vaccines currently in development, including the Moderna, Pfizer, and Astra-Zenica vaccines.
Antibody treatments seem to continue to work on this coronavirus varian
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
Antibody treatments including bamlanivimab and etesevimab and convalescent plasma seem to be less effective in neutralizing this coronavirus variant.
A recent study published in the New England Journal of Medicine found that the blood of people who had received the Moderna or the Pfizer/ BioNTech vaccines produced less of a neutralizing response against the B.1.351 than against the wild type coronavirus. It is unclear, however, how and if these lab-based studies of blood samples translate into real-life immunity of vaccinated individuals against the B.1.351. virus strain.
Another new highly-contagious variant has originated in Brazil.
California strain
A recent study showed that about half of the samples studied in California come from a strain (L452R) first described in Denmark. This variant is more contagious and possibly more deadly than the original SARS-COv-2.
It is also not clear yet how well the current vaccines protect against it.
On the brighter side, this strain is less ominous than the other major strains: it is less contagious than the U.K. strain and seems less resistant to vaccination than the the south African and Brazilian variants.
The various makers of COVID-19 vaccines are actively looking into how often their vaccines may need an update in response to new virus mutations. Luckily, many of the new COVID-19 vaccines are made with a flexible new technology that is easy to upgrade. Much like the flu vaccines are reconfigured every year, the coronavirus vaccine may also need to be reconfigured periodically.
The FDA announced that vaccine manufacturers that modify their COVID-19 vaccines to include the new SARS-COv-2 variants do not need to re-do the original vaccine studies, studies that take a long while. Instead, they would merely require "immunogenicity studies" that can be performed in a few months. This is a similar review process required of the flu vaccine which is modified every year.
Transmission:
A recent study published in MMWR reported the significant role played by teachers in the transmission of SARS-Cov-2. Two separate articles in the journal noted a strong risk of Covid-19 transmission in indoor fitness centers, especially if masks were not worn reliably.
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.
People who have a severely weakened immune system (like those with cancer and undergoing chemotherapy, untreated HIV disease, or people on high dose prednisone for more than 2 weeks) who also contract the novel coronavirus may shed the virus longer than usual. For this reason, such immunocompromised people should consult with an infectious disease specialist prior to getting out of isolation, as they may harbor the virus for longer and therefore be able to infect others for longer also.
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
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.
About 30% of patients with COVID-19 still had symptoms (usually fatigue, brain fog, and chest tightness) 3 to 9 months after onset of the illness.
There is a new name to the "long COVID" disease described above: it is now called "post-acute sequelae of COVID-19" or PASC.
Incidence/ Prevalence:
Some statistics:
San Mateo:
number of cases: 38,872 (37,437 two weeks ago)
number of deaths: 515 (447 two weeks ago)
number of people in the hospital: 50 (86 two weeks ago).
California:
number of cases: 3.56 Million (3.46 Million two weeks ago)
number of deaths: 51,435 (45,976 two weeks ago)
U.S.:
number of cases: 28.5 Million (27.4 Million two weeks ago)
number of deaths: 509,000 (475,000 two weeks ago)
World:
number of cases 113 Million (107 Million 2 weeks ago)
number of deaths: 2.5 Million (2.36 Million 2 weeks ago)
Previously, it had seemed that COVID-19 had largely spared Africa. However, it now seems that we hadn't seen the novel coronavirus in Africa because no one was looking: the British Medical Journal just published an article in which scientists looked for COVID-19 in 400 recently deceased people in Zambia: 16% to 19% were found to be infected with SARS-Cov-2. The authors noted that other diseases were also prevalent in this part of the world that could make the population especially susceptible to the virus. Such diseases include tuberculosis, HIV/ AIDS, and malnutrition.
Testing
In California, the coronavirus testing company Verily is being replaced by a company called OptumServe.
Treatment
Lots of other medications are being tested aggressively in the treatment against SARS-Cov-2. Indeed, over 200 possible treatments are in clinical trials.
Another medication, tocilizumab, has been shown 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.
A recent study published in JAMA Open Network showed that Vitamin C and zinc do NOT help prevent progression and treat COVID-19. Similarly, high dose Vitamin D was not helpful in treating hospitalized COVID-19 patients in Brazil.
Now this is interesting: studies published in Science showed that if ferrets were given a special intranasal Covid-19 medication, they were be protected from COVID-19 when exposed to infected ferrets. Indeed, all of the untreated ferrets became infected, but none of the treated animals did.
Vaccines:
Scientists are still waiting to learn if people who have been vaccinated can still spread virus to others.
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 you didn't do well with the first one.
Pfizer/ BioNTech:
The likelihood of an allergic reaction to the Pfizer vaccine is close to 5/ million.
Some Canadian researchers showed that just one dose of the Pfizer/ BioNTech vaccine was 93% effective in combatting the virus. This finding needs to be double-checked, however.
Between December 20 and February 1,2021, almost 600,000 vaccine recipients were matched with unvaccinated piers: in this "real-world" study, the vaccine was 94% effective in preventing hospitalization. Even better, the vaccine was 90% effective in preventing any infection (not just symptoms!), which is great news.
Another "real world" review out of Israel showed that even one dose of the vaccine was 62% effective at preventing any symptoms and 72% effective in preventing death. Overall efficacy was 92% after two shots.
Pfizer and Moderna have solved a production bottleneck issue and have committed to delivering 140 million more doses over the next 5 weeks. The companies have insisted that they can deliver enough vaccine for most Americans by the summer.
Moderna:
Studies show that severe allergic reactions to the Moderna vaccine are quite rare, on the order of 2.5 in a million.
Moderna has received permission from the FDA 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. It also completely protection against developing COVID-19 that was bad enough to require hospitalization or even kill you.
This last week, the FDA reviewed the J&J vaccine and found it to be safe and effective, especially in keeping people out of the hospital. Today, the FDA's "Vaccines and Related Biological Products Advisory Committee) is holding an all-day meeting to review the data further. If approved by this body, the FDA is likely to authorize use within a few days.
In the month after 20,000 people received the vaccine, not a single person needed to be hospitalized for COVID-19.
While the vaccine is about 72% effective in the U.S., it has prevented 64% of any symptomatic disease in South Africa, indicating it works against the South African variant also. In fact, the vaccine was 82% effective in preventing severe disease in South Africa. Indeed, South Africa has now pivoted and will administer the J&J vaccine to its citizens.
Side effects are less with this vaccine and there have not been any severe allergic reactions.
It now seems that J&J has only 4 million doses of their vaccine at the ready. By the end of March, they plan to deliver another 20 million doses. However, they are confident that they could produce 100 million doses by June.
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.
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.
This vaccine does not yet have emergency use authorization in the U. S.
The company hopes for emergency use authorization by early April. They could then deliver 30 million doses of vaccine immediately and 50 million doses by the end of April.
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.
More definitive results of the vaccine trials are expected in the spring with possible government EU authorization as early as April.
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.
Antibody therapy:
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.
The Infectious Disease Society of America now suggests that tocilizumab be added to the standard care of hospitalized patients with severe COVID-19.
A study published in JAMA just today, February 26, reviewed the use of convalescent plasma (i.e. blood products from people who had recovered from COVID-19 previously) in treating new infections. Recall, this was the "hot" treatment used and studied early on in the pandemic. Unfortunately, the recent study showed that it really didn't work very well...
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:
San Mateo County moved to the less restrictive red tier on February 24. This means most business and activities will now be allowed, albeit at reduced capacity:
Dance studios and gyms can reopen at 10% capacity
Hair and nail salons reopen indoors with modifications.
Restaurants may now serve diners indoors, though at reduced capacity.
Movie theaters and museums can reopen also.
San Mateo has done a very good job at testing and now has the second highest testing rate in the state.
Outdoor youth sports will be able to resume in San Mateo and Santa Clara counties.
Today and tomorrow (February 26 and 27) there will be vaccinations for San Mateo residents aged 65 and older at Jefferson High School in Daly City. For support, people can call 855-330-3763
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.
All of us in the office are healthy and doing well.
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 think I have discovered the perfect thing for me to knit: dog sweaters. First of all, they are very cute. Second of all, they are unisex. Third of all, you can make mistakes and the dogs won't complain. Finally, if the dogs do complain, no one will understand them.
Below you will find my first knit dog sweater. It is for my sister's dog (doggie nephew?), but my dog Mala is modeling it for your entertainment.
Did I show you the last piece of jewelry I had re-done? Like my other pieces, these were rings I had inherited from my grandmother and knew I would never wear. So now a local jeweler has turned them into fabulous necklaces! If I have told you this before, please just nod politely and consider me a bit forgetful in my old age...
My younger son and husband left for a ski trip in Tahoe just minutes ago. I am giddy with excitement! A whole weekend alone! I am already looking forward to some house-clean-out....okay, I realize my life must seem quite dull if this is what I do with my free time...