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.
March 11 was the one-year anniversary of the pandemic. Also, this week was the one-year anniversary of the first COVID-19 case in San Mateo County. I don't think any of us had any idea of the catastrophic effect this disease would have on our lives and livelihood, our social and private spheres, and on our families. Indeed, one in five Americans report that they have lost a relative or close friend to COVID-19.
I am optimistic that we are at the tail-end of this crisis and that we can go back to going out for dinner, attending cultural and sporting events, and hugging friends and family again soon. Let's also hope that we can remember some of the wisdom we (may?) have acquired in these trying times as well as some of our habits (exercise, crafting....sourdough starter, anyone?). So I invite all of you to think about the anniversary and consider
when did you realize that this COVID-19 pandemic was going to change things so drastically?
what new habits will you keep?
what are you looking forward to doing again?
President Biden announced on 3/2/2021 that there will be enough of the COVID-19 vaccines available to all adults by late May, 2 - months earlier than previously predicted. He also said that all adult Americans would be eligible to be vaccinated by the beginning of May.
Vaccination rates are steadily increasing. At this time, 10% of the U.S. population has received at least one dose of vaccine. According to a CNN analysis, if we continue at our current rate of 2 million shots daily, the U.S. could reach herd immunity by the summer by vaccination alone.
At this time, more than 200,000 educators and child care workers have been vaccinated in the state of California.
This week, the CDC finally published recommendations for people who have been fully vaccinated (i.e. 2 weeks after the final shot) and it opens up options!
Vaccinated people can hang out indoors with small groups other vaccinated people without wearing a mask.
Vaccinated people do not need to quarantine or get COVID-19 tested if they have been exposed to a COVID-19 person...as long as they don't feel sick themselves.
Vaccinated people can socialize indoors with non-vaccinated people of a single household as long as those people are at low risk of serious COVID-19 disease.
Vaccinated people still need to wear masks and physically distance in public.
General Information:
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.
A large international study suggests that any surgery should be delayed by 7 weeks after infection with SARS-Cov-2: this was associated with a lower mortality as compared to doing surgery more promptly.
There also seems to be a correlation between pollen and SARS-Cov-2 infection: infection rates waxed and waned along with pollen counts in 2020 (Proceedings of the National Academy of Sciences).
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.
You can also register at the special Blue Shield website (https://myturn.ca.gov/landing) to see if you are eligible to receive the vaccine and to put yourself on a list so that you can be notified if vaccines become available for you.
Also, check out www.hidrb.com: this is a website that allows people to sign up for "leftover" vaccines from vials that would otherwise be discarded if not used. It still categorizes people based on county recommendations, but will inform people regardless of eligibility if vaccine is available. But hurry! as you only have a short amount of time to reply if they call you in!
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
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.
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. These pharmacies are expanding distribution every week. At this time, vaccination are being given in Redwood City, Daly City, Pacifica, Half Moon Bay, and San Mateo.
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 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.
Fair warning to the women: it seems that we are more likely to get side effects from the vaccine compared to men....luckily we are made of stronger metal! :)
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.
All three vaccines approved in the U.S. (Moderna, Pfizer/ BioNTech, and Johnson and Johnson) have been effective in preventing death from the variants, even if the vaccines may be less effective in preventing mild to moderate disease caused by the new variants.
This is important, so take note: the vaccines have virtually eliminated hospitalizations and deaths even in people who are infected with one of the new 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.
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.
A recent study found this variant to be 43% to 90% more infectious than earlier strains.
A recent report out of the United Kingdom shows that this variant seems to be 30-100% more deadly than the original SARS-Cov-2 (BMJ)
It is likely to become the dominant strain in our country by the spring.
This variant likely makes up 20% of new COVID-19 cases in the U.S.
Researchers in Oregon have identified a patient with the B.1.1.7 variant that also has the E484K mutation. This mutation is also seen in the variants from South Africa and Brazil and it makes the virus more likely to infect people who have been vaccinated.
But here is the good news: more than 80% of the COVID-19 cases in Israel are due to the B.1.1.7 variant. Vaccination studies show that the Pfizer vaccine is equally effective against this variant as it is against the "original" virus.
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
Another new highly-contagious variant has originated in Brazil.
This variant is also known as P.1. Vaccines may also be less effective against this strain and people who have fallen ill with the original SARS-Cov-2 may get re-infected with this strain. There have been about 13 cases reported in the U.S.
California strain
Various new strains ( B.1.427 and B.1.429) have recently cropped up in California. These strains also seem more contagious and possibly also make people sicker.
It is also not clear yet how well the current vaccines protect against it.
New York: strain B 1.526 also seems to be able to evade some of the body's defenses against the coronavirus.
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.
Transmission:
It is estimated that about half of infections occur through contact with people who are infected by the virus but have no symptoms.
Another study has come out indicating that the SARS-Cov-2 virus is particularly attracted to the respiratory cells of people with blood group A (Blood Advances). This would explain why people with type A blood seem to be at higher risk for the disease.
A study out of Italy (Jama Network Open) looked at close contacts of people who had been diagnosed with COVID-19: only 26% of people younger than 60 developed a fever or respiratory symptoms. However, 6.6% of people older than 60 developed critical illness. Age matters...
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 snug 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.
Unfortunately, there are many, many counterfeit NIOSH (National Institute for Occupational Safety and Health) N95 masks around these days. Beware of masks that
don't have markings at all on the filtering facepiece respirator.
don't have approval numbers on the facepiece respirator or headband.
have "NIOSH" spelled incorrectly.
have decorative fabric or other decorative add-ons.
claim to be approved for children. NIOSH does not approve any masks for children.
have ear loops rather than headbands.
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.
COVID-19 patients, who initially had gastrointestinal symptoms, did better than people who had other types of symptoms due to the virus (Gastroenterology).
We have heard that SARS-Cov-2 often infects the heart muscle and can cause significant inflammation. A study published in JAMA Cardiology looked at 789 U.S. professional athletes. Only 5 of the athletes developed serious heart disease and none had significant heart issues after they had been cleared to return to play. This suggests that long-term complications are unlikely in people with mild to moderate COVID-19. That is very good news.
More than 2600 children have been diagnosed with MIS-C (multisystem inflammatory syndrome in children) between May, 2020 and March, 2021. Most cases were in kids aged 1 to 14. 1.3% of the cases end in death.
Incidence/ Prevalence:
Some statistics:
San Mateo:
number of cases: 39.571 (38,872 two weeks ago)
number of deaths: 528 (515 two weeks ago)
number of people in the hospital: 31 (50 two weeks ago).
number of people who have received at least one vaccine: 183,432 (28.6% of the adult population)
California:
number of cases: 3.61 Million (3.56 Million two weeks ago)
number of deaths: 55,132 (51,435 two weeks ago)
U.S.:
number of cases: 29.3 Million (28.5 Million two weeks ago)
number of deaths: 530,000 (509,000 two weeks ago)
World:
number of cases 119 Million (113 Million 2 weeks ago)
number of deaths: 2.63 Million (2.5 Million 2 weeks ago)
Testing
Labcorp now allows for PCR-based COVID-19 testing to be done at home with a "short nasal swab." You collect the sample yourself and then ship it back to Labcorp in the packaging provided. Results are available 1-2 days after the sample is received. Insurance often pays for the test.
The FDA has just granted EUA for an at-home test that doesn't require a prescription and provides results in 20 minutes. The test is from Cue Health.
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.
Several recent articles debunk claims that various medications (like the anti-parasitic agent ivermectin or the antibiotic azithromycin) improve outcomes in people with COVID-19. So please don't take these drugs for the disease: they will not help and can make you sick in their own right. The FDA has had numerous reports of people taking ivermectin while self-treating for the coronavirus and becoming ill or even dying.
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.
We are seeing promising results from a new oral anti-viral medication called molnupiravir. This medication is still in relatively early trials, so only time will tell if this is another good treatment option available.
Vaccines:
It is not uncommon to have irritation at the site of the vaccine injection.
In fact, both the Moderna and Pfizer/ BioNTech vaccines can lead to the immune system to be stimulated to such an extent as to cause the lymph nodes in the "vaccine arm" to become a bit enlarged. Such lymph node enlargement is temporary and normal and should not be mistaken for a sign of underlying cancer. Similar lymph node enlargement has not (yet?) been seen with the Johnson & Johnson vaccine.
Overall, people are more comfortable with getting vaccinated: in a survey published last week by the Pew Research Center, 69% of Americans said that the had been vaccinated or were planning on getting vaccinated. This compares to 60% of Americans who felt this way in November.
Another study (New England Journal of Medicine) showed a robust immune response after just one vaccine dose in people who had suffered for mCOVID-19 previously. It is certainly possible that the FDA will recommend that people who were previously infected with the virus only get one vaccine dose...we'll see!
Pfizer/ BioNTech:
The likelihood of an allergic reaction to the Pfizer vaccine is close to 5/ million.
Studies done in Israel provide a "real-world" example of how well the Pfizer vaccine works: 14 to 20 days after the first dose, the vaccine was 74% effective in preventing severe disease. One week after the second dose, the vaccine was 92% effective in preventing severe disease. Too few deaths occurred for them to be able to say anything about the mortality benefit. But these numbers are amazing! Also, this vaccine was 94% effective in preventing asymptomatic infection, which shows that it not only keeps you from getting sick, but it keeps you from getting infected (and capable of infecting others!)
Moderna:
Studies show that severe allergic reactions to the Moderna vaccine are quite rare, on the order of 2.5 in a million.
The New England Journal of Medicine reported on 12 patients who had received the Moderna vaccine and had developed skin reactions up to 8 days after their first shot. These skin reactions lasted an average of 6 days. All patients were encouraged to get their second shot, at which time half of them had recurrent reactions. No serious consequences were noted.
Some people getting the Moderna vaccine develop a red itchy rash after getting their first vaccine dose. The good news is that this reaction doesn't seem to get worse with the second dose.
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..
The FDA gave emergency use authorization to the vaccine on February 27. On February 28, it was recommended by the CDC's Advisory Committee on Immunization Practices.
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
It is a little difficult in comparing the J&J vaccine with the Pfizer/ BioNTech and Moderna ones: for one thing, the J&J vaccines was tested later during the pandemic and more people were infected with one of the new variants at that time...so at least we know that the J&J vaccine is quite effective against the new coronavirus mutations.
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.
Side effects are less with this vaccine and there have not been any severe allergic reactions.
J&J now plans on testing the vaccine in infants and even newborns! Also, pregnant women and people with compromised immune systems will be included in tests on the vaccine.
The pharmaceutical company Merck has announced that it will help J&J manufacture their vaccines, making more vaccines available sooner.
People, who have received the first dose of the Moderna or Pfizer/ BioNTech vaccine and can't get the second shot due to a severe allergic reaction, are eligible for the J&J vaccine. In these cases, however, the J&J vaccine should be given at least 28 days after the Moderna/ Pfizer vaccine.People who have an allergy to polysorbate should not receive the J&J vaccine.
President Biden has just ordered an additional 100 million doses of the vaccine to help stockpile doses and minimize supply issues in the future.
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.
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.
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.
Some European countries have suspended the use of this vaccine due to incidents of blood clots. However, the number of blood clots in people who have gotten this vaccine is not notably higher than the number of blood clots in people who have not been vaccinated. A causal relationship has NOT been established. But such a relationship is being investigated.
Novavax:
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.
Antibody therapy:
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 on 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...Indeed, the NIH has halted trials involving convalescent plasma in people with mild to moderate symptoms who show up at the Emergency Department.
The combination of Bamlanivimab and etesevimab was associated with an 87% reduction in risk for hospitalization or death when given to people with mild to moderate COVID-19. The NIH recommends this treatment, which is given in the emergency department intravenously, for people with mild to moderate disease but high risk of disease progression.
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:
On March 1, the California Department of Public Health announced that we will have a uniform, state-directed eligibility criteria as to who should be getting a COVID-19 vaccination. This is welcome news to those of us tired of the patchwork of regulations on this question across the various counties.
San Mateo County could move to the orange tier as early as next week, due to the low rates of infection in our community right now.
Starting April 1, California will allow outdoor sports stadiums, music and art locales, and amusement parks to open. Also, in the orange tier, the capacity restrictions for restaurants would be loosened and bars and breweries could open outdoors.
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.
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.
We are off to Tahoe (Kirkwood) again this weekend, taking advantage of the new snow. This will likely be our last ski trip for the year. Wish you were here!
My son Markus, who is a senior in high school, will return to school for the first time in over a year in early April. We are all very excited and Markus looks forward to seeing his friends again, even if it is at a distance and only for a few days per week. We take what we can get. It also looks like he will get an (abbreviated) lacrosse season, so that he can finish high school doing some of the activities he loves.
I made some "bath bombs" the other day. For those of you not familiar with the concept, they are bath salts usually in a ball-like shape and they make the bathwater soft and fragrant. Only mine were not entirely spherical because that part turned out to be harder than I realized. I found a recipe that was super-easy and I was trying to procrastinate in writing this newsletter, so there you go. Now I just have to try them out and see if they actually work...
