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.
As you may have noticed, I am sending out this missive a few days earlier than usual: I have looked at my calendar and noticed that the coming week will be BUSY, so I am trying to simplify my "to-do" list by sending out the newsletter early.
On 3/20/21, 100 million vaccine doses had been given in the United States.
About 70% of Americans aged 65 and older have received at least one dose of vaccine and 43% of people in that age group are fully vaccinated.
General Information:
New studies again show that the risk of re-infection with SARS-Cov-2 is low. However, that risk is a little bit higher for people over 65 (8 per 100,000 person-days versus 4-6 per 100,000 person-days). Also, it seems that the protection we get from the vaccines is much better than the protection we get from prior .
At the beginning of the pandemic (one year ago), 1 in 4 Americans admitted to the hospital for COVID-19 died. Within 6 months, the mortality dropped to 1 in 16.
Public Health officials area again warning of a new surge of coronavirus cases as people relax their social distancing and mask commitments and feel comfortable in going back to "the old ways" prematurely. Of particular concern is the fact that the incidence of new cases is now stagnant and not continuing to drop.
Two new studies show that fully vaccinated people CAN be re-infected with SARS-Cov-2, though this seems to be very uncommon: in one study, four out of 8,121 people became re-infected. In a second study, seven out of 14,990 became re-infected. This possibility of re-infection (and subsequent infection of others) is behind the ongoing recommendations that vaccinated people continue to wear masks....at least for now. Once we have a critical mass of people vaccinated, I would hope the mask mandate will be a thing of the past.
Vaccine Administration:
It is still hard to score a vaccine appointment, in part due to the ongoing paucity in vaccine and in part due to the many uncoordinated sites that are offering vaccination. And even though the process was supposed to be more streamlined via the "myturn" website, this has not always been found to be effective. So private citizens have figured out some work-arounds: there is a Facebook group called "vaccine hunters" which gives updated tips on when and where vaccines are available. Also, there is an app called "Telegram" which searches everything from private pharmacies to public vaccination sites and let's you know when something becomes available. Let me know how it works for you, if you do try it.
You can also register at the special Blue Shield website (https://myturn.ca.gov/landing or call (833)422-4255) 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
or
www.carbonhealth.com
or
flysfo.com/ vaccination-site-sfo
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, Walgreens, and Safeway 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: www.riteaid.com
You can make an appointment at CVS through their website (CVS.com) or by calling (800) 746-7287.
www.walgreens.com
One dozen states (but not California!) are expanding eligibility for the vaccine to all residents over the age of 15 even before May 1.
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
homeless people
transit workers
Please let me know if you get a COVID-19 vaccine, so I can add it to your medical chart.
As of 3/17/21, 34.4% of Californians aged 16 and older had received at least one dose of vaccine and 75.8% of people 65 and older had had at least one dose.
New COVID-19 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.
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 report out of the United Kingdom shows that this variant seems to be 30-100% more deadly than the original SARS-Cov-2 (BMJ)
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.
This variant now makes up 20-30% of new infections in the U.S. at this time.
A study published in JAMA this month suggested that prior infection as well as vaccination will be effective in preventing this variant.
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
The AstraZenica vaccine was shown not to prevent this variant (New England Journal of Medicine).
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.
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.
These strains are now the most dominant in the state.
The CDC has now classified these variants as "variants of concern" due to their being 20% more contagious.
Experts believe that the COVID-19 vaccines remain effective against this variant.
New York: strain B 1.526 also seems to be able to evade some of the body's defenses against the coronavirus.
Transmission:
The CDC recently relaxed its "6-foot-distancing" requirement for students in classrooms, indicating that a distance of 3-foot is adequate to prevent most disease. This recommendation also applies to middle and high school students (not just elementary school kids), as long as the amount of virus transmission in the community is low. This seeming flip-flopping of CDC recommendations is based on a new study published in Clinical Infectious Diseases that found no difference in disease transmission between the three-foot and the six-foot rule in schools.
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.
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. In a separate study, 51% of people who had been hospitalized with COVID-19 had symptoms 4 months later. But even people with mild COVID-19 cases can develop this long-haul syndrome.
Some people with "long haul" COVID-19 say their symptoms resolved or improved after receiving a SARS-Cov-2 vaccine....the mechanism of how this works is far from clear.
Children can also rarely develop persistent symptoms after SARS-Cov-2 infection.
Incidence/ Prevalence:
Some statistics:
San Mateo:
number of cases:40,032 (39.571 two weeks ago)
number of deaths: 528 (528 two weeks ago)
number of people in the hospital: 15 (31 two weeks ago).
number of people who have received at least one vaccine: 248,006 (183,432 two weeks ago with 28.6% of adult population)
California:
number of cases: 3.65 Million (3.61 Million two weeks ago)
number of deaths: 58,019 (55,132 two weeks ago)
U.S.:
number of cases: 30 Million (29.3 Million two weeks ago)
number of deaths: 544,000 (530,000 two weeks ago)
World:
number of cases 124 Million (119 Million 2 weeks ago)
number of deaths: 2.74 Million (2.63 Million 2 weeks ago)
20% of the blood, that has been collected by the Red Cross from unvaccinated people, has shown evidence of COVID-19 antibodies. This indicates that a substantial portion of the U.S. population has been infected already. At the same time, experts expect that about 80% of the population would need to have been infected to allow for herd immunity from exposure alone. We are hoping for a herd immunity of 80% based on natural infection rates as well as vaccination rates.
COVID-19 has disproportionately affected Latino communities. Indeed, Latino people between the ages of 35 and 49 are 5.5 times more likely to die of the disease compared to White people of the same age. As a consequence, Latinos' life expectancy has dropped in the U.S. by three years in 2020.
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
A recent study showed that low-dose aspirin may improve outcomes for people hospitalized with COVID-19. However, please don't take a baby aspirin if you have COVID-19 but are not sick enough to be in the hospital as it's not clear that this will help you and it may harm you.
Pfizer is starting a trials on a new oral medication for people infected with the novel coronavirus. In the lab, at least, this new medication showed promising results.
Vaccines:
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.
The good news is that the vast majority of people (about 96%) are going back for their second shot of mRNA vaccine.
Getting even one dose of a mRNA vaccine seems to drastically reduce the incidence of asymptomatic infection of SARS-Cov-2. Getting two doses can reduce the chance of getting infected by 80% (Clinical Infectious Diseases).
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.
Pfizer/ BioNTech is testing its vaccine in children aged 12 to 15 for now.
Moderna:
Moderna has started clinical trials of its vaccine on kids under the age 12, including babies as young as six months. They also have a separate clinical trial looking at their vaccine in kids aged 12 to 17.
Johnson & Johnson:
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.
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 Oxford/ AstraZenica vaccine:
This vaccine actually prevents virus transmission and actual infection - not just symptoms!
The company hopes for emergency use authorization by early April. However, even if approved, the vaccine may no longer be needed in the U.S. at that time; in May, there may be adequate amounts of other vaccines. Discussions are ongoing that the U.S. would donate the AstraZenica vaccines it receives to other countries that are still low on vaccine.
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. Among the 20 million people vaccinated with this vaccine, 7 have developed blood clots in their legs and another 22 have developed blood clots in their lungs. Of note, these numbers are actually lower than would be expected to occur in a population in general. AstraZenica also noted that in the clinical trials, blood clots were actually lower in the vaccinated population than in the placebo group.
About 1000 to 2000 blood clots occur in the unvaccinated U.S. population every day, as a reference.
The WHO reported on 3/17/21 that the benefits of the AstraZenica vaccine outweighed any potential risks and recommended that the vaccinations continue.
On 3/18/21, the European Medicines Agency likewise concluded that the benefits of the vaccine outweighed any potential risks. The agency said the vaccine was not associated with an overall increased risk of blood clots - though they could not rule out a possible associated of blood clots associated with low platelets. 18 cases of low platelets have been found in the 20 million people vaccinated.
Short-term lowered platelet levels have been seen as a rare side effect of other vaccines, including the measles/ mumps/ rubella vaccine as well as the Pfizer/ BioNTech, Moderna, and AstraZenica COVID-19 vaccines.
On 3/22/21, AstraZenica announced new trial results (involving 32,000 volunteers) that showed that the vaccine was 79% effective in preventing all symptoms of COVID-19 and 100% effective in preventing serious disease. The study was conducted in the U.S., France, Chile, and Peru and was funded by the U.S. Biomedical Advanced Research and Development Authority and the National Institutes of Health. Also, the trial showed that the vaccine was very safe: a specific review did not find an increased risk of blood clots.
However, less than a day after the 3/22/21 announcement, NIAID reported that an independent panel of medical experts helping to oversee the AstraZenica trial was skeptical of the way AstraZenica was using data and suggested the true efficacy was between 69 and 75%.
Novavax:
One advantage of this type of vaccine is that it can be manufactured on a large scale quickly.
The Russian vaccine known as "Sputnik V" was reported in the medical journal Lancet to have a 92% efficacy in preventing symptomatic disease.
Antibody therapy:
Final stage trials of the antibody cocktail manufactured by Regeneron are promising: in a study of 4,567 people with COVID-19 at high risk of getting very ill, those patients who received the antibodies were 71% less likely to be hospitalized or die. This is a lower dose "cocktail" compared to the one Regerneron received emergency use authorization for in November.
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.
San Mateo County moved into the orange tier on 3/17/21 - we are over-achievers, as we are the first Bay Area county to move back into orange since November. As a consequence, shopping malls, places of worship, restaurants, offices, bars/ breweries, movie theaters, gyms, fitness centers and indoor pools can be opened with modifications. Offices are still encouraged to have employees work remotely, but can have staff onsite also. Hotels, lodging, and short-term rentals, museums, zoos, and aquariums can also re-open with modifications. Finally, family entertainment areas (bowling alleys, go-kart racing, mini-golf, as well as smaller amusement parks can open at 25% capacity.
This week, San Francisco, Marin, and Santa Clara County will likewise join the orange tier.
Our Office: What We Are Doing to Keep You Safe:
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.
Next week is spring break in my son's school. When school resumes, he will be back in the classroom, though only 2 days every 2 weeks initially. He will also restart lacrosse, which will be hard for him after a less-than-active last 12 months.
Markus also finds out about what colleges he has been admitted to over the next two weeks. Wish him luck. It is a stressful time period, especially this year where the number of applications as well as the number of applicants is at record highs...
I am attaching a random picture of my two cats and dog Mala as they watch at the top of the stairs as the stove-repairman arrives.
By the way, for those of you that were wondering: the bath bombs (referenced in the last newsletter) worked great!
Spring is in the air and everything seems a bit lighter and easier (and not just because of the time-change!). I wish all of you a lovely spring, as well as happy Passover and Easter.
