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.
The big news these days are the blood clots in the brains (cerebral venous thrombosis = CVST) possibly associated with the Johnson & Johnson vaccine as well as the AstraZenica vaccine. This blood clot condition has been named "VITT" (vaccine-induced immune thrombotic thrombocytopenia) and is characterized by a low platelet count and the increased formation of blood clots. This is indeed worrisome and it is appropriate for vaccinations to be temporarily halted as we try to make sense of this information. Nonetheless, it is important that we put all the numbers and risks in context.
So far, about 8 patients out of 7 million who have received the J&J vaccine have developed these blood clots and one person has died (incidence of about one in a million). All but one of these cases has been in under the age of 50.
The risk of developing the blood clot after the AstraZenica vaccine is about five per million.
There is a high risk of developing these same blood clots due to actual COVID-19 infection. The risk of that is 39 in one million.
The risk of CVST is 10 times greater in people who develop COVID-19 compared to those that have received the Pfizer or Moderna vaccines. The risk of CVST is 8 times greater with COVID-19 infection compared to the risk of getting it after the AstraZenica vaccine.
Some comparative risks:
About 100 Americans will die in car crashes today alone.
The likelihood of being struck by lightning is about 2 in a million, twice as high as the current risk of blood clots with the J&J vaccine.
General Information:
One other negative from the pandemic...and this one is hardly surprising: the eating habits of Americans have gotten worse in the last year and there has been an increase of people with eating disorders.
Vaccination efforts in countries like Israel, where 62% of the population has been vaccinated, has allowed the outdoor mask mandated to be lifted.
Hospitalizations among those aged 65 and older is down 80% since the beginning of the year. This is the result of our effective vaccination efforts in that age group.
The CDC came out with new guidelines this week about the need to clean surfaces possibly contaminated with SARS-Cov-2: although it is clear that the virus can live for days on certain surfaces, it is now clear that people rarely get infected by "touching the wrong surface." This is an air-borne virus and so our attention should be put on avoiding standing too close to infected people, not in wiping everything down that could be potentially contaminated.
Vaccine Administration and Availability:
On April 15, all residents of California aged 16 and older are eligible for a coronavirus vaccine.
Since April 19, 2021, each state in the U.S. is allowing coronavirus vaccinations in people aged 16 and older.
At this time, about half of the adults in the U.S. (128 million) have received at least one dose of the coronavirus vaccine. More than 82 million (one third of adult) Americans are fully vaccinated.
The race is on to get many more people vaccinated and achieve herd immunity (when unvaccinated people will unlikely to become infected also) BEFORE new mutations arise that can circumvent current vaccines. This is why officials want to get as many people vaccinated as soon as possible. Time matters. It is for the greater good for the whole society (in addition to protecting the individual vaccine recipient). It is therefore disconcerting to learn that coronavirus vaccination administration has slowed significantly for the first time since February, a sign that demand is slipping even though all adults are now eligible for the vaccine.
In San Mateo County, over 57% of residents 16 and older have received at least one dose of the vaccine.
You can register at the special Blue Shield website (https://myturn.ca.gov or call (833)422-4255) to get a vaccine appointment. Check back frequently, as new vaccine appointments come up all the time.
San Mateo County is opening up 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: myhealthonline site. To sign up for this site, you can go to www.sutterhealth.org to register or call 844-987-6115.
CVS and Rite Aid, Walgreens, Safeway, and Walmart stores have started booking vaccine appointments at various locations throughout the county. These pharmacies are expanding distribution every week.
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
Please let me know if you get a COVID-19 vaccine, so I can add it to your medical chart.
The CDC recently reported that many end-stage kidney patients who are getting dialysis will soon be able to get the COVID-19 vaccine at the dialysis clinics.
New COVID-19 variants
The U.S. is setting up a $1.7 billion network to help better identify and track the new coronavirus variants. This increased monitoring will be vital as we try to prevent another wave of infections.
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.
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.
Two new studies (published in Lancet Infectious Diseases and Lancet Public Health) found that this variant, while more contagious, does NOT cause more severe disease and symptoms.
This variant is now the dominant virus an area containing two thirds of the U.S. population.
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
This variant has the E484 mutation (often called "eek") that helps the virus evade some (but not all!) of the antibodies that are produced by vaccination
Another highly-contagious variant has originated in Brazil. This variant is also known as P.1.
California strain
Various new strains ( B.1.427 and B.1.429) have cropped up in California. The CDC has now classified these variants as "variants of concern" due to their being 20% more contagious.
New York: strain B 1.526 also seems to be able to evade some of the body's defenses against the coronavirus. Two independent studies indicate that both the Moderna and the Pfizer/ BioNTech vaccine effectively protect against this variant.
Transmission:
Masks: I suspect you are all sick of me talking about the benefits of masks. I'm sorry. But just a few more points of interest:
A recent analysis found that U.S. states with mask mandates had lower COVID-19 rates than those who didn't. You figure out what that implies...
A recent article in JAMA Internal Medicine showed that wearing a medical mask snugly beneath a cloth mask nearly doubled the ability of the mask to filter out particles like the coronavirus.
Recent studies show that masks not only protect against SARS-Cov-2, but also filter out common allergens. People with severe allergies would benefit from wearing masks outside, if only to help control their allergy symptoms!
The million dollar question, for now, is if masks are really necessary outdoors - experts disagree. I think we really need to look at a more nuanced answer to this: risks are much lower if you are vaccinated. Risks are negligible if you are just passing by someone outside, but higher if you are sitting or standing close to them (like at a restaurant) for more than 10 minutes. And, of course, risks are higher if the number of infections in a community are high also. I will be sure to pass on this advice when Dr. Fauci calls to ask me my advice...
A recent article (JAMA Internal Medicine) looked at people associated with National Basketball Association (NBA players and staff in their closed tournament bubble) who had recovered clinically from COVID-19, but still had positive nasal swabs beyond the 10-day isolation. It turns out that such people did NOT transmit the virus to close contacts. So it seems safe to discontinue isolation 10 days after onset of symptoms, even if the nasal swabs still suggested that virus was in your body.
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.
Not only can symptoms last for many months, but the risk of death and chronic disease also increases in survivors of COVID-19 in the following months (Nature): survivors had a 59% increase of dying in the six months following infection with the virus.
While blood clots are a known complication of people hospitalized with COVID-19, a new study (Jama Internal Medicine) suggests that people with the disease, who not sick enough to be hospitalized, are NOT at increased risk of blood clots.
Anecdotal reports have suggested that the COVID-19 vaccines can ameliorate symptoms in people suffering from long-haul COVID-19. Investigational trials are now starting to evaluate this further.
Another studied just came out showing that pregnant women infected with SARS-Cov-2 have a higher incidence of pregnancy problems and even death. Luckily, the vaccines seem safe and effective in mitigating this risk.
Incidence/ Prevalence:
In the last week, 38 states have reported an increase in people hospitalized with COVID-19. For the eighth week in a row, the number of new cases of COVID-19 has increased. Particularly alarming is the increased incidence of disease in people aged 25 to 59.
Globally, the number of new weekly cases has almost doubled in the last two months...this could soon be the highest rate of infection we've seen since the pandemic first started.
On April 17, 2021, the number of people who had died of COVID-19 world-wide surpassed 3 million. To better understand how many people that is, consider that 3 million people are more than the residents of the city of Chicago. Philadelphia and Dallas combined have about 3 million residents...Also, it is believed that this number (3 million) is an underestimate of the true lives lost, as many countries have not been reporting their coronavirus deaths reliably.
Most of the current international hot-spots for disease are in developing nations in Asia, Eastern Europe, and Latin America. Most new infections have been in Brazil and India.
Some statistics:
San Mateo:
number of cases:41,318 (40,754 two weeks ago)
number of deaths: 560 (556 two weeks ago)
number of people in the hospital: 29 (13 two weeks ago).
number of people who have received at least one vaccine: 426,808 (340,517 two weeks ago) - 66.4% of the adult population!
California:
number of cases: 3.73 Million (3.69 Million two weeks ago)
number of deaths: 61,261 (60,142 two weeks ago)
U.S.:
number of cases: 32 Million (31.1 Million two weeks ago)
number of deaths: 560,000 (560,000 two weeks ago)
World:
number of cases 145 Million (134 Million 2 weeks ago)
number of deaths: 3.07 Million (2.9 Million 2 weeks ago)
Testing
The FDA recently granted emergency clearance to a SARS-Cov-2 test developed by Amazon; this test is PCR based and let's people test themselves with or without the supervision of a physician.
Also, the FDA just authorized the use of two new OTC rapid SARS-Cov-2 tests (Abbott's Binax NOW and Quidel's QuickVue). These tests can offer results in 10 to 15 minutes, can be done at home, and don't require a doctor's prescription. Also, the tests will be available for about $30 for a two pack. The test is not yet on pharmacy shelves, however.
Treatment
We are learning some more data about the efficacy of the COVID-19 vaccinations. The short-version is that these vaccines are extremely good, but not perfect: of the 66 million Americans who have been fully vaccinated, 5,800 people developed infection anyway, 394 required hospitalization, and 74 died. This means that 0.008% of people who are fully vaccinated still get sick. The risks of contracting COVID-19 will never be zero, but with vaccination, the risks are lower than getting into a car accident any time you drive in a car.
Recent tests looked at the efficacy of the Pfizer/ BioNTech and Moderna vaccines in the "real-world" setting, which can often be quite different than in a clinical study. The good news is that the vaccines were still found to be 90% effective in preventing symptoms. Getting only one dose still protected 80% of people.
Preliminary results published this week in the New England Journal of Medicine suggest that the Moderna and Pfizer/ BioNTech vaccines are safe for pregnant women.
Pfizer/ BioNTech:
The likelihood of an allergic reaction to the Pfizer vaccine is close to 5/ million.
Stanford is participating in a trial testing the Pfizer vaccine in children younger than 5.
This vaccine has now been shown to be effective in pregnant women as well as women who are breast feeding. This way, the mothers will be able to transfer protective antibodies to the newborn babies.
The Pfizer vaccine was found to be 100% efficacious in preventing severe disease. In South Africa, where the B.1.351 variant is prevalent, the vaccine was 100% effective in preventing hospitalizations.
Pfizer/ BioNTech has asked the FDA to grant emergency use authorization for their vaccines in children aged 12 to 15.
The Pfizer CEO Albert Bourla said on 4/15/21 that vaccine recipients will "likely" need a booster shot 6-12 months after the initial series. We may also need yearly booster vaccines, just like we get the yearly flu shot...
Moderna:
A recent report published in the New England Journal of Medicine showed that people who had received the Moderna vaccine still had protective antibodies 6 months later. Please note that the antibodies may hang around for even longer than that; we just have to wait for more time to do those tests as the vaccine has not been in trials for much longer than 6 months! Of note, these results are similar to the data seen with the Pfizer/ BioNTech vaccines.
Johnson & Johnson:
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
8 cases of blood clots and low platelet counts have been noted in people who had received the vaccine in the preceding 3 weeks. This is certainly disconcerting, but it is not yet clear if the vaccine caused the blood clots. The FDA and CDC have asked that this vaccine not be administered for now, as scientists look into this possibility for now. Here are some relevant details:
The blood clots were unusual in that the occurred in the brain as well as the abdomen.
Symptoms include severe headaches and abdominal pain. Please also look out for asymmetric calf swelling and shortness of breath.
8 cases have been reported while the vaccine has been given out to over 7 million Americans, so the incidence is about one in a million.
For those with blood clots, symptoms started 6-13 days after vaccination.
These blood clots seem to be somewhat similar to the ones described with the AstraZenica vaccine, but we do not now if the same disease process is responsible for both vaccine-related events.
Such blood clots have not been reported with the Pfizer or Moderna vaccines.
At this time in the U.S., the J&J vaccine has only been given to 5% of those vaccinated for COVID-19.
NIAID Director Dr. Anthony Fauci recently said that he believes that the J&J vaccine will likely be back in use as early as April 23. It seems likely that certain population groups will be more appropriate than others for the vaccine at that time.
On April 20, the European Medicines Agency found that the benefits of the J&J vaccine outweighed the risks. Although the vaccine had been put on hold previously, it was re-authorized for use with an appropriate warning about the rare risk of blood clots.
A new article published in the New England Journal of Medicine shows that the J&J vaccine is 85% effective in preventing severe disease, 28 days after vaccination.
The Oxford/ AstraZenica vaccine:
This vaccine has not been approved for use in the United States yet.
A small number of people have developed low platelet counts and blood clots in the brains and abdomen 5-20 days after receiving this vaccine.
These people had developed antibodies that activated the platelets and made them clot more. This is similar to a rare syndrome well known to physicians, in which patients develop low platelets and blood clotting after being given the blood-thinning medication "heparin."
The final efficacy reported by AstraZenica for its vaccine showed it to be 76% efficacious against any symptoms. The even better news is that the vaccine is 100% effective in preventing severe COVID-19 disease or hospitalizations.
Several European countries had temporarily suspended vaccination with this vaccine. However, most of these countries are now using the vaccine again, recommending them for people in older age groups.
German Chancellor Angela Merkel was recently vaccinated with the AstraZenica vaccine.
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.
However, a recent statement from the drug regulators in the country Slovakia (which has received the Sputnik vaccine) is worrisome: they state that a different "version" of the vaccine was delivered to them, suggesting potentially serious quality-control issues in the vaccine manufacturing process. This would indicated that the vaccine version reviewed favorably in the Lancet may not the same vaccine being distributed elsewhere.
Antibody therapy:
The antibody cocktail of casirivimab-imdevimab made by Regeneron was found to help protect people living in households with a COVID-19 patient: Household contacts were given the Regeneron injection and compared to household contacts who had not received the medication: after 29 days, 7.8% of people who had not received the medication became ill with COVID-19, while only 1.5% of those treated with the medication became ill. Regeneron is now looking for FDA approval for their medication for household contacts of COVID-19 patients.
As of April 15, the U.S. government has bought about 1 million doses of such antibodies (from Regeneron and Eli Lilly) and offered them to 5,800 sites across the country. They are intended for hospitals that would otherwise not have access to these medications.
Mills-Peninsula Hospital:
Peninsula Hospital continues not to be full and is managing its share of COVID-19 cases as well. ICU and acute care beds are still widely available. All the treatment modalities we discussed above are available here.
Our Community and Beyond:
San Mateo hopes to re-launch its mass vaccination site at the San Mateo Events Center soon. the counties weekly vaccine supply should triple by the end of June. Even now, increased doses are expected to arrive and be distributed in the next few weeks.
California is expecting 4 million doses of the vaccines per week starting mid May.
Starting April 15, venues hosting events like concerts and theater, may welcome larger crowds IF the attendees can prove that they have had a negative COVID test or proof of vaccination.
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 have been fully vaccinated.
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.
A rapid 10-minute test that is based on a nasal swab and performed in our office. 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.
My son, Markus, turned 18 last week. What a milestone! And how disconcerting that even my youngest child is now an adult! I must admit to feeling rather sad about this and wondering what the next phase of parenting will look like - though I do know that it will involve paying college tuition bills. So I guess our usefulness has not yet run its course....One of Markus's birthday gifts was a piñata in the shape of a coronavirus. I can't wait to give that thing a big whack.
My older son Stefan is back home, planning on completing the last month of the college semester from home. So my laundry duties will increase, as will the grocery bills. But I wouldn't have it any other way.
My parents came into town last week as well. It has been over 6 months since I last saw them and well over a year since I could hug them. I am so happy!
One other guest, who was uninvited but clearly wanted to join the festivities, was a raccoon: last night he crawled through our cat door and caused quite a ruckus until he could be chased back outside.
The news on coronavirus-related topics is slowly diminishing. I may lengthen the time period of this bi-weekly newsletter to once-every-three-weeks. But nothing is set in stone and I suspect the next few weeks will dictate how much news is available and what makes most sense. But I can always send more frequent newsletters regaling you with my knitting exploits and family activities for those that are interested! :)
