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.
I just looked at the blog I put out about one year ago. At that time, the CDC had just recommended that everyone start wearing a cloth mask when out in public...how quaint!
The CDC just looked at all of the deaths in the U.S. in 2020: the death toll was above 3.3 million, the highest ever recorded death toll. Of this, the coronavirus caused about 375,000 deaths and was the third leading cause of death behind heart disease and cancer. More than 3,600 American health care workers have died due to COVID-19 in the first year of the pandemic.
On the plus-side: in San Mateo about 50% of residents aged 16 and older had at least once dose of coronavirus vaccine and about half that number of people is fully vaccinated. Cases in California continue to drop since hitting a peak in early 2021. We have an average case rate of 2,700 new cases a day, which is the lowest it has been since June!
Vaccine passports may also be the next big thing: people who have completed vaccination fully may become eligible for public events, travel, and dining....
And Major League Baseball is back to playing to an audience of live people...!!
General Information:
Studies again show that the risk of re-infection with SARS-Cov-2 is low. Also, it seems that the protection we get from the vaccines is much better than the protection we get from prior infection.
Two new studies show that fully vaccinated people CAN be re-infected with SARS-Cov-2, though this seems to be very uncommon.
The CDC has come out with some new travel advice in the recent past.
Fully vaccinated people do not need to be tested prior to traveling inside the U.S. (unless the travel destination - like Hawaii - requires it).
Fully vaccinated people do not need to self-isolate after travel.
Fully vaccinated people traveling internationally should be tested for SARS-COv-2 3 to 5 days after returning to the U.S. This recommendation is based on the increased incidence of virus variants in different parts of the globe. Self quarantining is not necessary.
The CDC recommends against travel until a person is fully vaccinated. Regardless of vaccination status, masks and physical distancing during travel is still required.
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.
New federal guidelines now allow guest visits in nursing homes unless
the nursing home residents are unvaccinated and the the county has a high positivity rate.
the nursing home resident has COVID-19 and is quarantined.
the residents are under quarantine for other reasons.
Vaccine Administration and Availability:
About 76% of Americans aged 65 and older have received at least one shot of the vaccine.
More people are becoming comfortable with vaccination for COVID-19: In January, 31% of the population was undecided about vaccination. Now, that percentage lies at 17%.
As of April 1, all adults in California aged 50 and older became eligible to receive the COVID-19 vaccine. On April 15, all people aged 16 and older will be eligible also. The state of California is expecting a surge in supply (2.5 million doses per week) starting early April to help meet the increased demand given these new guidelines.
Much of the world is seeing a spike in COVID-19 cases....we are much better off here in the U.S. and death rates continue to decline here. Much of the reason is our vaccination process: at this time, 3 million doses of vaccine are being administered every day and it looks like this number will increase to 4 million daily doses by next month. Over the last 5 days alone, more than 5% of Americans have received a vaccine shot. The U.S. is administering more vaccines than any other large country except for Britain.
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.
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.
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
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.
Three new trials have come out recently looking at vaccine efficacy against the many variants. Long story short: most variants still seem to be prevented by the various vaccines...with the exception of the B1.351 (South African) vaccine, for which the vaccines may be less protective. Stay tuned...
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.
More studies are coming out showing that this variant is about 60% more deadly than the original type.
This variant is becoming ever more prevalent, increasing by 7.5% EVERY DAY and doubling in incidence every week since mid February. Indeed, this variant is now the dominant virus an area containing two thirds of the U.S. population (much of the Eastern Seaboard, the Midwest, and much of the Sunbelt).
South African strain (aka N501Y.V2 or B.1.351)
This strain is also more contagious than the original virus.
The Pfizer vaccine was recently shown to protect against this variant.
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 recently cropped up in California. These strains also seem more contagious and possibly also make people sicker.
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.
A new variant seems to be infecting the southwestern coast of India and may have led to an increase of 55% in COVID-19 cases in India. Stanford has identified one case of this new variant in the Bay Area as well as 7 suspected cases.
Transmission:
A recent report in MMWR shows us why we can't let our guard down: a bar in Illinois, with an indoor capacity of 100 people, held an opening event in February, 2021. Four of the patrons had symptoms of COVID-19 and one other had no symptoms, but had tested positive the previous day. Afterwards, 29 patrons and bar employees tested positive. These people spread the disease to an additional seventeen people. Also, one of the attendees worked at a long-term-care facility and three people there tested positive thereafter and one needed to be hospitalized. Also, one school needed to close because of the outbreak, affecting the lives of 650 children. No more need be said...
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.
Even after people get discharged from the hospital with COVID-19, they continue to be at risk of bad outcomes: 29% are readmitted and 12% die. New onset breathing diseases are 27 times more common than in people who were discharged from the hospital with non-COVD-19 diagnoses.
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.
We all now know that SARS-Cov-2 commonly affects the heart. However, we have seen some encouraging results in a study looking at people with mild or moderate COVID-19: the overwhelming majority of such patients recovers completely and can exercise normally and proceed with normal activities (JAMA Cardiology).
On the ongoing question of blood type and susceptibility to COVID-19: a new study (JAMA Network Open) shows there was NO association of blood type and disease susceptibility or disease severity.
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.
The journal Lancet Psychiatry recently reported that people who recovered from COVID-19 developed neurologic or psychiatric diseases (e.g. depression, anxiety, substance use, dementia, stroke) one third of the time. People who were severely ill from the coronavirus were most at risk of such sequelae.
Incidence/ Prevalence:
After declining steeply for 3 months, the incidence of COVID-19 is rising again, as are the hospitalizations in some states. These states include Illinois, Minnesota, Michigan, and New Jersey. Almost half of the new cases were seen in 5 states alone (Michigan, New York, Florida, Pennsylvania, and New Jersey). In the past seven days, 65,000 new cases have occurred each day, which is up by 20% from the previous 2 weeks. In Michigan, the increase has been 125%. However, California continues to see a decline in cases. Overall, the predicted surge in the U.S. has not (yet) happened, at least not compared to other countries. But, please, let's stay vigilant. We are now in our fourth week of increasing cases.
Some statistics:
San Mateo:
number of cases:40,754 (40,032 two weeks ago)
number of deaths: 556 (528 two weeks ago)
number of people in the hospital: 13 (15 two weeks ago).
number of people who have received at least one vaccine: 340,517 (248,006 two weeks ago)
California:
number of cases: 3.69 Million (3.65 Million two weeks ago)
number of deaths: 60,142 (58,019 two weeks ago)
U.S.:
number of cases: 31.1 Million (30 Million two weeks ago)
number of deaths: 560,000 (544,000 two weeks ago)
World:
number of cases 134 Million (124 Million 2 weeks ago)
number of deaths: 2.9 Million (2.74 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.
The CDC and NIH is starting a study to see if frequent rapid at-home testing for SARS-Cov-2 helps to slow the spread of the virus: one county in north Carolina and another in Tennessee will have easy access to rapid at-home tests with testing to be performed three times a week. I am curious to see what effect this frequent testing of asymptomatic people has on control of the disease...
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. Once these tests become available (they can't be purchased yet as the companies ramp up production) we will be able to do much more frequent testing and hopefully therefore prevent transmission also.
Treatment
Vaccines:
A new vaccine (with the lovely name of "NDV-VXP-S") is entering clinical trials abroad right now. This vaccine is special as it relies on a new molecular design that is widely expected to produce a more robust immune response and could also be easier and cheaper to make. It would be grown in chicken eggs, like many influenza vaccines are produced currently. But the results of the first phase of trials are not expected until July, so it will be a bit until this vaccine has been properly vetted and is widely available.
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.
Recent tests looked at the efficacy of these two 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.
Slightly more people getting the Moderna vaccine (than the Pfizer/ BioNTech vaccine) report side effects. Also, the second dose is more likely to give you side effects. People older than 65 were less likely to have side effects compared to younger patients.
Pfizer/ BioNTech:
The likelihood of an allergic reaction to the Pfizer vaccine is close to 5/ million.
Pfizer started testing its vaccine in kids younger than 12; the results of the trial are expected in the second half of 2021.
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 company has recently reported that its vaccine is extremely effective in kids aged 12 to 15. It is hoped that middle and high school students can receive the vaccine prior to the next school year.
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.
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.
The FDA recently permitted Moderna to pack 15 doses (not just ten) in each vial. This will significantly expedite deliveries of the vaccine.
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.
An error in a manufacturing plant in Baltimore resulted in the contamination of 15 million doses of the J&J vaccine. As a consequence, future shipments of the vaccine will be delayed.
All current doses of the J&J vaccine available here are considered safe, as they were produced in the Netherlands.
J&J has widened its clinical trial to include kids aged 12 to 17.
The Oxford/ AstraZenica vaccine:
The company hopes for emergency use authorization by 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.
The European Medicines Agency has noted that low platelet counts and blood clots seem to be a rare side effect (86 cases of blood clots in 25 million vaccine recipients...18 cases were fatal) of the vaccine. They still believe the benefits outweigh the risks of the vaccine.
However, on 4/7/21, Britain recommended against the use of this vaccine for people younger than 30, as this age group was at highest risk for low platelets and blood clots.
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.
Oxford University is launching a study looking at a nasal version of 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:
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.
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 County moved into the orange tier on 3/17/21.
However, it seems that we ill never graduate to a green tier because all tiers (purple, red, orange, and green) will likely be eliminated come June 15. This assumes that vaccinations will be widely available and that the hospitalizations will remain low. At that time, Californians (regardless of county!) will be able to go back to restaurants, bars, theaters, and concerts without strict capacity limits. We will need to continue to wear masks, however....at least for now.
On March 31, Gov Newsom announced that the state was infusing San Mateo and San Francisco counties with $750,000 each to help with administration of coronavirus vaccines. Santa Clara, Contra Costa, Alameda counties will receive $1.5 million each; $400,000 is going to Marin, Napa, Solano, and Sonoma counties (each). The plan is to use this money to help vaccinate those communities that have been particularly affected by the disease.
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.
As of April 8, Santa Clara County allowed all residents aged 16 yo 49 to scheduled COVID-19 vaccination appointments, though they will not start giving vaccinations to these people until after April 15...but it looks like this applies only to Santa Clara residents, not to residents of San Mateo.
San Mateo continues to have low COVID-19 rates and is making steady progress in vaccinations. Currently, about 50% of San Mateo residents 16 and older have received at least one dose of vaccine. The supply remains limited, however, as many of you who have tried to get an appointment already know!
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. 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.
About Dr. Sujansky's Life in These Times
On a more personal note, my family and I continue to do well.
We had a lovely Easter celebration. My husband and I were quite surprised on Easter morning to discover that the Easter Bunny had hidden some chocolate-filled eggs in our back yard. Somehow, the Easter Bunny had clued in my son Markus, as he was less surprised by this turn of events. At any rate, I have not looked for Easter eggs in a very long time, so it was quite a treat.
My son has heard from colleges and is headed back to the East Coast even as we speak (write?) to take another look at some schools. We are very excited for him, but are coming to understand that he will be 2000 miles away next year. I'll let you know what college he decides on, once we know!
I am also attaching a picture of our dog Mala with her new haircut. I have her get the "puppy cut" despite the fact that she is an old lady at 14 years old....I know that I myself ordered off of the children's menu at restaurants long after it was proper to do so....so I figured Mala could pull the same stunt with her hairdo.
