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.
On May 13, the CDC came out with new recommendations: fully vaccinated Americans now can go out without a mask or maintaining social distancing! Life seems on the brink of becoming normal again! Masks are still required on public transportation (think buses and planes) and in jails, homeless shelter, and medical settings. Any of the vaccines available in the United States will qualify a person to do without a mask. However, if your system is significantly compromised (like if you are receiving chemotherapy for cancer) then it may behoove you to continue to wear a mask, as the vaccines may not have bolstered your immunity as much as in others. Unvaccinated people will need to continue to wear masks....however, I think none of us would be surprised if some unvaccinated people weren't always compliant with wearing one.
These updated recommendations are based on the increasing vaccination rates in the U.S., the efficacy of the vaccines available, and the dropping cases of COVID-19 we have witnessed in the last month. People who have of COVID-19 still should be checked for the disease, even if they have been vaccinated in the past.
Of note, California has announced that they will not implement the new CDC mask recommendations until June 15. Also, the WHO's top European official also recommended ongoing donning of masks. At the same time, the vaccination rates in Europe are much lower than in the United States - on the order of 32% only.
Unfortunately, the pandemic is spreading rapidly in other parts of the world, especially in Asia. This is bad news for the United States also, as new, potentially more dangerous variants evolve when the virus is left un-checked. Even so, global cases are down 23% compared to their peak in April.
Most epidemiologists believe that we need to get 70% of the U.S. population (not just 70% of the adult population!) vaccinated to allow for most activities to resume without precautions. Getting younger teenagers vaccinated will be an important step in that direction. Currently, 60% of American adults (48% of the population overall) are at least partly vaccinated. Also, some people have been infected with the virus in the past and may have some degree of immunity from that.
Unfortunately, the total vaccination percentage belies the highly uneven vaccination rates across our country. The Southeast U.S., in particular, has much lower vaccination rates and these communities continue to be at high risk of COVID-19 outbreaks. As an example, in Mississippi, only 45% of the adult population has received the vaccine. To help boost vaccinations, several states (including Maryland and New York) have instituted lotteries, in which vaccinated people are eligible to win large amounts of money. Sadly, California is not one of those states...
Also of note, about 3% of the American population take medications that suppress their immune systems. Such people may get vaccinated and continue to be susceptible to the virus....which is why herd immunity -which protects everyone- is such an important goal.
The CDC and FDA have approved the Pfizer/ BioNTech vaccines for kids aged 12 to 15 and San Mateo has begun offering them to that age group already! Children aged 12 to 17 must be accompanied by a parent or grandparent to the vaccination clinic.
General Information:
The president of the European Commission said that American tourists would be able to visit the European Union this summer, as long as they were fully vaccinated.
The CDC has now clearly recommended that pregnant women should be vaccinated for COVID-19 and that no safety concerns were found after monitoring 35,000 women in their third trimester of pregnancy who had received the vaccines.
A new study published in the Annals of Internal Medicine looked at dialysis patients who had previously been infected with the SARS-Cov-2 virus; these are patients whose immune system is not as robust, in general, compared to those patients with healthy kidneys. But even 6 months after being ill with the coronavirus, analysis of blood of dialysis patients still suggests that these patients were protected from renewed infection.
Vaccine Administration and Availability:
More than 100 U.S. colleges are requiring COVID-19 vaccinations for students returning to campus.
Uber and Lyft will offer free rides to vaccinations sites starting in the next 2 weeks and going on until the 4th of July. This service is offered as part of a new partnership between the federal government and these ride-sharing companies. Other efforts in facilitating vaccination will include offering vaccines at community colleges and improved funding for local and tribal governments.
The federal government is investing $7.4 billion to hire more public health workers to deal with the pandemic as well as potential future health crises. The funds will come form the $1.9 trillion coronavirus relief package passed previously. About $3.4 billion will go to states and local health departments to help hire vaccinators, contact tracers, virus testing technicians, and epidemiologists.
Federal health officials have directed pharmacies to administer second COVID-19 vaccines to people who may have received their first shot from a different provider or source.
Please realize that your vaccination cards are NOT the only record of your vaccination status! All vaccine administrators have to document the vaccines they give in a central database. You can view your status at
https://cairforms.cairweb.org/AuthorizationToRelease/
If you have problems accessing this site, you can call 800-578-7889 or email CAIRHelpDesk@cdph.ca.gov
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.
You can also directly register via San Mateo County:
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.
Please let me know if you get a COVID-19 vaccine, so I can add it to your medical chart.
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.
SARS-COv-2 variants:
B.1.1.7
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.
This variant is now the dominant virus an area the U.S. population. However, for reasons that are not clear, the Bay Area has been relatively spared by this variant.
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.
India: the strain that is ravaging India (B.1.617) has spread to dozens of other countries so far. It seems that this strain is more contagious than previous strains, though details are still not known. We also don't yet know how well our current vaccines protect against this variant.
Transmission:
The CDC previously characterized the likelihood of SARS-Cov-2 transmission outdoors, as "less than 10%." While this is factually accurate, it is also belies the truly low rate of outdoor transmissions, which is actually less than 0.1%. And those outdoor transmissions that have occurred stem from crowded places or close conversations.
The CDC also just updated their guidance on transmission of the novel coronavirus, emphasizing that the virus has airborne spread in addition to droplet spread. This means that the virus can be spread through the air - not just through respiratory droplets. It also means that people more than 6 feet from the source can get infected, especially indoors. This will have public health ramifications as to proper ventilation systems and separation in public places. The details on what the CDC recommends on this latter issue is not available as yet.
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. However, a recent study coming out of Denmark found that "serious cases of 'long-haul COVID-19' are rare in patients who were not hospitalized after their infections, but these patients still report more doctor or health care visits after recovery."
A recent article published in Lancet Rheumatology confirmed previous findings that NSAIDS (like advil, motrin, aleve) do NOT make COVID-19 more severe in people who take such medications.
Incidence/ Prevalence:
COVID-19 deaths in the U.S. have dropped to only 600 per day, which represents the lowest level in the last 10 months. Confirmed cases have dropped also, which is the lowest level since September and an 85% decline since early January. COVID-19 deaths are at their lowest levels in 14 months!!
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. Not surprisingly, a recent study published in the journal Lancet, showed that people hospitalized with COVID-19 in Africa were much more likely to die of the disease than in the United States.
Some statistics:
San Mateo:
number of cases:42,126 (41,755 two weeks ago)
number of deaths: 570 (567 two weeks ago)
number of people in the hospital: 13 (21 two weeks ago).
number of people who have received at least one vaccine: 81% of people aged 16 or older; 78% of people aged 16 and older have completed their vaccination series.
California:
number of cases: 3.77 Million (3.75 Million two weeks ago)
number of deaths: 62,810 (62,165 two weeks ago)
U.S.:
number of cases: 33.1 Million (32,6 Million two weeks ago)
number of deaths: 588,000 (579,000 two weeks ago)
World:
number of cases 166 Million (156 Million 2 weeks ago)
number of deaths: 3.43 Million (3.26 Million 2 weeks ago)
Testing
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 $25 for a two pack. This test is currently available in retail pharmacies in the Bay Area.
Treatment
We are learning some more data about the efficacy of the COVID-19 vaccinations. 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.
About 8% of people who have received their first dose of Moderna or Pfizer/ BioNTech vaccines did not return for their second dose. This is troublesome, as the second dose significantly increases the protection provided by the vaccines and will help achieve herd immunity sooner.
People who have had transplants of their organs also respond to the Moderna and Pfizer/ BioNTech vaccines, but not has well as "healthy" individuals. This is hardly surprising, as such patients are on strong medications to suppress their immune systems to keep the "new" organs from being rejected. Unfortunately, this suppressed immune system also means that they are less likely to mount an large immune response to the vaccine.
More studies are coming out that using the Moderna or Pfizer/ BioNTech vaccines in pregnant and breast-feeding women is not only safe, but beneficial to the life of the mother and baby. Immune responses to some of the "variants of concern" were noted as well! (JAMA 5/13/2021). Protective antibodies can be passed on to the developing child.
Yet another study has come out showing that the Pfizer/ BioNTech and Moderna vaccines are 94% effective in preventing symptomatic disease.
Pfizer/ BioNTech:
Pfizer expects for apply for FDA emergency use authorization to use their vaccine in kids aged 2 to 11 by September.
More studies published in recent past confirm the fact that the vaccine significantly reduces the incidence of symptomatic and asymptomatic infections. This was seen in studies on Israeli health care workers (JAMA), the Israeli general population (JAMA), and in health care workers in Tennessee (Lancet).
On 5/10/21, the FDA authorized the Pfizer vaccine for kids between the ages of 12 and 15 - the vaccine had already received authorization for people 16 and older previously. This will help allow for schools to reopen and reduce transmissions in general. The FDA decisions is based on a trial of 2,300 kids aged 12 to 15, half of whom received the vaccine while the other half had a placebo: the vaccinated kids had a strong immune response that was even better than the immune response seen in young adults! Also, none of the vaccinated kids developed COVID-19.
Pfizer and BioNTech have asked the FDA for full approval for their vaccine. If this is granted, then the vaccine will be taken out of the "emergency use" category and could be given to patients even after the current public health crisis is over.
Moderna:
Moderna has announced that its vaccine can be stored at refrigerator temperatures for up to 3 months. This will make the vaccine more easily available to individual doctor's offices that do not have access to commercial grade freezers.
Early trials show that a third "booster" shot of the Moderna vaccine is very effective in preventing the coronavirus variants found in Brazil and South Africa. Moderna is also studying a shot that combines the original vaccine with one that includes antigens from these newer variants.
Johnson & Johnson:
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
On April 23, the CDC and the FDA authorized resumption of administration of the J&J vaccine, but that the vaccine should carry the warning about rare blood clotting events. Overall, the agencies stated that the benefits outweighed the rare risks.
On May 12, the CDC announced that their latest review found a total of 28 cases of blood clotting among the 8.7 million people who had received the vaccine. Three people of those 28 had died.
The safety monitoring system for the J&J vaccine was published on May 7 in MMWR: it found that 97% of reactions were not serious. A total of 17 instances of blood clots were found (in about 8 million doses administered). The rare serious instance of low platelet counts and blood clots occurs mostly in women. The good news is that this rare side effect was actually identified very quickly and speaks to the efficacy of the U.S. vaccine safety monitoring system.
The Baltimore plant of Emergent BioSolutions, which was supposed to produce millions of J&J vaccines, recently disclosed that 100 million more vaccine doses were currently on hold due to possible contamination. This was the same plant that ruined millions of doses of the vaccine previously. None of the J&J currently in circulation have come from this plant, so the J&J vaccine out there is not contaminated.
The Oxford/ AstraZenica vaccine:
This vaccine has not been approved for use in the United States yet.
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.
Novavax:
One advantage of this type of vaccine is that it can be manufactured on a large scale quickly.
It is produced my a company based in Maryland.
Studies are actually very promising for this vaccine and show very high efficacy. However, it won't be available in the U.S. until at least July.
Sinopharm:
The WHO has declared the vaccine produced by the Chinese company "Sinopharm" as safe and effective. This vaccine is not yet approved for use in the United States.
The Russian vaccine known as "Sputnik V" was reported in the medical journal Lancet to have a 92% efficacy in preventing symptomatic disease.
CureVac:
We may soon have a new mRNA vaccine on the market: the German firm CureVac has developed a mRNA vaccine that is in late-stage trials. The advantage of this vaccine is that it does not need to be stored in a freezer, but can be kept in a regular refrigerator.
The French pharmaceutical company Sanofi has partnered with GlaxoSmithKline in developing their own new COVID-19 vaccine. This vaccine is only in phase 2 trials for now, but seems very promising also: no safety concerns have been identified so far. Stage 3 trials should be starting soon.
Our Community and Beyond:
San Mateo and San Francisco counties moved into the least restrictive yellow tier on May 12, allowing yet more freedom of movement and larger gatherings. This is the first time San Mateo is in the yellow tier since the color-coded blueprint was announced for the state last summer.
Santa Clara and Santa Cruz counties may progress to the yellow tier by next week.
It is not clear if California will create a statewide system to allow easy verification of vaccine status. Santa Clara County, however, has implemented a new requirement that employers find out which of their workers have been vaccinated. This would let work places figure out if masks are needed in their places of work.
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.
Please note that the CDC continues to recommend face masks in medical settings. As a consequence, despite the recent loosening of mask mandates, we ask you to wear a mask when you come to our office.
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.
Both my sons received their second COVID-19 vaccine last week and we brought out the coronavirus piñata that I had purchased previously. Below, please find a very silly-looking Dr. Sujansky trying to whack the COVID-19 virus to the moon.
My older son Stefan leaves for Ghana tomorrow, where he has a summer internship. Happy for him, sad for me...
Meanwhile, preparations are in full swing for my other son, Markus, who will graduate from high school in a few weeks. We now have a yard sign on our front lawn indicating that there is a graduating senior in the house. He has picked up his cap and gown from school. This is bright orange (ouch!) as that is the school color...I hope it goes well with his orange (aka strawberry blond) hair! And he has his "senior soiree" tomorrow: as the school couldn't have an official prom, this event on the football field on Saturday night will feature all sorts of games and goodies to try to make it up to the kids.
