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.
More highs and lows in the coronavirus pandemic news: on one hand, more than 100 million people in the United States are FULLY vaccinated - 40% of the population! Unfortunately, experts believe that we will never reach "herd immunity" as there are too many people who refuse to get vaccinated. If we don't get to herd immunity, this infectious disease can't be eradicated and the virus will continue to be present in our community (hopefully at low levels!) for a long, long time. Only by reaching herd immunity can we hope to prevent future new variants that are immune to our current very effective vaccines. If we managed to get the vast majority of people vaccinated by July, however, the pandemic would be throttled - at least temporarily! - according to a recently released paper put out by the CDC.
Other parts of the world are not as lucky in their disease activity: over 800,000 new cases are reported every day throughout the world. At this time, half of those cases (400,000) are in India. And I suspect that this case count is a vast underestimate, as many countries are not reporting their number of cases (or deaths!) accurately.
General Information:
The CDC has updated their guidelines for summer camps: the recommendations are very similar to those they put together previously for schools:
Campers in the same cohort should stay 3 feet apart, except when eating: then they should be 6 feet apart.
All campers and staff (even if immunized) should wear a mask.
Camps should offer more outdoor activities. If activities are indoors, then doors and windows should be open (when possible).
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.
The CDC has now said that people who are fully vaccinated do NOT need to be wearing a mask outside as long as they are taking walks, hiking, jogging, biking, running, or meeting in small groups with family members or other vaccinated individuals.
Vaccine Administration and Availability:
More than 100 U.S. colleges are requiring COVID-19 vaccinations for students returning to campus.
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. This action hopes to address the 8% of Americans who have not returned for their second COVID-19 vaccinations and are therefore not optimally protected.
The CDC is rolling out a service that allows people to find out where vaccines are available via text message. The service will be launched along with a new-and-improved website ("Vaccines.gov") that will replace the "VaccineFinder.org" website currently in use.
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. 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.
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. A recent study published in the New England Journal of Medicine looked at the real-world Pfizer vaccine use in Qatar: 87 to 89.5% of the people were protected from infection. Also, for the South African variant (B.1.351), the vaccine was 72% to 75% effective)
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. 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.
Transmission:
I have nothing new to report here; remember:
masks, masks, masks, and common sense!
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.
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.
A study published in JAMA Network Open suggested that an increased risk of stroke due to COVID-19 persists 2 months after acute onset of the infection.
Incidence/ Prevalence:
California now is the state with the lowest incidence of COVID-19 in the U.S. On Tuesday in San Francisco, there were only 15 people hospitalized with the disease! Hospitalizations throughout the state are at their lowest level since the early days of the pandemic. And, mind you, these numbers are a huge, huge turn-around from the winter surge that left hospitals in Southern California overwhelmed.
Although children are much less likely to contract the novel coronavirus compared to the beginning of 2021, children do make up 22.4% of new cases overall. One year ago, children made up only 3% of new coronavirus cases.
Michigan, Florida, Texas, and New York still have significantly higher rates of COVID-19 infections.
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:41,755 (41,318 two weeks ago)
number of deaths: 567 (560 two weeks ago)
number of people in the hospital: 21 (29 two weeks ago).
number of people who have received at least one vaccine: 482,598 (426,808 two weeks ago) - 75.1% of the adult population!
California:
number of cases: 3.75 Million (3.73 Million two weeks ago)
number of deaths: 62,165 (61,261 two weeks ago)
U.S.:
number of cases: 32,6 Million (32 Million two weeks ago)
number of deaths: 579,000 (560,000 two weeks ago)
World:
number of cases 156 Million (145 Million 2 weeks ago)
number of deaths: 3.26 Million (3.07 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 available in retail pharmacies in the Bay Area starring this week!
Treatment
Vaccines:
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.
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.
A recent study done by CDC researchers again confirms that the Moderna and the Pfizer/ BioNTech vaccines are highly effective in preventing hospitalizations due to COVID-19 in older adults. Even those seniors who received only one dose of the vaccine were 64% less likely to be hospitalized due to the coronavirus compared to unvaccinated seniors.
Pfizer/ BioNTech:
The likelihood of an allergic reaction to the Pfizer vaccine is close to 5/ million.
The FDA may authorize the use of the Pfizer/ BioNTech vaccine in kids aged 12 to 15 as early as next week! Canada has already approved use of the vaccine in this age group.
Pfizer expects for apply for FDA emergency use authorization to use their vaccine in kids aged 2 to 11 by September.
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.
The pharmaceutical giant Sanofi will help Moderna make up to 200 million doses of its vaccine. This will help increase vaccine supply quickly.
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.
At this time, there have been a total of 17 cases of blood clots and low platelet counts (TTS) associated with the vaccine. This translates into a incidence of about 2 events of TTS per million people vaccinated. Women under 50 are at highest risk for blood clotting (approximately 7 cases per million). This could be compared to approximately 2,100 fewer COVID-19 related deaths and 6000 fewer COVID-19 hospitalizations if one million people were to receive the J&J vaccine..
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 the rare blood clotting events. Overall, the agencies stated that the benefits outweighed the rare risks.
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.
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.
AstraZenica is hoping to seek emergency use for use in the U.S. by mid-May.
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.
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.
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.
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:
Case rates of COVID-19 infection in San Mateo county are down, testing rates are up, and vaccines are available for any adult who works or lives in the county.
Officials said this week that they hope that San Mateo will move to the least restrictive yellow tier as early as next week.
There will now be two or three weekly COVID-19 mass vaccination clinics at the San Mateo County Events Center. Upcoming vaccine clinics include
May 7: 1 pm to 7 pm: Pacelli Event Center, Daly City (Moderna)
May 8 (1 pm to 5 pm): Cesar Chavez Ravenswood Middle School, EPA (Moderna)
May 8 (10 am to 4 pm): 616 Linden Ave Lot, SSF (J&J)
May 8 (10 am to 6 pm): San Mateo High School (J&J)
May 9 (11 am to 5 pm): Fair Oaks Health Center, RWC (J&J)
Community Clinics have made some progress in vaccinating the hardest-hit communities, but much work there still remains. In San Mateo's most vulnerable communities, the vaccination rate is now 59%, while the county-wise average is over 70%.
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, has made a choice for college next year: he is going to Boston College and we are all very excited. As my other son is at Georgetown, I see some cross-country plane trips in my future! As a consequence, I have just ordered a credit card from United Airlines...
Last night we watched this year's Woodside High School musical - featuring my son Markus. A year ago, the musical was cancelled 3 days before opening night. This year, it's a "pandemic musical:" the performance can only be viewed online. The kids had to be video-taped outside in front of a green screen and a new background was then super-imposed by the technicians. And the kids couldn't be on stage at the same time, but had to be filmed separately and then, again, super-imposed in post-production. Given all of this, you would think that the final product would be sub-optimal. Well, I know I am biased, but it was fantastic and certainly one to remember! Very fun!
Happy Mother's Day to all mothers as well as those who function in a maternal role. Your job is hard and valuable, though the rewards are many (though often come spread far apart!) My own mother never wanted to celebrate Mother's Day, believing that "every day should be Mother's Day." Alas, being a mother myself, I know that every day is NOT Mother's Day. So I have no problem letting my family spoil me with dinner and coffee in bed.
