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.
At least 25 states have reported that 50% of their residents are now fully vaccinated. However, communities with lower vaccination rates show ongoing infections and spread of the virus. The Biden administration has set a goal of getting 70% of American adults vaccinated with at least one dose of vaccine by July 4. At this time, about 63% of American adults have received at least one dose of vaccine.
A recent study from the World Organization stated that deaths associated with COVID-19 were likely two to three times higher in countries that have reported their data....and possibly much higher yet in those countries that have reported their death counts less reliably. At this time, it is estimated that 6 to 8 million people of have died from the disease directly or from the effects of the pandemic.
Also, the Institute for Metrics and Evaluation at the University of Washington projected that global deaths attributed to the coronavirus would reach 9.1 million by September, 2021. This number is about 50% higher than the current number of deaths and takes into consideration the significant undercounting that is occurring in parts of the world.
For the first time since March, 2020, the U.S. has recorded and average of fewer than 20,000 new cases of COVID-19 per day over the last two weeks.
General Information:
A recent study in JAMA showed that Americans of all demographic groups are less hesitant now to receive the COVID-19 vaccine than in late 2020. Black and Hispanic Americans, in particular, who have been disproportionately affected by the disease, had also been particularly suspicious of the vaccine. Luckily, these groups have also gained trust in the vaccine. Unluckily, there are still many people who don't want to be vaccinated and are concerned about vaccine repercussions.
A recent article published in JAMA found that expectant mothers vaccinated with the coronavirus vaccines later secreted protective antibodies in their breast milk, thereby providing additional protection to the newborn babies.
Many states have created a framework in which certain centers may legally require proof of vaccination for specific activities. Public universities in California will require proof of vaccination to attend school in the fall. Also, audience members at live entertainment venues will require either proof of vaccination or a negative test result.
A study published in the journal Nature showed that immunity to recurrent COVID-19 infection (in people who have had the disease previously) seems to last for at least one year! This is great news indeed.
Right now it seems that people who became ill with COVID-19 and then were later immunized will not need a booster anytime soon.
However, people who were not ill initially may well need a booster vaccine down the road. It is still unclear when such a booster would be needed. Studies show that vaccine immunity lasts at least 6 months (the vaccines haven't been around long enough to check if the immunity could last for longer...stay tuned). But we now know that we shouldn't just look at antibodies to judge a person's immunity: other immune cells like T-cells and memory B-cells, for instance, are harder to measure but are active in an ongoing immune response.
Remember the rumor that vitamin D levels were correlated with susceptibility to the coronavirus? Well, a recent article in JAMA Network Open looked at 18,000 study participants and showed that there was NO higher risk of infection if your vitamin D levels were low.
A recent study in the Annals of Internal Medicine looked at some of the financial costs of COVID-19 coming from the costs of direct patient care of Medicare patients:
Among the 28.1 million Medicare FFS beneficiaries, 4.2% sought medical care for COVID-19-related issues.
Of those 4.2% of patients, 23% needed to be admitted to the hospital and 4.2% died during hospitalization.
Overall, Medicare paid $6.3 billion, 93% of which were for the hospital stays.
Well, it looks like there will be 10%-15% more births this summer and fall due to the pandemic compared to prior years....Early in the pandemic, pregnancy rates fell, but people are clearing making up for this now!
Vaccine Administration and Availability:
Sutter has walk-in locations across the Bay Area: they offer the Moderna vaccine to anyone aged 18 or older. COVID-19 vaccination appointments can also still be made on line through the "my health online" website or by calling 844-987-6115.
Uber and Lyft will offer free rides to vaccinations sites 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.
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
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.
SARS-COv-2 variants:
B.1.1.7
Scientists estimate that this variant spread about 1.55 times faster than the previous variant.
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.
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. 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, including the United Kingdom. Indeed, this variant is the most common in the U.K. right now. This strain is more contagious than previous strains. A new study suggests that fully vaccinated people are protected from this variant. In particular, the data looks promising for the Pfizer vaccine - most of the other vaccines have been less well studied. The Astra Zenica vaccine seems less effective in preventing COVID-19.
Transmission:
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.
New findings published in JAMA used computer modeling to show that pandemic precautions of social distancing and masking in certain settings are needed to end the pandemic. Vaccination alone may not be adequate to achieve this goal.
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.
Remember the inflammatory disease that rarely affected kids who had come down with COVID-19 called "MIS-C"? A recent small study (Lancet Child) showed that most of the debilitating health issues resolved within a six month time period.
The lingering effects of COVID-19 infection ("long-haul COVID") continues to be investigated. Prominent symptoms include brain fog, kidney damage, and lung problems. Long-haul COVID-19 is seen in 45% of people who were sick enough to require hospitalization for COVID-19.
The Big Ten Conference athletes who developed COVID-19 showed that about 2% of the athletes had evidence of heart inflammation on testing. A total of about 0.5% of athletes had any symptoms (like chest pain and palpitations).
Incidence/ Prevalence:
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:42,396 (42,126 two weeks ago)
number of deaths: 576 (570 two weeks ago)
number of people in the hospital: 10 (13 two weeks ago).
84% of people aged 16 or older.
California:
number of cases: 3.79 Million (3.77 Million two weeks ago)
number of deaths: 63,392 (62,810 two weeks ago)
U.S.:
number of cases: 33.4 Million (33.1 Million two weeks ago)
number of deaths: 596,000 (588,000 two weeks ago)
World:
number of cases 172 Million (166 Million 2 weeks ago)
number of deaths: 3.70 Million (3.43 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. The tests are currently available in retail pharmacies in the Bay Area.
The NIH recently began offering a one month's worth of home rapid COVID-19 tests for free to residents of Pitt County, North Carolina, and Chattanooga/ Hamilton County, Tennessee. These counties were chosen due to their infection rates and other factors like infrastructure support and data access. The goal of this study is to better understand the effectiveness of readily-available home tests on the COVID-19 national response. These 160,000 residents can order the tests, to be used 3 times per week.
Treatment
Several recent studies examined how persistent symptoms from prior COVID-19 infection (the so-called "long haul symptoms" responded to people getting vaccinated: 23% of the symptoms improved, 5.6% of the symptoms got worse, and 71% remained unchanged.
Yet another study (published in JAMA on 5/26/21) looked at over 40,000 people who had received at least one coronavirus vaccine and found that it protected them exceedingly well from infection with the virus. None of the vaccine recipients who had received the vaccine developed severe disease. Serious adverse reactions to vaccination were rare and did not differ in people who received the vaccine and those that received the placebo.
Pfizer/ BioNTech:
Pfizer expects for apply for FDA emergency use authorization to use their vaccine in kids aged 2 to 11 by September.
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.
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.
There have been reports that a "very small" number of teenagers and young adults developed myocarditis (an inflammation of the heart muscle) after receiving their vaccines. The cases seem to have been mild and we are not clear how many cases have been reported or, indeed, if there is a causal relationship to the vaccine. Stay tuned. However, Israeli health officials do think there is a probably link between the vaccine and the rare heart disease; in their records, myocarditis occurs in about 5 out of 100,000 vaccine recipients. On 5/27/21, the FDA announced that myocarditis is rare among adolescents and young adults who have been vaccinated and again note that a correlation between myocarditis and vaccine administration is unclear.
Moderna
Moderna announced that trials of its vaccine on people aged 12 to 17 showed that the vaccine protected this age group well and safely. Moderna will apply for emergency use in this age group in June.
Moderna is looking to halve its current vaccine dose and use this (reduced-dose) version for children or to combat variants.
Moderna has joined Pfizer in applying to the U.S. Food and Drug Administration for full approval for it's vaccine - not just as an "emergency use authorization."
Johnson & Johnson:
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
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 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:
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.
The FDA as granted emergency use to a third COVID-19 antibody treatment for people at high risk of hospitalization. The new medication, "sotrovimab," is effective against the variants seen in India, U.K., South Africa, Brazil, California, and New York. Like previous antibody treatments, this medication requires intravenous administration and is usually available in the emergency departments of hospitals.
Another trial (Lancet) showed that convalescent plasma did not improve survival in COVID-19 patients who are sick enough to be in the hospital. Recall, in the early days of the pandemic, we hoped and believed that giving COVID-19 patients blood plasma from those who had had previously survived the disease we could make the patients better. Subsequent trials cast that assumption in doubt. And now another study has debunked this treatment method alltogether.
Our Community and Beyond:
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.
At this time, face coverings are NOT required in most outdoor settings for fully vaccinated people. However, even vaccinated people must wear masks in businesses and crowded spaces (indoors and out!). If you are not vaccinated, face coverings are still required even outdoors, when physical distancing can't be maintained.
On June 15, California will reopen almost entirely, as long as the number of hospitalizations remain low and vaccines remain plentiful. Here are some details:
Stores, gyms, restaurants, theaters, etc will no longer have a maximum number of patrons that can be present at one time.
The color-coded system of restrictions will end.
Social distancing guidelines will no longer apply.
Exceptions to the above new guidelines involve "mega events," in which more than 5,000 patrons (indoor events) or more than 10,000 patrons (at outdoor events) will be present. Such events are more likely to spread the coronavirus. As a consequence, attendees of such mega events need to either show proof of vaccination or have a negative COVID-19 test at entry. Conventions, sporting events, business conferences, and concerts may often qualify as "mega events."
On May 27, Governor Newsom announced a very lucrative lottery for people who have received the coronavirus vaccine. A total of $116.5 million will be distributed as follows:
$1.5 million will be given to each of 10 "grand prize" winners who will be picked randomly on June 15.
$50,000 will go to 30 people on June 4 and 11.
The remaining $100 million will be divided up in $50 retail gift cards for the next 2 million Californians to complete their vaccine.
If you have received your vaccine already, you will automatically be entered into the $1.5 million and the $50,000 contests.
Given the plentiful supply of vaccines at this time, the San Mateo County Events Center will no longer be offering vaccination. SFO will continue its mass vaccination sites for second-dose vaccinations.
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.
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.
I have had a busy last week, as my younger son graduated high school today! I feel so blessed that we could have an in-person ceremony, though attendance was limited to only 3 guests. I'll admit that I cried. But I also have to admit that I had a hard time recognizing my son in the field of students, all wearing the same graduation gown, with a mortar board covering their heads and a mask covering their faces.
Also, for my son's graduation, my parents as well my sister and brother-in-law are in town and staying with us. Our house is full but joyful...and we'll be eating out in celebration a lot in the coming days! We're also considering an outing to the Alameda Antiques Fair this weekend - let's see if we are up to it.
I think the news of COVID-19 has now finally dropped along with the cases of the deadly disease. So my next newsletter will be in 3-4 weeks, depending on the news and my mood. Feel free to shoot me an email with questions if any come up before my next missive!
