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. I will include some details on this topic from previous newsletters, as they remains important - new information will be in BOLD.
General Information:
All the talk these days is about the Delta Variant of SARS-Cov-2. As noted below, this variant is particularly contagious and also more aggressive. On 7/7/21, the CDC announced that this variant is the dominant strain in the U.S., accounting for for about 52% of new infections. Luckily, the vaccines used in the U.S. do protect against this variant. As a consequence, the CDC has said that vaccinated people need not wear a mask. At the same time, the World Organization has used the Delta variant as a reason to recommend ongoing mask-wearing, even in vaccinated people: the rational behind this is that vaccinated people can still carry the virus (asymptomatically) and then cause unvaccinated people to become infected with this nasty bug. See the information I have added below on the Delta virus also.
Most areas of the U.S. are seeing a surge of COVID-19: 41 states have noted an increase in average daily cases. The case count is 60% higher than it was only two weeks ago. The U.K. is now reporting their highest caseloads since January 29. The Delta virus is likely responsible for this increase, given is much higher transmissibility. One month ago, L.A. county joined the rest of the state in opening up its doors and removing mask mandates. As of last week, L.A. residents will again be required to wears masks in indoor public spaces - regardless of vaccination status.
Scientists in the journal Nature announced on 6/28/21 that the vaccines made by both Pfizer/ NioNTech and Moderna "set off a persistent reaction in the body that may protect against the coronavirus for years." This would be fantastic news, as this would mean that we would not need boosters for years - unless, of course, the virus mutates a lot and the current vaccine no longer offer protection....which leads us to two reason to get the vaccine:
it will likely protect you for a long while
If enough people are vaccinated, then we can prevent the virus from mutating in the future.
Vaccine Administration and Availability:
Luckily, some of the communities that have been hardest to vaccinate are now seeing an uptick in vaccination rates. Decreased vaccine hesitancy seems to be related to the large and ever-increasing number of people who have been vaccinated and not suffered any serious side effects from the vaccine.
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.
California recently launched a new way that residents can access their vaccine records: go to myvaccinerecord.cdph.ca.gov and input your name, date of birth, phone number/ email and four-digit PIN. Users will then receive a link to their digital record with their vaccination status. This may come in handy if businesses decide to require patrons to show proof of vaccination for entering without a mask. I'm thinking that entertainment and sports venues may likely do that. Another time this digital information may come in handy is if you are traveling.
New COVID-19 variants
A study published in early June in Nature provided some welcome results, indicating that our vaccines seem to be quite effective against the current variants. In particular, the J&J vaccine was tested on the South African variant ("Beta") and found a robust antibody and T-cell response. The T-cell response, in particular, doesn't seem to be any worse in the new COVID-19 variants - Alpha and Gamma as well as Beta. This would explain why the J&J vaccine is working so well in South Africa, where the three different variants are prevalent. Similar effects have also been observed with the Pfizer/ BioNTech and Moderna vaccines
SARS-COv-2 variants:
(Alpha Strain)
Scientists estimate that this variant spread about 1.55 times faster than the previous variant.
Beta Strain
This strain is also more contagious than the original virus.
Gamma Strain
Epsilon Strain
Delta Strain
This strain has been found in 80 countries and comprises 20% of the new infections in the United States.
This variant is both significantly more contagious than prior versions of the virus.
The recent evidence suggests that the Delta Variant is NOT more deadly that the previous virus strains.
A new analysis shows that the Pfizer/ BioNTech vaccine is 96% effective in preventing hospitalizations due to the Delta variant. The AstraZenica vaccine is 92% protective. So our vaccines work against this virus variant.
According to a new study (Nature), the variant does have some mutations that allow it to bypass the immunity we can get via vaccination or prior COVID-19 infections. As a consequence, only one of the two part vaccination offered by Pfizer/ BioNTech or Moderna does not protect people against this variant. However, getting both shots does protect significantly.
A study from Israel's Health Ministry showed that the Delta virus was more likely to evade Pfizer's vaccination protection. Even so, the vaccine prevented severe illness 94% of the time.
Unlike previous variants, the Delta strain is so contagious that it can spread after people are exposed for just 5 to 10 seconds (according to Australian health officials). Prior strains required many minutes of contact to afford transmission.
Lambda strain: a new variant has just emerged, originally in Peru. It is spreading in South American countries. AT this time, this variant does not seem to cause more severe disease. At this time, there is no suggestion that current vaccines don't protect from this variant.
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.
A recent article in Clinical Infectious Diseases showed that 0.7% of patients who have recovered from severe COVID-19 infections contracted the disease a second time....so: not a lot, but it does happen!
0.04% of COVID-19 cases in California are in vaccinated individuals in 2021. Of those cases, 7.6% were hospitalized
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.
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.
Yet another study (Jama Open Network) shows evidence of the "long-haul" COVID syndrome: more than 70% of people who have recovered from the infection experience at least one symptom for at least 60 days.
Some good news for those people who lose their sense of taste or smell after getting infected with SARS-Cov-2: the vast majority seem to recover within 8 months....a long time, I know, but at least they recover.
Testing
There are some great new tests coming out that can check for the novel coronavirus by having you blow into a tube. Although these tests are not yet licensed in the U.S., some European countries are using them already. Many of these tests seem to be quite accurate, and it sure would be nice to have testing available that doesn't involve someone sticking a swab up your nose...
Incidence/ Prevalence:
More than 4 million people have died of COVID-19 around the world at this time. To help put your head around this number, it is more than all the people who died in wars around the world since 1982. And this number is in all likelihood an undercount...
Due to the emergence of our "friend" the Delta variant, U.S. COVID-19 cases have risen 11% from last week, largely among unvaccinated people. The cases actually have doubled over the last three weeks. Deaths of COVID-19 in the U.S. have risen by 17%. 93% of infections occurred in counties where the vaccination rate was below 40%. If you look at the country as a whole, it seems like we are beating this virus-thing. However, COVID-19 cases are risking in almost 50% of the U.S. states: In Alaska and Arkansas, South Carolina and Kansas, the case count has more than doubled in the last week. In California, the number of people infected with the virus has increased 9% in the last month. About one third of new infections are coming out of five states (Florida, Louisiana, Arkansas, Missouri, and Nevada) where the vaccination rates are below 48%
In San Mateo County, the number of COVID-19 positive cases have doubled in the last two weeks.
A recent article in Science Translational Medicine again showed that most cases of COVID-19 were not even diagnosed in the first 6 months of the pandemic: for every diagnosed case of COVID-19 there were about 5 cases of undiagnosed infections in the United States.
As more and more adults are being vaccinated, children (who are largely unvaccinated) are making up a higher percentage of new coronavirus cases. In March, 2020, children made up 2% of new infections, but by late May, 2021, they made up 24% of new infections. At this time, kids make up 16% of the population as a whole. Luckily, infection hospitalization rates of kids are remaining stable.
Some statistics:
San Mateo:
number of cases:43,249 (42,756 three weeks ago)
number of deaths: 583 (576 three weeks ago)
California:
number of cases: 3.85 Million (3.81 Million three weeks ago)
number of deaths: 63,645 (63,490 three weeks ago)
U.S.:
number of cases: 34 Million (33.6 Million three weeks ago)
number of deaths: 607,704 (602,917 three weeks ago)
55.8% of people have received at least one dose of vaccine and 48.3% are fully vaccinated.
World:
number of cases 189 Million (180 Million 3 weeks ago)
number of deaths: 4.1 Million (3.9 Million 3 weeks ago)
Treatment
At this time it seems that the vaccines protect against EVERY variant of SARS-COV-2.
Vaccines work: in June, 2021, somewhere between 95% and 99% of hospitalizations and deaths due to COVID-19 are among people who were not vaccinated.
The risk of getting COVID-19 to land you in the hospital after being fully vaccinated is less than 0.0006%.
A recent study (Cancer Cell)showed that most cancer patients had a good immune response to the mRNA vaccines - of 131 cancer patients, 94% developed antibodies to the novel coronavirus after vaccination.
Some people who have suffered from COVID-19 infection in the past think that they wouldn't benefit from the vaccine. However, a recent study show that such people develop a much more vigorous immune response (100 times higher than previous!) after vaccination....so everyone should get vaccinated, even if they were sick with COVID-19 previously.
Moderna and Pfizer/ BioNTech could receive emergency use authorization for use of their vaccines in kids under 12 by the middle of winter.
More evidence is emerging that people vaccinated with the Pfizer/ BioNTech or Moderna vaccine are at a mildly increased risk of myocarditis/ pericarditis, an inflammation of the heart muscle. These events are rare, but tend to occur in young men aged 12 to 24. The WHO recently released a statement that the very small risk of heart inflammation is outweighed by the benefits of the vaccines preventing COVID-19.
On 6/25/21, the FDA added a warning to the Pfizer/BioNTech and Moderna vaccines indicating the associated rare risk of heart inflammation.
I am printing this part in RED because I think it is so noteworthy: only 150 of the 18,000 COVID-19 deaths in the U.S. in May, 2021 were in fully vaccinated people. Breakthrough infections in fully vaccinated people account for only 0.14% of hospitalizations for the disease. The Vaccines work and are safe.
Pfizer/ BioNTech:
Pfizer expects for apply for FDA emergency use authorization to use their vaccine in kids aged 2 to 11 by September.
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.
Pfizer/ BioNTech are now seeing FDA authorization for a third booster shot of their vaccine for people: the third shot would allow stronger protection that is longer-lasting. Details and proof of this claim have not been published. In addition, the company is now developing a vaccine targeted directly at the Delta variant.
The FDA, CDC, and NIH soon thereafter came out with a statement that it is too early to authorize a third booster shot at this time, given the excellent efficacy of the two part vaccine for all of the variants at this time. It is surmised that such a third booster may be appropriate for certain populations with severe immune dysfunctions, like those who have received an organ transplant.
The Advisory Committee on Immunization Practices, which makes vaccine recommendations for the CDC, will meet on July 22 to see if a third booster shot is appropriate for certain people with compromised immune systems ( people with organ trasnplants, HIV, leukemia, or actively getting chemotherapy for cancers
Moderna:
Moderna has applied to the FDA for use of its vaccine in kids aged 12 to 17.
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."
Moderna will be testing a a flu vaccines that uses mRNA technology used in its COVID-19 vaccine. Such a vaccine could be more effective and more-quickly produced than the current flu vaccinations.
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.
As noted above, a recent study found the J&J vaccine effective against the Alpha, Beta, Gamma, and Epsilon variants of the virus.
On July 12, the FDA warned that the J&J vaccine is associated with a slightly increased incidence of Guillain-Barré Disease: this is a autoimmune disorder that effects a person's nerves and can cause severe weakness and numbness. People seem to develop the disease up to 42 days after receiving the vaccine. So far, about 100 people have developed the disease after getting the shot. In the U.S., about 12.7 million people have received the J&J vaccine. One of these people has died of the disease. Of note, Guillain-Barré Disease is also associated with the yearly flu shot - though influenza itself is much more likely to give you Guillain-Barré than the vaccine is. About 1 in 100,000 people are affected by the disease every year. There have been no episodes of Guillain-Barré with the Pfizer/ BioNTech or Moderna vaccines.
In the fall of 2021, this vaccine will be studied in adolescents aged 12 to 17. In addition, there will be studies looking at the vaccine in kids aged 2 to 11 and even in those younger than 2 as well as immunocompromised children.
As you may know, production issues have stymied the J&J rollout from the beginning. However, on July 2 the FDA cleared 15 million doses of the vaccine for distribution. Hopefully this will mean that those people interested in getting this vaccine will be able to access it soon.
The Oxford/ AstraZenica vaccine:
This vaccine has NOT been approved for use in the United States yet.
This vaccine is associated with a slightly increased risk of a bleeding disorder known as ITP (Nature Medicine).
Novavax:
This vaccine is produced my a company based in Maryland.
This is also a two-shot vaccine series.
On June 14, Novavax announced that trials showed that the vaccine is 90% effective in preventing any COVID-19 infection, and 100% effective in preventing severe infections.
The company plans to seek emergency use authorization from the FDA in September.
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.
Antibody treatments:
Combinations of two different antibody therapies are likely effective in treating some of the newer nastier SARS-COv-2 variants that are out there (Nature)
On 6/25/21, HHS announced that is was stopping distribution of two of Eli Lilly's antibody treatments (bamlanivimab and etesevimab) as they don't seem to be effective against the COVID-19 variants.
Our Community and Beyond:
As of June 28, 88% of San Mateo county residents aged 16 and older have received at least one dose of vaccine (compared to 85% three weeks ago. Similarly, vaccination rates of 12- to 15-year-olds has risen, with 61% of this age group vaccinated (as of June 28) compared with 52% only three weeks ago.
San Francisco will require all city workers to be vaccinated.
San Mateo County is partnering with organizations as different as the Boys and Girls Clubs of the Peninsula, as well as churches and soccer clubs to boost immunization via pop-up clinics.
The CDC recently announced that vaccinated teachers and students do not need to wear masks when at school. However, California is enforcing stricter rules and is continuing to require everyone to wear a mask at school.
For those of you who are wondering: your job is legally allowed to require you to get the COVID-19 vaccine, as long as there are exemptions for health reasons or religious convictions.
On June 15, California reopened almost entirely:
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 has ended.
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 (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."
Masking will still be needed when riding public transit, being in a school/ child care setting or in medical clinics or nursing homes. Masks are also still needed in taxis and ride-sharing vehicles and in airports.
Individual businesses may still require patrons or employees to wear a mask.
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.
NOW, Some Non-Covid News:
The FDA recently approved a new medication for the treatment of Alzheimer's patients. This is exciting news , as the current medications are not fabulous. Sadly, this medication may not be as promising as it first seems:
The medication is called "aducanumab" (or the brand name is Aduhelm). It is given as a once-monthly intravenous infusion and costs $56,000 per year.
The FDA approved the drug even though none of the 11 members of the independent advisory committee considered the medication ready for approval, as they were not sure it worked very well and was associated with some serious side effects (brain swelling and bleeding). In fact, at least 3 of the members of this committee resigned in protest when Aduhelm was approved anyway by the FDA.
Also, the medication was approved for all people with Alzheimer's, even though the studies were done on people with very early stage disease only.
In fact, on June 25 the congressional House Committee on Oversight and Reform announced that it was looking into the FDA approval, especially given the high price of the medication as well as its unclear efficacy.
On 7/8/21, the FDA reversed it's decision to approve this medication for all Alzheimer's patients and now only recommends it for people with mild stages of disease.
Many private health insurers (including Blue Cross and Blue Shield) will not cover Anduhelm.
Remember the other terrible infectious disease that plagued the world starting in the 1980s? I am talking about HIV/ AIDS. Well, there is some good news on this front: According the Annals of Internal Medicine, people living with HIV/ AIDS now have life expectancies similar to their peers who are not infected! Thank you, modern medicine!
About Dr. Sujansky's Life in These Times
On a more personal note, my family and I continue to do well.
My family celebrated the 4th of July with a trip to San Francisco this year. We took in many of the sites of the city: we started at Baker Beach, walked halfway over the Golden Gate Bridge, took in Fisherman's Wharf, and ended up for dinner in Chinatown. Boy, were my legs sore that evening!
When we got to the restaurant in Chinatown - a no-nonsense kind of place that is known for its food and not its decor - an older man came to take our order. I was tired and wanted to study the menu a bit, but the waiter whipped away our menus and said he would bring us something good. But I was tired and grumpy and I took back my menu, wanting to order something I had eaten there previously. The waiter was insulted and, it turns out, he wasn't even the waiter: it was the owner/ chef of the restaurant who was offering to bring us a special treat. Well, needless to say, I felt more than a little sheepish!
My oldest son Stefan turned 21 last week. Now I am the mother of a full-fledged adult and I'm not sure I'm ready for that....I was both happy and sad about the occasion.
I celebrated July 14, Bastille Day by donning a beret and going out to a French restaurant...that was fun!
