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 constantly evolving. I will include some details on this topic from previous newsletters, as they remain important - new information will be in BOLD.
I know! You weren't expecting to hear from me for a few more weeks! Well, I wasn't expecting to write to you either! And then I looked at my calendar and realized that I needed to write to you now or not-for-a-while....so I chose now!
My next missive will likely be in about one month.
General Information:
U.S. life expectancy fell by 1.5 years in 2020, the biggest decrease since the Second World War. For African Americans and Hispanic Americans, the life expectancy dropped a staggering 3 years! This drop is largely due to the pandemic, which is responsible for about 74% of the overall life expectancy decline.
There has been a rapid increase in coronavirus cases both in the U.S. and abroad in the last month, largely due to the very contagious Delta variant taking over while vaccination rates are lagging behind in certain areas. Indeed, in the last month, the number of new COVID-19 cases has tripled and deaths rose by 25% in the last week alone.
In the last week, 48 of the 50 U.S. states saw an increase of COVID-19 cases. 30 states reported an increase of more than 50%!
More than half the people hospitalized now for COVID-19 are under 60 years old.
CDC Director Rochelle Walensky called the rise of coronavirus infections a "pandemic of the unvaccinated." At this time, about two-thirds of the U.S. counties have vaccinated fewer than 40% of their residents.
At the same time, of those U.S. adults who have not been vaccinated, 35% say they will probably not be vaccinated in the future, while 45% say they definitely won't.
Luckily, some of the states with low vaccination rates have seen an increase in the number of their residents that is wanting a vaccination. This is a likely response to the rising rate of COVID-19 infections in those states...These states include Arkansas, Florida, Louisiana, Missouri, and Nevada.
A U.S. District judge has ruled that Indiana University may require all of its students and employees to be vaccinated. Many private schools and universities have already done so also.
Yesterday, 60 major medical organizations (including the AMA) recommended mandatory vaccination of all health care workers (unless they have a medical contraindication to vaccination).
The Department of Veterans Affairs will mandate that its 115,000 frontline health care workers need to be vaccinated in the next two months.
AdventHealth, a hospital network serving 41 hospitals in the Midwest and Southern U.S., estimated that 97% of its 12,700 patients with COVID-19 were not fully vaccinated or not vaccinated at all.
The wildfires we have seen out here in the West have not helped either: Nevada-based scientists have found that the wildfire smoke seems to increase the risk of contracting the SARS-Cov-2 virus.
Starting August 9, Canada will allow U.S. residents to enter the country if they are fully vaccinated.
More studies are suggesting that our immune response to COVID-19 continues to evolve even one year after infection - and that the immune response was increased almost 50-fold if people with a history of infection then got vaccinated also.
In the aftermath of our country's opening up from the many pandemic restrictions in the last month, we are now also seeing vaccinated people come down with COVID-19. I have seen it in my own patients and my colleagues have as well. By and large, the affected individuals have not needed to be hospitalized and were usually immunocompromised.
In Italy and France, people are now being required to show proof of vaccination or a recent negative COVID-19 tests prior to engaging in certain social activities, such as dining indoors in restaurants, attending shows, and going to museums.
Vaccine Administration and Availability:
Vaccines are easily available throughout the Bay Area, through county websites or through pharmacies.
If you are homebound or not able to get to a vaccination site easily, you can call the San Mateo County Health Dept Home Bound Vaccinations line at 855-330-3763 and the vaccine will come to you!
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.
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 and it is more resistant to some of the antibody treatments we use on other strains.
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 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.
At this time, 83% of new COVID-19 infections in the U.S. are due to the Delta variant. This is up from 50% on July 3.
A study published this week in the New England Journal of Medicine confirmed that the full two-dose series of the Pfizer/ BioNTech or Moderna vaccines provided 88% protection against symptomatic disease, compared to 93% of the alpha variant.
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.
Transmission:
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.
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:
Southeast Asia is the latest COVID-19 hot spot, with countries like Indonesia, Malaysia, and Myanmar having now all surpassed the per capita death rate seen in India in previous months.
As mentioned above, in the United States, the states with lower vaccination rates have seen a surge of coronavirus infections: In Louisiana, health officials reported 5,388 new daily cases last week - this is the third largest daily count since the pandemic started!
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:44,189 (43,249 10 days ago)
number of deaths: 588 (583 10 days ago)
California:
number of cases: 3.92 Million (3.85 Million 10 days ago)
number of deaths: 64,265 (63,645 10 days ago)
U.S.:
number of cases: 34.5 Million (34 Million 10 days ago)
number of deaths: 611,000 (607,704 10 days ago)
56.8% of people have received at least one dose of vaccine and 49.7% are fully vaccinated.
World:
number of cases 194 Million (189 Million 10 days ago)
number of deaths: 4.16 Million (4.1 Million 10 days ago)
Treatment
At this time it seems that the vaccines protect against EVERY variant of SARS-COV-2.
Vaccines work: in the last week alone, less than 1% of those people who were vaccinated against COVID-19 had been fully vaccinated.
On 6/25/21, the FDA added a warning to the Pfizer/BioNTech and Moderna vaccines indicating the associated rare risk of heart inflammation.
The FDA has requested that Moderna and Pfizer/ BioNTech expand their studies of their vaccines on the youth to include kids aged 5 to 11. The goal of the expanded study would be to make sure the vaccines are safe in this age group as well.
A recent study published in JAMA Internal Medicine showed that people who had allergic reactions to their first shot of the Moderna or Pfizer/ BioNTech vaccines could receive the second dose without significant reactions.
Senior officials in the government now suggest that people older than 65 or those with a compromised immune system will likely need a third booster dose. The official word on this is still pending, but stay tuned...
Pfizer/ BioNTech:
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.
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.
The FDA has granted "priority review designation" to the Pfizer/ BioNTech vaccine and will likely be granted in the next few months. If this happens, it will take the vaccine out of the "emergency use" category and give it full approval.
Moderna:
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 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.
This week, the CDC's Advisory Committee on Immunization practices expressed strong support that the J&J vaccine's benefits by far outweigh its risks.
A recent article in the New England Journal of Medicine found that the immunity induced by the J&J vaccine lasted for AT LEAST 8 months.
The Oxford/ AstraZenica vaccine:
This vaccine has NOT been approved for use in the United States yet.
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.
Other treatments:
Combinations of two different immunologic therapies are likely effective in treating some of the newer nastier SARS-COv-2 variants that are out there (Nature)
Other:
A recent study suggested that the cholesterol medications known as "statins" may have a protective effect in people who get infected with SARS-Cov-2: people who were on statins may have a lower mortality rate than those not on statins...now don't all start taking statins "just in case!" This data looks promising, but still needs to be confirmed.
Our Community and Beyond:
Covid-19 infections are surging in the Bay Area as well. If we still had the color-tiered system (that the state got rid of last month) we'd have over one dozen counties in the most restrictive purple tier. San Francisco would be one of them. San Mateo would be red. The absolutes number of infections is now at 7 per 100,000 people. In early June, that number was 2 out of 100,000 residents. As scary as that sounds, however, recall that in January of 2021 we had 109 new infections in a population of 100,000.
Hospitalizations have risen significantly at Mills-Peninsula Hospital in recent weeks.
In San Mateo, hospitalizations due to the virus have risen to double digits since last week.
At this time, we don't have a mandate to wear masks in indoor public spaces (yet) for vaccinated individuals. But, given the information above, I- for one- am wearing a mask when going to a gym or grocery store.
Taking my lead :), the counties of San Mateo, Contra Costa, Marin, San Francisco, Santa Clara, and Sonoma have recommended that everyone wear a mask indoors in public places.
Starting July 26, face masks are required in all San Mateo County facilities.
All California state employees and health care workers (both in public and private institutions) will be required to show proof of vaccination by August 2. Unvaccinated employees will need to wear a mask and be tested either once or twice weekly, depending on their work situations.
Effective July 29, the San Francisco Bar Owner Alliance will allow only vaccinated patrons to enter their indoor bar spaces.
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.
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.
We traveled to our place in Kirkwood a few weeks ago. It was wonderful to get away from the Bay Area for a little bit and the weather was beautiful. Not far from us, however, the large Tamarack fire was raging. Luckily, the wind was blowing the fire away from us, so we didn't get any smoke and didn't need to evacuate. However, see the picture below during a bike ride: you can make out the smoke and faint pink hue to the sky.
My older son Stefan returned from Ghana last Sunday. I had a great experience and learned a lot. But he very much appreciated the hot water he got to shower in on his return - his first hot shower in 2 months...
