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 just got back from our family summer vacation and am trying to catch up on all the news! Long story short, this is what you need to know:
Coronavirus cases are surging throughout the United States due to the very contagious Delta Variant.
Not only are people getting infected, they are ending up in the hospital and (sadly) often dying. Over 95% of those requiring hospitalization have not been vaccinated. Vaccinated individuals who get infected tend to have milder symptoms. Exceptions are vaccinated individuals with significant immune system compromise (e.g. chemotherapy patients, patients on hemodialysis, people who have had an organ transplant).
Vaccines continue to be effective.
There are more and more mandates for people to get vaccinated and to wear masks in attempts to contain the current surge of the pandemic.
I had a great vacation!
So if you have got that, you really don't need to read the rest of the newsletter.
General Information:
At this time, more than 200 million people worldwide have contracted COVID-19. The countries reporting the most cases include the United States, Brazil, Indonesia, India, and Iran.
In the United States, daily cases have surpassed 100,000 for the first time since February and the seven-day averages are up by over 40% compared to the prior week. Deaths are trending higher by a similar amount.
President Biden announced that "all federal employees and on-site contractors will have to be vaccinated against the coronavirus or be required to wear masks and undergo repeated testing."
Defense Secretary Lloyd Austin plans to seek a mandate to require all service members to get a COVID-19 vaccine by mid-September.
HHS has announced that it would require more than 25,000 health workers (including contractors and volunteers) to received the COVID-19 vaccine. This mandate would include NIH and IHS employees who deal with patients, as well as the U.S. Public Health Service.
The CDC now recommends that pregnant women be vaccinated against the coronavirus. Numerous studies have found no increase risk of miscarriage due to the vaccine. These guidelines are now in line with those of the American College of Obstetricians and Gynecologists. A study published in JAMA Network Open on August 11 showed that infection with the virus increased the risk of serious disease and death in pregnant women and can lead to preterm births.
New York City will requires proof of vaccination for anyone who wants to frequent indoor public spaces. Such places include restaurants, gyms, and theaters. This new mandate will be implemented in August and September.
All California health care workers need to be fully vaccinated by September 30 based on a new order by the state's public health officer.
The CDC has changed its recommendation on testing for COVID-19 in vaccinated people and now DOES recommend testing if you are in close contact with a COVID-19 patient, even if you have no symptoms.
People who are wary of vaccines still make up a sizeable portion of the U.S. population, with 10.2 of the populations saying they would probably not get a vaccine and 8.2% say they would definitely not get one (Clinical Infectious Disease).
The above notwithstanding, the under-vaccinated regions of the U.S. are leading the U.S. in number of people getting their first dose of vaccine. This increase is prominent in the Southern and Central parts of the country with the highest daily rate of shots in Louisiana, Arkansas, and Missouri.
ON August 13, the U.S. administered 991,000 doses of the vaccine, the most doses given in a single day since early July. It is more than double the number of shots given in mid-July.
The U.S. has donated and shipped over 110 million doses of vaccine abroad.
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!
Please let me know if you get a COVID-19 vaccine, so I can add it to your medical chart.
New COVID-19 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 variant is significantly more contagious than prior versions of the virus.
People infected with the Delta variant have 1,000 fold higher viral load than those infected with the original SARS-Cov-2.
Unfortunately, people who were vaccinated against SARS-Cov-2 and still became ill with the Delta variant can spread the virus just as easily as unvaccinated people.
This variant is the most common variant causing infections in California (as well as the rest of the country).
Lambda strain: a new variant has just emerged, originally in Peru. It is spreading in South American countries. In California, there are now more than 152 cases reported. This variant is more infectious than the original strain, though it seems less infectious than the Delta variant. Although there are some rumors that this variant may be more resistant to the current vaccines, this is NOT clear and needs to be studied further. We do know that the Chinese Sinovac vaccine, which is not available in the U.S., seems to be less effective in preventing this strain.
Transmission:
0.04% of COVID-19 cases in California are in vaccinated individuals in 2021. Of those cases, 7.6% were hospitalized
If you are concerned about your specific transmission risk, check out the risk calculator at
www.microcovid.org
and you will better be able to quantify how risky your activities are.
There was an interesting article in JAMA that looked at the masking rates at 5 national men's basketball games. Even though the indoor events were held in a state with high popular acceptance of masking and masking was mandatory at the event, only 74% of the spectators wore the mask correctly. This is below the 80% masking threshold that is considered necessary to prevent the spread of the virus.
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.
While most kids with symptomatic COVID-19 recover within a week, a small percentage do go on to develop long haul COVID: 4.4% of children have symptoms 4 weeks after infection and 1.8% have symptoms 8 weeks after infection.
People with a penicillin allergy have a higher risk of doing poorly when they contract COVID-19 (Journal of Allergy and Clinical Immunology)
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.
Incidence/ Prevalence:
California is seeing the fastest increase in COVID-19 cases during the entire pandemic with 18.3 new cases per 100,000 people per day - this is a nine-fold increase in the last two months.
At this time, 15% of symptomatic COVID-19 cases are in kids. While most of these kids have relatively mild disease, the number who do require hospitalization is rising on a weekly basis. There are an average of 203 children with COVID-19 admitted to U.S. hospitals every day, an increase of more than 21% from last week.
Some statistics:
San Mateo:
number of cases:47,523 (105 in the last 24 hours)
number of deaths: 592
number currently in hospital: 62
California:
number of cases: 4.23 Million
number of deaths: 64,265 (64,265 3 weeks ago)
Currently, 63% of Californians aged 12 and older are fully vaccinated and an additional 10% are partially vaccinated.
U.S.:
number of cases: 37 Million (275,000 new cases in the last 24 hours)
number of deaths:622,000 (611,000 3 weeks ago)
70.6% of people have received at least one dose of vaccine and 50% are fully vaccinated.
World:
number of cases 209 Million (194 Million 3 weeks ago)
number of deaths: 4,40 Million (4.16 Million 3 weeks ago)
Treatment
The CDC has recommended that people who are at significant immune system compromise (like organ transplant recipients, people taking immune-suppressing medications, or those with blood cancers) receive a third vaccine as a booster shot. It is estimated that about 3% of the U.S. adults would fit into this category at this time. This recommendation only applies to people who have received the Pfizer/ BioNTech or the Moderna vaccines; no mention was made of those who have received the J&J vaccine. This recommendation is based on a study in the New England Journal of Medicine showing a significant improvement in immune response when organ transplant recipients who received a third booster dose.
The Biden Administration is said to be considering recommending booster shots for all others 8 months after their original shots. This has NOT been announced officially and I have NOT seen any recommendations from a scientific body on this, so STAY TUNED for now.
New guidelines from the CDPH allow COVID-19 vaccines to be co-administered with other vaccines without regard to timing. Previously, a 14-day interval had been recommended between the COVID-19 vaccine and other shots.
Vaccines are needed even in people who were ill with COVID-19 in the past: studies showed that people who had a history of COVID-19 and did not subsequently get vaccinated were 2.4 times more likely to get re-infected than those who did subsequently get vaccinated.
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.
A recent article in Jama Network Open looked to see if people who had a strong (negative) reaction (think: fever, chills, malaise) to the COVID-19 vaccines were more or less likely to mount a good antibody response afterwards. They found:
People who had contracted COVID-19 prior to vaccination were more likely to have symptoms associated with the first COVID-19 vaccine.
People who had not contracted the virus previously were more likely to have adverse symptoms after the second dose.
Antibody levels were higher in people who had had negative reactions after the vaccine, BUT all vaccinated people had adequate antibody responses overall.
Pfizer/ BioNTech:
The FDA now hopes to fully approve the Pfizer/ BioNTech vaccine by Labor Day.
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."
A study published in the New England Journal of Medicine showed that a third dose of the Moderna vaccine substantially improved protection in people who had received an organ transplant.
New research (New England Journal of Medicine) shows that the Moderna vaccine is safe and effective and safe in teenagers. Though Moderna has applied for Emergency Use Authorization for use in teens, the FDA has not yet granted this.
A new study, which has not been vetted by the academic community as yet, suggests that the Moderna vaccine is more effective than the Pfizer/ BioNTech vaccine in combatting the Delta variant. The study did show that both RNA vaccines are still very effective in preventing serious illness and hospitalizations. However, Moderna seemed better at preventing any infection at all. Again, this data is still very preliminary and should not prompt people to seek out the Moderna vaccine at this time.
Johnson & Johnson:
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
The CDC's Advisory Committee on Immunization practices expressed strong support that the J&J vaccine's benefits by far outweigh its risks.
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.
The company plans to seek emergency use authorization from the FDA in September.
Other treatments:
In early August, the FDA expanded an Emergency Use Authorization for an antibody combination (REGEN-COV): this injection medication may now be given to people at high risk for complications due to COVID-19 who were exposed to the virus or are in a setting that puts them at high risk of contracting it (e.g. nursing homes and prisons). High risk factors include age more than 65, obesity, diabetes, heart disease, lung disease, and an immunocompromised state). Non-vaccinated people as well as people with an compromised immune system (e.g. chemotherapy patients, HIV patients, blood cancer patients) are usually considered for this treatment. This EUA was based on a study in the New England Journal of Medicine: 4.8% of the people treated with REGEN-COV developed an infection, while 14.2% of the people not treated with REGEN-COV became infected.
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.
All state workers and workers in health care setting are now required to be fully vaccinated by September 30. This mandate applies to all people working in hospitals, doctor's offices, skilled nursing facilities and similar health care environments.
Health care officials in San Mateo have joined officials of neighboring counties to require people to wear a face covering when indoors in public places.
A new mandate in California requires all school employees to be vaccinated for COVID-19 or be tested weekly.
Hospitalizations continue to rise significantly at Mills-Peninsula Hospital in recent weeks. As of August 11, all hospital visitors need to provide proof of vaccination or have a negative COVID-19 test in the last 72 hours in order to enter the hospital to visit or accompany a patient. Limited exceptions will be issued for visits related to end-of-life, guardians accompanying minors, or those support persons considered to be essential to facilitating care.
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.
Non-Covid Medical News
Are you kidding me? I have my hands full just providing you with information on the Covid-19 infections at this time! :)....more next newsletter!
About Dr. Sujansky's Life in These Times
On a more personal note, my family and I continue to do well.
I returned last week from a vacation to the Galapagos. It was amazing and certainly one of the best trips I have ever taken. I was bowled over by the beautiful wildlife that had no fear of us humans: we snorkeled with sea lions and saw blue-footed boobies (a kind of bird) up close.
After the Galapagos, we also stayed a few days in the rain forest, which was equally impressive and exotic.
The best part was being able to share all this with my two boys, both of whom will be leaving in the next week for college!
So I will be dropping my younger son off at college in late August. If you see me with a tear-stained face and runny mascara, you will know why!
