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 inBOLD.
General Information:
Dr. Anthony Fauci just said that the U.S. could get the pandemic under control by the spring of 2022 - if enough people got vaccinated....personally, I find this prediction (while accurate) very disheartening, given the long time we have been living with the virus so far...
The CDC has recommended that everyone get a booster vaccine 8 months after the last COVID-19 vaccine.
This recommendation is based on several studies that indicate that the vaccines' effectiveness for all infections decreased to either 53% or 80% (depending on the study) over time.
Nonetheless, the studies also show that the two-shot initial vaccine series continues to be highly effective in preventing severe coronavirus disease. In California, for example, 1,615 people who had been vaccinated required hospital admission for COVID-19. This number represents 0.007% of the 22 million people that are fully vaccinated in the state.
There are no clear recommendations for people who received the J&J vaccine, in part because this vaccine was only given starting April or so...so we have less experience to see how well this vaccine continues to protect people. Nonetheless, those who have received a J&J vaccine will likely need a booster 8 months after their shot also. New studies show that a booster shot of J&J dramatically raises antibody levels. The company is submitting data to the FDA to get authorization for such a booster shot.
CDC Director Dr. Rochelle Walensky stated that this 3rd booster shot may be all that we need: there is evidence that this third shot will boost our immunity adequately so that we don't need annual vaccination against COVID-19....this is something we see, for instance, in the hepatitis B vaccination series. I'm keeping my fingers crossed for that one!
These booster shots are expected to be available starting the week of September 20.
Please don't confuse the above recommendation from the OTHER recommendation for people who have a severely compromised immune system (think chemotherapy patients, AIDS, organ transplantation, etc): these people should get a third booster any time that is at least one month after last shot. The recommendations for such people are different, as they don't produce a strong immune response to begin with - unlike the rest of us, where the immune response just wanes.
There are indications that the FDA may even approve this third booster shot soon for people who have received their last vaccination only SIX months ago....but that has not yet been officially sanctioned.
Vaccinations are going up! On August 18, one million Americans were vaccinated against COVID-19 - this is 31% increase from the previous week.
Sadly, the protection of the current COVID-19 vaccines have become less effective since the delta variant has become dominant. It is unclear if this is due to declining efficacy of the vaccines themselves, or due to an increased resistant of the variant to the vaccines. Nonetheless, the vaccines continue to protect against severe infections, just less so against more minor symptoms.
The incidence of COVID-19 infections is somewhat mixed: COVID-19 infections are falling in many of the national delta virus hot spots! And in San Mateo County, for the first time in seven weeks the number of new COVID-19 infections have plateaued. At the same time, the number of COVID-19 patient in U.S. hospitals is above 100,000 - the highest level in eight months. And admissions for people under 50 has never been at its current high rate since the pandemic began. Hospitalizations nationwide have increased almost 500% in the last two months. And one in five ICU's in the U.S. is at 95% capacity or more.
More children are currently hospitalized with COVID-19 than at any other previous point in the pandemic.
There was an interesting article in Plos One: this article showed that people who had been vaccinated against influenza in 2020 were protected from getting severe COVID-19 disease. My guess is that the flu shot stimulated the immune system in general and helped activate the body's immune response to COVID-19 while it was at it. Note that the flu shot did NOT prevent COVID-19 infection, but mitigated the effects.
COVID-19 infections are more common in areas where people are exposed to wildfire smoke.
The AMA has urged both public and private sector employers to mandate COVID-19 vaccinations to help the nation control the disease.
President Biden also announced that nursing home staff would need to be vaccinated against the coronavirus or else the facility would not receive federal funding (Medicare payments).
The European Union is considering new travel restrictions for unvaccinated people from the U.S. given the rise of infections in our country.
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.
A recent article in the New England Journal of Medicine showed only minor differences of the Moderna or Pfizer/ BioNTech vaccines in combatting the delta variant - as opposed to the alpha variant.
An article from Lancet shows that the delta variant is also more dangerous than the original alpha strain: people who contract delta are twice as likely to end up in the hospital than those who contracted alpha. Luckily, less than 2% of infections occurred in fully vaccinated people.
Lambda strain: a new variant has just emerged, originally in Peru. It is spreading in South American countries.
Transmission:
A recent article in JAMA Internal Medicine showed that people with COVID-19 were most contagious 2 days before onset of symptoms to 3 days after onset of symptoms.
CAL/ OSHA now encourages indoor masking at jobs for all employees, regardless of vaccination status, to help stem transmission 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.
Incidence/ Prevalence:
Some statistics:
San Mateo:
number of cases:47,523 (47,523 2 weeks ago)
number of deaths: 5959 (592 two weeks ago)
number currently in hospital: 49
California:
number of cases: 4.44 Million (4.23 Million 2 weeks ago
number of deaths: 64,265 (64,265 2 weeks ago)
U.S.:
number of cases: 39.2 Million (37 Million two weeks ago)
number of deaths:622,000 (622,000 2 weeks ago)
World:
number of cases 217 Million (209 Million 2 weeks ago)
number of deaths: 4.51 Million (4,40 Million 2 weeks ago)
Treatment
Dr. Sara Oliver, announced yesterday that a new study of hospitalized patients in the U.S. continues to show that all three vaccines are effective in combatting the delta variant.
A 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.
Pfizer/ BioNTech:
The FDA has granted full approval to the Pfizer/BioNTech vaccine for people aged 16 or older. It is the first vaccine that has now received FDA full approval and is no longer in the experimental stage. It is thought that many public and private institutions will now mandate vaccines for their employees and students.
About 30% of unvaccinated people have said in polls that they would get vaccinated once the vaccine was fully FDA approved.
A recent study published in the New England Journal of Medicine looked at adverse events found with this vaccines: after nationwide mass vaccination, the vaccines were not associated with an elevated risk of most adverse events. There was an increased risk of myocarditis (inflammation of the heart muscle) at about 1 to 5 events per 100,000 people. However, people who contracted COVID-19 are much more likely to develop myocarditis that people who are vaccinated against the disease.
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."
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.
Johnson & Johnson:
The Vaccine is about 85% effective in preventing serious COVID-19 illness and 100% effective in preventing COVID-19 associated death.
The Oxford/ AstraZenica vaccine:
This vaccine has NOT been approved for use in the United States yet.
Novavax:
This vaccine is produced by 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.
Ivermectin is a medication used to treat parasitic infections. It is also one of the medications that was rumored (falsely!) to effectively treat COVID-19 infection. That rumor has been debunked repeatedly in clinical trials. Unfortunately, many people don't get that and the number of new ivermectin prescriptions has sky-rocketed in recent months. Sadly, the number of calls to poison control centers for ivermectin-related adverse events has drastically risen also.
Our Community and Beyond:
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
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.
California is now requiring proof of vaccination or a negative test result in the prior 72 hours for any large indoor event with more than 1,000 people.
California is requiring all public and private teachers and staff to be vaccinated or test weekly for COVID-19.
Contra Costa County will pay a $100 "finders fee" to anyone who convinces another to get fully vaccinated.
San Jose will require proof of full vaccination against COVID-19 for all events held at city-owned facilities (e.g. the SAP Center, Convention Center, Center for Performing Arts). Proof of negative COVID-19 testing would not be adequate.
Stanford University will require students to be tested for COVID-19 every week, regardless of their vaccination status.
San Francisco is barring unvaccinated people from indoor dining, bars, nightclubs, gyms, large concerts, and theaters. These rules took effect on August 20. A negative COVID-19 test would not be an acceptable substitute.
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.
Non-Covid Medical News
There have been a few interesting articles on the topic of dementia in the news recently:
The British Medical Journal reported that "on-the-job" intellectual stimulation lowers levels of proteins that block brains from forming new connections. As a consequence, intellectually stimulation could prevent or postpone dementia. So keep learning and pushing your brain, folks!
There are certain behaviors that are correlated with developing dementia down the road: people who overlook a couple of credit card payments or habitually brake while driving may have very early signs of mental decline - long before a diagnosis of dementia is made (JAMA Internal Medicine). This finding would be much more useful, of course, if we had solid medications or procedures that we know can prevent dementia if the disease is caught early. We're not there yet. But please don't panic if you have missed paying a bill or if your spouse thinks you are a bad driver: this does NOT mean you will develop Alzheimer's Disease!
About Dr. Sujansky's Life in These Times
On a more personal note, my family and I continue to do well.
I dropped my youngest off at college last week. I know he is in the right place and I don't want him living in my basement for the next 40 years, but I am more than a little sad....a new stage in our life is beginning. My sister joined me to drop off my son(my husband had a work deadline and could not join us) and that was extremely helpful. It was really hot in Boston (well above 90 degrees) and so the moving in and running-around-looking-for-an-air-cooler-and-fan, etc. was less pleasant.
On the final day, my sister and I took a day-trip to Concord and Walden Pond, which was lovely. Attached, you will find a picture of the small lake.
It will be very weird living in a house without my kids now. I went to Costco last weekend and didn't know what to buy, as all of the portions seemed enormous - when in the past they had seemed just barely adequate.
