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.
General Information:
Omicron:
There is increasing evidence that the COVID-19 surge due to Omicron is finally starting to abate in certain parts of the country. For the last week, cases have dropped 30% in Connecticut, Maryland, New Jersey, and New York. Yet at the same time, many hospitals are still overwhelmed and almost 2000 people are dying of the disease daily. But hospitalizations tend to lag behind case counts by several weeks, so this is hardly surprising. Unfortunately, for now, it is still too early to let your guard down!
COVID-19 viruses can be detected in sewage. So checking the wastewater of a city can indicate how prevalent the virus is in a community: in Boston, the amount of SARS-Cov-2 in wastewater has dropped 40% since the beginning of the year. Other cities are reporting similar trends.
More and more studies are showing that Omicron -though incredibly infectious- is often milder, especially if you are vaccinated.
I know many of us are wondering if we should get a fourth booster shot (!!) to help stem the tide of the Omicron variant: don't do it! A recent study done in Israel did NOT find that a fourth dose helped prevent infection from the variant, though antibody levels were boosted.
Hospitalizations in California of kids are as high as they have been since the onset of the pandemic. Many of the kids in the hospitals are too young to be vaccinated.
Omicron seems to affect the upper respiratory tract more (nose, sinuses, throat) rather than the lungs.
The Incubation period for Omicron seems to be shorter than with the Delta variant: people often test positive three days after being infected with Omicron, as opposed to four to six days with Delta. The Omicron virus seems to be most contagious two days before symptoms occur and three days after symptoms start.
The above risk to kids notwithstanding, the vaccination rates among kids aged 5 to 11 in the U.S. is still quite low at 17%. It is thought that distrust, misinformation, and delays associated with the holidays and bad weather are responsible for this low vaccination rate.
At this time, 63% of the country is fully vaccinated and, of that group, only 37% have received a booster shot.
A study from the CDC found that children who had recovered from COVID-19 were 2.5 times more likely to develop diabetes than kids who had not been infected with COVID-19.
At least 20% of the U.S. population has been infected by COVID-19 at this time. Many experts believe this percentage is actually much higher, due to the large number of asymptomatic cases as well as those people who diagnosed themselves with a home test only and therefore "flew under the radar."
The CDC recently confirmed something most of us already knew: cloth masks are not as effective as surgical masks. Luckily, the surgical masks are now readily available. So: what do use when? Personally, I wear a N-95 or KN-95 mask when I'm in high-risk situations (like on an airplane) and I use regular surgical masks otherwise. I will put on a cloth mask when I feel like my risk of infection is very low (like while I talk to people outdoors)...
Given the improved efficacy of N95 masks, you may be happy to hear that San Mateo will soon be able to get up to three N95 masks at local pharmacies. They should be available by early February.
Italy recently made COVID-19 vaccinations mandatory for people aged 50 and older.
There are new quarantine and isolation guidelines associated with Omicron:
For people who have been exposed to COVID-19, but not tested positive themselves:
fully vaccinated and boosted people do not need to quarantine, but should monitor themselves for symptoms, get tested at day #5, and wear a mask for 10 days.
people who have not been vaccinated and/ or who have not received a booster should quarantine for 5 days, get tested on day #5, and also wear a well-fitted mask for an additional 5 days.
For people diagnosed with COVID-19:
people who have no symptoms or mild symptoms need only isolate for 5 days.
people who have moderate symptoms should isolate for 10 days.
people who require hospitalization may need longer periods of isolation.
Symptoms and Risk Factors:
A study published in JAMA Network Open found that people who got mild and moderate cases of COVID-19 (who were not hospitalized) still had many more functional limitations (e.g. ability to engage in household activities, to stand up after sitting in a chair, to participate in physical exercise) six months later than those without COVID-19.
An article in Nature Medicine showed that pregnant people with COVID-19 were not only more likely to have severe disease, but were also more likely to have preterm or stillborn births.
Incidence/ Prevalence:
California is certainly still in the throes of the Omicron surge: in many parts of California, elective surgeries are being cancelled. This is due to may hospital beds being filled with COVID-19 patients, as well as many essential hospital workers being home with COVID-19 themselves.
In San Mateo, the daily case rate increased from 79 new cases in the first week of 2021 to 905 one week later.
In 2021, COVID-19 killed eight-times as many Americans as influenza killed in the 2017/18 season, which was the worst flu season in over a decade. And even though Omicron is a relatively milder form of COVID-19, it is still deadlier than the flu.
Treatment
Vaccines:
I know the vaccine intervals have been evolving and are confusing. At this time:
The new interval for booster administration for both Pfizer/ BioNTech and Moderna vaccines is now FIVE months.
People who received the J&J vaccine should get a booster after two months.
Three recent studies published in the New England Journal of Medicine in January looked at the effectiveness of the vaccines:
A review of more than 10 million people in North Carolina found that -seven months after vaccination- the Pfizer/ BioNTech vaccine was 67%effective, Moderna was 80% effective, and J&J was 59% effective; in addition, all three vaccines were considerably more effective in preventing hospitalizations and deaths.
A study out of England found the Pfizer/ BioNTech vaccine 92% effective in preventing hospitalizations and death at 20 weeks.
Finally, a study in adolescents showed that the Pfizer/ BioNTech vaccine was 98% effective against ICU admissions....none of the seven people in the study who died of COVID-19 was vaccinated.
Another study published in MMWR supported the safety of COVID-10 vaccination during pregnancy: there was no association between the vaccine and preterm delivery or other adverse pregnancy outcomes. The CDC recommends vaccination for all women who are pregnant, who may become pregnant, or who are breast feeding.
Yet another study (this one published in the American Journal of Epidemiology) has shown that COVID-19 vaccination is NOT linked to infertility, a rumor that has been floating around since the vaccinations were offered. In fact, lower fertility was associated with people getting COVID-19 - another reason people interested in having babies may want to get vaccinated!
Pfizer/ BioNTech:
The CDC has found that two doses of the Pfizer/ BioNTech vaccine in kids aged 12 to 18 were 91% effective in preventing "MIS-C," the rare but serious disease of multiple organ inflammation associated with COVID-19.
Pfizer CEO Albert Bourla recently noted that he was unsure if a fourth COVID-19 vaccine was helpful. At the same time, he reported that a shot aimed directly at the Omicron variant would be available by March, 2022.
Moderna:
Johnson & Johnson
Other treatments:
The COVID-19 pill made by Merck ("molnupiravir")will soon be made by 27 different generic pharmaceutical companies and help supply 11 countries.
Pfizer has announced that their new pill "Paxlovid" to treat COVID-19 is likely to work against the Omicron variant. The most recent trials found that the pill could reduce the risk of hospitalization and death by 88% when given to unvaccinated people at high risk of severe COVID-19 and when given within 5 days of onset of symptoms. Treatment is authorized for people who test positive for the virus AND are vulnerable to becoming severely ill due to the disease, based on risk factors such as age, diabetes, or compromised immune systems.
Testing
The administration is in the process of completing contracts with companies that will be able to provide 500 million antigen tests in the near future.
Fake unauthorized at-home COVID-tests are being sold online. If you get a test via the internet, make sure it is authorized by the FDA (check the FDA's list of authorized diagnostic tests). You can also search online for the company's name being associated with scams. Finally, check out the online reviews, as they can be helpful also.
Starting January 15, private health insurance companies will be required to cover up to eight at-home COVID-19 tests per month. Tests can be obtained (where available!) for free from the pharmacy. Alternatively, people can submit receipts for the purchased tests to the insurance company for reimbursement. Unfortunately, Medicare will not cover such tests.
Also, as of January 18, you can get free home rapid COVID-19 tests from the government: each household is entitled to four tests. It is very easy to sign up: go to
Covidtests.gov.
It took me less than a minute to sign up for these tests. Shipping is expected by late January/ early February.
An article published in JAMA looked at how likely the rapid COVID-19 tests were to provide "false positive" results. "False positives" occur when the test shows that you have an infection, but you actually don't. The good news is that such results are very unlikely. So, if your rapid at-home test shows a positive result, then you are very likely to actually be infected. The converse does NOT hold true: if the rapid test shows a negative result, you could very well still be infected!
Our Community and Beyond:
COVID-19 has hit California and the Bay Area! COVID-19 infections are at record highs and testing lines stretch on for hours.
California is extending its indoor mask mandate until February 15.
Starting 1/7/22 (today!), the San Mateo Events Center (at 2495 Delaware Street, San Mateo) is offering vaccinations as well as PCR testing. Appointments are needed:
for vaccination appointments: go to myturn.ca.gov
for testing appointments, go to my.virusgeeks.com
Santa Clara County recently reported that the hospitalization rate among unvaccinated residents is 20-times higher than the rate of those who are fully vaccinated.
In San Mateo County, COVID-19 hospitalizations have shot up radically. Nonetheless, hospitals are less impacted than a year ago and there are still adequate numbers of hospital beds available.
Our office is also implementing some more stringent infection control strategies to help prevent the spread of the virus. As a consequence, we are trying to move many of our upcoming appointments to a virtual format, if that is appropriate.
Non-COVID-19 News
Remember the controversial new Alzheimer's medication "Aduhelm" I wrote about recently? At this time, Medicare and Medicaid have also expressed concerns about the risks and benefits of this medications are now are considering only paying for Aduhelm if the patients taking this medication are enrolled in a clinical trial. The final decision on this restriction will likely be made by April 11.
A recent report from the American Cancer Society showed that cancer deaths have been dropping steadily for the last 20 years! This overall improvement was mostly due to the number of lung cancer cases dropping and people with lung cancer living for longer.
About Dr. Sujansky's Life in These Times
I traveled to Washington, D.C. last weekend to join my mother and siblings in celebrating my father's 90th birthday. We had such a good time! The weather was cold and snowy, but we had enough warmth in our midst to make up for it....ok, I know that sounds super-corny, but it was actually true!
Otherwise, the kids are back at college and my husband and I are back to being "empty-nesters." Now I have to get used to this state all over again!
