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:
The Omicron wave has hit the United States and the Bay Area hard in recent weeks. U.S. daily cases have hit levels of 265,000 - this number is more than twice the number in the previous two weeks and supersedes the daily high-mark of 250,000 daily cases set in January, 2021. In addition, hospitalization rates are rising, but-luckily- daily deaths are declining.
About 95% of the COVID-19 cases in the U.S. are due to the Omicron variant at this time.
In South Africa, which was hit early by the Omicron variant, COVID-19 case counts are already declining and the peak seems to have passed without a major spike in deaths.
Omicron seems to affect the upper respiratory tract more (nose, sinuses, throat) rather than the lungs.
Luckily, those that have been vaccinated have usually not become seriously ill with the Omicron variant. Nonetheless, we are seeing staffing shortages across the nation in hospitals as well as other workspaces as people are out with COVID-19 or in quarantine.
Children are among the most frequently infected by the Omicron variant - this is in part due to kids under 5 not being vaccinated, the low booster rates among older kids, and the return to school for the youngsters.
Sadly, Omicron is also about twice as contagious as Delta. In fact, it is as contagious as measles!
A laboratory study out of South Africa suggests that people who had been infected with Omicron are more likely to be immune from the Delta variant of SARS-Cov-2.
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 OTC rapid COVID-19 tests may not be as accurate in detecting the Omicron variant than other SARS-Cov-2 variants. For this reason, PCR tests are recommended for people who have symptoms of COVID-10 but test negative on the rapid test.
The CDC has stated clearly that all cruise travel should be avoided at this time - regardless of vaccination status.
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:
Initial concerns about inflammation of the heart ("myocarditis") in athletes and young adults after COVID-19 infections were recently downgraded: a study showed that the risk of heart injury is extremely low. A study looked at over 3000 college athletes diagnosed with the coronavirus and found that 0.7% had hear injury. During subsequent surveillance, only one athlete had any heart issues, and even this was not thought to be related to COVID-19.
Incidence/ Prevalence:
It's all over the place, people. As I mentioned above, the U.S. is currently one of the world-wide hot spots...
Treatment
Vaccines:
I know the vaccine intervals have been evolving and are confusing. At this time:
The interval between the second Moderna shot and the booster shot is six months.
The interval between the second Pfizer/ BioNTech vaccine and the booster is five months.
People who received the J&J vaccine should get a booster after two months.
Two recent CDC studies show that COVID-19 vaccines protect young children from the worst effects of the virus and rarely are severe side effects.
Some women develop erratic menstrual cycles after being vaccinated. The menstrual cycles return to normal within a few months, however.
Pfizer/ BioNTech:
On January 3, the FDA authorized booster shots with the Pfizer/ BioNTech vaccine for kids aged 12 to 15. Also, the FDA has recommended that immune-compromised kids aged five to 11 can receive a third shot in the initial series, 28 days after their second Pfizer/ BioNTech vaccine.
Moderna:
Johnson & Johnson:
Pharmaceutical companies Medicago and GlaxoSmithKline announced on 12/7/21 that they have produced a plant-based coronavirus vaccine. A global late-stage trial found an overall efficacy of 71%. Moreover, it was 75.3% effective in preventing the Delta variant.
The Novavax vaccine, which is produced by a company based in Maryland, has been approved by the European Union. This vaccine does not rely on a mRNA-based immunity, but is made up of viral proteins, much like our current flu shots.
Other treatments:
Merck has developed the first pill that seems to be effective in preventing severe disease from COVID-19. The medication is called "molnupavir" and likely will be effective for different variants of the virus. Unfortunately, MERCK recently announced that the medication was only 30% effective in preventing hospitalization from COVID-19. This medication has received emergency use authorization for people who who have COVID-19 and are at high risk of progression AND for whom alternate treatments are not available or appropriate.
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. Pfizer laboratory studies also suggest that the new medication will be effective against the Omicron variant. On December 22, federal regulators approved the pill for use in the U.S. 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. Supply will be quite limited initially. Nonetheless, Pfizer plans on making enough pills available in the next week to treat 65,000 Americans. More treatments should be available in January.
Testing
The FDA has given emergency use authorization to a new at-home rapid COVID-19 test made by Roche. The test is an anterior nose swab that provides results in 20 minutes.
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.
A White House official has said that people can start getting reimbursed for rapid at-home tests starting next week.
To repeat: while the at-home tests for COVID-19 are still able to pick up the Omicron variant, they are NOT as sensitive for this variant as they were for Delta. So if you have good reason to think you have COVID-19 but your rapid test is negative, get a PCR test!
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.
Local schools, back in session after the winter holidays, are reporting record high numbers of COVID-19 cases among the students and staff. Schools are also struggling with high numbers of staff absences due to the disease and quarantine requirements.
Napa county is out of ICU beds, though Mills-Peninsula Hospital still has plenty of capacity (though they too are seeing an increase in hospitalized cases).
San Francisco's transmission rate ranks only behind Los Angeles and Mono counties in California. The daily average case rate in San Francisco is now at 104 cases per 100,000 residents.
Unfortunately, only 38% of vaccinated Californians have gotten their booster shots - though 55% of vaccinated Bay Area residents have gotten their boosters.
California is extending its indoor mask mandate until February 15.
Santa Clara county has issued new regulations mandating vaccination for workers in high-risk setting, such as health care facilities, jails, shelters, and long-term care facilities by January 24.
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
The Grammy Awards have been postponed due to the surge in virus cases.
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
OK: I know this isn't medical news, but I thought it was worth sharing: while I was skiing over the holidays, I noted that my cell phone was missing: it had fallen out of my pocket on the slopes when I had fallen. Luckily, I had one of those "find-my-iphone" apps and we were able to trace the phone to an area on the slopes the size of a bedroom. Then we kept calling it and heard it ring....eventually, we were able to dig it out under 6 inches of snow. Moral of the story: download the "find-my-iphone app" (or android equivalent)....worth it!!
About Dr. Sujansky's Life in These Times
We had a great holiday break! We went skiing at Kirkwood for the week between Christmas and New Year's. Unfortunately, the drive up was looooong (14 hours!) due to traffic. But the skiing that week made the arduous drive worth it, which is saying something!
