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:
A recent CDC study confirmed what we had been suspecting for a while: the Omicron variant causes less severe disease than previous variants. Omicron continues to be much more contagious than Delta, so hospitalization rates are still very high, but the percentage of people who get infected and then end up in the hospital is lower.
The number of people infected by the Omicron variant is finally dropping and the number of hospitalizations is decreasing as well. At this time, the U.S. is averaging about 290,000 new COVID-19 cases daily, a drop of 19% from last week. Unfortunately, the number of people dying of the disease is still rising. There are about 100,000 people hospitalized with COVID-19 in the U.S., which is down 38% from just a few weeks ago.
I have heard a lot of people wonder if the booster vaccinations are even helping prevent Omicron, as everyone-and-their-brother seems to be falling ill with this variant. Well, a recent study (JAMA) looked at 3 doses of the Pfizer/BioNTech or Moderna vaccines vs two: the likelihood of getting Omicron if you got the booster was only 33% of those who only got the two-dose vaccine series. Similar findings were seen in two other studies, published in MMWR. In addition, the booster shots are 90% effective in preventing hospitalization due to the virus; the boosters were found, not surprisingly, to be most effective in patients aged 50 and older. The CDC has also released data showing that boosted Americans are 97 times less likely to die of COVID-19 than those that are unvaccinated; vaccinated (but not boosted) people are 14 times less likely to die of the coronavirus than the unvaccinated.
The weekly likelihood that a person who has received a COVID-19 booster will die of the disease is about one in a million. As a comparison: the average American has a weekly likelihood of dying in a car accident of 2.4 per million. The weekly likelihood of dying of the flu or pneumonia: three per million.
To add insult to injury, there seems to be a new sub-variant of Omicron out there, called "BA.2." This variant seems to be even more contagious than the original Omicron. BA.2 isn't likely to cause a new surge in cases, but may well keep the current surge from diminishing as quickly.
There has been a lot of discussion as to whether prior infection or vaccination is more protective in preventing future COVID-19 infections (in case you're wondering, if you had prior infection and also were vaccinated, you are best off!): as with all things COVID-19, the answer to this is somewhat nuanced (MMWR):
Prior to the Delta variant becoming dominant, prior infections were less protective than vaccination. But by October, 2021, those with prior infections were more protected than those who had been vaccinated.
Overall, breakthrough infections in people who had been vaccinated were seen in people who had received the Pfizer/ BioNTech as well as the Moderna vaccines, but people with the Pfizer/ BioNTech vaccines were more likely to get re-infected (JAMA).
The other interesting fact is that many people who assumed that they had COVID-19 in the past (but were never tested) are wrong: only 55% of such people actually had antibodies suggesting prior disease.
Two studies looked at the incidence of heart inflammation in people who had received the mRNA vaccines:
People who had received the Pfizer/ BioNTech vaccines were at increased likelihood to get heart inflammation, but it was still a very rare event, occurring at 0.57cases per 100,000 (Annals of Internal Medicine)
An increased incidence of heart inflammation was also seen in an article published in JAMA, especially in adolescent boys and young men younger than 30. However, very few were seriously ill and most were just treated with anti-inflammatory medication like Advil.
Symptoms and Risk Factors:
An article published in JAMA looked at the long-term sequelae in people who had COVID-19 and were in the intensive care unit: one year after leaving the ICU, most patients still had ongoing symptoms: 74% had physical symptoms and 26% had mental symptoms, and 16% had cognitive symptoms.
Similar to above, an article published in the Journal of General Internal Medicine looked at 530 U.S. patients who were seen in the emergency department or hospitalized for COVID-19 one year ago: of these, 44% reported ongoing symptoms. The likelihood of persistent symptoms was independent of age, though women and HIV-positive patients were more likely to be affected.
Now this is interesting: in past newsletters I have repeatedly mentioned the gut microbiome: these are the different bacteria that normally live in our gut and seem to influence things as disparate as moods, heart disease, and cancer. Well, now it seems that disruption of the gut bacteria is linked with a susceptibility to the long COVID-19 syndrome. This data was recently published in the appropriately-named journal Gut. Patients with Long Covid had a lower diversity of gut bacteria as well as a lower abundance compared with patients who had suffered from COVID-19 but did not develop Long COVID. Hopefully, these new findings will lead to novel methods of treating Long COVID in the future.
Incidence/ Prevalence:
As of February 7, California is still confirming 103,7 new cases per 100,000 residents. This does not include those people who test only with home tests and therefore can't be counted.
In San Mateo, the seven-day average of new COVID-19 cases (per 100,000 population)is now at 85. In early January, that number was at 239.
The above notwithstanding, this week the world surpassed 400 million known coronavirus cases - only one month after hitting the 300 million mark. It took the world over a year to hit the first 100 million cases and it only took one month to hit the last increase of 100 million!
Treatment
Vaccines:
I know a lot of people are still hesitant about the COVID-19 vaccines out there, thinking they have not been well tested and were rushed to market. I understand that sentiment, especially in the early days of vaccine availability. But at this time, over 10.1 billion COVID-19 vaccinations have been administered world-wide, which is a large, large number. And the good news is that serious side effects are extremely rare. I would encourage all people who are not vaccinated (or not fully vaccinated) to get a vaccine.
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/ BioNTech is planning to obtain authorization for their two-part vaccine for kids under the age of 5, even as they are looking into a three-part vaccine regimen for the future also. This is a bit surprising to me, personally, as previous trials showed that the two-dose vaccine regiments for kids under 5 years were not particularly effective in preventing COVID-19...
Moderna:
On 1/31/22, the FDA (finally) granted full approval to Moderna's COVID-19 vaccine, after more than 200 million doses have been administered in the U.S. since December, 2020. The vaccine is now no longer considered "experimental."
The South African company Afrigen Biologics has used the publicly available genetic mRNA sequence to manufacture its own COVID-19 vaccine. This should be tested before the end of 2022 and could be the first vaccine designed and produced in Africa.
Johnson & Johnson:
In late 2021, J&J shut down the only plant making its COVID-19 vaccine. Instead, that plant is now making a vaccine against a different virus. This stoppage could reduce the company's vaccine supply significantly.
Novavax:
The American company Novavax has submitted an application to the FDA to get authorization for its COVID-19 vaccine. This vaccine is protein-based, like the J&J vaccine (and previous vaccines like the flu shot). If authorized, it will be the second protein-based COVID-19 vaccine in the U.S. market.
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's new pill "Paxlovid" to treat COVID-19 is likely to work against the Omicron variant. 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. Unfortunately, Paxlovid remains difficult to find in the pharmacies, due to the Omicron demand outstripping supply.
Testing
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. Also, starting this spring, Medicare will also start covering home coronavirus tests from certain pharmacies. Medicare too will cover up to 8 tests per month.
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.
Our Community and Beyond:
The San Mateo Events Center (at 2495 Delaware Street, San Mateo) is offering vaccinations as well as PCR testing. Appointments are needed. In addition, check out the website of San Mateo County (smc.gov) for lots of other sites for COVID-19 vaccinations and testing available.
As you may know, California currently requires everyone to wear a mask in indoor public spaces through February 15. However, as of February 1, San Francisco County is partially lifting this mask mandate. But San Mateo County has not lifted the mandate so we still have to toe the line with wearing a mask until 2/15/22. Even after February 15, masks will be required in health care facilities, homeless shelters, and public transit. Also, unvaccinated people will still be required to wear a mask in all indoor facilities.
California also announced that testing requirements for visitors to nursing homes will end next week.
The Virus Geeks, who were doing the COVID-19 testing at the San Mateo Event Center, have ended their operations there on January 28, due to very long delays in getting the results to patients. The new company doing the test is Carbon Health.
A Menlo Park-based biotech company, Avellino Labs, is offering free PCR-based COVID-19 tests 7 days a week (between 9 am and 5:30 pm). The testing will occur at the office's parking lot at 4300 Bohannon Drive. Appointments are not necessary. Turn-around time will be 48 hours.
New COVID-19 cases in the local schools are dropping significantly also: the Sequoia Union High School District, which has 10,200 students, only had 121 new cases last week. In early January, that number was 710!
Non-COVID-19 News
Recent data collected by the CDC show that 11.3% of the U.S. population has diabetes and 38% (!!) has prediabetes. These numbers are crazy high!
In "older women," a recent study (JAMA Internal Medicine) showed that increasing the amount as well as the intensity of exercise will help prevent diabetes. And the amount of exercise was not correlated to weight, so that exercise is really good for you, even if it is not associated with weight loss...It wouldn't surprise me if these benefits of exercise for diabetes also applied to men and other age groups...The investigators estimated that "more than 110,000 U.S. deaths could be prevented each year if adults over 40 added 10 minutes of daily moderate to vigorous physical activity to their normal routines."
An article from the European Journal of Preventative Cardiology showed that drinking "moderate" amounts of coffee (half a cup to 3 cups daily) was associated with a decreased risk of having a heart attack or a stroke. I am very happy to hear this, as I am a big coffee fan!!
I just heard about a lecture on February 16 that will be offered by the Palo Alto based senior services agency Avenidas: this lecture is intended for seniors who live alone and may need help at home and don't necessarily have the resources for in-home help or for care facilities. It is available online, but I think you need to register:
https://anc.apm.activecommunities.com/avenidas/activity/search/detail/3574
About Dr. Sujansky's Life in These Times
As you all know, Valentine's Day is coming up on February 14. I hope you all will not just think of it as a day to honor the "special someone" in your life, but also to honor all those people that are important to you. Also, I hope you honor yourselves this day as well....I know many of you who treat their family and friends so well, but aren't nearly as kind to themselves. So spoil yourself a bit that day - be it with a warm bath, a fun show or movie, or a special culinary treat. You are worth it!
As for me, I am treating myself by NOT cooking that evening and ordering take-out! Ahhh, heaven!
