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:
As of mid-February, the U.S. has recorded more than one million "excess deaths" due to the pandemic. This number is largely comprised of people who died of COVID-19. It also includes people who died of other disease (like heart disease) when they didn't have access to medical care.
Omicron:
Hospitalizations among children has increased with Omicron (as compared to Delta). This is based on a study published by the U.S. Centers for Disease Control and Prevention. During the Omicron peak, four-times as many kids were hospitalized compared to the numbers during the Delta peak.
Overall, Omicron is on the retreat! At this time, new cases of COVID-19, as well as the numbers of hospitalizations and deaths are dropping. In fact, new cases are down 90% from their high point in January.
As Omicron recedes, we are seeing a discontinuation of mask mandates throughout the country. And that is great! However, I ask each of you to consider your individual risks of infection and consider continuing to wear a mask in certain circumstances. A recent article in Emerging Infectious Diseases showed that uninfected people can cut their risks of infection in half if both they were a mask and the infected person is wearing a mask also.
A recent study (Brain, Behavior, and Immunology) found that people who exercised for 90 minutes after getting a flu or COVID-19 shot produced more antibody against the index virus than those who did not.
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.
A study out of the United Kingdom shows that vaccinated COVID patients recover from Long COVID faster than unvaccinated patients: vaccinated patients are half as likely to have ongoing symptoms after one month and 78% less likely to have symptoms lasting 12 to 20 weeks.
Scientists are finding different possible causes of Long COVID syndrome: evidence points to ongoing smoldering infection, nerve damage, ongoing blood clots, and auto-immune antibodies.
Recent studies (Archives in Pathology and Laboratory Medicine) show that the SARS-Cov-2 virus hurts the fetus during a pregnancy by infecting and destroying the placenta. This can lead to a miscarriage. On the other hand, if the pregnant mother is vaccinated for COVID-19, the babies will have long lasting antibody protection also (lasting at least 6 months).
COVID-19 infections are associated with an increased incidence of mental health disorders (BMJ) including depression and anxiety. In addition, there is an increased incidence of sleep problems and "neurocognitive decline." Even if you compare people who were hospitalized with COVID-19 to those who were hospitalized with influenza, the COVID-19 survivors had more mental health problems.
Unfortunately, there are more and more studies that show that COVID-19 infection has long-standing repercussions: a recent study published in Nature Medicine shows that people who have recovered from COVID-19 are at increased risk of various heart diseases for at least one year after contracting the virus. People who were severely ill with the virus were at higher risk than those with mild infections only. But even those with only mild infections showed increased risk of heart disease.
Incidence/ Prevalence:
Almost every state is seeing a significant drop in COVID-19 cases. Most states with mask mandates have started rolling them back.
The number of new COVID-19 infections has dropped significantly in San Mateo! As a matter of fact, for the first time this school year, the Sequoia Union High School district has not had a single case of COVID-19 for the week!
Treatment
Vaccines:
People who get COVID-19 vaccines and boosters from different manufacturers seem to be better protected against the virus than those that stick with the same manufacturer.
The CDC has recommended that some unvaccinated people that are planning to the either the Moderna or the Pfizer/ BioNTech vaccines wait 8 weeks (not just 3 to 4) between their first and second doses: it seems that waiting 8 weeks between doses will build a more robust immune response. However, if people have a weakened immune system, are aged 65 or older and/ or need rapid protection should get the traditional three to four week interval.
Booster shots seem to lose much of their efficacy of preventing any infection after about four months. Luckily, they are still very good (78% effective) at preventing hospitalization and death after four months. These results were recently published by the CDC.
Yet another study (this once published in JAMA Internal Medicine) looked at the safety of COVID-19 vaccines in patients who had allergic reactions to the mRNA vaccines: even if you already had an immediate allergic reaction to the first shot, your likelihood of having a mild reaction to the second shot was 13.65% and of having a severe reaction was only 0.16%!
I know many of you are frustrated by the number of vaccines and boosters we need to get to protect ourselves from this disease. We want to know how many more will be needed and how often...Well, several new studies suggest that it may not be so bad: some studies suggest that people older than 65 and/ or with a weakened immune system may need a fourth shot, most people will not benefit from more vaccination.
Pfizer/ BioNTech:
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...And the FDA was clearly reading my newsletter! the FDA stated on February 11 that they were holding off on authorizing the vaccine for kids under 5 until they had more data on the three-shot series. Pfizer hopes to have more information on the three-shot series by early April.
Moderna:
On 1/31/22, the FDA (finally) granted full approval to Moderna's COVID-19 vaccine.
Johnson & Johnson
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.
There is a new vaccine made by Sanofi and GSK that is proving to be very effective in early trials: after two doses, the vaccine was 75% effective against moderate disease and 100% against severe disease and hospitalizations. The vaccine is antigen based and therefore uses technology that has been around for decades and is used for flu shots.
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. A recent article in the New England Journal of Medicine looked at the efficacy of Paxlovid in unvaccinated, high-risk outpatients with COVID-19: the medication was 88.8% effective in preventing hospitalizations. Also, in the study, no one in the Paxlovid group died, while 7 people in the placebo group died. The number of side effects were the same in the Paxlovid and in the placebo groups. The medication remains difficult to get in our neck of the woods, due to limitations in supply. To be effective, Paxlovid needs to be started within five days of infection.
On February 11, the FDA approved a new monoclonal antibody that is given as an infusion to people who have COVID-19 but don't need to be hospitalized. This new infusion seems to be effective against Omicron in particular. The medication is indicated for people at high risk for bad outcomes if they get COVID-19.
There are still some people that believe that the widely available and inexpensive anti-parasitic agent ivermectin is helpful for the treatment and prevention of COVID-19. Multiple studies have not found that to be the case. Most recently, an article in JAMA Internal Medicine again found that high risk patients with COVID-19 who took 5-days of ivermectin did not have a lower likelihood of developing severe disease.
Testing
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 of February 16, most indoor masking mandates for vaccinated individuals have been lifted. Nonetheless, masking is still mandatory in health care facilities, on public transportation, correctional settings, as well as long-term care and senior care facilities. On February 28, California officials will reassess the need for masking in schools.
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.
Non-COVID-19 News
Sorry, I've got nothing for you in non-COVID news this time.... :(
About Dr. Sujansky's Life in These Times
It's hard to know what to make of the weather these days! It is either so cold that I have to put an extra blanket on my bed, or so warm that I want to unpack my summer clothes! But my husband and I did take advantage of the warm temperatures over the weekend to go to San Francisco to have dinner and to watch a show, "Harry Potter and the Cursed Child." I enjoyed it tremendously, in part because I have to admit to being a huge Harry Potter fan and in part because the stage craft was amazing: it really seemed that magic was real as people changed shape before my eyes, under water scenes were believable on stage, and time travel seemed to be occurring. So much fun!
Next weekend, my younger son comes home for his spring break and I plan on spoiling him rotten!
