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:
There have been a lot of questions as to whether we need yet a fourth vaccination shot. Here is what I know:
The antibodies we develop after vaccinations decrease substantially after 6 months (JAMA Oncology)
A letter recently published in the New England Journal of Medicine looked at hundreds of Israeli health care workers who received a fourth dose of vaccine (either Pfizer/ BioNTech or Moderna) and compared them to ones that had only received three doses: those that had received a fourth dose were not significantly more protected against the Omicron variant. It did NOT seem that healthy people, at a minimum, benefitted much from the extra shots.
Last week Pfizer/ BioNTech asked the FDA to authorize an additional booster for people over 65. Moderna also petitioned the FDA for an additional booster for all adults.
The J&J vaccine is getting some good recent press recently; while it does not seem to be quite as effective in preventing COVID-19 (compared to the mRNA vaccines), it has been found to have persistent protection even 6 months after vaccination: a single vaccine was 76% effective in preventing any infections and 81% effective in preventing hospitalizations. This is similar to the data from the CDC that showed that in the time between late December and February, 2022, those who had gotten a J&J shot had the fewest number of breakthrough infections. It is possible that the effects of the J&J vaccine lasts even longer than 180 days, it's just too early to tell for sure.
Data provided from the Ministry of Health in Israel have NOT shown any additional safety concerns associated with a second booster shot.
Today, March 29, the FDA authorized second booster shot of either the Pfizer/ BioNTech or the Moderna vaccine for those people who
are aged 50 or older or...
are older than 12 (but not necessarily older than 50) and immunocompromised (including people who have had an organ transplant or have a weakened immune system for other reasons).
AND have had their first booster (i.e. their third shot overall) at least four months previously.
The BA.2 subvariant of the Omicron virus is continuing to become more prevalent in the U.S., as it has also spread previously in Europe and Asia. At this time, it makes up fore than 33% of all COVID-19 cases in the U.S. As this subvariant is more infectious still than the "original" Omicron, the concern is that it may bring with it another spike in cases. For now, however, the number of infections is still DECLINING from the high levels of January.
Symptoms and Risk Factors:
Long COVID:
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.
A study published in JAMA Internal Medicine looked at the risks of getting COVID-19 while pregnant: infection was associated with an increased risk of various complications ranging from preterm birth to diabetes, and blood clots. The good news is, however, that it is rare for pregnant mothers to transmit the SARS-Cov-2 virus to their infants. Only 1.8% of newborns tested had the virus, when their mother was infected (BMJ).
A new study (published in The Lancet Diabetes & Endocrinology) shows that people who get COVID-19 have an increased risk of developing diabetes up to one year later. And the people who were sicker and ended up in the hospital were at higher risk than those who were more mildly ill.
Incidence/ Prevalence:
At this time, fewer than 800 people die of COVID-19 in the U.S. every day. The number of new cases also continues to drop, though at a slower rate that previously. some states in the Northeast and south (New York, Connecticut, Arkansas) have seen an increase of cases.
Meanwhile, in Europe and parts of Asia, Africa, and the Middle East, the BA.2 Omicron variant has led to a surge of now COVID-19 infections.
Treatment
Vaccines:
A large European study published in the BMJ found that various potentially severe side effects of COVID-19 vaccination (like Bell's palsy, inflammation of the brain, Guillan-Barre) were NOT more common with vaccination with the AstraZenica, Pfizer/ BioNTech, Moderna, and J&J vaccines.
A recent study showed (again) that three doses of the Pfizer or Moderna vaccines were 94% effective in preventing death or the need for a ventilator during the Omicron surge. At the same time, two shots were only 79% effective in preventing this!
About half of the eligible U.S. population has not received a booster shot. Data from California on the effectiveness of the booster shots are impressive:
for every million boosted Californians, fever than two are hospitalized for COVID-19.
Pfizer/ BioNTech:
The Pfizer/ BioNTech vaccine has been found to be much less effective in kids aged 5 to 11. While the vaccines is still good at keeping children out of the hospital, it does NOT protect much at all in getting the infection in general (medRxiv). The decreased effectiveness of the vaccine in this age group may well be related to the significantly lower doses used for these young children.
Moderna:
Moderna announced on 3/23 that its two-dose pediatric vaccine was safe in young kids. However, while still considered "successful," the vaccine was not that effective in kids aged 6 months to 5 years, due to the Omicron variant. Moderna will soon apply for Emergency Use Authorization in the U.S. and Europe for use of its vaccine in kids younger than 6.
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'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.
The antibody therapy "sotrovimab" does not seem to be effective against the BA.2 variant, though other therapies (Paxlovid, remdesivir, molnupiravir, and bebtelovimab) are expected to work against BA.2.
Testing
An article in Annals of Internal Medicine looked at how effective the rapid COIVD tests from BinaxNOW were in picking up the virus, when compared to PCR testing: over 95% of those who had a positive PCR test also had a positive rapid test. Most of the people had the Omicron variant.
Our Community and Beyond:
As of March 12, California ended its state-wide mask mandate in schools.
Santa Clara County is seeing more of the BA.2 Omicron variant BUT the overall number of new infections is not rising. In San Mateo County, evaluation of wastewater has estimated that 93% of circulating coronavirus is due to BA.2.
San Mateo County has closed the COVID-19 testing site at the San Mateo County Events Center.
83% of all San Mateo residents are now fully vaccinated.
