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:
The WHO has updated its assessments of worldwide deaths related to the COVID-19 pandemic: it seems that almost 15 million (!!) additional deaths occurred either due to the virus itself or due to issues associated with access to care related to the disease. This number is more than twice as high as the previous estimate of excess deaths. Almost 66% of all of these deaths occurred in just 10 countries, one of which is the U.S.
During the recent Omicron surge, hospitalizations for unvaccinated kids were twice as high as hospitalizations for vaccinated kids. For every 100,000 unvaccinated children, 19.1 were hospitalized with COVID-19 between mid-December and late February.
Booster shots:
A new article (New England Journal of Medicine) suggests that the second booster shot has a real effect: people aged 60 and above who had received their 2nd booster were compared to those who had only received one booster: although the extra booster was only 45% effective in preventing any sort of infection, it was 55% percent effective in preventing symptoms and 68% effective in preventing hospitalizations. In addition, the extra booster was 74% effective in preventing COVID-19-related death.
The BA.2 subvariant is now responsible for more than 90% of all COVID-19 cases in the U.S. BA.2 is 40% more transmissible than the original omicron.
However, there is now an even more contagious subvariant out there, called BA.2.12.1. This variant is 25% more transmissible than BA.2!! Currently, 20% of new infections are related to this subvariant.
The likelihood of death in patients hospitalized for COVID-19 is three to four times higher than the risk of dying if you are hospitalized for influenza (ECCMID).
Remember the early days of the pandemic when it was not clear how worried we needed to be about contracting the virus by touching a contaminated surface? Well, studies now show that you are 1,000 times more likely to get infected by airborne viral particles than by touching the wrong surface (Journal of Exposure Science & Environmental Epidemiology)....good news, I guess?!
Talking about airborne viral transmission: federal health officials on May 3 repeated their recommendations that masks be worn on planes, trains, and public transportation.
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.
Unfortunately, it seems that people who were only mildly ill from COVID-19 (or had no symptoms at all!) can still develop Long COVID. women and older adults appear more susceptible to Long COVID.
An article in Open Forum Infectious Diseases found that symptoms of Long COVID (as well as the onset of high blood pressure and diabetes after COVID-19 infection) can still occur in people who get the disease despite vaccination. BUT, vaccinated people were at much lower risk of these down-stream illnesses.
People with depression, substance abuse disorders, and other mental health issues are at higher risk of contracting COVID-19, even if they are fully vaccinated (JAMA Network Open).
Incidence/ Prevalence:
About one third of the U.S. is now reporting "substantial" levels of COVID-19 transmission. The Northeast and Midwest are most affected at this time. In Michigan and New Hampshire, the numbers of new cases has doubled since the beginning of April. In New York, hospitalizations due to the disease are up 30% in the last two weeks.
Coronavirus cases are increasing significantly in California. Indeed, the number of infections is three-times as high as it was in late March, 2022! And, unlike past COVID-19 spikes, the Bay Area is seeing many more cases than the rest of the state:
Hospitals across the state are treating 1,112 patients, up 17% in the last 10 days. Similarly, the number of people in the intensive care units is up 50%.
San Francisco now has the highest daily case rate in the state. Next highest counties are, in order, San Mateo, Santa Cruz, Santa Clara, and Alameda.
The increase in cases is due to the two highly contagious omicron subvariants (BA.2 and BA.2.12.1.)
The above notwithstanding, the official cases are still only 10% as high as they were in early 2022
In San Mateo County:
As of April 22, there have been a total of 124,946 cases of COVID-19, which comprises about 16% of the population. However, this figure is likely to be an undercount, as positive home tests were not included in this figure.
A total of 754 San Mateo residents have died of the disease.
87.5% of the population is fully vaccinated.
wastewater surveillance in the Bay Area suggests that virus levels continue to increase.
Treatment
Vaccines:
A new study (JAMA Network Open) looked at how safe the m-RNA vaccines were: after reviewing electronic health records of just under 50,000 people, researchers did not find an increased incidence of severe adverse effects in people who had received the 3-dose mRNA series. Milder side effects (e.g. headaches, fatigue) were more common after vaccination.
On June 28, the FDA is scheduled to meet to see if the composition of the vaccines should be modified to reflect the currently dominant strains and- if so- which strains should be selected for the vaccines available this fall.
Two new COVID-19 vaccines are in trials right now: they were developed by novel methods. Preliminary evidence suggests they are very effective in preventing severe disease. Both of these vaccines do NOT require storage in extremely cold environments. Details are still lacking about how well these new vaccines protect against the omicron variant, so there are still lots of questions that need to be answered prior to the vaccines hitting the market.
Pfizer/ BioNTech:
A small study (as yet unpublished) showed that a booster shot of the Pfizer/ BioNTech vaccine increased immunity in school-aged kids. The company now plans on requesting emergency use authorization for booster shots in that age group.
Pfizer/ BioNTech plan on completing their application for the vaccine in children under the age of five in June.
Moderna:
On 4/28/22, Moderna requested the FDA to grant emergency use authorization for its vaccine for children under the age of six. Early trial data provided by Moderna showed that the vaccine was safe and effective for young kids. However, Moderna reported that the two-dose vaccine was only 37% effective in preventing infections in 2- to 5-year-olds. The vaccines were 51% effective in children aged 6-months to 2 years.
Johnson & Johnson:
The FDA has restricted the use of this vaccine to those people who can't get an mRNA vaccine OR specifically request the J&J vaccine. This new restriction is due to a rare clotting condition ("thrombosis with thrombocytopenia syndrome") that can occur after the J&J vaccine. This clotting risk is NOT seen with the Pfizer/ BioNTech or Moderna vaccines.
Novavax:
The FDA is meeting on June 7 to consider authorization of this vaccine for adults.
Other treatments:
Pfizer's 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. Federal officials are trying to raise awareness of this treatment option as well as increase supply and access.
Unfortunately, there seems to be some evidence that people who are treated with Paxlovid, while initially improving significantly, may relapse after the course is completed. This data is still very new and there are now many more questions than answers....we don't know, for instance:
how often such a relapse occurs.
what patients are more likely to relapse.
if a longer course of paxlovid would prevent relapses.
The anti-depressant fluvoxamine, when taken soon after infection with SARS-Cov-2, seems to reduce the risk of hospitalization for COVID-19. (JAMA Network Open).
Remember remdesivir? This is a medication we still routinely use in hospitalized patients to treat COVID-19. Well, the FDA just approved use of this medication for children as young as 28 days...
Testing
Starting April 4, Medicare has started paying for up to eight home COVID-19 tests per month. Tests can be picked up at various pharmacies. This coverage will only apply to people enrolled in Medicare Part B.
Emergency use authorization was just awarded to a new COVID-19 breathalyzer test that can diagnose COVID-19 in as little as three minutes. Testing would occur only in medical settings (not in your home). The breathalyzer picked up 91% of the positive samples and correctly identified 99% of the negative samples....something to look forward to!
As you know, there is a lower sensitivity of home testing for COVID-19 compared to the PCR-based test. So if your home test is negative but you have symptoms of COVID-19 or a worrisome exposure, please re-test in 1 to 2 days to make sure your negative test is really accurate.
Our Community and Beyond:
A new study looked at hospitalizations and COVID-19 deaths in California in particular (JAMA Network Open): it is estimated that vaccination helped prevent more than 1.5 millions cases of COVID-19, 72,000 hospitalizations, and 19,000 deaths through October, 2021.
California has just launched a new automated electronic chat system that is aimed at fighting dis-information on COVID-19, with emphasis on parts of the population that speak Spanish primarily. The chatbot offers current information on COVID-19 vaccines, vaccination sites, and other relevant information. The system is free and can be accessed in both English and Spanish by texting "hola" to
833-422-1090
Across California, over 75% of residents aged 5 and above have completed their vaccination series. However, only 59% of Latino and Hispanic residents have been fully vaccinated.
California is no longer requiring face masks on public transportation, bus stops, and airports. At the same time, San Jose has just reinstituted a mask mandate for city employees.
According to new guidelines from the California Dept. of Public Health, people who were exposed to COVID-19 but have no symptoms will no longer need to quarantine for any length of time.
Controversy continues about mandatory vaccination of kids: officials are now pushing back the date for students to get vaccinated...
Non-COVID-19 News
Two new studies offer more evidence that we need to eat more vegetables and minimize red meat and processed meats: high consumption of vegetables (especially lettuce, legumes, and cruciferous varieties) lowers the risk of liver disease and liver cancer. A different study showed that processed meats is associated with a higher incidence of stomach cancer. (American Association for Cancer Research)
Ok, so this news is sort-of COVID-related: as you may have heard, much of the U.S. population put their regular health care maintenance (e.g. vaccines, screening colonoscopies and mammograms, doctor's visits) on hold in the first year of the pandemic. That is only natural. But now we are seeing that cases of measles have jumped 79% in the first two months of 2022 compared to 2021....makes sense: lower vaccination rates and now more socialization. So time to get back to preventative medical services!
The U.S. Preventative Services Task Force (USPSTF) now recommended that most healthy people do NOT take a daily aspirin to prevent heart attacks. Only those people with extremely high risk of heart disease and those who have had heart disease in the past should be on aspirin. For the rest of us, the risks of a daily aspirin (stomach ulcers, bleeding in the brain) outweighs the benefits of the medication.
Finally, I saw an article that found that knitting (and other needlework crafts) can help prevent mild cognitive impairment - better than reading, playing music, and other activities. Now, I must admit that I didn't research the validity of these claims further and I'm just going with it, for selfish reasons :).
About Dr. Sujansky's Life in These Times
A couple of weeks ago, I met up with some old friends from my days in medical school ("old" meaning "long-time," not "old" as if we are old...). We had re-connected during the pandemic via zoom and now got together for the first time in person at Avila Beach. It was fantastic and so much fun! Such re-connections, at least, were one good thing that came out of the shelter-in-place days! While there, we took long walks and explored the seaside bluffs as well as the Los Osos Oaks State Reserve. This park is gorgeous and features oak trees that are centuries old. See the picture below!
Next week, my older son graduates from college and we are headed out to the East Coast to celebrate him. I am very excited and also incredulous that my little boy is now done with college!
