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:
We have hit another grim milestone: now one million Americans have died of COVID-19 since onset of the pandemic. In 2021, COVID-19 was the third leading cause of death in the U.S. (after heart disease and cancer).
Unfortunately, the coronavirus is getting better at infecting people and even people infected with the omicron variant have become re-infected with one of the omicron subvariants, just a few months later.
The BA.2 subvariant (known as "BA.2.12.1) is now the dominant version of the virus in the U.S. population. This variant doesn't seem to cause more severe disease than earlier virus variations.
Symptoms and Risk Factors:
Long COVID:
A recent studies showed that people who were hospitalized for COVID-19 2 years ago developed long COVD 55% of the time. Most of the time, people had ongoing muscle weakness or fatigue (Lancet Respiratory Medicine).
A new study (BMJ) individuals who had already been infected with SARS-Cov-2 and then received a vaccination were somewhat less likely to develop long COVID. However, it is unclear that vaccination helps much to protect against long COVID-19 if you are vaccinated before you get infected (Nature Medicine).
A study published in the Annals of Internal Medicine looked at the likelihood of symptoms in people who contracted COVID-19 more than 6 weeks ago: 55% of COVID-19 patients reported ongoing symptoms, while 13% of controls (people who had never had COVID-19) reported similar symptoms.
The CDC now estimates that 25% of seniors and 20% of adults under 65 experience long-COVID (MMWR).
Some good news: college athletes with a history of COVID-19 have been found to recover completely with no evidence of long-term heart conditions (Circulation).
The above notwithstanding, 12% of patients who were hospitalized for COVID-19 were diagnosed with heart inflammation in the year after their infection (Nature Medicine).
For some strange reason, those people who have food allergies seem to be 50% less likely to contract COVID-19 infection (Journal of allergy and Clinical Immunology).
The risk of MIS-C ("multisystem inflammatory syndrome in children") that has been associated with COVID-19 seems to be much lower for kids infected with the Omicron variant, especially if the kids had been previously vaccinated against COVID (JAMA Pediatrics).
Incidence/ Prevalence:
At this time, COVID-19 cases are still rising and are 6-times as high as they were one year ago.
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.
Pfizer/ BioNTech:
The FDA has authorized booster shots of the Pfizer/ BioNTech vaccine in kids aged 5 to 11. Also, children with severely compromised immune systems are eligible for a fourth dose of vaccine.
Early studies suggest that a three-dose low-dose vaccine series with the Pfizer/BioNTech vaccine is effective in preventing infections for kids aged 6 months to 4 years old. It is hoped, that this age group will soon have authorization for vaccination as well, though the FDA has not yet approved vaccination for these young kids as yet. Nonetheless, the federal administration has implied that it hopes to make vaccines available to kids under 5 as early as June 19.
Moderna:
Moderna has developed an updated coronavirus vaccine that is designed to protect people against the Omicron subvariants. Moderna now plans on submitting the information to regulators in the next few weeks. it is hoped that the new vaccine will be available by the end of the summer.
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:
On June 7, a panel of independent vaccine experts recommended that the FDA authorize the Novavax vaccine. The FDA has not yet come to a decision on authorization of the vaccine, however, in part due to concerns relating to the manufacturing process.
This vaccines is protein-based, and therefore employs a different technology than was used with either the J&J or the mRNA vaccines.
The vaccine was found to be 90% effective in preventing mild, moderate, and severe COVID-19. None of the volunteers in the trials became seriously ill with infection after being vaccinated.
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.
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.
According to the CDC, patients who relapse after a course of paxlovid should isolate again for 5 days.
Relapses after paxlovid are usually more mild.
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.
The FDA has given authorization for Labcorp to offer a test direct to the public without a doctor's prescription: this test is PCR-based and checks for both the COVID-19 virus as well as RSV ("respiratory syncytial virus"), a common cause of respiratory infections in the U. S.
The White House has authorized distribution of more free at-home COVID-19 tests.
Our Community and Beyond:
We now have "test to treat" sites in San Mateo: at the College of San Mateo! This is a place where people can get a test for COVID-19 and immediately get treatment, if they are eligible for it! Eligible people are older than 50 or with underlying immune-compromising conditions. Other such "test to treat" sites are also at pharmacies such as the CVS in Millbrae, Foster City, and San Bruno. Other such sites are being planned also.
Testing of wastewater in the Bay Area shows that the concentration of SARS-Cov-2 has been going up since April.
Non-COVID-19 News
Now let's talk about a different infectious disease that is spreading across the world: MONKEYPOX!
Monkeypox is caused by a virus (an "orthopoxvirus") that is closely related to smallpox. It has been recognized for decades and in the past has been largely confined to Africa (especially Nigeria).
In the last month or so, we have seen an unusually large number of cases of monkeypox outside of West Africa. At this time, there are about 1356 cases in 29 countries outside of West Africa, and 44 cases in the United States.
You get monkeypox by getting into close contact with animals that carry the virus (some rodents and monkeys) or by being in close contact with the skin lesions of someone who has the disease or (less often) by close contact to respiratory droplets. Monkeypox is NOT a sexually transmitted disease.
Monkeypox is NOT very contagious and the risk of general transmission is low. Masks help protect from monkeypox (in addition to protection from COVID-19).
Symptoms of the current outbreak include initial chills and fever. A few days later, people develop a rash consisting of blister-like firm lesions that then scab over. Often times, the initial skin lesions are in the genital and rectal area. The mortality rate of monkeypox is about 4% (compare this to smallpox, which has a fatality rate of 30%). At this time, no deaths have been reported associated with the outbreak.
It is thought that the current outbreak is due to the decline in smallpox vaccinations, as smallpox was eradicated in 1980. Smallpox vaccinations protect against monkeypox. In addition, increase in travel and trade as well as expanding populations has led to more occasions for humans to come into contact with animal carrying the virus and then traveling abroad.
There are several types of vaccines available to protect from infection, but they are currently in small supply (though more are being produced now). At this time, close contacts of people infected with monkeypox are eligible for vaccination. The vaccine is NOT available to the general public.
One case of monkeypox has been now reported in Alameda county - the infected person was a close contact of someone who had recently tested positive for the disease.
About Dr. Sujansky's Life in These Times
We just returned from our summer vacation: we started out at my older son's college graduation and then went to New England. We had a wonderful time sitting by a lake, hiking, and kayaking (see images below). We were all able to thoroughly recharge our batteries and enjoy a beautiful part of the world.
This trip explains my lack of a newsletter in recent weeks...and I may have more than my usual amount of typos in this missive do to time constraints...:)