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 subvariants BA.4 and BA.5 now make up 8%-13% (each) of the cases in the United States. These subvariants seem to largely be resistant to immune responses from prior vaccination or COVID-19 infection (New England Journal of Medicine).
International travelers no longer need to have a negative COVID-19 test before flying to the U.S.
A recent study from the New England Journal of Medicine found that people who had gotten three doses of one of the mRNA vaccines were as protected against the Omicron BA.1 and BA.2 SARS-Cov-2 variants as those people who had been infected with the virus previously.
The Omicron variant is less likely to cause long-Covid than previous variants (Lancet).
Kids aged 6 months to 5 years are now eligible for the COVID-19 vaccinations, as the FDA approved of vaccines for this age group on 6/17/22. At this time, about 13.5 million children in the U.S. have contracted the disease...though data evaluating children's blood tests suggest that up to 75% of kids had been infected by the virus!
I know there are a lot of questions about booster shots going forward: what to get and when. Well, hopefully we will get more clarity on this soon: a panel of independent experts advising the FDA is meeting today about the newer versions of the Covid-19 vaccines (both Pfizer and Moderna now have a version that significantly increases antibody levels for the Omicron variant!!) and when to get those, especially given the upcoming winter cold and flu season. So stay tuned!
Symptoms and Risk Factors:
Long COVID:
A new study (based on survey data collected by the CDC) estimates that almost 20% of American adults have symptoms of Long COVID. Women are more likely to be affected by this than men.
People infected with one of the Omicron virus variants are much less likely to lose their sense of taste or smell compared to those infected with the original or the alpha variant.
A recent study (Jama Network Open) confirmed that COVID-19 is much more serious for kids than the seasonal flu: in the first 15 months of the pandemic, there were twice as many pediatric hospital admissions for COVID-19 than for influenza in the preceding two years.
Incidence/ Prevalence:
COVID cases have leveled off in California.
A study published in JAMA used blood obtained at the time of blood donations to estimate the number of people who have been infected by or vaccinated for SARS-Cov-2 at this time: of the people donating blood, 94.75 (!!) have either been vaccinated or previously infected. Sadly, it seems that neither previous infection nor vaccination fully protects us from future infections, though numerous studies have shown that such subsequent infections are much less dangerous.
Treatment
Vaccines:
It is estimated that almost 20 million lives were saved by COVID-19 vaccination (Lancet Infectious Diseases).
Both Moderna and Pfizer have developed a newer version of their vaccines that incorporates the Omicron variant.
Pfizer/ BioNTech:
As mentioned above, kids aged 6 months to 5 years are now eligible for the COVID-19 vaccinations, as the FDA approved of vaccines for this age group on 6/17/22.
Moderna:
FDA scientists have determined that Moderna's vaccine for infants and young kids under 5 is safe and effective. Vaccine-associated fevers are more common in this younger age group, but are similar in number to fevers associated with other childhood vaccinations.
An FDA committee has also determined that Moderna's vaccine is safe and effective in kids aged 6 to 17. Subsequently, the CDC echoed the recommendation to approve the Moderna vaccine for kids aged 6 to 17. Moderna also plan to later offer booster shots to that age group.
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.
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.
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.
A recent study found that rebound infections after paxlovid use are actually quite rare (Clinical Infectious Diseases), and only occur 0.8% of the time.
A recent study (MMWR) looked at the real-life effectiveness of paxlovid in preventing hospital admissions: of the 5,287 who received the medications, 6 were hospitalized and 39 ended up in the emergency department.
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.
As you may know, we have been assessing a person's immunity to COVID-19 by checking antibody levels to the virus in the past. As the antibody response is only one of several responses the immune system has to fight off the virus, these tests have been incomplete, at best. Now a new blood tests has been developed that helps measure the T-cell immune response also. We hope that such tests will be available to the general public soon (Nature Biotechnology).
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.
Vaccinations for kids aged 6 months to 5 years has started in San Mateo County; no large-scale vaccination clinics are planned, but the county will support pediatric providers in vaccinating the kids.
Unfortunately, hospitalizations for coronavirus infectious are rising in San Mateo county.
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).
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 as well as a severe headache and muscle aches. 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 disease can last for 2 to 4 weeks. 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.
The WHO has decided not to declare monkeypox as a global health emergency at this time. Instead, they are calling it a "evolving health threat." I'm not sure how reassuring I am finding that...
A suspected case of monkeypox has been found in Santa Clara County. The individual had been travelling internationally. The county is awaiting confirmation from the CDC.
About Dr. Sujansky's Life in These Times
My family continues to do well.
I recently went apricot-picking and was left with a ton of slightly bruised apricots....so now I have a lot of apricot jam! For similar reasons, I just finished making a lot of plum butter....but I think next time I will try making plum brandy instead!