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 Omicron sub-variant BA.5 is now the dominant coronavirus in the United States, making up about 80% of cases. Though it doesn't seem to be as deadly as prior versions of the virus, it is the most contagious variant yet and can infect people who have been vaccinated as well as those who have been infected by the Omicron variant previously.
The risk of infection with BA.5 is high due to the ability of the virus to circumvent the body's initial immune system as well as our community's lack of interest in limiting disease spread.
The new Omicron variants have a shorter incubation period with an average of 2-3 days.
People are considered infectious:
two days prior to onset of symptoms until 10 days after onset of symptom
if people do not have symptoms, they are considered contagious 2 days prior to the positive test result until 10 days after the positive test result.
if tested negative after 5 days, people are considered non-contagious, but still should wear a mask.
Recent studies (Brain) have found that the antibodies we produce in the setting of COVID-19 infection can lead to damage of the blood vessels in the brain and lead to strokes and blood clots.
Vaccine makers Pfizer/ BioNTech and Moderna will roll out COVID-19 vaccines including the BA 4 and BA 5 Omicron sub-variants this fall.
The U.S. government is yet again extending the public health emergency associated with COVID-19. This will allow millions of Americans to get special access to health insurance and tele-health.
The coronavirus pandemic has led to an increase of "superbug" infectious. These are infectious with bacteria that are resistant to many commonly used antibiotics. This increase is thought to be related to many people who fell ill early in the pandemic who were erroneously treated with antibiotics. In addition, false beliefs of various antibiotics being beneficial to treat the infection (e.g. ivermectin, azithromycin) led to their overuse and subsequent bacterial resistance. Studies show that deaths caused by such superbug infections increased by 15% from 2019 to 2020.
Symptoms and Risk Factors:
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 who have had two or three doses of the coronavirus vaccine are less likely to develop long Covid compared to those people who are unvaccinated (JAMA).
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.
Incidence/ Prevalence:
California is in the middle of one of the largest COVID-19 surges since onset of the pandemic, with about 19,000 new cases being reported daily. Most people are not as sick as early in the pandemic, a likely result of vaccination and prior infection.
Between March, 2020 and October, 2021. COVID-19 was the third leading cause of death in the U.S. (after #1 heart disease and #2 cancer) (JAMA Internal Medicine).
Treatment
Vaccines:
Both Moderna and Pfizer have developed a newer version of their vaccines that incorporate elements of the Omicron variant.
A new study looked at the risk of heart inflammation (myocarditis) after administration of the Pfizer/ BioNTech or Moderna vaccines (BMJ):
The highest risk was in young men aged 12 to 29 (risk of about 28 to 147 per one million doses administered).
Moderna vaccines are associated with more of a risk of myocarditis compared to Pfizer/ BioNTech.
Most people who develop myocarditis don't seem to have any long-term consequences of the condition, though we will need to follow up on this as time goes on.
Pfizer/ BioNTech:
U.S. health officials have committed to purchasing another 105 to 300 million doses of the Pfizer vaccine in anticipation of the fall booster campaign.
The FDA has now granted full approval for the Pfizer/ BioNTech vaccine for kids aged 12 to 15 (not just under "emergency use").
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.
Moderna is developing two new booster vaccines that attack the Omicron subvariant: one booster targets the BA.1 strain, while the other is geared at the BA.4/5 strain.
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.
Novavax:
This vaccines is protein-based, and therefore employs a different technology than was used with either the J&J or the mRNA vaccines.
On July 13, the FDA authorized the Novavax vaccine for emergency use for people aged 18 and older. Then, the CDC followed suit in recommending the vaccine on July 19.
The vaccine is administered in a two-part series, three weeks apart. It is 90% effective in preventing mild, moderate, or severe cases of COVID-19.
Like the Pfizer/ BioNTech and Moderna vaccines, there is an increased risk of heart inflammation associated with the Novavax vaccine.
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.
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.
The FDA has authorized pharmacists to prescribe paxlovid (in addition to doctors) to help address the lack of authorized health professionals that can treat the disease in the outpatient setting. Pharmacists need to review the patients' health records first, to evaluate their kidney and liver function prior to prescribing the medication. Also, the pharmacist needs to be aware of all of the medications a COVID-19 patient is taking prior to prescribing paxlovid. For this reason, patients are required to present health records form the last year for the pharmacist to review.
In addition, there are "test to treat" sites through out the U.S. that allow a patient to be tested and given paxlovid at the same time.
Paxlovid needs to be started within five days of onset of symptoms.
A new medication "sabizabulin" has been found to reduce the risk of death by half in patients hospitalized for COVID-19 (New England Journal of Medicine). The data is based on only a small study so far, so still needs to be validated in a larger trial. This medication was initially developed to fight cancer.
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.
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.
In San Mateo County, the BA.5 transmission continues to rise and has now has more than doubled compared to early May. I know we are all so tired of the pandemic precautions, but this is not a time to let down your guard!
OK, so this isn't COVID-related, but....3 Bay Area Counties (Santa Clara, San Mateo, and Marin) were ranked as some of the healthiest nationwide.
Non-COVID-19 News
Now let's talk about a different infectious disease that is spreading across the world: MONKEYPOX!
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.
There have been more than 14,000 cases of monkeypox in 58 countries since the current outbreak began. Five people have died.
The WHO will meet again to decide if monkeypox constitutes "global health emergency."
Distributed monkeypox vaccine doses have more than tripled in the last week, though supplies continue to be inadequate.
I don't know if you are aware, but the excellent sense of scent of certain animals (like dogs) has been found to be able to pick up diseases like cancer. Now, scientists have developed an "electronic nose" that was tested to find cancer in a patients exhaled breath. These "electronic noses" have found to be very accurate in picking up the cancers (sensitivity of 90% and specificity of 87%). Nonetheless, much work still needs to be done in standardizing these devices before we can expect their regular use in clinical practice.
I have written the past that the annual flu shots not only protect against influenza, but also help to protect against heart attacks and strokes. Well, a new study (Journal of Alzheimer's Disease) shows that the shots can also help prevent Alzheimer's Disease. Seniors who received at least one flu shot in the last four years were 40% less likely to develop Alzheimer's during that period.
As mentioned in previous newsletters, there is a new nationwide phone and text number ("988") for those people for those seeking mental health assistance. This number complements the pre-existing suicide-prevention hotline ("800-273-TALK").
About Dr. Sujansky's Life in These Times
We are doing well.
We spent the Independence Day weekend with friends in Washington state and were again reminded how beautiful our country is!
2 weeks ago, we celebrated my older son's birthday by doing one of those "escape room" experiences in San Francisco. I had such a great time! I highly recommend it for anyone looking to entertain kids aged 10 to 30!
I hope everyone is staying cool and drinking enough water in this summer heat. Take care.
