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.
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.
The federal administration is preparing to launch a new campaign for booster shots in September, as the newly reformulated vaccine (including Omicron subvariants) should be available at that time.
Because of the new boosters shots that will be coming out, second booster shots are currently not recommended in low risk individuals (people under 50 who have a healthy immune system).
The current COVID-19 surge is far from over. In addition, about 80% of new cases go unreported due to the widespread diagnosis with at-home tests. Nonetheless, it seems like we have finally hit a plateau and the rate of new infections seems to be dropping.
The NIH released no COVID-19 guidelines, that shift some of the responsibility from institutions like schools and business to the individual person. The focus is now more protecting vulnerable populations, as others now likely have some immunity and are unlikely to become severely ill:
People exposed to the virus (but not necessarily infected) no longer need to quarantine at home, though they should wear a mask for at least 10 days and get tested for the virus on day #5. People infected with the virus DO need to isolate for 5-10 days.
people no longer need to stay at least 6 feet away from others.
Symptoms and Risk Factors:
Long COVID:
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).
HHS is creating a new office for Long COVID to better understand the condition, making the disease a high priority in HHS.
About 6% of kids infected with COVID-19 have ongoing symptoms 90 days after testing positive (Jama Network Open).
21% of people suffering from long-COVID had at least one core symptom (e.g. chest pain, difficulty breathing, dizziness, headache, nausea, or fatigue) that worsened 90-150 days after their COVID diagnosis - compared to 8.7% of people without COVID-19 (Lancet).
Incidence/ Prevalence:
Although the number of COVID cases are still high, the number of new infections is finally dropping, as are the new hospitalizations due to COVID-19. This applies to the country as a whole, as well as our norther California region.
Treatment
Vaccines:
Both Moderna and Pfizer have developed a newer version of their vaccines that incorporate elements of the Omicron variant.
A new study (JAMA) indicated that full vaccination against COVID-19 also reduces your risk of heart attacks and strokes as complications of coronavirus infections.
A study (JAMA Network Open) suggests that people who were given different types of COVID vaccines develop a stronger immune response than those who have received vaccines from the same manufacturer.
Pfizer/ BioNTech:
The FDA has now granted full approval for the Pfizer/ BioNTech vaccine for kids aged 12 to 15 (not just under "emergency use").
Moderna:
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. In fact, the technology has been used for decades.
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.
At this time, more than 7,300 doses of the Novavax vaccine have been given in the U.S.
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.
Paxlovid needs to be started within five days of onset of symptoms.
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.
COVID-19 transmission in San Mateo County remains high. Hospitalizations due to the disease are level and numbered 58 on August 1.
UC San Francisco, the San Francisco Dept of Puble Health, and San Mateo County are partnering with local groups to learn more about long-COVID. Researchers for this project will be calling local residents who previously tested positive for COVID and ask them about their symptoms.
Non-COVID-19 News
Now let's talk about a different infectious disease that is spreading across the world: MONKEYPOX!
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.
Distributed monkeypox vaccine is ongoing, though still in very short supply. New studies have shown that a dose consisting of only 20% of a regular dose and given into the skin ("intradermally") may work as well, thereby allowing 5-times as many people to get the vaccine available
There have been over 6600 cases of monkeypox in the U.S., up from 5000 cases the previous week. California has seen 1,300 cases. Worldwide, 32,040 cases of monkeypox have been reported. 7 people have died, none in the U.S.
According to a study (New England Journal of Medicine). 98% of the patients with monkeypox were gay or bisexual men; 41% had HIV also.
On July 23, the WHO declared monkeypox a "Public Health Emergency of International Concern." This will allow for more funding to fight the outbreak and help individual governments to marshal support. similarly, the U.S. HHHS Secretary declared monkeypox a public health emergency and thereby made more funds available for awareness and prevention. Also, on august 1, Gov. Newsome declared the disease a state of emergency. California has more than 800 cases of the disease.
Monkeypox has been in San Francisco Bay Area since at least June, 2022. This data is based on wastewater detection.
About Dr. Sujansky's Life in These Times
For the first year ever, my peach tree is bearing fruit, and doing it with a vengeance! So now my family has eaten lots of peaches, peach pie, and peach crumble. Also, I've tried my hand at a peach schnapps, though I can't tell you yet if it's any good, as it is still "in process." If any of you have any good peach recipes, please let me know!!
Also, I know we are still four months from Christmas, but I've started knitting some wine bottle hats and scarves (see below) to keep the little guys warm and to use as hostess gifts.
Finally, I want to let you know that I am quite tired today, so I opted not to proof read this newsletter....which may explain a larger number of typos than usual. I ask for your indulgence with this.
Take care.