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.
According to the White House COVID-19 Coordinator, the new COVID boosters that incorporate the Omicron variant (as well as the original virus) will be available in a few weeks (after Labor Day).
56% of people infected with the Omicron variant were unaware that they had COVID-19, thinking instead they had a cold or allergies (JAMA Network Open).
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.
People with COVID-19 have not had a fever for 24 hours and have not used Paxlovid and feel better can end their isolation after 5 days.
As the acute phase of the pandemic seems to be over, the federal administration now plans so stop buying and administering vaccines, leaving that responsibility to individual insurance companies starting 2023.
The FDA is likely to authorize the new COVID-19 booster which contains the Omicron variant as early as this week. Actual booster shots would then be available shortly after Labor Day.
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:
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).
A recent study published in JAMA Internal Medicine showed that people who had COVID-19 but were not hospitalized still had a significant risk of developing blood clots. This risk was higher in men, older patients, overweight patients, and people who were not completely vaccinated for SARS-Cov-2.
Kids with asthma are NOT at higher risk for becoming infected or doing poorly with COVID-19 (Pediatrics).
People on dialysis are much more likely to require hospitalization if they get COVID-19 (Kidney Medicine).
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.
More than 80% of cases of COVID-19 are never reported to government agencies, as people are using at-home testing which do not require reporting.
Treatment
Vaccines:
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:
Pfizer's vaccines was 73% effective in protecting kids younger than 5 during the Omicron surge.
On August 22, Pfizer asked U.S. regulators to authorize the use of its new booster shot that incorporates the omicron variant.
Moderna:
Moderna sought U.S. authorization for its booster shot that incorporates the omicron variant on 8/23. If approved, it will be available in September. A phase 2 and 3 trial is currently ongoing.
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.
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.
The FDA has now allowed kids aged 12 to 17 to receive the Novavax vaccine.
Other treatments:
A trial published in The New England Journal of Medicine found that metformin, ivermectin, or fluvoxamine were NOT helpful in treatment of COVID-19.
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.
An article published in JAMA showed that kids aged 4 to 14, who swabbed their noses to look for COVID-19, got extremely accurate results (predictive value positive: 97.8%; predictive value negative 98.1%).
The government will stop paying for free at-home COVID-19 tests via the website COVIDTests.gov. Nonetheless, free tests will still be available at federally-supported community sites including some pharmacies, libraries, and community health centers.
Our Community and Beyond:
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.
San Mateo County is finally in the "green" zone for COVId-19, indicating a low community infection level. Nonetheless, compared to prior surges of the virus, the numbers of new infections are still high.
Non-COVID-19 News
MONKEYPOX:
Symptoms of the current outbreak include initial chills and fever as well as a severe headache and muscle aches. However, 33% of people have no fevers or achiness. A few days later, people develop a rash consisting of blister-like firm lesions that then scab over. Some people have only one single lesion. Lesions are usually painful and tender. 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 0.02% At this time, no deaths have been reported in the United States associated with the outbreak.
Even though the monkeypox virus can be found on surfaces touched by people who have the disease, it does not seem that others can get the infection by touching those surfaces.
Monkeypox is now often called "MPX."
There have been over 15,000 cases of confirmed monkeypox in the U.S.; California has the second highest number of cases behind New York. MPX has been reported in all 50 states at this time.
Nonetheless, the worldwide outbreak may have peaked due to increased vaccinations of vulnerable populations and curbing of risky behaviors. In the U.S., new cases are down 25% in the last 2 weeks.
Distributed monkeypox vaccine is ongoing. The amount of vaccine available is increasing, due to new administration methods as well as increased supply in the near future (fingers crossed).
According to the CDC, the following people are eligible for the Monkeypox vaccine:
People who have been in direct physical contact with a person with monkeypox in the last 14 days.
High risk individuals
transgender or men who have sex with men and
have multiple sexual partners.
People who have occupational exposure to monkeypox (lab workers, certain healthcare and public health workers).
People who anticipate engaging in high risk activities in the next 14 days.
Other than vaccines, other treatments are available (tecovirimat and vaccinia immune globulin IV) on a case-by-case bases for people who were exposed to monkeypox and can't be vaccinated.
According to a study (New England Journal of Medicine). 98% of the patients with monkeypox were gay or bisexual men; 41% had HIV also.
The FDA is now making hearing aids available over-the-counter (without a prescription). The hope is that such a move will lead to increased availability and decreased cost of the devices. The hearing aids will be available at pharmacies, in stores, and online. This new rule should go into effect in 2 months.
Another infectious disease has recently been in the news: polio! On July 21, a young adult in New York (who was not vaccinated against polio) contracted the disease and became paralyzed. This is not entirely surprising, as the polio virus has been found in New York wastewater in the past. Here are some important things to know about the disease:
Polio causes symptoms only 25% of the time, and then the symptoms usually feel like you have a flu. However, 1 in 200 to 1 in 2000 will become paralyzed with the virus, and a small percentage of these can die. So even though we have heard only of one case of a paralyzed individual, there may be more people who have become infected and just not had significant disease. This is bad, as they can spread the disease to others...
Polio is caused by a virus for which there is currently no treatment. Luckily, vaccination is VERY effective in preventing polio. The CDC recommends one lifetime booster in people who
travel to an area where polio is common
work as lab techs in polio labs
health care workers who treat patients with polio
Polio vaccines have been around for over 50 years.
In the United States, only about 79% of 2-year-olds are fully vaccinated.
About Dr. Sujansky's Life in These Times
We are enjoying the final days of summer with lots of summer activities; we went sailing with some friends in the San Francisco Bay; we have been taking some family hikes; we have been sitting in our back yard with a cool drink and good company. I do love this time of year!
I hope you are making the most of this beautiful weather also!
Finally, for those of you who were wondering, the peach schnapps I made with the peaches from my garden turned out quite good!
