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:
Federal regulators approved the new booster shots made by both Pfizer/ BioNTech and Moderna in early September. These boosters are bivalent and incorporate the BA4 and BA5 omicron strains, as well as the original SARS-COV-2 strain. These boosters are only appropriate for those people who have had their initial, primary series of COVID vaccinations. The Pfizer/ BioNTech boosters can be given to everyone older than 12, while the Moderna version is only for people older than 18. People should wait at least 2 months since their last booster to get this new-and-improved version. These booster shots have been rolling out and should be available at local pharmacies.
The CDC projects that boosters for kids aged 5 to 11 will be available by mid October.
Unfortunately, Americans are still very hesitant to get another booster. In fact, the U.S. is currently ranked #73 among countries in its uptake of booster shots. We are ranked below Rwanda, Uzbekistan, Iran, and Azerbaijan...
Infectious disease experts are cautiously predicting that there won't be a surge of COVID-19 cases this fall, like there has been in the previous 2 years: people are thought to be less vulnerable due to past infections with the virus as well as due to the vaccinations and boosters.
The latest CDC guidance says that both unvaccinated and vaccinated people exposed to COVID-19 should wear a high-quality mask for 10 days after an exposure....and they should test themselves 5 days in (or if they develop symptoms). Isolation is not required.
The CDC also now recommends that people actually infected with COVID-19 need to be isolated for 5 days; After 24 hours without a fever and if they are feeling better, they can leave their homes as long as they wear a mask around others for the next 5 days. People can test themselves for COVID-19 on day #6 of their infection and stop wearing a mask if they have two consecutive negative tests. People with severe disease need to isolate for a full 10 days. And people who start feeling poorly again need to restart isolation for another 5 days....Clear as mud?
Scientists have identified a new mouse antibody against the COVID-19 virus. This antibody is special as it seams to neutralize ALL the SARS-Cov-2 subvariants we have seen so far, as it targets an area on the virus's spike protein that has changed very little so far (Science Immunology). If we can isolate that antibody, it may be a great tool in our tool belt in treating COVID-19....but that is a ways off still.
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).
More recent studies suggest that ongoing inflammation (especially of the heart) may explain the long COVID syndrome.
People who were stressed, anxious, lonely, or depressed were more likely to develop Long COVID after infection (JAMA Psychiatry).
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.
A new study (Nature Medicine) showed that veterans who had been infected with COVID-19 were 7% more likely to have neurologic disorders: brain fog was the most common. Infected people were also 50% more likely to have a stroke.
Incidence/ Prevalence:
The U.S. is seeing fewer than 70,000 daily cases of COVID-19, the lowest level since early May, 2022. Case numbers are decreasing in every state and hospitalizations due to the virus are down also.
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 recent article (JAMA Internal Medicine) found that during the Omicron wave of the pandemic, unvaccinated adults were more than 10 times more likely to be hospitalized for COVID-19 than unvaccinated adults.
The White House COVID-19 Response Coordinator has predicted that in the future only one single COVID-19 booster will be needed each year. Such a schedule would mimic our current annual vaccination campaigns for influenza.
Women who are pregnant or breast feeding when they receive the COVID-19 boosters have tolerated the vaccine well (JAMA Network Open).
A recent study in JAMA showed that people who had received a mRNA booster were half as likely to end up hospitalized with COVID-19 compared to those who "only" had the initial two-dose series.
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.
Moderna:
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.
Other treatments:
A trial published in BMJ showed that Vitamin D does not help prevent COVID-19, sadly...
We have discussed the medication Paxlovid for the treatment of COVID-19 in people over 50 or in people with immune compromise in the past. I have also mentioned that some few people seem to rebound with the disease after they finish their course. Well, a recent study published in the New England Journal of Medicine showed that only 2.3% of people who take Paxlovid actually rebound. Unfortunately, this study only included people who had the Delta variant of the SARS-Cov-2 virus, so it's now clear how people with the Omicron variant will fare...
Two prior treatments for COVID-19 (sotrovimab and casirivimab-imdevimab) are no longer recommended by the WHO for the treatment of the disease. It seems that Omicron simply doesn't respond to them so well...
Testing
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 U.S. plans on ordering over 100 million at-home COVID tests to be prepared for a possible surge in coming cold-and-flu season.
Our Community and Beyond:
Much like the decreasing numbers of COVID-19 across the nation, our local schools are seeing only a small number of COVID-19 infections.
San Mateo County Health plans on reopening their vaccine clinics on September 12 and then to be able to offer the new booster shot; they will be given first-come-first-served, though appointments can also be made after September 21 on the state's MyTurn website.
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%.
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 21,000 cases of confirmed monkeypox in the U.S.; California has the highest number of cases. 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.
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.
New recommendations on those eligible for the vaccine may soon include HIV positive men or those with a recently diagnosed sexually transmitted disease.
According to a study (New England Journal of Medicine). 98% of the patients with monkeypox were gay or bisexual men; 41% had HIV also.
And, it's time again for the annual flu shot! Health experts have warned the nation that this flu season could be particularly severe, as we have been isolating in the last few years and not built up much immunity to the flu virus...Our office has gotten our supplies in our office already and you are welcome to come in to get yours. No appointment is needed, but please call ahead of time to let us know you are coming. As mentioned in previous newsletters, flu shots do more than protect against influenza: people who get the flu shot are also less likely to get COVID-19. They are also at lower risk for heart attacks and strokes (see the journal Neurology)!
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. At this time, the state of New York has detected polio in wastewater at 4 different counties as well as New York City. Even though only one person has fallen ill with paralysis, the state has declared a disaster emergency. This is due to a larger percentage of people not being fully vaccinated AND many people likely being infected, but not having any symptoms or only mild symptoms.
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.
And finally: one more epidemic: physician burnout! In 2020, 38% of physicians reported at least one symptom of burnout. In 2021, that number went up to 63% (Mayo Clinic Proceedings). This is thought to be due to increased work-related distress in general. The stresses of COVID-19 have then added to this baseline as have economic woes that came with the pandemic. Sad....
About Dr. Sujansky's Life in These Times
Sadly, summer is now officially over. I am attaching some pictures below of some final reminders of the summer season. I love fall also, but I do have a soft spot for the warmer months myself.