Here are some of the most recent updates of the novel coronavirus and how it is affecting our community as well as the rest of the world.
Read moreCOVID-19 Update February 26, 2021
I try to summarize all the recent updates on the COVID-19 pandemic and how it affects our community as well as the world.
Read moreCOVID-19 Update February 12, 2021
Here are the latest updates about the novel coronavirus and how it affects our community as well as the nation and the world.
Read moreCovid-19 Update January 28, 2021
Here are all the important updates about the status of the novel coronavirus in our community and beyond
Read moreCOVID-19 Update January 15, 2021
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 evolving on an daily basis. It is also clear that politics has played a major role in the information that has been distributed and the recommendations made. So I wanted to try to bring you unbiased, non-political information about the of the virus in our community and in general. I will include some details on this topic from previous newsletters, as they remains important - new information will be in BOLD.
I've been getting a lot of questions about the next phase of the vaccine rollout (known as Phase 1b). I admit it is all very murky and has not been well managed. The entire vaccination process has been slow, not just in San Mateo, but nationwide and, indeed, in many parts of the world. As of January 6, 70% of the vaccines that had been shipped out had not been administered yet.
This is what I know:
At this time, about 9 million people have received their first shot of a COVID-19 vaccine.
Different states are making different rules as to who can receive a vaccine - which is why you may have heard that Florida is giving it to people over 65 and New York has started vaccinating people over 75...and California still hasn't moved past tier 1a.
On January 11, Gov. Newsome has tried to speed up the vaccination process by allowing more individual discretion on the part of the individual counties about vaccination tier progression. This week, Gov Newsome has recommended that counties vaccinate everyone over 65 years of age....unfortunately, this has not come with any help in organizing vaccine administration, so many counties have not started offering vaccines on a wider basis yet.
With few exceptions, only Phase 1a ( workers and residents/ staff) are currently receiving the COVID-19 vaccine in San Mateo county.
I myself received my second dose of the vaccine on 1/13/2021.
Phase 1b (first priority) will include people over 74 years old as well as teachers and childcare workers, food industry and agriculture workers, and non-medical first responders.
Other sticky details include questions like which people over 74 should go first, how to contact them, what documents and tracking are required, and what to do for people who have transportation issues...the list goes on!
Health officials have created a "COVID-19 Hotline" that is open seven days a week who can advise people on eligibility issues etc.: 1-833-422-4255.
Sutter Health has started allowing patients older than 74 to sign up for the COVID-19 vaccine via their "myhealthonline" site. To sign up for this site, you can go to www.sutterhealth.org to register or call 844-987-6115. Fair warning: yesterday, when this option went live, the website crashed repeatedly as people were trying to sign up and the website was overwhelmed....just keep trying. Of note, some patients were told that they need to call our office to set up a Sutter "myhealthonline" account. That is incorrect, as we are not employed by Sutter and therefore can't do that. But let us know if we can help!
I am optimistic that other venues for vaccine distribution will become available in the very near future, through sites like CVS/ Walgreens as well as through San Mateo County itself. I will let you know more once I know more. We have been patient for 10 months now, so let's be patient for just a few days/ weeks more...
General Information:
As treatments have been improving, the mortality associated with COVID-19 has been steadily decreasing.
COVID-19 has had negative health impacts on many people who don't contract the virus: 40% of U.S. adults surveyed in late June reported at least one or behavioral health problem associated with the pandemic.
Compared to the yearly influenza, COVID-19 has a significantly higher risk of kidney failure, ICU stays, blood clots, strokes, and heart disease. People admitted to the hospital for COVID-19 are 5-times more likely to die compared to people admitted to the hospital for influenza.
Speaking of influenza, this season's flu is much, much milder than normal. From September 29 to December 28, 2019, 65,000 Americans contracted the flu. During the same time period in 2020, there were only 1,016 cases of influenza. Experts believe this is due to our social distancing guidelines as well as a much higher percentage of people receiving the flu vaccine in 2020.
A recent study in the journal Science suggested that COVID-19 will continue to be with us in future years. However, once we have reached her immunity via vaccinations and infection, it will not be worse than the common cold.
Transmission:
At this time, it is estimated that no more than 14% of the U.S. population has been infected by SARS-Cov-2. Unfortunately, that is a long way from heard immunity...
The incubation period can be 14 days (or more), though most people develop symptoms within 5-10 days.
A SARS-Cov-2 variant originally found in the United Kingdom seems to be much more infectious than other strains. South Africa has also seen a more contagious strain of the virus. This more contagious variant has now been found in the U.S. as well as in multiple other countries.
Transmission occurs predominantly via respiratory droplets. Transmission is more likely the longer you are close to an infected person, the closer you are, and the worse the air ventilation is. Transmission via touch (touching a surface with the virus on it and then touching your nose, eyes, and mouth) is quite unusual.
17% of the air samples taken close to people hospitalized for COVID-19 were positive for SARS-Cov-2. However, these viruses were rarely viable and rarely (if ever) caused the disease. This study reinforces the idea that the main mode of transmission of the SARS-Cov-2 virus is via direct human contact and droplets, not airborne. This is a huge relief!
A recent article (in the journal Emerging Infectious Diseases) found that one person was able to infect 6 other people during a flight from Dubai to New Zealand. Of note, this initial infectious person did not have any symptoms and had tested negative for the virus in the 72 hours prior to travel. A 14-day quarantine in New Zealand (mandatory for all people entering the country) revealed the outbreak and allowed for more detailed testing. It is unclear how often such airline-transmission occurs - but it can!
JAMA Network Open published a study in January that (again) showed that an estimated 59% of disease transmissions originate from people without symptoms.
A recent report out of England showed that children under 10 are half as likely to transmit SARS-COv-19 (even the new, more contagious variant!) than adults. This is great news for schools wanting to re-open or remain open.
The CDC has issued a new requirement about people flying into the U.S. from abroad: effective January 26, all travelers boarding flights from abroad must now have evidence of a negative COVID-19 test within 3 days of travel. The CDC also recommends that passengers get re-tested 3 to 5 days after arriving in the U.S.
A study in Emerging Infectious Diseases looked at people in South Korea who had had COVID-19 with no or few symptoms: even 8 months later, over 90% had positive antibodies! This finding suggests that people, once infected, are unlikely to get re-infected anytime soon. We don't yet know how long this immunity lasts, however...
Face masks are extremely important and effective in protecting the wearer as well as the people around them
The most effective cloth masks are multilayer - these can block 50-70% of droplets and particles. Materials like silk may also help repel moist droplets and reduce fabric wetting.
When using a disposable (non-medical) masks, please remember to don a new one daily - or more frequently if the masks get wet or soiled.
Symptoms and Risk Factors:
Although COVID-19 is associated with a wide array of symptoms, 96% of infected people have either fever, cough, or shortness of breath. About 45% of infected people have all three of these symptoms.
More studies are showing higher risks of severe COVID-19 disease in patients taking "PPI" medications. These medications include omeprazole, pantoprazole, nexium, and a few others. I am not suggesting anyone stop these medications needlessly, but I do suggest that you do not take them unless a physician has told you that the benefits outweigh the risks.
An increasing number of COVID-19 patients seem to have long-standing sequelae of their infection: three quarters of people previously hospitalized with COVID-19 have at least one ongoing symptom 6 months later (The Lancet). Such symptoms usually included muscle weakness or fatigue, sleeping issues, and anxiety/ depression.
Incidence/ Prevalence:
The post-holiday spice in coronavirus cases is ongoing. The daily death rate is around 4000 nationwide, and the death toll in the U.S. has climbed 45% sicne December 31 alone...
The death toll due to COVID-19 in December, 2020 set a new record at 77,500.
Some statistics:
San Mateo:
number of cases: 30,196 (24,589 two weeks ago)
number of deaths: 268 (227 two weeks ago)
number of people in the hospital: 188 (174 two weeks ago).
California:
number of cases: 2.9 Million (2.31 Million two weeks ago)
number of deaths: 32,239 (25,963 two weeks ago)
U.S.:
number of cases: 23.4 Million (20 Million two weeks ago)
number of deaths: 389,000 (346,000 two weeks ago)
World:
number of cases 93.3 Million (75.1 Million 2 weeks ago)
number of deaths: 2 Million (1.82 Million 2 weeks ago)
Testing
A recent article in The Annals of Internal Medicine showed that COVID-19 tests that use saliva (rather than the unpleasant nasal swab) could be less costly and just as likely to detect the virus. I am looking forward to more new saliva-based testing available soon!
Treatment
Remdesivir is the only medication approved for COVID-19 treatment in the United States.
You may recall a notation in this newsletter several months ago indicating that a certain anti-depressant (called fluvoxamine) may help prevent severe COVID-19 disease. We still don't know if that will turn out to be true, but larger trials are starting to see if there is a protective effect from this medication.
Vaccines:
The CDC Advisory Committee on Immunization Practices recommended on December 1 that health care personnel and residents of long-term care facilities should be the first to receive the upcoming vaccines (phase 1a).
The latest prioritization of vaccine delivery is as follows:
Phase 1b (first priority) will include people over 74 years old as well as teachers and childcare workers, food industry and agriculture workers, and non-medical first responders.
Phase 1b second priority will include people over 64, prisoners and the homeless, and essential transportation, manufacturing, and construction workers.
Phase 1c will include people aged 16 to 64 with chronic conditions or disabilities, and essential workers in the water, defense, energy, communications, financial, and government sectors.
Finally, phase 2 will include everyone else.
Scientists are still waiting to learn if people who have been vaccinated can still spread virus to others...though early data on this topic is promising. So you still need to wear a mask, even if you have been vaccinated!
Contrary to recent suggestions, top FDA officials now say that TWO doses of the Moderna of Pfizer vaccines are needed, not just one.
Both the Pfizer/ BioNTech and the Moderna vaccines are "reactogenic," which means people often get achy, tired, and may have a fever after they get their dose. This does NOT mean that they are having an allergic reaction to the vaccine and it does NOT mean they have developed COVID-19 after getting the vaccine - the latter is not physiologically possible. These reactions are signs that the immune system is being turned on, which is what we want!
Both the Pfizer and Moderna vaccines should not be given for a second dose if there was any allergic reaction with the first dose. Also, these vaccines are not recommended for people with an allergy to polyethylene glycol or polysorbate. People with such possible vaccines should be cleared by an allergist prior to vaccine administration and have the vaccine administered in a setting where advanced medical care is available - just in case!
Vaccine development is accelerating and the U.S. should have 200 million doses of the Pfizer/ BioNTEch as well as the Moderna vaccine by July. This would allow more than 70% of adults in the U.S. to become vaccinated.
Pfizer/ BioNTech:
Studies suggest that the Pfizer vaccines "starts working" within 10-14 days after the first dose. It seems effective across age groups, race/ ethnic groups, as well as in obese and non-obese patients.
By December 23, 21 people given the vaccine had severe allergic reactions (anaphylaxis). 17 of these 21 people had a history of known past allergic reactions to foods or medicines. On average, the anaphylaxis occurred 13 minutes after vaccine administration. Overall, at the time of the study, 1,893,360 doses had been administered. This means that there were about 11.3 severe allergic reactions per 1 million vaccinations. Some comparisons: 1.3 people out of 1 million people develop anaphylaxis to flu shots. Experts therefore believe that the incidence of anaphylaxis to the new COVID-19 vaccine is still "rare."
Preliminary data suggests that the Pfizer/ BioNTech vaccine is effective against the more contagious strains, like the ones first noted in Britain and South Africa.
Moderna:
The U.S. coronavirus vaccine team is in discussions with Moderna about allowing people under 55 to receive two doses that are half strength. Previous studies had shown that the efficacy of the half-strength doses was 94%. Using half-strength doses would allow twice as many people to be vaccinated. Studies looking at the efficacy of such an approach may take about two months. Stay tuned!
On 1/4/2021, Moderna announced that it would produce at least 600 million doses of its vaccine in 2021 - this is 100 million doses more than its previous forecast.
Johnson & Johnson is in the late stages of their new COVID-19 vaccine development: recent results show that the vaccine generated an immune response in nearly all volunteers, with minimal side effects. The advantage of the J & J vaccine is that it requires only one shot of vaccine. Also, the vaccine can stay stable in a refrigerator for months. Unfortunately, it may yet be another few months until this vaccine comes to market...
The Oxford/ AstraZenica vaccine:
On December 30, Britain became the first country to grant emergency use authorization for this vaccine, opening the door to production of a vaccine that is inexpensive and easy to store.
This vaccine does not yet have emergency use authorization in the U. S. and is unlikely to receive such authorization before April, 2021.
Novavax announced this last week that it “has begun a large late-stage study of its experimental COVID-19 vaccine in the United States..., after delaying the trial twice due to issues in scaling up the manufacturing process.” This vaccine is protein-based (not RNA-based like the Moderna and Pfizer vaccines). One advantage of this type of vaccine is that it can be manufactured on a large scale quickly.
The Russian "Sputnik V" vaccine:
Russian developers published new trial results for this vaccine on December 14 and reported that it was 91.4% effective.
A second vaccine (called Coronavac) produced by China has been studied in Brazil and was said to be effective at a rate of 78%. Unfortunately, subsequent studies suggested that the efficacy rate was just over 50%...
India is starting a large vaccination campaign using the vaccine developed by AstraZenica as well as a locally developed vaccine from India.
Antibody therapy:
An article published this January in the New England Journal of Medicine shows, for the first time, that transfusions of plasma from people who have recovered from COVID-19 helped prevent severe disease in seniors. Plasma therapy had been granted emergency use authorization months ago, but this is the first study that actually shows that it works!
The above notwithstanding, a different international trial tested whether convalescent plasma helped people with moderate to severe COVID-19 from getting worse: this trial was stopped early because no effect was found. Soooo, it's confusing whether convalescent plasma does anything and- if so- for whom. Stay tuned...
Mills-Peninsula Hospital:
Peninsula Hospital continues not to be full and is managing its share of COVID-19 cases as well as could be hoped for. ICU and acute care beds are still available and the surge capacity beds have not been activated yet. All the treatment modalities we discussed above are available here.
Our Community and Beyond:
At this time, only 0.7% of the Bay Areas intensive care unit beds remain available. Once ICU capacity hits 0%, the region will resort to "surge capacity" and additional ICU beds would become activated. Such additional ICU beds could be set up, for instance, in emergency departments, surgical suites, and even outside tents. The county actually has an adequate number of ventilators and hospital space, but they are running low on nursing staff and other personnel needed to care for patients.
As of Monday, January 11, San Mateo County is offering a drive-through vaccination clinic for COVID-19 vaccination. At this time, the vaccines are only available to people who fall into the 1a tier (health care workers and nursing home residents)...but we can only hope that once this infrastructure is set up, tier 1b (people older than 75) will have a place where they can get vaccinated also. The San Mateo clinic will be using the vaccine developed by Moderna. The clinic is being held at the San Mateo County Event Center. In the coming weeks, San Mateo County plans on opening up these vaccine drive-through-venues to tier 1b (people over 75).
San Mateo is still offering free PCR testing for COVID-19:
Scheduled testing occurs at the San Mateo County Event Center. Testing here can be scheduled Tuesdays through Saturdays from 8 am to 3 pm - all without a cost to the patients. Appointments are required and can be made at "projectbaseline.com/COVID19"
Our Office: What We Are Doing to Keep You Safe:
All patients seen in person will be screened for COVID-19 exposure and symptoms prior to coming into the building.
We disinfect all exam rooms and medical equipment as well as all door handles after EVERY patient visit, regardless of the medical issues involved.
I have been contacted by a number of you about when they can come into my office to get their vaccine: our office has not been given any COVID-19 vaccine, and it is not clear that we will ever be given a shipment. I suspect this is due to both logistical requirements in accounting for vaccine distribution as well as the very real issues related to vaccine storage (including freezers that can store vaccine at -100 degrees F!).
We are also using tele-health options that allow you to have video as well as audio interactions with us as part of a "remote office visit." With the recent surge of cases, we are postponing most routine physical exams and minimizing most in-person visits. Patients who require physical evaluations to diagnose and treat their medical issues will always be seen in person.
All of us in the office are healthy and doing well.
In addition to the "regular" Covid-19 testing that we have had all along (nasal swab, PCR-based test with approx. 24-48 hour turn around) our office also has two other COVID-19 testing options available:
A saliva based PCR-test that can be done in a patient's home. It is then sent via Fed-Ex to a lab and usually gives results in 36 hours. This test is usually covered by insurances and is 100% sensitive and 100% specific. It is accepted as evidence of immunity for most travel (not including travel to Hawaii, which does not accept this test).
A rapid 10-minute test that is based on a nasal swab and performed in our office. This test is 85% sensitive and 100% specific. This test is perfect for people without symptoms or prolonged exposure to a COVID-10 patient who "just want to make sure" they are ok. This test is not covered by insurance and costs patients $30/ test.