By the numbers: There are as of Friday November 26,2021: 49,050,917 positive cases to date in the U.S. and 799,138 deaths to date in the U.S.. This is up 1,288,381 and 5,668 respectively over last week. 2021 is proving to be a deadlier year for COVID than 2020 and we have FIVE weeks to go before the end of the year. To put it in perspective, as of December 31,2020, 377,000 people died versus 799,138 deaths. Sobering numbers to reflect on.
The latest Covid News: Particularly concerning to health officials is the upcoming holiday travel is expected to exacerbate the problem as it did last year when Thanksgiving and Christmas gatherings fueled a record number of new infections and led to more than 100,000 deaths in January 2020.
There was hope that this year would be different. In addition to vaccines, there are effective treatments, such as monoclonal antibodies, that can significantly reduce the chance of hospitalization and death.
Yet, as of Sunday (November 21,2021) evening, the country is averaging more than 1,100 deaths a day — almost the same tally as last year at this time before the vaccines had been authorized. That’s partly because millions of Americans remain unvaccinated and because the Delta variant is so much more transmissible than the version of the virus circulating back then. And now we need to worry about a new variant Omicron.
A new Variant on the Horizon. Scientists are closely tracking a new coronavirus variant, Omicron with a 'worrying' number of mutations which has been detected in South Africa, Botswana, and Hong Kong.
This new variant called B.1.1529 or Omicron has been designated by the World Health Organization (WHO) in an emergency meeting on Friday a "variant of concern," or VOC, a label applied when a particular strain is especially virulent, transmissible or able to defeat public health measures.
Omicron has 32 mutations in the part of the virus that attaches to human cells, called the spike protein, the target for existing vaccines and antibody treatments. A higher number of mutations in the spike protein may change its shape and means there is a greater risk those vaccines and treatments won't be as effective against it. The highly infectious Delta variant, which is the most common variant worldwide, has 11 to 15 mutations in its spike protein, and some of them help it avoid the immune
response, according to the Centers for Disease Control and Prevention.
Experts are worried the more mutations might make Omicron more infectious and help it avoid the antibody response, but this hasn't been proved as of yet. It is also not clear whether the mutations make the virus more deadly. As a result, at least ten countries have banned travel from southern African regions in an attempt to keep the virus from spreading.
The bad news is that Omicron may be potentially 500 per cent more infectious than previous variants.
The good news is that no cases have been seen/reported in the U.S. Both Pfizer and Moderna are testing their vaccines against this new strain. Pfizer and BioNTech said that, if necessary, they expect to be able to ship a new vaccine tailored to the emerging variant in approximately 100 days. Moderna Inc said in a statement it is working to advance a booster candidate tailored to the new variant and has also been testing a higher dose of its existing booster and to study other booster candidates designed to protect against multiple variants. Moderna said it has been able to advance additional boosters to clinical testing in 60-90 days.
The Pandemic’s Next Turn Hinges on Three Unknowns: 1. Vaccinations: The U.S. has fully vaccinated 59 percent of the country and recorded enough cases to account for 14 percent of the population. (Though, given limited testing, those case numbers almost certainly underestimate true infections.) What we don’t know is how to put these two numbers, vaccinated and tested together, says Elizabeth Halloran, an epidemiologist at the Fred Hutchinson Cancer Research Center. So the question becomes what percentage of Americans have immunity against the coronavirus—from vaccines or infection or both?
This is the key number that will determine the strength of our immunity this winter, but it’s impossible to pin down with the data we have. This uncertainty matters because even a small percentage difference in overall immunity translates to a large number of susceptible people.
2. The strength of immunity also varies from person to person. Immunity from past infection, in particular, can be quite variable. Vaccine-induced immunity tends to be more consistent, but older people and immunocompromised people mount weaker responses. And immunity against infection also clearly wanes over time in everyone, meaning breakthrough infections are becoming more common. Boosters, which are now available to all adults, can counteract the waning this winter, though we don’t yet know how durable that protection will be in the long term. If the sum of all this immunity is on the higher side, this winter might be relatively gentle; if not, we could be in store for yet another taxing surge.
3. Controlling the spread: At the beginning of the pandemic, scientists thought that this coronavirus mutated fairly slowly. Then, in late 2020, a more transmissible Alpha variant came along. And then an even more transmissible Delta variant emerged. In a year, the virus more than doubled its contagiousness. The evolution of this coronavirus may now be slowing, but that doesn’t mean it’s stopped. We should expect the coronavirus to keep changing. A new variant could change the pandemic trajectory again this winter. The coronavirus doesn’t hop on planes, drive across state lines, or attend holiday parties. We do. COVID-19 spreads when we spread it, and predicting what people will do has been one of the biggest challenges of modeling the pandemic.
New COVID Antivirals Do Not Replace the Need to Vaccinate: Nearly 30 percent of adults are not fully vaccinated against COVID-19. Clinical trial data: Pfizer’s vaccine was 95 percent effective in preventing infection in adults, Moderna’s vaccine was 94 percent effective, and Johnson & Johnson’s vaccine was 66 percent effective. And all COVID vaccines are extremely effective at preventing serious illness, hospitalization and death.
COVID antivirals, like monoclonal antibodies, are not a substitute for vaccinations. They are a complement to vaccines, and they serve an important function. Remdesivir, the only available monoclonal antibody treatment for COVID, requires hospitalization and dedicated space in a hospital. Having these oral antivirals helps us achieve one of the most important goals of managing the pandemic: preserving hospital capacity.
COVID is not a disease that will be eliminated. It is an efficiently spreading respiratory virus with an animal reservoir, and it spreads quickly, even before people have symptoms. The virus is here to stay, but we can keep adding tools to manage its consequences better. As the virus transitions to something endemic, like influenza, the aim is to keep it from hospitalizing and killing people.
Natural immunity doesn’t protect you as well as the Covid vaccines: “Natural immunity” has been a hot topic since the start of the pandemic. Currently, there’s no known way to test your immunity levels. The U.S. Food and Drug Administration says antibody tests, which can determine whether or not you’ve had Covid, are unreliable judges of your immunity because antibodies alone don’t fight against Covid. Memory B cells and T cells also play a significant role in helping your immune system fight against infections.
Even if you have lots of natural immunity, getting vaccinated significantly boosts your chances of staying healthy, according to data published last month by the Centers for Disease Control and Prevention. The agency studied more than 7,000 people, and found that unvaccinated people who’d recovered from Covid were five times as likely to catch it again, compared to people who got two doses of an mRNA vaccine from Pfizer or Moderna.
To date, only 59% of the U.S. population is fully vaccinated against Covid, according to the CDC. The development of Covid variants makes vaccination particularly important for people who’ve recovered from the virus. Currently, the Delta variant is dominating cases in the U.S. but “most of the people who were infected in 2020, and all the way through until the middle of 2021 were infected with earlier variants of the coronavirus,” says Dr. Chris Beyrer, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
Combining vaccination with natural immunity gives you a “hybrid immunity,” which provides even more protection than vaccination alone — sending your antibody levels to “astronomical levels that outpace what you get from two doses of vaccine alone,” says Rishi Goel, an immunologist at the University of Pennsylvania.
Experts also say all three of the country’s approved Covid vaccines are safe for people who’ve already recovered from the virus. “There’s been no evidence at all of any harm associated with Covid vaccination if you’ve already had, or you suspect that you’ve had Covid,” Beyrer says.
If you fall into this category, you may experience more side effects from the Covid vaccines — like fever, chills and tiredness because your immune system has already been exposed to the virus. That’s actually a good thing: It means your body is mounting a faster response to the vaccine.
Additionally, the strength of natural immunity can vary between people, with research still needed to identify what level of antibodies are enough to protect against reinfection.
Child COVID Cases Are Up 32% in the Last 2 Weeks as Infections Spike Nationwide: Despite making up 22% of the population, children now account for 25% of all COVID-19 cases in the U.S. In part because they are the last to be vaccinated and as research shows, they catch the virus from susceptible adults that they interact with. Children with co-morbidities are more likely to be hospitalized than there healthier counterparts.
During the week ending on November 18, nearly 142,000 kids tested positive for COVID-19, marking the 15th week in a row that pediatric cases — meaning infections in Americans 18 or younger — were above 100,000. The seven-day average of new cases is up by 18% according to Centers for Disease Control Director Dr. Rochelle Walensky.
"Heading into the winter months, when respiratory viruses are more likely to spread, and with plans for increased holiday season travel and gatherings, boosting people's overall protection against COVID-19 disease and death is important to do now. Even in our updated data, unvaccinated people are at 14 time’s greater risk of dying from COVID-19 than people who are vaccinated." Walensky said. And though children have a low risk of being hospitalized or dying from COVID-19, it is still possible they can transmit the virus to others. Experts are urging parents to get their kids vaccinated now that Pfizer's COVID-19 vaccine is approved for those age 5 to 11.
Unvaccinated have 14 times greater risk of COVID death: Unvaccinated people in the US are at a 14 times greater risk of dying from covid-19 than those who are fully vaccinated against coronavirus, according to data from September published by the US Centers for Disease Control and Prevention (CDC).
Pfizer says Covid shot 100% effective in adolescents after 4 months: Pfizer and BioNTech said Monday their Covid-19 vaccine remained 100 percent effective in children 12 to 15 years old, four months after the second dose. No serious safety concerns were observed in individuals with at least six months of follow-up data after the second dose.
The main safety concern among this age group is vaccine-linked myocarditis (heart inflammation) in males. But such cases are very rare, and the benefits of vaccination continue to strongly outweigh the risks, data has shown. The Covid virus has been shown to show a higher incidence of myocarditis than the vaccine.
Having poor oral health may ‘significantly’ raise severity of the COVID -19 virus: The Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, states that “the link between oral health and overall body health” is well documented and backed by robust scientific evidence. Studies have suggested that increased COVID-19 severity may be linked to poor oral health status. People with bad dental problems can end up with more severe symptoms if they catch coronavirus, and are more likely to be hospitalized, research has revealed. Numerous studies have already reported good oral care may reduce the risk of viral acute respiratory diseases.
Research shows that people with poor oral health can end up with more severe symptoms if they catch the coronavirus. COVID patients who also have gum disease are 3.5 times as likely to be admitted to intensive care compared to those without. They’re also 4.5 times as likely to need to be put on a ventilator and nine times as likely to die from COVID. The study showed: “The incidence of severe COVID-19 illness was significantly observed in participants with poor oral health status.”
The severity of COVID-19 symptoms significantly increasing in patients with poor oral health status, symptoms of severity “significantly decreased” in those with good oral health status.
The recovery period “was significantly delayed” to around six weeks in those with poor oral health, while patients with good oral health had a faster recovery.
It notes that several risk factors for COVID-19 infection have already been recognized, such as ageing, diabetes, hypertension, immunodeficiency and cardiovascular diseases.
COVID and diabetes don’t mix well, leading to high blood sugar and much worse: If you have diabetes, you have a higher risk of severe complications and hospitalization from COVID. “Patients who have diabetes do have a higher risk of needing hospitalization and also have higher mortality rates,” said Dr. Amy Aronovitz, medical director of adult endocrinology at Memorial Healthcare System. Getting vaccinated, controlling your weight and keeping tabs on your blood sugar level will help mitigate that risk.
Obesity alone can put you at higher risk for COVID, and because Type 2 diabetes is commonly associated with obesity, it compounds the problem, said Dr. Gianluca Iacobellis, endocrinologist and diabetes researcher, University of Miami Health System. “Obesity alone is an independent major risk factor for COVID-19 complications and for higher severity of COVID-19 complications,” he said. In particular, with visceral obesity, when body fat wraps around abdominal organs deep inside your body, “there is a higher rate of complication from COVID, regardless of whether they’re diabetic or not,” he said. How well a diabetic patient controls their blood sugar level and A1C also can affect COVID outcomes. “It’s not the case for everybody, but in general, diabetics will have a more severe course of COVID. It’s a vicious cycle,” said Dr. Pascual De Santis, endocrinologist at Baptist Health. “The more severe the disease, the higher the blood sugar, and the higher the blood sugar, the worse the outcome.”
If you are diabetic and diagnosed with COVID, contact your physician. “They should be paying attention to how they’re feeling and what their symptoms are,” Dr. Aronovitz of Memorial said. “And they should keep an eye on their blood sugars to make sure that they’re not either very high related to the inflammatory responses of coronavirus, or alternatively, low, because they’re not eating as much.”
Importance of Masks. Infectious particles can spread beyond 6 feet when someone with COVID-19 coughs without a mask:
When a person with COVID-19 coughs without a mask, they could spew infectious particles that travel beyond 6 feet, according to Cambridge University scientists. This means, in the absence of masks, a person with COVID-19 could infect another person at 6 feet, even when outdoors the study shows.
The study, published in science journal Physics of Fluids, tested ten scenarios of a person coughing without a mask using computer simulations.
Epaminondas Mastorakos, a professor in applied thermodynamics at Cambridge University and study lead, said that fluctuations in particle speed, temperature, and humidity meant the number of particles someone gets at the 6 feet mark can be "very different each time."
The 6-foot rule, keeping 6 feet apart from someone else, has been widely used to try slow the spread of coronavirus. The Centers for Disease Control (CDC) said in May that catching COVID-19 via inhalation of infectious particles further than six feet can occur. Factors such as bad ventilation and exposure of more than 15 minutes can increase the risk of contracting COVID-19, it said.
Research from the Massachusetts Institute of Technology (MIT) from April found social distancing of 6 feet was "insufficient" to stop airborne transmission of coronavirus indoors, but its physics-based models assumed particles was always spread evenly throughout a room.
The Cambridge scientists conclude that vaccination, ventilation and masks – while not 100% effective – were "vital" to contain the virus.
Until next time, Stay Safe, Stay Well, Practice Mitigation Factors including Mask wearing, Washing your hands frequently and consider getting Vaccinated if you have not already done so. This will make the difference how we end the year and gain control over COVID -19 in 2022.
James A Vito, D.M.D.