“Yearn for where you want to go, not for where you have already been: Your future will be better, your days will be brighter, and your nights will be filled with the glorious heavens.” - Unknown
Statistics to Date: As of April 23,2021: There have been 32,738,497 positive case, 585,115 deaths and 25,296,260 recoveries. In the United States as of April 23, there have been 83.2 million fully vaccinated people recorded out of 330 million. In Pennsylvania there have been 3,686,972 fully vaccinated individuals out of 12,801,989 people
SEQUENCING THE GENOME OF THE VIRUS BEHIND COVID-19: Peter Thielen and Tom Mehoke
members of Applied Physics Lab Research and Exploratory Development Department and the Johns Hopkins Center of Excellence in Influenza Research and Surveillance Institute have spent years sequencing the genome of influenza. Now, as a new strain of coronavirus spreads across the globe, these biologists are using handheld DNA sequencers to conduct immediate on-site genome sequencing of SARS-CoV-2—the virus that causes COVID-19. Their goal to see how quickly the virus mutates—integral information for mapping its spread, as well as developing an effective vaccine. Influenza, for example, mutates constantly. That's why it's necessary to vaccinate against different strains of the flu each year. The virus causing COVID-19, Thielen said, does not appear to be mutating as fast.
You're Fully Vaccinated. Do This, Not That: CDC guidance says fully vaccinated people -- those at least two weeks out from their second dose of a mRNA vaccine or their sole dose of Johnson & Johnson -- can gather in small groups indoors and travel on an airplane. But other activities fall into a gray area. For instance, is it safe for fully vaccinated people to eat indoors at a restaurant? What about going to church, or to the gym? And what about activities for kids, who won't be vaccinated for months?
"At this point of the pandemic, we can't think about things as black and white," said Leana Wen, MD, an emergency physician and health policy scholar at George Washington University and former health commissioner of Baltimore. While the vaccine efficacy is very good, it's not perfect, she said: "Nothing is 100% safe, and nothing is 100% risky."
But she noted that each risk is additive. "With that in mind, we should choose the activities that are most essential and of highest value to us."
Gregory Poland, MD, director of the Mayo Clinic's Vaccine Research Group in Rochester, Minnesota, said that while the CDC guidance represents a "step towards normalcy," there are a few key things it does not address, such as the durability of vaccine immunity, the effect of vaccines on variants, specific guidelines for patients who are immunocompromised, and how the possibility of a fourth surge should shape the way we think about our choices. That means it's critical to constantly update the guidance, Poland said: "We're flying the airplane while we're building it."
Indoor Dining: Dining inside at a restaurant or going to a bar are still some of the highest-risk activities. “I personally would not dine indoors," Poland said in an interview. "I think it's too early to do that, since we don't have enough people immunized."
If people could ensure that they would be 6 feet away from other tables, were in an environment with good ventilation, and knew that other patrons were also vaccinated, that would all reduce risk. But those factors are usually unknown, he noted. If people could ensure that they would be 6 feet away from other tables, were in an environment with good ventilation, and knew that other patrons were also vaccinated, that would all reduce risk. But those factors are usually unknown, he noted.
Airplane Travel: Current CDC guidelines say it's safe for people to travel domestically or internationally without the need for a test before departure or a self-quarantine when they return. After international travel, however, the CDC recommends getting a test within 3 to 5 days of returning to the U.S.
While experts recognize that this is recommended, some say non-essential travel should still be seriously considered, especially because vaccine efficacy is still uncertain against emerging variants.
According to a CDC report published in November, long flights carry significant risk of SARS-CoV-2 spread. A more recent study indicated risk of spread is reduced by up to 57% if the middle seat remains vacant -- however, many airlines are pushing back against that finding; many are currently flying full planes.
Gyms & Places of Worship: Paul Offit, MD, director of the vaccine education center at the Children's Hospital of Philadelphia, said that for indoor gatherings where people cannot keep their distance, he personally would wait until population-level immunity reaches 75% to 80%.
"If you're going to be in a group, and you're not going to be able to social distance -- so you'd just be relying on a mask -- I think you should just wait," he said.
What About Kids? While multiple vaccinated households are free to get together in their homes, it's less clear what to do about their unvaccinated kids. "There's a risk, especially now, since the B.1.1.7 is more prevalent," says Offit. "There are more kids that are getting infected now." As of April 8, more than 3.5 million kids in the U.S. have tested positive for COVID-19 since the start of the pandemic. Early evidence suggested that the B.1.1.7 variant, which originated in the U.K., made up a larger share of infections among kids under 20. Additionally, research from Britain found that households with kids were more likely to have a COVID-19 infection -- data that coincided with the emergence of this coronavirus strain.
Why Vaccination is important even if you have already had COVID -19.
Those who have had COVID-19 — including those with mild cases — have an increased risk of death in the six months following the diagnosis, according to research led by Washington University that is believed to be the largest comprehensive study yet on long-term complications related to the virus.
The study involved more than 87,000 COVID-19 patients and nearly 5 million control patients in a federal database. It was released online Thursday in the Journal Nature.
The investigators showed that after the first 30 days of illness, COVID-19 survivors had an almost 60% increased risk of death over the following six months compared with the general population.
At the six-month mark, excess deaths among all COVID-19 survivors were estimated at eight people per 1,000 patients. Among those sick enough to be hospitalized with COVID-19 and who survived beyond the first 30 days of illness, there were 29 excess deaths per 1,000 patients over the following six months.
"Our study demonstrates that up to six months after diagnosis, the risk of death following even a mild case of COVID-19 is not trivial and increases with disease severity," said senior author and assistant professor of medicine Dr. Ziyad Al-Aly. "It is not an exaggeration to say that long COVID-19 — the long-term health consequences of COVID-19 — is America's next big health crisis."
The researchers confirmed that long COVID-19 can affect nearly every organ system in the body:
— Respiratory system: persistent cough, shortness of breath and low oxygen levels in the blood.
— Nervous system: stroke, headaches, memory problems and problems with senses of taste and smell.
— Mental health: anxiety, depression, sleep problems and substance abuse.
— Metabolism: new onset of diabetes, obesity and high cholesterol.
— Cardiovascular system: acute coronary disease, heart failure, heart palpitations and irregular heart rhythms.
— Gastrointestinal system: constipation, diarrhea and acid reflux.
— Kidney: acute kidney injury and chronic kidney disease that can, in severe cases, require dialysis.
— Coagulation regulation: blood clots in the legs and lungs.
— Skin: rash and hair loss.
— Musculoskeletal system: joint pain and muscle weakness.
— General health: malaise, fatigue and anemia.
186 COVID Variants Confirmed In Montgomery County, PA: Variants have been attributed by experts as part of the reason for the fourth wave of the virus, which has cause case numbers to rise in Montgomery County and across Pennsylvania. Those rises appeared to moderate themselves a bit this past week, however, and experts are hopeful a plateau has been reached.
Montgomery County Commissioner Val Arkoosh reminded the public that "only a fraction of the samples are being tested for the variants," as complex genomic sequencing is required to detect them. No state government facilities have the capability, so universities and private labs are doing limited tested.
Of the 186 variants, 170 are of the most widespread U.K. variant, B.1.1.7. Of the remaining 16, there are four other variants that have been detected in the county.
COVID-19 Vaccine Manufacturers Are Hard at Work Improving Their Immunizations: It seems that booster shots to the currently available COVID-19 immunizations are definitely in our future to fight against an ever-changing virus. However, vaccine manufacturers have other developments in the works to ensure the safety and efficacy of their COVID-19 vaccinations. These advancements include delivery methods that bypass injections, simplification of storage requirements to ensure quick distribution, and reduction of side effects, particularly those following the administration of the mRNA vaccinations (Pfizer and Moderna).
First Data on COVID Vaccines in Pregnancy: Pregnant women were excluded from COVID-19 vaccine clinical trials, despite being at risk for adverse pregnancy outcomes and the CDC classifying pregnancy as a condition putting people at high risk for severe COVID-19. However, both CDC's Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommended that pregnant women should not be prevented from receiving COVID-19 vaccines, and advised shared clinical decision-making. COVID-19 vaccines appeared safe in pregnant women, with side effects that were consistent with those in non-pregnant people, researchers found.
In addition, though they were not directly comparable, incidence of reported adverse maternal and neonatal outcomes were similar to those reported prior to the pandemic, noted Tom Shimabukuro, MD, and colleagues from the CDC v-safe COVID-19 Pregnancy Registry Team in the New England Journal of Medicine.
Until next time Stay Safe, Stay Well, Stay Distant, Avoid Crowds and Wear Your Mask
James A Vito, D.M.D.