“If you want something you never had you must be willing to do something you’ve never done.” - Thomas Jefferson.
Point of View: As we continue to roll out COVID-19 vaccination here in the U.S. and, far too slowly, around the world, our next potential challenge is already looming on the horizon: the potential need for booster vaccinations. As we gather and weigh evidence on the necessity of boosters, we must not lose sight of the COVID-19 vaccine strategy that will protect us best and save the most lives.
Vaccine makers have suggested that we will need boosters and the Biden administration is reportedly working to ensure they will be available if necessary. And although it is absolutely right to prepare for the possibility that we may need boosters, in reality, we don't yet know if we'll need them and, if so, when. It appears that COVID-19 vaccines licensed in the U.S. provide excellent protection against mild and severe disease and against hospitalization and death, and the protection offered by both the Moderna and Pfizer vaccines reportedly lasts for many months.
Just as we have done for other vaccines, to establish clear guidelines for whether and when to boost, we need: a better understanding of the duration of protection against COVID-19 after vaccination; evidence on how markers of immunity change after COVID-19 vaccination over time; and data on how those markers correlate with protection. Levels of neutralizing antibodies against SARS-CoV-2 may decay over time, as they can after other vaccines. However, we don't know what levels of antibodies correlate with protection against COVID-19. In part, this is because it's not just antibodies that offer protection after vaccination: T cells may also offer robust, long-lasting immunity.
To wear a MASK or not to wear a MASK. This is still a confusing issue: The CDC's announcement 2 weeks ago that people who have been fully vaccinated against COVID-19 no longer have to wear masks came as a surprise "bombshell" for infectious disease experts and policymakers across the nation said top officials of the Infectious Diseases Society of America (IDSA) during a Thursday news conference.
The interim announcement on May 13 from CDC director Rochelle Walensky, MD, was "abrupt, and I think as you see, was misinterpreted by many as 'mask mandates are over,' and even to some that the COVID-19 outbreak threat is over," said Jeffrey Duchin, MD, a member of the IDSA board of directors and a public health officer for Seattle and King County in Washington.
The IDSA, the largest infectious diseases society in the U.S., issued a much more tempered statement on May 17, generally saying that the CDC's new guidance "should not send the message that the pandemic is over."
There's still reason to be extremely cautious. "Can you go to your favorite large bin store and not wear a mask? If you're fully vaccinated and you have no other conditions that compromise your immunity, and the rates of COVID are relatively low where you live and the vaccination coverage is high, I would be 100% fine pretty much going anywhere without a mask" said Walensky
However, one must consider many other factors in calculating risk. "Remember, we are a global community," she continued, noting that only a small portion of the global population has received at least one shot. "So when you go to your local big chain store, you may be exposed to many people who haven't had the opportunity to or haven't chosen to get vaccinated yet."
Where are we this week? “According to the CDC as of May 27,2021, 40% of the country has been fully vaccinated. Still short of the ideal goal of 90% originally set forth by Dr. Fauci and still short of the lowered bar as set by Dr Fauci of 60-70% to achieve some effective herd immunity. In Pennsylvania 42.67% of the state is fully vaccinated, New York 45.19% and New Jersey 47.92%.
AS of May 29,2021, the number of U.S. Positive Cases stands at 34,022,657 and the number of deaths is now 608,961. This is an increase of 160,369 of positive cases and an increase of 5,515 deaths over last weeks numbers. In comparison 2,977 people were lost in the attack of 9/11. These numbers are sobering and real.
Still hesitant about getting the vaccine? Read on: A Michigan father of five died from complications due to COVID-19 earlier this month, just weeks after making the decision with his wife not to receive the vaccine. Antwone Rivers, 39, and his wife Hollie contracted COVID-19 in mid-April. Despite having no underlying conditions, his symptoms continued to worsen. Antwone was placed on a ventilator, but eventually every organ in his body began to fail, Hollie told the news station. He died on May 13.
This should drive home the point that we are not out of the woods yet despite the MASK Mandates. There is still a lot we do not know about COVID 19 and we need to be proactive in not only our health, but the health of our families and of our communities.
Breakthrough Infections after receiving the vaccine:10,262 SARS-CoV-2 vaccine breakthrough infections were reported from January 1 through April 30 in 46 US states and territories. About one quarter of affected people, 27%, were asymptomatic. Two percent, or 160 people, with breakthrough infections died, preliminary data reveal. "Ten thousand is a very small number compared to the hundreds of millions we have vaccinated. It's way better than any flu vaccine we have had in our lives," Ali H. Mokdad, PhD, professor of health metrics sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. Breakthrough infections are expected, he said, because no vaccine is 100% effective. Furthermore, breakthrough cases have been asymptomatic or mild in general. He further adds that if all Americans aged 12 years and older get vaccinated "the number of COVID-19 cases, hospitalizations, and deaths that will be prevented among vaccinated persons will far exceed the number of vaccine breakthrough cases."
This further adds to the credibility of the vaccine in terms of dealing with the severe outcomes of COVID -19 or one of its variants. While no vaccine is 100 % fool proof the three vaccines, we have available have shown to work and to be effective and lessen the severity of COVID -19 or preventing one from getting it altogether.
First Vaccine Data Against Indian Variant: Both the Pfizer and AstraZeneca COVID-19 vaccines showed effectiveness against symptomatic disease from B.1.617.2, the so-called Indian variant, British researchers found. Two doses of Pfizer's vaccine showed 87.9% efficacy (95% CI 78.2%-93.2%) against the variant, while two doses of AstraZeneca's showed 59.8% efficacy (95% CI 28.9%-77.3%), reported Jamie Lopez Bernal, PhD, of Public Health England in London, and colleagues
Dental offices are a safe environment: More than a year after COVID-19 appeared in the U.S., dentists continue to have a lower infection rate than other front-line health professionals, such as nurses and physicians. The study, "COVID19 among Dentists in the U.S. and Associated Infection Control: a six-month longitudinal study," is based on data collected June 9 - Nov. 13, 2020.
“Dentists continue to show lower rates of COVID-19 infection compared to other health professionals, according to a recent study published in The Journal of the American Dental Association.” In monthly surveys of US dentists between June and November 2020, “the cumulative COVID-19 infection prevalence rate” among respondents was 2.6%, with incidence rates between 0.2% and 1.1% each month. For other health professionals, the cumulative COVID-19 prevalence rate ranged from 3.3% to 35.3% in June 2020.
The study is a continuation of the first large-scale report of incidence rates of COVID-19 among dentists in the United States published in Dentistry Today October 2020.” The results of both studies “show that prevalence and incidence rates among dentists continue to be very low when compared to the population as a whole and to other healthcare professionals.”
Until next time, Stay Safe, Stay Well, Wear your Mask wisely and get Vaccinated.
James A Vito, D.M.D.