Optimism is the most important human trait because it allows us to evolve our ideas, to improve our situation and to hope for a better tomorrow. - Seth Godin
As of January 2,2021, there was approximately 20 million positive cases and 348,000 deaths. Now 9 months later we are looking at approximately 44 million positive cases and 706,000 deaths. There are predictions of close to 800,000 -900,000 deaths by the end of the year. Staggering numbers in light of the fact we have vaccines.
Sad Reality: Covid-19 has officially became the deadliest outbreak in recent American history on Monday, surpassing the estimated U.S. fatalities from the 1918 influenza pandemic.
The AP (9/20, Johnson) reports, “COVID-19 has now killed about as many Americans as the 1918-19 Spanish flu pandemic did. Over a century ago 675,000 died from the Spanish flu. Today the number of people lost to COVID1-19 is 705,293.”
While “the U.S. population a century ago was just one-third of what it is today, the “COVID-19 “crisis is by any measure a colossal tragedy in its own right, especially given the incredible advances in scientific knowledge since then and the failure to take maximum advantage of the vaccines available this time.”
Large swathes of America has seen a surge in cases with total deaths running at more than 1,900 a day - the highest level since early March. There may be a further increase in the winter but not as deadly as last year, according to projections by the University of Washington.
The model are projecting an additional 100,000+ Americans will die of COVID-19 by January 1,2022, which would bring the overall US toll to 800,000-900,000 people.
“If we had no vaccines and we were suffering through Delta, the death rate would be dramatically higher,” said Dr. Bruce Farber, chief of infectious diseases at Northwell Health in New York. “Hundreds more thousands of people would have died, probably in the millions. And I think that’s what we saw in many countries where Delta spread through it quickly without adequate vaccination.”
55.1% of the adult U.S. population is fully vaccinated, according to the Centers for Disease Control and Prevention. This is far short of the 70% that we were striving for by July 4th when the mask mandates were lifted.
Immunity transferred to unborn child: Women who receive the mRNA COVID-19 vaccine during pregnancy pass high levels of antibodies to their babies, according to a NYU study. COVID-19 vaccines are proving to be very safe for both pregnant women and their unborn children. Doctors analyzed umbilical cord blood from 36 newborns whose mothers had received at least one dose of an mRNA vaccine from Pfizer (PFE.N)/BioNTech or Moderna (MRNA.O). All 36 babies had high levels of antibodies that target the spike protein on the surface of the virus - and all of the antibodies could be traced to the mothers' vaccinations. The findings, reported on Wednesday in the American Journal of Obstetrics and Gynecology - Maternal Fetal Medicine, indicate that "the antibodies that the mother is building to the vaccine are crossing the placenta and that's likely to confer benefits for the infant after it's born," said coauthor Dr. Ashley Roman of NYU Langone Health in New York City. It is not clear whether the timing of vaccination during pregnancy is related to antibody levels in the baby. And, "we don't know how long those antibodies stick around in the baby," Roman said. "But the presence of these antibodies in the cord blood, which is the fetus' blood, indicates that the baby also has potential to derive benefit from maternal vaccination." The research shows pregnant women who get an mRNA vaccine against COVID-19 pass high levels of protective antibodies on to their babies. Study authors hope their findings help encourage more women to get their shots. According to this work, it will not only protect them but their children as well.
Pfizer says its COVID-19 vaccine is safe and effective for younger kids: A lower dose of Pfizer-BioNTech's COVID-19 vaccine was safe and effective for children ages of 5 and 11, the companies announced today. Dr. Jesse Goodman of Georgetown University, a former FDA vaccine chief. The level of immune response Pfizer reported “appears likely to be protective.”
How do Vaccines Work and Why We See Breakthrough Infections: Right after vaccination you get a big surge in antibody levels up front. But that’s not the only part of your immune system that kicks in; your immune system is forming a memory response, through memory cells. And so, the antibodies may drift back down over time, but your memory cells are still there. Then, if you’re re exposed to an infection, your memory cells kick into gear, and you get another surge of antibodies. The issue is that it takes three to five days or so for your immune cells to start revving up to make antibodies, and in that time the virus can still infect you and replicate. The incubation period with the Delta variant is about four to five days. Your immune system nips it in the bud before you get really sick, but you could still end up with a breakthrough infection.
What most vaccines do is prevent the infection from taking off and making you very sick. One of the problems with this whole debate around boosters is that people have had very unrealistic expectations of what vaccines can or cannot do. They think that seeing breakthrough infections is a failure of the vaccines, when it’s actually quite predictable and normal activity of vaccines.
The science behind Covid-19 vaccine boosters: Do we really need an extra shot? The efficacy of both Pfizer's and Moderna's vaccines declines in a matter of months, and that one more dose of the Pfizer shot can reduce the rates of infections by 11 times and severe illness by 20 times in the elderly.
"There isn't a vaccine where you don't see a drop over time in antibody titers," Professor Rafi Ahmed told scientific journal Nature, referring to the unit of measurement for antibodies.
"There is always a drop," said the immunologist and director of the Emory Vaccine Centre in the United States.
"If you had high levels of antibodies to every pathogen that you come across, your blood would be sludge," said Dr Jane O'Halloran, an assistant professor of medicine at the Washington University School of Medicine in St Louis
With the science still murky on whether antibody levels are directly proportional to protection against infection and disease severity, experts have turned to examining real-world data.
A new study released by Moderna this week showed higher rates of infection among US volunteers vaccinated with its shots about 13 months ago compared with those vaccinated some eight months ago.
Recent studies in Israel, too, have shown that individuals vaccinated with Pfizer shots earlier in the country's immunization programmed were significantly more likely to catch Covid-19 and even suffer severe illness from the virus as the months passed.
Some experts point to other factors at play, such as the arrival of the more transmissible Delta variant and the fact that many of those earlier-vaccinated individuals were either healthcare workers who tended to be more exposed to the virus or immunocompromised people.
Experts note that some immunocompromised individuals are simply unable to produce satisfactorily high levels of antibodies even after full vaccination. Even with a third dose, their antibody levels - while improved - tend to remain below those seen in other vaccinated groups, according to a study involving organ transplant patients on immunosuppressive drugs that was published last month in the New England Journal of Medicine.
These findings may make the scientific case for offering extra shots to the elderly and those with comorbidity (the simultaneous presence of two or more medical conditions), no matter how marginal the protection is.
The vaccines never promised to eradicate infections - the vaccinated can still get Covid-19 - so stopping them altogether would be a pipe dream in modern-day society, with its porous borders and geographically mobile people.
If booster shots, in mounting a stronger immune response, can help further lower the chances - however marginal - of a fully vaccinated person getting infected or becoming more infectious, then that could also better protect members of the public, especially those who for medical reasons cannot get vaccinated.
"A booster will ultimately prevent others from going to the hospital, and it ultimately will benefit the way the country is going," said Professor Michel Nussenzweig, an immunologist and senior physician at The Rockefeller University in the US.
'Waning immunity?' Experts say term leads to false understanding of COVID-19 vaccines: The idea of waning immunity has picked up steam in recent weeks, with some countries using it to justify rolling out third-dose COVID-19 vaccine boosters to their populations. But immunologists say the concept has been largely misunderstood.
While antibodies -- proteins created after infection or vaccination that help prevent future invasions from the pathogen -- do level off over time, experts say that's supposed to happen.
And it doesn't mean we're not protected against COVID-19.
Jennifer Gommerman, an immunologist with the University of Toronto, said the term "Waning Immunity has this connotation that something's wrong and there isn't," she said. "It's very normal for the immune system to mount a response where a ton of antibodies are made and lots of immune cells expand. And for the moment, that kind of takes over.
Antibody levels ramp up in the "primary response" phase after vaccination or infection, "when your immune system is charged up and ready to attack," said Steven Kerfoot, an associate professor of immunology at Western University.
They then decrease from that "emergency phase," he added. But the memory of the pathogen and the body's ability to respond to it remains. Kerfoot said B-cells, which make the antibodies, and T-cells, which limit the virus's ability to cause serious damage, continue to work together to stave off severe disease long after a vaccine is administered. While T-cells can't recognize the virus directly, they determine which cells are infected and kill them off quickly.
Recent studies have suggested the T-cell response is still robust several months following a COVID-19 vaccination.
Antibodies from original strain COVID-19 infection don't bind to variants: People infected with the original strain of the virus that causes COVID-19 early in the pandemic produced a consistent antibody response, making two main groups of antibodies to bind to the spike protein on the virus's outer surface. However, those antibodies don't bind well to newer variants, a new study from the University of Illinois Urbana-Champaign found.
Antibody response is quite relevant to everything from understanding natural infection and how we recover from infection to vaccine design. The body has the capability to produce diverse antibody responses—it's estimated we could make a trillion different antibodies. So when you see people are making quite similar antibodies to a particular virus, we call it convergent antibody response," says study leader Nicholas Wu, an Illinois professor of biochemistry. "That means we can design vaccines trying to elicit this kind of antibody response, and that is probably going to improve the responsiveness of more individuals to the vaccine. Even though this antibody response is very common with the original strain, it doesn't really interact with variants," Wu said. "That, of course, raises the concern of the virus evolving to escape the body's main antibody response. Some antibodies should still be effective—the body makes antibodies to many parts of the virus, not only the spike protein—but the particular groups of antibodies that we saw in this study will not be as effective
COVID-19 is evolving, ‘getting better’ at becoming an airborne virus: Recent COVID-19 variants are much more adept at airborne transmission than the original version of the coronavirus, according to a new study in the journal Clinical Infectious Diseases. University of Maryland researchers analyzed the Alpha variant originating out of the United Kingdom and discovered that carriers breathe out 43 to 100 times more infectious viral aerosols than those infected with the original strain.
“Our latest study provides further evidence of the importance of airborne transmission,” says Dr. Don Milton, professor of environmental health at Maryland’s School of Public Health (UMD SPH), in a university release. “We know that the Delta variant circulating now is even more contagious than the Alpha variant. Our research indicates that the variants just keep getting better at traveling through the air, so we must provide better ventilation and wear tight-fitting masks, in addition to vaccination, to help stop spread of the virus.”
Scientists explain that these new variants result in a much larger “viral load” for infected carriers, which refers to the amount of the virus found within the body. However, the new study finds the amount of coronavirus released into the air by Alpha-variant carriers was significantly more (18 times) than what viral loads alone should be capable of doing. This suggests that SARS-CoV-2 is quite literally improving at airborne travel and transmission as time goes on.
Face mask tests showed that commonly used face coverings like loose-fitting cloth and surgical masks reduce the amount of virus-laden particles released into the air while breathing, cutting the amount by about 50 percent. However, the results certainly don’t suggest face masks alone can offer full protection.
“The take-home messages from this paper are that the coronavirus can be in your exhaled breath, is getting better at being in your exhaled breath, and using a mask reduces the chance of you breathing it on others,” concludes study co-author Dr. Jennifer German.
Three New variants on the Horizon: The B.1.621 variant, better known as Mu, variant with origins in Colombia has been placed on the World Health Organization's list of SARS-CoV-2 variants of interest, which are variants "with genetic changes that are predicted to affect virus characteristics," such as transmissibility and disease severity, among other factors.
R.1 appears to have "mutations of importance," according to the Centers for Disease Control and Prevention — one of which, the organization notes, "demonstrates evidence of increasing virus transmissibility." It was first detected in Japan last year and has since made its way to other countries, including the U.S., where it accounts for less than 0.5 percent of cases.
A new mutation of the Delta variant which could make it more resistant to vaccines has been identified in the UK.
Some 19 cases of Delta with E484K, the mutation associated with immune escape in other variants, have been found, including 17 in England and two in Scotland.
Although case numbers are very low, the presence of E484K – known in virology circles as “Eeek” because of its vaccine-dodging qualities – is a cause for concern and Public Health England have classed it as a “signal under investigation”.
Until next time, Stay Safe, Stay Well, Practice Mitigation Factors and consider getting vaccinated if you have not already done so.
James A Vito, D.M.D.