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January 20, 2021

What Are Covid Long Haulers?

Some update on Long Haulers (also called Post-acute Covid-19 Syndrome):  I first wrote about Long Haulers in September, and now there is more information about these patients who had documented Covid-19, but are still symptomatic, and virus negative.  Fatigue is one of the major symptoms, but there is a constellation of symptoms that persist for months and interfere with normal living.  It can occur in patients hospitalized with severe disease or even young people with mild acute infections. If more young people knew about these chronic symptoms, fewer would take risks thinking they would have a mild illness with complete recovery. 

Some recent studies estimate that 10% of Covid-19 patients become long haulers with fatigue, insomnia, shortness of breath, "brain fog,"  lack of smell and taste, depression, myalgias, arthralgias, headache, intermittent fever, and heart palpitations or rapid rate.  There are multiple theories about the cause of these symptoms, but much more data needs to be collected and studies done. Anthony Fauci thinks that some of these patients with symptoms lasting longer than 4 weeks after their virus clears, may develop chronic fatigue syndrome (myalgic encephalomyelitis).  

 

 

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Patients frequently had problems convincing doctors that their lingering symptoms, which prevented them from going back to work or resuming their previous activities, were real.  In recent months Post-Covid Care Centers and support groups are seeing these patients.  Medical School hospitals are among those who are following a large number of patients and collecting longitudinal data to share with other centers.   This is a good general reference for more information: https://www.scientificamerican.com/article/the-problem-of-long-haul-covid/

 

January 16, 2021

Third SARS-CoV-2 Vaccine: Johnson and Johnson

This week J and J published the full results from Phase 1 and 2a Trials on their SARS-CoV-2 vaccine.  These two types of trials are focused on Safety and ability to stimulate an Immune Response.  In these trials they tested multiple variables:  ages 18-55, ages 65+, low dose and high dose, and 1 versus 2 doses.  The vaccine was safe, with mostly low grade local and systemic symptoms (injection site pain, fatigue, headache, myalgia, rare fever).  Immunologic studies demonstrated a 90% immune response, including neutralizing antibodies against the virus.  In addition there was a T cell immune response.  Both age groups included slightly more than 400 volunteers.  Based on these two trials, J and J developed two Phase 3 clinical trials to assess the efficacy of 1 or 2 low doses of the vaccine.  Complete enrollment in the one dose trial was reported on Dec 17th.  An application to the FDA for an EUA requires that at least 50% of the volunteers must be 2 months beyond their vaccination for an adequate safety evaluation (probably Feb).  The 2 dose Phase 3 trial is still ongoing.  Unfortunately J and J says manufacturing is slow.  Read Below

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The virus in the above illustration is a harmless inactivated adenovirus that causes colds. 

The J and J vaccine is similar, but different from the mRNA vaccines by Pfizer and Moderna  The DNA code for synthesizing the SARS-CoV-2 spike protein is introduced into the cells of our body with a harmless adenovirus as the carrier.  There the DNA is a template for synthesis of the spike protein and our immune system responds to the spike proteins by developing antibodies and cellular immunity to SARS-CoV-2  J and J successfully made an ebola vaccine using this technique. Based on the results of the Phase 3 clinical trial it may only require one dose to achieve high levels of immunity and it can be stored in the refrigerator.

January 13, 2021

Allergic Reactions to mRNA Covid Vaccines?

Morbidity and Mortality Weekly Review (MMWR), a publication, of the CDC, reported on 21 cases of anaphylaxis between Dec 14-23rd following vaccination with the Pfizer vaccine.  Anaphylaxis can occur after any vaccination and these are cases from the first use of the Pfizer vaccine after their FDA Emergency Use Authorization was granted.  There were 1.9 million Americans who received the Pfizer vaccine during that period, for an incidence of 11.1 cases of anaphylaxis per million vaccinated.  These reports were sent to the CDC through multiple safety reporting methods, and after an initial review there were 175 cases that needed to be carefully assessed and only 21 cases of anaphylaxis were found. The diagnosis of anaphylaxis was based on a worldwide scientific system of classification of anaphylaxis.  17 of the patients had a history of allergies and 7 of the patients had a history of a prior anaphylactic episode. 

The median age of the patients was 40.  Ninety % were women.  The median interval to developing symptoms was 13 minutes with 14% occurring after 30 minutes.  All patients were treated with epinephrine and recovered.  One patient was lost to followup.  81% of these patients had a history of allergies: drugs, medical products, foods, insect stings.  These cases were spread geographically and none received vaccines from the same lot numbers.   

After review there were 83 cases of non-anaphylactic allergic reactions: itching, rash, itchy and scratchy symptoms in the throat, and mild respiratory symptoms.  67% of these patients had a past history of allergic symptoms. The remainder of the cases reviewed were non-allergic, i.e. like vasovagal syncope (fainting).

More below. 

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I watched the CDC broadcast on vaccine allergic reactions several weeks ago, mainly because  I have multiple allergies.  These are their recommendations:

1.  Any patient who has anaphylaxis to either the Moderna or Pfizer vaccine, should NOT be vaccinated again with those vaccines.

2.  Any patient who has a history of anaphylaxis to a prior vaccine (i.e. influenza etc) or to an IV drug should consult an allergist and their risk vs benefit ratio to vaccination assessed.

3.  Any patient with allergies to foods, animal danders, insect stings, meds (given orally), eggs, gelatin, and/or positive family history may receive the vaccines. 

Vaccination sites should screen patients for allergies, have medical resuscitation equipment and epinephrine in prefilled syringes available, and observe all patients with allergies for 30 minutes post vaccination, instead of 15 min.  Data from the Moderna vaccine experience will be reported soon.  Only one case of anaphylaxis was reported early as far as is mentioned in the press.

January 9, 2021

The Path Forward Combating Covid-19 - Dr. Francis Collins

I listened to an excellent interview of Francis Collins, Director of NIH and Dr. Fauci's boss, this week.  He talked about multiple aspects of the pandemic and I wanted to share some of that information. 

He did not accept the idea of giving only 1 dose, or two half doses of the current Pfizer and Moderna vaccines to spread out the vaccine.  The very high efficacy of these vaccines was obtained in clinical trials of 15,000 (Moderna) and 22,000 (Pfizer) volunteers using 2 full doses.  "Science must prevail" - there is no guarantee that the efficacy will remain high, especially in the different subgroups, if the dosing regimen is changed.  He also was hopeful that the current vaccines will be effective with the new mutations (UK and S.Africa), and this is being studied in the lab.  RNA viruses mutate all the time, and the US was not studying the genomic changes of isolated viruses like the UK.  The CDC has now set up a comprehensive genomic testing lab to follow the mutations.

The vaccinations started slowly, but this is partially understandable.  There is a learning curve for this as with anything else.  He wants to make sure that more than 1 million people are vaccinated per day with a goal of vaccinating 80-85% of the population to achieve herd immunity.  State Governors meet virtually, weekly, to share their experiences and advice with vaccine distribution.  He believes that vaccine availability might be the limiting step, but hopes to have the population vaccinated by summer.  See below

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There is still vaccine hesitancy in different groups.  The government developed many different ways to assure the public about the safety of the vaccines.  He stressed that dying of Covid-19 is a MUCH higher risk than having a side effect from the vaccine.   There are many different approaches being used to meet with groups of people through churches, community centers, and groups of community leaders to expand the number of people who will be vaccinated.  For those who wonder about historical distrust of the government re: "experiments," look up the Tuskegee Study in Wikipedia. 

Dr. Collins said that he speaks to Dr. Fauci every night and they both disseminate information using scientific facts.  One fact I want to emphasize:  After you are vaccinated you must still follow the Public Health guidelines until we achieve herd immunity.  We know that the vaccines were highly effective in the clinical trials, but you don't know if your personal immune response is as effective when the community virus rates are so high.  The virus will still be spreading until herd immunity is reached. 

 

 

 

January 6, 2021

A Brief Return to Figure Drawing - Virtually

I returned to non-Covid-19 figure drawing for the first time since February - this time virtually on ZOOM.  Simon Levinson of Drawing New York Meetup Group organized a Pride and Prejudice Reading as we sketched a model in a period costume.  These are 2 of the 4 drawings I did - and I really enjoyed the 2 hour session.  This will continue on Sundays in January - something different to look forward to, and I finally found my very old copy of Pride and Prejudice to read.  It is nice to take a break from pandemic art and science, although I will continue that when new topics seem important. 

A 7 minute pose 

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A 40 minute pose - with one break. 

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