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May 18, 2022

NYC is Now a High Covid Transmission Area

Today the NYC Health Commissioner raised the Covid-19 transmission rate to HIGH -from MEDIUM risk - which began on May 2nd.  There are 45 out of 62 counties in New York State with high transmission, and this is probably an undercount because results of rapid home tests are rarely reported.  The CDC reported that the average number of daily cases in the US is almost 88,000, four times what it was in March.  Hospitalizations are also rising - but they are divided between "admitted for Covid" and "admitted with Covid and another medical problem."  So far deaths are approximately 300/day and have not increased yet.   

Recommendations Beginning Now:  All New Yorkers should wear high quality masks in all indoor public settings, and those at high risk of severe illness should avoid crowded settings and limit "get-togethers."

The BA.2.12.1 which accounts for all of the circulating variants is 25% more transmissible than was BA.2 which was 30% more transmissible than the original Omicron variant.  The virus will continue to spread to millions of unvaccinated people, and even to vaccinated people who have not received a booster dose.  Breakthrough infections are even occurring in those that were infected by the first Omicron virus.  See Below 

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We are going away with friends for a beach vacation and  I may or may not have breaking news to report before June 4th.  Stay safe and healthy.  Long Covid has affected MANY people who had Covid-19, mild, moderate, or severe.  Reading their stories should make you want to avoid ANY Covid infections.

May 14, 2022

Every Adult Needs to Be Boosted Against Covid-19

Just a few comments today:  The Omicron BA.2.12.1 and BA.2.12 variants, which are more transmissible than Omicron BA.1, now account for all of the Omicron cases in Region 2 which includes NY, NJ, Puerto Rico, and the BVI.  While it doesn't appear to be more severe, US case numbers, breakthrough infections, and hospitalizations are climbing, especially in the  Northeast.  Deaths are also increasing, and not only in the unvaccinated.  Waning immunity and LOW BOOSTER NUMBERS most likely account for this decrease in vaccine effectiveness. 

It is now apparent that booster shots are critically important. One-third of vaccinated people who died from a breakthrough Covid-19infection hadn't had a booster shot (CDC data.). Dr. Peter Marks, Director of the FDA's Center of Biologics Evaluation and Research, said this week that is critically important that people who only had their initial 2 doses should get boosted NOW as the BA.2 subvariants are spreading across the country and cases and deaths are rising.   

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May 11, 2022

Rebounding Covid Symptoms After 5-day Paxlovid Treatment

Paxlovid, an antiviral oral drug for Covid-19 infections, doesn't prevent infections, but does prevent hospitalizations and deaths by 90% in high-risk patients.  Risk factors for severe disease, are required to get the drug and include age above 65, and comorbidities like asthma, hypertension, diabetes, obesity etc.  The vast majority of patients who receive Paxlovid report feeling much better after just a few days of treatment.  However, symptoms, which are usually mild, can reappear in 1-2% of patients and then disappear quickly again.  In the randomized placebo-controlled clinical trial rebound of symptoms occurred in the same number of patients receiving Paxlovid and placebo.  There are several theories and a number of studies being done to understand why this occurs, but no definitive explanations have been found as yet.  See Below

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There are several studies planned or underway to try to figure out why rebound occurs.  One 71 year old patient was recently studied by looking at daily changes in virus replication, and the numbers decreased during Paxlovid treatment and then increased again for several days.  The first virus peak was on Day 1 of treatment and the second peak was on Day 9, and then quickly decreased again.  This suggests that the patient was contagious again for several days.  Patients who experience rebound of symptoms should consider themselves contagious until rapid antigen tests are negative. There is no evidence that the virus is becoming resistant to Paxlovid.  Perhaps 5 days of drug is not sufficient to eradicate the infection for a small number of patients, although other hypotheses are being tested. Patients who have a rebound should contact their doctor to see if retreatment is necessary. 

May 7, 2022

Covid-19 Omicron Infections Study by Age

The CDC recently reported results of a "seroprevalence study" of Covid-19 infections, by age group, during the period September 2021 through February 2022.    (MMWR Morb Mortal Wkly Rep 2022;71:606-608)  It is very difficult to get an accurate picture of the number of Covid infections in the country.   But Scientists can measure antibodies that are directed to the NUCLEOCAPSID part of the SARS-CoV-2 virus, and not the spike protein.  These NUCLEOCAPSID antibodies are generated by infection, NOT vaccination.  Samples were collected from people in all 50 states, DC, and Puerto Rico.  Samples were collected every 4 weeks, except February when they were collected every 2 weeks.  The median number of samples was 73,869 except for Feb when it was 45,810.  Seroprevalence (i.e. the number of people who were positive for nucleocapsid antibodies due to covid infection) was assessed every 4 weeks and by age group.  *see definitions below.

RESULTS:  Sept-Dec 2021: overall seroprevalence increased by 0.9-1.9% every 4 weeks.

RESULTS:  Dec-Feb 3022:  overall seroprevalence increased from 33.5% to 57.7%

     Ages 0-11: increased from 42.8 to 75.2%    5-11 years:  Fully Vaccinated 28%

     Ages 12-17: increased from 45.6 to 74.2%                Fully Vaccinated 59%

     Ages 18-49: increased from  36.5 to 63.7%               Fully Vaccinated 69%

     Ages 50-64:  increased from 28.8 to 49.8%               Fully Vaccinated 80%

     Ages >65 years:  increased from 19.1% to 33.2%      Fully Vaccinated  90%     See Below

 

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As of Feb 2022 approximately 75% of children and adolescents had serologic evidence of a previous Covid-19 infection.  One-third of these children became newly positive since Dec 2021 when Omicron was surging.  The greatest increase in seroprevalence during Sept 2021-Feb 2022 occurred in the age groups with the lowest vaccination coverage.

DEFINITIONS: Seroprevalence:  The percent of the nucleocapsid antibody detected in a batch of SERUM samples from patients.  

Serum:  The liquid part of a blood sample after the blood has clotted in a test tube and the cells and clot have been removed.  Serum is pale yellow.

May 4, 2022

Virus Mutations Are Not Slowing Down

Virus mutations are not slowing down.  The Omicron variant was first reported from South Africa late in 2021, and it spread quickly to the US, causing the biggest Covid-19 surge of the pandemic.  The virus then continued to mutate (BA.1 and BA.2)and Omicron subvariant BA.1 was quickly overtaken by Omicron subvariant BA.2.  Why do we worry about these subvariant mutations.  Every mutation can change the rate of virus transmission, the severity of Covid 19 infection, and/or escape from immune protection (immunity after an infection or immunity from vaccination).  Two more subvariants have also appeared in South Africa- BA.4 and BA.5.   In a recent report from South Africa antibodies from patients who had BA.1 infection demonstrated a substantial loss of immune protection against the BA.4/5 subvariants, more in unvaccinated, than in vaccinated/unboosted patients.     See Below for NY Info

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Cases in the US are slowly increasing (49% in the past 2 weeks), and this appears to be due to a mixture of Omicron subvariants.  NEW YORK CITY Covid-19 cases are also slowly increasing and in the last weekly report Omicron subvariant BA.2.12.1 now makes up 58.1% in US Region 2 - NY, NJ, Puerto Rico, and BVI.  BA.2.12 makes up 40.9%.   Hospitalization, but not deaths, are also increasing.  BA.4 and BA.5 have been detected here, but their case numbers are still low.  In summary the Omicron BA.2 variant mutates frequently, and spreads more easily.  So far severe disease and death both have not changed.  New York City is now in the yellow risk category (medium risk).  When you look at a Risk Map of the US, almost all of NY state is yellow which stands out on a US map that is almost all green (low risk).  This is a great time to decide what risks you are willing to take and adjust your mask wearing and activities accordingly.