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June 9, 2021

July 4th Goal - 1 dose to 70% of Americans

We need to be happy about our vaccines - we wouldn't be at this stage of the pandemic without them.  Moderna is amending their EUA to include 12-15 year olds and both Pfizer and Moderna are testing their vaccines in younger children - maybe down to age 6 by September. We are told that an EUA for the 4th vaccine, from Novavax, will be coming soon.  Now seems like a good time to see where we've been since Mar 2020.

About 33 million of Americans tested + for Covid-19, and we didn't have sufficient testing in Mar-Apr 2020. 

About 595,000 Americans have died from the virus, deadlier than all wars, military conflicts combined in 80 yrs.

Last summer cases were over 65,000/day and by Winter hundreds of thousands had the virus and over 3000 died per day.

As of this week approximately 50% of Americans are fully vaccinated and over 60% have had at least 1 dose.   See Below


The US can't control the virus without vaccines and the risk is as high as ever for unvaccinated Americans.  There will be localized outbreaks in areas where relatively few people are vaccinated.  Highly contagious viruses will continue to spread until most susceptible people are infected. 

New York State still has approximately 800 cases/day (which is <1% of >200,000 Covid tests/day).  Another way to assess the new cases is to count the number of positive cases/100,000 population in each state.   NOW:  US Overall:  4/100,000. The most new cases are in Wyoming and Colorado.  The lowest number of new cases is in Vermont with 1 case/100,000.  NY and New Jersey are 3/100,000population.

In the beginning of April those statistics were: US Overall:  20/100,000 and NY 38/100,000.  But New Yorkers are still being vaccinated and the rates of infection, hospitalizations, and deaths decrease each day.  Latest STATS from CDC:  The 7 day average of new daily cases reported has decreased from 65,053 on Apr1 to 12,780 on June 5.  The 7 day average of new daily cases reported decreased from 681 t0 367.

The virus will continue to circulate in America, but it is now infecting the unvaccinated - and will continue to spread in the "susceptible."  Unfortunately more cases are being seen in children and adolescents who are not vaccinated, and more young people have severe infections and are hospitalized in ICUs.   


June 5, 2021

Covid Hope Over Fear

The CDC caused lots of confusion when new mask recommendations were announced by Dr. Rochelle Walensky at 2:17 PM on May 13th.  The number of vaccinations in the US were dropping everyday, and so were the number of new Covid-19 cases.  But some states still had increasing cases, were opening up, and vaccinated people were told that they could drop there masks outdoors, if they weren't in large groups.  Would this inspire vaccine hesitant people to get vaccinated?      See Below


"Almost immediately the number of visits to to find vaccination centers spiked - rising even higher that afternoon.  Later that afternoon President Biden encouraged people to get vaccinated so they could remove their masks in many instances.  The increase in traffic to continued and the number of vaccinations remained stable for the rest of May. This may have been a good example of how hope is better than continued fear.

The closing sentences in this NYTimes article said, "In the case of Covid vaccines, the hype is grounded in reality. Once you are fully vaccinated, you no longer have to organize your life around personal fear of Covid (unless you are immunosuppressed)."  Please get vaccinated, but remember, in some previous studies on "breakthrough cases" in vaccinated people, the efficacy of the vaccines were lower after only one dose.  If you only received 1 dose of the mRNA vaccines, get your second dose now - even if you missed the date for your 2nd dose.  The pandemic will not be over when the virus can still infect susceptible people.  


June 2, 2021

Protection Against Reinfection in Lombardy, Italy

How many patients who had Covid-19 infection during the first wave of the virus in Lombardy, Italy had it again, at least 90 days and 2 negative RT-PCR tests, later?  There is a new study from Lombardy that demonstrates that very few of the original cohort of Covid-19 + patients (Feb-July 2020) redeveloped Covid-19 during the next year. Patients who were negative during those early months were followed for almost a year for comparison, and many developed Covid-19.  The difference in the number of infections in these two groups was statistically significant (P<0.001).

Reinfection was defined as a positive RT-PCR Covid test more than 90 days after recovery plus 2 negative tests.  Only 5 patients of 1579 original Covid + patients had a reinfection - and one was hospitalized. 

There were 528 Covid-19 infections in the original 12,968 Covid-19 negative subjects while being observed for almost a year.


Antibody levels and other markers of immunity were not measured, but the statistical difference in infection rate was a strong indicator that the previously infected patients had enough natural acquired immunity from their first infection to prevent reinfection for almost a year.  (JAMA Internal Medicine May 28, 2021) Recent studies demonstrate that there is a robust antibody response in patients who had Covid-19 after just 1 dose of vaccine.

May 29, 2021

Moderna Vaccine Trial in Children 12-18

More Good News: This week Moderna released data on their clinical trial in Adolescents - ages 12 to less than 18.  There were 3,732 volunteers and 2/3rds of the group received the vaccine (in the same dose as adults) and 1/3rd received placebo.  Clinical trials in children are smaller than in adults and the goal is to make sure that it has the same efficacy as seen in the bigger Phase 3 trial in adults.  This is called "immunobridging."  The vaccine was given the same way as in adults, two doses 4 weeks apart.  More than 2 weeks after dose 2 there were 4 cases of Covid-19 in the placebo group and none in the vaccinated group for an efficacy of 100%.  The side effects were similar to that in adults with local pain at the injection site and generalized symptoms of headache, fever, chills, and myalgias - most were mild or moderate.  See Below 


They also calculated the efficacy rate using the CDC definition:  the presence of one symptom and a positive nasal swab or saliva test by RT-PCR molecular test.  Using this case definition the efficacy was 93%.  All volunteers will be followed for a full 12 months after their second dose.  Moderna will submit a request for approval of the vaccine in adolescents the beginning of June.  All of the data will be reviewed by FDA scientists, and the VRBPAC independent scientific advisory Committee and then presented to the CDC ACIP independent advisory committee for a a one day open discussion and vote.  If approved by the outside committee the CDC will have the final decision re: approval.

May 26, 2021

Part 4: Vaccine Effectiveness and Indian Variants

The more RNA viruses multiply, the more mutations occur.  Therefore uncontrolled infections, like in India or even hot spots in the US, will result in more mutations.  Will our current vaccines protect us?  Mutations can 1. Increase transmission of the virus, 2. Reduce effectiveness of our vaccines, and/or 3. Cause more severe disease.  The Indian mutant has 3 subtypes, and B.1.617.2  has increased transmission and may now be more prevalent than the UK mutant based on Public Health England studies just published.  The total number of cases in England are not increasing, but the Indian variant is replacing the UK variant in new cases.  Two doses of the Pfizer vaccine had an efficacy of 88% against the Indian variant and 93% against the UK variant.  However, the effectiveness after only one dose dropped to 33%.  See below. 


The NYC Dept of Health is performing genomic sequencing on viruses isolated from random samples of infected patients.  The UK variant has increased from 7% in Feb. to 47% as of May 9.  The NYC Variant remains at approximately 30% (3 subtypes), the Brazil variant is approximately 6%, and the Indian variant has just appeared at the end of April in 4% of New Yorkers.  So far the mRNA vaccines have demonstrated effectiveness against each of the variants, but the recent UK report found that two doses are necessary.  The vaccine was only 33-34% effective after one dose.  The mRNA vaccines are very effective and very safe - everyone who only got one dose should go NOW to get their second dose.  Please get vaccinated - the infection rate, which is published daily by the NY DOH, right now is about 1% or less in NY State, NY City, Manhattan, and in my Zipcode. The virus will now seek out the susceptible people in our midst.