Paper and Threads

The Omicron variant BA.2 has taken over BA.1 in the US.  It is surging in Europe, with many countries having a second wave.  I follow a newsletter by Dr. Katelyn Jetelina MPH PhD- an epidemiologist, biostatistician, professor, and researcher, and thought I'd cover some items from her newsletter (Apr. 1), to help people make a decision re: vaccination and boosting. 

1.  UK hospital admissions of the 65+ group have passed their January peaks (BA.1).  They have the lowest prevalence of infection, and the highest rate of vaccination, yet Covid accounts for about half of their hospitalizations.  Is this due to a behavior change as restrictions were lifted?  Or are they getting caught up in the high community transmission? 

2.  US:  The prevalence of the BA.2 variant is now over 70%, and if the rapid rise continues, about 40,000 new cases/day will be seen by mid-April. 

3.  National testing shows that the rates of positive tests (PCR and antigen tests) are starting to increase.  The infections have stalled at about 27,000 cases per day but peaked at approximately 800,000 cases per day during the first Omicron peak.  Last week only NY showed an increase and now 15 states have daily increases - mostly in the Northeast.  The case rate is being driven by the younger age groups. 

4.  This past week the US had the lowest number of hospitalizations since the pandemic started. 

5.  Right now an average of 700 people are dying every day.  The majority are still in the unvaccinated population.

See Below  

While we wait to see what this Omicron variant will do in the next few weeks, get vaccinated.  If you are vaccinated, get the first booster - booster #1 and VACCINE dose #3.  The fully vaccinated and boosted group did much better than the fully vaccinated group during the Omicron BA.1 surge. And now, if you are over 65 and had the first booster 5 or 6 months ago, consider getting the 2nd booster dose now.  The vaccine is very safe and there is no downside.  Older patients had a good antibody response to the 2nd booster, (4th shot) in Israel.  I was planning to wait until I watched the FDA Scientific Meeting "on boosters" April 6th, but watching the spread of the BA.2 variant and seeing the case numbers in NY reaching 3% already, I decided to get it now.  I had it Friday at our neighborhood CVS store and my husband (also a retired physician) will get his on Sunday.

Posted by Shirley at 6:14 AM | Permalink | Comments (1)

1.  Get a Booster Shot if you are fully vaccinated.  Approximately 25% of the US population are fully vaccinated, but didn't get a booster when they became eligible.  Anyone who had their 2nd vaccine dose more than 5 months ago is eligible now.  Get it!!. With a booster you are even more protected than after your 2nd dose.  California studies show that only 2 boosted patients out of every one million were hospitalized with a Covid breakthrough infection.

2.  Post-infection Treatments:  The antiviral drug Paxlovid can be given after a positive Covid-test in a high risk patient (age 65+ counts!), and can prevent severe disease as long as it is given within 5 days of the onset of symptoms.  The efficacy against getting severe disease was >90% in the clinical trials.  If you are at high risk and just found out you are positive - by PCR or at home test - call your MD immediately or visit the nearest hospital so an MD can prescribe the medicine.  Patients should have normal kidney function and a list of all of their meds to give to the MD before it is prescribed. Paxlovid pills are taken several times a day for 5 days.  

3.  States in the Northeast may have rushed a little too fast to discontinue mask mandates and other mitigation protection as the Omicron BA.2 variant was racing through Europe and could come here within weeks.  It is now over 50% of the virus isolated in NY and NJ as of more than 1 week ago.  And since I follow the % of positive cases in NYS, NYC, and Manhattan, I have watched the beginning of this increase, after the cases numbers for Omicron BA.1 dropped very rapidly.  An N95 level mask can protect you even if people near you are not masked.    

4.  Immunocompromised patients may need additional protection.  Astrazeneca has a new drug, Evusheld, that can provide Covid antibodies to these patients, AND the antibodies can last for 6 months.  The drug is readily available in the US and should be given for this added protection.  

Posted by Shirley at 5:32 AM | Permalink | Comments (0)

This week Moderna announced vaccine data for children >6 months to <6 years.  As childrens' vaccines are tested they use a process known as immunobridging, in which they move from adults (18 years) backward in age groups.  Each age group is then vaccinated with a smaller dose of the vaccine and results are compared with those obtained by the next older group.  The main criteria by which the new dose is judged  are immunity and safety.  The immune response is assessed by measuring neutralizing antibodies against the virus in the lab and vaccine efficacy by the number of cases of infection in the placebo group versus the vaccinated group.  These two immune markers for the new dose are then compared to the data from the age group above theirs.

Children in the phase 2/3 clinical trial received two 25ug doses 28 days apart.  Adults receive two doses of 100ug 28 days apart.  There were 2500 children in the >6mo-2yrs and 4200 in the 2yr to <6mos group.  Data from their group of children 6 yrs to 11 yrs old have been presented and approved in Europe, Canada, Australia and will be submitted here.  The clinical trial met the end point with "robust titers of neutralizing  antibodies" and was well tolerated.  The reactogenic symptoms were mild to moderate, and fevers of >38 degrees C were only 17% and 14.6 %. and mostly following the second dose.  There were no cases of myocarditis or pericarditis and no deaths.  See Below 

The vaccine efficacy of the vaccinated children was statistically significant compared to the placebo group, but was lower than expected (43.7% in the 2-<6yr group and 37.5% in the >6mos-2yr group).  The Covid cases that were seen were mild and there were no severe cases. hospitalizations, or deaths.  The trial was carried out when the Omicron variant was circulating, and the vaccine efficacy was similar to that seen in adults during the Omicron surge.  All trial subjects will be followed carefully for 12 months.  

Posted by Shirley at 6:16 AM | Permalink | Comments (0)

I rarely follow the Covid-19 information about children younger than my grandchildren, but I thought it was important to review the data recently collected and published by the CDC about Covid infections in 0-4 year old children.  These children are not yet eligible for the Covid vaccine.  It is regularly said that children are less frequently infected with Covid and usually have milder cases.  But as Omicron cases began to increase rapidly, so did the cases and hospitalizations in children 0-4 years of age.

Covid Net is a surveillance group that collects data from Covid infections from 99 counties in 14 states.  They just published information collected on children 0-4 years and analyzed it from March 2020 through Feb  19, 2022.  The total number of children 0-4 years who were hospitalized was 2,562.  The number of hospitalized cases from Dec. 19, 2021 to Feb 19, 2022 (Omicron period) was 5 times higher than the cases from June 27-Dec. 18, 2021 when Delta was the dominant variant.  And the number of ICU admissions were 3.5 times higher.  63% of the hospitalized children had no underlying medical conditions, and 44% of the children were <2 months which breaks my heart.  There were 2 in-hospital deaths.  Thankfully hospitalization rates have decreased since the Feb. 8th peak.

See Below

The Omicron BA.2 variant is increasing in the US; in NY and NJ it was 39% as of the last report.  This variant is 1.5x as transmissible as Omicron BA.1, and as the case numbers increase there may be another peak in this unvaccinated group of children.  Babies born to vaccinated mothers can be protected by transplacental transfer of antibodies during pregnancy  - which will help those <6mos.  The remainder of the unvaccinated children 6mos-4 years should be surrounded by vaccinated parents and other adults.  Their vaccines are anticipated to be approved by late April. 

Posted by Shirley at 7:21 AM | Permalink | Comments (0)

The bump in Omicron BA.2 cases from the NY Dashboard data published last Friday, and listed here, was gone the following day (with no comments or corrections).  However there was an increase in the Covid.19 case numbers in NY from 8.2 to 9.5 to 10/100,000 the last few days.  Between then and now, and the BA.2 variant rose to 39 % of the viruses identified on the genomic sequencing of patient virus sample reported out 3/12. It was 25% the week before.  So Omicron BA.2 is increasing in NY and NJ (Region 2), but the daily Covid-19 case numbers are barely moving locally. The data collected during the next few weeks will tell us whether there will be a surge in infections like we saw with BA.1.  

Omicron BA.2 spreads faster than BA.1 - probably due to 8 additional mutations in the Virus spike region.  It takes less time to spread in household groups than BA.1.  The existing vaccines are protective against BA.1 and BA.2 especially if you are boosted.  In addition those people who were infected by BA.1 appear to be protected against a reinfection by BA.2.  But if you were infected by earlier variants (alpha up to delta), there is minimal protection against BA.2 from these earlier variants.  See Below 

The BA.2 variant does not appear to have a higher risk of hospitalization than BA.1.  The monoclonal antibodies don't work against it, but Evusheld, Paxlovid, Remdesivir, and Molnupirivir do if they are begun very soon after the positive Covid test.  Paxlovid has the greatest efficacy against Omicron if started early in patients who have a positive Covid test and a high risk of severe disease.  Supplies are still somewhat limited, and you need to get a prescription for the meds - which are taken by mouth for 5 days.  Your physician has to provide addition medical information to the pharmacist about your health and medications before you can be approved.  It is also still hard to find pharmacies and hospitals who carry the medication.  WE are still not ready to give up our masks, and social distancing, especially when being 65+ is a separate risk factor for severe disease.   

Posted by Shirley at 6:31 AM | Permalink | Comments (0)