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February 9, 2022

Parallels From the 1918 Influenza Pandemic

The 1918 Flu didn't end in 1918.  What can it teach us asks the Washinton Post's Jeff McHugh. in an article this week  The flu epidemic began in the spring of 1918 and spread rapidly around the world.  The first wave in the US was relatively mild but was followed with a much more severe second wave in August-September of that year - it would turn out to be the most deadly surge. "In NYC street cars were converted into hearses and priests collected bodies with horse drawn carriages."  More Americans died during the surge than in WWI, WWII, Korea and the Vietnam wars.  There was then a third wave in the winter and early Spring of 1919 and historians report that "Americans were weary of the limitations on daily life" and masks and social distancing were discontinued and school and church closures were lifted.  In the winter of 1919-1920 more people in New York City died from Dec 1919 to April 1920 than in the first and second waves bringing the total US deaths to 675,000.  Mortality was highest the <5, 20-40, and 65+ year old people.

The 1918 flu virus didn't mutate as fast as the SARs-CoV-2 virus and the flu virus eventually grew milder. One-third of the world population was infected and there were 50 million deaths.  When the omicron variant of SARS-CoV-2 appeared, many scientists wondered if it was going to be like the milder flu virus which ended the 1918 pandemic.  The flu vaccine was not available in the US until 1945 and we have vaccines which modify the number of cases and deaths during the annual winter flu season.  Hopefully the number of Covid-19 cases will continue to decrease, as they are doing in NY, and it will become an endemic virus that will benefit from our vaccines and growing immunity.  However we could have another surge as society prematurely returns to a pre-pandemic life.  Which will it be?



February 5, 2022

More Information About Long Covid

On November 11, 2021 I wrote about Long Covid, which can occur in up to half of the patients who develop Covid-19.  It is defined as residual symptoms which last more than 4 weeks after the onset of a Covid-19 infection.  There are many different symptoms that make up Long Covid, and they often last for more than a year.  It is now clear that Vaccinations reduce the risk.  See the Long Covid information:

Long Covid can occur after mild or moderate infections, but the exact incidence is unknown.  It can even occur in a small number of vaccinated people with breakthrough infections.  A recent study of approximately 1500 vaccinated health care workers in Israel demonstrated that 7 of 39 breakthrough patients developed Long Covid symptoms for more than 6 weeks after infection.  A recent large study in London just reported that the incidence of Long Covid could be reduced by 50% by 2 doses of vaccine.  In a study of Veterans here in the US 11% of unvaccinated Covid patients developed Long Covid and it only occurred in 5% of vaccinated patients.  Vaccination also reduced Long Covid symptoms in a small number of previously unvaccinated infected patients.  See Below


NIH funded a large study in order to determine all aspects of the risk factors, development, and treatment of Long Covid  ( the trial is named RECOVER).  These studies will also collect data on vaccinated children and adolescents.  One study of more than 6700 adolescents found that about 30% of those who tested positive for SARS-CoV-2 had 3 or more symptoms 3 months after diagnosis compared with 16% of a control group that tested negative.  Many of the symptoms of long Covid occur in healthy people - like headache, fatigue, and muscle pain.  In randomized controlled, double blind studies the placebo group almost always reports some symptoms that are similar to those of the treatment group - making conclusions about cause and effect difficult.  Hopefully the individual programs that are funded through RECOVER help to elucidate the mechanism of disease, prevention, and treatment of Long Covid.    

February 2, 2022

News About Children and Covid: Vaccines and Masks

Two pieces of information to share. 

Vaacines and Vaccinations for 2-4 Year Old Children:  Parents of these young children are very anxious to get them vaccinated.  The FDA now requested that Pfizer submit their ongoing results from the clinical trial for 2-4 year old children so the FDA could start reviewing the data from the clinical trial in this age group. That would mean that the vaccine might be approved for 2-4 year old children by the end of February.  As vaccines are developed for children, scientists need to decrease the amount of the mRNA used in the dose for each younger younger age - always hoping that it would be exactly the right dose.  In the clinical trial the immune response needs to reach the same level of immune response as was seen in the next older age group (called immunobridging).  The dose used in the trial for 2-4 year olds was effective, just not as effective as the immune response in the 5-11 year old group.  The children in the clinical are receiving a 3rd dose and are being followed. Investigators  are currently seeing protection against omicron as they follow the children along.  Meanwhile they are giving the original trial subjects a 3rd dose and collecting data on these children.    The advisory boards, the FDA and the CDC must approve the proposed plan - a 3 dose regimen.    

Masks for Protection of Children in Day Care:  I saw a new prospective scientific study by investigators from Yale and Columbia about the effect of mask wearing by children >2 years of age on the number of closures of  their daycare center.  Professionals from the daycare staff completed 2 surveys about the efficacy of masks: (1) From May 22,2020-June 8 2020 they counted the number of closures as the baseline data. (2) The surveys were then repeated one year later - from May 26-June 23, 2021 to see if there was any effect of better mask wearing on the number of daycare center closures seen.  There was a 14% reduction in the number of closures after 1 yr which was statistically significant.  See Below 


There are so many opinions about whether there are adverse effects on socialization and learning when children are wearing masks, but parents are equally concerned about the current lack of vaccinations for children of these ages and are happy they are protected with masks..  A study which reported adverse effects of masks for children under 5 was retracted only 17 days after publication.  This usually occurs because of serious problems with data collection.  There are no studies that demonstrate adverse effects on these young children when they are only wearing masks intermittently..  I take my daily walks in my NYC neighborhood early in the morning when parents are walking their children to pre-school, day care, or elementary school and I am impressed that most children, even in strollers, are masked and happily involved in animated discussions with one or another of their parents as they happily go to "school." 


January 29, 2022

Omicron Sub Variant - BA.2 - Has Arrived

There is a sub variant of omicron that is spreading and it is now present in 49 countries and at least 20 states, including NY and CT.  The variant was first detected in the Philippines, and Asia. Delta also had sub variants.  As of this week, omicron BA.2 accounts for 65% of the cases in Denmark.  But It is not listed as a variant of concern at this time. 

TESTING: This variant has lots of mutations, but the virus is picked up on PCR tests.  BA.2 is also picked up on rapid antigen tests. 

TRANSMISSION: Might be slightly increased over the current omicron BA.1 variant.  Even though it is now the most common virus in Denmark, they say that infection numbers in the country are still decreasing.

SEVERITY:  There are no increases in the number of cases and hospitalizations in Denmark, but data is still limited.

IMMUNE EVASION:  Will the immunity against omicron BA.1 also protect against  BA.2?  Early reports say yes but it may be too early to know.

See Below: 


Scientists are saying there is no reason for panic at this time.  In Denmark the overall number of cases are still decreasing in spite of the BA.2 variant.  In addition, are no differences in the age distribution of the cases and the vaccines seem to have the same efficacy- as against omicron BA.1  Management of the infected patients is still the same - and to prevent infection get a booster if you are eligible and wear the N95 or KN95 masks in public.

January 26, 2022

Covid-19 Infection During Pregnancy

Nature Medicine, a premier science journal, just published a paper from Scotland about Pregnancy and Covid-19 infections.  They have a health system that allows scientists to survey large groups of the population and link them to specific therapy and health outcomes in thousands of patients.  Data of this type has not been available previously for pregnancy and Covid-19.  They were able to survey 79,148 deliveries, 80,183 live births (with multiples).  There were 273 stillbirths and 179 neonatal deaths during the SARS-CoV-2 pandemic.    

From Dec 1 2020 to Oct 31, 2021 21,194 (47%) of pregnant patients were vaccinated with 2 doses of Moderna, Astrazeneca, or Pfizer vaccines with equal distribution of vaccination over the 3 trimesters..  Only 5% of these patients received booster doses.  During the same time period 85% of non-pregnant women aged 18-44 years in the general population were vaccinated.  There were 4950 confirmed Sars.CoV-2 infections in pregnant patients and the incidence was very similar in all 3 trimesters.  Of the infections, 77% occurred in the unvaccinated women, 11% in partially vaccinated, and 11% in the fully vaccinated.  Hospitalization occurred in 19.5% of the unvaccinated and 98% of them were in the critical care units.  Only 5.1% of the fully vaccinated were hospitalized and only 0.2% required a critical care unit admission.  See Below for Baby Statistics.    



A total of 2164 babies were born to women who had Covid 19 infection during Mar 1, 2020 and Oct 31, 2021.  There were 11 stillbirths (death after 24th week of pregnancy), 241 were preterm births (<37 weeks gestation), and 8 live babies who died within 28 days of birth. All of the perinatal deaths occurred in women who were unvaccinated.

This was a complicated scientific paper and I tried to pull out the most important data.  The bottom line is that all pregnant women, not previously vaccinated, should get vaccinated during their pregnancy with 2 doses of vaccine plus a booster.  This is the first population wide study to document the value of vaccination to Mother and Baby! Another well-known benefit of maternal vaccination is transfer of Mother's SARS-CoV-2 antibodies through breast milk for months after childbirth.