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December 30, 2020

SARS-CoV-2 Mutations: Experts Weigh In

SARS-CoV-2 is an RNA virus and these viruses can mutate every time they divide.  If you isolated the virus copies from an individual infected cell, the group of virus copies might all be slightly different based on the mutations that have occurred.  The RNA pictured in my cell drawing has 30,000 building blocks and any one can change, which affects the amino acid it makes for proteins.  Some mutations increase transmission and/or severity, others do nothing, and still other mutations decrease transmission and/or severity.  

These viruses have spike proteins over their surface, and there is a binding region on the spike that attaches to a receptor on our cells and allows the virus to enter the cell and multiply.  Mutations in the spike protein part of the virus are more likely to have an effect on the disease, but it takes many animal and laboratory studies on the virus to determine the effect of dominant variants before any conclusions about the infections can be verified.  Read Below

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Dr. Racaniello, Professor and Virologist at Columbia  University, is concerned that the UK variant is being hyped by the  media  and the epidemiologic data from population studies can't be used to accurately predict biologic changes in the infection.  He says "I do agree we should look into these things but until we have some data we should be careful about what we say."  In studies done on the coronaviruses that cause the common cold it took up to 5 years before they were significantly changed by mutations. 

Several days ago Dr. Fauci said they are trying to get samples of the mutant variant from the UK so they can study it at NIH.  And now a young man in Colorado (with no travel history) has been found.  At this time there is no data that should make us worry about the two vaccines.  They postulate that the mutations affect transmission, but there is no data that suggests that the infection is more severe.  Dr. Osterholm, epidemiologist at the Univ of MN, said on his weekly podcast that if there ever is a mutation that blocks the vaccine,  the mRNA vaccine can be altered in as little as several months.  The collective advice from these scientists is to stay calm, wait for conclusive lab studies to be done, and get vaccinated whenever you can.

 

 

December 26, 2020

HAPPY HOLIDAYS 2020

We had a very quiet Christmas.  Since the pandemic first began we limited our time out of the apartment and have only seen our NYC children and grandchildren for limited times - on the sidewalk in front of our apartment, on socially distanced blankets on the grass in Central Park twice, or when they drive past to leave or pickup items.  ZOOM to the rescue!

We do have a Christmas Tree and enjoyed two full days reading and listening to classical Christmas music in the living room. next to the tree.  It was a change from our pandemic reading/TV room so it was special.  I'm posting a photo of the tree, with ornaments I made over almost 4 decades.  And I included a close-up photo of the ornament I made for this year.  I made 12 - and everyone in the family has one or will have one. 

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This ornament was made from my watercolor painting.  I cropped and sized it so I could fit 4 images onto a plastic backed 8.5 x 11" sheet of fabric which I then printed in our ink jet printer. I used 3 sheets for the 12 images and then used regular sewn techniques to make each one.  Our oldest son ran across town yesterday to pick up 8 for his and his sister's family when the rain stopped.

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Wishing everyone a Happy New Year and a healthy 2021. 

December 23, 2020

The CDC Votes on a Vaccine Distribution Plan

Happy News for some of us.  CDC met this past weekend in order to establish guidelines for vaccine distribution among people in the United States.  The National Academies of Sciences, Engineering, and Medicine developed some guidelines for distribution last Fall.  The Advisory Committee on Immunization Practices (ACIP), an unrelated committee of scientists and public health experts that advises the CDC then met regularly to further refine the distribution based in part on the risk of severe infections and deaths of people in these groups. Phase 1a includes Health Care Workers and staff and patients in Long Term Care Facilities.  Both of these groups just began vaccinations under the guidance of the their states. 

Last weekend the committee met to finalize their recommendations for the next Phase of vaccinations.  Their decisions were based on which groups had the next highest risk of serious infections and deaths. After extensive discussions among committee members, and an open session in which other speakers were able to present their opinions, the committee approved Phases 1b and 1c. These are recommendations for the jurisdictions (states/territories) to set up programs for vaccinations.  We are very happy with the guidelines adopted.   See Below 

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Phase 1b

People 75 years and older and non-health care essential workers (approximately 49 million people).

Phase 1c

People between 65 and 74 years of age and people 16-64 years with comorbidities, and essential workers not covered in Phase 1b: first responders (fireman, police, corrections officers, food and agriculture workers, US Postal Service workers, manufacturing workers (like those making medications) grocery store workers, public transit workers and those who work in education and child care. 

My husband and I are happy that we moved up in the vaccination schedule.  We are in the high risk >75 years group and we have severely limited our activities and contacts since the pandemic began.  Once vaccinated we will still wear masks and follow all of the public health recommendations, but at least we have something to look forward to - in person visits with our children and grandchildren. 

https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e2.htm?s_cid=mm695152e2_w 

 

December 19, 2020

The Moderna Vaccine Application for EUA

The Moderna Vaccine, developed by the Massachusetts Company in collaboration with Dr. Fauci's Institute at NIH, was approved by the FDA last evening.

On Thursday I watched the FDA Vaccine Related Biologics Products Advisory Committee Meeting, during which 21 independent scientific committee members heard 2 presentations: (1) by Moderna with detailed information from their Phase 3 Clinical Trial (30,420 volunteers) and (2) the FDA who presented their summary by the more than 100 FDA Career Scientists' of the Moderna Trial data.  In order to approve a product with an Emergency Use Authorization (EUA) there needs to be a catastrophic public health emergency, and no licensed product to treat people.  The drug companies need to submit an enormous amount of data from their phase 3 clinical trials and after scientific review by independent committees and the FDA, approval can be granted if the benefits outweigh the risks.  The committee voted 20 to 0 to recommend an emergency use authorization (EUA), and the FDA usually follows their guidance.  There are many studies yet to be done to examine the immune response and duration, and virus transmission in infected subjects.  The FDA EUA was granted and the vaccine will be shipped.    See Below

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The Moderna efficacy in preventing symptomatic Covid-19 was 94% for different age, ethnic, and racial groups.  The vaccine also prevented severe covid-19 with 0 cases in the vaccine group and 30 in the placebo group. At least 50% of the enrolled volunteers were followed for more than 2 months and the side effects were almost all mild to moderate - with fever, pain, swelling, and redness at the injection site, headache, chills, fatigue, muscle and joint aches following the vaccination. Patients should be aware of these symptoms. Some of the same symptoms occurred in the placebo group at a lower incidence - which always surprises me! Symptoms increased after the second dose but were gone after several days.  There were 4 cases of Bell's palsy, in which the facial nerve, on one side of the face, is affected, but recovers slowly.  There was one case in the placebo group and 3 in the vaccinated group.  The incidence will be followed closely to see if turns out to be more frequent than the spontaneous incidence in the general population.  There were no allergy symptoms or anaphylaxis seen.  The vaccine needs to be stored at only -4 degrees C.and can be maintained in the refrigerator for 30 days - making it easier to transport and store.   

 

December 16, 2020

What is Operation Warp Speed?

When the coronavirus SARS-CoV-2 was identified last year scientists knew that vaccines needed to be developed and many companies and research facilities began the process (more than 150).  The fastest a vaccine has ever been developed is 4 years - the mumps vaccine.  Suddenly a pandemic was declared and a worldwide catastrophe was imminent.  By early April Dr. Peter Marks, an oncologist who worked in academia and the drug industry and was currently the head of the FDA division that regulates vaccines, began laying the groundwork for what would become Operation Warp Speed.  Working with Robert Kadlec he wrote a proposal for the HHS Sec'y Alex Azar for a process that went from screening potential vaccine candidates to distributing the final product to 330 million Americans. Dr.Marks was a longtime Star Trek Fan and dubbed the proposal Operation Warp Speed.   

They wanted to find 8 vaccines that were promising in early testing, and select 2 for each method of vaccine development.  The first 5 companies that were selected were Moderna, Oxford-AstraZeneca, Johnson and Johnson, Merck, and Sanofi Glaxo Smith Kline.  Pfizer didn't accept government funds for vaccine development, but signed a contract with the government to buy 100 million doses of their vaccine if successful.  Novavax and Vaxart were accepted later.  Operation Warp Speed was announced on May 15th and vaccine development became a private-public partnership with gov't financial support. Government funding also allowed the companies to begin manufacturing, which is a financial risk if the vaccines aren't successful.    Read Below  

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All drugs and vaccines go through preclinical, Phase 1, 2, and 3 Clinical Trials.  Phase 3 clinical trials randomize volunteers between vaccine and placebo to determine efficacy in preventing Covid-19 and safety.  In Operation Warp Speed, every company had to have 30,000-50,000 trial subjects to make sure that the results were statistically significant. Pfizer and Moderna had very successful Phase 3 Trials and both should have an Emergency Use Authorization within days.  Developing vaccines can be very frustrating and both Oxford-AstraZeneca and Sanofi-GSK have hit some problems.  Oxford-Astrazenca's trial inadvertently used half the amount of vaccine for the first dose in a portion of their trial participants (~3000), which actually showed higher efficacy than the 2 full dose vaccinations.  They now need to test these varying doses and add additional trial volunteers in order to determine if the efficacy continues to be 90%. Sanofi's vaccine was not as effective in older volunteers and the vaccine will be revised and retested in older subjects.  We should soon be hearing about clinical trials from the other 4, especially J and J and Merck.

 

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